<p> Social workers in all care venues are increasingly responsible for clinical and case management services for people being treated with sophisticated medical interventions. Unfortunately, opportunities to aid in the promotion of quality of life (QOL), mental health, and informed consent are often not understood by social workers, other care providers, or patients. These missed opportunities may lead to attenuated effectiveness of medical interventions and negative impact on patients&rsquo; QOL. One such technological treatment is the implantable cardioverter defibrillator (ICD), a lifesaving therapy which carries risk to patients&rsquo; QOL. Moreover, patients frequently do not accurately understand the benefits, limitations, and possible risks associated with ICD therapy. A small body of literature exists addressing experimental and demographic groups at risk of QOL decrements among the ICD patient population, including those who have been shocked more than five times, older adults, female patients, and those who have experienced a life threatening cardiac event. A much more limited body of literature addresses the quality of some forms of patient educational activities and materials. No research to date has attempted to characterize potential relationships between patient information acquisition, treatment knowledge, and QOL/mental health outcomes in this patient group. </p><p> Using a cross-sectional survey of ICD patients being treated at the University of Colorado Hospital (UCH), this dissertation project uses a social-ecological approach to describe the media through which ICD patients learn about device therapy, how well they understand their treatment, QOL and mental health outcomes, and any relationships between these constructs. The project was conducted in iterative phases, including the creation of two new measures assessing patient informational media history and ICD treatment knowledge, a pilot survey of 100 randomly selected patients to assess the quality of the new measures, and a larger survey of the remaining 655 potential ICD patient participants. </p><p> A total of 205 ICD patients responded to the survey, with a mean age of 60.7 years (sd=14.53), 34.1% of whom identified as female, 10.2% of whom are African American, and 37.5% of whom live in a household with an annual income of less than $40,000. Findings from survey responses revealed both the viability of the new informational media history and ICD treatment knowledge measures, as well as broad use of a number of specific forms of media to learn about treatment. Older adult patients illustrated significantly lower treatment knowledge and use of fewer forms of informational media than their younger counterparts. Multiple regression analyses revealed significant relationships between patient history of having been shocked, health related depression, and QOL, but failed to replicate earlier findings linking these problems to demographic indicators. Each of these findings highlight opportunities for improved social work research and practice with ICD patients, including the need for improved patient education processes for older adults with these devices, and the importance of mental health status, particularly depression, to patient QOL.</p>

<p> The purpose of this project was to develop a grant proposal seeking funds for the implementation of a youth-led nutrition and education program utilizing the development and maintenance of a community garden. The participants will be youth from low income and minority backgrounds in San Diego, California. The service partners of San Diego Youth Services TAY Academy will have the opportunity to participate in this community garden program to learn about healthy eating habits, the risks of obesity, and food desert communities. </p><p> Through a review of the literature on obesity, food deserts, and community gardens the writer proposed and designed a youth-led community garden program. The writer explored potential public and private funding sources, which yielded the Robert Wood Johnson Foundation as a potential funding source. </p><p> The actual submission and/or funding of this grant proposal were not a requirement for the successful completion of this project.</p>

<p> Objective: Studies have shown that people often report stigma as a barrier to entering treatment for substance related conditions. This study attempted to determine whether if using stigmatizing language when referring to individuals with substance related conditions would perpetuate stigmatizing attitudes among social worker and other behavioral health professionals.</p><p> Methods: Participants were asked to read a vignette that contained one of two terms substance abuser or substance use disorder to rate their agreement with a number of related statements. <i>N</i> = 65, Master's level Social workers (25%) and other behavioral health professionals (75%). A likert-scale questionnaire with three subscales (perpetuator-punishment, victim-treatment, and social threat) was used to assessed whether the character was a social threat, able to regulate substance use, and should receive punitive or treatment option.</p><p> Results: No significant differences were found on the social-treat or victim treatment subscales. However, a difference was detected on the perpetuator-punishment scale. Those who responded to the substance abuser vignette in specialization Other were more likely to perceive the character as culpable.</p><p> Conclusion: Results from this study suggest that there is chance that it may matter how we refer to individuals with problematic substance and/or alcohol use. The term substance abuser may influence stigmatizing attitudes. </p>

<p> This curriculum was designed for older adults and their caregivers. The curriculum begins with an overview of the issue and addresses aging issues through six 3-hour sessions. The design was deliberate in nature to bring to light the importance of a social worker. It focuses on competence to work with families who seek caregiver model options, realities, and expectations of both the older adult and the caregiver, and what to look for in assisted living or aging in place. The importance of understanding cultural and spiritual aspects and their meanings in the caregiving process is emphasized. An extensive literature review identified various stressors among older adults and their caregivers and identified effective interventions to address their psychosocial needs based on evidence-based and empirically based research studies. This curriculum was designed to provide information and to bring awareness of the importance of empowerment of older adults and their caregivers. </p>

<p> The purpose of this study was to explore the decision making of family caregivers who were considering transitioning an older adult family member from independent living to an assisted living facility (ALF). A total of 15 caregivers were interviewed; 12 (80%) decided to place the older adult in an ALF and 3 (20%) decided not to do so. </p><p> This study found that the decision to place an older adult in an ALF was primarily due to the declining health of the older adult and safety concerns. All of the twelve caregivers who placed their family member in an ALF reported that they continued to be involved in caregiving after placement. Caregiver support groups and self-care were two interventions that participants described as most effective to support them during their caregiver experience. More research is needed on how to support family caregivers who are considering placement in an ALF.</p>

<p> The purpose of this project was to write a grant to implement an educational program for healthcare professionals employed by Kaiser Permanente (e.g., physicians, nurses, and social workers) on older adult sexual health. Topics would include the increased transference of sexually transmitted infections among the older adult population. The professionals would also acquire the tools needed to enhance their comfort levels when engaging in sexual health discussions with older adult patients. </p><p> The goals are to increase (1) the professionals' knowledge of sexuality and sexual behaviors among older adults and (2) their comfort levels when discussing sexual health with their older adult patients. A total of 2,100 healthcare professionals would participate during the funding period. The program would be evaluated by means of pre/post-testing of knowledge and comfort levels, as well as a satisfaction survey. The actual submission and/or funding of this grant were not requirements for the successful completion of this project.</p>

<p> The purpose of this project was to develop a proposed program, write a grant proposal, identify a funding source, and select a host agency for an educational program to educate skilled nursing facility staff members on alternative treatment options for people with Alzheimer's disease. A literature review was conducted in order to examine the history of Alzheimer's disease, prevalence and symptomology of the disease, and past, current, and alternative treatment approaches. The educational program will be located at Community SeniorServ, Inc. Senior Serve in Anaheim, California. The program will provide skilled nursing facility staff members with education on the harmful side effects psychotropic medications have on patients with Alzheimer's disease, and on innovative techniques to treat the negative behaviors associated with the disease. The actual submission or funding of this grant was not a requirement for the successful completion of the project.</p>

<p> African American older adults have historically been identified as vital members of the African American family and community (Hill, 1972; Cox, 2002; Waites, 2008). Unfortunately, research has shown an increasing number of older African Americans are being admitted into nursing facilities (Paul, 2004; Feng et al., 2011). Between the years of 1998-2008, it was projected African Americans living in nursing homes increased by 10.8% (Feng et al., 2011). This study explores the intergenerational relationships of older African American adults with their grandchildren, family, and community through the lens of Intergenerational Family Systems Theory. By viewing this qualitative study through the lens of Intergenerational Family Systems Theory, changes in the older adults&rsquo; kinscripts were analyzed to obtain a greater understanding of affects associated with nursing home relocation and the older adults&rsquo; relationship with their grandchildren, family, and communities since being admitted. By utilizing a grounded theory approach, this study has found key areas to influence future social work practice and research.</p>

<p>Healthcare provider practices around older adult sexuality are increasingly the focus of scholarship. Researchers use available scales to study health worker knowledge and behavior in their research. This dissertation argues the need for a new scale, because the available measures are dated and do not account for changes in attitudes and medical advances over three decades. After a review of the increasing role of physicians, social workers, and other health workers providing care for sexual issues throughout history, I describe available scales for measuring knowledge and behaviors about older adult sexuality and review research that employs them. The purpose of the dissertation was to develop a contemporary measure regarding older adult sexuality practices among health workers. I utilized a two-phase plan following Bowen and Guo&rsquo;s 12-step mixed-method approach for scale development (2012). Phase I included a literature review and qualitative interviews with experts on older adult sexuality regarding the construct. Then I created a universe of items, reviewed them with the experts, and revised items. In Phase II, I tested the items with 155 healthcare providers and conducted analysis for reliability and validity. Based on the analysis, I culled items to create a shortened scale. I proposed a scale consisting of 52 items with three subscales: a 25-item Knowledge subscale, a 13-item Attitude subscale, and a 14-item Behavior subscale. The Knowledge subscale showed poor internal reliability (<i>KR-20</i> = .625). The Attitudes (&alpha; = .825), and Behavior (&alpha; = .837) subscales showed good internal reliability. I also evaluated content validity and criterion-related validity for the subscales. Flaws in the methods and analysis make the 52-item proposed scale conceptually unsound. Limitations in generating the pool of items, evaluating the items, and testing reliability and validity did not produce a viable scale. I analyze problems with the methodological approach and propose a redesign that corrects for flaws in the approach employed here. I will use an inductive, social justice model that expands scale development to include interviews with practitioners and older adults. I conclude with a number of research, practice, and policy implications that will result from a redesigned scale. </p>

<p> The experience of anxiety and depression can have detrimental effects on the body, especially that of a developing fetus. Depression and anxiety have been linked to the experience of greater pregnancy symptoms, miscarriage, poorer birth outcomes and difficult deliveries. Despite their detrimental effects, depression and anxiety may be common during the prenatal period. A history of miscarriage may heighten normally occurring symptoms, adding a layer of difficulty to an already stressful time period.</p><p> Mind-body practices have been linked to a number of health benefits, including attenuation of psychiatric symptoms and improved pregnancy outcomes. While many of these practices have received increasing attention in popular literature, lacking are studies utilizing large, randomized clinical trials empirically validating the efficacy of these interventions.</p><p> The purpose of the original study was to examine whether miscarriage status and the engagement in mind-body practices were associated with lower levels of depression and anxiety in pregnant women. Forty-three (N=43) pregnant women in the second and third trimesters were recruited and questioned about their pregnancy, their engagement in mind-body practices (past and present) and were asked to complete the Center for Epidemiological Studies Depression Scale (CES-D) and the State Trait Anxiety Inventory (STAI). It was anticipated that women with a miscarriage history would report higher levels of anxiety and depression and that women engaging in mind-body practice, past or present, would report lower levels of depression and anxiety. When statistical analyses failed to yield significant results, this author chose to explore the process of generating new knowledge through autoethnography. This dissertation moved from an empirical study to a qualitative, autoethnographic exploration of pregnancy loss in which the themes of meaning making, personhood and the expression of feelings were explored through the literature, the author's personal experience and through participation in an online pregnancy loss support group.</p>