Eugene Maguin

Alcohol, Drugs, and Violence in Children’s Lives

This chapter reviews the current state of knowledge concerning the interrelationship between the cycle of alcohol and other drugs (AOD) use and the cycle of violence. This issue is framed in terms of two questions. The first is the extent to which AOD use by the perpetrator is related to the perpetration of violence toward children, defined here as including both physical and sexual abuse. The second question is whether the experience of abuse during childhood is related to the subsequent development of the abuse of alcohol and other drugs. The review indicates that parental AOD abuse is related to physical and sexual abuse. However, because most perpetrators are not parents, the relationship is not yet clear. The data do support the link between experiencing childhood violence and the development of later AOD abuse. Theoretical explanations for each link are reviewed and mediating variables are identified. The review concludes with a presentation of methodological issues and the directions for future research.

An Exploratory Study of the Nature of Family Resilience in Families Affected by Parental Alcohol Abuse

Resilient families are able to adapt to adversities, but the nature of family resilience is not well understood. This study examines patterns of family functioning that may protect families from the negative impact of alcohol abuse. Naturally occurring patterns of family functioning are identified and associations between these patterns and parenting, current parental alcohol use, recent family stressful events, supportive relationships outside the family, and demographic characteristics are assessed. Cross-sectional data are analyzed from racially diverse American and Canadian families (N = 674) who have at least one parent with an alcohol abuse problem and a child between ages 9 and 12 years. Cluster analyses derived from family functioning indicators are used to identify naturally occurring family patterns. Multivariate assessments evaluated relationships between family functioning clusters and potentially influencing factors. The study results reveal a continuum of family functioning associated with parenting, child’s perception of teacher caring, and race.

Individual Worker-Level Attitudes Toward Empirically Supported Treatments

Objectives: There is a growing literature indicating that organizational and individual worker-level factors affect decisions about whether or not empirically supported treatments (ESTs) are adopted within health care agencies. The purpose of this pilot study is to further investigate and measure worker’s attitudes within a community organization. Method: A small organization participated in the study due to their diversity in services offered. Of the 92 workers eligible for participation in the study, 66 (72%) completed the Evidence-Based Practice Attitude scale survey. Results: Multivariate analyses revealed that female workers scored higher on both Openness and total score; workers with nursing, education, or psychology majors scored lower than workers with other (excluding social work) majors on both Divergence and total score; and that older workers scored higher on Divergence. Conclusion: Although small, this study identifies individual characteristics that are most likely to fit the profile of an EST adopter.

Empirically Supported Treatment’s Impact on Organizational Culture and Climate

Objectives: With the continued push to implement empirically supported treatments (ESTs) into community-based organizations, it is important to investigate whether working condition disruptions occur during this process. While there are many studies investigating best practices and how to adopt them, the literature lacks studies investigating the working conditions in programs that currently use ESTs. Method: This study compared the culture and climate scores of a large organization’s programs that use ESTs and those programs indicating no EST usage. Results: Of the total 55 different programs (1,273 frontline workers), 27 programs used ESTs. Results indicate that the programs offering an EST had significantly more rigid and resistant cultures, compared to those without any ESTs. In regard to climate, programs offering an EST were significantly less engaged, less functional, and more stressed. Conclusion: Outcomes indicate a significant disruption in organizational culture and climate for programs offering ESTs.

Factors Influencing Worker Morale: Evaluating Provider Demographics, Workplace Environment and Using ESTs

Objectives: Mental health organizations are strongly encouraged to implement empirically supported treatments (ESTs); however, little is known about their working environments. The present study investigated how provider demographics, workplace environment, and whether ESTs were used affected the worker morale. Method: Frontline workers (N = 1,273) from 55 different programs in a single, large organization completed a measure of organizational culture and climate (OCC) and worker morale. A multilevel regression analysis used worker demographics to predict worker morale at Level 1 and EST use and OCC scales to predict program-level worker morale. Results: Worker morale was significantly negatively correlated with EST use and significantly correlated with OCC dimensions. Regression results showed that culture and climate but not EST use predicted morale. Conclusions: Although EST use by programs in this agency had negative effects on both morale and OCC, separately, the effect on morale was subsumed by the effect on OCC.

Associations Between Post-Traumatic Stress Disorder Symptoms and Alcohol and Other Drug Problems: Implications for Social Work Practice

This study examines the associations between alcohol and other drug problems (AOD) and post-traumatic stress disorder (PTSD) symptoms in 499 women recruited from outpatient treatment programmes for AOD problems and the general community in western New York. The women were divided into three groups: no-AOD, past-AOD, and current-AOD. The current-AOD group was further subdivided into groups based on alcohol, marijuana, and cocaine misuse. Group comparisons on PTSD symptoms revealed that the current-AOD group experienced more PTSD symptoms than the no-AOD and past-AOD groups. The alcohol and cocaine misuse groups experienced more PTSD symptoms overall and for each symptom cluster than the no-AOD and past-AOD groups, but did not differ from each other or the marijuana group on PTSD symptoms. These findings suggest that individuals who have AOD problems should be assessed for PTSD symptoms and provided with trauma-specific interventions when warranted. Trauma-informed care may benefit those in AOD treatment. Individuals who have PTSD symptoms should be assessed for AOD problems as well.

Do Organizational Culture and Climate Matter for Successful Client Outcomes

Objectives: The existing literature on the impact of workplace conditions on client care suggests that good cultures and climates provide the best outcomes for clients. The primary purpose of this study was to investigate the relationship between organizational culture and climate and the proportion of children and youth successfully discharged from a large organization in New York state. Method: Thirty-three child and youth programs with existing culture and climate data evaluated outcome information from 1,336 clients exiting its services. Results: Programs reported as having bad culture and climate yielded superior client outcomes, measured as discharge to a lower level of care and successfully completing. Conclusion: This study and its conclusion point to a gap in knowledge concerning the relation between workplace culture and climate and the impact on client care and workers’ perceptions; this warrants further investigation in similar studies of agencies and their outcomes.

Trauma, Stress, and Self-Care in Clinical Training: Predictors of Burnout, Decline in Health Status, Secondary Traumatic Stress Symptoms, and Compassion Satisfaction.

Objective: Courtois and Gold (2009) have called for the inclusion of trauma in the curriculum for all mental health training programs. The present study investigated the impact of trauma-related content, stress, and self-care (SC) on trainees in such a program. Method: The study examined potential risk factors (trauma exposures in training [being faced with or reacting to trauma-related field work experiences and course content] and perceptions of stress in field and coursework) and protective factors (SC effort and importance) in relation to burnout (BO), health status (HS), secondary traumatic stress symptoms (STSS), and compassion satisfaction (CS) among 195 students in a graduate social work training program. Results: All students reported trauma exposures in their field placements and/or coursework, including retraumatization experiences that were associated with higher STSS and BO. Field stress and SC effort were both consistent predictors across outcomes. Higher field stress levels predicted higher BO and STSS, a greater likelihood of decline in HS, and lower CS. Lower SC effort was also associated with higher BO and STSS, and a greater likelihood of decline in HS, while higher SC effort predicted higher CS. Older students, those with traumatized field clients, and those whose field work addressed trauma, also reported higher CS. Conclusions: These findings suggest that clinical training involving trauma content can be both rewarding and stressful, and may evoke distress in some trainees. Given that learning about and working with trauma are essential to adequate clinical training, the authors suggest adopting a trauma-informed approach within clinical training programs.

Prehospital Providers’ Perceptions of Emergency Calls Near Life’s End

The nature of emergency end-of-life calls is changing as people live longer and die from chronic illnesses. This study explored prehospital providers’ perceptions of (1) end-of-life 911 calls, (2) the signs and symptoms of dying, and (3) medical orders for life sustaining treatment (MOLST). The exploratory–descriptive pilot study was survey based and cross-sectional. Calls to nursing homes occur most often, (47.8% every shift). The MOLST was seen infrequently (57.9% rarely never). The most frequent signs and symptoms of dying were diagnosis (76%), hospice involvement (82%), apnea (75%), mottling (55%), and shortness of breath (48%). The MOLST identifies wishes about intubation (74%), resuscitation (74%), life-sustaining treatment (72%), and cardiopulmonary resuscitation (70%). Synergy exists between the fields of prehospital, hospice, and palliative medicine which offers potential for improved education and care.

Organizational Leaders’ and Staff Members’ Appraisals of Their Work Environment Within a Children’s Social Service System

Several studies have demonstrated the effect of an organization’s culture and climate on the delivery of services to clients and the success of clinical outcomes. Workers’ perceptions are integral components of organizational social context, and in order to create a positive organizational culture and climate, managers and frontline staff need to have a shared understanding of the social context. The existing literature does not adequately address how discrepancies in perceptions of culture and climate between frontline staff and managers affect the implementation of policies and services. The purpose of this study is to compare the workgroup-level culture and climate of a single, large, child and family social services organization, based on the reported experiences of frontline workers and senior managers. The results show that, as a group, senior managers rate the organization as having a culture that is much more proficient and much less rigid and a climate that is more engaged and more functional than the ratings of the average frontline workgroup. The discrepancies between the perceptions of upper management and workgroup-level staff indicate the need for interventions that can improve communication and cohesiveness between these two groups.