The experience of dealing with end-stage cancer in a family member has been reported to be stressful. One source of stress experienced by family members may be dissatisfaction with care received by the patient and themselves. For health professionals to provide care that promotes family satisfaction, it is essential to measure this phenomenon and understand the elements that contribute to satisfaction. An examination of the literature revealed four competing explanatory theories of satisfaction, none of which has solid empirical support. Moreover, these theories had not been tested with families or those experiencing cancer care in particular. Therefore, the aim of this research was to test these alternative theories using theoretical and empirical modeling with the expectation that a useful model would be identified to guide clinical practice of families in terminal care situations. The theories tested were: (1) Vroom's Fulfillment Theory, (2) Porter's Discrepancy Theory, (3) Thibaut and Kelley's Social Comparison Theory, and (4) Ajzen and Fishbein's Expectancy Value Theory. A correlational design with a causal modeling methodology was used. One hundred and nine family members of patients with advanced cancer were obtained from three different palliative care services. Five instruments were used to collect data: (1) FAMCARE Scale, (2) F-Care Needs Scale, (3) F-Care Expectations Scale, (4) F-Care Perceptions Scale, and (5) a short demographic questionnaire. Data analysis included use of descriptive statistics to summarize the sample in terms of demographic variables, reliability and validity testing of the instruments, and theoretical and empirical model testing using multiple regression techniques and residual analysis. Of the four theories tested, Discrepancy theory was the most credible, accounting for 68 percent of explained variance in family care satisfaction. Empirical modeling resulted in identification of the Family Care Satisfaction Model, which explained 78 percent of the variance in care satisfaction. Implications for theory construction and clinical practice are presented and recommendations for further research offered. The family constitutes perhaps the most important social context within which health and illness occur. As more families are required to care for dependent or ill members at home, understanding the needs, expectations, and satisfactions with care experienced by families will become increasingly important.

Men who were sexually abused during childhood (MSAC) represent a highly stigmatized, marginalized population at risk for a variety of psychological problems across the lifespan. Little research has been conducted to understand why some MSAC incur mental health problems and others do not. The purpose of this study was to identify which factors are related to mental distress among MSAC using a psychosocial trauma processing model: account-making. Using a cross-sectional design, the researcher collected data on 487 MSAC through an online survey. Multivariate analyses revealed that four abuse severity factors (clergy abuser, force, penetration, injury), disclosure variables (told after one year, response to first disclosure, overall response to disclosure, in-depth discussion), account-making, and high conformity to masculine norms were related to higher levels of mental distress. Furthermore, posttraumatic growth moderated the relationship between abuse severity variables (force, penetration) and mental distress. This study strengthened the knowledge base of MSAC, further developed account-making theory, and provided useful recommendations for clinical practice with this population. Future research areas were identified.

Healthy food store availability is by no means equitable, that is supermarkets and supercenters are not located nearby for certain populations. Shopping at healthy food stores is important, as dietary intake is associated with adverse health outcomes, which disproportionally affects racial and ethnic minorities. Yet rural areas and disadvantaged neighborhoods—low income or predominantly racial/ethnic minority compositions—have few healthy food store options available near home. Thus residents must use more resources to access them or make do with what is available close by. However, little is known about the characteristics associated with shopping at healthy food stores or shopping near home. Thus the purpose of this study was to examine predictors of shopping at healthy food stores and shopping within increasing distances from home. This study used data from the USDA’s National Household Food Acquisition and Purchase Survey (FoodAPS) which asked about household food purchasing behaviors. The FoodAPS data set was used to conduct a secondary data analysis of US households (N = 4,826) that was a nationally representative sample. A series of multilevel logistic regression models were conducted to examine the four research questions guiding this study. The four questions examined predictors of: (1) shopping at a healthy food store, (2) shopping at a healthy food store among rural and suburban respondents, (3) shopping within increasing distances from home, and (4) shopping within increasing distances from home among healthy food store shoppers. Results indicated that Hispanic/Latino and other racial/ethnic minority, the distance of travel to the store, and the number of food stores available within 5.0 miles were negatively associated with shopping at a healthy food store. In addition, among rural and urban/suburban respondents had differing predictors of shopping at a healthy food store. Predictors of shopping within increasing distances from home included car to store and living in rural areas. Respondents who used a car as the transportation to the store were less likely to shop within 2.0 miles of home or less. Not surprisingly, rural respondents were also less likely to shop within 5.0 miles of home or less. Several control variables were significant predictors of shopping within increasing distances from home which were unexpected. Results in some instances were surprising and contradictory to findings from past studies. Thus these results are discussed and are compared and contrasted with past studies. The results of this study have practice implications for social workers. Social work practitioners working with individuals can advocate for improving client access in their communities by improving and introducing programming whose goal is to connect people to food resources. Social workers engaged in policy efforts can work at the local, state, and national levels by working in multidisciplinary groups to improve existing programs and prioritize funding that improves issues of equality. While this study examined predictors among a nationally representative sample, it is important for future research to look at differences specifically among age groups, racial and ethnic minorities, and rural residents.

ABSTRACT This study explored the challenges medical social workers face that lead to burnout. Currently, there is literature on burnout among health care providers and social workers, but not specifically on social workers in the medical field. The current study aimed to fill this gap in literature. Due to the lack of literature, the study used an exploratory, qualitative design. The study utilized individual interviews with a non-random purposive sample of nine medical social workers currently employed at Kaiser Permanente’s Fontana/Ontario Social Services Department. Interviews with participants were recorded and transcribed. Transcriptions were analyzed using thematic analysis. Major themes that emerged were organizational challenges, challenges working in multidisciplinary teams, working in the medical field, and limited resources. The study’s findings aim to increase awareness of the issue of burnout among medical social workers and to contribute to the implementation of interventions or policies within health care settings to prevent burnout among medical social workers.

The purpose of this study is to explore the extent to which Social Workers' clinical judgement is altered by administrative needs in a population of Veterans Administration social workers. The importance of this study to research is to find out whether administrative mandates do, in fact, influence social workers' clinical judgement, hence altering treatment to some significant degree. Administrators will be interested in seeing whether there is acceptance or resistance to their directives and what factors are involved in this dimension.

This study investigated the effects of sex differences on clinical judgements. It was hypothesized that: l) clinicians will respond differently to aggressive, self-assertive, or dependent behavior, depending upon whether this behavior was performed by a man or a woman; 2) clinicians will have different treatment goals for a man and a woman who behaved in the same manner; 3) clinicians will describe the client engaged in aggressive, self-assertive, or dependent behavior differently, depending on the sex of the client; 4) clinicians will have different feelings towards men and women behaving in exactly the: same manner, and; 5) clinicians will rate aggressive women and dependent men as more emotionally disturbed and, as such, in need of longer and more intensive treatment than dependent women and aggressive men.

The purpose of this study was to assess the special needs of the families of hospitalized mental patients. The study focused upon the time prior to and including the decision to hospitalize a mentally ill family member. Particularly, the researchers wished to examine the stresses that the family encountered in attempting to deal with a disturbed member as well as their concerns regarding psychiatric hospitalization and the effect which it had upon the family.

Indigenous women experience intimate partner violence (IPV) at a disproportionate and epidemic rate. A common thread among indigenous women's experiences is that of colonization, which has been linked to both IPV and other social ills. Many tools of domination and control used throughout colonization to subjugate and oppress indigenous peoples are consistent with the tactics of power and control used in IPV. Given the distinct history of colonization along with the absence of research on indigenous women from the Southeastern portion of the United States, the purpose of this critical ethnography was to understand the culture and context of IPV for women from a Southeastern tribe across the life course. Because they complimented and supplemented each other in their ability to increase understanding about indigenous women' experiences with IPV, critical theory, historical trauma, life course theory, and resilience theory guided this qualitative inquiry. Paulo Freire's vision of critical theory was used to conceptualize this dissertation within the specific historical context. Using Carspecken's critical ethnographic method, the relevant data collected for this study included 28 participant observation sessions with indigenous community members and 28 life histories with indigenous women. Data analysis followed Carpsecken's method of reconstructive analysis. The patterns of power and domination at the societal, community, and interpersonal levels were identified with the broader beliefs that might perpetuate IPV across generations. Results included key factors within the specific historical context of indigenous women that had salient linkage to IPV. The potential symptoms of historical loss and trauma, including alcohol abuse, IPV, and family breakdown, were highlighted. Women's emergent pattern of violence that occurred across the life course was delineated within the culturally specific family structure. Women's perceptions of experiences with the formal and informal support systems were explored. Likewise, the various coping strategies of women who experienced IPV were identified along with the culturally specific protective and risk factors across multiple levels. Women's suggestions for emancipation from oppression were highlighted along with the implications for social work practice and policy.

Latinos are the fastest growing minority group in the Unites States (Fry, 2008). One in eight adult Latinos living in the United States has diabetes (CDC, 2011), and by the year 2020 diabetes is expected to increase by 107% in the Latino population (Caballero & Tenzer, 2007). Within the general diabetic population approximately 26% of the diabetic population requires the use of insulin in the management of their diabetes (DHHS: NDIC, 2011), making insulin-dependent diabetes a prevalent experience. The literature on how diabetes is experienced is divided. Clinical assessment literature strives to measure how people are coping with the illness and how one's experience with the disease impacts self-care. Literature on the diabetes experience is limited; however, the overall image that emerges is the negative expectation associated with having diabetes such as loss and suffering. Little is known about insulin-dependent diabetes as a lived experience, particularly among Latinos. The purpose of this research is to understand the experience of having insulin-dependent diabetes among adult Latinos, because focusing on this experience clarifies how daily nuances of living with the illness gives meaning to insulin-dependent diabetes. Increased understanding of how people interpret their illness can improve diabetes management, specifically within patient and social work interactions, and promote competent social work practice. The guiding research question for this research is, "what is the lived experience of insulin-dependent diabetes among Adult Latinos in a Primary Care Clinic in San Antonio?" This study uses van Manen's (1990) hermeneutic phenomenological approach to guide the research in capturing the nature of the phenomenon in order to gain a deeper understanding of the meaning Latinos attribute to daily experiences of having insulin-dependent diabetes. Utilizing a phenomenologically designed interview guide, this study includes interviews with 10 participants from a predominantly Latino, safety-net clinic in Texas with a 60% diabetes diagnosis rate. Five essential themes arose in exploring the lived experience of insulin-dependent diabetes among adult Latinos in a primary clinic in San Antonio. The themes include 1. diabetes goes against the natural state of the human body; 2. diabetes rules everything 3. insulin is the fast track to deterioration; 4. the relationships don't end, but they're not the same; and 5. managing diabetes with a broken system. The theme "diabetes goes against the natural state of the human body" is considered a core theme because it represents the other themes. Of those themes identified three support the current literature found on living with diabetes. The three themes insulin is the fast track to deterioration, managing diabetes with a broken system, and the subtheme love hate relationship with food are emerging themes identified by the study

Purpose. The purpose of this study was to evaluate whether severe victimization experiences, and psychological and social resources were shared risk factors for internalizing only, externalizing only, and co-occurring internalizing and externalizing disorders among victimized substance-using adolescents. Method. Data for this cross-sectional study were obtained from a multisite research project. Adolescents, ages 11-18, participated in a comprehensive screening program for substance abuse at 106 Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT)-funded grantee sites throughout the United States. Results. Longer duration/frequent victimization, more than one type of victimization, recent victimization, low self-efficacy beliefs and available sources of emotional support were related to co-occurring internalizing and externalizing disorders. Victimization by a trusted person, however, was only related to internalizing disorders. Conclusion. The findings show that some indicators of severe victimization experiences, psychological and social resources are shared risk factors for internalizing, for externalizing, and for co-occurring internalizing and externalizing problems, thus providing support for the common factors model of co-morbidity. These findings suggest that practitioners in substance abuse treatment must thoroughly assess for severe victimization experiences among adolescents presenting with co-occurring mental health issues. Treatment planning and interventions may focus on helping adolescents cope effectively with their victimization experiences and addressing their MH needs. Particular emphasis may be placed on enhancing self-efficacy and social skills, so that adolescents may benefit from their available sources of support.