Roberta G. Sands

Using Data Triangulation of Mother and Daughter Interviews to Enhance Research about Families

Qualitative researchers use the term triangulation to describe the use of multiple strategies to study the same phenomenon. Although it is endorsed in social work research textbooks and contested in the literature, qualitative social work researchers are left on their own to determine how to ‘do’ triangulation. This article discusses triangulation, including recent debates around the concept. It describes two methods of data triangulation and illustrates them with examples from the study of mothers and daughters coping with a daughter’s religious intensification. From the first method, a comparative analysis of mother-daughter dyads, the authors identify and provide examples of five types of triangulated data: (1) same story, same meaning; (2) same story, different interpretations; (3) missing pieces; (4) unique information; and (5) illuminating. The second method, triangulation within groups and between groups, makes visible perspectives that are common and distinct to mothers and daughters as members of different cultural groups. The article discusses the advantages of systematic data triangulation for qualitative research and draws implications for social work research and practice.

Utilization of mental health services by low-income pregnant and postpartum women on medical assistance

ABSTRACT This paper examines mental health service use among publicly insured white and African-American pregnant and postpartum women who live in a metropolitan area. The study examines the extent to which ethnicity, physical health problems, and behavioral health risk factors are associated with the probability of service use during the pre-natal-postpartum period. It also analyzes the patterns of service utilization for those women who used mental health services. Medicaid claims and eligibility data, County Reporting System claims and admissions data, and Pennsylvania State Vital Birth Records were integrated using a unique algorithm. Logistic regression was employed to estimate the probability of mental health service use among 3,841 low-income women residing in Philadelphia who were continuously enrolled in Medicaid for 9 months preceding delivery and 6 months postpartum. Analyses were also conducted on the intensity and location of service use, as well as psychiatric diagnosis, during pregnancy and the postpartum period. About 10% of the women used mental health services during the study period. Women were more likely to use services if they were Caucasian, had a number of chronic diseases, had a number of pregnancy complications, and smoked. Among users, the same proportion (ca. 6%) used services during pregnancy and postpartum, with the average number of outpatient visits slightly higher during pregnancy than during the postpartum period. Most outpatient services (86%) were delivered in the specialty sector. Most women who used mental health services (84%) were diagnosed with minor psychiatric disorders including minor depression and anxiety disorders. Women who used services during the postpartum only were more likely to be diagnosed with major depression, whereas women who used services throughout the perinatal period were more likely to be diagnosed with severe mental disorders. Health providers can use information generated in this study to identify women who are likely to have a need for mental health services.

The elusiveness of identity in social work practice with women: A postmodern feminist perspective

During the 1980s, feminist literature proposed the existence of a silent, tongue-tied, “different” woman who craves to exercise her own voice. The more recent postmodern feminism raises questions about the existence of woman, self, and identity as categories, promoting instead the idea of multiple selves and multiple identities. This article visits the concept of “identity” and its partner “self” in psychological, feminist, and postmodern feminist literature and discusses why self/identity is problematic for women. An alternative narrative identity is proposed with narrative identity reconstruction integrated into clinical social work practice with women. A narrative excerpt from an interview illustrates the process.

Evaluating cultural competence among behavioral health professionals.

Persistent racial and ethnic disparities in access and utilization of behavioral health services have highlighted the need for cultural competence among providers. In response, many agencies are now implementing education and training programs to ensure that behavioral health professionals improve their skills when serving diverse ethnic, racial, and cultural populations. The evaluation of these trainings is vital to ensure that they both improve the cultural competence of providers and promote recovery among persons with severe mental illnesses. This paper discusses the philosophical and practical issues related to measuring cultural competence, based on the evaluation of statewide cultural competence trainings for behavioral health professionals. The evaluation process illustrates the challenges of operationalizing cultural competence, balancing the needs of program implementers and evaluators, and developing a robust and feasible evaluation design, which assesses outcomes both for persons in recovery and providers.

Conceptualizing Community: The Experience of Mental Health Consumers

In this article we describe a focus group study of the perspectives of diverse groups of mental health consumers on the concept of community. We identify the core domains that constitute the notion of community, and commonalities and differences in the perception of community along the lines of ethnicity and sexual orientation/gender identity. Seven focus groups were conducted with a total of 62 participants. Transcripts were analyzed using the grounded theory approach.Two domains—togetherness and community acceptance—emerged as common to four types of communities that were most frequently mentioned in the focus group discussion. Our findings show that identities other than those associated with mental illness and the role of service user are critical to the understanding of the psychological sense of community among persons with psychiatric disabilities. We suggest that mental health providers empower consumers to expand their “personal communities” beyond that of mental health clients using their diverse identities, and design interventions for addressing the stigma emanating from identities that are discriminated against by the wider society.

Two modes of case management: Assessing their impact

This is a study of two strategies of case management-Community Treatment Teams (CTTs) and Intensive Case Management Teams (ICMTs). A random sample of 30 cases from the CTT group were matched with 30 cases from the ICMT group using 4 criteria. Data were collected from case records and verified with case managers. The analysis revealed that although the CTTS engaged in more case management activities, there were few significant differences in the outcomes of the two approaches. The results are discussed in relation to a possible “ceiling effect” of case management, cost effectiveness, and limitations in the sample.

Interview Shocks and Shockwaves

This article uses a postmodern lens to examine “shocks,” cognitive emotional reactions of the interviewer to the unexpected, and shows how shocks and “shockwaves,” responses to shocks, are related to the process of Othering. The concepts master narrative, coherence, Othering, positionality, and nonunitary subjectivity are used to present the analysis. Using excerpts from research interviews as illustrations, the article describes three types of shocks—those based on a violation of a social taboo, those deriving from professional role reversal, and those that are based on stereotypes. In addition, it explains three types of responses to shock—avoidance, circular strategies, and acceptance and moving on. The article shows how interviewees resist being Othered and, in an attempt to negotiate a more equitable interview situation, administer shocks. Interviewer expectations of master narratives and the process of Othering prevent interviewers from hearing complex, multifaceted, and atypical stories.

“Can you overlap here?”: A question for an interdisciplinary team

Interdisciplinary teams sometimes view overlapping roles as problematic. In this article, a 1‐min, 7‐s segment of team conversation in which “overlap” is discussed is subjected to a microanalysis. The analysis includes an expansion of the meaning of the text (cf. Labov & Fanshel, 1977) and reveals participants’ territoriality in the face of an ideology of interdisciplinary collaboration. The larger ethnographic study of which this is a part, as well as interviews with participants in the conversation, supports the interpretation of the text that is presented.

Educational and Mental Health Factors Associated with the Return of Mid-Life Women to School.

A population of 74 mid‐life women (ages 30‐49) at a midwestern state university were interviewed during their first year of entrance or reentry to the university to assess variables associated with satisfaction with their school performance, rating of the priority of school, and mental health symptoms. Factor analyses of symptoms and stepwise multiple regression analyses were performed. Factors related to the educational experience (obstacles at school, academic rank) influenced a womans satisfaction with her performance with school. Employment (but not long hours of working) while attending school and perception of public attitudes toward returning women were related to prioritization of school. The women at the highest risk of experiencing symptoms of stress (depression, anxiety, compulsivity) were the younger women and those with relatively low incomes.

Service Components of Case Management Which Reduce Inpatient Care Use for Persons with Serious Mental Illness

This is a study of two types of case management:case management (CM) which provided the servicecoordination functions, and Intensive Case Management(ICM) which consisted of both the coordination function and the provision of direct support to theclient. Using secondary data on public clients,characteristics of mental health service use wereanalyzed for 80 ICM and 84 CM clients. The ICM clientshad significantly fewer episodes per patient and less inpatientdays per year than the CM clients. These findingssuggest that direct support services make a significantdifference in reducing annual hospital care.