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Studying and facilitating the development, installation and initial implementation of an interdisciplinary buprenorphine treatment/practice: A practice-focused, action research, implementation study.
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Using Action Research, Implementation Science, and Institutional Ethnography, this practice-focused research explored inhibiting and promoting factors related to implementing buprenorphine treatment within HIV primary care while simultaneously developing, installing and initially implementing an interdisciplinary buprenorphine treatment/practice. Data was collected and analyzed using constructivist grounded theory method strategies. Data collection/generation included documentary analysis, key informant interviews, field data from collaborative interdisciplinary team processes, researcher reflective practice, a patient focus group, and an interdisciplinary buprenorphine treatment/practice manual. The research had several achievements. It identified three key implementation inhibiting categories, (1) significant and persistent bias, (2) plaguing and difficult questions, and (3) buprenorphine expectionalism. It also developed countering implementation promoting categories, (1) be an educated advocate and dispel myths, (2) identify core components of interdisciplinary buprenorphine treatment and uniformity of care, and (3) dementionalizing interdisciplinary treatment/practice. It exposed scope of practice issues and mapped out the specifics of the types of services each discipline would provide, the detail of those practices, their coordination, as well as the areas of practice where there was joint responsibility and overlap. It increased the capacity and competences of the research organization and the 18 interdisciplinary buprenorphine team members. It also explicated the many forms of power operating in the study and the importance of power sharing, adapting treatment, leadership support, structural components and resources on the development and implementation process. This study shed light on the reality that prescribing buprenorphine and taking up the practice of treating opioid dependence/addiction means that clinicians must be prepared and skilled to provide care where issues of life and death, emotional distress, and significant uncertainties are part of the landscape. The study findings also highlight that balancing safety (both patient and staff) with control and authority is an important aspect of buprenorphine treatment. An interdisciplinary focus expanded the concept of treatment and addressed many important aspects of caring for people with opioid dependence/addiction that often go unaccounted for and/or unnoticed. Without an interdisciplinary frame, patients are at risk for receiving substandard care. This study demonstrated that the interdisciplinary practices needed to provide quality care and improve health outcomes are interdependent.
A Study of Predictors of College Completion Among SEEK Immigrant Students
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This study examined the strength of the relationship between eight situational and demographic variables and college completion among immigrant students in SEEK, an educational opportunity program. The eight variables studied as possible predictors of college completion included household composition, length of residency, English as a primary language, high school grade point average, age, gender, ethnicity, and year of entry. In addition, the study compared graduation rate of SEEK immigrant students admitted earlier in the program (1995-2000) versus those who entered later (2001-2003) when the admission criteria were changed. The study took place at the City College of New York (CCNY), a four-year, urban, public institution which is a branch of The City University of New York (CUNY). The study focused on the overarching question of are selected factors predictors of college completion among SEEK immigrant students? The conclusions of this archival quantitative study were based on data from a sample of 390 SEEK immigrant students. Data was collected from the SEEK City College admission application form which provided pre-existing, multi-year information on student background characteristics and graduation status. Results from chi-square, t-test and regression analysis suggested that four out of the eight pre-enrollment variables are useful in discriminating between completers and non-completers. High school GPA was the strongest predictor of college completion. Household composition, year of entry and gender also seem to have significant effects on college completion. It is notable that completers have a significantly higher GPA than non completers. Students who entered CCNY as members of the later cohort, enrolling in 2001 or after when the CUNY admission requirements became more selective, had a higher high school GPA and were more likely to graduate. The results also indicate that students who came from a large family household were more likely to complete than students from nuclear families. To some extent the study concluded that what students come into college with influences whether they complete college. Other pre-enrollment variables ( e.g. age, English as a primary language and length of residency) did not seem to significantly effect college completion in this sample.Overall, the study provided an initial and important exploration of some of the pre-enrollment factors that are associated with college success and therefore upward mobility among immigrant students. The implication of the study is that some pre-enrollment background characteristics effect college completion and should be taken into account in counseling theory, practice and policy. Based on the findings of the study, programmatic interventions were suggested to address the needs of this specific population
The Presentation of Trans in Everyday Life: An Autoethnographic Exploration of Gendered Performance
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The life experiences of transgender men are an understudied area in social work research. Given the negative experiences many transgender men have utilizing the medical and social service systems, greater understanding is needed about how these men negotiate their identities in an array of relational contexts. This dissertation uses autoethnography to explore how one transgender man navigates his identity as a man, father, and social work professional. Viewed through the theoretical frame of Erving Goffman's work, and in dialogue with masculinities studies and queer theory, this study finds that trans men are continually negotiating their identities in varying relational contexts, even post transition. They face ongoing choices about self disclosure. Transgender men face constant challenges to their masculinity, even to their humanity. Transgender fathers challenge traditional notions of parenting. Out social work professionals face these complexities even among colleagues. Despite this, transgender men are remarkably resilient and find numerous ways to surmount the impact of stigma. Practice implications include acknowledging the challenges to a trans man's masculinity while helping him place it is the broader context of manhood in America, providing support for the many ways he is continually navigating his identity, creating opportunities for transgender fathers to connect and share resources, and nurturing the varied ways trans men thrive in the midst of pervasive stigma.
A Cross-National Comparison of Perceptions of Aging and Older Adults
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This study provides an overview of perceptions of aging and older people from five different countries. It focuses on demographic variables that have been shown to have an influence on how people perceive aging and older people. It explores the perceptions of aging and older adults in a cross-national context. The study conducts a quantitative analysis of a database consisting of survey responses from five countries conducted by Harris Interactive, Inc. for the International Longevity Center - USA in 2000. The five countries compared are: the Dominican Republic, France, Japan, the United Kingdom, and the United States. There are four categories of attitudes: Perceptions of Aging and Older People; Perceptions of Life Satisfaction for Self; Perceptions of Quality of Life for Self; and Perception of Quality of Life for People Sixty-five and Older. Data from each of the five countries are analyzed separately and are then compared and analyzed. This study is a secondary analysis of a database consisting of responses from 7,161 people between 18 and 99 years of age (Dominican Republic N = 1,001; France N = 1,004; Japan N = 1,118; United Kingdom N = 990; United States N = 3,048). The independent variables are: age, gender, marital status, and income levels. The dependent variables are the four attitude domains of: Perceptions of Aging and Older People; Perceptions of Life Satisfaction for Self; Perceptions of Quality of Life for Self; and Perception of Quality of Life for People Sixty-five and Older. Each country is separately analyzed using one way Analysis of Variance, Chi-Square, or Independent T-Tests. The results of the analysis are then compared with the other countries and discussed. This study demonstrates that perceptions of aging and older adults differ when viewed through the cultural lenses of various countries.
Experiences with Infant Mortality as Reported by Middle Class Black American Women: In Their Own Words
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The issue of Black Infant Mortality (BIM) appears to mirror the findings of disparities in poor health care and poor medical outcomes for minorities in the United States. The BIM rate of (13.3) is almost twice for all women (6.7) and more than twice the rate for white women (5.6). The BIM disparity holds even when variables such as income, education, and marital status are similar. This study explored the lived experience of infant loss through in-depth interviews with eight black-American middle-class women. It aimed to understand the contributing factors present among middle class black women, which could help in understanding the adverse birth outcomes for the target group studied. All of the women revealed experiences with stress, from the time of pre-conception and throughout the entire pregnancy, although they gave little recognition to the negative affects of such stress on their medical health or the health of their unborn fetus. Coping mechanisms linked to a racial history, influenced the concept of self-expectation and responses to stress. The presence of medical markers, a prominent theme, should be useful in the prevention of adverse pregnancy outcomes, if addressed. The role of race was implicated in quality of care issues, imbedded in medical views influenced by the prevalence of adverse birth outcomes for black women. The lack of timely medical tests to rule out the presence of a medical diagnosis was a probable consequence of such views. In this study, an unexpected finding was that the majority of the fathers had a family history of premature births and infant loss.
The relationship between social support and health-related quality of life among Korean American nursing home residents
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This descriptive and exploratory mixed-method study examined the relationship between social support and health-related quality of life among Korean American nursing home residents. It examined the social support networks of the Korean American nursing home residents, the nature of their interpersonal transactions, and the association between social support and quality of life indicators. A cross-sectional survey involving face-to-face interviews (using the social support questionnaire) and data extraction from an existing dataset (Minimum Data Set-MDS) on a sample of 73 cognitively intact Korean American nursing home residents were utilized to examine and understand the relationship between social support and health-related quality of life indicators. Bivariate and multiple regression analyses revealed that social support had main and interactive effects on health-related quality of life indicators. In the bivariate analysis, the appraisal support variable was significantly associated with ADL impairments, depressive symptoms, and self-rated health. In addition, satisfaction with support person was significantly associated with depressive symptoms and self-rated health. Other social support variables, including negative behaviors (being hurt or being upset), perceptions of giving, and perceptions of support were significantly associated with self-rated health among Korean American nursing home residents. After controlling for the covariates, four social support variables were found to be predictive of depressive symptoms: negative behaviors; perceptions of control; frequency interacting with negative behaviors; and negative behaviors interacting with perceptions of control. In addition, perceptions of control and negative behaviors were found to be predictive of negative self-rated health among Korean American nursing home residents. These findings demonstrate the most important sources and types of social support for Korean American nursing home residents and suggest interventions that may help facilitate their quality of life in a nursing home setting. Implications for social work practice and future directions for research are also discussed.
The Experience of Clinician-Litigators at Impartial Hearings: An Exploratory Phenomenological Study with Social Policy Implications
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This exploratory study investigated the experiences of social workers, psychologists, and educators serving as clinician-litgators representing the the local education agency at impartial hearings. The role of the clinician-litigator provides a window into the conflict between the principles of ethical advocacy that informs the work of the helping professions and the principles of traditional adversary advocacy that guides the work of the legal profession, because it requires bridging these two advocacy traditions. The fifteen clilnician-litigators interviwed for this study acquired and applied legal skills in theier work as district representatives at impartial hearings but also retained their traditional professional orientations toward understanding and serving the needs of students. A phenomenological, grounded-theory approach to studying the experiences of the clinican-litigators facilitated reflection on their experiences and observations of the hearing process, which illuminated the ethical contradictions they encountered. Exploring the experiences of the clinician-litigators yielded rich data on their individual performance of a heretofore uninvestigated role. It also highlighted several societal issues concerning the provision of services to special education students. The Individuals with Disabilities Education Act was intended to promote the integration of disabled students into the educational mainstream. It specified the use of impartial hearings as a mechanism of dispute resolution between parents and the local education agency with the two parties on an equal footing. Over the past two decades, impartial hearings have been increasingly used by parents to seek private school tuition, fostering a form of segregation directly opposed to the intent of the Act. The observations and experiences of the clinician-litigators revealed how this mechanism of dispute resolution increased conflict between parents and the local education agency. It undermined the efforts of educational professionals to serve the best interests of students. Further, highlighted the tension between the forces in society that would utilize the principles of distributive justice to promote integration and create equality of opportunity and those that would promote privitization of public services and institutionalize segregation based on socioeconomic status.
THE SOCIAL CONSTRUCTION OF RACIAL AND ETHNIC IDENTITY AMONG WOMEN OF COLOR FROM MIXED ANCESTRY: PSYCHOLOGICAL FREEDOMS AND SOCIOLOGICAL CONSTRAINTS
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In the context of the 21st century, when an increasing number of people cannot be classified by an archaic system based on race, an awareness of the complexities of ethnic and racial identity is more important than ever. This study assists in the development of a critical understanding of the complexity of racial and ethnic identity by exploring the construction of racial and ethnic identity among women of color from mixed ancestry. These women are the offspring of parents from multiple racial and ethnic backgrounds. As a result, their identities--both internally and externally constructed--belie traditional racial and ethnic categories. This population faces unique struggles, as identified in the empirical literature and supported by the data analysis. Women of color from mixed heritages: have been assigned monolithic labels based primarily on their physical appearance; may feel pressured to adopt a single and predetermined ethnic or racial label; and are often researched as one ethnic or racial group. Furthermore, scholars agree that institutional racism has been a constricting force in the construction of identity and identification for ethnic groups of color in the United States. This study is important because women of color are not always comfortable with the ascribed identity, particularly when it is based on faulty characterizations and when their ethnicity is overlooked. Additionally, this study brings insight to the psychological and social impact of socially constructed identifications. This study regards race and ethnicity as social constructions, defined by human beings and given meaning in the context of family, community, and society. As such, women of color from mixed ancestry find themselves in the middle of the psychological freedoms and sociological constraints of identity construction within the dominant society. As a result, they develop management techniques for integrating components of self and for managing the freedoms and constraints in social constructions of race and ethnicity. This is a subject of pivotal importance to multiple fields of inquiry as well as one having significant educational, clinical, and programmatic implications. Among the implications for social work practice and pedagogy are the need for critical reflection, increased awareness, and cultural diversity.
Filipino Women Domestics on an International Economic Mission: A Multi Method, Data-Mining Study
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Abstract FILIPINO WOMEN DOMESTICS ON AN INTERNATIONAL ECONOMIC MISSION: A MULTI METHOD, DATA-MINING STUDY By Sanjana Ragudaran Adviser: Irwin Epstein This dissertation explored factors contributing towards intentions of return migration of female Filipino domestic workers. Based on available data, I also addressed the reason for migration, individuals' domestic work experiences in the United States and their connection to the homeland during their absence. This was a multi methods study with a combination of Clinical Data Mining and Secondary Analysis in which the data was made available by The Urban Justice Center and Damayan Migrant Workers Association. This study drew from 182 self-administered survey respondents, 22 individual interviews and 4 focus groups of female Filipino domestic workers. In the research, convenience, snowball and purposeful sampling as well as quantitative and qualitative analysis were employed. Findings from the survey data revealed that over half (N=110, 63.9%) of these women migrated primarily for financial reasons, to support their families. Majority (N=132, 74.6%) entered the United States with a Tourist Visa and many (N=96, 61.5%) reported having no legal status. Their lives in the United States have been challenging as domestic work is unregulated and therefore, women had negative experiences. In addition to an unfulfilling job, women maintained minimalist lives and shared accommodation. By doing so, 93 (65%) remitted 30% or more of their income. During their time away from home, women also spoke of the negative impact their absence has had on themselves and their loved ones. When discussing return intentions, 99 (59.6%) women reported wanting to return. Seventeen of twenty-two (77.3%) individual interviewees and 29 (93.5%) Focus Group participants indicated that they had return intentions. Due to the multi-methods nature of this study, I did not draw my conclusions solely from the quantitative data. The qualitative data revealed that although they seemed to initially be "target" migrants, despite their return intentions many continued to work as domestic workers solely because there was a continuing need to support their families financially. The "dream" of return at retirement was echoed in qualitative data where women spoke regretfully about working until they could work no more. I conclude this study with a discussion on policy, service and future research implications.
Implicit Bias about Disabilities: How it Exist for Forensic Interviewers and Could It Affect Child Credibility Decisions in Child Abuse Investigations: An Exploratory Study
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Abstract IMPLICIT BIAS ABOUT DISABILTIES: DOES IT EXIST FOR FORENSIC INTERVIEWERS AND COULD IT AFFECT CHILD CREDIBILITY IN CHILD ABUSE EVALUATIONS By Elizabeth Reiman Advisor: Profession Gary Mallon This research project considered two questions regarding forensic interviewers: Do forensic interviewers hold implicit biases toward people with disabilities? If so, could this influence whether a forensic interviewer finds a child with a disability believable? To examine these questions, a quantitative exploratory study was conducted. Using an online survey, participants were randomly assigned to read a scenario about a child's disclosure of sexual abuse (children with and without a disability), and respond to questions about the believability of the child. Participants then completed an adapted version of the Disability Attitude Implicit Association Test (DA-IAT). The results yielded four significant findings. First, implicit bias about disabilities does exist in the forensic interviewer population. The results suggest that bias about disabilities exists on a continuum (High Bias, Low Bias and No Bias) and not in a binary representation as previously measured by other authors. Second, of all the interviewer characteristics that might predict representation in the three bias groups, only professional discipline was significant. The third conclusion demonstrated that, the interviewer attributes showed a significant relationship to credibility but none of the child characteristics were associated. The fourth finding was that the identification of a disability prior to the interview could affect the interviewer's bias score. The results raise the question of how interviewer's implicit bias about disabilities can change the course of an interview. Using this information as a starting point, further research on this topic is critical to forensic interview best practice. The training of these specialized practitioners needs to move beyond simply providing basic information about disabilities and begin to explore interviewers' beliefs, attitudes and values about people with disabilities.