This study aimed to determine the need for practical and academic training in Spanish for bilingual social work students. Using an exploratory method with a qualitative approach, the researcher interviewed bilingual MSW students who were providing counseling services in Spanish and who had not received any training in clinical Spanish. The study used purposive sampling to interview and evaluate participants’ perception of competence in providing services to Spanish speakers. Through data analysis, the researcher identified three themes: linguistic issues in clinical terminology, discomfort feelings, and language expectation. A limitation of this study included that the results could not be generalized to the larger population due to the small sample size. Recommendations included support from bilingual field instructors to process cases in Spanish and to strongly recommend students to participate in the Certificate Program in Healthcare at CSUSB to assist students who wish to continue working with Spanish speaking clients.

This study seeks to understand the perceptions of African American parents on preventive family therapy and their help-seeking behaviors. Specifically, this study aims to identify the factors that influence African American families in engaging in preventive family therapy and the barriers to accessing treatment. The data was collected through two group interviews that consisted of a total of 11 African American parents residing in Riverside County and San Bernardino County. The findings indicate that: (a) African American parents sought therapy primarily for crisis; (b) Alternatives to therapy were viewed as being just as effective; (c) Barriers to treatment include institutional fear, lack of diversity, and stigmatization; and (d) African Americans held positive views of therapy and individuals who received treatment. These findings highlight the perceptions of an underserved community that is disproportionately represented in child welfare and provides practitioners with strategies to develop effective interventions. Recommendations for future social work practice, policy, and research include continued community outreach and mental health awareness campaigns, partnership with faith-based organizations in developing youth mentoring programs, and the need for research centered on current and former African American child welfare clients.

This project explores the barriers to reunification with their children for incarcerated mothers in an effort to provide more support to child welfare social workers who engage with this population. Project participants were selected from one regional office of a child welfare agency in Southern California to complete qualitative interviews. Participants included seven Social Service Practitioners (SSPs), two Supervising Social Service Practitioners (SSSPs), and one Data Analysist. Each participant’s interview was digitally recorded, transcribed, and analyzed following the systematic manual coding method with the assistance of Microsoft Word (Ose, S, 2016). Five common barriers were identified: child visitations with incarcerated parents, variances of social worker’s knowledge of services and programs provided by institutions, presence of guidance and support, maintaining contact with incarcerated parents, and length of sentence. At the conclusion of the project, the researcher provided findings to study participants and the Deputy Director of the child welfare agency.

The focus of this study will be on how the stigma attached to mental illness impedes adolescent’s experiencing suicidal ideation & depression, willingness to seek out mental health services. The purpose of the study is to determine what action needs to be taken to address these issues to facilitate adolescent’s willingness to seek services. The study was qualitative and was conducted utilizing the constructivism approach with a theoretical orientation emphasized on the labeling and empowerment theory. The literature reviews focus on labeling of mental disorders and stigma, preventing factors and interventions that influence help seeking and mental health services utilization, and willingness of seeking services. The major themes identified include the following barriers: parental stigma, cultural beliefs, lack of understanding, mental health as a last resort, and accessibility of services. Recommendations made to encourage utilization of mental health services amongst adolescents include parental involvement/engagement and mental health education.

The role of school-based mental health counselors (SBMHCs) is essential in addressing the mental health needs of U.S. adolescents. The purpose of this phenomenological study was to examine SBMHCs' perceptions about factors that affect the use of SBMH services by adolescents from a school district in Connecticut. SBMHCs were chosen for this study because they provide direct mental health services to adolescents. Mechanic's general theory of help-seeking provided the framework to interpret research findings using the 10 interrelated constructs. Fifteen SBMHCs participated in face-to-face semistructured interviews. Colaizzi's 6-steps-guide was used to organize, code, and identify common themes. The following themes were identified: (a) there was no uniform process to identify and refer a student for services, which makes it time-consuming for SBMHCs to identify students in need; (b) there was a lack of established trusting relationship between adolescents and SBMHCs; (c) adolescents with persistent truancy at school had issues associated with poverty, housing, and family security that negatively affect access to use SBMH services; (d) financial resources were needed to support schools to hire more qualified professionals, create programs, and assist families of adolescents who may need SBMH services. Barriers to the use of SBMH services were identified as the lack of parental engagement, SBMHCs time constraints, and social stigma. Study findings may raise awareness to mental health access factors and barriers faced by adolescents and SBMH professionals and help improve access to critical SBMHCs and use of mental health services as needed.

Patient engagement is one of the 6 quality directives issued by the Institute of Medicine for patient-centered care. Federal meaningful use regulations require health care organizations to offer patients a secure online website, or patient portal, to access their health information. Although the patient portal offers patients the opportunity to be more involved in their care, the portal has not been widely used. However, barriers to utilization are best understood from the perspective of the patient. Any barriers to patients accessing the portal are also barriers to patient engagement. The purpose of this project was to understand from the patient perspective why 99% were not using the portal at a large health system. The goal was to understand the patient preferences and their expectations for the portal as well as the perceived barriers. The Diffusion of Innovation Theory guided this quality improvement project to understand the patient perspective to initiate focused portal revisions and program changes. A focus group method was used to interview patients about their portal knowledge, willingness to use the portal, and general preferences for accessing health information. Four focus groups were conducted with 15 participants. Each session was recorded, transcribed within the program NVivo, and reviewed through content analysis. The main barrier to patient portal use is a general knowledge deficit about the purpose, usefulness, and accessibility. As possible solutions, the participants suggested education and promotion materials are essential. Also, nursing staff will need to offer patients information about how to access and use the portal. Through this project, positive social change can be achieved as patients will have better access to their personal health information with the revised portal.

The problem addressed in this project was poor medication acceptance among patients with bipolar disorder in an outpatient psychiatric clinic. The practice-focused question asked about the factors that contribute to medication nonacceptance in patients with bipolar disorders and further sought to determine strategies that promote medication acceptance. The project took place in an outpatient psychiatric clinic in the southern United States. The Iowa model and the Orem self-care deficit nursing theory were used to guide the project. Deidentified data from 55 patients in an outpatient mental health clinic formed the basis of the project. The data included a survey made up of 6 open-ended questions asking about reasons for not taking prescribed medications. A second source of deidentified data was the results of the medication adherence questionnaire, a Likert-style questionnaire that asked about the level of adherence to medications. Qualitative data were examined by manually coding the results, and the quantitative questions were analyzed for frequencies and percentages. Results from the analyses indicated that 70% of patients with bipolar disorder had missed doses of medications and were not adherent to their prescribed medications. Results of the project were then used to develop recommendations for addressing medication nonadherence among patients with bipolar disorder. Recommendations included education for nursing staff on how to teach patients and their families the advantages of medication adherence and to promote self-care consistent with Orem's model of self-care. Positive social change is possible as a result of this project as patients with bipolar disorders learn self-care strategies for medication adherence.

During the summer of 2004 I interned with the Mental Health Association of Greater Tampa Bay (MHA), a local affiliate of the National Mental Health Association. My time spent with the MHA became a gateway into the world of mental health. In the course of fulfilling my duties, I developed a particular interest in understanding the services that are available to persons, especially adults seeking treatment/services for mental illness. Through the MHA I was introduced to a wide range of people who have some link to mental health services, including psychiatrists, therapists, policy makers, and lawyers. This thesis utilizes an anthropological perspective to review the mental health policies, services, and provider networks available in the Tampa Bay region. My findings reflect the views of providers of or advocates for mental health services. This thesis is therefore presented as a necessary baseline and prelude to a more comprehensive study of consumer/client responses to the system. My data suggests that mental health services in Florida provide only a patchwork of services: there are not enough professional service providers to handle the actual patient load. Providers of mental health services who serve the uninsured are particularly overburdened. The largest barrier to providing treatment is underfunding, relative to the actual cost of services. Treatment is also impacted by the stigma attached to seeking mental health services.

BakgrundDen fysiska aktivitetsnivån sänks för många i samband med graviditet och kan vara kvarstående en längre tid efter förlossning. Det finns begränsad kunskap om vilka faktorer som stärker self-efficacy (S-E) att utföra träning, underlättande och hindrande faktorer för initiering eller återupptagande av fysisk aktivitet och träning efter förlossning. SyfteSyftet var att undersöka upplevelser efter deltagande i gruppträning på en vårdcentral hos kvinnor med kvarstående besvär efter förlossning, S-E till fortsatt träning på egen hand samt hindrande och underlättande faktorer för träning. Design och metod  En kvalitativ deskriptiv design användes och fem semistrukturerade intervjuer genomfördes. Vid databearbetning användes en kvalitativ innehållsanalys. ResultatResultatet beskriver betydelsen av ledarledd gruppträning och dess innehåll, S-E till- och underlättande samt hindrande faktorer för träning på egen hand, individuella strategier för träning, betydelsen av att ha drivkraft och omgivningsfaktorer som påverkar träningen. KonklusionInformanterna beskrev positiva aspekter gällande ledarledd gruppträning med andra mödrar. Fler träningstillfällen och ytterligare vägledning beskrevs kunna stärka S-E för träning på egen hand. Olika underlättande och hindrande faktorer påverkade om kvinnorna tränade på egen hand eller inte. Denna information kan vara till nytta för fysioterapeuter och barnmorskor för att främja fysisk aktivitet och träning efter förlossning. / BackgroundThe physical activity level decreases among many women during pregnancy and this decline may remain a long period of time postpartum. There is limited knowledge about the factors, such as self-efficacy (S-E) and barriers for exercise, influencing physical activity postpartum. ObjectivesThe aim of this study was to investigate how women with postpartum complications experienced group training in primary healthcare. The purpose was also to analyze their S-E for self-managed exercise and facilitating factors and barriers for exercise. Design and methodA qualitative descriptive study design was used. Five semi-structured interviews were conducted and analyzed with qualitative content analysis. ResultsThe informants described the impact of supervised group training and how self-efficacy and different factors, influenced self-managed exercise. They described individual exercise strategies, the importance of motivation and environmental factors affecting the exercise.   ConclusionDifferent positive aspects emerged regarding supervised exercise and exercise in a group with other mothers. To enhance S-E in individual exercise additional supervised exercise and further guidance were highlighted.Different facilitating factors and barriers for exercise affected whether or not the informants exercised on their own. This information can be of use for physiotherapists and midwives to promote physical activity and exercise postpartum.

The primary objective of this thesis is to evolve a method for assessing and developing features of a learning organization . To fulfill this, I approached the thesis by examining several research questions and using multiple research methodologies. The research questions were not all established at the outset. Rather, they evolved as features of a journey down a road less traveled. With this journey came the decision to write the thesis in the first person. The first research question was Q1: What will bridge the divide between organizational learning and the learning organization? By reviewing the extant literature on organizational learning and the learning organization, I developed a theoretical framework that linked these two streams. The framework suggests that the extent of divide between the two streams is determined by the extent of learning transfer. The learning transfer is affected by the learning barriers operating at the levels of learning (i.e., individuals, groups, and organizational). This led me to my second research question Q2: What are these barriers to learning transfer and how do they impact the levels of learning in the organization? I cumulated the dispersed literature on learning barriers, and synthesized the learning barriers into five key dimensions: Intrapersonal, relational, cultural, structural, and societal. I then used the Delphi technique on 17 individuals to investigate the impact of the learning barriers on the levels of learning. This generated two additional research questions. The third research question was Q3: How do individuals initiate a double-loop change? This deals with the little researched area of initiation of double-loop change whilst engaging with the interfaces at the levels of learning. I used multiple case studies to examine this question and found that individuals transit through four distinct stages when initiating double-loop change: 'embedded', 'embedded discomfited', 'scripted', and 'unscripted'. Once double-loop learning has been initiated at the individual level, it is important that it is transferred across the organization. Therefore, my fourth research question was Q4: How does a new shared understanding for a double-loop change develop across the organization? I did an in-depth, single case based investigation of an organization. Using Identity and Complexity theory perspectives, I tracked the evolving new shared understanding through four phases: de-identification phase, situated re-identification phase, transition phase, and identification with core ideology phase. The key insights from examining these research questions, particularly insights from examining Q3 and Q4, enabled me to suggest nine key organizational interventions necessary to overcome the learning barriers and develop a learning organization: Identifying, developing, and dispersing double-loop mastery; Enabling constructive contradictions; Creating a superordinate organizational identity; Building emotional intelligence (in individuals and groups); Ambidextrous leadership; Strategic support for experimentation; Promoting 'systems doing'; Accessibility of valid information; Institutionalizing scanning across industry boundaries. When these nine organizational interventions are implemented, they produce five new learning organization orientations: genetic diversity, organizational ideology, organizational dualism, organizational coupling, and strategic play. These five new learning organizational orientations provide the archetypes of the learning organization. I then developed an instrument to assess these five new orientations, and did a preliminary testing of the instrument. While aspects of my work overlaid with previous knowledge, new advances in knowledge were established by: Postulating a link between the streams of organizational learning and learning organization Synthesizing learning barriers into the five key dimensions, and investigating their impact on the levels of learning Understanding the stages of double-loop learning initiation by an individual, whilst engaging with the interfaces at the levels of learning Understanding the process of a new shared understanding evolving Postulating five new orientations of the learning organization