Older adults with advanced metastatic lung cancer are faced with both poor prognosis and options for cancer-directed therapies very late into their disease trajectory. This trend of increasing chemotherapy close to death in older cancer patients continues to grow resulting in unmet psychosocial and existential needs at the end-of-life for patients who choose to continue cancer-directed therapies. The present study is grounded in an existential and social constructionist perspective which characterizes the either/or choice of late-stage cancer treatment or palliative care through a hospice program as an existential conflict within a context of socially constructed options for end-of-life care. This observational study examined differences among three groups of older advanced lung cancer patients (N = 30) to determine whether simultaneous care patients have better psychosocial and existential quality-of-life at the end-of-life than patients receiving only cancer-directed therapy or routine hospice care. Simultaneous care refers to a care model in which patients with late-stage cancer receive cancer-directed therapy and routine hospice services concurrently. Quality-of-life at the end-of-life represents developmental tasks and concerns associated with preparation for death and life closure. Participants were recruited from a Veterans Affairs Medical Center oncology clinic and a non-profit community hospice. Nonparametric statistics examined the study's primary hypothesis whether simultaneous care makes a difference in quality-of-life at the end-of-life compared to conventional care models such as cancer-directed therapy or routine hospice care. The primary hypothesis was not supported in the present study, although subgroup analyses based on demographic variables indicated statistically significant results. These findings support a sense of generativity, interpersonal connection, and having social support in which one can communicate substantial concerns or thoughts as important components of life closure. Methodological challenges within the present study reify cultural influences embedded in oncology practice and society as a whole that continue to support a taboo around dying and death. Efforts to integrate a hospice care model and cancer-directed therapy earlier in a cancer diagnosis face considerable challenges as a result of socially-constructed meanings of hospice. Further study is needed to determine which palliative care models can best meet the psychosocial and existential needs of older advanced lung cancer patients at varying points on the cancer trajectory. / A Dissertation submitted to the College of Social Work in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Degree Awarded: Summer Semester, 2011. / Date of Defense: July 1, 2011. / Advanced lung cancer, Quality-of-life, Palliative care / Includes bibliographical references. / Jean C. Munn, Professor Directing Dissertation; Kenneth Brummel-Smith, University Representative; Stephen J. Tripodi, Committee Member.

This research examined relations between parenting styles and children's social status. Seventy-eight families and their children from Boston, Massachusetts and Tallahassee, Florida constituted the sample for this study. To determine parenting style, parents completed the Parenting Styles and Dimensions Questionnaire, whereas children completed a peer-rating measure. This research also examined sex of parent, sex of child, socioeconomic status, and race as mediating variables. It was found that parenting styles did not relate to children's social status. The only variable that mediated this relationship was racial identity. Implications of these findings are discussed in relation to future research. / A Thesis submitted to the Department of Family and Child Science in partial fulfillment of the Requirements for the degree of Master of Science. / Degree Awarded: Summer Semester, 2004. / Date of Defense: June 9, 2004. / Peers, Social Status, Parenting / Includes bibliographical references. / Ronald Mullis, Professor Directing Thesis; Christine Readdick, Committee Member; Nicholas Mazza, Committee Member.

This study examined the relationship between exposures to a traumatic event and play behaviors of child witnesses to the World Trade Center terrorist attacks in 2001, using a subsample of 71 children from the NYC Young Children's Project (NYCYCP) interviewed 9-12 months after the event. Child Behavior Checklist broadband scales revealed little disturbance in the total sample. As expected, a larger percentage of children met alternative PTSD diagnostic criteria than DSM-IV diagnostic criteria. Through level of change in observed play behaviors in the exposed children, this study explored impact of a traumatic event. Analysis of the change in child play behavior in Pre-WTC mention and Post-WTC mention segments of the videotaped interviews revealed common themes in the play behaviors seen in other studies of trauma exposed children, such as aggression, anxiety, generalized fears, and event specific fears. This study describes strategies of self-soothing and self-regulation used by the children as they recounted their experience. The findings suggest that through play behaviors, young children are able to supplement verbal report and provide self-reported complex internalized affective experiences when impacted by traumatic experiences. Additionally, the study reveals that the children were impacted by their experience of the event 9-12 months later.

Decision-making in the field of child protection has been the subject of focused study for decades, propelled by repeated reports of its questionable reliability. Although researchers have examined the extent to which caseworker characteristics influence child protection decision-making, studies into the influence of caseworker motivation on decision-making is scarce. This initial study into the regulatory focus of child protection investigators adds to the nascent body of knowledge on the impact of caseworker motivation on the specific decision of whether to place a child in out-of-home care. Drawing from Higgins' (1997) regulatory focus theory this study seeks to explain, at least in part, why caseworkers make the kinds of decisions they do. It was hypothesized that child protection investigators' placement recommendations would be related to their regulatory focus generally speaking, and in more pronounced ways for investigators with a strong prevention focus. A sample of 100 child protection investigators employed by a large urban public child welfare agency participated in the study, in which workplace regulatory focus was measured using the Work Regulatory Focus scale. Participants were asked to read and react to two vignettes adapted from actual child protection cases. Following each vignette were questions regarding placement recommendations, assessments of risk, and emotional reactions to reading the vignettes. Socio-demographic information was also collected. Findings suggest a relationship between regulatory focus and placement recommendations, although test statistics at the margin of statistical significance and low power preclude definitive statements as to whether the null hypotheses can truly be rejected. Interpretation is made more difficult given the duality that characterized the regulatory focus of this sample of child protection investigators, with more than half of the sample scoring high on both the prevention and promotion subscales of the WRF scale. Implications for future research and practice are discussed.

This research explores factors associated with psychological well-being (happiness, depressive symptomatology, and anxiety) among three groups of older adults living in the community: the soon-to-be-old (ages 50-64), the young-old (ages 65-74), and the old-old (ages 75 and over). The study is framed within the conceptual framework of the stress and coping model and informed by socio-emotional selectivity theory, the life course perspective, and critical theory. Using a national U.S. sample of adults over age 50 (the Aging, Status, and Sense of Control data), this construct allows for analysis of respondents' subjective factors for promoting or maintaining their psychological well-being. Data analysis explores age group differences on psychological well-being outcomes among the three age groups. Major findings demonstrate that average levels of psychological well-being vary only slightly by age cohort with age group having no significant unique effect on explaining any dimension of happiness, depressive symptomatology, or anxiety. Factors associated with these outcomes vary among age groups with only two common predictors for two outcomes. The most powerful predictors for all age groups are the 1995 psychological well-being covariates; other predictors are distinct by age group. The results show that factors associated with psychological well-being fall in multiple areas suggesting a need for multi-component interventions unique to each age group to maintain and promote psychological well-being among older adults. Findings endorse the positive aspect of aging demonstrating that individuals can maintain and promote positive psychological well-being in later life. Insights into policy, program, and social work practice to promote well-being among the rapidly growing and aging segment of the American population are discussed. Study limitations and implications for future research are presented.

This study examined the influence of: 1) research experience; 2) knowledge and education; and 3) agency characteristics on providers' willingness to be involved in research and DEBI use. Grounded in an integrated theoretical framework of organizational and behavioral theories, this study used concurrent mixed methods for a secondary analysis of 20 in-depth interviews and cross-sectional surveys from 141 providers in New York City. Content analysis identified specific research tasks/procedures employed by providers involved in collaboration with researchers, according to whether they do or do not resemble service provision ("proximal") or ("distal"). Multivariate linear regression was applied to determine the influence of these tasks/procedures on willingness to be involved in research and use of DEBIs. The study showed that having been involved in proximal tasks was positively associated with providers' willingness to collaborate with researchers and with their use of DEBIs. Having been involved in distal tasks was negatively associated with providers' use of DEBIs. Providers' level of education, attitudes toward research, and agency capacity were positively associated with willingness to be involved in research. Providers' level of education, knowledge of DEBIs, and agency capacity were positively associated with use of DEBIs. This study demonstrates how proximal tasks/procedures and other modifiable factors (e.g., education, agency capacity, knowledge) may influence providers to use DEBIs. The findings may help inform: 1) best practices for research collaboration; 2) funding to involve providers in research; and 3) training for researchers and providers to collaborate.

This study explores the lived experiences of foster youth in participating in decisions about their lives while in care. Using a research methodology grounded in hermeneutic phenomenology, the study sought to identify the "essence" of this experience through careful analysis of the self-reported experiences of eight former foster youth. Fifteen themes emerged from the interviews with those young adults: (1) No Control; (2) Being Voiceless; (3) A Focus on Now; (4) Not Being Heard; (5) Settling; (6) Living a Public Life; (7) I Can Talk for Myself; (8) Being Spoken For; (9) Powerlessness; (10) Not Knowing; (11) No One Cares; (12) Alone; (13) Confidence; (14) Broken Promises; and (15) Acting Out. Some of these themes -- such as "No Control," "Being Voiceless," "Not Being Heard," "I Can Talk for Myself" and "Being Spoken For" -- echo findings from earlier literature that identified a lack of meaningful opportunities for foster youth to participate in important decisions about their lives while in care. A second group of themes -- "Settling" and "Acting Out" -- captured the study participants' experience in reacting to having few opportunities to contribute to decisions about their lives while in care. The themes in the final group -- "A Focus On Now," "Living a Public Life," "Powerlessness," "An Unclear System," "No One Cares," "Alone," "Confidence" and "Broken Promises" -- provide a more nuanced understanding of the experience of being involved in decisions about one's life while in foster care. Findings from this study suggest that foster children would benefit from having increased opportunities to be involved in decisions about their lives while they are in care. Such opportunities can be facilitated by ensuring frequent, meaningful interaction between foster children and their caseworkers and law guardians; encouraging foster children to attend court proceedings; moving toward a child-centered practice paradigm in child welfare services; respecting the due process right of children; and improving legal representation in dependency cases.

This dissertation examines youth participation in child welfare decision-making in the context of permanency planning family team conferences. It explores the factors that influence youth attendance and participation in decision-making opportunities. It also examines the strategies conference facilitators use to engage youth in decision-making in permanency planning family team conferences. The study employed a focused ethnography design, characterized by relatively short-term field visits, intensive data collection and intensive data analysis. Data collection included observations of permanency planning family team conferences, followed by in-depth interviews with young people and conference facilitators. Grounded theory conventions for data analysis, including initial coding, focused coding, theoretical coding, and analytic memos, were used. Data analysis focused on gaining a deeper understanding of how youth are incorporated into decision-making procedures, including a comparison of youth and conference facilitators' perceptions and experiences. It also explored the specific strategies facilitators used to engage youth in decision-making at the family team conference. The study findings demonstrate that youth attendance and participation in child welfare decision-making opportunities are influenced by the degree of relationship between youth and agency staff. Youth in the study valued workers who provided them with a combination of instrumental and emotional support. Factors that facilitated the development of a positive relationship with agency staff included, case continuity, non-judgmental listening, establishing trust, and transcending roles. Regarding facilitator engagement strategies, findings revealed two different facilitation styles: adult centric and youth centric. Adult centric facilitation placed adults at the center of decision making by failing to engage youth, silencing the youth voice, adopting the adult narrative, and going through the motions. Youth centric facilitation placed youth at the center of decision making by establishing trust, encouraging youth to speak, adapting the youth narrative, and demonstrating genuine care and concern. The facilitation styles are demonstrated through case illustrations and examples. The study's policy and practice implications, limitations and areas of further research are presented.

The elderly population is rapidly growing in all nations. With advanced age comes the risk for age-associated illnesses, such as disorders of dementia. People with neurocognitive disorders of dementia experience impaired cognition and require increasing support and care. They also experience numerous behavioral and psychiatric syndromes as these disorders progress. Their care needs are complex and multidimensional, causing great difficulty and high rates of burnout among informal and formal caregivers and subsequent premature institutionalization. Yet research aiming to discover methods for delaying costly institutional care of people with neurocognitive disorders has focused primarily on bolstering family caregiver capacities. Knowledge gaps pertaining to the use of formal services raise serious concerns. The capacity of the home health care service industry to adequately meet the needs of people living with cognitive impairment is highly questionable. This study adapts the Anderson-Newman Health Services Utilization Model and uses newly available health services survey data to make novel comparisons of service use and cost between consumers with moderate-to-severe cognitive impairment and those with little-to-no cognitive impairment. Previously unstudied agency characteristics are also examined in relation to service utilization, and multilevel analyses examine agency characteristics that influence the relationship between consumer cognitive impairment and service use. The findings of this study demonstrate that home health care consumers with moderate-to-severe cognitive impairment, as compared to consumers with little-to-no cognitive impairment, are less likely to have a spouse, their informal caregivers are more likely to be other family members, and they are more likely to be enrolled in health insurance programs for people living in poverty. They typically have more needs for care, more co-occurring illnesses, greater medical needs, and disabilities that are more severe and long-lasting. Home health care consumers with moderate-to-severe cognitive impairment receive services for many more days, including more medical and non-medical service visits, and are more likely to be readmitted to home health care as compared to their less impaired peers. Excess costs of service associated with significantly higher durations and intensities of service are more likely to be expended on multiple occasions because of readmission. This study also identifies compelling factors that significantly influence the relationship between cognitive impairment and service volume and cost. The most influential factor in determining service costs is the insurance program used to pay for services. Several other characteristics of provider agencies found to significantly influence the relationship between consumer cognitive status and service volume include the number of annual admissions, the size of the array of referral sources, the number of years in business, the provision of care, counseling, health, and social services, the number of full-time employees providing care services and health services, entry-level wages for home health aides, instrumental incentives offered to direct care workers, and retention rates for home health aides and personal care aides. These findings are used to inform recommendations for future research and policy efforts.

Foster care parents are key members of the foster care system and have an immense responsibility to provide a new home, and a healthy, clean and nurturing environment for children who have been removed from their own homes. Several studies have been conducted that discuss the risks and protective factors of foster care children, parenting skills and training, as well as retention strategies. However, only a few studies focus on the experience of foster care parents, specifically mothers, and what prompts them to take care of this defenseless population. A qualitative phenomenological study of 30 foster care mothers served by Episcopal Social Services of New York City was conducted to attempt to understand the unique experience of this group by identifying sources of support, family environment, experiences, satisfaction and cultural socio-environmental factors that have an impact on their role. This research included a first qualitative phenomenological study interviewing fifteen non-kinship foster mothers and a second qualitative phenomenological study interviewing fifteen kinship foster care mothers about their experiences. The interview questions and themes of these two studies are informed by an ecological systems framework. A caregiver stress and coping model, as well as role theory, were applied to understand foster mothers' and their view of their role versus the reality of what they experience, taking into consideration the influence of their non-kinship or kinship status. Among this group of foster care mothers, 20 foster care mothers identified as Latina encompassing the sub sample that was analyzed for the third study. The aim of this study was to understand how culture manifests among Latina foster care mothers. The research evaluates the role of empowerment theory and cultural constructs for this subgroup of Latina foster care mothers, and how both can be integrated into practice within the foster care system. The knowledge of the experience, challenges and views of foster care mothers elucidate important information for the provision of services and aid in the recommendation of interventions and future research for this population. Additionally, this research leads to suggestions to enhance recruitment and retention strategies within the foster care system. By studying foster care mothers, the researcher addresses an important gap in the literature and enhances current understanding of this population.