Lisa de Saxe Zerden

Adult daughters and aging mothers: The role of guilt in the experience of caregiver burden

Although guilt is often identified as being a common emotion experienced by family caregivers in the clinical literature and in small descriptive studies, it has only recently emerged as a construct in the empirical research focused on identifying predictors of caregiver distress. Using Pearlins stress process model, and based on data from 66 midlife adult daughters caring for aging mothers, we explored the extent to which guilt contributes to caregiver burden. Hierarchical regression analysis revealed that guilt was positively correlated with burden and that it accounted for a significant amount of the variance in caregivers sense of burden even after contextual and stressor variables were controlled. Our research suggests the importance of clinicians seeking to understand how individuals judge their caregiving performance and targeting negative self-appraisals, which affect individuals’ mental health, for change. The challenge for clinicians is to help guilt-ridden caregivers revise their evaluative standards and engage in self-forgiveness and self-acceptance.

Needle Sharing Among Puerto Rican Injection Drug Users in Puerto Rico and Massachusetts: Place of Birth and Residence Matter

This study explored whether place of birth and residence was associated with needle sharing for Puerto Rican injection drug users (IDUs) (N = 348). In-person interviews were conducted in Puerto Rico and Massachusetts during 2005–2007. Multivariate regression analyses revealed IDUs born and living in Puerto Rico were four times more likely to have shared needles compared to those residing in Massachusetts. Respondents residing in Massachusetts were 76% less likely to have ever shared needles with an HIV-positive individual, controlling for covariates. Findings highlight the increased HIV-risk of Puerto Rican IDUs born and residing in Puerto Rico. Prevention and treatment needs are discussed.

Attitudes Toward Evidence-Based Pharmacological Treatments Among Community-Based Addiction Treatment Programs Targeting Vulnerable Patient Groups

ABSTRACT A national sample of addiction treatment Program Directors (N = 296) were assessed regarding their attitudes about pharmacological treatment for addiction disorders. Multivariable analyses indicate that directors who worked in organizations affiliated with research institutions and who had more professional experience had significantly more positive attitudes about a range of pharmacological therapies. Also, directors in organizations serving higher percentage homeless clients and clients with severe and persistent mental illness had more negative attitudes toward use of buprenorphine. Community-based organizations providing addiction treatment to specific vulnerable client groups exhibit more negative attitudes about pharmacological evidence-based practices and may underutilize those practices.

The influence of childhood welfare participation on adulthood substance use: evidence from the National Longitudinal Study of Adolescent to Adult Health

ABSTRACT Background: The associations between early life-socioeconomic status and health, specifically substance use, are well substantiated. The vulnerabilities associated with adversity in childhood, particularly poverty, can have a cumulative effect on an individual’s risk and resilience throughout the life course. While several studies substantiate the relationship between substance use and welfare participation, less known is the impact of and prevalence of behavioral health problems later in life among young adults who were welfare recipients before age 18. Objective: This article explores whether childhood welfare participation before the age of 18 years influences substance use until young adulthood (24–34 years). Methods: This study used Add Health data with sample sizes ranging from 12,042 to 12,324 respondents, and propensity score matching methods to balance the samples and account for selection bias. Matched data were then used to run a series of regression models. Results: Those who participated in welfare before the age of 18 years had a significant lower probability of remaining substance-free until young adulthood (marijuana-free by 30%, p < 0.001; and other illicit substances-free by 16%, p < 0.05). However, no significant between-group differences were found on any of the alcohol-related variables. Conclusions: Findings highlight long-term behavioral health risks, especially substance use, faced by young adults who participated in welfare before the age of 18 years. Acknowledging the vulnerabilities associated with welfare participation and living in poverty could help increase the effectiveness of program and treatment efforts. The prevention of long-term behavioral health disorders hinges on early diagnosis and intervention.

Evidence-based policy versus morality policy: the case of syringe access programs

Evidence-based practice (EBP) combines proven interventions with clinical experience, ethics, and client preferences to inform treatment and services. Although EBP is integrated into most aspects of social work and public health, at times EBP is at odds with social policy. In this article the authors explore the paradox of evidence-based policy using syringe access programs (SAP) as a case example, and review methods of bridging the gap between the emphasis on EBP and lack of evidence informing SAP policy. Analysis includes the overuse of morality policy and examines historical and current theories why this paradox exists. Action steps are highlighted for creating effective policy and opportunities for public health change. Strategies on reframing the problem and shifting target population focus to garner support for evidence-based policy change are included. This interdisciplinary understanding of the way in which these factors converge is a critical first step in moving beyond morality-based policy toward evidence-based policy.

Integrated Primary Care and Social Work: A Systematic Review

Objective: Behavioral and physical health services are increasingly being integrated, with care provided by interprofessional teams of physicians, nurses, social workers, and other professionals. The objective of this study was to describe the functions of social workers on interprofessional teams in primary care and to assess the impact of interprofessional teams that include social workers in integrated care settings. Method: We undertook a systematic review of randomized controlled trials (RCTs) of routine vs. integrated primary care where social workers served on interprofessional teams. A 5-phase search process to identify RCTs from 9 electronic databases and the gray literature published between 2000 and 2016 was used. We calculated effect sizes across identified studies and conducted 2 subsample meta-analyses for behavioral health outcomes. Results: The searches recovered 502 citations. After screening, 107 reports were retained for a full-text review, and 32 of those (from 26 RCTs) met study criteria. In the 26 RCTs, social workers engaged in 3 patient-centered activities: behavioral health treatment, care management, and referral for social services. Conclusion: Although mixed, the findings suggest that, compared to routine services, integrated primary care provided by interprofessional teams that include social workers significantly improves the behavioral health and care of patients.

Infusing Integrated Behavioral Health in an MSW Program: Curricula, Field, and Interprofessional Educational Activities

ABSTRACT An essential aspect of integrated care is the coordination of medical and behavioral health needs concurrently. This has sparked renewed emphasis on interprofessional (IP) education and practice. The impetus for IP efforts was crystalized in large part because of health care reforms, and federal funding to expand the behavioral health work force. Using an ecological systems perspective, this article describes how one school is preparing a new generation of MSW students to work in integrated behavioral health care using a three-pronged approach involving curricula, field education, and IP activities. Social work education must ensure that new and experienced professionals can (a) understand the profession’s role in IP health care settings, and (b) navigate an evolving and complex health care environment.

Better Engaging Social Science Graduate Students in Introductory Research Methods Courses: A Class Activity

Abstract This paper outlines a classroom activity to help students engage in research methods and lessen anxiety and apprehension commonly associated with research methods courses. The described class activity offers students a shared research experience to promote the skills necessary to understand, conduct and translate research into ethical social science practice. The activity was conducted in a graduate social work programme but is applicable across the social sciences. Content covered includes sampling, research design, ethical considerations, brief evaluation and helping students think critically about ways to improve research methods in order to facilitate competencies necessary for evidence-based practice (EBP). An introduction to the activity, class discussion points including integration throughout the course, and implications for curricula and practice are discussed.

Debunking macro myths: findings from recent graduates about jobs, salaries, and skills

Abstract Research suggests that interest in macro social work practice is declining, a trend that has been well documented in the United States. Studies find that social work educators and practitioners may foster beliefs among MSW students that discredit macro practice and associated skills while asserting macro graduates are likely to face poorer employment prospects and lower salaries than micro counterparts as they start their careers. This study builds on and extends this literature by examining 27 skills in their current job using a five-point Likert-type scale among the early career trajectory of MSW alumni (N = 182) who graduated between 2008 and 2012 from a public social work institution in the southeastern United States. The skills included in the survey, as well as decisions about how to group them into scales, were made based on theoretical links between the skills by macro faculty members. Findings highlight the use of macro practice skills regardless of concentration focus, no differences in salary, or the time it takes to find employment between micro and macro alumni. Implications for social work education are discussed.

Social and economic factors associated with recent and lifetime incarceration among Puerto Rican drug users.

Using a sample of 280 Puerto Rican drug users with a history of incarceration residing in Massachusetts, we explore whether a significant association exists between social and economic factors (maintaining social network contacts, receiving public assistance) and lifetime incarceration. Analysis of survey data using regression methods shows that respondents who live in their own home, receive public assistance, and have recent familial contact are significantly less likely to have been incarcerated in the past 6 months. Among study participants, men and those who initiated heroin use at younger ages are more likely to have greater lifetime incarceration totals. Practice implications are discussed.