Progress through partnership: Providing Holistic Services VIA SERVICE LEARNING to Benefit Students, the University and the Community

poster abstractIn 2012, the presenters developed a new service learning opportunity through an interdisciplinary partnership between the schools of Law and Social Work. The purpose of the project was to enhance the joint JD/MSW program, as well as the experiences of JD and MSW students respectively. The presenters redesigned a Civil Practice Clinic, which had formerly involved only law students, to now pair law students and social work students in order to serve the holistic needs of clients. Referrals for the clinic are obtained through a variety of partner referrals. All of the clinic’s clients do not have the resources to retain legal counsel or services by other means. The law students address the clients’ legal issues and the social work students ensure the clients are connected with appropriate social services, such as domestic violence counseling and social welfare benefits. The teamwork between students increases law students’ aptitude in client-centered lawyering, and familiarizes social work students with the legal rights and resources available to clients. The presenters have adapted pedagogies of engagement, most notably through problem-based and peer-led interdisciplinary team teaching and learning. Students more effectively and efficiently serve community members in need of legal counsel and social services, resulting in a clinic that is beneficial for both students and community members. The partnership resulted after years of witnessing law students struggle with interpersonal skills how to handle client emotions (and a perceived inability to help connect to services) while social work students struggled with an awareness of the law, litigation process/strategy and the roles/responsibilities involved in legal case management. Key to this partnership was not only the development of the interdisciplinary model and structure, but also assessing both disciplines and the success of the pairings. Quantitative data is gathered through an interpersonal skills survey pretest and posttest research design, and qualitative data is gathered through a survey of open ended questions. All students were given the same questions, and responses were anonymous, with surveys administered by a third party. Using the generated responses, the presenters reformat the course each semester based upon feedback, as well as promote the use of this sort of model to other institutions and at various conferences. Other interdisciplinary partnerships are also explored based on student feedback, client and clinic needs. The initial surveys focused on a main goal of increasing law students’ interpersonal skills – as far too often law students’ focus is on the legal tasks and not the human components of interactions with clients. Data analysis found a statistically significant improvement in law students’ interpersonal skills, and level of comfort in dealing with clients in emotional situation. The second round of surveys have been submitted to both disciplines and hope to show two increases: 1) that the law students’ interpersonal skills maintain improvement; and 2) that social work students have a better understanding of the law and legal processes via their participation in the interdisciplinary clinic

Social Work and Law: The Educational Benefits of Collaboration

poster abstractLow income clients seeking civil legal services are rarely in need of only legal assistance. Instead, the issues that drove them to seek an attorney typically overlap into multiple mental health and social service needs. The poster will explain how a newly piloted clinical partnership between the School of Social Work and the School of Law improved the educational outcomes of students, and also enhanced the services offered to clients. The clinic historically served the legal needs of low income clients in Indianapolis. In 2012, an interdisciplinary collaboration involving law and social work students and faculty from both fields was implemented in order to provide holistic services to clients. The poster will describe the model, including how the clinic is structured and the roles for students and faculty. Preliminary data on the educational benefits for both law and social work students will be provided. The clinic has been found to address both student learning needs and the needs of clients in the local community

IVF and the Anti-Abortion Movement: Considerations for Advocacy Against Overturning Roe v. Wade

As the anti-abortion movement gains ground in the United States, it is important to explore the potential impact of overturning Roe v. Wade (1973) on the practice of IVF (in vitro fertilization). If the United States Supreme Court abandoned the legal right to early pregnancy terminations, it would open the door for states to enforce laws defining life to begin at conception. In all likelihood, legally establishing life to begin at conception may make IVF far less likely to be successful, significantly more expensive, more likely to result in high risk pregnancies with multiples, and more medically invasive. As the prevalence of IVF grows, this is a practice that should no longer be ignored in the political discourse on abortion. Instead, the unintended consequences of life at conception bills on the cost, availability, safety, and success rates of IVF can provide a strong argument in the toolbox of strategies for social workers lobbying against anti-abortion legislation

Legal Education for Human Rights Work: Social Work Practicum Students in Forensic Placements

The Council on Social Work Education tasks social work programs to ensure students illustrate competency with regard to advocating for and advancing human rights. Given the three generations of human rights experience differing levels of guarantee and protection, multiple tools are needed in order to advance human rights across the board. As human rights cannot be sufficiently realized until they are protected by law, many of those tools are made more useful when combined with knowledge of the legal system and processes. Advocacy is a key aspect of social work practice, and therefore social work education provides a solid foundational understanding on the legislative branch of government. However, as all three branches of government have the ability to impact human rights law, social work programs are advised to integrate more opportunities for students to learn about the judicial and executive branches as well. Recognizing that not all programs are positioned to inject forensic social work education into their curriculum, an interprofessional practicum model that integrates social work students into university legal clinics is provided

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Why aren't similarly situated murderers treated alike? A comparative history of how the discourse of Michigan and Indiana's legal system and media have impacted the states' capital punishment legislation.

In the US, the state which has jurisdiction over a homicide can have significant impact on the criminal sanction an offender will receive. For example, a murderer who offended in Indiana can receive a death sentence. If the same crime were committed in Michigan, the harshest sentence the murderer would receive is life imprisonment. Indiana and Michigan, bordering states, have had opposing stances on capital punishment for over 150 years. Michigan was the first state to abolish capital punishment in 1846, and Indiana has used capital punishment since its founding in 1816. Historical institutional theory guides this study. It is posited that the media and the legal systems in these states have established differing discourse boundaries which constrain the state lawmaker's debates regarding the death penalty, and therefore, constrain the laws as originally enacted. The methodology of this study is a parallel comparative history of Indiana and Michigan. The primary sources of evidence include: Michigan and Indiana legal codes, state historical documents, legislative histories from the states, Indiana State Supreme Court case law, and newspaper archives. Discourse from these sources was analyzed at pivotal points in the history of the states when change to capital punishment laws might have been expected. Data analysis indicates that each state has established different discourse boundaries that hinder alterations in the states' stances on capital punishment. The primary finding is that Michigan gives more weight to arguments of a utilitarian nature and Indiana is more willing to accept arguments that capital punishment is appropriate retribution for some types of homicide. The differences in the states' discourse boundaries have constrained the debates of lawmakers and the choices they make regarding capital punishment; thus, continuing to constrain the states' original stance on the death penalty.Ph.D.Communication and the ArtsCriminologyLawMass communicationSocial SciencesSocial workUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/125032/2/3186586.pd

Let’s Talk About Same Sex: How Social Workers Can Make Judges Listen

Researchers have created a diverse toolbox of literature reporting that same sex cohabitating relationships are strikingly similar to heterosexual marriages in amicus curiae briefs submitted to the courts. However, judges are trained to fit information into legal frameworks and to ignore data that does not fit the rhetoric of a case. The following article aims to fit existing data on same sex relationships into the framework judges will use to decide whether same sex marriage can be prohibited. The primary precedent used to support same sex marriage is based on the analogy of a case prohibiting marriage discrimination based on race. The legal framework created by this case requires social work policy practitioners to frame research in terms of the evolution that has occurred in scientific understanding of same sex attraction and public opinion. A simple shift in the discourse used to frame the data can significantly impact whether judges listen