Social work students with personal experience of sexual abuse: Implications for diploma in social work programme providers

Social work training attracts a significant proportion of students with personal experience of psychosocial trauma and oppression, including various forms of abuse. This article considers some of the implications for social work educators. Sexual abuse is the oppression selected to illustrate this discussion because it is central to contemporary social work training and practice and it is the author's experience that student disclosures of sexual abuse are common. Emotive but unavoidable for both students and educators, sexual abuse issues demonstrate the need for programme providers to address their responsibilities to applicants, students, partner agencies and service users. Continued failure to do so ignores the risks of legal liability and raises questions of whether their practices are consistent with the DipSW's value base. DipSW programme providers are advised to take practical steps both to protect themselves and to provide appropriate support for students. They are asked to review application and selection procedures and urged to define the roles and expectations of course tutors and practice teachers.     

Simulating Real Life: Enhancing Social Work Education on Alcohol Screening and Brief Intervention

Social work students typically use role play with student colleagues to practice clinical intervention skills. Practice with simulated clients (SCs) rather than classmates changes the dynamics of the role play and may improve learning. This is the first known study to employ the SC model in substance use assessment in social work education. Social work students completed a questionnaire assessing attitudes, knowledge, and perceived skills (AKS) regarding substance misuse prior to completing an online screening, brief intervention, and referral to treatment training, and then following role plays with SCs. Paired t-tests indicate increased confidence in substance use assessment and intervention ability, and stronger feelings that routine screening is critical to practice. Incorporating SCs with didactic learning increases students’ self-perceived ability to assess and change client behaviors and reduce substance misuse.     

A Screening,Brief Intervention,and Referral to Treatment Collaborative: Impact for Social Work Students

Screening brief intervention, and referral to treatment (SBIRT) is a clinical intervention empirically linked to reductions in substance usage. However, less is known on how to effectively train social work students on SBIRT. This study examines the impact of a SBIRT training administered to BSW and MSW students (N=228) at the University of Oklahoma. Based on exposure to the training, our evaluation measured changes on students’ objective knowledge of how to perform SBIRT and in attitudes toward practicing with substance users. Results indicated exposure to the training was associated with robust gains across variables and across classes. Such results suggest that the proffered SBIRT training is an effective means to educate social work students on substance abuse practice.     

What really happened? Incidence and factor assessment of abused children and adolescents

Abuse of children and adolescents is a societal problem. If health-care providers are to intervene adequately in abuse, they must identify the occurrence, elicit all pertinent information surrounding the abuse and the patient's response, and integrate pertinent abuse issues in the overall treatment plan for the patient. This study has conclusively demonstrated the failure of health-care providers to assess and plan treatment based on the comprehensive documentation of sexual and physical abuse factors. Findings clearly indicate a need for education of health-care providers in the development of comprehensive and integrated treatment plans for abused psychiatric patients based on documentation of all factors related to trauma learning and replay. Service agencies must be willing to implement in-service programs that provide nurses and other health-care providers with the cognitive and affective knowledge and skills necessary to feel comfortable in the management of abuse issues.     

Barriers to Integrated Treatment of Substance Abuse and Trauma Among Women

Despite increasing empirical support for an integrated approach to treating trauma and substance abuse, many substance abuse treatment programs have been slow to embrace integrated models of practice. Using an embedded case study design, the purpose of this study was to understand barriers that prevented a substance abuse treatment provider and 20 professionals and staff from adopting an integrated approach to treating substance abuse and trauma. Data analysis revealed 2 kinds of barriers that prevented substance abuse treatment professionals from fully integrating substance abuse and trauma: systemic and professional barriers. These barriers have to be taken into account when trying to move providers and professionals toward integrated approaches to treating substance abuse and trauma.     

Relationship of interpersonal behaviors and health-related control appraisals to patient satisfaction and compliance in a university health center

OBJECTIVE: The authors' aim was to evaluate patient-provider relationships in a college health center. PARTICIPANTS: Eighty student patients and their health-care providers. METHODS: Patients completed a measure of perceived health competence before a consultation and measures of provider participatory behavior and interpersonal behavior before and after the consultation. They evaluated their satisfaction with care and compliance after the consultation and again 2 weeks later. Providers completed measures of their participatory behavior and patients' interpersonal behavior after the consultation. RESULTS: Patients preferred to be well informed and to have their preferences taken into account, and generally felt competent at managing their own health affairs. They indicated they obtained the high level of participation they desired. Patients desired and actually experienced friendly and submissive providers. Degree of match between patients' desired and actual level of involvement in their care was associated with greater satisfaction. A greater match between the extent to which they desired the provider to be affiliative and the provider's actual affiliative behavior was associated with more satisfaction. No variables were predictive of patient compliance. CONCLUSION: The authors discuss results in terms of the influence of situational factors characteristic of a college health center.     

Building,Engaging, and Sustaining a Continuum of Care From Harm Reduction to Recovery Support: The Rutgers Alcohol and Other Drug Assistance Program

Since 1983, the focus of the Rutgers Alcohol and Other Drug Assistance Program (ADAP) has been developing policies, training staff to identify students at risk, developing and implementing evidence-based screening and brief interventions, providing short-term counseling by professionals trained in alcohol and other drug abuse to assist students beyond brief interventions, identifying effective treatment for college students, developing a campus recovery program, on-campus recovery housing, and other supports for students in recovery. This article presents a case study of the Rutgers ADAP program, of building and sustaining a program committed to engaging students in both evidence-based risk reduction interventions and an on-campus recovery community given their stage of change and motivation to make changes. Historical milestones are described as part of a creative model for intervention. We identify the challenges of integrating substance abuse recovery into campus mental health programs, and of integrating recovery into other university communities.     

Negotiating case decisions in substance abuse managed care

In substance abuse managed care, the number of treatment sessions that a provider can deliver is constrained by the policies and procedures of the specialized managed care organizations (MCOs) that typically administer the substance abuse portions of healthcare plans. Managed care organizations commonly are alleged to control treatment providers through rules, but they also might rely on a particular patterned authorization of discretion, whereby they determine when and how frequently to respond to providers' appeals of rule-based decisions. The current paper uses data from a national random sample of managed care contracts between MCOs and substance abuse providers to test the hypotheses that (1) managed care organizations' "logics" about the types of provider discretion to allow affect the rate to which they concede to appeals, and (2) the rate of conceding to appeals, in turn, affects the providers' duration of substance abuse treatment. Results from generalized linear estimation models support the hypotheses and suggest that many MCOs pattern discretion to balance strict rules with concern about the quality or cost of care. The results more generally suggest that MCOs use discretion in planned ways, and thus that the patterns of control are more complex and sophisticated than commonly described in the literatures on managed care, transaction cost economics, or other perspectives.     

Effectiveness of a screening tool to detect injuries during Army Health Care Specialist training

The purpose of this project was to evaluate the effectiveness of an initial screening and referral process in reducing the impact of musculosketetal injuries among soldiers attending Health Care Specialist training. Musculoskeletal injury among Army Health Care Specialist students have been reported to be approximately 24% for men and 24-30% for women. The highest student visit rate to the troop medical clinic for musculoskeletal injuries, for men and women, occurs during the first week of training. Anecdotal reports indicate that many students arrive for training with existing injuries or symptoms. This project was designed to assess whether formalized early screening, referral, and intervention could 1) identify arriving students who need musculoskeletal injury-related medical attention, 2) reduce the number of students receiving limited duty status during their 10-week training, 3) decrease the total number of limited duty days for students, and 4) decrease the number of students who cannot graduate due to musculoskeletal injury. Students (N=291) from one company were divided into three groups of 97 students. Three methods were used to screen and refer students for medical intervention: 1) traditional (T), 2) by health care providers (HCP), or 3) by Drill Sergeants (DS). Screening by HCP and DSs involved using a new screening tool to identify and consequently refer students with symptoms to a troop medical clinic (TMC) for early evaluation and intervention. Using the screening tool, HCPs identified 92% of students with injuries, while DSs accurately identified 80%. The screening did not reduce the number of students receiving limited duty status, total limited duty days, or the number of students that could not graduate due to musculoskeletal injury ("holdovers") (p>0.05). The screening tool demonstrated good sensitivity and specificity whether conducted by HCPs or DSs. It failed to demonstrate efficacy in reducing the impact of musculoskeletal injuries among Combat Medic soldiers, as measured by limited duty days and holdovers.     

Screening and Brief Intervention for Tobacco Use by Student Health Providers on College Campuses

Abstract

Objective: This study assessed college students’ reports of tobacco screening and brief intervention by student health center providers. Participants: Participants were 3,800 students from 8 universities in North Carolina. Methods: Web-based survey of a stratified random sample of undergraduates. Results: Fifty-three percent reported ever visiting their student health center. Of those, 62% reported being screened for tobacco use. Logistic regression revealed screening was higher among females and smokers, compared to nonsmokers. Among students who were screened and who reported tobacco use, 50% reported being advised to quit or reduce use. Brief intervention was more likely among current daily smokers compared to current nondaily smokers, as well as at schools with higher smoking rates. Screening and brief intervention were more likely at schools with lower clinic caseloads. Conclusions: Results highlight the need to encourage college health providers to screen every patient at every visit and to provide brief intervention for tobacco users.     

Substance abuse by men in partner abuse intervention programs: current issues and promising trends

This article discusses key studies linking intervention for co-occurring substance abuse and partner abuse. Findings are grouped into three areas: (a) the effect of addictions treatment on partner violence; (b) application of transtheoretical, motivational, and culturally focused approaches to improve engagement and prevent attrition; and (c) assessment-based matching of services. Finally, the relative value of serial, coordinated, and integrated substance abuse programs and partner abuse intervention programs are considered. We reached three primary conclusions: (a) Addiction treatment alone reduces the risk for future domestic violence in a subset of men who batter, (b) screening and assessment for substance abuse by all men in partner abuse intervention programs is a standard of practice but needs to extend beyond "intake" and occur periodically, and (c) coordinated and integrated substance abuse and domestic violence programs probably offer more safety than traditional serial substance abuse treatment followed by partner abuse intervention.     

Relationship of Interpersonal Behaviors and Health-Related Control Appraisals to Patient Satisfaction and Compliance in a University Health Center

Objective: The authors' aim was to evaluate patient-provider relationships in a college health center. Participants: Eighty student patients and their health-care providers. Methods: Patients completed a measure of perceived health competence before a consultation and measures of provider participatory behavior and interpersonal behavior before and after the consultation. They evaluated their satisfaction with care and compliance after the consultation and again 2 weeks later. Providers completed measures of their participatory behavior and patients' interpersonal behavior after the consultation. Results: Patients preferred to be well informed and to have their preferences taken into account, and generally felt competent at managing their own health affairs. They indicated they obtained the high level of participation they desired. Patients desired and actually experienced friendly and submissive providers. Degree of match between patients' desired and actual level of involvement in their care was associated with greater satisfaction. A greater match between the extent to which they desired the provider to be affiliative and the provider's actual affiliative behavior was associated with more satisfaction. No variables were predictive of patient compliance. Conclusion: The authors discuss results in terms of the influence of situational factors characteristic of a college health center.     

HPV knowledge and behaviors of black college students at a historically black university

College students are at high risk for human papillomavirus (HPV) infection, yet their knowledge and self-protective behaviors appear inadequate. Researchers who have measured HPV-related knowledge and behaviors in evaluating college intervention efforts pay secondary attention to black college students because this group generally represents only a small subset of samples of the broader college population. OBJECTIVE AND PARTICIPANTS: The authors' purpose in this study was to examine HPV-related knowledge and behaviors in 351 black undergraduates attending a historically black southeastern university in the spring of 2003. METHODS: Voluntary and anonymous student participation was solicited in randomly selected undergraduate classes. RESULTS: Results indicated that most students lacked HPV awareness (64%), became aware of HPV largely after infection, and gained their HPV knowledge from a health-care provider or college class. The authors performed an analysis by gender and found that women were more knowledgeable about HPV than were men. Observed HPV-related knowledge and behaviors were similar to samples of the broader US college population. CONCLUSIONS: Findings suggest a greater need for HPV intervention efforts for all college students, including those at black colleges.     

Teaching Note—Meeting the Demand for Behavioral Health Clinicians: Innovative Training Through the GLOBE Project

ABSTRACT

The national move toward integrated mental health and substance abuse service delivery has a significant impact on social work education and necessitates changes in how we train students. To address this need, the Global Leaders of Behavioral Health Education (GLOBE) training project was developed. GLOBE is a student training and stipend program that prepares students for clinical behavioral health practice in integrated care. This teaching note describes GLOBE, reports challenges encountered in its implementation, and provides strategies for overcoming them. The challenges include assigning students to grant-compliant field placements, engaging other health care professionals in the educational efforts, and implementing curriculum changes. Suggestions for social work program administrators interested in integrated care training are provided.     

SUBSTANCE ABUSE TRAINING AND PERCEIVED KNOWLEDGE: PREDICTORS OF PERCEIVED PREPAREDNESS TO WORK IN SUBSTANCE ABUSE

As frontline mental health care providers, social workers need to be prepared to confront and properly manage substance abuse issues in practice. This study examined predictors of recent master of social work (MSW) graduates' perceptions of preparedness to practice in the area of substance abuse. A cross-sectional design was used, and 232 recent MSW graduates completed a mail-in survey (65.7% response rate). Respondents were more likely to perceive themselves as prepared to work with substance abuse issues if they received more formal academic training in substance abuse and had higher knowledge of substance abuse concepts and models. The findings support the need to include substance abuse education in social work curricula.     

Social Norms of Alcohol,Smoking, and Marijuana Use Within a Canadian University Setting

Abstract

Objective: To study actual and perceived substance use in Canadian university students and to compare these rates with US peers. Participants: Students (N = 1,203) from a large Canadian university. Methods: Participants were surveyed using items from the National College Health (NCHA) Assessment of the American College Health Association questionnaire. Results: Alcohol was the most common substance used (65.8%), followed by marijuana (13.5%) and cigarettes (13.5%). Substance use and norms were significantly less than the NCHA US data. Overall, respondents generally perceived the typical Canadian student to have used all 3 substances. Perceived norms significantly predicted use, with students more likely to use alcohol, cigarettes, or marijuana if they perceived the typical student to use these substances. Conclusions: Similar to their US peers, Canadian university students have inaccurate perceptions of peer substance use. These misperceptions may have potentially negative influences on actual substance use and could be a target for intervention. Further research examining the cross-cultural differences for substance abuse is warranted.     

HPV Knowledge and Behaviors of Black College Students at a Historically Black University

College students are at high risk for human papillomavirus (HPV) infection, yet their knowledge and self-protective behaviors appear inadequate. Researchers who have measured HPV-related knowledge and behaviors in evaluating college intervention efforts pay secondary attention to black college students because this group generally represents only a small subset of samples of the broader college population. Objective and Participants The authors' purpose in this study was to examine HPV-related knowledge and behaviors in 351 black undergraduates attending a historically black southeastern university in the spring of 2003. Methods Voluntary and anonymous student participation was solicited in randomly selected undergraduate classes. Results Results indicated that most students lacked HPV awareness (64%), became aware of HPV largely after infection, and gained their HPV knowledge from a health-care provider or college class. The authors performed an analysis by gender and found that women were more knowledgeable about HPV than were men. Observed HPV-related knowledge and behaviors were similar to samples of the broader US college population. Conclusions Findings suggest a greater need for HPV intervention efforts for all college students, including those at black colleges.     

A survey of substance abuse prevention efforts at Virginia's colleges and universities

The extremes of college student substance use and the negative consequences students face as a result of such use are of great public health concern. Although a multitude of campus-based substance abuse prevention efforts have appeared in literature, a clear picture of the programs and policies currently in use at colleges and universities is not readily available. This research was undertaken to detail both the efforts aimed at general student samples and those targeting at-risk (eg, Greeks, student athletes) and historically underserved (eg, ethnic minorities, students with disabilities) student groups at colleges and universities in the Commonwealth of Virginia. While a variety of efforts were being made, there was a reliance on program orientations with limited scientific support. Four-year institutions used a wider array of outlets for their prevention messages. Targeted programs for at-risk groups were common but were largely unavailable specifically for ethnic minority students and students with disabilities.     

HIV rapid testing in substance abuse treatment: implementation following a clinical trial

The Substance Abuse Mental Health Services Administration has promoted HIV testing and counseling as an evidence-based practice. Nevertheless, adoption of HIV testing in substance abuse treatment programs has been slow. This article describes the experience of a substance abuse treatment agency where, following participation in a clinical trial, the agency implemented an HIV testing and counseling program. During the trial, a post-trial pilot, and early implementation the agency identified challenges and developed strategies to overcome barriers to adoption of the intervention. Their experience may be instructive for other treatment providers seeking to implement an HIV testing program. Lessons learned encompassed the observed acceptability of testing and counseling to clients, the importance of a "champion" and staff buy-in, the necessity of multiple levels of community and agency support and collaboration, the ability to streamline staff training, the need for a clear chain of command, the need to develop program specific strategies, and the requirement for sufficient funding. An examination of costs indicated that some staff time may not be adequately reimbursed by funding sources for activities such as adapting the intervention, start-up training, ongoing supervision and quality assurance, and overhead costs.     

Pulsar: a qualitative study of a substance abuse prevention program

The purpose of this study was to explore the risk, protective factors, and resiliency characteristics of students selected to participate in the Police, Public Educators and Peers Utilizing the Leadership Skills of Students At Risk/As Resources (PULSAR) program. The study is significant as it employed qualitative methods and a resiliency-focused framework to evaluate a substance abuse prevention program. Findings revealed that the PULSAR program: facilitated self-reflection on student negative attitudes toward substance abuse and positive attitudes toward school; allowed students to gain skills that addressed individual needs; and fostered relationships between the students and adult facilitators in a safe environment. These results speak to increased protective factors and resiliency characteristics, but were not found to be constant with each student. Implications for continued research on the PULSAR program are addressed.