Full text for dissertations and theses included in this collection dates back to 2011. For older dissertations, check the library’s catalog CatalogUSMAI or Dissertations and Theses database.

Recent Submissions

  • Covariates Associated with Completing Short-Term Residential Treatment for a Substance Use Disorder Among Adults in the U.S.

    Ware, Orrin; Sacco, Paul; 0000-0002-3269-5324 (2021)
    Substance use disorders (SUDs) are associated with harmful outcomes across the biopsychosocial spectrum. Although completion of treatment for SUDs is associated with beneficial outcomes such as improved well-being and reduced mortality, premature treatment termination remains high in the United States. Short-term residential treatment is brief and for more severe SUD. This 3-paper dissertation focuses on exploring covariates of treatment completion in a short-term residential setting for adults with an SUD. Secondary data include the Treatment Episode Data Set Discharges 2017 and the Short-Term Residential Treatment Dataset, which contains data gathered from a Mid-Atlantic treatment facility’s electronic medical records. Paper 1 examines the associations of sociodemographic and substance use characteristics with completion of short-term residential treatment. This paper also has a primary focus on observing sex differences in treatment completion. Results from logistic regression models indicated that men were more likely to complete treatment than were women, nonpolysubstance users were more likely to complete treatment than were polysubstance users, and individuals with alcohol identified as their primary substance were more likely to complete treatment than were individuals with other primary substances. Paper 2 examines the associations between perceived stress, distress tolerance, and treatment completion in the short-term residential SUD treatment setting. Perceived stress and distress tolerance were negatively associated. Men had lower perceived stress and higher distress tolerance than did women. Those who completed treatment had lower perceived stress and higher distress tolerance than did those who were discharged from treatment prematurely. Lower perceived stress was found to predict treatment completion conditional to including a Perceived Stress × Distress Tolerance interaction variable. Distress tolerance did not moderate the relationship between perceived stress and treatment completion. Paper 3 examines a scale based on the theory of planned behavior to predict treatment completion in the short-term residential SUD treatment setting. In a path model, the theory of planned behavior’s constructs attitude and perceived behavioral control positively predicted greater intention to complete treatment. Intention to complete treatment and perceived behavioral control did not have a direct effect on treatment completion.
  • Parents’ Experiences and Perspectives of Early Childhood Mental Health Services and Child Welfare

    Keyser, Daniel; Ahn, Haksoon; 0000-0002-7812-7496 (2021)
    Children birth to five in the child welfare system often experience trauma and are at risk for mental health problems and developmental delays (Barth, Scarborough et al., 2007; Cooper, Banghart & Aratani, 2010; Painter & Scannapieco, 2013; Whitaker, 2015). However, despite the high need for services, few children in child welfare receive them (Horwitz et al., 2012; Stahmer et al., 2005). Qualitative studies have used interviews with service providers to identify themes related to mental health service barriers (Hoffman, 2016). However, a gap remains in understanding birth parents’ experience accessing mental health services for children birth to five involved in child welfare. The purpose of this dissertation is to understand the experiences and perspectives of parents of toddlers and preschoolers in child welfare accessing mental health services. A mixed-methods study using qualitative methods as the primary method was conducted. Ten African American birth parents participated. Participants had children 1.5 to 5 years old and involved in child welfare when accessing mental health services. The qualitative data explored parents’ experiences and perspectives of mental health and child welfare services. The quantitative data provided descriptive statistics to assess child behavior, parent stress, parent psychological distress, and mental health service satisfaction compared to national norms. The qualitative data and the quantitative data were integrated to understand parents’ experience with early childhood mental health and child welfare services. The qualitative results of this study showed three major qualitative themes; complex mental health needs, navigating systems: child welfare and mental health, and equity and understanding. Quantitative results suggested most participants had their children placed in foster care, a high level of mental health need for participants’ children, participants had lower psychological distress, but had elevated levels of parenting stress. The integrated data showed participants referred to early childhood mental health services did not immediately seek services, but when they did, they often navigated through several barriers before receiving services. Some participants did not seek services until a major traumatic incident. A conceptual model was developed for early childhood mental health service utilization. Implications for practice, policy, and future research are discussed.
  • Comparing the impact of community-based mediation vs. prosecution on assault recidivism among adults

    Harmon-Darrow, Caroline; Bright, Charlotte Lyn; Sharpe, Tanya L.; 0000-0001-5553-1034 (2021)
    Although violence continues to damage community and family life, crime reduction victories over the past 30 years have come with the cost of expanding criminalization of human life, especially in communities of color. Solutions that reduce both violence and over-criminalization are urgently needed. Community-based mediation for diversion of misdemeanor assault cases has been practiced around the country since the 1970s, but little is known about its ability to prevent further violence between participants or reduce assault recidivism. Secondary analysis was conducted with assault cases (n = 162) within a Maryland Judiciary dataset from a quasi-experimental longitudinal comparison group study of criminal court mediation recidivism. Bivariate analyses and logistic regression with inverse proportion of treatment weighting were conducted. Semi-structured qualitative phone interviews (n = 19) were conducted with mediation participants in three counties of Maryland’s Eastern Shore and Baltimore City. Community-based mediation for misdemeanor assault had a small and statistically non-significant association with return to court at six months, versus usual court processes. Had assaults between couples been excluded, recidivism for mediation cases would have been one third of those treated as usual. For interviewees, the justice system was capable of protection and of worsening the danger and damage, and in mutual cases, respondents wanted to cut ties with it. Mediation could only resolve the conflict if participants were offered: safety; free expression; clarity about the incident; solutions; and active, neutral mediators. Outcomes included no further violence or court charges between participants, little interaction, and for some: loss of housing and livelihood, emotional closure, or endings that needed to happen. Mediators, community mediation centers, and local prosecutors’ offices could improve screening for intimate partner violence and work together to divert more mediatable cases earlier in the process via police officers and court commissioners. Future studies of mediation recidivism should consider comparison groups of people who chose to use the service but their fellow participant declined, and mediation evaluations with a dependent variable of self-reported violence would be best suited to understanding community mediation’s ability to meet its founding mission of community-created peace.
  • The Role of Self-efficacy, Technology Acceptance, and Support, in E-Learning for Child Welfare Workers

    Gunn, Meredith W.; Bright, Charlotte Lyn; 0000-0002-4092-0026 (2020)
    Over the last 15 years, the use of online technology for training and workforce development has increased due to cost savings, convenience, ease of tracking, uniformity of training delivery and messaging, and accessibility. The Association for Talent Development indicated in its 2017 State of the Industry Report that 45% of all employee training was being delivered through technology. Despite its growth, much of the research on online workforce training is limited to training outcomes (e.g., passing the knowledge posttest in order to receive a certificate, certification, or Continuing Education Units) and trainee evaluations (e.g., trainee satisfaction surveys) with no higher level analysis regarding the role of the following: theory, learning or technology; enablers, like technological savvy or organizational support; and/or barriers, like technological difficulties or lack of organizational support in users’ success The specific aims of this study were: (1) to examine what user characteristics and/or factors associated with use of helpdesk support, video tutorials, and test reset, and (2) to identify what factors predicted online training completion. Data for this dissertation were obtained from the National Adoption Competency Training Initiative which was established in October 2014 through a 5-year, $9 million cooperative agreement with the Center for Adoption Support and Education, the U.S. Department of Health and Human Services, and the Administration for Children and Families, Children’s Bureau. The University of Maryland School of Social Work and The Institute for Innovation and Implementation were primary partners in the initiative. Regression analysis showed that older users were more likely to use the help desk, to have a test reset, and less likely than younger users to complete the training; mandated users were more likely to complete the training but were also more likely to require a test rest and to use the video tutorials; and race/ethnicity was significant across all research questions. Findings revealed factors that impact success with online learning, as well as areas for future research into the role of race/ethnicity, personal agency, and variation of training types (self-paced or timed) in online training success.
  • Fidelity and Alliance Effects on Youth Outcomes of Functional Family Therapy

    Cosgrove, John; Lee, Bethany R.; 0000-0003-1723-5909 (2020)
    This dissertation contributes to the scant and inconclusive literature on fidelity and alliance effects on outcomes of manualized youth behavioral health intervention. The aims of this study are to test the comparative effects of fidelity and alliance on (1) treatment progress, (2) change in behavioral health symptoms, and (3) recidivism among juvenile offenders receiving Functional Family Therapy (FFT) – a community-based family therapy intervention. The concurrent effects of fidelity and alliance on FFT outcomes have not been previously tested, which can help to better understand the relative importance of the technical and relational aspects of delivering an intervention effectively. This study involved secondary analysis of data collected for a statewide evaluation of FFT for delinquent youth in Maryland. Using a single-group longitudinal design, treatment progress and change in behavioral symptoms were observed at discharge, and recidivism was observed at 12 months post-discharge. Mixed-effects models regressed treatment progress, behavioral symptoms change, and recidivism on fidelity, alliance, and other covariates. Therapist random intercepts estimated between-therapist variance in each outcome when controlling for fidelity and alliance individually, and both simultaneously, to better understand the role of each in differentiating the effectiveness of FFT across different practitioners. Stronger alliance was associated with greater reductions in youth behavioral symptoms and recidivism for any offense. Higher fidelity was associated with further progress through treatment and reduced recidivism for adjudicated offenses. Neither fidelity nor alliance substantively explained between-therapist variance in outcomes. Results suggest that the relative importance of fidelity and alliance is contingent upon the goals of implementing the intervention, with alliance being more salient for clinical outcomes and fidelity for program retention and delinquency status. For public systems-involved youth with emotional and behavioral challenges, both clinical functioning and systems involvement are critical outcomes, underscoring that both fidelity and alliance are essential for effectively serving this population.
  • Social Workers and Disproportionate Minority Contact: A Mixed Methods Study

    Afkinich, Jenny Lee; Bright, Charlotte Lyn (2020)
    Disproportionate minority contact (DMC) is the disproportionate representation of racial minority youth at all levels of the juvenile justice system. DMC is evident in rates of initial arrests, referrals to court, delinquency findings/ adjudications, out-of-home placements, and transfers to adult criminal court. Race remains a significant predictor of legal outcomes for youth even when factors such as prior legal history and current charge severity are considered despite White and minority youth reporting similar levels of offending. This mixed methods study examined the relationship between community social workers employed by the South Carolina Department of Juvenile Justice (SC DJJ) in the agency’s county offices and DMC. Administrative data from SC DJJ was utilized to determine the extent of DMC in the state, to compare legal outcomes (i.e., receiving confinement dispositions and being waived to adult court) for youth in counties with community social workers to youth in counties that do not employ community social workers, and to compare the legal outcomes for youth in counties with community social workers over time. The results indicate that DMC continues to exist in South Carolina when measured via relative rate indices. Overall, there was little evidence that employing community social workers is sufficient to reduce DMC at the disposition or waiver stage. Qualitative interviews with nine of the 11 community social workers were used to identify and understand the mechanisms, barriers, and facilitators for reducing DMC. The findings suggest multiple nuanced ways the social workers can play a role in reducing DMC. The social workers identified two stages in the juvenile justice process in which they can and have had an impact on increasing equity: (1) out-of-home placement decisions for youth on probation or parole and (2) determining probation requirements. The social workers described a need for hiring additional social workers. They also believe they could train police officers and school officials about alternatives to making a referral to SC DJJ to reduce inequitable decisions at the front-end of the juvenile justice system. Implications for the study include an expanded role for community social workers and new ways to examine DMC quantitatively.
  • The Interrelationships of Adverse Childhood Experiences (ACEs), Alcohol use in Adulthood, and Intimate Partner Violence (IPV) Perpetration Among Black Men in the United States

    Lee, Kerry-Ann; Bright, Charlotte Lyn (2020)
    Historically, Black men have been found to perpetrate IPV at higher rates in comparison to other ethnic groups; however, studies of IPV perpetration have largely focused on samples of White individuals. There is a paucity of empirical research related to the interrelationships among ACEs, IPV perpetration, and alcohol use among Black men. This study used data from Wave 2 of the National Epidemiologic Survey of Alcohol and Related Conditions. Study aims were: (1) to examine the interrelationships of ACEs, alcohol use, and IPV perpetration; to investigate whether alcohol use moderates the relationship between ACEs and IPV perpetration; and whether interpersonal social support moderates the relationships between ACEs and IPV perpetration and between alcohol use and IPV perpetration; (2) to determine if higher cumulative ACE score is associated with increased alcohol use and IPV perpetration; (3) to determine if racial discrimination is significantly associated with increased alcohol use and IPV perpetration; and (4) to identify how subgroups of ACEs (individually or in combination) are associated with alcohol use and IPV perpetration among Black men in adulthood. The sample consisted of 2,326 Black men aged ≥ 20 years. Bivariate results indicated an interrelationship among ACEs, alcohol use, and IPV perpetration. Regression analyses showed that alcohol use exacerbated the ACEs and IPV perpetration relationship for men with no ACEs; but for men who had a history of ACEs, the effect of alcohol on IPV was less substantial. Contrary to study hypotheses, higher interpersonal social support was found to buffer the relationship between ACEs and IPV perpetration for men with three ACEs, but exacerbated the alcohol use and IPV perpetration relationship. Higher cumulative ACE score was significantly associated with alcohol use and IPV perpetration. Racial discrimination was not significantly associated with study outcomes. Latent class analysis yielded three classes. Membership in classes 1 and 2 was associated with IPV perpetration; however, only class 1 membership was associated with alcohol use when compared to class 3 membership. Findings revealed factors that may contribute to IPV perpetration among a sample of Black men. Future research with Black men should aid in the development of culturally-appropriate interventions.
  • Relationship Between Caregiver Social Support, Depressive Symptoms, and Child Asthma Outcomes in Low-Income, Urban, African American Families

    Margolis, Rachel; Bellin, Melissa H; Dababnah, Sarah (2020)
    Caregiver depressive symptoms are prevalent and put low-income, urban, African American children with asthma at risk for poor asthma medication adherence and control. Caregiver social support may improve medication adherence and asthma control directly or buffer against the negative effects of caregiver depressive symptoms. In Paper 1, I systematically reviewed the literature and identified nine studies examining the relationship between caregiver social support and child asthma outcomes. Most studies measured informal social support using self-report instruments and evaluated clinical indicators of asthma morbidity in ethnically diverse school-age children. Studies were limited by referral and recall bias. A pattern of significant results suggested that more caregiver social support is associated with better child asthma outcomes; however, due to the variety in asthma outcomes and the heterogeneity in their measurement, further research is needed to draw more definitive conclusions. In Paper 2, I examined the factor structure of the five-item Medication Adherence Report Scale (MARS), in a sample of caregivers of low-income, urban, African American children with uncontrolled asthma. Confirmatory factor analysis indicated that a five-item one-factor model marginally fit the data. The MARS demonstrated acceptable internal reliability. MARS was associated with caregiver-reported inhaled steroid adherence, but not with Asthma Medication Ratio, asthma control, or caregiver perception of asthma control in the regression model. These results suggest it may be more productive for clinicians to engage in consistent, non-judgmental communication with families about asthma medication rather than using the MARS. In Paper 3, I used generalized estimating equations and ordered logistic regression to investigate the longitudinal relationships among caregiver social support and depressive symptoms and two asthma outcomes: (a) medication adherence and (b) asthma control in the above sample. The analyses revealed that caregiver social support did not have an effect on either outcome, nor did it moderate the relationship with depressive symptoms in either model. Medication adherence and asthma control improved over time. Caregiver depressive symptoms predicted decreased medication adherence. Severe and moderate baseline asthma, very low income, and season (fall) were predictors of poorer asthma control. Clinicians should target depressive symptoms as a modifiable factor associated with child asthma outcomes.
  • Examination of Social Exclusion as a Construct and Its Impact on Mortality and Survival Time among Older Adults

    Lee, Joonyup; Cagle, John G.; DeForge, Bruce R. (2020)
    Although social exclusion may be an important predictor of mortality, there is a lack of empirical evidence on the impact of social exclusion on mortality/survival time among older adults in the U.S. The study reported in this dissertation examined the effects of social exclusion on mortality and survival time using a nationally representative sample of adults over 50 years of age. The primary goal was to better understand how social exclusion affects mortality and survival time among older adults. Data were drawn from the 2010 and 2014 Health and Retirement Study (core wave, exit wave, and psychosocial supplement) and focused on older adults aged 65 years or older (8,439 participants). Social exclusion indicators were based on previous conceptual and empirical frameworks, and a total of 21 possible indicators were measured. On the basis of correlation analyses, three indicators were excluded due to very low correlation coefficients or statistical nonsignificance. The remaining indicators nested in four social exclusion domains (material resources, social, health, and community). Average inter-item correlations supported the reliability of the remaining 18 indicators, and multiple regression models supported the validity of the four domains. The results of a Cox regression model revealed that the material resources domain had a higher influence on mortality than did the other three domains. Six individual indicators (wealth, car availability, social activity, social membership, self-rated health, and disability) were associated with mortality, adjusting for demographic variables. Kaplan–Meier survival analyses based on each indicator showed that all social exclusion indicators were significantly associated with survival rate with the exception of social support, city/town satisfaction, and neighborhood safety. The findings from this dissertation indicate that social exclusion affected mortality and survival time among older adults in the U.S. However, not all indicators were associated with mortality and survival time. The results of the dissertation imply that policies can be modified to improve social participation and access to transportation and that multidimensional services or interventions focusing on the more influential social exclusion indicators are needed (e.g., connecting resources, facilitating social connections). Further, there is a need to reconcile the differences between conceptual and empirical domains/indicators.
  • Beyond Efficacy, Toxicity, and Cost: Patients Define Cancer Care Value in the United States

    Franklin, Elizabeth; Shdaimah, Corey S.; DeForge, Bruce R. (2020)
    Per-capita health-care costs in the United States outpace those of all other countries. Oncology care is particularly expensive, with costs that have nearly doubled over the past twenty years. Cancer care costs are expected to continue to grow exponentially and comprise a considerable proportion of overall health spending costs. While there have been some “blockbuster” or “game changing” treatments, many others offer seemingly minimal benefits. As such, there has been a heightened focus on the concept of cancer care “value,” with multiple organizations promulgating value frameworks designed to assess the perceived value of medications derived from various health economics perspectives. Yet, value is an elusive target, and there is not consensus regarding the dimensions that should be included in such assessments. Value frameworks have the potential to impact patient access to care, yet it is unclear to what extent patient preferences, values, and goals have been incorporated into the value assessments. This study explores how cancer patients and survivors define the concept of “value” in cancer care and if those definitions align with current value frameworks and assessments. This research study was conducted through primary data collection and sought to describe and clarify experiences (such as receiving a cancer diagnosis, engaging in treatment decision making, and moving forward throughout survivorship) as they have unfolded in the lives of cancer patients and survivors. Findings will be used to inform the future direction of value assessments and ultimately, policies that impact the lives of cancer patients and their families.
  • Community-level and Individual-level Predictors of Variation in Rates of Homelessness among Youth Transitioning Out of Foster Care

    Sneddon, Dori; Bright, Charlotte Lyn (2019)
    Youth who age out of foster care are a known high-risk subgroup for homelessness. Studies estimate between 19% and 36% of youth experience homelessness shortly after emancipation. This study examined homelessness among youth transitioning out of foster care by incorporating individual-level and county-level influences to better understand the risk of homelessness among this population. Multilevel models and generalized estimating equation models were constructed to include both individual- and county-level variables. Data were obtained from multiple national datasets: the 2011-2015 National Youth in Transition Database (NYTD), 2011 Adoption and Foster Care Analysis and Reporting System (AFCARS), University of Wisconsin’s County Health Rankings & Roadmaps Data and the 2013 U.S. Department of Agriculture (USDA) Rural-Urban Continuum Code data file. The analytic sample included 3,968 youth who responded to the NYTD Wave 1 (age 17), Wave 2 (age 19) and Wave 3 (age 21) survey. Of the sample, 35.3% experienced homelessness between 17 – 21 years old. Findings indicated statistically significant variation between counties in the proportion of youth who become homeless. Multiple individual-level factors were found to predict homelessness between ages 17 – 21. Prior homelessness, substance use history, and incarceration had a positive relationship with risk of homelessness. Connection with a caring adult, enrollment in school, and employment were inversely related to risk of homelessness. Specific to foster care experience, number of placements and age of entry had a positive relationship with risk of homelessness. Being in foster care at age 19 and at age 21 were related to a reduced risk of homelessness. Not as hypothesized, receipt of independent living services had a positive relationship with homelessness. None of the county-level indicators had a statistically significant relationship to the homelessness outcome. Policy and practice implications for child welfare include extending foster care, capturing housing histories and prioritizing housing plans for youth, and targeting intensive services to youth at the highest risk of homelessness. Future research to further examine socioeconomic community- and state-level predictors of homelessness among this population inform homelessness prevention and housing strategies for youth aging out of foster care. Suggested areas for improvement in NYTD data are also discussed.
  • Neighborhood Disorder and Mental Health Outcomes Among a Sample of Baltimore City Residents: The Influence of Urban Parks, Social Cohesion, and Social Control

    Mattocks, Nicole; Meyer, Megan; 0000-0002-4935-0859 (2019)
    The physical and social environments have increasingly received attention as key factors that explain health outcomes and health disparities for individuals. Recent studies have shown that being exposed to high levels of physical and social disorder (i.e., crime, vandalism, vacant buildings, drug activity) in the neighborhood environment can compromise mental health by generating fear, stress, anxiety and depression. Residents of urban disadvantaged neighborhoods are most at risk of exposure to disorder, and also experience higher rates of anxiety and depression, compared to those living in other settings. Some studies suggest green spaces (e.g., parks, gardens, tree canopy) and collective efficacy (i.e., social cohesion and informal social control) provide mental health benefits in the urban neighborhood environment. However, the relationships among these factors, and how they impact mental health in urban environments is complex, and research in this area is limited. The purpose of this study was to elucidate the relationships between these factors by first examining how one indicator of green space, proximity to parks, moderates the relationship between neighborhood disorder and mental health, and second testing whether social cohesion and informal social control mediate this relationship, for a sample of adults living in Baltimore City. Results from multilevel models demonstrated that neighborhood disorder was associated with anxiety and depression symptoms, consistent with theory and prior research. Proximity to parks did not moderate this relationship; however, social cohesion partially mediated the associations between disorder and both depression and anxiety, while social control partially mediated the association between disorder and anxiety, but not depression. Contrary to expectations, higher levels of perceived social control were linked to higher levels of anxiety symptoms. This study demonstrates that neighborhood conditions matter to individual mental health, and perceptions of the social environment act as an important pathway through which the environment influences mental health for Baltimore residents. More study is needed to understand the relationship between exposure to urban parks and mental health. Findings from this study contribute to our understanding of the social determinants of health, and provide further evidence that the neighborhood context is critical to the mental health of urban residents.
  • Mothers Engaging in Street-Level Prostitution: A Lived Experience

    Bailey-Kloch, Marie; Shdaimah, Corey S. (2019)
    Abstract Title of Dissertation: Mothers Engaging in Street-Level Prostitution: A Lived Experience Marie G. Bailey-Kloch, Doctor of Philosophy, 2019 Dissertation Directed by Corey Shdaimah, PhD, Professor, School of Social Work This dissertation is a qualitative study with mothers who engage in street-level prostitution. Using a phenomenological approach, this study explored how respondents understand their roles as mothers who engage in street-level prostitution and how these two identities co-exist. The aim of the study was an examination of the way motherhood is understood and explained by the women themselves. The purpose was to understand the way women who engage prostitution construct and define motherhood and how they feel about themselves by eliciting their stories through a phenomenological lens. Six mothers engaging in street-level prostitution were interviewed; a second in-depth semi-structured interview was conducted with five of these. After an analysis employing an interpretive phenomenological approach (IPA), three themes emerged from the data: addiction, perseverance and motherhood. All the respondents met the criteria for the DSM 5 diagnosis of severe substance use disorder. They had the resilience to survive in spite of a lack of resources and enduring trauma. They all believed they had qualities of being a “good mother” even if that meant not living with their children. These findings may help to structure programs that may help influence whether they will seek services to improve the quality of their own lives and the lives of their children. Current programs delivering services to mothers engaged in street-level prostitution, such as substance abuse treatment and diversion programs, do not always recognize the significance to their women participants of being identified as a mother. The insights and perspectives of study respondents regarding their lived experience provides guidance to improve policy and programs that deliver services to mothers who engage in street-level prostitution.
  • Multiple Challenges in Kinship Families: How Are They Associated with Children’s Behavioral Health in Kinship Care?

    Xu, Yanfeng; Bright, Charlotte Lyn (2019)
    The use of kinship care has increased in the United States. This dissertation, comprised of three papers, aims to understand multiple challenges in kinship care and their associations with children’s behavioral health using data from the second National Survey of Child and Adolescent Well-being (NSCAW II). Paper 1 developed a new kinship typology based on financial assistance and examined factors associated with receiving Temporary Assistance for Needy Families (TANF) and foster care payments. Results from logistic regression models showed that child maltreatment, children’s externalizing problems, and receiving social services were significantly associated with receiving foster care payments. Living in poverty and a single-adult household were associated with receiving TANF. The results of paper 1 imply that child welfare workers need to increase kinship caregivers’ awareness of financial resources and to make the right resources accessible for them. Paper 2 examined longitudinal relations among economic hardship, economic pressure, TANF, foster care payments, and children’s behavioral problems in kinship care and non-relative foster care. Results of multi-level mixed-effects generalized linear models indicated that economic pressure was associated with children’s internalizing and externalizing problems, as was receiving TANF. Receiving foster care payments was associated with lower externalizing problems. Significant interaction terms showed that foster care payments had positive effects on children’s behavioral health among families without economic hardship and families with economic pressure. The results of paper 2 imply that assessing caregivers’ subjective economic experiences is important to promoting child wellbeing. Findings point to the hardships of families that receive TANF and suggest providing financial and non-financial services to these families. Paper 3 examined the association between neighborhood disorder and children’s behavioral problems and tested the mediating role of social support and the moderating role of race/ethnicity. Results of moderated mediation regression models showed that neighborhood disorder was associated with lower social support, while more social support predicted lower children’s internalizing and externalizing problems. Social support mediated the relation between neighborhood disorder and children’s behavioral problems, but race/ethnicity did not significantly moderate the pathways. The findings of paper 3 imply that interventions are needed to enhance kinship caregivers’ social support and neighborhood quality.
  • Health Savings Account Effects on Health and Debt

    Hageman, Sally; Shaw, Terry V. (2019)
    Title of Dissertation: Health Savings Account Effects on Health and Debt Sally Anne Hageman, Doctor of Philosophy, 2019 Dissertation Directed by: Terry Shaw, Ph.D. More than a decade ago Health Savings Accounts (HSAs) were deemed contrary to social work values and practice (Gorin, 2006). More recent research, however, demonstrated HSAs may help individuals’ access financial resources when encountering financial barriers (Hageman & St. George, 2019). To further examine the potential of HSAs, this study examines HSA effects on health and debt outcomes. Applying the framework of the social determinants of health (Dahlgren & Whitehead, 1991) and the health lifestyles theory (Cockerham, 2005), a subset of 12,686 respondents from three years (2010, 2012, and 2014) of secondary quantitative data from the National Longitudinal Surveys of Youth (NLSY) was drawn. The sample included respondents who answered survey questions about owning an HSA, chronic disease status, health behavior, and health-related debt. Descriptive, bivariate, weighted logistic regression, and generalized estimating equation (GEE) analyses were conducted. Descriptive analyses indicated about 47% of HSA owners were male, 64% were Non-Black/Non-Hispanic race/ethnicity, with an average age of 53.34 (SD=2.26) years old, 99% owned their home, and had an average income of $126,853 (SD=$122,994). About 75% of HSA owners reported they did not have a chronic disease and 70% reported they did not have health-related debt. Weighted logistic regression was conducted to determine if Chronic Disease status was associated with HSA ownership status. Results indicated Chronic Disease status (p=.88) was not significantly associated with owning an HSA. GEE was conducted to determine whether HSA ownership status was associated with respondent debt. Results of the GEE analysis indicated HSA ownership status (p=.76) was not significantly associated with reporting Debt.
  • The impact of organizational culture and climate in child welfare agencies on outcomes for children involved in the child welfare system: A multi-level analysis of a nationally representative sample

    Goering, Emily Smith; Hopkins, Karen M., 1954- (2019)
    Child welfare organizations in the U.S. are tasked with the overarching goal of protecting children from abuse and neglect. The achievement of this goal has been found to be difficult and some child welfare organizations seem to be more effective at reaching this goal than others. A dearth of empirical literature exists in understanding how child welfare organizational functioning impacts its ability to achieve positive outcomes for the children who come into contact with their local child welfare system. An extensive review of the literature revealed that culture and climate of organizations may play an important role, but the existing research is unclear about the extent and direction of that role. Additionally, methodological issues with the existing studies threaten the validity of the results. The present dissertation builds on existing research and conducts secondary analysis using a nationally representative sample. The study applied theories of organizational social context and ecological model to answer the research question: When controlling for risk factors related to child characteristics and organizational contextual characteristics, to what extent do the culture and climate of the child welfare agency impact child-level outcomes? Using the National Survey of Child and Adolescent Wellbeing (NSCAW II), bivariate and multivariate analyses were conducted to answer the research question. Results indicate that individual, agency, and local context characteristics impact recurrence of abuse during the study period. At the individual level, living in a poor household and having prior substantiated maltreatment increased the odds of recurrence. At the agency-level, of the six culture and climate variables, only the climate score of functionality had an impact on risk of recurrence. The agency-level local context variable of county child poverty had the largest effect on recurrence and added explained variance to the model. However, both significant agency-level variables did not impact recurrence in the expected direction. Future research should continue to focus on research methods, better conceptualization and measurement of organizational constructs, and utilize an ecological perspective approach.
  • Patterns of Suicidal Risk and Its Relationship with Suicidal Ideation and Attempt: Practice and Policy Implications

    Nam, Boyoung; DeVylder, Jordan E.; Jacobson Frey, Jodi; 0000-0001-6799-5434 (2019)
    Despite efforts to prevent suicide, suicide mortality rate has been increasing since 2000. This dissertation examined distinct patterns of suicidal risk based on the interpersonal-psychological theory of suicide (IPTS; Joiner, 2005), and the most critical patterns of suicidal ideation and suicide attempt were explored using latent class analysis. A nationally representative sample of White, Black, Latinx, and Asian adults from the Collaborative Psychiatric Epidemiology Surveys (Alegria et al., 2016) was used. For White adults, five latent classes were identified, and respondents in the All Three with Alcohol/Drug Dependence, All Three without Alcohol/Drug Dependence, and Thwarted Belongingness + Perceived Burdensomeness classes were more likely to demonstrate suicidal ideation and suicide attempt than those in the Only Acquired Capability for Suicide class. For Black adults, six latent classes were identified, and respondents in the All Three with Alcohol/Drug Dependence and All Three without Alcohol/Drug Dependence classes were significantly more likely to attempt suicide than those in the Low Risk class. For Latinx respondents, four latent classes were identified, and respondents in the Thwarted Belongingness + Acquired Capability for Suicide class were significantly more likely to attempt suicide than respondents in the Low Risk class. For Asian respondents, three latent classes were identified, and respondents in Thwarted Belongingness + (Active) Acquired Capability for Suicide class had a significantly higher risk for suicidal ideation and suicide attempt than those in the Low Risk class. Findings of this dissertation supported the major tenets of the IPTS that individuals are at the greatest risk for suicide attempt when thwarted belongingness, perceived burdensomeness, and acquired capability for suicide coexist. In addition, this dissertation found some variations across the four racial/ethnic groups. Findings suggested that clinicians working with people with higher risk for suicide should explore multiple dimensions of suicidal risk, especially clients’ capability for suicide (e.g., past exposure to trauma and pain- and fear-reducing experiences). Suicide-prevention campaigns and trainings need to include exploration of past exposure to trauma, physical violence, and risk-taking behaviors as well as access to means in training sessions so that trainees can better detect people with higher risk of suicide attempt.
  • The association between services and recidivism for adjudicated youth with behavioral health problems

    Winters, Andrew Madison; Bright, Charlotte Lyn (2018)
    Research consistently shows that a considerable proportion of adjudicated youth have substantial behavioral health problems; however, few studies compare a range of services for adjudicated youth with behavioral health problems and the association with continued offending. Therefore, the purpose of this longitudinal study is to explore the role of services for youth with behavioral health problems, comparing types of services, and the association with continued offending. The sample consisted of adjudicated youth who were placed in an out-of-home setting (N=2277). As such, placement type was used to explore the role of services. Survival analysis was employed to assess the time at risk for recidivism. Multivariate results suggest boys compared with girls, and youth from urban areas are more likely to recidivate, while older youth and youth who were adjudicated for a felony offense were less likely to recidivate. Youth with a high index of mental health problems had a 16% lower hazard of recidivating, and youth with a moderate and high index of aggression had greater than twice the hazard of recidivating. Youth who were placed in community-based residential programs were 24% less likely to recidivate compared with a more secure setting. As the length of placement increased youth were less likely to recidivate, and youth who had multiple placements were more likely to recidivate. This study is among a few studies comparing a range of services for adjudicated youth with behavioral health problems and strengthens the literature on out-of-home placements. Results suggest community-based placements may act as a buffer for continued offending and aggression problems significantly increase the likelihood of further offending. Furthermore, outcomes from this study suggest a tailored service approach for youth with aggression problems prior to justice involvement is needed. This study provides empirical knowledge for practitioners and policy makers by highlighting service pathways for adjudicated youth with behavioral health problems. Further research is needed to explore key decision entry points in the justice system in which services are most effective at reducing ongoing court involvement. Moreover, future research is needed to address how symptoms and services may differ by gender, race and ethnicity, and age.
  • Neighborhood and Cumulative Ecological Risk: Predicting Physical Abuse and Neglect in an Urban Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) Sample

    Moon, Catherine Anne; Harrington, Donna; Shaw, Terry V.; 0000-0001-9301-2606 (2018)
    The "role of cultural processes, social stratification influences, [and] ecological variations" (Institute of Medicine and National Research Council, 2014, p. 12) in the etiology of child abuse and neglect remains elusive despite a proliferation of studies over the past 40 years. This study seeks to further the knowledge base by longitudinally modeling cumulative ecological risk for child physical abuse and neglect, with a specific focus on the additive contribution of neighborhood structure and process. The Ecological-Transactional Framework (Cicchetti and Lynch, 1993) is used to conceptualize and organize the place of risk markers where cumulative risk theory (Rutter, 1979) is used to guide the analysis. This study combines two sources of secondary data (1) individual risk markers and parents' perceptions of their neighborhood process from the LONGSCAN Eastern site with (2) contemporaneous (1990) census indicators of neighborhood social disorganization. The risk markers and neighborhood structure and process at age six are used to predict child physical abuse and neglect from age 6 through 18. Participants (n=188) were experiencing elevated levels of ecological cumulative risk on the ontogenic and microsystem levels, per the sampling design of the Eastern study site. Further, the characteristics participants' exosystem, or neighborhood level, indicated elevated social distress as measured by The Social Distress Scale (Hyde, 2002). Neighborhood process at age 6 were associated with child report of neglect between ages 13 and 16, however, neighborhood structure was not associated with neglect and physical abuse. The findings suggest the necessity for further study with more diverse samples.
  • Rural Veterans: Pathways to Homelessness

    Jorden, Brenda J.; Belcher, John R.; DeForge, Bruce R. (2018)
    Veterans are overrepresented in homeless populations compared to non-veterans (Gamache, Rosenheck, & Tessler, 2001; Perl, 2015). Most homeless individuals live in urban centers and as a result most research studies have focused on urban homelessness leaving the rural homeless less studied and understood (Knopf-Amelung, 2013). The purpose of the current qualitative study was to explore the pathways to homelessness for a sample of rural homeless veterans. Fifteen veterans and 16 staff/administrators were interviewed to determine the causes of homelessness for veterans living in a rural area. A limited grounded theory approach was used to develop themes identified as causing homelessness. The primary pathway according to both groups was chronic substance abuse. Mental health and economic problems, and adverse childhood events were also major factors in veterans experiencing homelessness. Social support appeared to delay the onset of homelessness for some individuals. Not all veterans qualify for VA services, which leaves a segment of the population without access to VA services. Overcoming barriers to substance abuse and mental health services for rural homeless veterans is an area to focus research efforts. Creative ways to provide outreach to the hidden homeless are needed.

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