The Benefits of Trauma-Informed Social and Emotional Learning Curricula among Court-Involved Students Living in Congregate Settings
Henry Joel Crumé
This three-paper dissertation examined the use of a trauma-informed social and emotional learning (TI-SEL) curriculum among court-involved students attending a specialized public charter school co-located with a residential treatment center. The dissertation study used secondary qualitative and quantitative data gathered through a school-led community-based participatory research (CBPR) evaluation study. The three papers examined how the public charter school’s TI-SEL curriculum impacted school engagement among the school’s students and explored different critical aspects related to meeting the educational needs of the court-involved young people. The first paper, Chapter Two of this dissertation, is a qualitative analysis of focus group data collected with school staff members that examined how faculty viewed the strengths and challenges of using a TI-SEL curriculum to promote educational resilience among court-involved youth with complex trauma histories. The second paper, Chapter Three of this dissertation, is a quantitative analysis that focused on the importance of social and emotional learning competencies for school engagement. The third paper, Chapter Four of this dissertation, is a qualitative analysis that explored how students perceived their school engagement while living in an institutional setting. Together, these three papers analyzed the ways teachers, service providers, and students understood and benefited from a trauma-informed social and emotional learning skills curriculum. Chapter Five discusses implied related topics, the dissertation’s implications for social work practice, and proposes further research. This dissertation underscores strategies for facilitating school engagement, educational normalcy, and resilience for court-involved young people living in congregate care settings.
Uncertain Destinations: Characterizing the Role of Place in the Later-Life Experiences of Palliative Care Patients Experiencing Homelessness
Ian M. Johnson
Purpose: Homelessness is a pervasive social injustice that stems from the sociopolitical construction of disposable human life. The shifting age demographics of those experiencing homelessness in the United States exposes the shortcomings and barriers within homelessness response services and safety-net healthcare to address serious illness, disability, and age-related needs. Through a partnership with the only specialty palliative care program for people experiencing homelessness in the United States, the Research, Action & Supportive Care at Later-life for Unhoused Peoples (RASCAL-UP) study aimed to (1) identify barriers to care across a spectrum of services for unhoused people facing serious illness; and (2) examine residential trajectories of unhoused patients over the course of palliative care treatment. Methods: A constructivist grounded theory approach was taken. Retrospective chart review of palliative care patients (n=75) was paired with semi-structured interviews with service providers across healthcare and homeless response systems (n=30), as well as observation of palliative care meetings (n=12). Findings: An exploratory analysis of patient charts led to the identification of a 4-category qualitative typology of residential trajectories during palliative care enrollment. The Aging & Dying in Place typology showed sustained continuity of care within supportive housing. Providers described permanent supportive housing and low-barrier temporary accommodations as optimal lodging for people experiencing both homelessness and serious illness, due to the relative privacy, autonomy, and peer and community support they offer. Some of these locations, such as Tiny Villages, offer modularity, allowing for personalized adaptations. However, increasing system strains promote burnout among staff and limit supply. There are accessibility barriers in supportive housing, emergency shelters, Single Room Occupancy sites, and hotels and challenges in partnership with health and caregiving services. The Frequent Transitions typology was developed for patients who were unable to establish continuity of care during their palliative care enrollment, moving between locations on the housing care continuum, healthcare institutions, jail, and street-based settings. In these cases, health and housing systems were not able to adequately patch together care. The third typology, Healthcare Institutions as Housing, identified a set of patient experiences characterized by long-term hospitalizations and skilled nursing utilization. Health services within homeless systems, like medical respite, were designed to assist with acute and temporary issues and faced limitations in serving people with aging-related health issues or chronic serious illness. Medical providers noted that access and admission to long-term care services were influenced by system strain and capacity, financial disincentives for taking dual-eligible (i.e., Medicare and Medicaid qualified) patients, perception and stigma of unhoused populations, and limited knowledge of harm reduction, serious mental illness, and trauma. Providers noted the pervasive ideology of punishment as a form of health motivation, and how health policy and practice is not low-barrier. The fourth typology, Housing as Palliation, illustrated a pathway in which patients secured housing later in their illness trajectory, suggesting their prognoses and symptoms activated a system of support for older, disabled, and/or seriously-ill people that isn’t available until one is deemed most-vulnerable. Discussion: This study offers an initial framework for understanding how current systems of care fall short for people facing simultaneous homelessness and serious illness, and opportunities to address housing and health service gaps. Potential advances in closing the gap between health and housing services include incentivized interdisciplinary, cross-system education, training, and consultation that focuses on both homelessness and palliative care, as well as mobile health and low-barrier housing interventions that attend to chronic and high medical acuity. Researchers can contribute implementation science tools to measure and translate the innovative aging and health programming and services emerging in the spaces where housing care continuum, healthcare, government aging and disability services, and community mutual aid intersect.
Exploring the Ambivalent Relationship Between Social Media and Youth Sociopolitical Development: A YPAR Project with Youth Organizers
Sociopolitical development (SPD) is an emerging set of theories for the process by which youth develop knowledge, skills, and capacity for critical social and political action. Adolescence is an important time for SPD; and it is a powerful protective and promotive factor for marginalized young peoples’ social, emotional, academic, and political well-being. SPD can also lead to stronger social movements that interrupt oppressive systems/practices that are embedded into U.S. institutions (e.g., education, housing, political systems, healthcare, etc.). Over the past two decades, social media has come to play an essential role in youth social, emotional, and political development. It has also played a vital role in numerous youth-led social movements over the past decade, such as #BLM, March for Our Lives, and the global youth climate strikes. Despite social media being an essential part of multiple domains of youth development and political participation, it is often neglected in the study of youth SPD. What we do know about the relationship (which has mostly been explored with young adults) is really ambivalent and has signaled a complex relationship with critical consciousness and the health of social movements.
Our understanding of youth and technology shapes how adults relate to youth across education and practice settings. This includes how families, service providers, and educators incorporate technology into their work and the policies that can contain and restrict youth behavior or technology use. Additionally, in previous local YPAR projects, youth organizers communicated the need for a better understanding of how to create healthier relationships to social media and how to strategically use social media for their organizing work.
Social media is an increasingly central space for young people to develop their sociopolitical identities and engage in sociopolitical action. With a better understanding of social media’s relationship to youth SPD, we can better integrate social media as a protective and promotive tool in various youth learning and practice contexts while also working to mitigate the adverse effects of social media on youth SPD. This dissertation outlines a participatory action research (YPAR) project to explore the relationship between social media and youth sociopolitical development. The overarching research questions are: (1) In what ways does social media facilitate youth sociopolitical development, and (2) in what ways does social media limit, or even act counterproductive to, youth sociopolitical development? I applied case study and virtual photovoice research methodologies to address these questions. All analysis was done collaboratively amongst the YPAR collective.
This dissertation highlights three important products of this work. First, it shares the results of the YPAR collective’s theoretical and conceptual work. We critically examined normative assumptions of what youth SPD is and collaboratively constructed a definition that is rooted in youth organizers’ lived experience and folk theory. The collective’s work is largely compatible with current models of youth SPD but offers additional insight into key social and emotional elements, and further operationalizes key elements in a way that race, power, privilege, and oppression are centered. The young co-researchers' conceptual definition served as an anchor for our study and makes an important contribution to the field of youth SPD.
Then, the YPAR collective addresses the overarching dissertation research questions using the virtual photovoice data. The guiding research questions were: (1) In what ways does social media facilitate youth sociopolitical development, and (2) in what ways does social media limit, or even act counterproductive to, youth sociopolitical development? Using activity theory as an analytical framework, we identified a total of nine important contradictions, conflicts and tensions in the relationship between social media and youth SPD. They identified ways that they, and other young people, work through those issues, and assessed the impact of their actions on youth SPD.
This dissertation outlines the findings for two of these issues. These were highlighted as most prevalent and relevant to how they saw social media interacting with youth SPD. First, the collective explores some of the ways that social media facilitates SPD by increasing accessibility of critical learning, communities, and opportunities for critical action. However, youth researchers note that while social media increases accessibility, social media also amplifies gatekeeping and unhealthy boundary setting in ways that are detrimental to youth SPD. Then, the youth researchers note specific ways that social media facilitates a deepening of critical awareness and analysis, but that social media also contributes to oversimplification, reduction of complex ideas and identities, and echo chambers.
I close by discussing the implications these insights hold for social media policy, digital literacy interventions, and community organizing. I also identify future directions for research, including an exploration of the other seven themes, and additional cross-case comparisons that may provide insight into other questions around social media and healthy youth development. The collective also reflects on how the YPAR project has transformed their critical consciousness development, organizing strategy, and social media use. Planning for translating our findings into action was also discussed.
Minimum Wage Increases and Child Support Payments: A Secondhand Anti-Poverty Regime
Anita Louise Rocha
Background and Purpose: By 2010 in the United States, approximately 11.3 million cases owed over $110 billion in back child support. The accumulated debt from unpaid child support may be due, at least in part, to non-custodial parents’ inability to afford it. The setting of order amounts relies on a set of assumptions which may not reflect the reality of low-earnings, non-custodial parents, like uncertainty in wages and intermittent workforce participation. Even attempts to improve economic conditions for the lowest-wage workers, like a local minimum wage increase, may have uncertain effects on non-custodial parents’ earningss and thereby, their ability to pay child support. Could a local minimum wage increase be followed by an alteration in the number of hours worked, earnings, and the amount of child support paid by low-earnings, non-custodial parents? Analyzing data from a cohort of low-earnings, non-custodial parents (NCPs) from 2010 through 2016, both those working in jurisdictions with local minimum wage increases (Seattle, Tacoma, SeaTac) and those working in other areas of Washington state, findings from this study could inform policies that support families which depend on financial support from a non-resident parent.
Methods: With Washington State administrative data from 2010 to 2016, I examine over 70,000 low-wage, non-custodial parents, all of whom have active child support orders around the time of an increase in local minimum wages. As a longitudinal cohort study, I use a difference-in-difference approach to compare parents who worked in jurisdictions subject to local minimum wage increases to those who did not. Using interrupted time-series models with propensity score weighting, I examine outcomes involving hours worked, earnings, and child support payments before and after an increase in a local minimum wage.
Results: Relative to NCPs not exposed to a local minimum wage increase and after the implementation of Seattle's minimum wage ordinance, exposed NCPs saw a 5% decline in the chance of having any job in a quarter. They also saw a 14-hour reduction in the expected mean number of hours worked per quarter. a drop averaging about 1 hour per week. Even with a small increase in expected mean hourly earnings of $0.05 per hour, NCPs saw a decrease in expected mean earnings of $260 per quarter, about $20 per week. Finally, there was a change in predicted percent of child support paid after a minimum wage increase, depending on NCPs’ earnings level. Those earning less than $2,700 showed as much as a 1 percent increase in child support paid, while those at higher earnings levels had up to a 1 percent decrease.
Conclusions and Implications: While many factors influence consistent and full child support payments, results in this study suggest that a local minimum wage increases can lead to a decrease in hours worked, earnings, and child support payments among non-custodial parents, at least in the short-term. A decline in child support payments was only evident among those with higher earnings, and the change was small, approaching 1 percent of the order amount. Rather than statistical significance, my conclusions, therefore, rest on questions of practical significance. Will the magnitudes of these shifts change in any real way resources available to children whose families are dependent on child support payments? This prompts a discussion of what constitutes substantive material support for children.
Understanding the Service Needs of Gang-Involved Youth: Social Identity and Ecological Influences on Health Decision-Making
Asia Sarah Bishop
Gang-involved youth experience multiple forms of marginalization and are members of communities experiencing significant health disparities (e.g., youth of color, poor). Yet, research and policy narratives routinely center delinquency, violence, and legal system intervention with limited attention to health and well-being. To develop relevant and responsive service approaches to address needs and reduce disparities, research is needed to examine how and why health varies within the youth gang population. Broadly informed by social ecological, social determinants of health, and health lifestyle frameworks, this dissertation used multiple methodologies to examine health experiences among gang-involved youth. Methods: Paper 1 was a scoping review of 65 studies to understand how researchers are currently approaching the gang-health link. A thematic analysis was undertaken to explore how and why health variation might emerge within the gang context. Papers 2 and 3 utilized latent class analysis to test for unobserved health decision-making profiles among a statewide, school-based sample of self-identified youth gang members. Quantitative analyses also examined how emerging health profiles differentiated according to youths’ social identities and living contexts. Results: The review illuminated key gaps in our current understanding of the influence of gangs and gang membership on adolescent health. Authors of the reviewed studies theorized that gangs represent social-cultural contexts where norms and values shape health behavior, and that these norms and behaviors may often be gendered in nature. Despite this theorizing, few studies operationalized gang context measures beyond individual membership. Additionally, authors frequently took an ecological approach in their theorizing, citing neighborhood and family influences as important for youth gang members’ health. Yet, the potential mediating role of gang membership in the environment-health link was neglected in analyses, and few studies examined how ecological factors help explain health variation within gangs. The quantitative analyses of this dissertation tested for, and found, distinct profiles of sexual and physical health decision-making. For both sexual and physical health, a pattern emerged whereby youth of color and those identifying as LGBQ were disproportionately represented in profiles characterized by fewer health promoting behaviors and greater environmental adversities (e.g., poverty, housing instability, limited health care access, violence exposure). Gender varied, with males represented in riskier sex profiles and females in poorer physical health profiles. Discussion: Findings suggest that health disparities exist among gang-involved youth, and that these disparities may be attributable to youths’ ecological contexts. Findings have several implications for research and practice. First, gang-involved youth are a heterogeneous group with respect to health, and flexible service approaches are needed. Second, heterosexuality within youth gangs is not universal and those who identify otherwise may be at heightened vulnerability for adverse health, highlighting the need for intersectional approaches to research and practice. Third, the structural and environmental drivers of gang membership (e.g., racism, poverty, neighborhood violence) are also undermining health for these youth, indicating the need for an intentional research and policy focus on macro- and meso-level factors. Conclusion: Youth gang membership in the U.S. is highly racialized, and emerging research suggests that youth gangs are gendered and heteronormative. Failing to attend to the health challenges of, and within, this population represents a complex, yet pressing social justice issue. Addressing health disparities for gang-involved youth will require research and practice frameworks with a multilevel focus on healthy development, issues of intersectionality, and the structural and environmental drivers of adverse health.
It Does Matter for Us, Too: Implications of Digital Divide Among Older Americans
In the U.S., older adults have long overrepresented a digitally marginalized group who did not fully benefit from the digital lifestyle. Despite the rapid adoption of digital technology, the digital divide among older adults is still critical. About four out of ten older Americans, aged 65 or older do not have Internet access in 2021.
Nevertheless, relatively little public attention has been paid to the digital divide among older adults and its impacts since they were not the primary consumers in economic growth driven by digital technologies. This dissertation project aimed to expand knowledge in the determinants of older adults' engagement in digital lifestyle and the impacts of the digital divide on their wellbeing through a series of three cohesive research papers, analyzing data from the Health and Retirement Study (HRS).
The first part of the dissertation explored the digital divide among older Americans, seeking a better understanding of the role of stereotypes on older adults assimilated from surrounding cultures. Drawing on resources and appropriation theory and stereotype embodiment theory, paper one investigated the relationship between older adults' self-perception of aging and regular Internet use. The results from logistic regression show that the higher level of the negative self-perception of aging was positively associated with no regular internet use. The results were in line with another critical argument from the resources and appropriation theory, indicating socioeconomically marginalized groups with limited resources were less likely to use the Internet.
Based on the implications from paper one, the study expanded its scope to the impacts of the digital divide on older adults' health and wellbeing. The second paper examined the association between older adults' regular Internet use and the likelihood of new-onset mild cognitive impairment (MCI), employing survival analysis techniques with longitudinal data from the HRS study waves from 2002 to 2016. Following the core arguments from the cognitive enrichment framework, the paper posited regular Internet use as a mentally stimulating activity that might help maintain or stimulate older adults' cognitive function. The study found that older adults who regularly used the Internet during the prior study year showed a lower likelihood of new-onset MCI than non-Internet users.
The last part of the current study investigated the relationship between digital technology as a social communication tool and older adults' subjective wellbeing. Specifically, paper three examined the association between older adults' social network services (SNS, i.e., Facebook, Skype, and Twitter) and perceived loneliness mediated by perceived social support and dispositional optimism. The study found that a more frequent SNS use might be associated with a lower level of loneliness, mediated by perceived social support. In addition, older adults with a higher level of dispositional optimism, indicating those who were optimistic toward their life, were more likely to frequently use SNS and perceive a higher level of social support from the SNS use than those who were pessimistic.
In brief, the current study found that the digital divide among older Americans was significant, while engagement in digital lifestyle might positively affect the population group's health psychological wellbeing. In addition, this study found that older adults' engagement in digital lifestyle might be affected by various psychological factors, indicating older adults might have a different level of willingness or reluctance to adopt digital technology based on their experiences over life.
Based on the findings, the current study provides policy and practice suggestions and future research to close the digital gap among older Americans. First, Digital technology training for older adults should be supported by policy and law. Second, Programs to support Internet connectivity of low-income groups, such as Emergency Broadband Benefits, a temporary program to mitigate economic hardship due to COVID-19, should be extended and further expanded to more population groups. Third, policymakers and practitioners need to understand psychological traits and attitudes toward digital technology shared by the older adult population groups to implement better the policy options mentioned above. Future research needs to investigate further psychological factors associated with older adults' reluctance or willingness to engage in digital lifestyle and causal relationships between digital technology uses and various health or psychological outcomes.
The Availability and Generosity of Medicaid Home & Community Based Services for Economically Vulnerable Older Adults: State Differences and Their Relationship to End of Life Outcomes
Most older adults express a wish to age and die in their homes, yet without a support system at home that could provide comfort and security, this can be impossible due to high needs for assistance with self-care and mobility activities, high symptom burden and low functioning at the end of life. The care needs of economically vulnerable community dwelling older adults can be addressed via Medicaid 1915(c) waivers that provide home and community–based services (HCBS). Medicaid 1915(c) waivers reach the most economically vulnerable older adults - who are commonly known as Medicare/Medicaid dual eligible older adults – and provide services that can help with symptoms, with housework, with daily activities, with caregiver support and with home safety. There is no federal policy regulating Medicaid waiver programs and 1915(c) waivers are offered at the discretion of the states. As a result, states dramatically vary in their availability and generosity, which may create disparities in the end of life experiences among dual eligible older adults based on the state they live and die in. Aims: This dissertation aimed to investigate the state variation in Medicaid 1915(c) waiver availability and generosity to provide HCBS to dual eligible older adults, and to explore the association between state variation in availability and generosity of Medicaid waivers and end of life experiences of this sample, such as unmet needs with self-care and mobility activities and quality of end of life. Methods: To answer the first aim of this dissertation, a policy analysis was conducted to explore availability and generosity of 1915(c) waivers utilizing three datasets, namely waiver application documents located at CMS.Medicaid.org, the Medicaid Analytic Extract - Other Services (MAX-OT) dataset, and Genworth State Cost of Care Survey 2013. For the second aim, the National Health and Aging Trends Study (NHATS) (Wave 2-7, 2012-2017 was utilized. Drawing on unmet need and quality of end of life measures from NHATS, variation of the outcome variables was examined by socioeconomic characteristics, severity of illness and impairment factors, end of life indicators and waiver availability and generosity variables. Results: This dissertation found that there is a variation between the states in available services, coverage for target groups, service slots available, ability to direct participants’ own care and generosity. The second part of the dissertation examined the end of life experiences of dual eligible older adults and found that 40.26% of the sample had any unmet needs with self-care and mobility activities and 56.07% had a low quality of end of life. Unmet need for assistance was found to be associated with dementia, not having participant direction option, lower numbers of waivers available and less generosity for homemaker and adult day services. Low quality of end of life was associated with living alone, higher numbers of chronic diseases, receiving hospice, nursing facility placement during the last month of life and less numbers of available slots for the 1915(c) waivers. Discussion: This dissertation showed that community dwelling dual eligible older adults nearing the end of life experience unmet needs with self-care and mobility activities and low quality of end of life, such as high symptom burden and lower functioning. The findings indicated that 1915(c) waivers should provide participant direction more often and tailor their services for older adults with dementia due to their higher risk for unmet needs. Generosity for the services and slots available for dual eligible older adults were also associated with end of life experiences of this sample, therefore Medicaid waivers should increase their generosity and slots to better meet the needs of economically vulnerable older adults at the end of life.
Statutory Inclusion: An Evaluation of Mental Health Among Lesbian, Gay, and Bisexual Military Personnel Following the Repeal of “Don’t Ask, Don’t Tell”
Thomas O. Walton
Lesbian, gay, and bisexual men and women have served in the U.S. military since this nation’s founding despite the many forms of marginalization denying their existence. Formal sanctions have ranged from imprisonment to dishonorable discharge while the hetero-masculine mandate of military culture has consistently targeted and maligned homosexual behavior and identity. The minority stress perspective explains how these multiple layers of discrimination are likely to harm the mental health of lesbian, gay, and bisexual service members (LGB SMs). The 1993 law, commonly known as “Don’t Ask, Don’t Tell,” was meant to lessen the deleterious effects of anti-gay sentiment in the military. Unfortunately, it did the opposite, increasing tensions and incidence of harassment. The law also prevented the military from collecting data on LGB SMs. Until 2011, when the law was repealed and LGB SMs gained the statutory right to serve, it was not possible to study the well-being of this long-silenced population that is likely to be at high risk of adverse mental health outcomes. However, few studies have yet to explore the needs and experiences of LGB SMs.
This three-paper dissertation is one of the first studies using a large representative sample of the active-duty force to investigate mental health, social support, and barriers to treatment among LGB SMs.
METHODS: A secondary analysis is conducted using data from the 2015 Department of Defense Health Related Behaviors Survey – the first wave of this longitudinal study to collect data on sexual identity. The first two studies of this dissertation use the full sample of 14,405 active duty personnel who completed the survey item on sexuality, of which 863 (6.0%) self-identified as lesbian, gay or bisexual. In the first study, a series of logistic regressions describe the prevalence of adverse mental health outcomes, exposures to physical and sexual abuse, and suicidality among subgroups based on gender and sexual orientation. The second paper uses a structural equation model to assess the indirect effects of LGB identity on mental health as mediated by social support. The final paper takes a subsample of only those respondents who were identified as having an unmet need for mental health treatment (n = 1,237; LGB n = 95, 7.7%) and compares barriers to treatment experienced by LGB SMs to those of their straight peers.
RESULTS: The first paper revealed that bisexual men and women serving in the military have significantly greater prevalence of adverse mental health outcomes compared to their same-sex straight peers, with disparities most notable among bisexual women. Lesbian women did not significantly differ from straight women on measures of mental health or trauma exposures while on active duty, while gay male service members were found to have significantly lower prevalence of some mental health measures compared to straight males despite being significantly more likely to experience unwanted sexual contact. Results of the second paper are consistent with other studies showing the importance of social support as a mental health buffer. Lesbian identity did not affect social support, however gay male identity did have a moderate negative impact on social support with indirect effects on adverse mental health. The final paper found prevalence of concern about confidentiality and mental health treatment harming one’s career to be greater barriers to care among LGB SMs compared to their straight peers, yet prevalence of stigma-related concerns were significantly lower among LGB SMs.
CONCLUSION: Together, these studies are a first step toward what should be a growing body of literature on the health, well-being, and welfare of LGB SMs. The most immediate implications are to support those found to be in greatest distress – bisexual female service members. Military clinicians should discuss LGB identity and adjust treatments accordingly, while military health leaders should develop campaigns to clarify and reaffirm the right to confidential treatment. Additional interventive implications and the possibility that changing cultural norms may be benefitting gay male service members are discussed. LGB SMs will benefit from ongoing attention from both military and civilian investigators who will also need access to data on transgender and nonbinary service members if the military’s mission of inclusion is to be achieved.
Between International Policy and Local Practice: Negotiating Meaning and Strategies to
Address Domestic Violence in Nepal
Claire C. Willey
In recent decades, domestic violence (DV) has gained traction as an international concern. The Beijing Platform for Action (BPfA) outlined steps that governments should take to live up to commitments expressed in the ratification of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and, largely in response to national women's movements, laws against DV have been passed in 144 countries. However, in low-income countries such as Nepal, policymakers and donors concentrated in wealthier (often Western) countries have disproportionate influence on DV policy and practice, both through international treaties and policies, and through donor funding priorities. Nepali activists and service providers working both within and outside of government run organizations play a crucial role in the translation of international and national policies into local practice. Yet, in this context, two enduring questions are the degree to which international policies reflect and respond to local knowledge and experiences, and how knowledges grounded in local practice can meaningfully inform international DV policy. This dissertation explores these questions across three papers: one theoretical and two empirical papers. The empirical papers are based on fieldwork conducted with DV service providers in Pokhara, Nepal across two summers (2015, 2018). It is informed by my situatedness as a white American daughter writing from a U.S.-based research institution and a Nepal buhari (daughter-in-law) with experiences living and working in Nepal.
Given the complex structures of power that shape—and are reproduced through—colonial knowledge production practices, the first paper outlines major contributions of postcolonial theory for epistemic justice in international social work research. This paper suggests three research strategies that extend from postcolonial theoretical insights: reflexivity, critical discourse analysis, and postcolonial translation. Subsequent papers apply these strategies to the analysis of Nepali-language interviews and focus groups with DV service providers in Pokhara, Nepal. Paper two employed critical discourse analysis to compare service providers' constructions of DV with those forwarded in major international policy documents (BPfA & CEDAW). The analysis revealed that service providers constructed DV both through an analysis of systemic oppression and through recognition of the centrality of family for individuals' economic and social well-being, as well as for their legal standing as rights-holders in Nepal. Given these findings, the third paper explored community strategies that have been employed to address DV. This analysis revealed that service providers understood these strategies broadly, to include strategies used by women and marginalized groups to shore up their own resources, strategies used to promote gender and other forms of equity in the wider society, and strategies used to engage and/or confront those using DV. The results of this dissertation not only elucidate contextually and culturally responsive DV practice in Nepal, but also challenge dominant international assumptions about what it means to address DV.
Developing and Validating a Behavioral Framework for Dementia Care Partners' Fall Risk Management
Older adults living with dementia (OLWD) experience nearly two to ten times higher fall risk than older adults without dementia. Despite this, evidence is limited concerning effective fall management strategies for them. Care partners (broadly defined as relatives, partners, and friends) play a critical role in managing the fall risk for community-dwelling OLWD. However, it is unclear what behaviors dementia care partners adopt are relevant to fall risk management (FRM) and how these behaviors are associated with fall-related outcomes for OLWD. This dissertation utilizes an exploratory sequential mixed method study design to develop and validate a behavioral framework for dementia care partners' FRM.
This first paper proposes a behavioral framework for dementia care partners’ FRM using a grounded theory approach and semi-structured, in-depth interviews with 14 care partners of community-dwelling OLWD. This paper makes a distinctive contribution by identifying eight domains of dementia care partners’ FRM behaviors (1. functional mobility assistance, 2. assessing and addressing health conditions, 3. health promotions support, 4. safety supervision, 5. physical environment modification, 6. receiving, seeking, and coordinating care, 7. learning, and 8. self-adjustment) across four stages of FRM (1. providing support before dementia diagnosis, 2. preventing falls, 3. preparing to respond to falls, and 4. responding to falls).
The second paper validates this behavioral framework by using two linked national surveys, the National Health and Aging Trends Study (NHATS) 2015 and the National Study of Caregiving (NSOC) 2015, to examine the prevalence and dimensionality of care partners’ FRM and to compare the differences between primary and secondary care partners. The exploratory factor analysis (EFA) approach under the item response theory paradigm is utilized to examine the dimensionality of FRM behaviors. EFA results illustrate the complexity of two domains of FRM behaviors that emerge from the first paper: receiving, seeking, and coordinating care, and assessing and addressing health conditions. These discrepancies illustrate the need to explore different mechanisms, facilitators, and barriers for care partners navigating multiple care systems and service providers and addressing different types of health conditions for managing OLWD’s fall risk. Furthermore, this study identifies similarities and differences between primary and secondary care partners that may inform the development of different strategies to engage care partners based on their caring roles.
Informed by this validated framework, the third paper focuses on assessing fall risk reduction for community-dwelling OLWD associated with receipt of FRM support from their care partners utilizing longitudinal data NHATS 2015-2016 and the linked care partner data NSOC 2015. Study findings from this paper highlight the importance of care partners’ medication management, wound care, learning behaviors, accessing formal social care, and physical environment modifications in potentially reducing the risk of falling for community-dwelling OLWD. The study also found that certain FRM behaviors, including functional mobility assistance, health promotion support, and medication management might be associated with a higher risk of falling for OLWD.
Overall, the findings from this dissertation yield contribution to both practice and health and social behavior science inquiries. The dissertation addresses the need for a behavioral framework to understand care partners’ FRM and assess the contributions and limitations of care partners’ efforts. Future interventions can be developed by applying this framework to engage dementia care partners.
Dissertation: “You Don’t Look Anorexic:” A Mixed Methods Study of Weight Stigma and Healthcare Experiences in a Diverse Sample of Patients with Atypical Anorexia
Erin Nicole Harrop
“Atypical anorexia” (AAN) is an eating disorder (ED) describing those who meet all criteria for anorexia nervosa (AN) except being underweight. By having larger bodies, AAN individuals are more likely to experience weight stigma. The present study used multiple methodologies to explore the AAN experience, focusing on how weight and weight stigma affect healthcare. Methods: Study 1 utilized a systematic review of 54 articles to determine the weight history and medical complications of AAN. Study 2 utilized in-depth semi-structured arts-based qualitative interviews with 38 AAN patients to describe their experiences of weight stigma in healthcare. Study 3 utilized stepwise multivariate regression to determine associations between weight-related variables and treatment delay. Results: The review revealed that patients with AAN experienced lower rates of amenorrhea and bone density loss compared to AN. However, life-threatening symptoms (electrolyte imbalance, bradycardia, hypothermia, orthostasis) occurred at commensurate rates, despite AAN weights being higher. Qualitative findings demonstrated that across the illness trajectory (risk development, pre-treatment, treatment, relapse prevention), patients reported that provider weight stigma contributed to initiation and persistence of ED behaviors, complicating illness trajectories. Quantitative results corroborated the impact of weight-related variables on treatment receipt and delay. Participants experienced a mean weight suppression of 28.4% (SD = 10.0) of their premorbid weight and a treatment delay of 11.6 years (SD = 11.7) from the time patients believed they had an ED until receiving treatment. In regression analysis, minimum BMI and largest percent weight loss emerged as marginally significant (p = .048, .059, respectively) predictors of treatment delay, such that lower BMI and greater percent weight loss were associated with shorter treatment delays. Discussion: These findings demonstrate that 1) AAN is a serious illness with similar medical comorbidities as AN, 2) higher weight patients were counseled to lose weight despite impairing ED cognitions and behaviors, 3) healthcare providers generally failed to recognize AAN in normal and higher weight patients, and 4) consequences of provider weight stigma included longer periods of living with undiagnosed, untreated EDs and instances of providers triggering (or re-triggering) ED behaviors, leading to increased medical risk. These findings suggest several needed steps. First, transitioning to a spectrum model for AN diagnosis (wherein weight is one severity indicator) may facilitate faster diagnosis and treatment. Second, training is needed for primary care providers to increase recognition and screening of EDs in normal and higher weight patients. Third, conversations are needed between obesity and ED professionals to ensure that universal health promotion efforts do not cause unintended harm. Addressing weight stigma in these ways could enhance treatment receipt, quality of care, and healthcare engagement for ED patients, particularly those at higher weights.
An Examination of Novel Harm Reduction Interventions for Indigenous and Other Youth of Color
Alcohol and other drug (AOD) use among youth populations remains a pressing social issue in the United States. Young people who experiment with or regularly use AODs are at heightened risk for experiencing AOD-related harms such as mental health issues, overconsumption, and death. Among American Indian/Alaska Native/Indigenous (hereafter, “Indigenous”) youth, contextual risk factors such as limited access to culturally relevant AOD prevention information can exacerbate their risk for AOD harms such as early onset for problematic AOD use, AOD-use disorders in adulthood, infection of the human immunodeficiency virus (HIV), unresolved issues of trauma, and related experiences of inter-personal violence. An effective approach to reduce AOD-related harm among youth is harm reduction. Youth-specific harm reduction studies have shown significant effects in reducing AOD use and related harms, as well as increasing knowledge and awareness. However, there is a dearth of empirical literature on the development, acceptability, and measurement of culturally relevant, theoretically grounded harm reduction interventions for Indigenous youth. This dissertation examines three sets of interrelated questions regarding novel interventions designed to prevent and reduce AOD harms for youth of color (YOC), with a focus on the needs of Indigenous youth who participate in an Indigenous-specific after-school program. The first study reports use, usability, and overall satisfaction outcomes for the MyPEEPS (Male Youth Pursing Empowerment, Education, and Prevention around Sexuality) mobile app, an evidence-based HIV prevention intervention. A pre-post pilot feasibility study was conducted with racially and ethnically diverse 40 young men living in Birmingham, Alabama; Chicago, Illinois; New York City, New York; and Seattle, Washington. Results indicated 62.5% (25/40) of all participants completed the intervention in an average of 28.85 (SD 21.69) days. Overall, participants reported the app was easy to use and useful and had the potential to improve their sexual health knowledge, behaviors, and awareness in risky situations. The second study focused exclusively on the AOD prevention needs of Indigenous youth towards the development of a culturally relevant and theoretically grounded harm reduction intervention. A community-based participatory research approach was used to understand the perceptions of AOD use, harm reduction and culture among Indigenous youth 13-17 years of age enrolled in an Indigenous-specific after-school program. Key themes were organized with the Indigenous framework of Relationality and included: a) youth understand the negative consequences of AOD use, b) youth appreciated balanced, non-abstinence based AOD education, c) youth described a need for safe opportunities to talk about the impacts of AOD use, and d) youth described a desire to lead and help prevent AOD harms for their future selves and for those in their circle. The third study examined perceptions of Indigenous adults (18+ years of age) affiliated with the same Indigenous after-school program regarding AOD use, harm reduction, and risk factors for youth participants. Findings were organized using a risk environment framework to identify risk factors for youth on micro and macro levels across physical, social, economic, and policy domains. Last, adult-identified risk factors were paired with the previously reported youth recommendations where similar, to establish core content for a community-based, culturally relevant, and theoretically grounded harm reduction intervention for Indigenous youth, inclusive of multigenerational Indigenous perspectives. Results of these studies strongly indicate that harm reduction interventions as an acceptable approach to prevent AOD use and harm among diverse YOC. In addition, findings support culturally relevant harm reduction education as a valuable way to prevent AOD use and harm among Indigenous youth participating in an after-school program. Future research should seek to explicitly test the hypothesis that interventions designed to enhance relationality among Indigenous youth can serve to buffer risk for AOD use and harm. Finally, meeting the needs of diverse YOC requires a community-based approach. Trust and respect must be established in order to develop a mutually beneficial research partnership with representatives from diverse populations and communities.
The Practice of Intergroup Dialogue Across Eductional Settings
Kristin J. McCowan
Consciousness-raising educational efforts, that help learners critically examine the sociopolitical structures that create and sustain discrimination and disadvantage (Larson, 2014) are needed. Friere (1979) suggests that the most promising approaches to educating for critical consciousness reflect three interconnected components; an in-depth understanding of the world, reflection on social and political contradictions, and taking action against oppressive elements in one's own life (Friere, 1979). Intergroup Dialogue (IGD) is one evidence-based approach that uses critical pedagogy and experiential learning to help students develop a structural analysis of how power and privilege are related to various types of inequalities (Gurin, Nagda, & Zuniga, 2013). Evidence suggests that IGD is an effective approach to reducing prejudice and increasing intergroup understanding, collaboration and action among learners (Dessel, Rogge, & Garlington, 2006; Lopez & Zuniga, 2010; Maxwell, Nagda, & Thompson, 2011; Schoem & Hurtado, 2001; Zuniga et al., 2007). While the majority of research on IGD tends to examine outcomes, less is known about how students experience and navigate the cognitive and affective processes that facilitate the aforementioned outcomes. This dissertation seeks to understand the ways in which IGD fostered critical consciousness among students. Across these three studies, IGD served as a promising approach that enabled high school and undergraduate students to increase their understanding of the world around them, to engage in critical (self) reflection, and the findings across these studies also demonstrated students’ ability to take action to incorporate their new learnings into their everyday lives. Although the experiential nature of the course proved challenging at times, the vast majority of students reported that the dialogic challenges supported their ability to apply critical dialogue skills across both contexts. Analyses also revealed that IGD was instrumental in the development of students’ listening skills. In particular analyses revealed that students' may have developed a more integrated form of listening, or conscious listening which involves the integration of multiple senses (e.g. eyes, heart, mind, ears) that promoted their ability to awareness across all three domains (context, content and intrapersonal). Analyses from the high school study, revealed that IGD supported students’ sociopolitical development. While, there is not sufficient evidence to suggest that a school-wide approach is feasible, evaluation of the pilot program was appropriate and conducive to high school students, in the third study, there More trials are needed to further develop a programming model that addresses the unique contingencies embedded in the school environment; which include, the duration of each meeting was limited to 40 minutes and inconsistent access to physical space within the school.
Indigenous Connectedness as a Framework for Relational Healing within Alaska Native Child Welfare
This study was embedded within the Alaska Native child welfare context to fill a gap in the literature that further theorized and made evident the key concepts and mechanisms of Indigenous child wellbeing. Twenty-five foster care alumni, relative caregivers and foster parents provided their perspectives and life experience of child wellbeing within ICWA preference placements. The use of directed content analysis and Indigenous storywork helped make meaning of the knowledge bearers’ stories in comparison with an Indigenous Connectedness Framework. Results indicate that: 1) relational wounds and trauma must be acknowledged and addressed; 2) relational continuity is a crucial for wellbeing within child welfare, and 3) relational healing happens when children and adults know who they are and where they come from. This study is significant because it shifts the narrative, philosophy, values, beliefs and theory of child wellbeing within child welfare and influences how we live in right relationship with ourselves and others for the benefit of our sacred children.
Micro, Mezzo, and Macro Levels of Implementation: An Examination of Minnesota's Cultural and Ethnic Minority Infrastructure Grant Program
Using Minnesota’s Cultural and Ethnic Minority Infrastructure Grant (CEMIG) program as a case study, this dissertation, using a multi-paper format, analyzes how race, ethnicity, and culture interact with large-scale, system-wide implementation projects at the micro, mezzo, and macro levels. CEMIG funded 21 agencies over $8.83 million in workforce development efforts (e.g., assist individuals in obtaining mental health licensure) for 281 individuals, clinical and ancillary services, and EBP training for cultural and ethnic minority populations from 2008-2017. Data used for these papers was varied, including 62 online survey responses from clinical trainees, over 1000 grant documents gathered and maintained by Minnesota’s Department of Human Services (DHS), and 23 interview transcripts from 27 participants collected between summer 2017 and fall 2018. While the primary method of data analysis was qualitative content analysis, multiple regression was used to assess the relationship between challenges and supportive services among clinical trainees who participated in the CEMIG program and responded to the online survey. Micro-level findings indicate that while there was no statistically significant relationship between clinical trainees and their demographics, education debt amount, or perceived level of graduate training for the mental health licensure exam, in comparison, services and supports, specifically financial assistance with test fees, were found to be beneficial. The qualitative component of the survey found that clinical trainees experienced the exams as culturally biased and were warned that the licensure exams are challenging and required code-switching behaviors to be successful. Mezzo-level findings separated grantee agencies into four types: sovereign, legacy, transitional, and grassroots; themes generated described the differential need, based on agency typology, to create internal infrastructure, attend to hidden bias, and maintain autonomy during the grant contract process. Macro-level findings demonstrate the participants perceived that the grant program perpetuated inequities by neglecting to promote the program, advocate for clinicians of color, and coordinate isolated policy ecology systems. Findings from these studies highlight the complexities of racial and cultural identity in the implementation process. At the micro level, the need for clinical trainees to engage in codeswitching behaviors to succeed, questions the role of the licensure exam in assessing competence or cultural assimilation. At the mezzo level, findings suggest that when including non-legacy agencies, more technical assistance and funding for data reporting and contract management should be included. Further, government or private funders should engage in conversations that uncover hidden biases that affect relationships and implementation processes with sovereign, transitional, and grassroots agencies. Last, at the macro level, suggestions for process improvement included enhanced data collection, innovation cross-fertilization, and stakeholder advocacy involvement. Especially within policies engaging with disparate communities, including ethnicity-specific mental health provider advocacy groups in the stakeholder advisory board and collaborating with these advocacy groups for grant program development and data collection efforts are critical for project enhancement and sustainability. Further research is needed to describe differences in implementation based on culture and ethnicity within mental health settings, as well as examining institutional norms, such as licensing exams that clinicians of color may experience in discriminatory ways.
On the Cusp: Pathways to Employment, Education, and Disability in First-Episode Psychosis (FEP)
Poverty is a persistent problem in serious mental illness (SMI) with adult unemployment rates consistently hovering around 80%. A psychiatric paradigm shift toward early intervention for first-episode psychosis (FEP) has shown promise in supporting employment and education in early stages of treatment, but with mixed outcomes. Theories implicate existing low SES and its associated structural barriers, social drift into disability following onset in early adulthood, and disability status with its accompanying label and stigma, in the maintenance of poverty for this population. Utilizing life course theory and considering that the developmental period before disability is established is a particularly critical intervention point for poverty prevention among this group, it is an urgent research priority to learn how young adults with FEP negotiate employment and/or education and how interventions can facilitate this process. This dissertation explored the ways in which employment, education, or disability trajectories form during the early stages of living with a FEP. Utilizing a standpoint epistemological lens, which seeks to highlight the position of the marginalized, 19 interviews were conducted with a critical case sample of young adults with lived experience of a FEP and early intervention programs to explore the key moments, messages, and structural influences that determined their trajectories towards employment, education, or disability. Results indicate that the initial life disruption from a FEP in young adulthood leads to a suspension of gainful activity, followed by a period of forward progress through overcoming their early experiences with hospitalization and medication regimes, and adjusting their self-concept after the label of psychosis. Mental health professionals sent different messages about disability or capability depending on treatment ideology, while families provided varying levels of support and encouragement based on their own SES and subsequent values. Finally, young adults who were successful in entering the labor market did so by moving into direct career pathways instead of looking for work in the secondary labor market, utilized university disability centers, and found support and direction through their involvement with the council. These conclusions have significant implications for early intervention programs, including targeting early-onset FEP, shifting employment focus to the primary labor market, promoting adjunctive peer-based support, and challenging the professional mental health discourse about disability. Implications for research include the need to better understand the pathways of FEP young adults who are not in education, employment, or training (NEET) and who face additional barriers to accessing employment programs and the labor market.
“Wherever I Go, I Have It Inside of Me”: Indigenous Cultural Dance as a Transformative Place of Health and Prevention for Members of an Urban Danza Mexica Community
Angela R Fernandez
Background and Purpose: In 2012 the U.S. Census Bureau used “Mexican American Indian” (MAI) as a new category to describe people with ancestry from Indigenous groups of Mexico. This census category comprises the fourth largest Indigenous population group in the United States and encompasses a vastly diverse, complex, and intersectional population, for which there is little empirical health research. Many Indigenous scholars and community members cite involvement in place- and settings-based cultural and spiritual practices as potentially protective in reducing health risks and promoting well-being. The aim of this study is to understand the role of participation in cultural dance as a potential protective place for reducing alcohol and other drug abuse (AOD) and HIV risk, and for promoting overall health among a sample of people from an Urban Danza Mexica Community (UDMC). Narrative, as storytelling, is a powerful medium of communication with the potential to uncover important risk and protective factors among Indigenous communities globally.
Methods: This study is a secondary data analysis (n = 12; 9 included in the final analysis) of a larger qualitative AOD and HIV prevention study with UDMC in the Pacific Northwest (n = 21). The larger pilot study uses a community based participatory research approach to assess AOD, HIV and overall health needs through in-depth interviews. This secondary analysis introduces the decolonizing narratives of health (DNOH) model, developed by the author as an innovative, relational, analytic framework that places Indigenous stories in relationship to their context across 3 distinct yet interconnected levels—the personal, the communal, and Indigeneity in the larger world. These levels of narrative analysis function as culturally grounded, relational pathways through which to articulate health prevention and promotion methods. The sample of 9 participants identified ancestry among 4 Indigenous groups from across Mexico. Their ages were evenly distributed across younger and older adult cohorts (18+) with education levels from 0-8th grade, to graduate/professional degrees. Five participants self-identified as cisgender female, and 4 as cisgender male. Among the 9, one participant identified as cisgender two-spirit.
Results: The DNOH model’s narratives delve into the complex and nuanced relationships within participants’ internal worlds (personal), between themselves and their danza community (communal), and between themselves and their overall Indigenous identity within society (Indigeneity). Participants use narrative as a mechanism for resistance to colonial assaults and transmission of ancestral teachings about health and prevention. While marginalization of their intersectional identities is an ongoing challenge, participants within the danza circle use narratives to create spaces wherein they navigate complex conversations that resist oppression, reconnect with and strengthen their Indigenous identities, and strive toward ancestral visions of health and well-being.
Conclusion and Implications: This study contributes to Indigenized theoretical and methodological expansion, and to the development of place/settings-based, narrative cultural health interventions aimed at decreasing health risks and promoting wellness among populations similar to UDMC. Identifying
protective places and spaces that foster distinct pathways for decolonizing narratives helps increase understanding of its role in preventing health risk behaviors and promoting overall health and well-being among Indigenous Peoples.
A Population-Based Study of Child Maltreatment-Related Hospitalizations and Child Protection Responses
Despite the breadth of the identified impacts and costs of child maltreatment, a primary challenge in our understanding of child maltreatment is that we still do not have solid numbers of children who experience it. Further, despite child protection systems (CPS) being reliant on mandated reporters to bring concerns of child maltreatment to their attention, there is little information about how systems respond to concerns of child maltreatment. Informed by the public health approach and ecological systems theory, this dissertation utilizes a novel linked administrative dataset of birth, hospital discharge, and CPS records to provide new knowledge about hospitalizations related to child maltreatment. It does so in three ways: identifying the incidence and prevalence of child maltreatment-related hospitalizations, the risk and protective factors of these hospitalizations, and the systems responses to these hospitalizations, as measured by CPS reports and removals by CPS. Results indicate that most common form of child maltreatment-related hospitalizations was neglect and, more specifically, supervisory neglect. Identified risk factors included child’s low birth weight, mothers who were teenagers at the time of birth, non-first born children, maternal residence in zip codes with high concentrated disadvantage, and a prior CPS report. System responses were dependent on the subtype of maltreatment and type of diagnostic code used. Specifically, physical abuse and codes specifically related to maltreatment had higher rates of CPS reports and removals compared to the other maltreatment subtypes and diagnostic codes not specifically related to maltreatment. These results provide new knowledge regarding child maltreatment. The results can be used to target prevention programming, which are identifiable at birth, increasing their utility. The new knowledge identified through this study has important implications for our understanding of child maltreatment, how we can prevent it, and how current systems are responding to it.
Period Changes in Intergenerational Income Mobility between Welfare State Contexts in South Korea and the United States
Social mobility has stalled or declined in most advanced welfare states in an era of rising inequality, implying that socioeconomic disadvantages persist across generations and questioning the permeable class structure premised by a capitalist democracy. Welfare state policies aim to enhance upward social mobility for the citizenry by reducing inequality and promoting inclusive growth; however, social mobility is rarely examined as embedded within the institutional and sociocultural contexts of alternative forms of the market economy welfare state.
Although South Korea and the United States have generally similar residual and limited welfare state regimes, this dissertation finds that the intergenerational income mobility (IGM) trends in recent decades differ remarkably between the two countries; thus, this paradox becomes the focus of the dissertation. This dissertation analyzes cross-national differences in IGM in South Korea and the United States for two birth cohorts representing contrasting period effects: between 1980-1995 and 1996-2015, using data from the Korean Labor and Income Panel Study in South Korea and the Panel Study of Income Dynamics in the United States. It then conducts a historically informed comparative analysis of between-country mobility differences as contextualized by different philosophical underpinnings of the welfare state—Confucian familial orientation in South Korea vs. libertarian individualistic orientation in the United States.
This study presents findings in four areas. First, findings suggest no period effects on IGM in both countries, though the Korean IGM improved and the U.S.’s IGM eroded. Second, results suggest that women’s IGM in Korea changed: shifting from less to more mobile than that of men between the two study periods; whereas in the United States, IGM eroded for both men and women, with the erosion of IGM particularly pronounced among women. Third, results indicate that not only income but also family structure impacts IGM in both countries. Finally, this dissertation theorizes that it is plausible that more favorable IGM trends in Korea might in part be attributable to the benefits of its Confucian Welfare State orientation, which emphasizes promoting family system support and responsibility, over the more individualistic orientation of the American welfare state.
Examining Discourses ofBisexual Identities among Older Women
The Institute of Medicine (2011) has recognized LGBT (lesbian, gay, bisexual, and transgender) older adults as an understudied and underserved population at-risk of poor physical and mental health outcomes. While the acronym “LGBT” is frequently used to define this population, implying a common identity or experience, important subgroup differences are often overlooked within empirical literature (fredriksen-Goldsen & Muraco, 2010). In particular, little research explores the experiences of older bisexual individuals separately from those of lesbians and gay men (Kaestle & Ivory, 2012), an oversight that reflects the relative invisibility oftheir social position both within LGBT communities and in the broader population (Brewster & Moradi, 2010). When separate analyses or comparison studies are carried out with bisexual research participants, important differences are revealed in terms of social resources (Erosheva, Kim, Emlet, & fredriksen-Goldsen, 2015), psychological resources and coping mechanisms Battle, Harris, Donaldson, & Mushtaq, 2015), and health-related outcomes (Fredriksen-Goldsen, Shiu, Bryan, Goidsen, & Kim, 2016). Thus, a variety ofrisk and protective factors likely influence their health in unique ways.
This dissertation seeks to shift the focus of LGBT literature to center the lives of older bisexuals, who represent a sexual minority group with significant and unique health disparities in relation to heterosexual, lesbian, and gay older adults. Particularly, I will center the lives of older bisexual women whose experiences of bisexuality are also distinct from those of both bisexual men and younger bisexual women. This study is informed by a critical feminist conceptual framing, theoretical influences from gerontology and bisexuality literature, and key concepts from foucauldian discourse analysis. I will examine the ways that older bisexual women (age 60 and older) construct and make meaning out oftheir bisexual identities on individual, social, and political levels by drawing on both broad discourses and specific linguistic tools in semistructured in-depth interviews. This research is a crucial first step toward developing a better understanding of how bisexuality and experiences related to bisexuality may influence the health of older women.
Culture and History Matter: A Mixed-Methods Study of Historical Trauma and Cultural Practices as Determinants of Alcohol Use among Truku Tribal People in Taiwan
Ciwang Teyra (Mei-Yi Lee)
Taiwanese indigenous peoples are part of the larger fabric of indigenous groups across the Pacific region. Although indigenous communities in the Pacific region possess enormous diversity in their cultures and political histories, one unfortunate commonality is significant health inequalities in comparison with non-indigenous counterparts. In Australia, for instance, the life expectancy of Aboriginal and Torres Strait Islander people has been shown to be 17 years less than that of the non-indigenous populations (Pulver et al., 2010). In New Zealand, the average life expectancy for Māori people was 7.3 years lower than for non-Māori populations in 2010 to 2012 (Statistics New Zealand, 2013). Similarly, indigenous peoples of Taiwan have experienced significant health inequalities in comparison with their non-indigenous counterparts, the Han population. In Taiwan, indigenous peoples have a higher mortality rate than the majority Han population, with a life expectancy that is 8.7 years lower than the national average (Council of Indigenous Peoples, 2011). Additionally, Taiwan Indigenous Health Report of 2011 indicated that alcohol-related chronic liver disease/cirrhosis and accidental injuries are among the 10 leading causes of death among indigenous communities. Indeed, alcohol use has become one of the highest-priority concerns for Taiwanese indigenous communities.
Supporting Latino Families Vulerable to Child Welfare Involvement
Jessica A.N. Rodriguez-JenKins
Background: Latino families with young children are the fastest growing group in the public child welfare system, yet a limited amount of research focuses on understanding their parenting context. This makes research understanding the context of parenting and possible predictors of nurturing parenting a central concern for child welfare researchers. A clear picture of who these families are, and how they are faring, is critical to illuminate potentially modifiable areas for interventions and prevention of future child welfare involvement. Objectives: (1) Estimate hypothesized group differences of sociodemographic characteristics and maltreatment risk and protective factors, stratified by race (Black, White, and Latina) and Latina country of origin (Mexican, Puerto Rican, and other origin) among Latinas who have been the subject of a child welfare investigation. (2) Explore possible predictors of nurturing parenting among Latina mothers drawn from variables of within group difference and micro, mezzo, and macro contexts. Methods: Data are taken from the National Survey on Child and Adolescent Well-being II – Restricted Release (NSCAW-II), a national probability sample of families who were investigated for possible maltreatment between February 2008 and April 2009 in 83 counties nationwide. The study analysis was restricted to mothers of children between 0 and 5 years old who remained in their biological mother’s care (n = 1,836). Results: Bivariate results examining sociodemographic and maltreatment risk factors demonstrate heterogeneity when Latina mothers were examined by country of origin. Puerto Rican mothers have significantly higher risk factor rates when compared to Mexican and other origin mothers – which was often obscured when Latinas were examined homogenously due to the larger percentage of Mexican mothers in the sample. Conclusion: Results from this study bring to light within group heterogeneity among these Latina mothers which was obscured by examining Latinas in aggregate. This study furthers our understanding of racial and ethnic differences among Latinas with vulnerability to child-welfare involvement in a contextually and culturally responsive manner.
Social Policy Context and Family Economic Well-being from a Comparative Perspective
My dissertation, Social Policy Context and Family Economic Well-being from a Comparative Perspective, investigates three corresponding questions of themes of social policy, family economic well-being, and inequality from comparative perspectives; (1) how family policies relevant to economically vulnerable families have changed across countries; (2) how family policies influence female employment from cross-national comparative social policy perspective; and (3) whether and to what extent U.S. maternity leave is associated with less reliance of welfare on low-income families. These three questions correspond to three papers that are connected through the development of a theoretical framework with two empirical applications.
The first paper, Welfare States, Market Economies and Family Policies, sets a framework of a broad context of cross-national comparison by integrating two contradicting theories of welfare states and market economies, one by Esping-Andersen and the other, varieties of capitalism, by Hall and Soskice. The first paper questions in what way market economies and social policy tradition (welfare states) interact to produce different clusters of family policy. This integrated framework enables us to understand the changes of family policies in different welfare states clusters, and further various forms of gender inequality by stressing the influence of family policies.
The second paper, The Danger of a One-sided Story: The Effects of Market Economies and Family Policies on the Gender Employment Gap in 17 OECD Countries, examines the effects of family policy, market economies and labor protections on female employment outcomes across countries. Using several cross-national data such as the Luxembourg Income Study (LIS), OECD Employment Outlook, and Comparative Welfare States data, I question how and to what extent macro social policy contexts such as family policy, market economies impact family well-being and gender equality especially for female work experience.
The third paper, titled The Effect of Paid Maternity Leave on Welfare Use for Low-income Families focuses on the effects of state paid maternity leave within the U.S. The various structures around maternity leave in the U.S. provide an opportunity to examine the effects of policy context, in this case different types of maternity leave, for welfare use for low-income families. I make use of a difference in difference (DinD) strategy, comparing family-level outcomes across states and over time. My findings suggest that paid state maternity leave is associated with less participation in Temporary Assistance for Needy Families (TANF) or public cash assistance for families with newborn babies. These results have implications for policy practice promoting family economic wellbeing in the U.S.
My dissertation contributes to the understanding of various aspects of family wellbeing, poverty and inequality across countries. It also promotes the relevant social work policy as it develops a theoretically rigorous comparative framework for understanding gender inequality and family well-being as well as it provides empirical evidences on the impacts of social welfare policies in cross-national and the U.S. contexts.
An examination of neighborhood contexts and substance use across the life course
My dissertation project seeks to explicitly marry prevention science perspectives on risk and protective factors for problem behaviors with a consideration of proximal and distal contexts for problem health behaviors across the life course. Employing nearly 30 years of longitudinal data from the Seattle Social Development Project in conjunction with recently added GIS data, this project aims to understand the extent to which childhood and adolescent risk and protective factors impact relationships between neighborhood contexts and problem health behaviors in adulthood. The findings of this project will aid in understanding the etiology and consequences of problem behaviors across the life course and enhance the design of preventive interventions. The first paper of this project demonstrates a relationship between perceived neighborhood safety and disorganization and slowed desistance from alcohol use disorder (AUD) among adults. Employing latent growth curve modeling, results show that more disorganized neighborhoods, as characterized by crime, building decay, and lack of safety, are related to increased AUD symptoms above and beyond the average rates of decline in AUD symptoms from age 21 to 39. Model results are robust to controls for gender, ethnicity, and education as well as to accounting for more proximal predictors of AUD such as marriage status and anxiety or depression. Further analyses will help disentangle relationships among neighborhoods and health behaviors through expanded consideration of built environment features and attention to early life risk and protective factors as a precondition for later life health behavior.
Intergenerational Adversity: Longitudinal Implications on the Parental Capacities of Latina and African-American Mothers and Their Children’s Wellbeing
Sharon G. Borja
Adversities in childhood pose significant jeopardy of poor early life outcomes that can have lasting consequences, compromising future wellbeing of young children. Childhood exposures to extremely stressful experiences including multiple forms of adversities such as child maltreatment, poverty, family instability, violence at home and parent criminal and substance abuse histories become potential pathways to negative social and emotional outcomes. My dissertation uses a two-generation approach to build upon the mounting evidence on adverse childhood experiences and generate evidence regarding intergenerational adversity and its impact on parental capacities and early childhood socio-emotional health. This approach considers the nested nature of the parent-child relationship and focuses on further disentangling intergenerational processes of adversity accumulation and their impact on both generations.
Using the Fragile Families and Child Wellbeing data (N=4,898), a birth-cohort longitudinal study of mostly low-income children and their parents, I am examining intergenerational adversity and its proximal consequences during critical periods of development in early childhood (ages 1, 3, and 5) and testing variations across racial/ethnic group. Secondly, I am using structural equation modeling to test the cumulative effects of adversity on parenting stress and parental capacities and whether they serve as mechanisms through which adversity impacts child socio-emotional outcomes. Testing parenting stress and parental capacity as pathways to socio-emotional health outcomes helps us understand how adversity could deplete energies of otherwise caring adults and whether it also reduces their capacities to provide a safe and nurturing environment during developmentally sensitive life periods. Finally, I am testing the protective role of informal supports in buffering adversity’s negative impact on parental capacities and childhood socio-emotional wellbeing over time and comparing these results across racial/ethnic groups. The growing cultural diversity of families in the U.S. is illuminating, for example, differing forms and composition of support system (e.g. extended family members, friends, and church and community members) theorized in my conceptual model as buffering factors that are more figural in some family populations.
The longitudinal approach of this dissertation in understanding complex intergenerational processes of adversity accumulation and childhood socio-emotional outcomes sheds light to the factors that could vary over time and whether these variations account for some of the outcomes in both generations. These variations over time especially during critical periods of early childhood have been mostly overlooked in literature. Results from this project have implications toward the prevention of child maltreatment as it takes a two-generation approach to better understand ways that parents thrive in adversity so they can create a safe and nurturing context necessary for their children. This is particularly crucial for families of color who are often at the intersection of multi-form adversity and racial disparities and are disproportionately represented in the child welfare system.
Policy-driven vis-à-vis refugee-driven resettlement: A nationwide, multiple methods, case study examination of placement patterns and services for resettled refugees
Odessa Gonzalez Benson
Refugees and resettlement policy have been contentiously debated in public and policy discourse, prompted by the ‘refugee crisis’ in Europe in 2015 and public reaction in the US. Resettlement policy is about refugees and local communities, but, importantly, it also bespeaks the commitments and values of countries of reception. Called for are new insights and critical examination of the latest cohorts of refugees in the post-Sept11 era of resettlement.
Resettlement policy, as anti-poverty program for refugees, forwards its goal of socioeconomic integration through appropriate geographic placement and service provision. However, refugees and their communities, naturally, very much also determine their own resettlement, via self-placement and refugee-based services. My research examines (a) refugees’ selfplacement or internal migration patterns and (b) services and goals of refugee-ran community organizations, and the ways in which those patterns, services and goals are in/congruent with policy. This research is nationwide in scope and applies a case study approach, focusing on Bhutanese refugees, one of the new refugee cohorts in the post-September 11 era. Empirically, I apply both quantitative and qualitative methods to examine data from several sources, and partnered with refugee organizations for primary data collection, participant recruitment and analyses.
First, I lay the national landscape of primary arrival placement and internal migration patterns, and then conduct a comparative examination of relevant city-level factors explaining refugees’ in/out-migration patterns into localities across the US. Appropriate placement of refugees is important but has long been problematic in resettlement policy. After placement in primary cities of arrival, refugees commonly move or relocate domestically -- internal migration, disarraying the government’s planned dispersion strategy. Migrants’ voluntary movements are natural and expected, but difficult to predict and track, complicating policy funding appropriations and service provision and impacting refugees and local communities.
Quantitatively, I use official population data in US cities of arrival (n=287) from the US Office of Refugee Resettlement and community-based population data in cities of domestic migration. I visually and represent resettlement patterns in maps, using the Geographic Information Systems software ARCGIS. I used data from the US Census, the US Office of Refugee G. Odessa Gonzalez Benson 2 Resettlement and other publicly available sources to construct city-level indicators for relevant factors, particularly low-wage labor and local immigrant policy. I conducted multivariate analyses of the contribution of each factor to the net in- or out-migration of refugees in each city, using the statistical package STATA. Findings indicate job quality and local integration policies as relevant factors for refugees’ internal migration away from traditional immigrant gateways and into new immigrant destinations in the midwest and southwest, mimicking domestic paths of previous migrants, particularly those from Mexico and Latin America.
Second, I examine refugee community organizations’ goals and activities, and congruence with federal policy and implementing agencies. Self-sufficiency as policy goal is measured as refugees’ job rate within eight months of arrival; the bulk of services goes to job placement. That outcome has been critiqued as misguided and failing to capture self-sufficiency in a more meaningful way. Integration, meanwhile, as policy goal is not systematically measured due to lack of policy guidance and a clear definition. Unclear and unmeasured policy goals pose problems in program implementation, with ramifications for refugees and local communities. Too often neglected in resettlement policy research are refugee community organizations that form and operate along the sidelines of federally-contracted resettlement agencies, and serve high-needs, high-poverty areas. Interrogating refugee organizations against the broader policy and institutional contexts offers new insights and raises questions about participatory approaches and effective service provision with refugee communities.
Qualitatively, I use 40 semi-structured interviews and four focus groups with refugee leaders of Bhutanese refugee organizations in 30 cities across the US, using the coding software ATLAS.ti. I identify themes and patterns in the data and formulate a typology of activities, and then examine goal congruence with federal policy. Findings indicate that refugee community organizations fill in gaps in service to complement policy-mandated service provision and federal policy goals, but are also self-determining in other ways.
The theoretical dimension of my dissertation project draws upon social work literature and interdisciplinary perspectives, in political science and human geography or migration studies specifically. I formulate discussions about refugee resettlement that considers participatory approaches and labor equity as part of socioeconomic integration or adjustment processes of refugees, as contextualized by locality and policy.
Native Women, Intimate Partner Violence, and Drug Use and Consequences: Prevalence and Associations among Tribal College and University Students
Katie A'Neil Schultz
Research has demonstrated high rates of problematic substance use in college and American Indian and Alaska Native (AIAN) samples and disproportionately high rates of intimate partner violence (IPV) among Native women. Epidemiological data on drug use and comorbidities in AIAN populations are scarce and the identification of tribally-specific protective factors that might buffer the effect of IPV on subsequent drug use lacks adequate empirical research in this population. This study investigates prevalence estimates and relationships between drug use and IPV and the potential for ethnic identity to buffer the effect of IPV on drug outcomes among Native women at Tribal Colleges and Universities (TCUs).
State Social Safety Net Programs and the Great Recession: The First Line of Defense and the Last Resort for the Economically Disadvantaged
The Great Recession (2007‒2009) and its lingering aftermath have posed challenges to the state safety net programs that are intended to provide income supports to the economically disadvantaged. The stratified, decentralized structure of the US social welfare system has contributed to uneven policy responses to the economic hardship across programs and states. With a focus on the Unemployment Insurance (UI) and General Assistance (GA) programs, this dissertation consists of three papers that investigate (1) the impacts of state UI modernization, (2) state UI approaches to social protection, and (3) state legislative reform of GA, respectively. This dissertation takes a multidisciplinary approach that integrates theoretical perspectives and research methods from social welfare, sociology, political science, and economics.
The first paper evaluates the effects of state UI modernization on the trajectories of household income-to- poverty levels during and after the Great Recession. It uses the nationally representative 2008 Survey of Income and Program Participation panel dataset (merged with state data) and multi-level growth models to test the policy effects from 2008 through 2013. Findings show that working families had not yet fully recovered from the Great Recession by the end of 2013. However, working families in states enacting UI modernization provisions, on average, experienced a greater economic improvement rate in the income-to- poverty level than their counterparts, controlling for state and household characteristics.
The second paper classifies state UI policy approaches to social protection by using an advanced model-based clustering technique to analyze multidimensional policy design and performance characteristics of 51 UI programs. Results indicate two distinct state UI approaches to social protection for workers: high and low protection. The high-protection approach, compared to its low-protection counterpart, is characterized as combining high financing adequacy with high taxable wages and average tax rates; high program accessibility with inclusive eligibility criteria; and high wage replacement with high benefit levels. These two approaches remained comparatively stable over time. However, both showed a declining trend in the social protection performances from 2007 to 2014.
The third paper employs a thematic content analysis of 26 legislative videos to examine how policy actors used knowledge to frame the problems of the poor and shape GA reform in Washington State. Findings show that knowledge construction of the GA-unemployable population as social deviants with psychological and behavioral problems influenced the GA reform directions toward a regulated, punitive model. These negative social constructions, intersecting with the mainstream welfare ideology of personal responsibility and work ethic, contributed to dismantling the safety net of last resort for the least resourceful poor.
As a whole, this dissertation research contributes to the fields of state welfare politics, policies, and practice through enhancing the understanding of the connections among macroeconomic conditions, anti-poverty politics, policy designs, and the state safety net system. Policy implications for promoting economic justice for disadvantaged and marginalized populations are offered.
Foreclosure Counseling with Latino Households: Policy Assumptions in a Changing Demographic Landscape
Maria Y. Rodriguez
Social work practice and scholarship was historically rooted in the development and analysis of policy (Rodriguez, Ostrow, & Kemp, 2016). Yet, little work has extended our knowledge base on the factors surrounding the development of housing policy and its impact on the populations we serve. The dearth of housing policy research within social welfare is particularly troubling in light of the recent foreclosure crisis (2007-2012). Notably, low-income and Latino households were disproportionality represented in the foreclosure crisis (Hall, Crowder, & Spring, 2015; Rugh, 2014), suggesting that foreclosure mitigation policies should have been crafted with these groups in mind. This dissertation aims to investigate how these households fared in the development of foreclosure mitigation policies, in order to understand how responsive policy makers can be to the context of social problems. Using a three-paper format, this dissertation investigates the development, implementation, and impact of the National Foreclosure Mitigation Counseling (NFMC) program. The dissertation uses a policy process centered conceptual framework to explain how certain groups were left out of NFMC’s purview. Each paper addresses one of the three levels of social work practice: micro, mezzo, and macro. Results indicate that, beyond being adversely impacted by the foreclosure crisis, communities of color have reaped little benefit from foreclosure mitigation policy as a result of the social constructions they are assigned during the policy making process. Latino households in particular, while experiencing a rising contender status in the federal housing policy arena, are nonetheless not benefiting from foreclosure mitigation policy in ways commiserate with the impact of the crisis on this demographic group. Recalibrating the social work research agenda toward policy study is the most direct way to address the social and economic conditions that prevent the most vulnerable from claiming and exercising full citizenship in the United States today.
Examining the role of place-based interventions in supporting military families: A qualitative study of family-centered therapeutic landscapes
Sara R. Green
United States military families, including active duty, Reserve and National Guard, and veteran families, continue to face challenges and risks to psycho-social health and well-being. Deployments are ongoing and represent a significant source of stress during which families attempt to maintain relationships across great distance and within the dangerous context of wartime service. Injured service members (both those who continue to serve and those who are separated from the military) and their families, contend with multiple issues related to managing symptoms, finding adequate treatment, and carving out lives under new circumstances. Research with military families continues to be essential to understanding how to best support the military members, spouses/partners, and children who sacrifice so much with their service.
This qualitative dissertation uses a grounded theory approach to explore military families’ experiences of stress and coping during deployment, especially those of female spouses. In addition, it examines family-level efforts to reconnect and reintegrate post- deployment and post-injury through participation in a family retreat program. In particular, this study focuses on the emplaced experiences inherent to maintaining the home during deployment and attending a place-based retreat. In doing so, this study implements a family systems approach to understanding these emplaced experiences, acknowledging the complex relational connections within families and the ways in which stressful events in particular, have ripple effects through the family unit.
This dissertation is comprised of three papers empirically based on qualitative interviews with parents who attended the National Military Family Association’s Operation Purple Family Retreat® (OPFR) and Operation Purple Healing Adventures® (OPHA) programs in 2013. The first paper looks at the deployment experiences of 43 female spouses with children, with particular attention to the often overlooked duties spouses take on as the primary parent on the home front. This paper conceptualizes military spouses as “stay-behind parents” and presents findings related to the stress and coping processes characteristic of this role. The second paper turns to parents’ experiences at the Operation Purple retreats and seeks to understand how these family programs function as “therapeutic landscapes,” a health geography framework used to understand links between places and healing. Interviews with 50 parents demonstrate interconnected program components related to the physical environment, social environment, and symbolic environment that facilitated participants’ therapeutic experiences. The third paper examines respondents’ experiences of the nature settings where the Operation Purple retreats occurred, seeking to illuminate the lived (military family) experience of spending time in natural environments. Findings are arranged in three phenomenological domains that both confirm and extend existing nature-health research: Being away, Being in, and Being fascinated.
This study seeks to deepen our understanding of military family life and the ways in which military family systems are impacted by wartime service, deployment, and parental injury. It also aims to direct attention to existing, on-the- ground supports for military families, and place-based programs in particular. By theorizing mechanisms at work in these programs, practices can be further refined and developed to meet the needs of military families.
Cultivating Care: Understanding Intimate Partner Violence Experiences of Undocumented Latinas in Washington State
Researchers have broadly studied the etiology, prevalence rates, incidence rates, health consequences, and potential interventions for intimate partner violence (IPV) often referred to as domestic violence (DV). However, research with immigrant communities has remained limited especially with respect to a link between undocumented immigration status and IPV for Latinas in Washington State. IPV dilemmas continue to impact many undocumented women. This qualitative study utilized testimonio 1 to investigate the IPV experiences of undocumented Latina immigrant women. Community-based participatory research techniques were integrated throughout the research process; hence, IPV phenomena were examined using an alternative conceptual model that centered the voices of the women. A Chicana feminist lens and intersectionality frameworks were incorporated to IPV survivorship models (Gondolf & Fisher, 1988) to expand the understanding of undocumented IPV survivors’ lived experiences.
This study empirically captured the perceptions of 20 Latina immigrants living in western Washington State to first examine how their immigration status impacted their IPV experiences. The impact of their ethnicity, gender, class, and nationality was explored not only as discrete phenomena but also from an intersectional perspective. Second, attention was given to their interactions with informal social support networks (e.g., friends, family) and formal help-seeking efforts (e.g., accessing shelters, calling the police) to better illustrate their survivorship process based on Gondolf & Fisher’s (1988) survivor theory. Third, the research highlighted how survivors expressed strength and hope to imagine a future without IPV for themselves and women relatives in future generations. Aligned with social work’s commitment to social justice and advocacy to end injustices, the knowledge generated from this inquiry propositioned new insights to inform IPV practices with marginalized communities such as undocumented immigrant women whose voices were often silenced or not visible in previous studies.
School Mobility for Children in Out-of- Home Placement: Incidence, Educational Outcomes, and Tools for Mitigation
Joseph A. Mienko
Elevated school mobility (SM) for students in foster care (i.e. out-of- home placement (OHP)) is something that has been previously noted in non-peer- reviewed literature. At some level, this trend is precisely what would be expected. In the absence of a policy seeking to actively prevent SM for students in OHP, removing a student from one home and placing him in another would necessarily place him at increased risk of a school change. While such school changes would be expected to contribute to decreased educational achievement for any student, the combination of such changes in conjunction with the potential social and emotional barriers faced by a student in OHP appears to exacerbate the effects on academic performance for students in OHP compared with the effects of SM on students in the general population. Understanding the phenomenon of SM for students in OHP and policies that can be adopted to combat SM is thus of importance to the fields of education and social work. In spite of the importance of SM for students in OHP, the peer-reviewed literature is nearly silent on this topic. This dissertation seeks to provide a comprehensive analysis of differences in school mobility as a function of OHP status and assess specific policy tools for minimizing SM.
“Truth Plus Publicity”: Paul U. Kellogg and Hybrid Practice, 1902-1937
Caroline A. Lanza
Intended as a historical starting point for a critically informed assessment of the state of multimedia social work research, advocacy and practice, this dissertation explores the methods and practice models envisioned by Progressive Era social work leader and media producer, journalist, and editor Paul U. Kellogg (1879-1958). Kellogg harnessed the most advanced visual technologies of his time in service of progressive social change. In social surveys such as The Pittsburgh Survey and in his editorship of two widely read periodical publications, The Survey and Survey Graphic, Kellogg brilliantly combined documentary photography, art, maps, data, and textual narratives with the goal of making unavoidably visible the inequities of industrializing America.
Key aspects of Kellogg’s contributions—particularly his vision for a social work practice deploying media production in service of community-based research, education, and political advocacy—have largely been forgotten, particularly in social work. Responding to this historical amnesia, this dissertation aims to document and analyze, in their innovation and limitations, the projects Kellogg undertook during his career. I aim to enrich the field’s historical memory of Kellogg’s variation on the social survey method, which sought to assess conditions of health, environmental safety, and labor in a given geographic area as carried out during the Pittsburgh Survey, 1907-1908.
Representing a moment in which the social work profession was focused on environmental intervention in low-income urban communities, Kellogg’s variation on the social survey method emphasized the significance of multidisciplinary teams and partnerships with local community organizations. In light of a recent re-commitment by social welfare researchers to environmental, place-based practice (Kemp & Palinkas, 2015), it feels especially timely to explicate Kellogg's social survey methodology.
Kellogg’s approach was distinctly journalistic in that it demanded that social workers produce media in order to disseminate findings not only to community stakeholders but also to the larger voting public in order to influence social action and policy-making. As social work research methods employing media approaches ranging from photography and video to participatory mapping rise in popularity, there seems to be little awareness of this prior rich period of media-based practice and research during the Progressive era. Revisiting Kellogg’s methodology counters a presentism in currentscholarship regarding media-based methods.
Several scholars of social research have measured the success of the Pittsburgh Survey by contemporary standards of empirical, quantitative research and found it lacking (Bulmer, 1991, 1996; Turner, 1996; Zimbalist, 1977). I believe I bring a fresh perspective by considering it as a genealogical forebear of community-engaged approaches operating in epistemological frameworks that appreciate the significance of both emic and etic knowledges of place and community.
Paul U. Kellogg’s publications positioned social workers as public pundits in regards to interventions in poverty and social welfare policy (Chambon, 2012), providing them with a public voice that the field has largely lacked since his journals closed down in 1949 and 1952. By exploring Kellogg’s publishing collective, Survey Associates, and their publications, The Survey and Survey Graphic, I hope to raise questions regarding the loss of a media platform upon which social work practitioners and scholars can engage each other and the public regarding a variety of issues and to consider what the legacy of what this period means for current practitioners of public scholarship in social work.
Being, Belonging, and Connecting: Filipino Youths’ Narratives of Place(s) and Wellbeing in Hawai′i
Stella M. Gran-O'Donnell
Environmental climate change is an urgent concern for Pacific Islanders with significant impact on place along with bio-psycho-social-cultural-spiritual influences likely to affect communities’ wellbeing. Future generations will bear the burden. Indigenous scholars have begun to address climate-based place changes; however, immigrant Pacific Islander populations have been ignored. Although Filipinos are one of the fastest growing U.S. populations, the second largest immigrant group, and second largest ethnic group in Hawai’i, lack of understanding regarding their physical health and mental wellbeing remains, especially among youth. This dissertation addresses these gaps. In response to Kemp’s (2011) and Jack’s (2010, 2015) impassioned calls for the social work profession to advance place research among vulnerable populations, this qualitative study examined Filipino youths’ (15-23) experiences of place(s) and geographic environment(s) in Hawai′i. Drawing on Indigenous worldviews, this study examined how youth narrate their sense of place, place attachments, ethnic/cultural identity/ies, belonging, connectedness to ancestral(Philippines) and contemporary homelands (Hawai’i), virtual environment(s), and how these places connect to wellbeing.
Proximal minority stressors, chronic health conditions, and lesbian, gay, bisexual, and transgender (LGBT) older adults’ psychological well-being: Do sexual orientation and gender identity play differential roles?
Charles P. Hoy-Ellis
An accumulating body of research indicates that lesbian, gay, bisexual, and transgender (LGBT) older adult populations in the United States experience significant physical and mental health disparities relative to their heterosexual peers (Institute of Medicine, 2011). LGBT older adults are among those specifically targeted in the national initiative to reduce population health disparities and improve the nation’s health (I.S. Department of Health and Human Services, 2011). High levels of psychological distress among LGBT older adults are among the identified disparities (Fredricksen-Goldsen, Kim, Barkan, Muraco, & Hoy-Ellis, in press; Valanis et al., 2000; Wallace, Coehran, Durazo, & Ford, 2011). The relationship between sexual orientation and psychological distress among LGBT older adults is far from clear (Cochran & Mays, 2007). It is not enough that health disparities be documented; understanding the underlying mechanisms of risk is crucial to the development of effective interventions (Institute of Medicine, 2011). Effective interventions are important tools in reducing population health disparities.
In the general population, psychological distress and psychiatric morbidity have been linked to significantly increased risk of premature onset of age-related chronic health conditions (Russ eta al., 2012; Wolkowitz, Reus, & Bellon, 2011). Conversely, those who experience psychological distress are more likely to report chronic health conditional risk factors such as alcohol misuse and smoking do not fully explain these recursive relationships (Wolkowitz et al., 2011). In addition to significantly higher rates of psychological distress, LGBT older adults also have higher rates of age-related chronic health conditions (Fredriksen-Goldsen, Cook-Daniels, et al., in press; Fredriksen-Goldsen, Kim, et al., in press; Valanis et al., 2000; Wallace et al., 2011). The relationship between age-related chronic health conditions, sexual orientation, gender, gender expression and identity, and psychological distress among LGBT older adults is only just beginning to be explored by researchers (Fredriksen-Goldsen, Cook-Daniels, et al., in press; Fredriksen-Goldsen, Emlet, et al., in press; Sandfort, Bakker, Schellevis, & Vanwesenbeeck, 2006).
Multi-type maltreatment and adult health risk behavior: A latent variable modeling approach
J. Bart Klika
Child abuse and neglect increases the risk for later health risk behaviors including substance abuse and antisocial behavior. Research shows there is considerable overlap in different forms of child abuse, as well as neglect, yet most studies of adverse outcomes only examine single forms of abuse or neglect in predictive models. Various methods have been used to examine the overlap in child abuse and neglect, including Latent Class and Latent Profile Analysis (LCA/LPA). LCA/LPA, a latent variable modeling approach, accounts for heterogeneity in maltreatment experiences by grouping individuals together into distinct classes/profiles who share similar experiences of abuse and neglect. In the proposed dissertation, I plan to utilize LCA/LPA to examine overlap in child maltreatment types and to study predictors and outcomes of latent class membership representing this overlap. Outcomes of particular interest ate health risk behaviors, such as substance abuse and antisocial behavior.
An examination of Family Capital (resources) effects on young adults education attainment and other life outcomes: focus on economic, social and cultural capital
Eric N. Waithaka
The current cohort of young adults in America is transitioning into adulthood in a period characterized by changing social and economic opportunities. Currently, the American society is reported to be experiencing increased levels of social and economic inequalities in virtually every aspect of American life, from wealth, to incomes, to educational attainment, to health care or even job security (Blank, 201 1; Page & Jacobs, 2009). For example, current estimates ofthe wealth gap between the rich and the poor suggests that the top 1% of households holds more wealth than the entire bottom 95% (Blank, 2011). This increasing inequality is troubling and scholars, politicians and the popular media pundits are providing their opinions on the implications of this troubling trend. In addition, various groups (such as labor unions, government employees, community groups, student organizations) in the general • citizenry all over the nation are organizing and demonstrating (as the 99% versus 1%) about a societal system and public policies that appear to favor the rich and disfranchise everyone else.
Gender differences in the link between trauma and smoking in two generations
Although men and women have similar rates of tobacco use, there are differneces in consequences and recent trends. Women who smoke have unique health consequences including cervical cancer, increased susceptibility to tobacco carcinogenesis, early menopause, and problematic fetal development . Alarmingly, women’s rate of smoking has been declining slower than men’s. Reasons why smoking is showing less decline in women are not clear, and this warrants further investigation.
The experience of trauma has been proposed as a reason for gender disparities in substance use in general, and may be specifically relevant for smoking behavior, however much less is known about the role of gender in the link between trauma and smoking [2-4]. Trauma itself is inherently gendered with differences in the prevalence rates, types of trauma and consequences. Men are more likely to report combat-related trauma while women are more likely to experience interpersonal trauma such as childhood maltreatment (CM) and intimate partner violence (IPV) and are also more likely to receive a trauma-related diagnosis including Post Traumatic Stress Disorder (PTSD) [2, 5\. Studies have connected stressful life events and trauma-related disorders with increased smoking behavior, resistance to quitting and failure to quite [6-8]. However, few studies investigate gender differences in trauma exposure as a risk factor for smoking. Understanding the role of trauma, in conjunction with other risk factors for smoking, is particularly important amount woman since (1) it remains unclear which smoking interventions are more effective for women compared to men [9, 10] and (2) women are disproportionately more likely to be primary caregivers of children. Thus, investigating differences in how women and men experience traumatic events, how they use smoking to cope with these experiences and how comorbid trauma and smoking translates to their children’s smoking may explain underlying causes and cross-generational persistence of smoking behavior.
Gender differences and similarities in the link between trauma and smoking behavior will be examined using existing data from two linked longitudinal studies: the Seattle Social Development Project (SSDP), a gender-balanced sample of 412 men and 396 women who have been followed from childhood (age 10)to adulthood (age 33), and the SSDP Intergenerational Project (TIP), a study of the children of SSDP participants who have been followed from childhood through adolescence. SSDP and TIP data are ideal for studying the role of gender in the trauma-smoking behavior link because they include comprehensive longitudinal measures of smoking onset, frequency and patterns of use, DIS/DSM-IV diagnostic assessments for nicotine dependence and multiple measures of trauma including childhood maltreatment, intimate partner violence and PTSD diagnostic criteria. Both longitudinal studies are gender balanced and have multiple assessments (13 in SSDP, 7 in TIP), with high retention across waves. The proposed study is illustrated in Figure 1 and has the following aims.
Development and Impact of Future Self-Concept among African American and Latino Young Men
How young people conceptualize and cognitively represent their futures— as full of positive potential or constraints and negative possibilities—bears influence on their developmental trajectories. Adolescence is marked as a developmental period when future-thinking (or future orientation) becomes increasingly salient. Future self-concepts, or possible selves, are self-relevant cognitions of enduring goals, aspirations, hopes, fears and threats that function as a framework and guide for individual identity development (Markus & Nurius, 1986). For adolescents, a foreshortened view of the future, or beliefthat “I might nct be here tomorrow,” contributes to increased risky health behaviors (Rothrnan, Bernstein & Strunin, 2010; Borowsky, Ireland & Resnick, 2009; Burton, Obeidallah & Allison, 1996) and lower • educational investment (Abedalu, 2007; Horstmanshof & Zimitat, 2007; Oyserrnan, Bybee & Terry, 2006), underscoring the importance of future orientation as a potential change mechanism for intervention and prevention efforts to promote healthy youth development.
Truncated life expectancy may contribute to hopelessness and a subsequent stunting of a young person’s ability to take initiative, imagine and pursue goals, and persist towards desired future aspirations. Prevalence rates of the belief in premature death reported by adolescents are significantly over-inflated when compared with actual rates of early death (Jamieson & Romer, 2008). A recent study conducted using the National Longitudinal Study of Adolescent Health found that I in 7 youth endorsed the belief that they had a 50% chance of living to age 35 (Borowsky, Ireland & Resnick, 2009). Low adolescent perceived survival expectations are more prevalent in males, racial/ethnic minorities, urban-dwelling youth and youth who receive public assistance (Duke, Skay, Pettingell & Borowsky, 2009). Youth who endorse fatalistic beliefs in early to mid-adolescence are less likely to be in school, employed, in the military and less likely to have a high school diploma in young adulthood (Duke, et al, 2011). Evidence suggests the consequences of fatalistic beliefs in adolescence extend into adulthood, predicting lower educational attainment and socioeconomic status (Nguyen, Hussey, Haplern, et al, 2012). The implications of truncated life expectancy for adolescent health and well-being warrant future investigation.
The central focus of this dissertation is to investigate how African American and Latino young men envision their overarching future possibility and the consequences of blunted future perspective on indicators of their well-being. This involves research and service response implications germane to social welfare in terms of supporting healthy development for historically marginalized and underserved youth. The Chicago Youth Development Study (CYDS), a longitudinal prospective cohort study, will serve as the foundation for my dissertation research.
Association of Filial Responsibility, Ethnicity, and Acculturation of Asian Family Caregivers of Older Adults
Christina E. Miyawaki
Due to Confucian, Asian culture is known to respect elders and practice of filial obligation is embedded in their cultures. The proposed study seeks to explore the level of filial (e.g., familial) responsibility, health status and needs of later generation (2’’ and 3rd generations) of Asian American family caregivers of older adults, specifically five ethnic subgroups of Chinese, Filipino, Japanese, Korean, and Vietnamese caregivers. Data from a biennial population-based telephone survey, the 2009 California Health Interview Survey Adult 18+ are used. There are three studies within the overall design. Study 1 uses one-way analysis of variance to describe the overall characteristics of Asian, Latino and White American caregivers. Study 2 utilizes multivariate regression to examine the generational differences in caregiving-related issues across these three racial and ethnic groups. Based on findings from Study 1 and 2, Study 3 focuses specifically on Asian American caregivers and involves interviews with 2’ and 3td generations of two ofthe subgroups: 40 Chinese- and Japanese-American caregivers in order to explore in-depth generational differences in their level of filial responsibility and their caregiving needs. Given the increasing ethnic diversity of immigrant populations, especially older Asian population, it is imperative to understand how caregivers’ level of filial responsibility, effects of caregiving on their health, and needs vary by ethnicity and generation. Understanding these relationships will help the development of more targeted culturally- and generationally-specific assessment and clinical interventions, and therefore, has implications for social welfare policies and programs.
Incarceration and the life course: Predictors and consequences of varied patterns of juvenile incarceration
Goals and Objective: The purpose of this study is to examine the role of juvenile incarceration in life course development. I will use a longitudinal study spanning from childhood to adulthood, a mixed methods design aimed at increasing both the breadth and depth of understanding, and an innovative measure of incarceration (examining patterns over adolescence, rather than a single indicator of incarceration). This study investigates the early childhood legal and extra-legal factors predicting these patterns, and the long-term criminal, health, and mental health outcomes associated with differential exposure to incarceration during adolescence.
Subjects: Data are drawn from the Seattle Social Development Project (SSDP), a longitudinal study ideally suited to address these research questions, consisting of a gender-balanced, ethnically diverse sample of 80$ participants who were in the 5th grade in 1985 in the Seattle Public Schools. Participants have been followed prospectively into adulthood, and at the last data collection period were approximately 35 years old. Fifty-two percent had participated in the National School Lunch Program. Approximately 34% of the sample experienced a referral to the juvenile delinquency court at some point in adolescence and 14% were incarcerated as a result of a court adjudication.
Research Design and Methods: Secondary data from the SSDP sample will be used to quantitatively analyze predictors and consequences of incarceration for youth who experienced this sanction during adolescence, using the remainder of the high-risk sample who were never incarcerated as a comparison group. Additionally, original qualitative data will be collected from a subset of those who were incarcerated as youth to examine how their experiences of incarceration affected their transition to adulthood.
Analysis: Multinomial logistic regression will be used to predict patterns of incarceration. Propensity score analysis, in conjunction with regression analyses, will be used to examine consequences of patterns of incarceration. Finally, qualitative interview data will be coded for common themes and used to further understand and interpret the results found in the quantitative analyses.
Products and Reports: The results of this work will be pertinent to public policy, juvenile justice practice, and life course criminology, and will result in at least three manuscripts which will be submitted to high-quality academic journals for publication. My broad dissemination plan also involves presenting the findings at both academic and practitioner-oriented conferences, dissemination through The Social Development Research Group (SDRG) newsletter and mailing list, and outreach to the general public through the use of op-eds.
Understanding Protective Factors and theft Effects on Youth Developmental Outcomes: Implications for Community-Based Prevention
Kyung Elizabeth Kim
The social work profession emphasizes the importance of strength-based practice, policy, and research. Despite this current emphasis on a strengths perspective, only in the 1 9$Os did the transition from deficit-focused to strengths-based practice occur (Saleebey, 1996; Weick, Sullivan, & Walter, 1989). Rather than simply diagnosing problems, social workers came to respect the possibility and capability of individuals to overcome problems and change for the better. The fundamental premise of a strengths-perspective is that the individuals will indeed fare better if they “identify, recognize, and use the strengths and resources available in themselves and their environment” (Graybeal, 2001, p. 234). Thus, strength-based practice is inherently grounded in a person-in-environment perspective where “strength” does not stem from individuals alone but also from the surrounding environment — friends, families, schools, neighborhoods, etc. (Kemp, Whittaker, & Tracy, 1997). Also in research, social work scholars became more interested in understanding individual and environmental strengths that foster healthy development in the face of adversity (Benard, 2006). In addition to understanding the likelihood of youth exposed to adversities engaging in problem behaviors, studies focused on how youth with adversities develop into successful adults. Yet, clearly defining and operationalizing “strength” remains a challenging task (Mm, 2011).
In my dissertation, using strength-based framework, I incorporate important elements of prevention science and theory to provide further clarity in defining strengths across youth development — what they are and how they develop. Furthermore, I seek to understand the role of strength in reducing problem behaviors and promoting positive behaviors through a community based prevention strategy. In doing so, I hope to shed light on how and when these strengths can be targets of interventions to achieve social, emotional, and behavioral health across youth development.
Patterns of Adolescent and Young Adult Sexual Behavior: Predictors and Consequences
Kari M. Gloppen
Adolescent and young adult sexual behavior is an important health and welfare issue that has the potential to impact the entire life course. Risky sexual behavior can lead to sexually transmitted infections including HW as well as unintended pregnancy. By understanding the social and cognitive processes that influence sexual behavior choices during adolescence and young adulthood, we will be better able to promote positive sexual health and reduce the potential negative consequences of risky sexual behavior. This sttidy uses data from the Raising Healthy Children study, a longitudinal study of participants from 10 public elementary schools in the Pacific Northwest, to explore the social and cognitive influences on sexual behavior decisions, the patterns of sexual behavior during adolescence and young adulthood, and the predictors and consequences of those sexual behavior patterns. This dissertation uses the 3 paper option preceded with an introduction and summarized by a conclusion that integrates the findings from the three papers. Paper I examines theory-guided social and cognitive predictors of age of sexual initiation using structural equation modeling. Paper 2 identifies patterns of sexual behavior over time among adolescents and young adults and the predictors of those patterns using latent class analysis. Paper 3 explores the consequences of the identified sexual behavior patterns and examines gender differences in both the patterns and consequences. Findings from these papers will increase our understanding of the social and cognitive processes during childhood and adolescence that influence sexual decision making. They will provide us with information on the longitudinal patterns of sexual behavior of young people and their predictors, and how these patterns influence later emotional, health, and social outcomes. These results will provide important information that can be used in developing both sexual risk reduction and sexual health promotion programs.
Front Line Accounts of Implementation of Evidence-Based Interventons in Core Safety Net Settings
Margaret A. Cristofalo
Despite a prolific amount of evidence-based practices (EBPs), patients are not receiving these health and mental health interventions as much as they should. Patients relegated to the core safety net, a subset of the health care safety net with a mission or legal mandate to care for uninsured, underinsured, or other vulnerable populations, face even greater obstacles to receiving evidence-based care. The fundamental research that has shaped current implementation models has been informed by multiple fields, including health and mental health care primarily serving patients with insurance, and fields outside of human services. Therefore, much less is known about the processes and influences unique to implementation of EBPs in settings serving vulnerable patients. Three qualitative studies, using grounded theory methodology, were undertaken to examine the unique processes and contextual influences of implementations of three different EBPs in three different core safety net settings. Semistructured interviews and focus groups of administrators and front line clinicians participating in the implementations of the EBPs were employed to ascertain their knowledge and experiences. Findings in all three studies revealed interacting beneficial and challenging factors woven together in ways that the fabric of their combinations supported successful implementations, or possessed vulnerabilities that impeded them. Key findings across all studies were the importance of the following influences: 1- intervention fit with patient characteristics and beliefs, community needs, and organization mission, 2- intervention adaptability, quality, and observability, 3- clinician beliefs and behaviors 4- clinical staffing, training, and education, 5- structural and cultural organizational assets, and 6- ongoing network and system building. Results from these studies can provide direction for developing implementation frameworks unique to core safety net settings.
Religious Beliefs and Practices and Mental Health Care: Examining the Use of Mental Health Services among Immigrants
Amelia Seraphia Derr
Members of immigrant communities are at greater risk for mental health disorders, yet are less likely than other groups to access critical health and mental health services (Alegria et a!., 2007; DHHS, 2001). One reason for disparities in service utilization may relate to the religious beliefs and practices of immigrants and how these are associated with help-seeking behavior. Despite the increasing awareness of the centrality of religion in immigrant identity (Ebaugh & Chafetz, 2000), and the association of religious beliefs and practices with immigrant adjustment and immigrant mental health care (Cadge & Ecklund, 2007), religious beliefs and practices have rarely been studied as a factor in accessing mental health services for immigrants. To address this shortcoming, this study is designed to examine the role of religion in the help-seeking process in order to further understand immigrant mental health service utilization. To capture the heterogeneity of immigrant experiences with mental health service use, I propose to use Latent Class Analysis with data from the NIMH Collaborative Psychiatric Epidemiology Surveys (CPES) to determine if subgroups of service users exist based on their religious beliefs and practices. Subsequently, predictors of subgroup membership and their relationship to mental health service use will be tested through regression analyses. Findings will inform interventions for adaptation by health and mental health practitioners in order to improve immigrant wellbeing.
Effects of Childhood Adversities on Positive Adult Functioning across Racial Groups, and Examination of School Bonding as a Moderator
Ebasa B. Sarka
Research has established that adverse experiences during childhood increase the risk of complex sets of long term detrimental effects in adulthood, including poor physical and mental health, as well as functions in multiple social domains. There is a need for a broader (discipline wise), yet focused and unified definition of childhood adversity, in order to adequately appreciate its prevalence and long term consequences. There is also a need to consider a growing evidence in studies of resilience that despite harsh childhood experiences, some achieve a healthy and successful life as adults. This study examined three questions with focus on the long term impacts of childhood adversity: (1) Does childhood adversity as measured by abuse and neglect, poor bonding with parents, poor attachment to neighborhood, family conflict, and poverty impact resilient adult functioning at age 27?; (2) Does the effect identified in question 1 vary across races? In other words, does childhood adversity predict positive adult outcomes differently across three racial groups?; and, (3) Do the experience of high/low school bonding in high school moderate the relationship of childhood adversity on resilient adult functioning? The data in use comes from the Seattle Social Development Project (SSDP), a longitudinal study in which 808 children from 18 schools in an urban area in the Pacific Northwest were followed into their adulthood, and regularly interviewed over the last 25 years. This study focuses on the experiences of African Americans (n=192), Asian Americans (n=171), and European Americans (n=374).
The structural equation modeling (SEM), and Multiple Groups SEM (MGSEM) technique was used to examine questions in this dissertation. Results of the full sample indicate that adverse childhood experience has a negative impact on resilient adult functioning at age 27. In particular, child maltreatment, poor bonding with parents, and eligibility for free lunch (a proxy for poverty) showed significantly negative impacts. Identifying as Asian American was also found to positively predict positive adult functioning. Tests of invariance in the regression paths of childhood adversity on positive adult functioning suggests an overall difference in how childhood adversity predicts adult functioning across racial groups. The differences are tied to how two predictors, specifically child abuse and neglect and poor bonding to parents more strongly predict adult functioning for European Americans. Poor bonding with parents also strongly predicted negative adult functioning for the Asian American group. However, this model did not predict any significant relationships between childhood adversity and positive adult functioning for the African American group.
Examining the moderating effect of high versus low levels of school bonding indicates a non-invariant measurement, which indicates that the measurements are not similar across high and low groups. Results of this analysis suggests that there is not much evidence that bonding to school moderates the relationship between childhood adversities and positive adult functioning as measured in this study.
Experiences of Belonging and Wellbeing
Kimberly Dree Hudson
Community borderlands are spaces that are shifting, polyvocal, and multidimensional; they embody, transform, and resist systems and cultures of oppression, impacting the material realities and lived lives of their occupants and visitors alike. In this dissertation, I applied a borderlands framework to learn about lived experiences in relationship to three central concepts within social work: community, belonging, and wellbeing. This project integrates elements of transnational feminism, postcolonial studies, and borderland epistemology within a queer framework, employing theoretical pluralism to interpret stories of lived lives, material realities, and perceived wellbeing. Using critical narrative and feminist methodologies, I interviewed 12 adults in the Seattle area who identified in flexible, critical, or ambiguous ways across race, gender, and sexuality; most study participants self-identified as mixed and queer. I explored articulations and intimations of liminality and belonging used by participants to make meaning of being in community and being well. Emerging from this analysis is a conceptual framework to understand belongingness in community borderlands and corresponding, contradictory experiences that enhance and detract from participants’ perceived wellbeing. Wellbeing itself, from a borderland perspective, is understood through participant positions on reclaiming “healthy bodies,” priority-setting within their communities, and critical self-reflection regarding the intentional creation of spaces and the unintentional replication of oppressive practices and discourses. This dissertation challenges the monolithic assumption that having liminal status is a source of chronic stress and social disconnection that deteriorates wellbeing. Instead, I demonstrate that borderland experiences of community may provide a sense of connectedness that actually enhances perceived and actual wellbeing through increased resources, sense of safety, and belonging. However, I also highlight the complexity, ambiguity, and discontinuities of these relationships. This study suggests the application of a borderlands framework in social work scholarship, pedagogy, and practice, namely by informing existing and potential collaborative community efforts to address disparities and promote wellbeing.
Impact on Pathways to Adulthood and Adult Criminal Outcomes
JoAnn S. Lee
In today’s social and economic context in the U.S., many individuals experience an extended transition to adulthood period during which they are able to delay adopting adult social roles and responsibilities, such as initiating careers, making long-term commitments to a romantic partner, and starting a family. However, many individuals do not have the resources or supports that would enable them to delay adopting one or more of those roles, experiencing an accelerated transition to adulthood. An accelerated transition can pose more challenges in the form of economic or housing hardships and may hinder the ability of individuals to accumulate additional and necessary human capital. This dissertation applies an institutional lens to the study of the transition to adulthood in order to help illuminate the role of social structures in shaping individual lives during childhood, adolescence, and the transition to adulthood, and consists of three analyses. Chapter 2 examines the experiences of a general sample of diverse, urban youth, and chapters 3 and 4 focus on foster youth aging out of care. Chapter 2 considers whether the normative socializing institutions of family and school play a role in shaping the transition to adulthood, whether extended or accelerated, and whether the individual’s bond to these institutions mediates the relationship. Although the findings indicate that the prosocial socialization process operating in the family and school does not play a role in explaining differences in who experiences an extended or accelerated adulthood, other characteristics of the family play an important role, such as parent school expectations, a family disruption, and immigrant status. Chapter 3 examines the impact of legal system involvement on foster youth in preparation for the transition to adulthood on criminal activities during the transition to adulthood. The findings indicate that legal system involvement is associated with higher levels of criminal activities at age 21. In addition, legal system involvement initiates a process of social exclusion where youth are less likely to graduate from high school by age 19, and this has an impact on their employment status at age 21. Chapter 4 investigates the impact on arrests of extending foster care support during the transition to adulthood; the findings indicate that extended support in the first year after turning 18 reduces the risk of arrest, but this effect declines after the first year. Together, this dissertation research finds that during childhood and adolescence, as well as during the transition to adulthood, institutions play an important role in shaping the transition to adulthood.
Diasporic Intersectionalities: Exploring South Asian Women's Narratives of Race, Ethnicity, and Gender through a Community-based Performance Project
Gita Rani Mehrotra
Although South Asians constitute one of the largest, fastest growing Asian groups in the country, there is a paucity of U.S.-based social work literature about this community. Further, professional social work organizations and feminist social work scholars have called for the field to build paradigms and practices that address the intersections of oppressions facing individuals and communities, such as race/ethnicity, gender, sexuality, and class, in a global context. Drawing from intersectionality theorizing, transnational feminisms, diaspora studies, and theories of narrative identity, this study explores how a local group of South Asian women construct their experiences of race/ethnicity, gender, class, and diaspora. Thirty-one in-depth interviews were conducted with participants of a culturally-specific, community-based performance project,Yoni Ki Baat (Talk of the Vagina). Thematic analyses, with attention to context and discourse, elucidated important similarities and differences across women’s narratives.
While all participants communicated a high sense of agency in defining themselves in terms of race/ethnicity, first and second generation women’s narratives diverged significantly in the following domains: use of racialized vs. ethnic constructs, nationality, significant life events impacting racial/ethnic identification, and ways women perceive race/ethnicity assigned to them by others. In contrast, despite differences in age, generation, religion, and other life experiences, all participants narrated the centrality of marriage as a “cultural script” that produces ideal, middle-class, South Asian womanhood. Women’s narratives illustrate some everyday ways this cultural script is communicated, enforced, and negotiated within families and communities.
Overall, this study demonstrates the utility of narratives and cultural scripts for understanding meaning and self-making processes within diverse communities. Research findings herein also challenge traditional social work frameworks that often rely on essentialized representations of social groups, single-oppression analyses of inequality and identity, and/or U.S.-centric approaches to understanding oppression and experience. Analyses of South Asian women’s narratives point to the need to expand intersectionality theorizing and social work education to incorporate: context; temporality, age, and lifecourse; transnational experiences; concepts of diaspora; and relationships between experiences of privilege and marginalization. Fostering deeper understandings of intersecting oppressions and processes impacting transnational populations in these ways can contribute to more liberatory social work scholarship and practice.
Overrepresented, Underserved: The Experiences of LGBTQ Youth in Girls Detention Facilities in New York State
Sarah E. Mountz
Among LGBTQ youth, queer women, transgender and gender non-conforming youth have been particularly marginalized in both social science research, social service settings, and in the community, where they are especially vulnerable to violence and significantly more likely to become involved with law enforcement. This is particularly the case for queer young women, transgender and gender non-conforming youth of color and youth or who are low-income. For my dissertation research, I have conducted an oral ethnography with young adults, ages 18-25, who have been incarcerated in girls detention facilities in the Juvenile Justice system in New York State. The study design used the principles of Community Based Participatory Research (CBPR) and was facilitated by a Community Advisory Board composed of practitioners, legal advocates, researchers, activists, and young people. Life History Interviewing was used to gain insight into participants’ experiences in relation to the research questions asked. It was determined to be the most appropriate methodological tool for its capacity to dialogically elicit a narrated panorama of young people’s lives that elucidated pathways prior to and following their involvement with the Juvenile Justice system in order to identify life choices, systemic barriers, experiences of violence and harassment in detention and elsewhere, and childhood and family history and events. Moreover, Life History Interviews allowed participants to delve richly into questions of how they negotiate their sexual orientation, gender, gender identity, and race in relation to various contexts, relationships, and systems, over time. Interviews were analyzed using Carol Gilligan’s Listening Guide. Findings from the study revealed themes related to identity processes, the role of family acceptance and rejection in systems involvement, pipelines and revolving doors between and amidst child welfare, educational, and juvenile justice systems, the prevalence of interpersonal and state sanctioned violence in participants lives, and participants’ tremendous capacity for resiliency and creative modes of collective and community based healing. Findings suggest profound importance of hearing LGBTQ young adults’ own stories about their lives and experiences in the juvenile justice system and beyond, the need to decriminalize young people’s survival strategies, and to challenge the use of detention facilities, and the rampant abuse of power by law enforcement towards LGBTQ young people within and outside them. This dissertation research draws upon my direct practice experience with LGBTQ youth in the child welfare system and as a queer activist.
Sexual Assault Response Teams: Exploring the Discursive Negotiation of Power, Conflict, and Legitimacy in Coordinated Service Delivery Models
Carrie A. Moylan
To improve services for sexual assault victims, many communities have adopted coordinated models of service delivery, often called Sexual Assault Response Teams (SARTs). Uniting law enforcement officers, rape crisis advocates, and health care professionals, SARTs frequently aim to create a seamless and compassionate experience for victims who engage with formal helping services. There is some indication that the process of implementing SART is contentious. Furthermore, replicating in practice the ideals of SART coordination has proved elusive for some communities. This research explores the challenges of SART implementation, focusing on why there is sometimes a disconnection between the philosophy of integrated services and the realities of front-line service delivery. Using a qualitative within-case and cross-case method, interviews with 24 SART professionals were analyzed, resulting in three studies of SART functioning. The first study explored the discursive construction of conflict in SARTs. Analysis identified how SART professionals discursively positioned one another in terms of authority, expertise and credibility in order to protect their own professional autonomy and to stake a claim on setting the agenda for the team’s work together. The second study explored strategies that interviewees used to manage conflict in teams. Four categories were identified including preventative, responsive, unobtrusive, and resignation strategies. All professions were engaged in processes of managing conflict, but advocates talked much more about strategies and were almost exclusively responsible for all discussions of unobtrusive and resignation approaches to managing conflict. The final study draws on institutional theory to explore how external forces shaped the adoption and operation of SARTs. The analysis revealed two simultaneous processes. The first process illustrated how SART was discursively legitimized, starting with the framing of sexual assault service delivery as a moral imperative for communities and continuing with the identification of coordination as a means of meeting the moral imperative. Concurrently, a process of decoupling is indicated by the continuing resistance both to the moral imperative and the logic of coordination, as well as by the inconsistent and incomplete implementation of SART. Implications for SART practice and future research are also discussed.
Community Coalitions: Resolving the Gap between Research & Practice for the Prevention of Youth Mental, Emotional, & Behavioral Problems
Valerie B. Shapiro
Tested and effective approaches are available to prevent mental, emotional, and behavioral problems in youth, but they are underutilized. Communities That Care (CTC) is a coalition-based strategy that creates a local infrastructure for prevention service delivery that facilitates the community-wide adoption of a scientific approach to preventing these problems. A community-randomized trial of CTC in 24 communities, matched in pairs and randomly assigned to a control or an intervention condition, has demonstrated that CTC significantly increases the community-wide adoption of a science-based approach to prevention, as reported by community leaders. For this dissertation, I first examined the extent to which the effect of CTC on the adoption of a community-wide scientific approach to prevention varied significantly across matched community pairs. Results indicated significant and substantial variation in the effect of CTC on the adoption of a scientific approach to prevention across the 12 community pairs. Next I explored potential sources of the variation across community pairs in community transformation toward a scientific approach to prevention. These sources included five coalition capacities: member knowledge, member acquisition of new skills, member attitudes, organizational linkages, and influence on organizations. Findings indicated that CTC coalitions successfully built capacities. Results also showed that new skill acquisition by coalition members and the engagement of diverse sectors in coalition work, as reported by coalition members, moderated the relationship between CTC and the community-wide adoption of a science-based approach to prevention. Finally, I explored whether the internal coalition functioning of CTC coalitions predicted community-wide adoption of a science-based approach to prevention directly or through a coalition culture that builds capacities necessary for coalitions to achieve system transformation. Findings indicate no direct effect of goal-directedness, efficiency, opportunities for participation, or cohesion on community-wide adoption of a science-based approach to prevention, but suggest the possibility of an indirect pathway through building new member skills and external linkages to diverse sectors. Identification of these malleable coalition processes and capacities, which facilitate the community-wide adoption of a scientific approach to prevention, will be useful for improving the overall effectiveness of community coalitions focused on preventing adolescent mental, emotional, and behavioral problems.
Political Violence, Trauma, and Resilience
In recent decades, there has been an expanded effort to examine the adverse effects of political violence on the health of civilian populations; substantial evidence now points to the effects of political violence on outcomes like PTSD, anxiety, and a variety of physical health symptoms. Despite the variety of risks inherent within political violence, we know individuals and communities actively cope with the stressors of political violence, exhibiting marked resilience as they function much better than might be expected. Individual and community resilience is generally defined as the successful recovery from or adaptation to stress or adversity through the use of individual or community characteristics, resources, strategies, and processes. While researchers have increasingly focused on political violence in the past few decades, several areas within the field of political violence and global health remain under-explored. To address these areas, this dissertation explores experiences inherent within the political violence, their effects on health and well-being, and processes of resilience within the experience of political violence. Each paper within this dissertation sheds light on one shared question: How does political violence affect people’s health and how do people and communities endure the stress and trauma it poses? The papers within this dissertation employ distinct guiding questions and associated research methods to: (1) provide an interdisciplinary overview of resilience to clarify what we currently know from scholarly literature about how individuals and communities weather the effects of political violence; (2) explore how political violence affects a variety of health outcomes (including general health, PTSD and distress) and examine how these health effects of political violence might differ along various sources of coping, ranging from self-reliance to use of support from one’s family and from religious and political resources; and (3) examine how women describe the specific, particular experiences they endure within political violence and their strategies of resistance within that context.
A Life Course Perspective on the Social Determinants of Multiracial American Health
Karen Tabb Dina
Few studies provide data on the health of self-identified multiracial (two or more races) Americans. Subsequently, we know little about this population and existing health disparities. Three areas relevant to multiracial health include health status, health care service utilization, and health related to racial stability over the life course. Although some investigations report the health service use of children and adolescents, almost no studies report the health service use of multiracial young adults. Most studies on multiracial groups are cross-sectional and thus focus on a single time point, so it is difficult to establish how health indicators change for multiracial groups over time. This dissertation employs epidemiological methods to investigate the health of self-identified multiracial young adults in a series of three linked papers. I used data from the National Longitudinal Study of Adolescent Health (N = 20,774) in-home sample taken during the period 1994-2008 to examine factors related to multiracial health as individuals enter difference phases of life. Using multivariate logistic regression I tested a series of hypotheses for three distinct research questions. In the first paper, I found that there are differences in self-rated health for some multiracial groups. In the second paper, I found that there are differences in the rates of health care service utilization when comparing specific multiracial groups to the monoracial majority. In the third paper, I found that there are differences in report of self-rated health when comparing monoracial adults with multiracial adults who switch racial categories over time. These findings contribute to the wider understanding of health disparities for vulnerable populations and assist in identifying salient mechanisms of health disparities over the life course. These results also demonstrate the importance of critically examining changes in categories over time and effects when using quantitative data.
Where is “Home?” Interpreting Horn of Africa Youth Discourse and the Politics of “Displaced Youth”
Aster Solomon Tecle
This dissertation is a discursive inquiry into the language Horn of Africa (HOA) youth use as they talk about their experiences. Study participants are 1.5 and second generation HOA youth, mainly from Eritrea, Ethiopia, and Somalia, living in the Pacific Northwest and actively participating in youth programs provided by three agencies serving HOA immigrant populations. Youth in the study participated in three focus groups. Employing postcolonial and poststructuralist frameworks, the study aims to reveal the function of language in representing HOA youth: it assumes language to be a “site of contestation” where youth position and reposition their claims as they characterize themselves and their experiences.
The study’s thematic findings highlight three aspects of HOA youth experience: their strategic use of the language of difference; the hybridity of their experiences and aesthetics; and their use of this inbetweeness as a space of possibility. The study captures the nuances of HOA youth discourse, moving beyond dichotomous frameworks to more fully acknowledge the complexities for immigrant youth of negotiating inbetween spaces. These complexities reveal that HOA youth can and do displace discourses that represent them. Revealing the complexities of HOA youth language also has the potential to dismantle underlying paradigms that take-for- granted the politics of “displaced youth.” The study potentially contributes to social work methodology, theory, and practice, and to youth programming.
The study findings challenge theoretical and conceptual frameworks that assume HOA youth have a stable, rational, and unified identity, and assume related ideas about empowerment and change, which can ultimately victimize youth for not fitting into expected norms. From the perspective of this study, liberation from dominant discourses does not require a stable identity; rather, identities are continuously and complexly produced in and through competing discourses. The research points to the need for youth programs to focus on exploring how cultures and languages represent youth, and their populations, while also questioning what it means to talk across borders, as the youth move beyond conventional discourses of multiculturalism. The study also has the potential to inform host society perceptions of HOA youth in particular and African immigrants in general.
Courts, Child Welfare, and Criteria for Terminating Parental Rights
William Michael Vesneski
Few legal proceedings in the U.S. have more significant consequences for families than the termination of parental rights. Previously described as family law’s “death penalty,” termination leads to the complete severance of the parent-child bond. Yet, despite its profound consequences, termination is infrequently addressed in social work scholarship. This dissertation aims to help fill this gap by examining North Carolina judicial opinions, written in 2010, that resolved disputed actions to terminate parental rights. A total of 100 opinions were examined using content analysis. All of the cases involved child neglect. The study focused on neglect because of ongoing difficulty in clearly defining this common form of child maltreatment. A large majority (n=86) of the cases resulted in the termination of parental rights. The study yielded a typology of factors appellate courts used to justify their termination decisions. Altogether, 39 factors were identified and organized into 10 different domains: parental conditions, service compliance, home environment, economic conditions, child conditions, bonding, child welfare history, physical abuse, physical presence, and sexual abuse. These factors are more expansive than the termination criteria listed in the federal Adoption and Safe Families Act as well as North Carolina statutes. Just as important, chi-squared analyses revealed that when courts made their termination decision, they looked to different factors depending upon which parents were involved in the cases (mothers, fathers, or both parents).
Two domains were selected for closer examination using discourse analytics: “service compliance” and “economic conditions.” The goal of this examination was to understand the ideology and social values underlying the rulings. The results indicate that the courts placed significant importance on parents’ compliance with case plans when deciding whether to terminate their rights. At the same time, the courts were very concerned with parents’ poverty and their surrounding economic circumstances. Overall, the study underscores the critically important role the courts play in the child welfare system. Not only do courts safeguard parents’ rights during termination proceedings, they are actively involved in creating child welfare policy and setting the parameters of social work practice in the field.
Same-Sex Partnerships and the Health of Lesbian, Gay and Bisexual Older Adults
Mark Edward Williams
While extensive research has examined associations between marriage, cohabitation and the health of heterosexual adults, it remains unclear whether similar patterns of health are associated with the same-sex partnerships for older adults. The following papers examine how having a same-sex partner may be related to general self-reported health, mental health, and satisfaction with life for older adults. Analyzing survey data collected from lesbian, gay, and bisexual (LGB) adults 50 years of age and older, the first paper reports findings that those with same-sex partners have significantly better self-reported health, fewer depressive symptoms, less perceived stress, and greater life satisfaction, controlling for gender, age, education, income, sexuality, and relationship duration. Relationship duration did not significantly impact the association between partnership status and health, nor did gender. The importance of culturally sensitive clinical practice and policies that recognize the role that same-sex partnerships may play in older adult health are discussed along with implications for future research. The second paper further examines how identifying as married is associated with significantly fewer depressive symptoms and greater life satisfaction compared to those identifying as unmarried partners, but not significantly less perceived stress. Social integration, as reflected in increasing access to and identification with marriage by LGB older adults, is an important area for future research to examine in order to study how changing social acceptance of sexual minorities may impact older adult health. The final paper reviews the theoretical frameworks that have been employed to study lesbian, gay, and bisexual older adult health. Social determinants of health models are contrasted with social constructionist and post-structural critiques of gender, sexuality, age and health. Future research needs to envision both structural sources of health disparities as well as account for individual agency and the resilient subject as important elements for theorizing the source and meaning of health disparities for lesbian, gay and bisexual older adults.
Heterogeneity among Youth at Risk for Violence:
Implications of a Stress and Coping Framework for Prevention
This dissertation uses a stress and coping resource framework to examine heterogeneity among adolescents and young adults at risk for violence. Three studies are included that build on existing literature concerning risk and protective factors for violence by consideration of etiological differences that bear upon stress exposures and coping capacity. Participants were recruited from high schools on the basis of risk for drop-out and suicide behaviors (Mean age = 16.0), which resulted in an ethnically diverse, gender-balanced sample. Additional surveys were delivered 5 and 7 years later with satisfactory retention. Paper 1: Latent Profile Analysis was used to detect four distinct groups with differential risk and protective factor profiles and concomitant problem behavior outcomes, demonstrating important differences for etiological risk of violent behaviors. Paper 2: The sustained impact of adolescent violence histories was established relative to early adulthood psychosocial functioning, across multiple dimensions of risky behaviors and emotional distress. Paper 3: An assessment of stress and coping resources in early adulthood successfully predicted continuity and discontinuity in violent behaviors from adolescence to young adulthood. Collectively these findings demonstrate the importance of investigating variation among violent youth with respect to stress-related risk, protective factors, and ways in which coping affects development—distinctions that are crucial to insuring interventions are well matched and proportionate to respective risk profiles among youth. Results strongly bolster arguments concerning the value of preventive and early interventions toward curbing the developmental and transgenerational impacts of violence. Major implications include the need to assess for histories of violence among vulnerable youth, as well as attend to traumatic experiences and emotional distress of youth engaging in violence.
Predictors Associated with Late-Life Depressive Symptoms among Older Black Americans
Gillian L. Marshall
With the projected growth of a diverse older adult population in the U.S., their mental health status is of increasing concern. It is a concern since little is known about what places them at risk and what factors protect them against late-life depression. The primary aim of this dissertation is to address this concern by examining the risk and protective factors associated with depressive symptoms between older black Americans. Data analyzed for all three studies used the National Survey of American Life. The study sample consisted of older persons age 55 years and older who self identified as either African American (N=837) or Caribbean Black (N=271). Results indicate that socio-economic status was significant in predicting high depressive symptoms, especially for older African Americans. Results also highlight the fact that greater depressive symptoms are associated with stress in the form of perceived discrimination which poses a risk for late-life depression among both groups of older Black Americans. In addition, both social support and social connectedness were significant in moderating the effect of stress for both older African Americans and Caribbean blacks. The findings from this study will contribute to the general body of knowledge on black Americans, and more specifically, to the heterogeneity embedded between and within older African Americans and Caribbean Black populations.
Bark Made Rope, Roots Made Baskets
Background: Over the last several decades space and place have emerged as important concepts and how they are theorized is beginning to shape many policies and practices that impact the health of indigenous peoples. For indigenous peoples, the ultimate location of space and place is embedded in a profound relationship with the earth. The earth (or land) is both literally and figuratively the first and final teacher for understanding our world, communities, families, selves, and bodies. This dissertation articulates an indigenous framework for triangulating the concepts of space and place, historical trauma, and embodiment as they impact health and wellness of indigenous peoples. Methods: Innovative qualitative methods including narrative analysis of in-depth interviews about traditional and contemporary perceived experiences between land and health from 13 tribal members of a Washington reservation was conducted along with a GPS and photographic survey of food and activity resources on tribal lands. Data points were mapped onto an interactive web-based map and used to illustrate and deepen individual narratives. Poetic narrative was also woven throughout the dissertation to evoke a fourth analytical space referred to as “differential consciousness” which transcends the bounds of academic words and ideas. Results: Qualitative analysis revealed an overall ambivalence including a simultaneous profound love, care, and loss of original tribal land/health relationships. Thematic findings were organized into eight primary categories with more nuanced sub-themes articulated within each category. The over-arching themes for how Tulalip tribal members experience the relationship between land and health include: 1) Simultaneous reverence and loss; 2) Close kinship relationship; 3) Respect and reciprocity; 4) Dissonance of historical trauma and cultural strength; 5) Impact of development and western values; 6) Cultural transitions and losses; 7) Contemporary practices and realities and; 8) Cultural revival and regeneration. Photographs and map illustrate these themes. Conclusions: Using personal narratives to investigate complex environmental conditions helps describe how relationships to historical and contemporary cultural knowledge impacts the health of indigenous community members.
From Healthy to Unhealthy: Disaggregating the Relationship between Race, Nativity, Perceived Discrimination, and Chronic Health
Shauna K. Carlisle
There is a clear association between race and health outcomes in the United States. Needed is a systematic examination of the relationship between chronic health and race, ethnicity, nativity, and length of residency. Further, the role of perceived discrimination and health decline must be explored beyond broad racial categories with the inclusion of Caribbean ethnic subgroups. Utilizing the linked data from the Collaborative Psychiatric Epidemiology Surveys (CPES), this dissertation addresses the gap in literature by examining differences in reports of chronic cardiovascular, chronic respiratory, and chronic pain conditions across three samples of Asian American (n=1,628), Latino Americans (n=1,940), and Afro-Caribbean American (n=978) respondents. Chapter 2 examines the ethnic subgroup variation in chronic health by comparing self-reports of chronic conditions across diverse subgroups of Asian American (Vietnamese, Filipino, Chinese), Latino American (Cuban, Portuguese, Mexican), and Afro-Caribbean (Haitian, Jamaican, Trinidadian/Tobagonian) respondents. Chi square analysis reveals significant differences by race for chronic cardiovascular [c2 (2, n=4969) 16.77, p<.0000], respiratory [c2 (2, n=4975) 10.23, p<.0001], and pain conditions [c2 (2, n=4973) .22, p>.8]. Logistic regression revealed significant differences in reports of chronic conditions across nine ethnic subgroups. Chapter 3 examines the nativity differences in reports of chronic cardiovascular, respiratory, and pain conditions between foreign-born (n=3,579) and native-born (n=1,409) respondents. Results reveal that native-born respondents were significantly more likely to report chronic respiratory [c2(1, n=4958) 30.78, p≤.05] and pain [c2(1, n-4958) 3.77, p≤.05] conditions than were their foreign-born counterparts. Logistic regression models reveal significant associations between chronic conditions, and other demographic factors known to influence immigrant health. Chapter 4 explores the relationship between chronic conditions, nativity, perceived discrimination, and length of residency among the three racial and nine ethnic subgroups. Afro-Caribbean subgroups were more likely to report perceived discrimination than Asian and Latino American subgroups were. However, a significant positive association with perceived discrimination was found only for Latino American respondents (b=.60; P≤.01). An interaction term called “exposure” was created to estimate the effects of long-term exposure to perceived discrimination among foreign-born respondents in this study. Logistic regression analysis was conducted to determine which groups within the model were more likely to report exposure effects.
Participatory Action Research in a Prison Nursery
Incarcerated mothers and their babies are invisible to most of us. Little is known about the discourses surrounding women who give birth and begin raising their babies while doing time in prison. I conducted a two year, exploratory, qualitative study of babies’ experiences in the Residential Parenting Program in Washington Corrections Center for Women, using Participatory Action Research (PAR). I present just one aspect of our work, namely operationalizing PAR concepts with prisoners, officers, early childhood educators, nurse practitioners, birth attendants, and community members. These stakeholders hold divergent views about incarcerated women and their newborns. They rarely if ever come to the same table to talk and learn from one another. Stereotyped identities, differences in power, privilege and autonomy, and the divergent missions of their organizations present real challenges to linking research and action on behalf of babies. PAR literature raises questions about the extent to which PAR philosophy can be truly carried out in prisons, when participation is not limited to one or two groups of allied stakeholders. I explain challenges. I present evidence supporting and contraindicating PAR in settings that mandate limited autonomy and agency for women. I present strategies that led to the emergence of a common discourse. I offer recommendations for future work.
Investigating the Social Context of Immigration-Related Factors and Asian American Health
Aileen A. Duldulao
This dissertation examines the social context of immigration-related factors as they relate to the health of Asian American immigrants and focuses specifically on age at migration and period of migration as potential explanatory contexts for elucidating the strong relationship between immigration and health. In the first paper, an historical, social, political and theoretical framework is outlined that argues for the use of expanded contexts when empirically examining Asian American health. This paper provides recommendations as to how such contexts can be brought to bear on Asian American health, such as using model specification techniques used in research on racial health disparities. The second paper is an empirical test of historical context as a way to frame the relationship between Asian American self-rated mental health, age at migration and the historical period of migration. Specifically, this paper tests the applicability of age at migration as a predictor for self-rated mental health between pre- and post-1965 immigrations using model specific path analyses. The third paper also builds on analytical recommendations set forth in the first paper and provides an empirical test of the relationship between suicidal ideation, ethnic density and historical period of migration using multilevel modeling techniques. In its entirety, this dissertation argues for and provides a more holistic, nuanced approach to examining and explaining the relationship between immigration-related factors and Asian American health.
Maltreated, Displaced, and Under-Served Foster Youth: Predictors of Developmental Outcomes among Racially Diverse Foster Care Alumni
Antonio R. Garcia
Child welfare practitioners and researchers’ are faced with the daunting challenge of ensuring children in foster care successfully transition into adulthood. In fact, for many of the youth who experienced prior history of chronic abuse and placement instability, the likelihood of experiencing negative mental health, employment, and education outcomes increase. Due to the fact that research focusing on the experiences of foster care alumni of color is limited, existing interventions to address their negative developmental outcomes may not be effective. The Latino Child Welfare Research and Practice (LCWRP) Model (Garcia, 2009) provided a conceptual framework to aid in identifying areas that warrant further attention for this study. Incorporating the individual/social and institutional domains of the model and utilizing data from the Casey National Foster Care Alumni study, this study addressed the following primary questions: 1) Does chronicity of child maltreatment and cumulative familial risk factors impact foster care alumni’s mental health outcomes, and if so, are they moderated by race/ethnicity? 2) Do positive coping mechanisms (high self-esteem and ethnic identity) mediate the relationship between individual stressors during childhood (chronic abuse, cumulative risk factors, and placement instability) and being diagnosed with a mental health disorder during adulthood? 3) Controlling for placement instability, does access to services and agency preparation for leaving foster care uniquely predict developmental outcomes among Latino, Caucasian, and African American foster care alumni? Finally, this dissertation study, from the perspective of front line caseworkers, also examined barriers and challenges Latino children and families experience in the child welfare system. Relying on mixed methods (logistic regression, multiple group structural equation modeling, and grounded theory) to address these questions, this dissertation study offers valuable contributions by: 1) examining unique predictors of developmental outcomes among foster care alumni of color, 2) highlighting strengths and areas where improvement in child welfare practice is needed to ensure foster care children and adolescents receive evidence based, culturally sensitive services to thrive as adults, and 3) exploring factors that may mitigate negative developmental outcomes and contribute to timely permanency and reunification among Latinos in the child welfare system.
Impediments to Facility Delivery among HIV Positive Women in a Kenyan Setting: Insights from Women’s Accounts and the Service Delivery Context
Peris W. Kibera
In sub-Saharan Africa, where over 85% of pregnancies among HIV positive women occur, many countries report low rates of uptake of the widely available and virtually free services to prevent mother-to-child transmission of HIV (PMTCT), such as facility delivery and infant prophylactic antiretroviral drugs. A small but growing body of scholarship that has examined the reasons why women might fail to take advantage of PMTCT services has primarily documented structural and resource factors such as long distance or inability to pay for transportation to a health care facility as key barriers to service uptake. The influence of service delivery dynamics (for example, the nature of provider-patient interactions and the quality of counseling) demonstrated in other health literatures to be salient in service utilization is a perspective that is largely ignored in the assessment of PMTCT service use.
Thus, to understand the influence of service delivery dynamics on women’s uptake of PMTCT services, this study utilized ethnographic methods to examine how i) the bureaucratic organization of services, ii) patients? experience of the care environment, iii) patient-provider relations, and iv) providers’ experience of their work affected facility delivery among HIV-positive women attending Mathare North Health Center, a community health facility in Nairobi, Kenya.
Findings revealed that guarding against inadvertent disclosure of HIV positive status to a partner or relations accompanying a woman to the facility during childbirth was an important motivation for participants’ non-delivery at Mathare or other public sector health care facilities. In understanding how the inadvertent disclosure of a woman’s HIV status could occur during childbirth at Mathare, Michael Lipsky’s (1980) theory of street-level bureaucracy provided an analytical point of departure. Specifically, several patterns of practice elucidated by Lipsky were mapped out in ANC service delivery with pregnant HIV positive women. Because of the work practices that providers at Mathare adopted to cope with the mismatch between limited resources in the work environment and patients’ needs, women did not receive the care necessary to support childbirth at the health center. Insights from this research offer useful directions for modifying care practices to boost facility delivery among HIV positive women.
Is Knowledge Power? A Comparative Textual, Historical, and Practical Study of "Sex Ed" Policy and "Teen Pregnancy" in Canada and the U.S.A.
Morna E. McEachern
In modern welfare states, teen pregnancy, a social phenomenon that is inextricably linked with poverty, inequality, and race, is considered an indicator of social wellbeing. The teen pregnancy rate in the U.S.A. is the highest of modern welfare states, more than twice that of Canada, its culturally similar neighbor. There is evidence that comparative studies of culturally similar countries can reveal factors that are useful in informing policy reform. Sexual activity is a precursor of teen pregnancy, and public schools are a dominant site for sexual health education in both countries. Yet no studies have compared the “sex ed” policy approaches of these two countries. Addressing this gap, this study compares sexual health education policy exemplars from Canada and the U.S.A., focusing on the language in which these policies are framed with three research questions: 1) What does the political symbolism in the language of two policy exemplars reflect, implicitly and explicitly, about Canadian and U.S. approaches to “sex ed”? 2) How do Canadian and U.S. “sex ed” policies and discourses about “teen pregnancy” converge and diverge over time? 3) How do Canadian and U.S. high school principals, as front-line policy implementers, describe “teen pregnancy” and its relationship to “sex ed”? What does the political symbolism of their discourse reveal about Canadian and U.S. “sex ed” policy practices? In order to support pregnant and parenting teens, this dissertation addresses these questions through a critical feminist epistemology and a comparative, historical, qualitative and interpretive methodology. The contributions of the study fall in three areas: 1) it breaks new ground in comparing sexual health education policies in the U.S.A. and Canada; 2) it shifts the focus from individual outcomes of teen pregnancy to policy and policy frames related to preventing unintended teen pregnancy; 3) in so doing, it potentially sheds light on factors that differentially influence the discourse about “sex ed” and “teen pregnancy” in the two countries.
Queering Queer Space
Jennifer M. Self
Lesbian, gay, bisexual, transgender, and queer (lgbtq) college centers emerged in the early 1970s in response to student, faculty, and staff activism and demands for safe and protective spaces from heterosexism and homophobia. Despite 40 years of practice, however, little research has been conducted about these spaces. Recognizing the importance of lgbtq campus centers and the political and identity struggles within the movement that created them; this dissertation addressed this gap in research knowledge. Specifically, the study aimed to: 1) interrogate the power and influence of the leadership of lgbtq centers (directors and other primary leaders) via the exploration of the ways in which dominance in the form of “homonormative whiteness” is interrupted, disrupted, resisted, and (re)produced discursively and spatially through lgbtq campus-based centers; and 2) examine tensions that arised as directors and programs operationalize social transformation praxis models while maintaining their core purpose of safety and respite from heterosexism and homophobia. To explore these issues, I undertook a modified extended case study of six campus centers. The case study data included in-depth interviews with directors and center leaders, researcher observations, photographs, and hand-drawn maps produced by center leaders. The methodological approach was broadly critical and interpretive: specific analytic strategies included critical discourse analysis (spatial and dialogic). By examining the role of lgbtq center leadership discourse and center space in the (re)production and resistance of homonormative whiteness, this study contributes to several bodies of literature: 1) center development and practice; 2) intersectionality and praxis within student and community centers; and 3) social justice within higher education.
Examining the Process of Critical Youth Participation in Promoting Health and Wellness: A Case Study of a Rural Community Program for Asian Pacific Islander Young Adults
Alma M.O. Trinidad
Despite research on health disparities among low-income young adults of color, few studies critically examine how grass-roots, community-based youth programs affect their individual and collective health and wellness. In particular, little is known about how they develop a critical awareness of the historical-cultural contexts of marginalization and whether such awareness leads them to become activists in promoting health and wellness. Furthermore, a gap exist in research on the participation of rural young adults in community life and the role they can play in educating, and promoting empowerment in their communities. To address these gaps, this dissertation bridges theories of community youth participation, critical pedagogies of place, and community epistemology. Using a community-based youth program in rural Hawai‘i as a case study with 17 interviews and content analysis of texts about the program, this dissertation consists of three articles. The first examines the program’s use of adult allies and youth participation in farming, while also helping improve community health and well-being. Findings suggest that the program utilizes an integrated approach that includes: 1) locating the role of adult allies, 2) perceiving young people as partners and agents of change, 3) aiming for a democratic decision-making process, and 4) promoting a learning community. The second examines how the program through critical Indigenous pedagogy of place (CIPP) encourages youth to interrogate the inequities in their community, thus assisting in their sociopolitical development. Findings indicate that the use of CIPP provides opportunities to: 1) identify the disparities in the local community, 2) critically explore the complexity of oppression and systemic inequalities, 3) promote a commitment to serve that community and a sense of place, and 4) participate in a knowledge-action-reflection cycle of critical praxis. The third article examines how the program utilizes Native Hawaiian epistemology and values. Findings indicate that the program promotes indigenization through CIPP, which provides opportunities to: 1) learn about the genealogy of a geographic place, 2) reclaim Native Hawaiian values and 3) promote a sense of aloha (love) ethic for the community. Acknowledging the study’s limitations, specific recommendations and implications on youth community organizing, place, and health are discussed.