Edward V. Pecukonis

Reducing barriers to interprofessional training: Promoting interprofessional cultural competence

The need to train health professionals who can work across disciplines is essential for effective, competent, and culturally sensitive health care delivery. By its very nature, the provision of health service requires communication and coordination between practitioners. However, preparation for interdisciplinary practice within the health care setting is rare. The authors argue that the primary reason students are not trained across disciplines is related to the diverse cultural structures that guide and moderate health education environments. It is further argued that this profession specific “cultural frame” must be addressed if there is any hope of having interprofessional education accepted as a valued and fully integrated dimension of our curriculum. Each health discipline possess its own professional culture that shapes the educational experience; determines curriculum content, core values, customs, dress, salience of symbols, the meaning, attribution, and etiology of symptoms; as well as defines what constitutes health, wellness and treatment success. Most importantly, professional culture defines the means for distributing power; determines how training should proceed within the clinical setting; and the level and nature of inter-profession communication, resolution of conflicts and management of relationships between team members and constituents. It might be said that one factor limiting interdisciplinary training is profession-centrism. If we are to achieve effective and fully integrated interdisciplinary education, we must decrease profession-centrism by crafting curriculum that promotes interprofessional cultural competence. The article explores how to promote interprofessional cultural competence within the health education setting.

Motivational intervention to reduce rapid subsequent births to adolescent mothers: a community-based randomized trial.

PURPOSE One-quarter of adolescent mothers bear another child within 2 years, compounding their risk of poorer medical, educational, economic, and parenting outcomes. Most efforts to prevent rapid subsequent birth to teenagers have been unsuccessful but have seldom addressed motivational processes. METHODS We conducted a randomized trial to determine the effectiveness of a computer-assisted motivational intervention (CAMI) in preventing rapid subsequent birth to adolescent mothers. Pregnant teenagers (N = 235), aged 18 years and older who were at more than 24 weeks’ gestation, were recruited from urban prenatal clinics serving low-income, predominantly African American communities. After completing baseline assessments, they were randomly assigned to 3 groups: (1) those in CAMI plus enhanced home visit (n = 80) received a multi-component home-based intervention (CAMI+); (2) those in CAMI−only (n = 87) received a single component home-based intervention; (3) and those in usual-care control (n = 68) received standard usual care. Teens in both intervention groups received CAMI sessions at quarterly intervals until 2 years’ postpartum. Those in the CAMI+ group also received monthly home visits with parenting education and support. CAMI algorithms, based on the transtheoretical model, assessed sexual relationships and contraception-use intentions and behaviors, and readiness to engage in pregnancy prevention. Trained interventionists used CAMI risk summaries to guide motivational interviewing. Repeat birth by 24 months’ postpartum was measured with birth certificates. RESULTS Intent-to-treat analysis indicated that the CAMI+ group compared with the usual-care control group exhibited a trend toward lower birth rates (13.8% vs 25.0%; P = .08), whereas the CAMI-only group did not (17.2% vs 25.0%; P = .32). Controlling for baseline group differences, the hazard ratio (HR) for repeat birth was significantly lower for the CAMI+ group than it was with the usual-care group (HR = 0.45; 95% CI, 0.21–0.98). We developed complier average causal effects models to produce unbiased estimates of intervention effects accounting for variable participation. Completing 2 or more CAMI sessions significantly reduced the risk of repeat birth in both groups: CAMI+ (HR = 0.40; 95% CI, 0.16–0.98) and CAMI−only (HR = 0.19; 95% CI, 0.05–0.69). CONCLUSIONS Receipt of 2 or more CAMI sessions, either alone or within a multicomponent home-based intervention, reduced the risk of rapid subsequent birth to adolescent mothers.

The future of health social work.

Abstract The practice of social work in health care is at a critical juncture, and faces an uncertain future. The authors provide an overview of the challenges facing social work practice within the health care setting, as well as recommendations for enhancing social work practice and education. Challenges discussed include economic factors, demographic changes, and technological advances influencing the practice of social work in health care. The need for a proactive stance among social work professionals and educators is promoted. The proposed changes are intended to stimulate discussion and an exchange of ideas needed to maintain Social Works relevance and integrity in the evolving health care delivery system.

Screening and Brief Intervention Practice Model for Social Workers in Non-Substance-Abuse Practice Settings

The social costs of substance abuse problems in the United States are staggering. Although social work has a long history of working in the substance abuse field, the profession does not pay similar attention to potential substance abuse problems in non-substance-abuse practice areas despite the high prevalence of substance abuse in these settings. A screening and brief intervention practice model that emphasizes a feasible and practical framework for social workers to screen for potential substance abuse problems in non-substance-abuse practice settings and make appropriate brief interventions is provided. Implications for social work educators, administrators, and practitioners are discussed.

Physical self-efficacy and alexithymia in women with chronic intractable back pain.

This study explores the relationship between chronic intractable back pain and physical self-efficacy and alexithymia in 112 women sampled from a large university-based health center. Fifty-nine women suffering from chronic back pain were compared with 53 control subjects. Results note that women with chronic intractable back pain had significantly higher scores on the measure of alexithymia and lower scores on the measure of physical self-efficacy compared with control subjects. The predictive model was useful in correctly classifying 81.4% of back pain subjects. Perceived self-presentation confidence was protective, and being married and increased age were associated with the risk of having chronic back pain.

Interprofessional Leadership Training in MCH Social Work

The need to train health social workers to practice interprofessionally is an essential goal of social work education. Although most health social workers have exposure to multidisciplinary practice within their field work, few social work education programs incorporate interprofessional learning as an integrated component of both course work and field experiences (McPherson, Headrick, & Moss, 2001; Reeves, Lewin, Espin, & Zwaranstein, 2010; Weinstein, Whittington, & Leiba, 2003). In addition, little is written about the kinds of curricula that would effectively promote interdisciplinary training for social work students. These findings are particularly puzzling since there is increasing and compelling evidence that interdisciplinary training improves health outcomes (IOM, 2001). This article describes a social work education program that incorporates an Interprofessional education and leadership curriculum for Maternal and Child Health Social Work (MCHSW) at the University of Marylands School of Social Work. The University of Marylands Interprofesisonal Training Model is described along with the components needed to formulate an interdisciplinary learning experience. Various outcomes and lessons learned are discussed.

Where Have All the Teachers Gone? The Selling Out of Social Work Education

This article addresses a significant challenge in social work education: the move to emphasize research and the downgrading of teaching and practice. We argue that this is a disturbing trend that has the potential to diminish the education of social work students. Grant-funded research has become the end all of social work education. We propose that the profession needs to endorse the scholar-teacher-practitioner that will be able to combine scholarship, teaching, and practice so that students will benefit from teachers who bring their scholarship and practice into the classroom. Further, we argue that teaching requires a great deal of investment and the focus on grant-funded research ignores the investment needed for teaching.

An adapted language training strategy in the treatment of an electively mute male child

The present study investigated the usefulness of an Adapted Language Training Program in the treatment of an electively mute seven-year-old male. Training utilized a multiple baseline across behaviors single subject design. Four phases of treatment focused on non-verbal attending, verbal imitative responding, and functional language responding. Systematic attempts at promoting generalization of verbal responses across situations and persons were employed throughout the language program. A 90% appropriate response criterion was reached for all measures. Non-verbal attending and imitative verbal responding remained above criterion at the termination of treatment, but functional language responding regressed to below criterion. Generalization of verbal responses was noted outside of the training sessions.

“I Can Get Through This and I Will Get Through This”: The unfolding journey of teenage motherhood in and beyond foster care:

Using a series of 18 in-depth qualitative interviews from six participants, the present study employed Interpretative Phenomenological Analysis (IPA) to explore emerging conceptualizations of motherhood among young mothers who gave birth as teenagers while living in foster care. Analysis revealed three themes: Ambivalent Beginnings, Coming into Our Own, and Finding Our Way, which, together, offer an understanding of youths’ interpretation of their experiences of motherhood over time. Findings extend and complicate a risk-only view of teenage pregnancy within foster care settings. They call for a compassionate view of mothering and attuned intervention in these challenging circumstances in order to support both mother and infant mental health and well-being. Study findings further suggest a need for ongoing, relationship-based parenting support coupled with thoughtful pregnancy planning, foster parent training in coming alongside teens rather than either withdrawing or taking over, and nurturing postpartum support.

Correlates and Consequences of Father Nurturance in an African American College Sample

The objectives of the present study are to identify sociodemographic factors associated with father nurturance and assess the relationship between parental (mother and father) nurturance and youth psychological well-being among 216 African American college-aged youth. Participants attended a historically Black college in the Mid-Atlantic region. Findings indicated that the frequency and duration of the participants’ interactions with their fathers were associated with levels of father nurturance. Youth whose mothers and fathers were married or cohabitating, compared with those who were separated, divorced, widowed, or never married, had lower levels of psychological well-being. Furthermore, youth who reported more mother nurturance had higher levels of overall psychological well-being. These findings highlight the importance of time-based variables in youths’ perceptions of father nurturance and raise important questions about how the nature of the coparental relationship and variations in the fathering role affect youth well-being.