Increasing military social work knowledge: an evaluation of learning outcomes

Service members and veterans face a myriad of health, mental health, and social challenges stemming from the combat and operational stressors experienced during deployment and the challenges ofreintegration to civilian life. To intervene effectively with this population, social workers must be knowledgeable about these issues and the cultural context within which they occur. Although schools of social work across the country are developing course work in military social work, little is known about the learning outcomes of these courses. This article describes a military social work course that was developed to increase student preparedness to work with a military or veteran population and the learning outcomes achieved. Using a quasi-experimental pre-post design, this study compared the learning outcomes of students enrolled in the course with a group of students who had not taken the course. To measure this knowledge, the authors developed a 50-item Military Social Work Knowledge Scale for the study. Significant differences between pre- and posttest scores were found for the social work students enrolled in the course. Specific areas of knowledge that increased for the class participants included knowledge about cultural sensitivity to military populations and knowledge about service and advocacy frameworks.

Psychosocial concerns of veterans of operation enduring freedom/operation iraqi freedom

U.S. veterans present with complex medical and psychosocial concerns postdeployment. Identification of psychosocial concerns is necessary for appropriate and targeted social work interventions to improve delivery and receipt of health care through the U.S. Department of Veterans Affairs. The purpose of this article is to identify specific psychosocial concerns of veterans of Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) presenting at the War Related Illness and Injury Study Center. A retrospective chart review of psychosocial concerns from all OIF/OEF veterans seen fromJune 2008 toJune 2010 provided data for this mixed methods study. Veterans in the sample (N= 356) reported an average of 5.2 psychosocial concerns (SD = 2.32, range = 0 to 11). The most commonly reported concerns were pain (72 percent), sleep (62 percent), cognition (61 percent), vocational issues (53 percent), education (49 percent), finances (42 percent), relationships (37 percent), anger (30 percent), substance abuse (23 percent), and social support (20 percent), though these categories were not exclusive and many veterans endorsed more than one category. Multiple psychosocial concerns reported by veterans suggest the need for targeted social work intervention.

Decreasing role strain for caregivers of veterans with dependence in performing activities of daily living

In response to the implementation of new Patient Aligned Care Teams (PACT) within the Veterans Administration health care system, the interdisciplinary nature of social work in health care settings is expanding to address emerging needs of veterans and their caregivers. One such area of expansion is the receipt of extended care services in the veteran's home environment. Social workers within PACT, also known as the patient-centered medical home, are tasked with movement of health care resources and care coordination centered around veterans in their residences. This presents social workers in the health care setting with new challenges for dealing with high burden and role strain for caregivers of veterans in noninstitutional settings who are dependent in performing activities of daily living. The current article establishes an approach, grounded in community science, for interventions within the Veterans Health Administration aimed at alleviating caregivers' role strain when caring for veterans with functional disabilities while optimizing implementation of home care and care coordination.

Impact of gender on reactions to military sexual assault and harassment

Research has shown that experiences ofmilitary sexual assault and harassment can have a negative impact on veterans' health and functioning, even years or decades later, thus clearly identifying this as an important area of concern for social workers. In addition to understanding the scope and general impact of military sexual assault and harassment, social workers also must thoroughly understand how different cultural factors may intersect with veterans' experiences. To this end, this article reviews the current knowledge base on how veterans' life experiences related to gender can affect their experience of and recovery from military sexual assault and harassment, highlights common gender-specific issues, and discusses implications for practice.

Cervical cancer screening: exploring Appalachian patients' barriers to follow-up care

This article describes a community-based Patient Navigation (PN) project conducted to identify potential barriers to seeking follow-up cervical cancer care in southeastern Kentucky. Patient navigators (PNs) were placed in cervical cancer programs within county public health departments where they interviewed patients about their perceived barriers to seeking follow-up care after receiving a positive Pap test result. Participants identified various potential barriers at three levels: the individual/personal level, the health care system level and the community/environmental level. One identified barrier that was unique to this study was a lack of consistency between follow-up recommendations and follow-up guidelines for patients under age 21. Implications are discussed.

Changing organization culture: data driven participatory evaluation and revision of wraparound implementation

Family members and professionals in a Substance Abuse and Mental Health Services Administration Children's Mental Health Systems of Care Initiative in Houston, Texas conducted a participatory evaluation to examine wraparound implementation. Results guided systematic, theory-based program revisions. By focusing through empirically derived frameworks for implementation, the evaluation team identified and generated useful data sources to support and improve wraparound provision. Despite working with a more diverse population in which youth displayed more severe behaviors than in similar grants, after 18 months more families received service and outcomes improved as fidelity scores advanced above the national mean.

Insuring the integrity and validity of social work interventions: the case of the subsidized guardianship waiver experiments

The near loss of the ability to conduct randomized controlled trials in the Title IV-E waiver demonstrations makes the negotiation of a ceasefire urgent in the "causal wars." Results-oriented accountability is a conceptual framework for managing the micro-macro tensions that arise in social work practice and research. This article uses subsidized guardianship experiments to illustrate the results-oriented accountability process by which innovation is aggregated from the micro level through formative implementation and evaluation into a usable, stable intervention that can be rigorously tested through summative implementation and evaluation at the macro level, and if validated, generalized to the micro level through translative implementation and evaluation.

Best interests decisions: professional practices in health and social care

This paper reports on data collected in 2011 from a national study about the operation of the best interests principle, a key feature of the Mental Capacity Act (MCA) 2005 for England and Wales. The objective was to provide a picture of current professional practices in best interests decision-making. Four contrasting sample sites were selected, in which National Health Service trusts, social care and other organisations were recruited to participate. A multimethod design was followed, including an online survey with 385 participants, followed by qualitative research through a telephone survey of 68 participants, and face-to-face semi-structured interviews following up 25 best interests cases, with different perspectives on the process in 12 of those cases. The current paper reports only on the qualitative findings. The findings indicate that the MCA was successful in providing a structure for these practitioners, and that the five principles of the MCA were in general adhered to. A variety of perceived risks led to best interests processes being undertaken, and a typical scenario was for a period of hospitalisation or ill health to trigger a best interests decision process about a social care and or a life decision. The study supported previous research in finding the notion of capacity the most difficult aspect of the MCA, and it provides evidence of some specific capacity assessment practices, including problematic ones relating to 'insight'. Best interests decisions were often made by consensus, with practitioners taking on different roles within the process. Meetings played a key part, but other ways of involving people lacking capacity and significant others were also important. It was recommended that the issues highlighted in this research could be clarified further in the Code of Practice, or within risk guidance.

School-based vaccination programs and the HPV vaccine in 16 Appalachian Kentucky school districts: results from a pilot study

The purpose of this article is to describe a pilot study of 16 Appalachian Kentucky school districts designed to gather information about their school vaccination and health education programs in relation to the Human Papillomavirus (HPV) vaccine. School district administrators were contacted by a professional telephone interviewer and asked to participate in a structured interview that also included open-ended questions. Results suggest that few schools have school-based vaccination programs, and of those that do, very few programs include the HPV vaccine. A majority of respondents reported that information leaflets about HPV are available in the schools, whereas few schools include discussions of HPV in their health programs. Almost all respondents reported an excellent relationship with their county health departments, school nurses, and school social workers, although most schools lacked the presence of a school social worker. Implications for social work practice and policy and directions for future research are also discussed.

Between the empowered self and the social costs: Arab abused women's perceptions of their relationship with social workers in community health clinics in Israel

Abused women seek help from medicine services extensively. Qualitative interviews were conducted with 12 married Arab-Israeli abused women about their relationships with social workers in community health clinics. Analysis reveals that women's evaluation of the impact of encounters with social workers is bipolar. On one pole are the difficulties and stressors derived from the cultural limitations that are placed on their ability to bring changes. On the other pole are the benefits--awareness in coping with repressive social powers and empowerment as competent choosers. The discussion elaborates the conflicts and paradoxes inherent in the nature of the interventions with abused women in a collectivistic culture.

Developing a reliable and valid scale to measure psychosocial acuity

This tool is a unique comprehensive scale and methodology to measure the psychosocial acuity of patients and families across a health care continuum. Coupled with other measures, psychosocial acuity can tell a complete and compelling story of social work contributions and aid in resource alignment. Accurately conveying the full scope of social work value to anyone, especially health system leadership, requires that the psychosocial acuity of the patient and family be measured and factored into the equation, along with productivity, time spent, and services provided. The development and utilization of the Psychosocial Acuity Tool is the focus of this publication.

Adapting an empirically supported intervention for a new population and setting: findings and lessons learned from Proyecto Puentes

With an increasing emphasis on evidence-based practice, the need for social work researchers and practitioners to adapt empirically supported interventions for new populations and cultures is essential. However, social work suffers from a lack of guidance and detailed examples of intervention adaptations that may not proceed "by the book" and actually falter but recover. Many of these situations result from lack of attention to setting and context even when researchers believe they have full stakeholder buy-in. This article presents process evaluation findings from an intervention adaptation called Proyecto Puentes that allowed for self-correction and successful intervention development.

Creating a vision for the future: key competencies and strategies for culturally competent practice with lesbian, gay, bisexual, and transgender (LGBT) older adults in the health and human services

Sexual orientation and gender identity are not commonly addressed in health and human service delivery, or in educational degree programs. Based on findings from Caring and Aging with Pride: The National Health, Aging and Sexuality Study (CAP), the first national federally-funded research project on LGBT health and aging, this article outlines 10 core competencies and aligns them with specific strategies to improve professional practice and service development to promote the well-being of LGBT older adults and their families. The articulation of key competencies is needed to provide a blueprint for action for addressing the growing needs of LGBT older adults, their families, and their communities.

Hospital to community transitions for adults: discharge planners and community service providers' perspectives

Discharges from the hospital to community-based settings are more difficult for older adults when there is lack of communication, resource sharing, and viable partnerships among service providers in these settings. The researchers captured the perspectives of three different groups of participants from hospitals, independent living centers, and Area Agencies on Aging, which has rarely been done in studies on discharge planning. Findings include identification of barriers in the assessment and referral process (e.g., timing of discharge, inattention to client goals, lack of communication and partnerships between hospital discharge planners and community providers), and strategies for overcoming these barriers. Implications are discussed including potential for Medicaid and Medicare cost reductions due to fewer re-hospitalizations.

Selecting an EBP to reduce long-term foster care: lessons from a university-child welfare agency partnership

A growing implementation literature outlines broad evidence-based practice implementation principles and pitfalls. Less robust is knowledge about the real-world process by which a state or agency chooses an evidence-based practice to implement and evaluate. Using a major U.S. initiative to reduce long-term foster care as the case, this article describes three major aspects of the evidence-based practice selection process: defining a target population, selecting an evidence-based practice model and purveyor, and tailoring the model to the practice context. Use of implementation science guidelines and lessons learned from a unique private-public-university partnership are discussed.

Creating an EBP framework on a journey to becoming an EBP agency: pioneers in the field of children's mental health

Agencies servicing children, youth, and families have been particularly pressured to demonstrate service effectiveness and accountability by government funders. The human service fields have not fully embraced research evidence into the organizational culture creating a challenge of introducing research evidence into agencies. Gaps in knowledge have been identified when agencies attempt to travel down the path of introducing evidence-based practice into organizational culture. The paradigm shift of introducing research into practice was the journey taken by one mid-sized agency in southwestern Ontario, Canada. A framework for assessing evidence-based practice programs in services was created as part of their journey.

Diabetes in homeless persons: barriers and enablers to health as perceived by patients, medical, and social service providers

The ways homelessness and diabetes affect each other is not well known. The authors sought to understand barriers and enablers to health for homeless people with diabetes as perceived by homeless persons and providers. The authors performed semistructured interviews with a sample of participants (seven homeless persons, six social service providers, and five medical providers) in an urban Midwest community. Data analysis was performed with the qualitative editing method. Participants described external factors (chaotic lifestyle, diet/food availability, access to care, and medications) and internal factors (competing demands, substance abuse, stress) that directly affect health. Social service providers were seen as peripheral to diabetes care, although all saw their primary functions as valuable. These factors and relationships are appropriately modeled in a complex adaptive chronic care model, where the framework is bottom up and stresses adaptability, self-organization, and empowerment. Adapting the care of homeless persons with diabetes to include involvement of patients and medical and social service providers must be emergent and responsive to changing needs.

Go to the hospital or stay at home? A qualitative study of expected hospital decision making among older African Americans with advanced heart failure

To address the need for more information concerning hospital decision making, we conducted in-depth interviews among African Americans with heart failure and their family caregivers (n = 11 dyads). Using a case scenario, we asked participants about their anticipated hospitalization decisions. Most patients indicated that they would seek care to avoid further deterioration or death from their worsening condition. Many family caregivers anticipated having an active influence on hospitalization decisions. Findings suggest that social workers should encourage the development of adequate home-based services, recognize diverse communication styles, and use this information to facilitate medical decision making by these patients and their caregivers.

"I learned that the aging population isn't that much different from me": the final outcomes of a Gero-Ed BEL Project

This article describes a Council on Social Work Education (CSWE) Gero-Ed Center BEL Project's activities and reports its final outcomes. An oral history interview in paired human behavior and practice skills courses addressed gerontological social work competencies focused on assessing and addressing values and biases regarding aging, and the ability to relate concepts and theories of aging to practice. Significant increases in perceived proficiency in these competencies occurred, as did significant decreases in negative attitudes toward older people and working with older adults. Qualitative data supported these results. Findings suggest social work educators utilize a combination of classroom-based and experiential learning to maximize student development.