Testing, Treatment, and Trust: Social Work Professional Development and the Genomics Revolution

Knowledge in the area of human genetics and genomics is expanding at an exponential pace, with significant implications for social work in health, mental health, and other settings. This article identifies some key roles social workers may play in the arena of genetics, discusses social workers responsibility for ongoing professional development in this area, and describes a flexible genetics and genomics social work curriculum developed by the authors. We provide an evaluation of pilot curriculum implementations, discuss ongoing strategies and barriers to dissemination, and make recommendations for future actions to more fully incorporate genetics and genomics content into the social work professional knowledge base

Social Work Practitioners and Technology Transfer

The application of new skills and interventions into the practice community is often slow and haphazard. A coaching intervention is proposed to augment traditional social work education techniques and maximize the integration of new knowledge into social work practice. This coaching model includes assessment of a practitioner\u27s readiness for change, stage-wise coaching interventions, assessment of organizational barriers to the transfer of new information, and development of strategies to address these barriers. Implications for social work professionals development and future research are discussed

Who Do Farmers Trust? Identifying Farmer Support Systems During Times of Stress and Suicide Risk

Farmers experience high stress and elevated suicide risk. Using surveys distributed at a regional agricultural exposition, our study identified those who are closest to farmers and trusted during times of high stress, and how to communicate stress-related information to farmers. We found farmers were most likely to trust spouses, other farmers, friends, and faith leaders and preferred information from other farmers, agricultural publications, social media, churches, and Extension offices. Farmers and non-farmers differed significantly in views on these questions. This work identifies potential partners for Extension programming on farmer stress, highlighting the importance of including farmers in program development/delivery

Understanding the Personal and Clinical Utility of Psychiatric Advance Directives: A Qualitative Perspective

Psychiatric advance directives (PADs) are legal tools that allow competent individuals to declare preferences for future mental health treatment when they may not be capable of doing so as a result of a psychiatric crisis. PADs allow individuals to maintain self–determination during times when they are most vulnerable to loss of autonomy and in need of assistance to make their preferences known and honored. This article describes the content of twenty–eight open–ended, semi–structured qualitative interviews of adults with PADs who have experienced psychiatric crises. The qualitative analysis revealed three major themes from the interviews: (1) PADs as tools for empowerment and self–determination, (2) limited knowledge of PADs among service providers; and (3) difficulties communicating PADs to inpatient staff. In general, many participants expressed enthusiasm of the implementation of PADs but concern regarding clinicians’ general lack of awareness about them. Additionally, some consumers discussed discomfort in even mentioning that they had a PADto clinicians for fear of a negative response from them, or some type of involuntary treatment during their hospitalization. However, participants consistently viewed PADs as a positive tool to promote autonomy with the potential to facilitate stronger patient–provider relationships. Therefore, when working with individuals in psychiatric crisis who have a PAD, and who have never before experienced a sense of control over their own treatment, clinicians must recognize the potential troubling disequilibrium this sense of control may engender. In sum, though the most significant challenges facing the implementation of PADs involve clinicians’ familiarity with and education about PADs, much promise for the future growth of PADs lies in the benefits perceived by the patients

Multilevel challenges to engagement in HIV care after prison release: a theory-informed qualitative study comparing prisoners’ perspectives before and after community reentry

Abstract Background Although prison provides the opportunity for HIV diagnosis and access to in-prison care, following release, many HIV-infected inmates experience clinical setbacks, including nonadherence to antiretrovirals, elevations in viral load, and HIV disease progression. HIV-infected former inmates face numerous barriers to successful community reentry and to accessing healthcare. However, little is known about the outcome expectations of HIV-infected inmates for release, how their post-release lives align with pre-release expectations, and how these processes influence engagement in HIV care following release from prison. Methods We conducted semi-structured interviews (24 pre- and 13 post-release) with HIV-infected inmates enrolled in a randomized controlled trial of a case management intervention to enhance post-release linkage to care. Two researchers independently coded data using a common codebook. Intercoder reliability was strong (kappa = 0.86). We analyzed data using Grounded Theory methodology and Applied Thematic Analysis. We collected and compared baseline sociodemographic and behavioral characteristics of all cohort participants who did and did not participate in the qualitative interviews using Fisher’s Exact Tests for categorical measures and Wilcoxon rank-sum tests for continuous measures. Results Most participants were heterosexual, middle-aged, single, African American men and women with histories of substance use. Substudy participants were more likely to anticipate living with family/friends and needing income assistance post-release. Most were taking antiretrovirals prior to release and anticipated needing help securing health benefits and medications post-release. Before release, most participants felt confident they would be able to manage their HIV. However, upon release, many experienced intermittent or prolonged periods of antiretroviral nonadherence, largely due to substance use relapse or delays in care initiation. Substance use was precipitated by stressful life experiences, including stigma, and contact with drug-using social networks. As informed by the Social Cognitive Theory and HIV Stigma Framework, findings illustrate the reciprocal relationships among substance use, experiences of stigma, pre- and post-release environments, and skills needed to engage in HIV care. Conclusion These findings underscore the need for comprehensive evidence-based interventions to prepare inmates to transition from incarceration to freedom, particularly those that strengthen linkage to HIV care and focus on realities of reentry, including stigma, meeting basic needs, preventing substance abuse, and identifying community resources

Clinician impact on consumer decisions regarding psychiatric advance directives

This dissertation examines associations between clinician attitudes both towards Psychiatric Advance Directives (PADs) and towards coercive intervention with consumers' decisions regarding PADs. In addition, it examines associations between characteristics of clinician/consumer relationships and consumers' PAD decisions. The research is grounded in the Health Beliefs model expanded to include the theory of relational autonomy. A secondary analysis of data from a randomized trial of Facilitated PADs (N=469) was completed. Multilevel logistic regression analyses examined whether clinician characteristics and attitudes were significant predictors of PAD completion by consumers and whether consumers valued PADs more highly for proscriptive purposes. Multivariate logistic regression analyses examined whether characteristics of the clinician/consumer relationship were significant predictors of these same dependent variables. Results showed that neither dependent variable was significantly associated with clinician characteristics and attitudes. PAD completion was significantly more likely if consumers were older, demonstrated greater PAD understanding, valued treatment for relational purposes, and reported having a friend; it was significantly less likely if consumers reported medication satisfaction, victimization, or if consumer and clinician were discordant on PAD attitudes. Valuing PADs as a proscriptive tool was significantly more likely if consumers were white, had experienced involuntary hospitalization, reported treatment dissatisfaction, or reported having no one to trust, and showed a trend towards significance if the consumer reported avoiding treatment for fear of forced treatment; it was significantly less likely if consumers reported not knowing enough about PADs, reported avoiding treatment for fear of being put in seclusion, agreed that consumers should talk with their provider about PADs, and if neither consumers nor their clinicians agreed that people should have a PAD to protect them from hospitalization. Findings suggest that consumers make decisions regarding PAD completion and purpose based on: 1) prior experiences with treatment; 2) perceptions regarding treatment benefits/barriers; 3) understanding of PADs; and 4) the relational context in which they make decisions. Due to the exploratory nature of the study and limitations of a secondary data analysis additional research is needed to understand the dynamics of these factors in greater detail

Acceptability Of A Social Support Intervention For Re-Entering Prisoners

A relatively unexplored area of prisoner reentry programs involves actively engaging the prisoner’s naturally occurring social support in the reentry interventions. Most reentering prisoners rely on loved ones for social support, but that support is often fragile. Interventions that strengthen the sustainability of social support are crucial to a successful reentry. This study evaluates the acceptability of a social support intervention for male prisoners with substance-use disorders who are reentering the community. The manualized, community-based Support Matters intervention is delivered to dyads comprised of a reentering prisoner and a support partner through 10 weekly group sessions. Support Matters teaches cognitive and relational skills that reduce the likelihood of relapse to substance abuse and crime. This acceptability evaluation pilot tested Support Matters with a sample of 30 prisoner-support person dyads and 7 program facilitators to assess the recipients’ and intervention deliverers’ perceptions of the suitability and satisfaction with the program and to gather recommendations for refining Support Matters. Quantitative and qualitative data were collected through semi-structured assessments, individual interviews, and focus groups. Intervention deliverers and recipients indicated the model was satisfactory and appraised Support Matters as highly suitable for this audience. Recipients expressed appreciation for the skills training and the group format. Recommendations for improvements included extending the program length, expanding the content, and incorporating engagement strategies before release from prison. Findings regarding this promising intervention approach will help guide the growing number of scholars and practitioners seeking to improve reentering prisoners’ engagement with positive social supports