Lydia P. Ogden

A Working Relationship Model That Reduces Homelessness Among People With Mental Illness

We applied grounded theory methodology to generate a working relationship model that influences motivation for stable housing among homeless people with serious mental illness, to understand the role of a working relationship in critical service transitions. We focused on practitioners’ perspectives and practices in Critical Time Intervention (CTI), a community intervention aimed to reduce homelessness through providing support during the transition from institutional to community living. We found a working relationship that highlighted “nonauthoritative” and “humanistic” features. Workers respected client autonomy and maintained flexibility in the format of client contact and service activities. They used practice strategies including following client leads and informal relating approaches to facilitate the development of client trust. The trusting relationship enhanced client interest in obtaining housing and the commitment to the transformation crucial for retaining housing. We discuss the significance of the relationship and ethical considerations of relationship-building activities in community mental health practices.

“My Life as it is Has Value” Narrating Schizophrenia in Later Years

I used thematic narrative analysis, informed by the developmental life course perspective, to formulate a line of semistructured questioning for interviews with 6 older adults who experienced ongoing symptoms of schizophrenia. From the 31 resulting interviews and 38 observation points, I developed life history narratives that yielded findings across four shared core themes. In this article I present my findings on the theme of narrative insight into schizophrenia in later years. Whereas only 2 of the participants had clinical insight into their mental illness, all had developed personal stories about their lives with schizophrenia. I discuss the significance of the shared narrative profile and the importance of using narrative insight to develop more effective clinical practices and to focus future research with older adults with schizophrenia.

Enhancing Social Work Students’ Knowledge and Attitudes Regarding Substance-Using Clients Through SBIRT Training

ABSTRACT Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based protocol that addresses both moderate-risk and high-risk substance use problems for individuals. In an urban college’s master’s and bachelor’s social work programs with 218 students, SBIRT training was introduced into core course curricula, with many students subsequently using SBIRT in their field placements. Evaluation of the initiative demonstrated increases in the students’ knowledge and favorable attitudes regarding working with substance using clients. Students’ ratings of the usefulness and effectiveness of SBIRT were high. In response to studies indicating the lack of preparedness of graduating social work students to work with substance users, this study demonstrated the effectiveness of SBIRT training to educate students to work with this population.

A Model for Implementing an Evidence-Based Practice in Student Fieldwork Placements: Barriers and Facilitators to the Use of “SBIRT”

ABSTRACT This article reports on focus group data analysis that was used to understand initial, largely positive outcomes from a university-based initiative to disseminate and implement an evidence-based practice (EBP)—Screening, Brief Intervention, and Referral to Treatment for Substance Use (SBIRT)—into student fieldwork placements, which are usual care social work settings. Focus groups were conducted with three groups of stakeholders involved in the ongoing project: social work department faculty (n = 10), bachelor- and master-level social work students (n = 8), and social work fieldwork instructors (n = 6). Dimensional analysis of the focus group data yielded results indicating that dissemination and implementation of SBIRT was influenced by agency- and school-level factors and perceived fit between the EBP and individual professional identity, intrapersonal characteristics, and timing. The resulting model, developed through the focus group analysis, is offered and shows how these factors interacted and affected training, supervision, and use of the EBP. The model provides social work educational programs and agencies a working tool for diagnosing and proactively addressing barriers and breakdowns in the EBP implementation process. Future research that tests the model as a diagnostic tool and generates knowledge about its influence in developing competent evidence-based practitioners is indicated. Future focus groups in relation to this initiative are needed to better understand these barriers and facilitators in the EBP implementation process and their critical roles in the process of translating SBIRT into standard social work practice.

Interpersonal relationship narratives of older adults with schizophrenia-spectrum diagnoses.

Shared themes connected to interpersonal relationships across the life courses of older adults with schizophrenia-spectrum diagnoses were identified in first-person life history narratives and explored in depth. Findings were developed through thematic narrative analysis of 35 interviews with 7 older adults currently in treatment for schizophrenia-spectrum diagnoses. A combination of open-ended questions, life history calendars, and time diaries were used to structure interviews, and narrative and analytical development. Themes of relational losses, relational voids, relational adjustments, relational adaptations, and the need for solitude were identified and located as they occurred in patterns across the life course. Specific implications for theoretical development, practice, policy, and future research on interventions that address social recovery for older adults with schizophrenia are discussed.

“To fill the emptiness”: The importance of work in life history narratives of older adults with schizophrenia-spectrum diagnoses:

Objective: This study’s purpose was to develop an understanding of the importance and meaning of vocational histories, present-time employment status, and vocational goals for older adults who were in treatment for schizophrenia-spectrum diagnoses. Methods: The theory of cumulative adversity and advantage focused 35 semistructured interviews and 43 field observation points that developed life history narratives of seven older adults in treatment for schizophrenia-spectrum diagnoses. Thematic narrative analysis was the primary analytic strategy. Results: Five shared themes within the life history narratives connected to vocational histories: “Purpose is provided by work,” “identity in work,” “perseverance toward value-based vocational goals,” “the importance of an income,” and “illness symptoms and their treatment disrupted work.” Discussion: Findings connect to practice implications for vocational programs for persons with serious mental illnesses, suggesting that vocational services for older adults could be rehabilitative and that vocational assessments should be holistic and values oriented. Psychiatric rehabilitation programs developed specifically for older adults might benefit from the inclusion of vocational rehabilitation options that do not rule out competitive employment. Social workers must be aware of bias in the profession toward persons on the basis of age and serious mental illnesses. Conclusion: In line with current vocational rehabilitation literature, the study concludes that psychiatric rehabilitation treatment that inhibits work can have unintended negative consequences for all persons with serious mental illnesses. Those negative consequences have to potential extend into later life challenges that range from identity challenges to challenges in day-to-day survival.

A postgraduation follow-up of social work students trained in “SBIRT”: Rates of usage and perceptions of effectiveness

ABSTRACT Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based modality that can help social workers work with substance-using clients as part of an integrated health care approach. This study reports the findings of a post-graduation one-year follow-up survey of 193 master’s and bachelor’s social work students trained in SBIRT in practice courses at a Northeast urban college. Forty-three percent of the trainees who were practicing social work after graduation were using SBIRT. A content analysis of participants’ comments found that the vast majority found SBIRT to be a valuable practice modality, with barriers to utilization of SBIRT identified.

Assessment of Integration of Disability Content into Social Work Education

ABSTRACT Three hundred members of the Council on Social Work Education (CSWE) responded to a survey regarding the inclusion of disability content in social work courses and supports needed to increase disability content. Although respondents generally agreed that disability content is important in social work education, its inclusion is inconsistent, with most frequent inclusion in courses on diversity and least frequent inclusion in courses on research. Respondents identified barriers to increasing disability content, including lack of resources for teaching, lack of relevant faculty expertise, and an overcrowded curriculum. Strategies and resources for infusing disability content into social work education are discussed.