Robert M. Hock

Barriers and Facilitators to Substance Use Treatment in the Rural South: A Qualitative Study

PURPOSE Little qualitative research has examined factors associated with care in substance abuse treatment agencies in Southeastern rural communities. This study explored client- and agency stakeholder-perceived barriers and facilitators to substance use treatment delivery in southeastern rural communities. METHODS Group and individual interviews were conducted with 40 key stakeholders and 40 clients at 9 substance abuse agencies serving rural communities in a southeastern state. Qualitative thematic analysis was used to identify perceived barriers and facilitators to substance abuse services in rural communities. FINDINGS Four primary themes emerged from the client and stakeholder interviews as both barriers and facilitators: availability of services for individuals with substance use disorders; access to the current technology for client services and agency functioning; cost of services; and stigma. CONCLUSIONS This study identifies novel barriers and facilitators to substance use care in the rural South and highlights essential areas for consideration when developing and implementing substance use care in this geographic region. These findings can be used as guidelines to provide better care to individuals with substance use disorders living in rural communities.

Experiences Delivering a Marital Intervention for Couples With Children With Autism Spectrum Disorder

Previous researchers have indicated that parents of children with autism spectrum disorder (ASD) are vulnerable to relationship stress, lower marital satisfaction, and potential relationship dissolution. We describe the experiences of three couples who participated in a 10-week, in-home couples therapy intervention using Emotionally Focused Therapy (EFT). Each couple and their progress through the intervention are described using therapist and supervisor reflections, and qualitative evaluation interviews with the participants after termination. Based on the experiences of the couples, we conclude that couples would benefit from an in-home couples therapy intervention aimed to strengthen their relationships.

Exploring Core Issues in Adoption: Individual and Marital Experience of Adoptive Mothers

Theoretical literature on adoption discusses what are known as the “core issues in adoption.” The original core issues have been modified specifically for the adoptive family system and include 1) loss and grief, 2) entitlement, 3) claiming, 4) unmatched expectations, 5) family integration, 6) bonding and attachment, 7) identity, and 8) mastery and control. Using a self-report survey, this descriptive research assessed the degree to which adoptive mothers (N = 104) reported experiencing these core issues individually, and in their marriages. Results indicated that all of the core issues were experienced, but in varying degrees. Although challenging, some participants reported that their marriage was strengthened as a result of having encountered these issues. Qualitative data illuminated what was difficult and supported the need for skill-building marital interventions for adoptive parents.

Exploring the Youth and Parent Perspective on Practitioner Behaviors That Promote Treatment Engagement

Treatment engagement is critically important to child and family social work practitioners, given its documented relationship with youth and family outcomes. Despite this, little is known regarding the practice behaviors youth and parents perceive as important for promoting their engagement in treatment. The purpose of this study was to explore the perspective of youth and parents regarding practitioner behaviors important for fostering treatment engagement. Three semistructured focus groups were conducted with 30 youth and parents. Using a constant comparative analysis procedure, two domains of practice behaviors emerged: developing the therapeutic alliance and collaborative service delivery. Specific alliance-building behaviors included building rapport and demonstrating care, acknowledging and listening to the youth and family perspective, asking questions, not judging youth and parents, allowing youth and family input to direct care, and supporting motivation to change. Collaborative practice behaviors included providing culturally competent services, sharing treatment information, demonstrating awareness of other services/supports, and engaging other meaningful adults. Youth and parents both discussed the importance of these practice behaviors. Youth, however, seemed to emphasize the therapeutic alliance more than parents in the sample. Clinical implications for family social work practitioners regarding these key practice behaviors are discussed.

What Couples Who Adopt Children From Child Welfare Want Professionals to Know About Supporting Their Marriages

This article provides suggestions for supporting the marriages of couples who adopt children from the child welfare system. These suggestions emerged from qualitative data obtained from 22 spouses in 4 focus groups. Data reveal that couples want professionals to address the impact of adoption on the marital relationship prior to placement of children, to facilitate contact among adoptive couples that focuses on couple relationships in addition to parenting issues after children have been placed, and to actively support the marital relationship in postplacement/postadoption services even when childrens behaviors or needs constitute the presenting problem. Taken together, results indicate that it is appropriate for a broad range of professionals to address the couple relationship throughout the adoption process.

Defining Coparenting for Social Work Practice: A Critical Interpretive Synthesis

Coparenting, referred to as “an enterprise undertaken by two or more adults working together to raise a child for whom they share responsibility,” is responsive to intervention, associated with multiple indicators of individual and family well-being, and applicable to diverse family structures. Because of a lack of conceptual clarity, however, and absence from social work publications, coparenting has not yet entered the purview of social work. In this review, the authors attempt to synthesize existing coparenting definitions into one that is conceptually clear and clinically useful for social work practice with families. Implications for social work practice and research are discussed.

Time-Lag Between Diagnosis of Autism Spectrum Disorder and Onset of Publicly-Funded Early Intensive Behavioral Intervention: Do Race–Ethnicity and Neighborhood Matter?

Health coverage of early intensive behavioral intervention (EIBI) for children with autism spectrum disorder (ASD) is rapidly expanding across the United States. Yet we know little about the time-lag between diagnosis and treatment onset. We integrated administrative, Medicaid claims, and Census data for children in an EIBI Medicaid waiver (n = 473) to examine the relationship between time-lag and (a) child race–ethnicity and (b) neighborhood racial composition, poverty, affluence, and urbanicity. We explored whether the relationship between child race–ethnicity and time-lag varies by neighborhood characteristics. Average time-lag between diagnosis and treatment onset was nearly 3 years. Child race–ethnicity and neighborhood characteristics did not predict time-lag. Reducing time-lag is critical to ensuring that children with ASD receive treatment as early as possible.

Parent perceived challenges to treatment utilization in a publicly funded early intensive behavioral intervention program for children with autism spectrum disorder

Background: In recent years, the delivery of early intensive behavioral intervention (EIBI) for children with autism spectrum disorder (ASD) in the United States has significantly changed. More children with ASD than ever before are eligible to use publicly funded EIBI. Yet, the challenges to large-scale implementation of EIBI remain unclear. Specific Aims: We examined parent perceived challenges to treatment utilization, predictors of increased challenges to treatment utilization, and parent recommendations for increasing utilization in a statewide EIBI program. Method: Using a cross-sectional design, we surveyed parents of children with ASD receiving EIBI through South Carolina’s Pervasive Developmental Disorder Program (N = 145). To examine the contributions of parent demographic characteristics, parent social support, and child challenging behaviors to perceived challenges to utilization, we used multiple linear regression. Parent recommendations were collected using a single open-ended question. Findings: The most frequently endorsed challenges included the child’s school schedule (62.1%) and the child being overburdened with other treatment demands (65.2%). Greater child challenging behaviors were associated with a greater degree of perceived challenges, and social support was associated with a lesser degree of perceived challenges. Discussion: Parents perceived various challenges to utilization, and child and family characteristics may increase the risk for experiencing challenges to utilization. As the delivery of EIBI continues to evolve in the United States and elsewhere, these findings have implications for policy, programming, and future research.

Opening Options: Making Field Education Work in a Private Practice Clinic Setting

This article describes the use of social work field placements in a private practice setting to prepare MSW students for clinical work. The authors used autoethnography, which is personal narrative that explores the writers experience of life, to describe interpersonal and contextual characteristics, as well as procedures implemented to conduct social work field education in a private practice setting. Participants include 1 social work field instructor and 2 graduate students who learned under these conditions. The authors describe and discuss reflections on the learning experience, and they indicate that effective social work education may be achieved in a private clinic setting.