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

  • 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
    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.
  • Teaching and Learning Motivational Interviewing: Examining the Efficacy of Two Training Methods for Social Work Students

    Hodorowicz, Mary; Barth, Richard P., 1952-; 0000-0001-5542-5733 (2018)
    This study examines the efficacy of two innovative training methods used to teach beginning Motivational Interviewing (MI) skills to social work students in a child welfare training program. The two training methods tested include live supervision (LS), a small group experiential learning interaction with standardized client actors (SCAs), and in-the-moment guidance from a supervisor, and a coding learning method (CL), where students in a classroom setting are introduced to MI skill development via learning core MI concepts as identified in the Motivational Interviewing Treatment Integrity Coding Manual 4.2.1 .Comparison between these methods was enhanced with a randomized controlled trial design. Changes in MI knowledge, attitudes, and MI skill were assessed over three time points through self-report and observational measures. The study also evaluated participant satisfaction and efficiency of training methods via examination of educational resources required by each training method. After participating in pre-test measures, 17 student participants were randomized to receive either the LS or CL training. Both trainings provided 12 hours of MI training instruction over a period of two days. Students were assessed post-training, and at 5 months follow-up, after a semester of learning-as-usual. T-tests and ANOVAs were used to examine efficacy of training methods. Results show that both groups demonstrated an improvement in MI knowledge and attitudes from pre-test to follow-up. MI skill gain within groups varied for specific MI skills. There was no difference between groups in participant training satisfaction for 10 out of 13 satisfaction items. Participants in the LS group endorsed a higher level of satisfaction than the CL training participants for the remaining 3 training satisfaction items. The LS training method is more costly and requires more resources than the CL training method. Findings suggest participants in both groups were satisfied with the training experience, both training methods are effective for improving MI knowledge and attitudes, the LS training method requires more resources than the CL method, and training method effectiveness varied for specific MI skills. Implications for social work education, MI training, and future research are discussed. Keywords: motivational interviewing, social work education, standardized clients, live supervision, MITI coding, training methods
  • Decision-making among philanthropic foundations in the U.S.: Factors that influence international giving

    Chatterjee, Anusha; Reisch, Michael, 1948-; 0000-0002-1273-3979 (2018)
    Philanthropic foundations utilize private money for public purposes. U.S. based foundations play an increasingly important role in shaping global agendas and efforts, providing $22.03 billion towards international causes in 2016. As their resources are vital but limited, grant-making foundations are always making decisions aimed at improving the effectiveness and reach of their grant dollars. Understanding the decision-making processes adopted by foundations help identify decision-making patterns, examine donor preferences, and learn about the various factors that affect foundations decisions. This study sought to address the gap in literature on international grant-making decisions by foundations. The research questions of the study were: 1) What factors influence foundations' decision-making processes, their determination of funding priorities or goals, and the philanthropic strategies they employ in their grant making to international civil society organizations? 2) What characteristics of targeted beneficiaries or recipient organizations do foundations consider in making funding decisions? This study used a multiple case study approach to examine international grantmaking in five independent foundations that have offices in mid-Atlantic U.S. Primary data on were collected through in-depth interviews with a key staff member at each foundation. In addition to the interviews, publicly available information about the foundations including web content, reports and publications were used to supplement the data collected. In each of the five case studies, the participants discussed how the grant making practices at their foundations have evolved over time, highlighting that although the core mission of their foundations may remain unchanged, foundations adapt priorities, goals, strategies and decision-making. Factors in the external environment of the foundation that influence decision-making processes include international policies and priorities, U.S. policies, tax regulations, and priorities, local country policies and priorities, grantmaking behavior of peers, and market forces. At the foundation level, leadership and staff, donor motivations, and foundation structure affect decision-making. Foundations also seek to increase impact and fund programs that are a philanthropic fit. Foundations support needy and vulnerable beneficiaries, build institutional capacities, and seek knowledge development. Foundations support grantees based on familiarity and reputation, past experience, and organization size. The implications for theory, research and practice are discussed.
  • An examination of Social Dominance Orientation and Cultural Competence of Social Workers

    Shaikh, Naeem; DeForge, Bruce R.; 0000-0002-3476-2703 (2018)
    Social Dominance Theory (SDT) attempts to explain oppression, discrimination, and inequalities by focusing on group-based social hierarchies. A social hierarchy is defined as the social legitimacy of one dominant group over one or more other groups. SDT suggests that social workers should be low in social dominance orientation (SDO), i.e., their psychological orientation or preference for hierarchies; however, some social worker scholars have posited that the profession acts as an agent of social control. Prior research shows that there can potential conflicts between social workers, and between social workers and clients because of differences in political ideology and religious affiliation. Similar differences have the potential to adversely influence social workers self-perceived cultural competence. In addition, SDO has only been examined in graduate social work students, and there is little or no previous research that examines the relationship of social workers religious or political variables with SDO and cultural competence. This study aimed to test some assumptions of SDT, examine if social workers' political ideology, religious, and political affiliation influenced their perceptions of SDO and cultural competence, and fill other gaps in the knowledge base of cultural competence. Qualtrics was used to collect survey data from 497 social workers registered with the Oregon Board of Licensed Social Workers. Respondents were found to be low in SDO and high in cultural competence and a significant but negative and weak relationship was identified between the two variables. Results of multiple regression analyses showed that gender, ethnicity, being a not strong Democrat, social desirability, general social ideology, and issue-based economic ideology predicted SDO whereas age, race, cultural competence training, general economic ideology, social desirability, affiliation with Republican or Other (non-Democratic) Party, and SDO predicted cultural competence. Number of cultural competence trainings attended was the most important predictor of higher cultural competence. Social desirability was the only common predictor of SDO and cultural competence. Findings for gender differences in SDO suggest support for SDT's invariance hypothesis of SDT but there no racial or ethnic differences in SDO which is inconsistent with findings from previous studies. Implications for social work practice, education, and research are discussed.
  • Healthcare Provider Communication with Young Adults: Patient-Centered Communication, Patient Satisfaction, Patient Trust, Social Support, Self-Care Skills, and Emotional Well-Being

    Nichols, Helen M.; Sacco, Paul; 0000-0002-6782-0869 (2018)
    Patient-centered communication is critical to the delivery of quality healthcare services. Although numerous health outcomes have been connected to patient-provider communication, there is limited research that has explored the processes and pathways between communication and health. Research among young adults (ages 26-39 years) is even more scarce, despite findings that health communication does vary with age. This study used data from the 2014 Health Interview National Trends Survey to (1) test a scale of seven items measuring patient-centered communication among young adults age 26 to 39 and (2) explore the relationship between patient-centered communication, patient trust, patient satisfaction, social support, self-care skills, and emotional well-being among young adults age 26 to 39. Exploratory and confirmatory factor analyses were conducted and results showed that a one-factor model of patient-centered communication among young adults fit the data well. In the final regression model, income, history of depression diagnosis, patient-centered communication, patient trust, social support, and patient self-efficacy (self-care skills) were all significantly related to emotional well-being. Post-hoc analyses showed that self-efficacy and patient trust modify the association between general health and emotional well-being. Among respondents who reported poor overall health, increases in self-efficacy and trust in their provider are associated with corresponding improvement in their predicted emotional well-being. This is in contrast to respondents who reported excellent overall health, for whom an improvements in self-efficacy and trust did not have the same effect on predicted emotional well-being. There was a significant interaction between depression and self-efficacy, as respondents who reported being diagnosed with depression showed a stronger relationship between self-efficacy and greater predicted well-being. Post-hoc analyses also showed significant interactions between patient-centered communication, satisfaction, and social support. Respondents who reported lower levels of PCC, showed decreased predicted emotional well-being as their satisfaction and perceived social support increased. These findings suggest the need to explore the means through which communication can impact emotional well-being, specifically among young adults who are in poor health or have a history of depression. Future research should also include longitudinal studies, in order to determine causality and directionality among constructs.
  • Understanding the Health Consequence of Sexual Victimization: Assessing the Impact of Social and Economic Factors

    Fedina, Lisa; Bright, Charlotte Lyn; 0000-0003-4398-5009 (2018)
    The long-term physical health consequences of sexual violence are well documented; however, few studies have examined the impact of social and economic factors on physical health outcomes associated with sexual violence. In particular, the health consequences of sexual violence are not clearly understood among racial and ethnic minority women, including the extent to which socioeconomic status (SES) influences health within racial and ethnic populations. Drawing upon the Social Determinants of Health Framework and intersectionality, this study examines the relationship between race, ethnicity, SES, and multiple health outcomes in a sample of female sexual violence victims (N = 3,622) using the National Intimate Partner and Sexual Violence Survey (NISVS). Findings highlight significant group differences based on race, ethnicity, and SES in health status and chronic disease. African American women reported higher proportions of poor/fair health and most chronic diseases (i.e. diabetes, high blood pressure) compared to Latina women and White non-Hispanic women. Women with lower incomes, lower education, past-year food insecurity, past-year housing insecurity, and past-year financial barriers to healthcare access also reported higher proportions of poor/fair health and most chronic health conditions. Multivariate results highlight within-group relationships between victimization characteristics, SES, and health status based on race and ethnicity. Among African American women, financial barriers to healthcare access was associated with poor/fair health. Among White non-Hispanic women, lower income, lower education, food insecurity, older age of first victimization, and disclosure to healthcare professionals were associated with poor/fair health. Among Latina women, food insecurity, younger age of first victimization, no history of intimate partner physical and/or psychological violence, and disclosure to police were associated with poor/fair health. Findings provide an intersectional understanding of the unique needs and experiences of sexual violence victims based on race, ethnicity, and SES. Results suggest the need for affordable and accessible healthcare as well as police training to reduce poor health outcomes among victims, particularly African American and Latina women. High levels of economic insecurity among victims suggest the need for practitioners to screen for socioeconomic needs (e.g., housing, food and nutrition) in order to reduce poor health outcomes among victims.

    Leitch, Judith; Lee, Bethany R.; 0000-0002-6201-5609 (2017)
    Background. Research indicates that practice behaviors with gay and lesbian clients are determined by practitioners' knowledge, skills, attitudes, self-efficacy, and beliefs. It is currently unknown how these determinants relate to practice with other sexual and gender minority (SGM) clients such as bisexual and gender minority (GM) clients. Additionally, measurement in this area is limited as the current standard measure of affirmative practice has been criticized for a lack of validity. Purpose. The current study has five goals: 1) To learn about how determinants of practice differ when working with SGM sub-groups, 2) To determine how affirmative practice behaviors differ between SGM subgroups, 3) To refine the current model of practice with SGM clients by differentiating between knowledge and skills, 4) To test the interaction between client type and practice determinant, and 5) To establish basic psychometric properties of the LGBT Competency Assessment Tool (LGBT-CAT), a new way to measure practice behavior with SGM clients. Method. A cross-sectional design was used to learn about participant's practice via an online survey. Participants included practicing social workers (N =357) completing a measures about their practices with either lesbian and gay male clients, bisexual clients, or GM clients. Results. Participants had more positive attitudes about lesbian and gay male clients than GM clients, and greater skills in working with lesbian and gay male clients than in working with either bisexual or GM clients. Engagement in affirmative practice behaviors did not vary between client types. Knowledge and skills appear to be different but related constructs in their relationship with clinical practice with SGM clients. No interaction was found between practice determinant and client type in predicting practice behavior. In a model of practice determinants with all SGM clients, both skills and self-efficacy were significant predictors of positive practice behaviors. The LGBT-CAT demonstrated good reliability and basic psychometric properties. Conclusion. Client type should be considered when educating and training practitioners to work with SGM clients. Both knowledge and skills should be included in future practice models with SGM clients, and research should be done to improve measurement in this content area.
  • Making it Happen: Understanding Factors Related to Worker and Organizational Fidelity to Family Connections, a Child Maltreatment Prevention Program

    Bartley, Leah; DePanfilis, Diane; Bright, Charlotte Lyn (2017)
    It has been well documented that the degree to which interventions are implemented as intended, or with fidelity, in typical service settings has varied. Frequently, interventions are developed or tested in highly controlled or early adopter settings. Less attention has been given to what implementation looks like in the real world, and which factors promote a worker's ability to implement an intervention with fidelity. Individuals and organizations implementing intervention receive varying levels of support from external sources and little information from established research, and are often left to persevere through implementation efforts. It is necessary to pay attention to these factors in child maltreatment prevention to ensure that vulnerable children and families have access to, and receive when necessary, interventions as intended in agencies in their home communities. In the quantitative phase of this study, 32 case planners implementing FC, a child maltreatment preventive intervention, completed a survey about their perceptions of individual and organizational factors related to fidelity. These factors were identified through prior research and theory to be important in supporting the implementation of interventions. This survey data was connected to case level fidelity scores to understand the relationship between these variables. The qualitative phase of this study involved further exploration with nine case planner interviews and two separate focus groups with supervisors and agency leadership. The results of this study suggest that supervision is a key contributor to a worker's ability to implement an intervention in the real world. The quantitative and qualitative results suggest that various aspects of supervision, including supervisors' perseverance, proactiveness, knowledge, availability, and skill reinforcement are important components of efforts to support a worker's ability to learn and use FC. The quantitative results suggest that level of education and the perceptions of the intervention's limitations may be negatively related to implementation. Additional components also emerged from the qualitative phase that are worthy of future exploration, related to system expectations and policies, individual worker attributes, and characteristics of the intervention. Implications for practice, policy, and future research are discussed as they relate to the main findings of this study.
  • The Relationship Between Alcohol Use and Gambling in Emerging Adulthood

    Jun, Hyun-Jin; Harrington, Donna; Sacco, Paul (2017)
    Emerging adults (ages 18-29 years) display higher prevalence and co-occurrence of alcohol use and gambling than do adults over age 29, which may lead to negative psychological symptoms, behavioral problems, and socioeconomic and medical costs. However, nationally representative research focused on the developmental relationships across these behaviors is limited. This study used multiple waves of National Longitudinal Study of Adolescent to Adult Health (Add Health) data to examine the relationships between earlier depressive symptoms (Wave III), antisocial behaviors (Wave III), alcohol use (Wave III), and gambling behaviors (Wave III) as predictors of later gambling behaviors (Wave IV) in emerging adults ages 18-29 while adjusting for relevant sociodemographic characteristics ((Waves I, II, and IV). It also examined gender differences in those prospective links. Findings from the path analysis suggested that alcohol-use behaviors were associated with antisocial behaviors but not with depressive symptoms, and earlier gambling behaviors were the best predictors of later gambling behaviors. Earlier depressive symptoms and binge drinking were associated with decreased risk of later gambling participation. Interestingly, endorsement of earlier antisocial behaviors was indirectly associated with a decreased risk of later gambling participation through its effect on binge drinking. The findings from multigroup analyses identified significant gender differences in the relationships between past-year alcohol use and heavy drinking (Wave III), binge drinking (Wave III) and gambling problems (Wave IV), and alcohol-related problems and gambling participation (Wave III). However, the only parameter statistically significant in models for both gender groups was past-year alcohol use and heavy drinking, indicating that a stronger association for men than women. The results suggest the need to focus on multiple risk behaviors and support for screening and early intervention for these risk behaviors (i.e., alcohol use and gambling) as a means of secondary prevention in emerging adults. Future research should further investigate the roles of antisocial behaviors, binge drinking, and gambling during emerging adulthood in vulnerability for future alcohol and gambling problems and consider other confounding factors and gender-specific risk factors.
  • County Context and Mental Health Service Utilization among Older Racial and Ethnic Minorities

    Kim, Kyeongmo; Harrington, Donna (2017)
    Underutilization of mental services by older racial and ethnic minorities is a growing concern in the United States, as it may have a huge impact on the older adults' well-being and generate significant financial costs. Using Andersen's (2008) Behavioral Model of Health Services Utilization, this study examined county contexts associated with mental health service use among older racial and ethnic minorities in the United States, controlling for individual characteristics. This study used the 2008-2012 Medical Expenditure Panel Survey linked with county-level data from the 2013-2014 Area Health Resources Files and the 2008-2012 Chronic Conditions Data Warehouse. This study included 1,143 Hispanic Americans (156 counties), 1,567 Black Americans (237 counties), and 422 Asian Americans (81 counties). Two separate multilevel logistic regressions for Hispanics and Blacks and one multiple hierarchical logistic regression for Asians were conducted to examine which factors were related to mental health service utilization among the three groups. At the individual-level, better mental health status decreased the odds of using mental health services in all three groups. Higher individual income was a significant predictor of mental health service utilization for the Black and Asian samples but not the Hispanic sample. In addition, having a high school diploma significantly predicted mental health service utilization only among older Hispanics. At the county-level, the findings varied across groups. A higher proportion of older adults in a county increased mental health service utilization among older Hispanics but decreased utilization among older Asians. In addition, a higher proportion of Black residents was related to decreased use of mental health services by older Blacks. The existence of community mental health centers in a county significantly predicted mental health service utilization by older Hispanics. This study suggests that county contexts may be helpful to understand mental health service utilization among older racial and ethnic minorities, even adjusting for individual-level characteristics. The findings varied across the three groups, indicating the need for further research. Social workers and policymakers should understand both individual- and county-level characteristics associated with mental health service utilization to develop tailored outreach programs as well as to develop and evaluate mental health policy.
  • Assessing the Relationship between Adverse Childhood Experiences and Body Mass Index Trajectory of Children and Adolescents

    Park, Hyeshin; Barth, Richard P., 1952- (2017)
    Background: More than a third of American children and adolescents are overweight or obese. Because childhood obesity is a risk factor for various health, mental health, and socioeconomic problems in adulthood, health practitioners, policy makers, and researchers continue to identify growth trajectories and clarify risk factors for unhealthy growth trajectories. The purpose of this dissertation was to identify subcategories of children who follow different body mass index (BMI) trajectories, describe these groups, and explore whether adverse childhood experiences (ACEs) predict group membership. Methods: A sample of children who participated in the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) study at the Eastern site (Baltimore, MD), and whose demographic and BMI data were collected at age four, were included in the study (n=201). Latent Class Growth Analysis (LCGA) was used to examine longitudinal patterns of BMI growth over a span of 14 years (4 years - 18 years). Data were assessed and the optimal number of classes to describe the growth trajectories was selected. Bivariate and multivariate data analyses were used to describe the children in each group. Multinomial logistic regression was used to examine whether the number of cumulative preschool (age 4) or school-aged ACEs (ages 4 to 14) predicted group membership. Results: Overall, the percentage of overweight/obesity increased with each additional wave. Based on z-BMI score, at age 4, 20.1% were overweight/obese. A marked increase was identified when children were 12 years old (42.0%) and then at 18 years (49.4%). Three BMI growth trajectories were identified: expected growth, emerging overweight, and increasing obesity. Most children followed an expected growth trajectory (73.6%). However, about a fifth followed a trajectory with a steep increase in BMI over time (emerging overweight = 21.9%) and a small percentage of the children exhibited a high initial BMI as well as a high rate of increase (increasing obesity = 4.5%). Ages 8 to 12 and ages 16 to 18 had especially steep slopes when it came to BMI increase in the emerging overweight and increasing obesity trajectories. A higher preschool ACEs score was associated with a low odds ratio of being in the emerging overweight group compared to the expected growth group; school aged ACEs score did not predict membership to a particular class. Female children and those with a higher primary maternal caregiver BMI when the children were 4 years old predicted being in the emerging overweight group compared to the expected growth group. Implications: The time periods that are especially sensitive to steeper weight gain are likely to be the time periods when interventions should be targeted for children in a low income, urban, largely African American community. The current study had results that were divergent from the hypothesis in that children who had higher ACEs at age four were less likely to have an obesity-prone BMI trajectory. Reasons and implications are discussed. The child's gender and the child's maternal caregiver's weight status should provide some guidance in intervention and treatment decisions.
  • Alternative Response in Child Welfare: A Mixed Methods Study of Caseworker Decision Making

    Shipe, Stacey LeAnn; Harrington, Donna (2017)
    A family's entrance into the child welfare system begins once a report meets a jurisdiction's definition for child maltreatment. Alternative response (AR), a legislatively mandated policy in Maryland, is an approach to child protective services (CPS) where caseworkers are required to provide a family-centered, strengths-based approach as opposed to making a final determination of abuse/neglect. Once a family begins their trajectory into the child welfare system they are reliant on caseworkers to make the best decisions for them, but these decisions are influenced by multiple factors. This mixed-methods study examined caseworker decision making and the influence child, family, and organizational factors had on recurrence. The quantitative phase of this study used administrative data for 2,871 families from three jurisdictions in the state of Maryland. Using child and caregiver characteristics that are predictive of recurrence, differences were examined between families who received a traditional response (TR) versus an AR. These same characteristics were used to predict which families would receive a subsequent investigation, and among those, what predicted a substantiated recurrence. In the qualitative phase, AR caseworkers participated in focus groups where they were asked about the findings from the quantitative portion of the study as well as other organizational factors that influenced their overall decision making for families. County level differences were found among the TR and AR families for child and caregiver race, maltreatment allegation, Medicaid receipt, and re-investigation. These differences held when the counties were examined individually. The number of children, child gender, and Medicaid receipt predicted a subsequent investigation. Child age, maltreatment allegation, Medicaid receipt, previous investigative finding/response, and county predicted a substantiated recurrence. The findings from the focus groups revealed challenges specific to agency mandates and that caseworkers rarely differentiated their approach between a TR and AR. The results suggest that additional research is needed to fully understand the influence of case factors and organizational context and its impact on family outcomes. Also needed is additional training for caseworkers to fully understand the purpose of AR as well as the processes that place families on an AR track.
  • The Validation of a Set of Principles for Social Work Leadership

    Peters, Sara Colby; Hopkins, Karen M., 1954- (2016)
    A recent increase in social work leadership research reveals two primary issues: 1) lack of demonstrated linkages between the social work mission and leadership theories commonly used in social work research; and 2) leadership deficit on multiple practice levels. This first part of this dissertation examines the historical evolution, current trajectory, and consequences of these issues, and the negative outcomes for the profession, its employees, and its clients. The primary purpose of this dissertation research, to develop a model and measure of social work leadership to address challenges in leadership practice and research, is fulfilled using the following methodological steps: 1) extraction of social work leadership principles from a systematic theoretical literature review, empirical literature reviews, and focus group; 2) development of a definition of social work leadership; 3) a review of leadership measures that have been used in social work research to determine if one or more could be used as the basis of a social work leadership measure; 4) development of a measure of social work leadership based on the leadership principles, with the addition of a set of items measuring respondents' perceptions of positive change facilitation for clients; and 5) statistical validation of the leadership measure. Exploratory factor analysis, used to validate the measure, produced a five factor model provisionally labeled organizational health, change management, community relations, relational empowerment, and social work ethics. Multiple regression analyses are performed to assess the relationship between the validated leadership measure and respondents' perceptions of client outcomes. All subscales, except for change management, predicted a significant amount of variance in their corresponding change score. The five subscales together accounted for about 50% of the variance in the total change score. The conceptual meaning behind each of the five subscales is explored with the use of supporting literature and results of the statistical analyses are used to develop implications for research and practice. Potential uses of the final leadership measure and model in addressing the previously identified research and practice challenges are discussed.
  • High School Graduation in Context: A Multilevel Examination of the Factors Related to On-Time Graduation for Students Who Persist Through Four Years of High School

    Uretsky, Mathew Cory; Harrington, Donna; Woolley, Michael E.; 0000-0002-4765-6889 (2016)
    Background: Despite recent national data describing reductions in dropout and increasing graduation rates, the number of students who persist through four years of high school without earning a diploma has remained steady. Although reduced dropout is a promising trend, persisting but not graduating may not be meaningfully different from dropout in terms of life outcomes. This dissertation examined this population of peristers, with the goal of informing policy, programming, and practice. Method: The dissertation sample, drawn from administrative data, included 4,190 first-time freshmen enrolled in 40 Baltimore City Public High Schools during the 2010-2011 school year (SY). Students enrolled for less than 90 days in SY 2010-2011 or that dis-enrolled from the district and did not re-enroll during SY 2013-2014 were excluded. Multilevel models assessed the relationship between student- and school-level factors with the odds of students earning a high school diploma four years after beginning their first-freshmen year. Independent variables included student-level demographic and academic indicators, school-level concentrations of student characteristics, and staff-reported school climate. Results: Twenty-two percent of students who persisted through four years of high school did not graduate on time. Several student-level factors were related to the odds of on-time graduation, such as below average attendance or not passing an High School Assessment by the end of the first freshmen year. The school environment played an important role in student outcomes, accounting for 25% of the variation in on-time graduation; however, among school-level factors, only staff-reported family involvement was significantly related to the odds of on-time graduation. Conclusion: Findings shed light on an understudied population of students at high risk of not graduating on time. The multilevel examination of student- and school-level factors indicated that on-time graduation for 4-year persisters should be understood as a function of students within their academic environment. The findings presented in this dissertation suggest that the phenomenon of persisting should be considered along with dropout as a critical element of a more informative analysis of high school graduation. Implications for research, policy, and practice are discussed.

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