Julie Tennille

Unwanted Unprotected Sex Condom Coercion by Male Partners and Self-silencing of Condom Negotiation Among Adolescent Girls

This exploratory study used the theory of reasoned action and the theory of gender and power to guide elicitation of partner-related impediments to condom use among 64 adolescent girls living in poor urban areas with high rates of HIV and partner abuse. About 53% indicated that they had experienced unwanted, unprotected vaginal sex and 25% indicated that they were unable to discuss condom use with a partner. Novel qualitative findings related to condom coercion, condom sabotage, and self-silencing of condom negotiation are discussed in the context of connecting partner abuse to interpersonal control over condom use. Implications for intervention design are discussed.

From Principles to Practice: A Study of Implementation of Supported Housing for Psychiatric Consumers

In the post-deinstitutionalization era, supported housing has emerged as a housing and service approach considered most conducive to the goal of consumer empowerment and community integration. Although prior research found beneficial effects of supported housing, little empirical work has been done on identifying the gaps between the principles and practice of supported housing. Using multiple data sources on 27 supported independent living (SIL) programs for psychiatric consumers in a large metropolitan community, this paper examines the extent to which these programs are implemented in accordance with supported housing. Findings suggest consistency with as well as deviation from the supported housing approach in regard to consumer choice, typical and normalized housing, resource accessibility, consumer control and provision of individualized and flexible support. This study suggests methods for assessing housing programs for psychiatric consumers along these domains. Implications for the development of housing programs that promote consumer empowerment and community integration are discussed.

Case Managers Discovering What Recovery Means Through an HIV Prevention Intervention

Following a randomized trial of case manager delivered HIV prevention intervention to persons with severe mental illness (SMI), this study sought to document changes within the service environment and with case managers themselves as a result of their experience and skills training. Utilizing qualitative methods, researchers conducted focus groups and in-depth interviews with 22 case managers and 3 administrators at an urban community mental health center. Beyond confirming previously established barriers to case manager delivery of HIV prevention interventions for persons with SMI, most noteworthy was the finding that case managers were generally unskilled in conducting assessments and tended to focus on “spoiled identity” and illness parts of their consumers. Experimental case managers revealed that they had been transformed by the training experience in a manner permitting them to both understand and work from a recovery model. Implications and directions for further study are discussed.

Urban adolescent girls' perspectives on multiple partners in the context of the sexual double standard and intimate partner violence.

&NA; This article describes the influence of abusive and nonabusive relationship dynamics on the number of sex partners among urban adolescent girls. Focus groups were conducted with 64 sexually active adolescent girls ages 14 to 17 years. General coding and content analyses identified patterns, themes, and salient beliefs. More than one third (37.5%) reported having experienced physical, intimate partner violence; 32.8% had two or more recent sex partners, and 37.5% had ever had a sexually transmitted infection (STI) or HIV. Although some girls in abusive relationships feared retribution if they had more than one partner, others sought additional partners for solace or as an act of resistance. Adolescent HIV/STI prevention programs need to address the influence of gender norms such as the sexual double standard, as well as partner pressure and partner abuse on adolescent decision‐making about safer sex, and also promote healthy relationships as integral to advancing HIV/STI risk reduction.

Elicitation of cognitions related to HIV risk behaviors in persons with mental illnesses: implications for prevention.

OBJECTIVE An important step in research using the Theory of Reasoned Action and Theory of Planned Behavior (TRA/TPB) is conducting an elicitation process to identify topic and population specific cognitions. This study explored HIV risk behaviors in persons with mental illnesses and introduces findings from focus groups conducted during the development phase of an HIV primary and secondary prevention intervention study. METHODS Researchers held four focus groups with persons with mental illnesses focused on HIV risks and condom use. RESULTS Participants discussed sexual side effects of psychotropic medications as a potential cause of both medication non-adherence and HIV risk behaviors. The intersection of these two issues is specific to this population. CONCLUSIONS We conclude with the recommendation that HIV primary and secondary prevention intervention for persons with mental illnesses must incorporate the promotion of healthy sexuality, including attention to sexual side effects of psychotropic medications.

Motivational Interviewing: Creating a Leadership Role for Social Work in the Era of Healthcare Reform

To better address the needs of individuals with a range of complex health conditions, the Affordable Care Act has shifted the focus from acute care to prevention through behavior change and promoted the integration of physical and behavioral healthcare systems. Central to healthcare reform is delivering person-centered care, which means actively engaging people in their treatment decisions and managing their wellness. Motivational Interviewing (MI) is perhaps the most widely used intervention to promote behavior change. Although MI is utilized across most health disciplines, social workers are uniquely positioned to lead dissemination and on-going training efforts in this area.

Field Instructors Extending EBP Learning in Dyads (FIELD): Results of a Pilot Randomized Controlled Trial

Objective: The act of moving, tailoring, and sustaining evidence-based practices (EBP) into real world settings has proven formidable. Schools of social work are responsible for preparing students to deliver EBP interventions while trying to engender the practice of routinely using evidence for decision making. Given the difficulty of accomplishing these objectives and cognizant that field education is the heart of the experiential component of graduate social work curricula, we developed FIELD as an educational intervention for dyads of field instructors and their students. FIELD is a multiphase didactic and experiential intervention driven by the interests of field instructors. This article presents findings from a pilot randomized controlled trial that examined the effectiveness of FIELD using motivational interviewing as the focal EBP. Methods: A convenience sample of 40 dyads (composed of a field instructor and a field student) was randomly assigned to experimental (n = 38) or control conditions (n = 42). Data collected at baseline and 1- and 3-month post intervention included 2 measures to examine attitudes toward both the EBP process of decision making as well as toward the use of designated EBPs. Results: Both groups were equal at baseline. At the 2 follow-up time points, experimental dyads had significantly higher scores on the attitude measures. Conclusion: FIELD holds promise as an EBP implementation strategy that capitalizes on the important role of field instruction in social work education by bridging classroom and field curricula while imparting competencies to both future and current generations of social workers.

Building Capacity for Evidence-Based Practice Together

ABSTRACT Social workers are increasingly called to implement evidence-based practices and systematically evaluate efficacy. As healthcare reform magnifies these mandates for a growing population of service users, social work educators are positioned to play important roles in helping organizations build capacity for this work. This article presents two examples of faculty members successfully filling this role; one developed a teaching model for evidence-based practice that synchronized classroom and field continuing education, and the other linked curricular goals with an agency’s need for program evaluation. The success of these initiatives identifies opportunities for educators to meet growing needs in health services.

Being Superwoman: Low Income Mothers Surviving Problem Drinking and Intimate Partner Violence

We elucidate ways mothers think about behavior change related to heavy drinking and violent relationships. A purposive sample of 32 women, predominantly black and low income, were identified as engaging in both problem drinking on the AUDIT and experiencing severe partner violence on the Conflict Tactic Scale. Narratives from audiotaped Motivational Interviewing sessions conducted in an urban emergency department were transcribed, inductively coded and examined through the lens of feminist standpoint theory. Our analysis suggests motherhood is a powerful motivator for positive change, but multiple barriers combine to prevent self-protection and modification of adverse behaviors among this vulnerable population. Interventions to help low-income mothers dealing with relationship violence and substance abuse should also address the structural violence and substantive barriers these mothers face. Further work should examine the power of personal narratives related to being a good mother on women’s ability to improve life circumstances for themselves and their children.