Judith L. M. McCoyd

Conducting Intensive Interviews Using Email: A Serendipitous Comparative Opportunity.

This article examines the use of computer-mediated recruitment and email intensive interviewing in contrast to more traditional methods of data collection. Email interviewing is compared to telephone and face-to-face interviewing with the same study population utilizing the same interview guide. This allows analysis of the advantages and disadvantages of each interview format to emerge. This serendipitous comparison opportunity arose from a study of the decision-making and bereavement process of women who terminated desired pregnancies after diagnosis of a fetal anomaly. History and analysis of ethical and methodological issues related to computerized communication for research purposes is included. Although more methodological analysis (Illingworth, 2001) must occur, results suggest that computer-mediated methods allow the research to include isolated, geographically dispersed and/or stigmatized groups who are often overlooked or ignored. This is important for social work researchers who need additional research methods to collect rich data about these difficultto-access groups.

Pregnancy interrupted: loss of a desired pregnancy after diagnosis of fetal anomaly

Prenatal diagnostic techniques both enable and force women and couples to make decisions about whether to continue a pregnancy where the fetus has an anomaly. Few studies have explored the decision-making and bereavement processes of women who terminate a desired pregnancy after the discovery of a fetal anomaly. This reports the qualitative results of a study designed to explore these processes while placing them within the context of the societal milieu. Findings are reported as themes that emerged from the 30 intensive interviews conducted with women at varying stages after this experience. These include mythical expectations based on denial that anomaly could occur, misconceptions about the nature of prenatal testing and inaccurate expectations about the experience and duration of grief. Further, the contradictory norms in society are defined as creating additional dilemmas for women as they attempt to gain support and understanding following their loss. Suggestions for how providers may assist women with their grief are incorporated.

What Do Women Want? Experiences and Reflections of Women After Prenatal Diagnosis and Termination for Anomaly

It is difficult to hear the voices of women describing their experiences of perinatal health care in the United States. This article reports results from interviews with 30 women about their experience of pregnancy termination for fetal anomaly (TFA) and their encounters with the medical system during the diagnosis through the aftermath of termination process. The ways researchers inadvertently silence womens voices are analyzed. Themes emerged from the interviews, including the role of preparedness, access and barriers to care, and the importance of empathic compassion by the provider. Additionally, women give relatively unprocessed advice and feedback to the varied disciplines of the medical care team.

“I'm not a saint”: Burden Assessment as an Unrecognized Factor in Prenatal Decision Making

Prenatal testing is widely utilized, yet few studies have explored decision-making processes about diagnosis from the pregnant womans standpoint. This qualitative, exploratory study reveals a factor not accounted for in prior research geared toward associations between demographic categories and decisions. The 30 women in this study demonstrated a three-part decisional trajectory that included an effort to collect information about the challenges a potential child with their particular diagnosis might experience. They then assessed their social context, familial supports, and resilience as a couple. A final yet crucial step was an assessment of the womans own capacity to provide this level of care within her unique context. Few genetics teams have a member with biopsychosocial expertise and time who can help the woman/couple reflect on the situated context of the decision and its impact. Better care strategies to support women and couples through this experience are warranted.

Authoritative Knowledge, the Technological Imperative and Women’s Responses to Prenatal Diagnostic Technologies

Theories about authoritative knowledge (AK) and the technological imperative have received varying levels of interest in anthropological, feminist and science and technology studies. Although the anthropological literature abounds with empirical considerations of authoritative knowledge, few have considered both theories through an empirical, inductive lens. Data extracted from an earlier study of 30 women’s responses to termination for fetal anomaly are reanalyzed to consider the women’s views of, and responses to, prenatal diagnostic technologies (PNDTs). Findings indicate that a small minority embrace the societal portrayal of technology as univalently positive, while the majority have nuanced and ambivalent responses to the use of PNDTs. Further, the interface of authoritative knowledge and the technological imperative suggests that AK derives not only from medical provider status and technology use, but also from the adequacy and trustworthiness of the information. The issue of timing and uncertainty of the information also are interrogated for their impact on women’s lives and what that can illuminate about the theories of AK and the technological imperative.

Teaching Reflective Social Work Practice in Health Care: Promoting Best Practices

Reflection on case material is traditionally believed to promote better clinical practice; recent neurobiological understandings explain why reflection consolidates learning and allows professional heuristics to develop. Here, we describe a practice in context (PIC) framework that requires reflection on the contextual and decisional aspects of a case and further reflection on potential changes for use in similar cases in the future. We analyze cases using the PIC framework to identify themes related to the use of self to identify potential best practices. The framework is shown to function to promote reflection at all levels of practice; published cases provide “role-modeling” for students, while also creating data for analysis of best practices.

Preparation for prenatal decision-making: a baseline of knowledge and reflection in women participating in prenatal screening

Abstract Objective: This prospective study gathered baseline information about knowledge and intentions regarding prenatal testing from women attending their nuchal translucency (NT) ultrasound and first sequential blood screen. Method: Surveys including questions about pregnancy history and hypotheticals about fetal diagnoses were distributed to all willing participants at an urban hospital and a suburban medical building during the waiting time for the NT (N = 659). Results: The majority “never thought anything could be wrong” with their fetus and had not talked with the father or the health providers about that possibility. Presented with varied fetal diagnoses, the larger group nearly always “had the baby”, except in the case of a fatal condition where 28% said they would have the baby in contrast to 26% who would end the pregnancy (remainder undecided). Hypotheticals about varied fetal conditions were generally “undecided” by a quarter to nearly half of the respondents. Conclusion: Women’s baseline knowledge and reflection about the nature of prenatal screening and diagnosis are minimal in contrast to the large impact positive results could have on their lives. Providers need to weigh the benefit of priming decision-making by exposing women to the possibility of fetal diagnosis, against the cost of raised anxiety.

Balancing Genetics (Science) and Counseling (Art) in Prenatal Chromosomal Microarray Testing

Genetic counselors frequently are called upon to assist patients in understanding the implications of prenatal testing information for their pregnancies and their family’s lives. The introduction of highly sensitive testing such as chromosomal microarray has generated additional kinds of uncertainty into the prenatal period. Counselors may feel uncomfortable or inadequately prepared to engage in discussions with prospective parents who are faced with making critical, and timely, decisions about a pregnancy based on uncertain information. As highly sensitive prenatal testing becomes routine in prenatal care, counselors may be in search of approaches to prenatal counseling, as well as specific skills to approach, engage with, and help families find resolution in such challenging circumstances. To assist genetic counselors, we describe practice skills and provide language for approaching conversations with prospective parents. When clinicians regularly provide care to patients and families making life-altering decisions under conditions of significant uncertainty, discomfort is common and compassion fatigue is likely. We make recommendations directly to the genetic counselor working in reproductive and perinatal settings to enhance training and self-care and to decrease discomfort in balancing the scientific- and art- demands of genetic counseling.

Social Work Sense and Sensibility: A Framework for Teaching an Integrated Perspective

The divisions between ‘micro practice’ and ‘macro practice’ are often traced to historical splits between the originating strands of the social work profession. These splits have been reified in social work education and in institutional settings that largely focus on particular aspects of practice. We argue that this split has been overly polarized and, more importantly, disregards the science and ethics of social work—what we call the sense and sensibility of the profession. Science requires that we recognize the complexity of human activity; ethics require that we alleviate individual suffering and work to attack its root causes. Social work sense and sensibility interweave expectations that practice, policy, theory and research understandings must all be informed by, and inform, ethical social work practice. This bridging framework can help educators respond to calls for connecting all levels and types of social work practice.

A Different Kind of Holding Environment: A Case Study of Group Work with Pediatric Staff

ABSTRACT This paper reports a nearly two-year intervention with staff at a major urban pediatric facility. The authors worked as trainers and consultants for two groups–the Emergency Department (ED) and Chronic Care units (CC). Following two days of training about grief and loss, highlighting skill building for work with traumatized and grieving children and parents, the consultants worked to develop teams which could provide a Winnicottian holding environment for staff. The efficacy of this staff training is analyzed and support needs of staff members are identified. Findings include varied willingness to make use of group support. Chronic care participants are more likely to express willingness to engage in on-going support for one another, while ED staff members seem to prefer structured, educational training and episodic support. The holding environment of the processing groups must be adapted to fit the needs of the medical sub-culture.