Jerry Floersch

Integrating Thematic, Grounded Theory and Narrative Analysis: A Case Study of Adolescent Psychotropic Treatment

In this article, we integrate thematic, grounded theory and narrative analytic techniques. We apply methods from each to the same qualitative data to illustrate how they provide different interpretive scopes on medication meaning making. Findings from each are concatenated to produce an integrated conceptual framework for understanding adolescent experience of psychiatric medication. We conclude that thematic, grounded theory, and narrative methods, when integrated, produce a multidimensional understanding of medication experience.

Adolescent Experience of Psychotropic Treatment

Despite growing concern over the treatment of adolescents with psychiatric medications, little research has examined youth understandings and interpretations of mental illness and psychotropic treatment. This article reports the exploratory findings of semi-structured and open-ended interviews carried out with 20 adolescents diagnosed with one or more psychiatric disorders, and who were currently prescribed psychiatric medications. Grounded theory coding procedures were used to identify themes related to adolescent subjective experience with psychiatric medications. The categories identified are interpreted as different points of view through which adolescents understand and take action upon their illness concerns; their need for medication treatment; their perceptions of how medications work; their responses to parental and other influences upon medication treatment; and, their everyday management activities.

SUBJECTIVE EXPERIENCE OF RECOVERY FROM SCHIZOPHRENIA-RELATED DISORDERS AND ATYPICAL ANTIPSYCHOTICS

Aims: This article investigates the subjective experience of the process of improvement and recovery from the point of view of persons diagnosed (according to research diagnostic criteria) with schizophrenia and schizo-affective disorders. Methods: A community study of persons using psychiatric services was conducted for a sample of ninety subjects taking atypical antipsychotic medications. Sociodemographic data and clinical ratings were collected to complement the qualitatively developed Subjective Experience of Medication Interview (SEMI), which elicits narrative data on everyday activities, medication and treatment, management of symptoms, expectations concerning recovery, stigma, and quality of life. Results: Recovery was observed through: (1) relatively low ratings of psychiatrically observed symptomatology through BPRS scores; (2) the subjective sense among the majority (77.4%) of participants that taking medication plays a critical role in managing symptoms and avoiding hospitalization; and (3) the subjective sense articulated by the vast majority (80%) that they would recover from their illness and that the quality of their lives would improve (70.6%). Conclusion: The overall quality of improvement and recovery is best characterized as an incremental, yet definitively discernable, subjective process.

The Coming Crisis in Social Work Some Thoughts on Social Work and Science

In this essay, the authors consider the challenge made by two keynote speakers at recent social work research conferences, one in the United States and the other in Europe. Both spoke of a knowledge crisis in social work. Both John Brekke (Society for Social Work and Research) and Peter Sommerfeld (First Annual European Conference for Social Work Research) proposed some version of realism as a solution to the crisis. The authors will deepen the argument for realism, however, by discussing how a critical realist perspective allows us to rethink positivist and conventionalist assumptions about the fact/value relation. Using a critical realist philosophy of social science, the authors discuss how social work has taken up positivism and myriad forms of conventionalism and also identify how practical knowledge gradually loses its place and thus contribute to social work’s ongoing knowledge crisis. The authors then offer a way of thinking about practice. The authors will consider forms of practice knowledge and propose that social work has four kinds that unfold in essentially open systems: discursive, visual, embodied, and liquid systems, and that each of these have both tacit and explicit dimensions. These forms of practice, moreover, are inevitably situated in theory-to-practice gaps (the authors call them phenomenological practice gaps), which are the source of social work’s knowledge crisis. The authors conclude with a discussion of the role of reflexivity in a science of social work.

A Method for Investigating Practitioner Use of Theory in Practice

This article describes a methodology for studying the relationship between scientific theory (technical-rational or textbook) and theory generated in practice (knowledge-inaction or practical). It identifies the written and oral practice narrative as empirical sites for studying the use of technicalrational theory in practice. The strengths and limitations of studying the written narrative alone are discussed and a method for juxtaposing the oral and written narrative of the same practice event is described. By respecting both forms of knowledge as productive powers, identifying their empirical referents, and investigating in vivo practice events, it is argued that practice research will remain open to discovering its dual or holistic potential.

The Subjective Experience of Youth Psychotropic Treatment

Abstract The psychotropic treatment of youth is increasing dramatically. This article examines child and adolescent psychopharma-cological research and argues that social work practice and research must examine the complex relationships, social and psychological, in youth pharmacologic treatment. Regarding identity formation, this article explores the developmental consequences when youth adopt an illness narrative to make sense of everyday medication treatment. A conceptual framework for mapping the socio-cultural context of youth medication management is outlined. In the conclusion, youth psychotropic treatment is connected to a perplexing ‘interpretive gap,’ which highlights the subjective quality of medication treatment.

Practitioners' Understandings of Spirituality: Implications for Social Work Education.

Over the past 2 decades the topic of spirituality and its relationship to the social work profession has taken its place as a significant and important part of the agenda for social work research, education, and practice. In this article we discuss the results of a qualitative study that addresses how a group of social work practitioners defined spirituality and the implications of these findings specifically for social work education. Based on findings from a thematic analysis of interviews with 20 social workers, we explore the usefulness of the term spirituality in social work education and the importance of student engagement in a self-awareness process related to spirituality. A template to initiate discussion of these issues for use in the classroom is proposed.

ethnographic approaches to child care research a review of the literature

This article presents the findings from a review of ethnographic approaches to child care research. Ethnographic research has enhanced researcher and practitioner understandings of the child care environment by providing entry into the child care center as an important site not only of development and education, but also of social reproduction and enculturation. The extant research is summarized by identifying four dominant perspectives for viewing non-parental child care: (1) caregiver-centered, (2) mother-centered, (3) child-centered, and (4) societal. This article argues that studying the perspectives of caregivers, mothers, and children in isolation limits understandings of child care experience, since experience is shaped by continuous interactions among participants. We suggest that a more holistic ethnographic approach could enhance child care practice by increasing understanding of the relationships among caregivers, mothers, and children, and how these relationships influence children’s social and emotional development. The article concludes with a proposed agenda for ethnographic research on child care.

THE CONCEPTUAL ADEQUACY OF THE DRUG ATTITUDE INVENTORY FOR MEASURING YOUTH ATTITUDES TOWARD PSYCHOTROPIC MEDICATIONS: A MIXED METHODS EVALUATION

Adolescents are routinely treated with psychiatric medications; however, little is known about their attitudes toward pharmacological intervention. The authors used a concurrent triangulation, mixed methods design to assess whether the Drug Attitude Inventory (DAI), developed for adults, is suitable for measuring adolescent attitudes toward psychiatric medications. Factor analytic techniques and qualitative data were used to investigate whether the instrument provides comprehensive measurement of medication-related constructs in adolescents. Findings suggest that the DAI contributes to knowledge of youth attitudes toward psychotropic treatment; however, limitations were uncovered by the mixed methods approach. This study enhances the measurement and mixed methods literature by showing how qualitative and quantitative techniques served as parallel data reduction strategies for examining an instrument’s utility with a new population.

Are Health Beliefs Related to Adherence Among Adolescents with Mood Disorders

This study explored the illness perceptions, attitudes towards mental health services and adherence behaviors among a group of adolescents in treatment for mood disorders in an urban city in the United States. Seventy adolescents completed a battery of questionnaires assessing demographics (e.g., gender, family income), perceptions of illness (e.g., consequences, treatment control) and overall attitudes towards mental health services. Adolescents and their parents also reported on the youth’s adherence to both psychotropic medication and mental health appointments. Simultaneous logistic regression analyses revealed that attitudes and family income made a significant and unique contribution in explaining adolescents’ adherence behaviors. Interventions that help adolescents become aware of their attitudes toward mental health services and provide information on dimensions of mood disorders, such as the chronic nature of depression and the effectiveness of treatment, may impact adherence behavior. Also, among a group of families with access to services, yearly family income remained a significant barrier to attending appointments all of the time. Policy implications are discussed.