The purpose of this dissertation was to expand the understanding of youth in psychiatric residential treatment facilities by using psychosocial indicators to develop subgroup profiles. Additionally, differences in treatment outcomes between subgroups and the extent to which within-treatment factors accounted for observed differences in treatment outcomes between subgroups were examined. Data were extracted from the case records of 447 youth who were served in psychiatric residential treatment facilities over a seven year span of time. A latent class analysis was used to identify and describe subgroups. A series of multivariate regression analyses were used to examine group differences in functional impairment at discharge. Next, a path analysis was used to determine if there were differences in average change in functional impairment from admission to discharge between subgroups and to test within treatment factors as potential mediators of group differences. Finally, a logistic regression was used to determine if there were differences between groups in the probability of discharging to a community-based placement or discharging to another congregate care facility. The latent class analysis revealed four distinct subgroups of youth. The analyses of treatment outcomes revealed statistically significant differences in the level of functional impairment at discharge and average change in impairment between groups. Results from the path model of indirect effects supported that within treatment factors accounted for a statistically significant proportion of the observed difference in change between groups. No differences were found in discharge placement outcomes between groups. Implications for future research, practice and policies focused on youth in residential treatment are discussed.

This study examined whether the disproportionality of African American children referred to special education is influenced by the level of implicit racial bias among teachers, using the aversive racism theory. Data were collected from teachers of kindergarten through sixth grade in the Iowa City Community School District through email recruitment. Using a factorial survey design, teachers evaluated five vignettes, each with five questions mirroring the referral process to special education, an implicit and explicit racial bias measure, and demographics. Of the 307 teachers emailed, only 21 completed the full survey. The small sample size hindered the analysis due to violations of two of the major assumptions of linear regression: normality and constant variance. Due to these violations, only limited interpretations can be concluded from the linear models. A logistic regression was also completed on the referral for special education dependent variable and yielded the following significant results: The teachers who scored high on the explicit racism measure were more likely to refer a child to a special education assessment and other results revealed associations between certain characteristics and behaviors of the children and their likelihood of referral. The majority of teachers in the sample (67%) scored high in implicit racial bias but none of the models indicates a relationship between the child's race and referral to special education. The study suggests there is some connection between implicit racial bias and referrals to special education but not due to race. However, the complexity of relationships among these and other factors in both interpersonal relationships and classroom dynamics makes it necessary to further investigate this question and potentially remedy the problem of disproportionality in special education.

Quality citizen participation in processes of policy development is crucial to a democracy interested in equity of voice for all its citizens. Citizens with less political power, however, are often absent from policy development for a variety of reasons, despite legislative and advocacy efforts for inclusion. In policy development processes, community representatives are a mechanism for traditionally marginalized or disadvantaged citizens to have a voice; yet the question remains how to effectively utilize that voice. This question stems from research demonstrating an increase in quantity citizen participation but not in quality citizen participation, which is more interested in the process of policy development as opposed to a final product. To understand quality citizen participation, a critical ethnography guided by a socio-ecological perspective allowing for the investigation of contextual as well as individual factors impacting policy development processes was conducted to assist in advancing knowledge about the best practices necessary to facilitate quality citizen participation in policy development. The policy development process explored in this qualitative study was the context provided by three CHCs in a Midwestern state. Information was gathered about these three CHC boards from multiple sources to best represent the context surrounding participation on the boards and that participation experience from the perspective of board members. The data analyzed included: descriptive statistics of seven counties which comprised the patient community of the three CHCs participating in the study, descriptive statistics of the patient communities of those three CHCs, interviews with national and state policy experts, the clinic directors and board chairs of the three CHCs and interviews with 16 board members of the three CHCs. Analysis of these data identified individual, relational, organizational, community and public policy level factors which impacted the participation of board members of three CHCs. For example, the education and background experiences of board members (individual) as well as relationships between board members and the management teams of the clinics (relational) facilitated the quality of their participation on the boards. Contextual knowledge of economic, political, and cultural factors were discovered for each of the three clinics, and proved important to understanding the quality of participation of board members. Social work educators and practitioners will benefit from the advancement of knowledge about what factors facilitate the quality of citizen participation in policy development processes. The results of this study suggest that practitioners interested in empowering consumers to have a role in the provision of services need to understand what facilitates the quality of citizen participation to ensure that consumers have a legitimate voice in policy development and implementation processes. The results of this study also inform our understanding of citizen participation in multiple policy development processes. For example, because legislators will benefit when barriers to the quality of citizen participation are identified, educators teaching social work students about macro practice will have concrete lessons to draw from; practitioners who work with non-elected members of boards will benefit from barrier identification allowing them to assist in the empowerment of future board members engaged in policy development on a wide variety of boards; and finally actual board members, especially those representing traditionally disadvantaged or marginalized communities, will benefit from knowledge gleaned from similar experiences, and educators teaching social work students about the benefits of advocacy and empowerment could assist to make their participation more effective.

Substance use disorders (SUD) and mental health disorders are often thought of as completely separate problems even though these disorders commonly co-occur. Among adolescents who seek treatment for substance use problems, co-occurring mental health problems (MHP) are common. This is concerning because co-occurring disorders among adults have been associated with more severe MHPs, relapsing to substance use sooner, being less likely to maintain abstinence, and other problems. Despite the awareness that co-occurring disorders are problematic for adolescents, few studies have been conducted to understand these problems with an adolescent sample. The purpose of this study was to understand if factors commonly related to co-occurring disorders among adults were the same for adolescents and to examine two measurement models for the dependent variable, substance use. This secondary analysis of data first examined characteristics that are related to MHPs among a sample of adolescents (N=801) who use substances. Factors in three domains were examined: demographics, substance use, social factors. The results indicated that among these adolescents, MHPs were common. Two key factors related to having a MHP were gender and the severity of the SUD. Females and adolescents with more severe SUDs, like dependence, were more likely to have MHPs. Furthermore, severity of the SUD partially mediated the relationship between several of the other factors and MHPs. The type of substance an adolescent reported using was also important. In addition, adolescents who had more peers and more family members who participated in deviant activities had more severe substance use problems and were more likely to have a MHP. In addition to examining the factors related to mental health problems among a substance using population, this study modeled the dependent variable in two different ways which had not been done before and allowed for variance in the measure to be accounted for in the model. MHPs were measured both continuously and categorically. The results of the comparison indicated that there were not major differences between the two models. Implications for social work practice, policy and research are discussed.

The fast growth of the Chinese oldest old population indicates higher demand for long-term care. In China, families assume the primary responsibility of caring for older adults. Since the oldest elders are more likely to be widowed, their adult children usually become their caregivers. Focusing on the Chinese adult children who provide care for their oldest-old parents, this study documented and helped to explain Chinese adult children's caregiving strain. A conceptual framework was developed based on Pearlin's stress process theory, Higgins' framework of self-concept discrepancy, and previous studies on family caregivers of elders. Using an existing dataset from the 2005 Chinese Longitudinal Healthy Longevity Survey of 895 caregivers and their care recipients, the researcher tested whether and how caregiving context (caregiver's structured context and care recipients' needs for care), caregiving performance, and sibling support were related to five types of caregiving strain including sacrifice strain, exhaustion strain, capability strain, expectation strain, and dependency strain. The results indicate that caregiving context and caregiving performance are statistically related to different types of caregiver strain. Three independent variables in the set of caregiving context, self-evaluation of living standard, education, and cultural identity, were related to two types of caregiver strain in different directions. The caregivers who were the eldest sons, who were females caring for female elders, who had a close relationship with their care recipients, who lived with the care recipients, who provided care for the elders with more needs for care in ADL (Activities of Daily Living), or whose care recipients had health insurance reported higher levels of at least one type of caregiver strain. Care recipients' cognitive status and entitlement to pension were negatively related to at least one type of caregiver strain. Caregivers' rural residence, having a job outside the family, having a child under age 16, and care recipient's needs for care in IADL (Instrumental Activities of Daily Living) were not found to be related to any type of caregiver strain. Monetary assistance, which was indicated by the proportion of their annual household per capita income that the caregivers provided to care recipients, was found to be positively related to caregivers' capability strain. The amount of time spent in caregiving (time assistance) was positively related to three types of caregiver strain: exhaustion, expectation, and dependency strain. Time assistance was also found to mediate the relationship between care recipients' needs for care in ADL and caregivers' exhaustion strain and the relationship between dependency strain and three caregiving context variables: closeness between caregivers and care recipients, co-residence with care recipients, and care recipients' needs for care in ADL. The results revealed the importance of caregiving context and caregiving performance in explaining Chinese adult-child caregivers' experience and the necessity of investigating caregiver strain in different dimensions. This study contributes to understanding caregiver strain from a filial perspective. The results imply directions for future research, social work practice and education, and policy legislation in addressing Chinese adult children's strain in caring for their oldest-old parents.

Thesis (Ph. D.)--University of Hong Kong, 2007. / Also available online.

Thesis (Ph. D.)--University of Hong Kong, 2007. / Title proper from title frame. Also available in printed format.

The Primary Care Posttraumatic Stress Disorder (PC-PTSD) screen (Prins et al., 2003) is used by the Department of Defense to identify military members who are at increased risk of PTSD. This screen has been offered to all returning deployers since 2005. However, validation studies of PC-PTSD scores from military samples have seldom employed a significant number of female subjects and no published studies have examined it for gender bias. Ruling out bias is important because routine under-identification of PTSD risk in any group could result in hindered access to needed assessment and/or care. With the current proportion of military females historically high (Women’s Research & Education Institute, 2007), it is imperative that the PC-PTSD be analyzed to ensure measurement equivalence across gender. Using a large sample of male and female veterans returning from deployment, the validity of the PC-PTSD scores was first examined by conducting a differential item functioning (DIF) analysis across male and female subgroups. Then, using a clinical diagnosis as the criterion, both logistic regression and diagnostic likelihood ratio methods were employed to assess for differential predictive validity by gender. Finally, confirmatory factor analysis (CFA) was used to examine convergent and divergent validity in a two-factor model containing both PC-PTSD and depression screen responses. Results revealed no statistically significant gender-related DIF or differential prediction of PTSD by PC-PTSD scores. Good convergent and divergent validity were also observed in the CFA analysis. The results generally supported the continued use of the PC-PTSD with both male and female military veterans returning from deployment. Limitations of the study and recommendations for future research were discussed.

Thesis (M.S.W.)--University of Hong Kong, 1984.

Medical social workers from health care institutions in the urban lower mainland of British Columbia were asked about their views, values and practice regarding passive and active euthanasia. This qualitative, exploratory study focused on the attitudes, values and structures that influence professional social work practice with clients requesting euthanasia. During the months of August to November, 1994, seventeen medical social workers, who were experienced in this area, were interviewed. An interview guide format was used that was previously tested in a pilot study of this project. Within the pre-selected categories; views, values and practice, responses were described and emerging themes were identified through content analysis. The study results confirm medical social workers are playing an active professional role with terminally-ill patients, families and staff when requests are made for euthanasia in the health care system. In this study population, in most cases, the social worker's views, whether for or against euthanasia, did not determine his/her practice with patients. Instead, it was the social worker's willingness to give up his/her control in the patient/professional relationship in an effort to support the patient's decision to die with dignity. This practice was based on the value of patient self-determination being paramount against all other interests. Self-determination was ranked as the most influential factor in determining practice by most of the participants. Responses revealed there was a lack of understanding by health care professionals at all levels regarding the process of separating personal values from the professional obligation to respect patient self-determination. Feminist medical ethics suggests that all health care professionals need to engage in self-evaluation to address any need they may have for power and control in the professional/patient relationship. Furthermore, medical social workers should recognize their own such needs, particularly when their personal views and values come into conflict with a patient's decision regarding euthanasia. This study not only presents the issues of power and control that social workers and other health care professsionals experience in the medical system, it also explores and describes the contributions social workers have made in their practice with patients who request the right to die with dignity.