RSS 1.0Theses and Dissertations School of Social Work
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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.
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The Role of Relationships for Adults Who Served Long Prison Sentences that Began in Childhood: A Mixed Methods ApproachThe US is the only country in the world to sentence children to die in prison. As of 2016, there were over 12,000 people in US prisons who had, starting between the ages of 12 and 17, been sentenced to spend the rest of their lives behind bars. Several Supreme Court rulings have opened the door for reconsideration of some of these sentences, resulting in the release of more than 980 “juvenile lifers.” Trauma histories, depleted social networks, diminished well-being and complex barriers to reentry are well-documented realities for people leaving prison after long sentences that began in adulthood. However, the post-release lives of those who served life and long sentences that began during childhood remain almost completely unexplored. This dissertation study, believed to be the first national study of returned juvenile lifers, used mixed methods with a social network component to explore the post-release lives of this population. Findings are reported from a quantitative sample of 78 juvenile lifers from 24 US states and Washington, DC, with social network analytic tools considering the type, quality, and social support of the sample’s 555 social network members. Data from in-depth semi-structured interviews with 46 of the 78 participants were compared and integrated into the quantitative data. Quantitative analyses included multivariate regression and multi-level modeling, while qualitative analyses used thematic analysis. Respondents report high quality of life, overall positive relationships, high amounts of social support, and very little undermining. In a multiple regression model, attending religious services, spending more than 20 years in prison, and having fewer unmet reentry needs were all associated with higher well-being. Themes were developed regarding how respondents navigated different types of relationships (with family members, romantic partners, friends), life in prison, barriers to reentry, and parole, as well as their well-being. Positive relationship assessments, supportive relationships, number of types of support, and proportion of friends in a network were all associated with higher quality of life scores in social networks. Social network age, race, employment, and incarceration history were also associated with altered levels of well-being. Research, policy, and practice implications are discussed.
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Reimagining Cis-Stems of Care: Exploring Health and Well-Being Among Transgender and Gender Diverse Young Adults Through an Intersectional Strengths-Based LensIndividuals who identify as transgender and gender diverse (TGD) are among the most vulnerable and stigmatized groups in society. As of this writing, there are approximately 1.6 million transgender individuals aged 13 years and older in the United States. Addressing challenges related to healthcare is often complicated due to an overall lack of understanding regarding the health needs of TGD populations and traditional deficit-based healthcare approaches to TGD health. There is greater need to understand the lived experiences of TGD folx, specifically as it relates to the nuances associated with how TGD young adults conceptualize health and overall well-being beyond deficit-based models of care. To date, there are no known studies that have adopted an explicitly intersectional strengths-based perspective on examining health and well-being among TGD young adults. This study explored what is working well across multiple domains of TGD young adults’ experiences of health and well-being employing qualitative research methodologies. The following research questions were explored: (1) How do transgender and gender diverse young adults define and understand health and well-being? and (2) What protective factors (e.g., strengths, assets, resources) have contributed to the health and well-being of transgender and gender diverse young adults? This was an exploratory qualitative study that employed semi-structured interviews among TGD young adults (N=14) aged 19-25 years (M=23, SD=1.8). This study also recruited and paid a Community Advisory Board (CAB), comprised of healthcare professionals and TGD folx, to guide the research process. Data were transcribed verbatim and analyzed using Thematic Analysis. Analysis revealed that TGD young adults conceptualize health and well-being through three key themes: (1) Separate, but Connected: Perceptions of Health and Well-Being; (2) Navigating Gender Pathways Through Health and Well-Being; and (3) Gender-Affirming Care is Lifesaving Care. This study provides a rich, detailed analysis of TGD young adults’ healthcare experiences through a strengths-based and intersectional lens. Addressing TGD young adults’ needs related to health and well-being requires understanding how they experience health and well-being within systems. Systems that are affirming, compassionate, and focused on providing comprehensive trans and gender diverse care are well-positioned to enhance TGD young adults’ overall well-being and improve health outcomes.
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Recovery Support Services for Opioid Use Disorder in Maryland: A Mixed Methods Study with a Two-Paper DissertationThe alarming fatality rates associated with opioid use disorder (OUD) in the United States have triggered an increased level of public concern and awareness. Recognizing the urgency of addressing this crisis, adopting a fundamental proactive approach becomes imperative. Offering recovery support services (RSS) for individuals with OUD, in addition to treatment, emerges as a strategic pathway to guide society away from the opioid crisis. This two-paper dissertation is dedicated to comprehensively exploring RSS for individuals with OUD within Maryland. The first paper investigated the provision status of RSS across the local jurisdictions in Maryland. This investigation involved virtual interviews with key informants, examination of pertinent written documents, and online searches. While all jurisdictions had at least one service provider offering services for Mutual Support Groups, Care Coordination/Case Management, Medical Assistance Transportation, Harm Reduction, and Peer Support Services, considerable disparities in provision were observed among the twenty-four jurisdictions for the remaining RSS categories, RCC, WRC, Recovery Housing, Homeless Shelters, and Supported Employment Services. The second paper examined the associations between the provision of RSS, county-level covariates, and opioid overdose admission among jurisdictions in Maryland. In the second paper, the analysis incorporated the provision of RSS, the results from the first paper and secondary data including the Maryland State Emergency Department Database, Healthcare Cost and Utilization Project (2016-2020). Counties with more RSS were positively associated with opioid overdose admissions, compared to counties with fewer RSS. Drug overdose death rate, patient capacity rate, single-parent household rate, and non-Hispanic White rate were also positively associated with opioid overdose admissions. Notably, a significant reduction in opioid overdose admissions was observed in the year 2020 compared to the reference year, 2016.
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Comprehensive U.S. Federal Boys’ and Men’s Health Policy: Examining Barriers and Strategies Through a Mixed Methods Policy DelphiBackground: Boys’ and men’s poor physical and behavioral health outcomes, as well as social determinants of health, have been extensively researched. Disparities facing marginalized subgroups are particularly severe. Federal U.S. policy responses have been lacking, as has research on policy inaction. This study examined barriers to comprehensive federal boys’ and men’s health policy (CFBMHP), and strategies for policy adoption. Methods: The study engaged a diverse, national, purposive sample of 16 key stakeholders with expertise in health and gender using a two-round mixed methods Policy Delphi. In round one interviews, participants described reasons for the lack of CFBMHP and conditions that would facilitate adoption. After using Braun and Clarke’s reflexive thematic analysis, 46 proposed strategies were presented via survey for assessment by importance and feasibility. Survey data analysis computed means for each strategy and overall themes. Results: Key themes with top-rated strategies by both importance and feasibility were: 1. Getting at the root with structural problems that impede CFBMHP, 2. Addressing bias with strength-based intersectional approaches (Strategy – take a strength-based approach, not just focus on negative things boys and men bring to the table), 3. Increasing societal value of boys’ and men’s health – Addressing patriarchy and “which men?” concerns (Strategies – stress how men’s health benefits women’s, family, and community health; stress that many boys’ and men’s deaths are preventable), 4. Engaging boys and men effectively in health services and advocacy (Strategy – implement regular holistic health check-ups beginning in adolescence), 5. Creating momentum through strategic communication, coalition, and consensus building (Strategy – highlight successes of relevant existing federal policies). The most highly rated themes across importance and feasibility were three and four. Discussion: Greater dialogue among key stakeholders appears needed around issue framing so more see this as a social problem in need of policy action. Clearer commitments to women’s, family, and community health, and addressing health disparities facing marginalized men, may increase policy support. Future research may increase study duration and sample, including impacted boys and men, mirroring multi-year consultation processes undertaken in countries that then enacted comprehensive men’s health policies.
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Moving Beyond ‘A white Man’s Thing’: A Case Study of Urban Kenyan Youth Mental HealthBackground: Kenya is a lower middle-income country located in Eastern Africa with a population of over 54 million people and a median age of 20 (World Bank, 2020). Competing health emergencies, a healthcare infrastructure ill-prepared for crisis, and inconsistent framing of mental health in culturally relevant terms have all created a gap between mental health need and services in Kenya (Meyer & Ndetei, 2016). This study explores how 15–24-year-olds in Nairobi, Mombasa and Kisumu counties define their mental health and which resources and barriers impact their engagement with mental health services. This study was designed to contribute to the ongoing REACH-MH (Reaching, Engaging Adolescent and youth adults for Care Continuum in Health-Mental Health) project. Methods: I used an inductive approach to answer two research questions: 1) How do adolescents/young people (AYP) define their mental health? and 2) How do relevant stakeholders describe resources and barriers to AYP mental health? For this case study focused on LVCT Health’s One2One program, I used five sources of data: in-depth qualitative interviews with One2One hotline counsellors; One2One hotline data; youth focus group transcripts; stakeholder meeting notes; and government document review of the Mental Health Taskforce Report of 2020 and the Mental Health Amendment Act of 2022. Findings: Five themes emerged from the data regarding the universality of “stress” as a concern for youth, the common conflation of mental health and mental illness, and recommendations for youth-friendly provision of mental healthcare. Overwhelmingly, study participants defined “mental health” in ways that captured broader social determinants of health, along with descriptions of “emotional, psychological and social wellbeing”. Barriers to mental health included cost and a lack of trust in mental health professionals, while youth’s capacity for coping and knowledge of the few, but existent, community services available were reported as facilitating factors. Conclusions: Though challenges abound, also numerous are the strengths and resources possessed by Kenya’s people who continue to solve problems and utilize ways old and new to strive toward a uniquely Kenyan conceptualization of mental health.
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Attitudes Toward Medical Aid in Dying in a National Sample of Hospice CliniciansAs of this writing, medical aid in dying (MAID) is available in 11 U.S. states and the District of Columbia, with further expansion projected. Legal protections for conscientious objection foreground clinician attitudes as substantial barriers or facilitators to MAID access for interested patients. Although upward of roughly three quarters of patients who use MAID are enrolled in hospice care, little is known about hospice clinicians’ attitudes toward MAID. The purpose of this three-paper dissertation was to examine attitudes toward MAID in a national sample of hospice clinicians. Participants were recruited from national hospice and palliative care membership associations representing the four core disciplines of the hospice interdisciplinary group (i.e., medicine, nursing, social work, chaplaincy) to complete a one-time, self-administered survey. Paper 1 examined the preliminary psychometric properties of a modified version of the only empirically evaluated scale on attitudes toward MAID. Confirmatory factor analysis results indicated that the Attitudes Toward Medical Aid in Dying Scale demonstrated factorial validity. Construct validity was established through correlation analyses targeting convergent validity (vis-à-vis a researcher-constructed measure of attitudes toward MAID) and discriminant validity (vis-à-vis a researcher-constructed measure of attitudes toward euthanasia and a scale assessing religiosity). High congeneric reliability estimates supported internal consistency reliability. Despite the favorability of these statistical results, conceptual mismatches between scale items and the U.S. practice context as defined by state laws caution against wider scale use. Further psychometric development is warranted. Paper 2 explored institutional factors tied to the hospice context of care as correlates of MAID attitudes. Using a 3-point version of Paper 1’s ordinal convergent validity item, results of a partial proportional odds model indicated that professional experience working in a state where MAID was legal and increased orientation toward patient-centeredness were both significantly associated with higher odds of more supportive MAID attitudes across each threshold of the dependent variable. Increased commitment to the hospice philosophy of care also was significantly associated with higher odds of more supportive MAID attitudes. Accounting for differing slopes across dependent variable thresholds, however, this association reached statistical significance only when estimating the odds of being in a category above the midpoint response option (neither support nor oppose). Findings support the assessment of ecological factors that drive hospice ethos and functioning when exploring attitudes toward MAID. Paper 3 explored attitudes toward being physically present throughout MAID in a hypothetical patient scenario governed by certain safeguards. The 74% of participants who indicated willingness to be present did so based on feelings of personally derived support for MAID, definitions of quality clinical care, and values from their professional training. This broad support, however, was conditioned by boundary setting though which participants described specific conditions required for their participation. In contrast, 15% of participants were unwilling to be present. These attitudes were attributed to objections to the concept of MAID, objections to participation in MAID, and perceptions that MAID is misaligned with health care. Merely 11% of participants were unsure, relating their hesitation to feelings of ambivalence and a lack of experience with MAID. The tensions that participants across samples reported experiencing with themselves, their profession, and broader society reflect a need for greater professional guidance on the safe and effective provision of MAID.
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Push Factors, Moving, and Mental Health Among Older Adults: The Moderating Effects of Indicators of Social SupportDue to their inclination to age in place, older adults can experience stress when push factors require them to leave their current residence. Consequently, older adults who are moved because of such factors may be susceptible to adverse effects on their mental health. This study aimed to (1) identify the push factors affecting the moving of older adults, (2) investigate whether the relationship between push factors and mental health is mediated by moving, and (3) examine the moderating role of indicators of social support on the relationship between moving and the mental health of older adults. I conducted analyses of a sample of 4,856 community-dwelling older adults using secondary data derived from Rounds 6 and 7 of the National Health and Aging Trends Study. I used logistic regression and structural equation modeling to test aims. The findings revealed that older adults who had been hospitalized and were renters demonstrated a higher propensity to move and that those who were Medicare beneficiaries were less likely to move. Several health issues were associated with lower well-being and higher depression. Renters reported lower well-being, and Medicaid beneficiaries reported higher depression. Housing interior conditions were also associated with depression and well-being. However, the study produced no evidence that social support moderated the relationship between relocation and mental health in older adults. These findings can inform targeted interventions and policy development to improve the mental health of at-risk older adults who may face push factors such as health problems, limited income, and poor housing conditions.
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Oral Histories of Black Women Advocates in the Civil Rights Era: Illuminating Perspectives of Black Healing, Wellness and SpiritualityAfrican American women have been the backbone of the African American community since their ancestors were forcefully brought to what is now known as the United States. While this remains a fact, the nuances of Black womanhood and its relationship to public and private advocacy have been largely ignored, dismissed, and/or unable to be captured by social work researchers. When the focus shifts to Black women narratives, too often what follows are insights in alignment with dominant Eurocentric frameworks, focusing chiefly on experiences that are palatable to those disinterested in acknowledging the legacy of racism and oppression. As a result, there is a dearth of knowledge exploring the wisdom borne from generations of advocacy executed by Black women as a source of survival and fulfillment. This leaves modern-day Black women advocates without a roadmap for combatting race-based trauma, and the practitioners that serve Black women reliant on harmful so-called “best practices” that defy Black cultural values. Much research conducted about Black women activists is less focused on their personal experiences and more on their perspectives about what they have contributed to society. While these insights are valuable, without the full picture of Black women’s lives, pathology and dehumanization are perpetuated. This study explains findings from a secondary data analysis of oral history interviews archived in the Radcliffe Institute’s Schlesinger Library, Black Women Oral History Project, collected from 1976 to 1981. By applying an anti-colonial Womanist conceptual framework, this study centers on the everyday experiences of six African American woman advocates during the civil rights era. Perspectives around concepts of mental health, healing, spirituality, and religion are illuminated. Utilizing the Womanist Triad of Concern, concerned with the human-human relationship, the human-spirit relationship, and the human-nature relationship, I discuss how sustenance, sacrifice, and solidarity are seen throughout the themes: connection and protection. Employing a reflexive thematic analysis, this study sought to amplify oral history as an anti-colonial methodology to interrupt harmful, dominant narratives in history. As a spiritually guided, African American woman advocate, I engaged in collaboration and meaning-making of the oral histories and this informed the sensemaking around the implications for contemporary change-making Black women, as well as recommendations for future research, policy, and decolonial social work practice.
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Moving from Moral Distress to Moral Emotion: A Socioecological ModelAmong social workers, morally relevant distress has been associated with negative emotional and physical outcomes for the practitioner as well as increased intent-to-leave and burnout. Moral distress, a term that arose in the nursing literature, has traditionally been understood as the discomfort that arises when one knows the right thing to do, but is unable to act on that knowledge. However, social workers’ perspectives and experiences of moral distress have not been fully explored, including whether certainty and constraint are central features. A diverse sample of 20 master’s prepared social workers participated in individual semi-structured interviews exploring experiences they identified as morally or ethically troubling or distressing. Grounded theory was used to guide analysis of respondent interviews and revealed that constraint was a common, but not essential feature of morally distressing scenarios. Additionally, uncertainty was often described as an aspect of the experience. The Model of Moral Emotion emerged during the analytic process, demonstrating the layered and contextual nature of a range of morally challenging emotions (e.g., anxiety, depression, anger, traumatic stress). Within this model, moral emotion is shaped by the features of the moral scenario (i.e., constraint, conflicts, complexity, complicity, and trespass) and the individual’s capacity, via internal and external resources, to work through practice challenges. This micro level experience is nested within the mezzo level of practice (e.g., agency context, resources, and culture), the macro level of practice (e.g., sociopolitical, economic, and historical context), and the practitioner’s development as an individual and professional (chronosystem). The Model of Moral Emotion is best suited for use as an assessment tool with students and practitioners to explore how and in what contexts moral emotion develops, how it is experienced or impacts the practitioner, and what actions or responses are needed. Future research will benefit from exploration of the positive end of the moral emotion spectrum (e.g., moral courage), the nuances of diverse cultural understandings of moral emotion, and possible adaptation of the model for quantitative analysis.
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Mindfulness, Self-Compassion, Emotion Regulation, and Parenting Stress in Mothers of PreschoolersParenting stress is known to have adverse effects on both parents and children and is particularly salient during the early childhood years. Parenting stress can lead to harsh parenting behaviors which in turn have negative consequences for children, including internalizing and externalizing behaviors. Parental emotional dysregulation and low levels of compassion toward oneself are factors associated with elevated parenting stress. Mindfulness has been identified as a state of being negatively associated with symptoms of high stress, anxiety, and depression, and has been shown to be beneficial for parents of children with autism and those with chronic illnesses. The purpose of this dissertation study is to analyze the relationship between mindfulness and parenting stress, looking specifically at self-compassion and difficulties with emotion regulation as possible mediators. Using an electronic survey administered by Qualtrics Panels, I gathered data from mothers of 2- to 5-year-old children and analyzed the data using mediation models. I hypothesized that self-compassion and/or difficulties with emotion regulation would mediate the relationship between mindfulness and parenting stress. Results were that self-compassion partially mediated the relationship between mindfulness and parenting stress. Difficulties in emotion regulation did not mediate the relationship between mindfulness and parenting stress. This research has implications for the field of social work, and for parenting interventions in particular, as it has the potential to expand our understanding of how mindfulness works to reduce parenting stress.
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Exploring Child Welfare Placement Pathways to Residential Treatment Settings: A Three Paper DissertationResidential treatment settings (RTS) provide access to services in a safe environment for child welfare involved youth with behavioral health challenges. Despite the potential benefits of RTS, there are concerns that have led to legislation aiming to reduce their use. Policy that aims to reduce the use of RTS should be informed by an understanding of how youth enter RTS. This three-paper dissertation aimed to increase our understanding of how youth placement histories are related RTS entry in the context of youth behavior and development using secondary analysis of state administrative child welfare data. This dissertation also aimed to understand how caregivers experience accessing mental health care for youth through interviews. The first paper explored aggregate patterns of placement transitions and individual factors associated with risk of RTS entry. Findings include that transitions are most likely to occur between similar types of placement settings and that developmental period at first entry to out-of-home care is associated with RTS entry. The second paper explored the presence of unobserved subgroups of child welfare involved youth based on placement histories and whether youth move through these groups over time. The second paper found two subgroups of placement histories, multiple placements in group settings and stability in family care settings. The second paper further found that child behavior and developmental period at first entry to care were associated with group membership and transitions. The third paper identified that caregivers gain empowerment in decision making when accessing mental health services, but that this empowerment declines when accessing acute inpatient services. The third paper further found that accessing RTS was a challenging journey that impacted caregiver well-being, and that the decision to place a child in RTS came following a safety inflection point. Implications include that youth who enter out-of-home care in pre- and early adolescence and their caregivers may require additional support to remain stable in family placement settings. Further implications include the need to improve caregiver access to knowledge about the mental health care system to improve empowerment when making decisions and more resources for acute mental health service settings.
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Surviving High School Transfers: A Multilevel Study of Student and School Characteristics Related to School Transfer, Graduation, and College EntryBackground: Transferring schools frequently happens across the United States from kindergarten to college. While student mobility studies have focused more on elementary and middle school grades, research at the high school level is limited. In addition, studies on transfer during high school related to postsecondary education are even more scarce. This dissertation investigates transfer risk associated with student and school characteristics and its association with high school graduation and college enrollment. Method: The dissertation used analytic samples from a cohort of 6,810 first-time ninth graders enrolled in Baltimore City Public Schools from 2012-2013 to 2017-2018. To examine the factors related to college entry, a second analytic sample included only students who obtained a high school diploma, a certificate of completion, or a GED (N = 4,297). The study employed mixed-effects parametric proportional hazards modeling to investigate student- and school-level characteristics associated with time to the transfer event, and multilevel binary logistic regressions to analyze student and school factors related to odds of high school graduation and college enrollment. Results: Thirty-four percent of students transferred schools during the study period. White students, those with missing 8th-grade math test scores, students who received a suspension, and employed students were at a reduced risk of transfer. Chronic absentees and those with standardized 8th-grade math scores had increased transfer risk. While the school percentage of students eligible for free and reduced meals related to a reduced transfer risk, the school special education rate was associated with increased transfer risk. Transferring schools was associated with lower odds of graduation and college entry, and percentage of school transfer was associated with lower odds of college enrollment. Transfer, as it related to graduation and college entry, varied across schools. Conclusion: School transfer is a multidimensional event related to adverse educational outcomes for many students. This dissertation identified student and school characteristics associated with time to transfer risk. Moreover, the study highlighted the adverse effects of transfer on graduation and college entry. Finally, a discussion of the limitations, strengths, and implications for research, policy, and practice are presented.
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Perceived Need for Care and Mental Health Service Use: The Moderating Effect of Race/Ethnicity and Military Veteran Status among a Population-based Sample of U.S AdultsBackground: Black, Indigenous, and People of Color (BIPOC) adults and military veterans are susceptible to chronic and severe mental illness given their higher likelihood of exposure to risk factors compared to the general population. Despite the consequences of untreated mental illness and federal initiatives aimed at expanding healthcare access, treatment utilization among both groups remains low relative to treatment need. Research has found significant racial and ethnic differences in perceived need for care (PNC) and severity of psychological distress, important antecedents of treatment seeking. However, the extent to which these factors apply to veterans has not been widely examined. Using the Behavioral Model of Health Services Use (Andersen, 1995) and Behavioral Model for Vulnerable Populations (BMVP, Gelberg et al., 2000), this dissertation aimed to address these gaps in the existing literature given their significance to ongoing research, policy, and intervention efforts. Methods: Data were drawn from the 2018 National Survey on Drug Use and Health (N = 43,026). Binary logistic regression was used to examine the associations of PNC and symptom severity with mental health service use among veterans and nonveterans of diverse racial and ethnic backgrounds with interaction terms for race/ethnicity and veteran status. Results: PNC and symptom severity are associated with higher probabilities of mental health service use. However, there are differences in the adjusted probabilities in mental health service use favoring White nonveterans. Veteran status moderates these associations such that the probabilities of mental health service use were stronger for veterans than nonveterans who reported PNC, except for Asian veterans. Conclusions: Veteran status moderates some longstanding racial and ethnic disparities in mental health service use. Further research is needed, particularly among Asian veterans, to identify factors that contribute to lower probability of mental health service use in comparison to White adults, and to identify ways to leverage the effectiveness of interventions employed among veterans in support of other vulnerable groups.
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Understanding Financial Behavioral Health and Race (Racism), and their Association with Investment Risk WillingnessThe conception of financial behavioral health (FBH) is new and lacks a common definition. This dissertation frames FBH as being comprised of financial precarity, financial self-efficacy (FSE), and financial well-being, and has the potential to influence multiple other behavioral health domains. The literature review shows how each component of FBH relates to other domains of behavioral health, including mental health, physical health, coping health, and social health. Stress and life course theory and insights on scarcity from the behavioral sciences are used to understand how FBH impacts the human condition, which, in a negative context, can manifest as money disorders. To explore FBH empirically, data from the 2018 National Financial Capability Study (N = 27,091; FINRA Investor Education Foundation, 2018) was used. First, a measure of financial precarity was constructed with both objective and subjective components, using exploratory and confirmatory factor analyses, and achieved adequate fit. Next, the relationship between FBH and its component parts was assessed, again with adequate fit. The study attempted to determine how a subset of Black and White survey respondents experienced FBH differently, according to collectivist or individualist financial values orientations. However, it was found through measurement invariance testing that although the FBH model had an excellent fit for White respondent data, it poorly fit the data from Black respondents. Due to the model variance, determining further impact of racial group affiliation on the outcome could not be conducted. The study concluded with a structural equation modeling analysis and determined that, controlling for key demographic variables, FBH accounted for 37% of the variance in investment risk willingness (R2 = .368; β = 0.256, p < .001). The project contributes a new measure of financial precarity and a basis for FBH. The variance between the sub-groups may indicate that the survey questions are inadequately capturing the collectivist experience by which many people treat their finances. The project shows how finances can have a psycho-behavioral impact on well-being and decisions, the influence FBH has on investment risk willingness, and suggests that low FBH may perpetuate wealth gaps.
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Time-Use and Well-Being in Family and Other Unpaid Caregivers of Older AdultsDue to the intensive time commitment for caregiving, caregivers report limited freedom to engage with others, participate in physical activities, pursue leisure activities, and have adequate time for sleep. Few studies have focused on caregivers’ time-use across different activities, particularly how different patterns of time-use are associated with well-being. This study aimed to: (1) identify time-use profiles of family caregivers of older adults, (2) examine associations between identified time-use profiles and caregiver well-being, and (3) assess whether the effects of gender and race on caregiver well-being vary by the identified time-use profiles. I analyzed 1,640 family caregivers of community-dwelling older adults by combining secondary data from Round 7 (2017) of the National Study of Caregiving and the National Health and Aging Trends Study. I conducted latent profile analysis to estimate time-use profiles including covariates and outcomes. Three classes of caregivers emerged based on time-use patterns. The High Committed class (20%) spent the longest time in non-eldercare related committed activities, such as household activities and paid work. The High Discretionary class (49%) spent the highest amount of discretionary time, including social activities, physical activities, and other free-time activities. They also spent the least amount of non-eldercare committed time compared to the other two caregiver types. Lastly, the Balanced class (31%) allocated time relatively evenly in all activities. When comparing well-being outcomes between time-use profiles, caregivers in the High Discretionary class had worse self-rated health but lower levels of anxiety than the Balanced class. This study also found significant gender differences in depression, which varied by time-use profiles. Research on time-use and caregiver well-being may help identify at-risk caregiver groups based on lifestyle profiles and develop targeted policies to promote better caregiver well-being.
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An Evaluation of the Effectiveness of Extended-Release NaltrexoneMedications for the treatment of opioid use disorder (MOUDs) are considered the gold standard form of treatment for this condition. There are two forms of MOUD treatment, agonist, and antagonist. Agonist treatment has the medical system provide people with opioid use disorder methadone or buprenorphine which are long lasting opioids that do not produce a euphoric reaction with the goal of alleviating cravings and mitigating illicit use of opioids. Conversely, antagonist treatment blocks opioid absorption in the brain. Extended-release naltrexone (XR-NTX) is the most common antagonist treatment it is administered as a once-monthly injection. During the month after injection, patients who use opioids will not experience their effect and by negating the reward of opioid use the treatment discourages continued use. This study evaluated the effectiveness of buprenorphine and XR-NTX treatment on three characteristics: treatment retention, risk of opioid related acute care incidents, and changes in healthcare costs during treatment. Data from the Truven Health MarketScan® databases which records the date, type of interaction, and cost of every interaction that a person insured privately with one of over 250 insurance providers has with the healthcare system was used to identify a sample of approximately 30,000 people who were treated with buprenorphine or and 617 who were treated with XR-NTX for opioid use disorder. Treatment episodes were constructed based on filled prescription information and a frailty model survival analysis was fit both to a matched sample and the whole sample to length of treatment for each medication. The risk of acute care incidents was evaluated using a generalized estimating equation, and healthcare costs were evaluated using fixed-effects regression models. The study found that there are no significant differences in treatment retention between the MOUDS. Treatment with either medication was associated with an approximately 10% reduction, per day in treatment, of the odds of experiencing an acute care incident during one month. Healthcare costs increased while people were in treatment, with either MOUD, between approximately 0.85% and 1.5% for both opioid related and non-opioid related services.
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Centering Black Lives: Exploring Oral Histories of Legacy African American Women in the Black Belt to Heal the Wounds of Racialization as JusticeNarratives of unresolved racialized injury among Legacy African American(s) (LAA) women in the rural US south, or the Black Belt, offer meaning to observed disparities and healing to the contemporary and future lives of LAA in Black Belt communities. This dissertation study considered LAA women’s layered exposures to racialized adverse live experiences (ALE)/traumas with historical, cultural, intergenerational, race-based, and complex traumas, and the impact of this multidimensional trauma perspective, on wellness outcomes for rural African Americans. Adverse mental and physical health conditions among LAA are critically disproportionate in this population yet current research and treatment protocols to address these disparities are based in a Eurocentric worldview. For example, race is often examined in research as a demographic category without fully conceptualizing the impact of racialization. By applying the Black Lives Matter Healing Justice framework, this study centers the Black experience and aims to elucidates the relationship between racialization and ALE/trauma through the voices and lived experiences of LAA women in the Black Belt, captured in archived oral histories. Employing thematic, critical constructivist, and historical discourse analysis, this study also sought to reveal the language of racialized trauma, expressed in the archived oral/life histories of LAA women sharing their ALE of Jim Crow segregation and racial integration in the Black Belt. Findings suggest that Race-Place-Space collectively served as the foundation of the gendered and racialized experiences of this population. Relying on my personal reflective experiences as a LAA Black Belt woman and an assembled research advisory panel (RAP) as well as theory and extant literature, I discuss the meaning of Race-Place-Space, racialized trauma, and healing justice. Contributions and implications to social work practice and research are presented along with suggestions for future directions in research and practice centering the Black perspective.
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Examining depression and social and emotional development outcomes in parents and children in migrant and seasonal farmworker familiesMigrant and seasonal farmworkers (MSFWs) provide essential food production services in the U.S. yet often experience discrimination, stress related to migration and work, and financial insecurity. Such ecological risk factors unique to agricultural work and being an immigrant of color have previously been shown to heighten MSFW risk for depression. A glaring gap in the literature is that just over half of MSFWs are parents accompanied by their families, and half have children 5-years or younger. This study, guided by the Modified Integrative Model of Child Development for Latinx families, is one of the first to investigate the mental health and social and emotional development outcomes of MSFW families. Specifically, binary logistic regression was conducted using data from the 2017-18 Migrant Seasonal Head Start (MSHS) Study, to examine the relationship between discrimination, work experiences, and cultural resources with the depressive symptomology of caregiving MSFWs. Further, the association of these factors with child social and emotional development outcomes was investigated. MSFWs were mostly women (89%), married or cohabitating with a partner (79%), born outside the U.S. (83%) and mostly from Mexico (80%). All children were 36 months through 5-years of age, just over half were girls (51%), the majority born in the U.S. (93%) and had been enrolled in MSHS for an average of 1.5 years. Results indicated that MSFW caregivers with higher levels of MSFW stress, higher levels of acculturation, and who were separated/divorced had higher levels of depressive symptomology. Children with caregivers with higher levels of depressive symptomology had greater odds of scoring in the range of concern/clinical concern for cognitive social problems. Further, children whose caregivers reported greater importance of religion were less likely to score in the range of concern/clinical concern for emotional behavioral regulation problems. Contrary to this study’s hypothesis, parent depression did not mediate the relationship between contextual factors and child social and emotional development outcomes. Findings are highly significant as they advance understanding of a critically under-studied group and have implications for intervention strategies uniquely suited for this family population. Future research that explores MSFWs’ resiliency along with their structural vulnerability is recommended.
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The Interplay of Home Visitors’ Personal and Professional Identities in Effectively Screening and Supporting Women around Sensitive TopicsHome visiting programs provide information, support, resources, and tools that empower new parents to promote positive maternal and child health outcomes. During home visits, there is a unique opportunity to screen for intimate partner violence (IPV), reproductive coercion, and unintended pregnancy with women in unguarded settings (i.e., the women’s homes) while providing ongoing services via a therapeutic relationship. Using individual interviews and a deliberative discussion focus group, the current study examined the research question, to what degree do home visiting staff members’ personal and professional identities impact their ability to effectively screen and support pregnant women and new mothers around the topics of unintended pregnancy and intimate partner violence including reproductive coercion? Interviews and a deliberative discussion focus group were conducted virtually with staff members from Healthy Families America (HFA) programs in Maryland. Six major themes emerged from the interviews and focus group: personal versus professional experience, therapeutic alliance building, keeping families engaged, use of supervision, addressing intimate partner violence/reproductive coercion in families, and home visiting in the time of a health pandemic. Participants shared how their personal and professional identities helped shape their perceptions of their roles within the home visiting field including the terms, its meaning, and the expectations of that role. The findings suggest that home visitors need additional training around reproductive health since they routinely interact with pregnant women and new mothers who are at-risk for poor pregnancy-related health outcomes that may be due to the lack of control or intention related to reproduction. Participants expressed general knowledge, comfort, safety plan creation, and resource linking around the issue of IPV. Participants had received extensive training on administering the Relationship Assessment Tool (RAT), which is the IPV screener for HFA. However, relatively few program recipients endorsed that their HFA program recipients are experiencing IPV using the RAT. Therefore, HFA staff would benefit from advanced level training utilizing more clinical skills around the topic of IPV including advanced screening skills.
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Youth Worker Perspectives on Building and Maintaining Relationships with Older Adolescents and Emerging Adults in StrongportYouth worker relationships with program participants in community-based programs are integral to the promotion of positive youth development. There is a paucity of studies that specifically explore youth worker perspectives of their relationship development with older adolescents and emerging adults in the US. The purpose of this multi-method qualitative study was to examine how youth workers in community-based programs developed and maintained relationships with older adolescents and emerging adults living in a large city in the US. This study also explored what constrained or supported youth workers in developing relationships with older adolescents and emerging adults. The study was grounded in the constructivist paradigm and guided by Bronfrenbrenner’s (Bronfrenbrenner & Ceci, 1994) bioecological framework and anthropological theories of social suffering and embodiment. Twelve youth workers currently working with older adolescents or emerging adults in the same US city, and one key stakeholder, participated in this study. Data was collected through multiple qualitative methods, including interviews, photo-elicitation, document review, member checking, and researcher journal notes to obtain multiple perspectives of youth worker experiences of relationships with older adolescents or emerging adults. Demographic surveys were also used to provide information on youth workers’ self-reported social identities and organizational contexts that may have influenced their perspectives on relationships with older adolescents and emerging adults. This study found that youth workers build relationships with older adolescents or emerging adults in various ways that fit with their embodied social identities or relational style. All youth workers rooted their relationships with program participants on affirmation or trust. Youth workers also embodied authenticity during the relationship process that contributed to deeper relationship development. Facilitation of communication and creation of space that promoted safety or comfort were also used to develop relationships. Aspects of youth workers’ selves (e.g., desire to work with older adolescents) and their environments (e.g., program funding requirements) supported or constrained the development of relationships with older adolescents or emerging adults. Study results can inform key stakeholders in the youth worker field in strategies that support youth workers in building positive relationships with older adolescents and emerging adults for positive youth development.
