OBJECTIVE: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. METHOD: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual (TAU), or to a fourth condition of TAU only. All were assessed at intake and followed at 3, 6, and 12 months. RESULTS: Clients in all four conditions significantly decreased substance use by 3 months after intake and maintained most gains over time. However, the addition of ICM to TAU did not improve substance use outcomes. CONCLUSION: Overall, the addition of case management did not significantly improve drug treatment as hypothesized by both researchers and clinicians. Some results were mixed, possibly due to the heterogeneous sample, wide range of case management activities, or difficulty retaining participants over time.
This study tests the applicability among adolescents in Mexico of the keepin' it REAL (refuse, explain, avoid, and leave) strategies that are common and effective ways that U.S. youth resist substance use. Following a social learning, communication competence and ecological theory integrated approach, the study draws on self-reported questionnaire data from a non-probability sample of 327 adolescents attending two public high schools in Monterrey, Nuevo León. Multivariate regressions were used to test whether the respondents' use of the REAL strategies by the participants could be predicted by key demographic variables. Separate models were estimated for the frequency of use of each strategy and for different substances. Findings indicate that most adolescents in this sample utilized each of the REAL strategies as well as other strategies to respond to offers of alcohol, cigarettes, or marijuana. Mexican and U.S. youth residing close to the US border appear to use similar drug resistance strategies. Use of the strategies varied considerably by the level of exposure to offers, but only minimally by gender and age. There were no notable differences by socioeconomic status or academic performance. Implications for prevention science, social work practice and social work research are discussed in the context of the bi-national border region and the applicability and prospect for dissemination of U.S. evidence based youth substance use prevention interventions.
Child welfare and criminology research have increasingly sought to better understand factors that increase the likelihood that abused and neglected children will become involved in the juvenile justice system. However, few studies have addressed this relationship among African American male adolescents. The current study examines the relationship between child maltreatment (i.e., neglect, physical abuse, sexual abuse, and other/mixed abuse) and the likelihood of a delinquency petition using a sample of African American males (N = 2,335) born before 1990. Multivariable logistic regression models compared those with a delinquency-based juvenile justice petition to those without. Results indicate that African American males with a history of neglect, physical abuse, or other/mixed abuse were more likely to be involved in the juvenile justice system than those without any child maltreatment. Additionally, multiple maltreatment reports, a prior history of mental health treatment, victimization, and having a parent who did not complete high school also increased the likelihood of a delinquency petition. Implications for intervention and prevention are discussed.
OBJECTIVE: To preliminarily evaluate telephone-delivered motivational enhancement therapy (MET) in motivating unadjudicated and nontreatment seeking intimate partner violence (IPV) perpetrators, who also use substances, to self-refer into treatment. METHOD: 124 adult men were recruited via a multimedia marketing campaign and were randomly assigned to the intervention (MET) or comparison group following a baseline assessment. Participants in the MET condition received a personalized feedback report on their IPV and substance-use behaviors, consequences, and social norms beliefs. RESULTS: Results supported the likely effectiveness of MET in short-term reduction of IPV behavior, increasing motivation for treatment seeking, and changing perceived norms for IPV and substance abuse (SA). CONCLUSIONS: Applications for brief MET interventions to facilitate voluntary treatment entry among substance-using IPV perpetrators are discussed.
This study examines the demographic correlates of depressive symptoms, serious psychological distress (SPD), and major depressive disorder (MDD; 12-month and lifetime prevalence) among a national sample of African American men. Analysis of the National Survey of American Life (NSAL) data set provides first-time substantiation of important demographic differences in depressive symptoms (measured by the Center for Epidemiological Studies Depression scale [CES-D]), SPD (measured by the K6), and 12-month and lifetime MDD among African American men. Findings illuminate the heterogeneity within the African American male population. Findings also demonstrate the need for additional research focusing on within-group differences and a comprehensive research and mental health promotion agenda that recognizes the importance of improving access to education and employment and promoting healthy coping behaviors, while acknowledging the larger social context in which African American men live.
Objective: A pilot randomized clinical trial (RCT) examined effectiveness of HIV/STD Safer Sex Skills Building + Alcohol (SSB+A) intervention for women with Alcohol Use Disorders (AUDs) in a residential treatment setting. Method: After randomizing thirty-six women with AUDs and reporting having intercourse with a male partner in the past 180 days to SSB+A or HE (standard HIV/STD education) groups, rates of penetrative intercourse with and without condoms at 60 day and 180 day follow-up were compared between SSB+A or HE groups. Results: There was a significant difference in mean number of sex acts with condoms between SSB+A and HE groups over time. Specifically, SSB+A and HE groups did not differ at 60 day follow-up, but at 180 day follow-up, mean sex acts with condoms among SSB+A group was significantly higher than HE. Conclusion: Pilot study findings affirm the effectiveness of the SSB+A in reducing sexual risk behaviors of AUD women and support the need for further research, testing the SSB+A intervention in a larger sample of women and across different treatment modalities. The present study also illustrates the critical link between practice and use of a step by step model of intervention research.
To determine the concordance between the Structured Clinical Interview for DSM-IV (SCID) and the Patient Health Questionnaire (PHQ) in diagnosing anxiety and depressive disorders.
Fifty women seeking psychiatric services for their children at two mental health centers in Western Pennsylvania were assessed for anxiety and depressive disorders using the SCID and the PHQ.
Twenty-five women met SCID criteria for at least one anxiety disorder, 11 (44%) of whom the PHQ failed to identify. The PHQ was particularly limited in identifying individuals with anxiety disorders other than panic disorder. Seventeen women met SCID criteria for at least one major depressive disorder, 6 (35%) of whom the PHQ failed to identify. The PHQ was particularly limited in identifying depressed individuals with dysthymia.
Caution should be used when screening for anxiety and depression with the PHQ. Implications for improving diagnostic accuracy in social work practice are discussed.
Few social science theories have a history of conceptual and empirical study as long as does the diffusion of innovations. The robustness of this theory derives from the many disciplines and fields of study in which diffusion has been studied, from the international richness of these studies, and from the variety of new ideas, practices, programs, and technologies that have been the objects of diffusion research. Early theorizing from the beginning of the 20th century was gradually displaced by post hoc empirical research that described and explained diffusion processes. By the 1950s, diffusion researchers had begun to apply the collective knowledge learned about naturalistic diffusion in tests of process interventions to affect the spread of innovations. Now, this purposive objective has given form to a science of dissemination in which evidence-based practices are designed a priori not just to result in internal validity but to increase the likelihood that external validity and diffusion both are more likely to result. Here, I review diffusion theory and focus on seven concepts-intervention attributes, intervention clusters, demonstration projects, societal sectors, reinforcing contextual conditions, opinion leadership, and intervention adaptation-with potential for accelerating the spread of evidence-based practices, programs, and policies in the field of social work.
OBJECTIVES: This study tested the quality of data collected with the online ESSP for Children from a diverse sample of 1,172 third through fifth graders. METHODS: Mplus confirmatory factor analysis (CFA) procedures for ordinal and clustered data were used. RESULTS: Of 80 original items, 61 loaded on 13 dimensions in a first-order model that had good fit in three random subsamples. Children in grades 3 through 5 may not be reliable reporters about neighborhood adults' caring. However, 12 statistically sound and independent dimensions related to school, peers, family, and well-being were obtained. CONCLUSIONS: The ESSP for Children provides school staff with quality data to use in conjunction with family and teacher ESSP data to guide intervention choices in schools.
OBJECTIVE: The purpose of the current study was to examine the practice validity of a new ecological assessment instrument for 3(rd) through 5(th) graders in terms of whether it provided school staff with new knowledge about students. METHOD: Pre-assessment knowledge of school staff was compared to data obtained from 21 children and their parents on 29 measures. Data were collected using the Elementary School Success Profile (ESSP). School staff pre-assessment knowledge was compared to obtained data across seven domains of children's lives (neighborhood, school, family, peers, parent educational involvement, well-being, and home behavior), data sources (child and parent), and grade level of students. RESULTS: Pre-assessment knowledge was not highly correlated with obtained data; pre-assessment expectations matched obtained data only about 41% of the time; and knowledge varied by domain, source, and grade level. CONCLUSIONS: Ecological assessments can address gaps in school staff's knowledge of targetable factors that influence the success of students.
Despite growing evidence that child welfare youth are at increased risk for juvenile delinquency, little is known about gender-specific processes and effective treatment programs for girls. Multidimensional Treatment Foster Care (MTFC), an empirically validated intervention for child welfare and juvenile justice populations, has demonstrated efficacy in reducing arrest rates in delinquent boys and girls. In this study, the efficacy of MTFC on school attendance and homework completion was examined in juvenile justice girls who were referred to out-of-home care (N = 81). Results from this randomized intervention trial suggest that MTFC was more effective than group care in increasing girls' school attendance and homework completion while in treatment and at 12 months postbaseline. In addition, the previously reported effect of MTFC on reducing girls' days in locked settings was mediated by homework completion while girls were enrolled in the intervention setting. Implications for policy and practice are described.
OBJECTIVES: There is a growing literature indicating that organizational and individual worker-level factors affect decisions about whether or not empirically supported treatments (ESTs) are adopted within health care agencies. The purpose of this pilot study is to further investigate and measure worker's attitudes within a community organization. METHOD: A small organization participated in the study due to their diversity in services offered. Of the 92 workers eligible for participation in the study, 66 (72%) completed the Evidence-Based Practice Attitude scale survey. RESULTS: Multivariate analyses revealed that female workers scored higher on both Openness and total score; workers with nursing, education, or psychology majors scored lower than workers with other (excluding social work) majors on both Divergence and total score; and that older workers scored higher on Divergence. CONCLUSION: Although small, this study identifies individual characteristics that are most likely to fit the profile of an EST adopter.
This study utilized data from the National Survey of American Life to investigate the use of professional services and informal support among African American and Caribbean black men with a lifetime mood, anxiety, or substance use disorder. Thirty-three percent used both professional services and informal support, 14% relied on professional services only, 24% used informal support only, and 29% did not seek help. African American men were more likely than to rely on informal support alone. Having co-occurring mental and substance disorders, experiencing an episode in the past 12 months, and having more people in the informal network increased the likelihood of using professional services and informal supports. Marital status, age, and socioeconomic status were also significantly related to help-seeking. The results suggests potential unmet need. However, the reliance on informal support also suggests a strong protective role that informal networks play in the lives of black men.
As evidence-based practice is increasingly accepted in social work, the challenges associated with its actual implementation become more apparent and pressing. This article identifies implementation as a critical issue for research; implementation itself must be better understood if evidence-based practices are to be used and resultant improvements to practice are to be realized. Social work needs to engage more fully in (a) service system research and (b) implementation research, each of which complements and has potential to extend the benefits of efficacy and effectiveness research. Service system research can enhance the fit of empirically supported treatments to the needs of real-world practice and thus facilitate their implementation. Implementation studies examine the acceptability of evidence-based interventions, the feasibility and likelihood of their sustained use, and the decision-support procedures that can help practitioners apply probabilistically based, empirically supported treatments to the individual case in real-world practice.
OBJECTIVES: The purpose of this article is to highlight the benefits of collaboration in child focused mental health services research. METHOD: Three unique research projects are described. These projects address the mental health needs of vulnerable, urban, minority children and their families. In each one, service delivery was codesigned, interventions were co-delivered and a team of stakeholders collaboratively tested the impact of each one. RESULTS: The results indicate that the three interventions designed, delivered, and tested are associated with reductions in youth mental health symptoms. CONCLUSION: These interventions are feasible alternatives to traditional individualized outpatient treatment.
This paper presents preliminary outcomes associated with an experimental, longitudinal study of a Multiple Family Group (MFG) service delivery approach set within thirteen urban outpatient clinics serving children and their families living in inner-city, primarily African American and Latino communities. Specifically, this paper focuses on parent reports of child oppositional behavior and parenting stress over time. MFG is a flexible, protocol-driven approach designed to address the most common reason for referral to outpatient child mental health clinics, childhood behavioral difficulties. The MFG also aims to enhance family-level engagement and retention in ongoing care. Further, the service delivery model was collaboratively developed with intensive input from parents rearing children with conduct difficulties, parent advocates, community-based child mental health providers and services research staff in order to ultimately expand the number of effective service models that can be situated within "real world," urban child mental health settings.
OBJECTIVE: The authors conduct a within intervention group analysis to test whether caregiver engagement (e.g., participation, homework completion, openness to ideas, apparent satisfaction) in a group-based intervention moderates risk factors for foster child outcomes in a state-supported randomized trial of caregiver parent training. METHODS: The intervention is delivered in 16 weekly sessions by trained leaders. Outcomes are pre-post change in problem behaviors and negative placements. RESULTS: Analysis of 337 caregivers nested within 59 parent groups show caregiver engagement moderates number of prior placements on increases in child problem behaviors, and moderates risk of negative placement disruption for Hispanics. CONCLUSIONS: Variance in parent group process affects program effectiveness. Implications for practice and increasing effective engagement are discussed.
OBJECTIVE: In the context of the importance of valid self-report measures to research and evidence-based practice in social work, an argument-based approach to validity is presented and the concept of developmental validity introduced. Cognitive development theories are applied to the self-report process of children and cognitive pretesting is reviewed as a methodology to advance the validity of self-report instruments for children. An application of cognitive pretesting is presented in the development of the Elementary School Success Profile. METHOD: Two phases of cognitive pretesting were completed to gather data about how children read, interpret and answer self-report items. RESULTS: Cognitive pretesting procedures identified validity problems with numerous items leading to modifications. CONCLUSIONS: Cognitive pretesting framed by an argument-based approach to validity holds significant potential to improve the developmental validity of child self-report instruments.
OBJECTIVES: With the continued push to implement empirically supported treatments (ESTs) into community-based organizations, it is important to investigate whether working condition disruptions occur during this process. While there are many studies investigating best practices and how to adopt them, the literature lacks studies investigating the working conditions in programs that currently use ESTs. METHOD: This study compared the culture and climate scores of a large organization's programs that use ESTs and those programs indicating no EST usage. RESULTS: Of the total 55 different programs (1,273 frontline workers), 27 programs used ESTs. Results indicate that the programs offering an EST had significantly more rigid and resistant cultures, compared to those without any ESTs. In regard to climate, programs offering an EST were significantly less engaged, less functional, and more stressed. CONCLUSION: Outcomes indicate a significant disruption in organizational culture and climate for programs offering ESTs.
To examine the effects of psychosocial cognitive rehabilitation on employment outcomes in a randomized controlled trial for individuals with early course schizophrenia.
Early course schizophrenia outpatients (N = 58) were randomly assigned to Cognitive Enhancement Therapy (CET) or an Enriched Supportive Therapy (EST) control and treated for two years. Comprehensive data on cognition and employment were collected annually.
Individuals treated with CET were significantly more likely to be competitively employed, had greater earnings from employment, and were more satisfied with their employment status by the end of treatment compared to EST recipients. Mediator analyses revealed that improvements in both social and non-social cognition mediated the CET effects on employment.
CET can help facilitate employment in early schizophrenia, by addressing the cognitive impairments that limit functioning in the disorder. Inclusion of cognitive rehabilitation in social work practice can support more optimal functional recovery from schizophrenia.
In the United States about 17% of adolescents meet diagnostic criteria for mental, emotional, and behavioral disorders. Six million young people receive treatment services annually for mental, emotional, or behavioral problems. These problems affect 1 in 5 families and cost $247 million annually (O'Connell, Boat, & Warner, 2009). Some strategies for preventing mental, emotional, and behavioral disorders in young people have been developed, tested, and found to be effective in preventing the onset, persistence, and severity of psychological disorders, drug abuse, and delinquency. Unfortunately, tested and effective prevention policies, programs, and practices are not widely used (O'Connell, Boat, & Warner, 2009). This paper highlights recent advances in prevention science and describes some opportunities and challenges in advancing the use of science-based prevention in communities. The chapter concludes by exploring the potential role of social work education in developing a workforce ready to increase community access to effective prevention strategies.
OBJECTIVE: The present study has two goals: to assess the difference between secondary trauma and job burnout and to examine the utility of secondary trauma in predicting psychological distress. METHOD: The data come from a survey of social workers (N = 236) living in New York City 20 months following the September 11 terrorist attacks on the World Trade Center (WTC). RESULTS: Social workers' involvement in WTC recovery efforts is related to secondary trauma but not burnout. Analyses also reveal that both secondary trauma and burnout are related to psychological distress after controlling for other risk factors. CONCLUSION: This study supports the importance of compassion fatigue as a risk factor for social workers counseling traumatized clients and its association with psychological problems.
OBJECTIVES: This article describes the process of developing a culturally based family intervention for Spanish-speaking Latino families with a relative diagnosed with schizophrenia. METHOD: Our iterative intervention development process was guided by a cultural exchange framework and based on findings from an ethnographic study. We piloted this multifamily group 16-session intervention with 59 Latino families in a randomized control trial. Data were collected on family- and client-level outcomes, and poststudy focus groups were conducted with intervention participants. RESULTS: Preliminary evidence indicates that the intervention is effective by increasing illness knowledge and reducing family burden. CONCLUSIONS: This work can provide a model for how to integrate cultural factors into psychosocial services and enhance interventions in real-world settings for culturally diverse populations.
OBJECTIVES: The authors examine if some of the reason clients from racial and ethnic minority groups experience outcome disparities is explained by their therapists. METHOD: Data from 98 clients (19% minority) and 14 therapists at two community mental health agencies where clients from racial and ethnic minority groups were experiencing outcome disparities were analyzed using hierarchical linear modeling with treatment outcomes at Level 1, client factors at Level 2, and therapists at Level 3. RESULTS: There were substantial therapist effects that moderated the relationship between clients' race and treatment outcomes (outcome disparities). Therapists accounted for 28.7% of the variability in outcome disparities. CONCLUSIONS: Therapists are linked to outcome disparities and appear to play a substantial role in why disparities occur.
Grant writing is a necessary skill for becoming an independent and successful social work researcher. Since social work dissertation grants are a relatively new trend, students face many challenges in identifying, preparing, and submitting dissertation grants. Lack of resources and experiences, difficulties in protecting time for grant writing, and the uncertainty of
success can hinder work on dissertation grants. Thus, this article provides an overview of dissertation grants, including a
review of grant mechanisms, suggestions for preparing grants in the context of program milestones, and identifying institutional infrastructure to facilitate submissions. Strategies discussed include how to learn about funding priorities, how to establish timelines to account for grant deadlines, and how to use peer reviews to guide the revision process.