A Model for Implementing an Evidence-Based Practice in Student Fieldwork Placements: Barriers and Facilitators to the Use of “SBIRT”

ABSTRACT

This article reports on focus group data analysis that was used to understand initial, largely positive outcomes from a university-based initiative to disseminate and implement an evidence-based practice (EBP)—Screening, Brief Intervention, and Referral to Treatment for Substance Use (SBIRT)—into student fieldwork placements, which are usual care social work settings. Focus groups were conducted with three groups of stakeholders involved in the ongoing project: social work department faculty (n = 10), bachelor- and master-level social work students (n = 8), and social work fieldwork instructors (n = 6). Dimensional analysis of the focus group data yielded results indicating that dissemination and implementation of SBIRT was influenced by agency- and school-level factors and perceived fit between the EBP and individual professional identity, intrapersonal characteristics, and timing. The resulting model, developed through the focus group analysis, is offered and shows how these factors interacted and affected training, supervision, and use of the EBP. The model provides social work educational programs and agencies a working tool for diagnosing and proactively addressing barriers and breakdowns in the EBP implementation process. Future research that tests the model as a diagnostic tool and generates knowledge about its influence in developing competent evidence-based practitioners is indicated. Future focus groups in relation to this initiative are needed to better understand these barriers and facilitators in the EBP implementation process and their critical roles in the process of translating SBIRT into standard social work practice.     

The discovery of the true self—A case study

This paper addresses the diagnosis and treatment of clients whose lives are constricted, and whose relationships are characterized by adaptations to the needs of others. This life style is believed to be the result of very early adaptations to pathological parental needs which interfered with psychosocial development and identity formation. It is suggested that Winnicott's theory of ego distortion in terms of True and False Self provides a useful conceptual framework for diagnosis and treatment of such cases. His theory is presented, followed by a case report, illustrating the application of these principles.     

GALILEO's CHILDREN: Italian Americans' Difficult Entry into the Intellectual Elite

We examine the possibility of ethnic exclusion by U.S. intellectual elites for the case of Italian Americans, a large, identifiable group that has assimilated into the mainstream during the last half century but is still the subject of demeaning stereotypes with wide currency. Membership in the American Academy of Arts and Sciences, a fellowship of nearly 4,000 members drawn from throughout the academic, scientific, and artistic worlds, is used as a window into processes of ethnic stratification among intellectuals and academics. The analysis establishes that Italian Americans are represented in the Academy at a level well below their percentage among college and university faculty. Their frequency of election has increased substantially in recent years, but we conclude that the evidence is consistent with continuing ethnic disadvantage.     

Energy Poverty and Low Carbon Just Energy Transition: Comparative Study in Lithuania and Greece

Social Indicators Research - EU has set ambitious commitment to achieve low carbon energy and economy transition up to 2050. This low carbon transition means sustainable energy development path...     

Gender and Employment Restructuring in British National Health Service Manual Work

While managerial initiatives to cut costs through increased labour flexibility are widespread, we have limited knowledge of the micro-politics of gender and contemporary restructuring at the local level: of the processes and dynamics through which flexibility and other initiatives reconstitute or transform gendered patterns of work and advantage in specific workplaces. This case study, based upon extensive interviewing, observation, and examination of documentary materials, examines the gender implications of several different types of restructuring initiatives in three types of manual work at two hospitals in an NHS Trust. On the whole, it finds that restructuring created more continuity than change in gendered patterns of work and advantage in the two sites. The case study suggests, first, that employment restructuring incorporates elements of structural, institutional and interactive gendering; managers use women's subordination in the workplace and labour markets to achieve their objectives, and male workers actively resist loss of their advantages. Second, it suggests that competitive tendering exercises have a disproportionately negative impact upon women workers, while functional flexibility initiatives are somewhat more positive. Third, the case study suggests union resistance to restructuring is limited and particularly circumscribed in relation to restructuring of women's jobs.     

Using psychodynamic interventions to engage in trauma-informed practice

In recent years, trauma-informed practice has received increased attention in the social work literature. Although the adoption of trauma-informed practice is necessary for preparing social workers to practice effectively with clients, these frameworks do not necessarily provide social workers with the specific skills for doing so. Therefore, we argue that using interventions grounded in contemporary psychodynamic theory can help transform them into trauma-informed practitioners. Psychodynamic psychotherapy interventions, especially from object relations and self psychology, align with many of the principles of trauma-informed practice (e.g. establishing an atmosphere of safety and acceptance, relying upon relational collaboration). We begin by discussing trauma-informed practice and then discuss how the use of psychodynamic psychotherapy interventions (holding environment, containment, and selfobject transferences) can facilitate the application of trauma-informed principles. We conclude with a case illustration of how to incorporate psychodynamic interventions into trauma-informed practice.     

A Qualitative Exploration of the Premigration Victimization Experiences of Sexual and Gender Minority Refugees and Asylees in the United States and Canada

Progress in analyzing and interpreting the concepts of sexual orientation and gender identity in the context of refugee law has contributed to a rise in individuals seeking asylum in such countries as the United States and Canada. However, few studies have examined the victimization experiences of sexual- and gender-identity forced migrants prior to their arrival in North America. This qualitative study used thematic analysis to explore the premigration adult victimization experiences of 26 lesbian, gay, and transgender individuals who obtained refugee, asylee, or withholding-of-removal status in the United States or Canada based on persecution for their sexual orientation and/or gender identity. Participants originated from countries in Asia, Africa, the Caribbean, Eastern Europe, Latin America, and the Middle East. Analysis revealed the following themes: living on the edge, adopting concealment strategies, routine victimization, and protectors as perpetrators. Participants described living in a constant state of hypervigilance, and they adopted numerous strategies to protect themselves from victimization. Despite the use of such strategies, participants experienced victimization by community members and state actors, leaving them no choice but to flee to ensure their safety and well-being. Findings are discussed using the ecological framework outlined by the World Health Organization (WHO). The discussion concludes with implications for international policy and clinical practice.     

Talking about work stress: Discourse analysis and implications for stress interventions

This study used discourse analysis to explore the way in which employees understand work stress. Twenty-two female clerical workers in a Canadian city participated in focus group meetings where they talked about and made sense of their experiences of work stress. The women's accounts were analysed using discourse analysis methods (i.e. an examination of how talk is constructed). The findings revealed that talking about being stressed provides a socially acceptable way of expressing discomfort and regaining a sense of importance that is lost through feeling under-valued and under-appreciated in the organization. In contrast, admitting to being unable to cope with stress was considered to be 'abnormal'. The stress discourse fosters a sense of helplessness and ambiguity by not acknowledging external influences on clerical workers' experiences, such as their place within the power structure of the organization, and by limiting their sense of agency and control over problems experienced at work. The implications of these findings for organizational culture and interventions are discussed. For example, employers are encouraged to be conscious of the messages being sent to employees about how negative emotions or distressing experiences at work are to be addressed (i.e. how 'stress' is to be managed). Recommendations are made for future research using discourse analysis, such as the examination of alternative discourses that aim to improve conditions at work.     

Habitual failure: A childhood adaptation to the threat of abandonment

This paper attributes habitual failure to an early childhood adaptation: The immature, dependent child, making repeated unsuccessful attempts to satisfy unrealistic or pathological parental demands, fears that its inadequacies will result in abandonment by the parents. Repeated cycles of attempted compliance and failure are internalized and become a life pattern. A case history illustrates these dynamics and their treatment.