This study examines the predictive validity of the ASAM PPC-2R utilized within the state of Florida for the placement of substance abuse clients receiving treatment. Archival data collected by the Florida Department of Children and Families Substance Abuse Program Office from state fiscal years 1999 to 2001 of 458 clients were used in this study. The study sample of 458 was drastically reduced to 49 clients due to data collection inconsistencies of the state. Two Institutional Review Boards (IRBs) approvals were required to conduct this study. In addition to the educational institution, the second approval was needed because of the data source--the state government. The second IRB approval from the Florida State Department of Health contributed to collapsing the original sample size and restricting the use of demographic information, such as ethnicity, drug used, gender, age or race. The study proposed three hypotheses relating to treatment completion, readmission rates and time between treatment completion and readmission. The treatment completion rates were compared for clients placed in treatment in consistent with the ASAM recommended level of care, against those clients placed in treatment not consistent with the ASAM recommended level of care. Chi-square and the Yates' Correction for Continuity were calculated for the first two hypotheses. The null hypothesis was rejected for the first hypothesis at the 0.05 level with the original Chi-square calculation and at the higher 0.10 with Yates' Correction for Continuity. The results of the two Chi-square calculations for the second hypothesis rejected the null hypothesis at the 0.05 level. The readmission rates were also compared for clients placed in treatment in consistent with the ASAM recommended level of care, against those clients placed in treatment not consistent with the ASAM recommended level of care. Twelve percent of the clients were readmitted to treatment, but all had been initially assigned to treatment that was not consistent with the ASAM recommended level of care. Without a comparison group, the length of time between treatment completion and readmission was not examined. In review of the overall assignment of care, Outpatient treatment was the most frequently assigned level of care. Of the 49 clients in this study, 80% (39) were assigned to Outpatient treatment. Of this total, 36% were assigned to Outpatient consistent with the ASAM recommendations. The remaining 64% were assigned to Outpatient treatment, inconsistent with the ASAM recommendation. / A Dissertation submitted to the College of Social Work in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester, 2008. / November 12, 2007. / Substance Abuse, ASAM / Includes bibliographical references. / Bruce Thyer, Professor Directing Dissertation; Robert Lee, Outside Committee Member; Charles Figley, Committee Member.

This research study sought to understand parents? use of intuition in their parenting and how its use affects their sense of competence as a parent. Systems Theory and Phenomenology provided the foundation for this study. Metaphors were created for each participant to enhance the understanding of intuition. In-depth interviews were used to gather the data. Results indicated that parents use their intuition to help them make decisions in their parenting. The most common time for the parents to use their intuition involved the safety and well-being of their child(ren). Overall, the parents of this study agreed that intuition does help them in their parenting. Intuition as a process is discussed. As one acquires more experience and history, and becomes more adept at picking up subtle clues, one is able to build upon that foundation, which may lead to a spontaneous knowing. Intuition is also discussed as an internal safety system of the parent. Subsystems from this study included past experiences and/or history, subtle clues found in the environment, and emotional and mental thoughts. Subsystems from the literature included the physical level of intuition, and spiritual beliefs and thoughts. Suggestions for further research are made, including the idea for a study to create a concrete operationalized definition of intuition. A cross-cultural study might yield more information on how other cultures utilize their intuition. Suggestions for practice include the teaching of intuition at all levels of education. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester, 2004. / January 29, 2004. / Intuition, Parent Competence, Parenting / Includes bibliographical references. / Marsha Rehm, Professor Directing Dissertation; Charles Figley, Outside Committee Member; Barbara Allison, Committee Member.

Framed in social exchange theory, the purpose of this study was to investigate differences in relationship factors between virgins and non-virgins who are currently in romantic relationships. Data from 134 participants, 67 virgins matched with 67 non-virgins, were analyzed to determine differences in couple conflict level and management, communication, and relationship satisfaction. Results from a series of analyses of variance indicated that virgins and non-virgins differed only on 3 of 13 relationship constructs: psychological aggression, argumentativeness, and constructive communication. Specifically, non-virgins reported higher levels of psychological aggression and more arguments than did virgins, whereas virgins reported using more constructive communication than did non-virgins. In general, correlations between indicators of conflict and communication with relationship satisfaction were in the expected direction, with higher levels of communication and lower levels of conflict being associated with higher levels of relationship satisfaction. Testing the differences between correlations among conflict, communication, and satisfaction revealed four differences—a stronger correlation between physical assault and both relationship fulfillment and happiness, negativity and relationship contentment, and constructive communication and relationship contentment for the virgins compared with non-virgins. Limitations and implications are discussed, focusing on the need for continued research that explores the effect of virginity status on relationship factors. / A Thesis submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Master of Science. / Spring Semester, 2010. / April 5, 2010. / Relationship Factors, Romantic Relationships, Sexual Abstinence, Virginity / Includes bibliographical references. / Kay Pasley, Professor Directing Thesis; Ming Cui, Committee Member; Karen Randolph, Committee Member.

Despite passage of the 1997 Adoption and Safe Families Act, children prenatally exposed to alcohol, tobacco, and other drugs (ATOD) continue to languish in the child welfare system, partly because of misinformation and uncertainty regarding their outcomes. From a cumulative risk perspective, ATOD exposure is but one of many factors that together influence outcomes. This study is a secondary analysis of cross-sectional survey data collected from adoptive parents receiving subsidies for one or more adopted children. The sample includes 636 children ages 6 through 17. Temporal ordering of risk factors/predictor variables is used in the analyses with adoption designated as the intervention between pre-adoption moderation and post-adoption mediation. Structural equation modeling (SEM) is used because of its ability to handle complex analyses, which has positive implications for the richness of knowledge generated. Risk factors are examined individually and additively to determine degrees of moderation or mediation of the relationship between pre-adoption functioning (PAF) and post-adoption adjustment (PAA)—more risk factors are expected to result in greater effects. Hypotheses 1 states that few statistically-significant differences exist between prenatally-ATOD-exposed and non-exposed children. Hypotheses 2 and 3, respectively, indicate that the relationship between pre-adoption functioning (PAF) and post-adoption adjustment (PAA) is moderated by pre-adoption risk factors and mediated by post-adoption risk factors. The latent variable used to measure PAF is found to be a statistically significant predictor of PAA, producing good model fit. Few statistically-significant differences between prenatally-exposed and non-exposed children are found. ATOD exposure is found to be significantly associated with PAF, but not with PAA—an important finding supporting the notion that positive outcomes are possible despite early trauma. The experience of sexual abuse and number of placements, the two environmental factors, provided stronger individual moderation models than the two prenatal factors, ATOD risk exposure and sex. Due to the low occurrence of the environmental risk factors in this population, the moderation analysis identified a buffering effect. Adoptive parent's perceived stress provided the strongest individual mediation model. Two potential mediators, child age at survey and adoptive family risk index, did not function well as mediators in this analysis. The total cumulative moderation model had the best model fit supporting the concept of cumulative risk. The cumulative mediation model was penalized for the addition of factors that did not add to the model, resulting in poorer model fit. These findings provide critical information needed to address the multidimensional challenges associated with adoption of prenatally ATOD-exposed children. This study views prenatal ATOD exposure directly and as one of many factors influencing behavioral outcomes. Analysis found a lack of influence of prenatal ATOD exposure by itself on behavioral outcome, which is consistent with current research on prenatal exposure. This finding also is consistent with adoption research that finds time in a stable home environment improves child outcomes. Less apprehension regarding potential outcomes for prenatally ATOD-exposed children may facilitate increased adoption rates. Additionally, increasing the depth of understanding of cumulative risk effects may contribute to development of more effective policies and timely, age- and sex-specific interventions for ATOD-exposed children and their adoptive families. / A Dissertation submitted to the College of Social Work in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2007. / September 19, 2007. / Structural Equation Modeling, Child Welfare, Risk Factors, Prenatal ATOD Exposure, Adoption / Includes bibliographical references. / Scott D. Ryan, Professor Directing Dissertation; Akihito Kamata, Outside Committee Member; Darcy Siebert, Committee Member.

The present study examined the relationship between specific areas of family functioning and both family engagement in prevention services and youth delinquency involvement. Out of 308 families who initiated services with a non-profit agency during a calendar year, 147, who completed the Family Assessment Measure (version III): General Scale, were included in the study. Results of binary and multinomial logistic regression analyses indicated significant relationships between areas of family functioning and both family treatment engagement and youth delinquency involvement. In addition to demographic variables, communication, task accomplishment, and denial made significant individual contributions to one or more of the evaluated models. Implications for prevention services are discussed and suggestions are made for future research. / A Dissertation submitted to the Program in Marriage and Family Therapy in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2003. / October 9, 2003. / Family Dynamics, Engagement, Delinquency, Family Functioning, Delinquency Prevention, Family Patterns / Includes bibliographical references. / Thomas A. Cornille, Professor Directing Dissertation; David Quadagno, Outside Committee Member; Mary W. Hicks, Committee Member; Nicholas F. Mazza, Committee Member.

The cumulative effect of high incidence and long term nature of the consequences, lead to steadily increasing numbers of suffers of the effects of TBI (Burns & Cockrell, 1993). With immediate focus on the patient's physical and cognitive state, the relatives' needs go unnoticed. To date, no measurement instrument has been developed which assesses reactions of traumatic brain injury patients' relatives. The development of such an instrument, the Reaction to Brain Trauma Scale (RBTS) is the focus of this dissertation. The RB TS is a 19-item multidimensional scale scored on a 5-point Likert scale consisting of three domains. The main domain (reaction of relatives to brain trauma) is divided into sub domains of anxiety, depression and life satisfaction. The purposive, nonprobability sample (n = 279) was collected at the National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bangalore, India. Reliability was tested by determining the internal consistency of the instrument using Cronbachs' coefficient of alpha. Anxiety, depression and life satisfaction had reliabilities of .73, .81, and .79 respectively. Each sub domain had a low standard error of measurement (SEM). Anxiety and depression had 1.02 and .93 while life satisfaction had an SEM of 1.03. Strong evidence of factorial validity was found. Good convergent construct validity was found by correlating RBTS with three long established instruments, single item indicators and specific demographic indicators (relationship, duration and help received). Discriminant construct validity was demonstrated with correlations of RBTS with education, gender and income. / A Dissertation submitted to the School of Social Work in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester, 2003. / June 16, 2003. / Reaction Of Relatives To Brain Trauma / Includes bibliographical references. / Thomas E. Smith, Professor Directing Dissertation; Joyce L. Carbonell, Outside Committee Member; Neil Abell, Committee Member.

The researcher of this study used an applied developmental contextual framework to examine the predictors of the ethnic identity level in transracial, inracial, and interracial couple adoptees of African descent. The relationship between ethnic identity level and age, sex, parent-child relationship satisfaction, family functioning, perceived social support, and type of adoption were investigated through ANOVA, Pearson r Correlations, and Standard Multiple Regression analyses. The model significantly predicted ethnic identity level. The moderating effects of sex and type of adoption were significant. Implications regarding research, clinical practice, and policy were provided. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester, 2008. / April 25, 2008. / Interracial Couples and Adoption, Transracial Adoption, Ethnic Identity, Black/African American Adolescents and Adoption, Inracial / Includes bibliographical references.

Background. Grief is considered complicated when symptoms are found to predict long-term functional impairments resulting in a failure to return to pre-loss performance levels (Prigerson, Frank, et al. 1995). Objective. The objective of this study was to examine the relationship between self reported trauma, complicated grief, and depression among college students. Limitations. The study of the relationship between loss of a loved one, complicated grief and depression may be an indicator of a relation to other psychological and physiological disorders. The use of self-disclosure instruments to determine grief states is a design flaw because respondents in certain stages of grief may be in denial or do not realize their difficulty with grief issues. Method. The study group consisted of 144 college students from a large southeastern university. Complicated grief was measured using the Inventory of Complicated Grief-Revised (ICG-R), and depression was assessed by the Beck Depression Inventory (BDI). Outcomes were assessed by self-report and analyzed using chi-square tests, Fisher Exact tests, ANOVAs, and regression analyses to determine the significance of the relationships among variables. Results. Depression was found to be a predictor of complicated grief, traumatic distress, and the number of months of disturbing feelings since the loss. Impairment was found to be a predictor of depression, separation distress and traumatic distress. The regression analysis indicated that students with a traumatic loss of six months ago or longer accounted for the significance of depression as a predictor of traumatic distress. Implications. Complicated grief is a phenomenon that clinicians should be knowledgeable of and possess the proficiency to provide appropriate intervention. Traumatic distress and impairment were found to be highly correlated with depression. Conclusion. Trauma, complicated grief, and depression are positively correlated and all serve as predictors of impairment. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester, 2006. / April 27, 2006. / Traumatic Grief, Grief And Loss, Depression, Trauma, Complicated Grief / Includes bibliographical references. / Charles R. Figley, Professor Directing Dissertation; Maxine Jones, Outside Committee Member; Mary W. Hicks, Committee Member; Ann K. Mullis, Committee Member; Sally P. Karioth, Committee Member.

Research on adolescent substance abuse treatment effectiveness has grown in quantity, as evidenced by several review articles (Deas & Thomas, 2001; Muck, Zempolich, Titus, Fishman, Godley, & Schwebel, 2001; Williams & Chang, 2000). The results have shown substance use dissipates during treatment, but relapse to substance use occurs at high rates following treatment discharge (Catalano, Hawkins, Wells, Miller, & Brewer, 1991; Godley, Godley, & Dennis, 2001). Despite the heterogeneity of post-treatment outcomes, the likelihood of post-treatment relapse is often dependent on a number of variables, including whether or not the adolescent participates in continuing care services, such as self-help groups. However, there remains a dearth of empirical studies examining the use and effectiveness of self-help groups among adolescent outpatients. Therefore, this research examined the effects of self-help group meeting attendance among adolescents during the three-month time period immediately following publicly funded outpatient substance abuse treatment. Factors postulated within social-cognitive theory, social learning theory, group theory and included in cognitive and behavioral relapse prevention models were assessed to determine how they are influenced by self-help group attendance and whether these effects can be used to help explain all or some of these observed relations. The following research hypothesis was examined: at the end of the three-month time period following treatment, there will be no differences between male and female adolescents who attended self-help groups during that three-month time period and those who do not attend regarding substance use frequency, severity of substance-related problems, cognitive and behavioral factors (motivation, coping, self-efficacy), and social-environmental factors (social support, environmental risk). In addition, the following research question was incorporated: while controlling for gender and attending a self-help group, can severity of substance-related problems, motivation, coping, self-efficacy, social support, and environmental risk be integrated to predict substance use frequency? To examine the hypothesis and research question, a secondary analysis was performed using data from the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (CSAT) Adolescent Treatment (AT) 2008 Outcome Dataset. The final dataset focused on adolescent outpatients and key questions from the original assessment that addressed the hypotheses and research question. Variables of interest were constructed, using items from scales and indices that were part of the assessment. The secondary data were analyzed using PASW Statistics (formerly SPSS) and AMOS 18.0 software. Analysis of variance (ANOVA) revealed no differences in the mean scores between self-help group attendees and non-attendees at the end of the three-months following treatment on motivation, social support, substance use frequency, and environmental risk. However, differences existed for coping, self-efficacy, and severity of substance-related problems. In addition, gender differences were found when adolescents entered treatment, in that females presented for treatment with higher environmental risk and higher severity of substance-related problems. Path analysis was performed to test for the relationship of predictor variables in the model to the substance use frequency outcome variable. The findings revealed that higher severity of substance-related problems, higher coping, greater environmental risk, less self-efficacy, and no self-help group attendance during the first three-month period following treatment were the factors related to more substance use among adolescents in that period. In addition, environmental risk followed by severity of substance-related problems had the greatest total effects on substance use frequency following treatment. There were also some indirect relationships to substance use, as severity of substance-related problems had indirect relationships on substance use through risk, and coping; coping was indirectly related to substance use through self-efficacy; and self-help group attendance was indirectly related to substance use through environmental risk. Overall, this model fit well with the observed data (x2=15.71, df=13, p=.265, GFI=.995, AGFI= .983, RMSEA=.018). The model explained 40% of the variance in substance use frequency scores among adolescent outpatients. Several implications were identified regarding methodology, research, and clinical practice. In light of the findings is the clinical importance of linking adolescents to continuing care services, such as self-help groups following treatment discharge. The results suggested that attending self-help groups following treatment was beneficial for some adolescents in the short-term, particularly those with greater severity. A second implication is that environmental risk factors played an important role in substance use decisions following treatment. These findings suggested that attending self-help groups might be a potential strategy to decrease these risks, which in turn decreased substance use. Third, these findings highlighted the importance of examining post-treatment factors, which typically account for the majority of the variance in outcomes (Catalano et al., 1990–91; Latimer et al., 2000). Lastly, findings suggested that adolescent females responded similarly to substance abuse treatment and self-help groups when compared to males despite poorer initial clinical indicators. While the current study identified post-treatment factors that appear to underlie substance use relapse among adolescent outpatients, little is known regarding the way each of these factors was differentially associated with subgroups characterized by distinct substance use trajectories. Consideration of how these factors changed during the early recovery period is key to understanding how substance abuse treatments and continuing care strategies may impact adolescents differentially. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester, 2011. / March 22, 2011. / Adolescents, 12-step Groups, Self-help Groups, Substance Abuse Treatment / Includes bibliographical references. / Carol Darling, Professor Directing Dissertation; Nicholas Mazza, University Representative; Lenore McWey, Committee Member.

Purpose: The purpose of this exploratory study was to examine outpatient social work service utilization and associated costs among patients with combat-related polytrauma who received services at the James A. Haley Veterans' Hospital between 2007 and June 2011. Design and Methods: The research design is a retrospective cohort study using secondary data extracted from the Veterans Health Administration Medical SAS Outpatient and CPRS databases. The sampling strategy is purposive and nonrandom with a sample size of 265. Descriptive statistics and nnegative binomial regression modeling were used to address the research objectives. Results: Combat-related polytrauma patients had a total of 10,437 outpatient social work service encounters between 2007 and June 2011. Patients received 91 different outpatient social work service procedures for a total number of 8,564 outpatient social work service procedures. Unlisted evaluation and management services accounted for 51% of the diagnoses. Patients receiving outpatient social work procedures were coded with 115 different diagnostic codes for a total number of 3,457 diagnostic codes. Unspecified psychosocial circumstances accounted for 48% of the coding. Social workers were the largest providers of outpatient social work service procedures accounting for a total of 10,031 procedures. The total associated costs were $3,830,379. The rate of social work service encounters for females was 77% less as compared to men (IRR=.23), when controlling for age, ethnicity, marital status, mechanism of injury, and race. Married patients had a 48% lower rate of social work service encounters than single patients (IRR=.52), when controlling for age, ethnicity, gender, mechanism of injury, and race. Asian patients had a 37% lower rate of social work service encounters than white patients (IRR=.63), when controlling for age, ethnicity, gender, marital status, and mechanism of injury. American Indian patients had an 87% lower rate of social work encounters than white patients (IRR=.13), when controlling for age, ethnicity, gender, marital status, and mechanism of injury. Conclusions: Results suggest that there are disparities in the utilization of outpatient social work services at the James A. Haley Hospital between 2007 and June 2011. Healthcare providers and policy makers should be aware that female, married, Asian, and American Indian veterans with combat-related polytrauma are less likely to use outpatient social work services. Additionally, there are inconsistencies between the services provided by the Polytrauma Rehabilitation Center social work case managers and the way these services are coded. The highest frequencies for procedural and diagnostic coding are "unspecified". The provision of social work services need to be studied in order to maximize efficiency, cost-effectiveness, and the quality of care being provided to combat-related polytrauma veterans. Finally, results suggest the research studying the role of social work case management in the continuum of care is limited. Current studies do not specifically focus on veterans with polytrauma or TBI using social work services despite explicit policy directives indicating the essential role those services have within the continuum of care. / A Dissertation submitted to the College of Social Work in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Spring Semester, 2012. / March 26, 2012. / Case Management, Polytrauma, Social work, Traumatic Brain Injury, Veterans / Includes bibliographical references. / Bruce A. Thyer, Professor Directing Dissertation; Betsy J. Becker, University Representative; Stephen J. Tripodi, Committee Member.