Social Work Commons^™

“It’S Not That We Care Less”: Insights Into Health Care Utilization For Comorbid Diabetes And Depression Among Latinos, Sharon Borja, Miriam G. Valdovinos, Kenia M. Rivera, Natalia Giraldo-Santiago, Robin Gearing, Luis R. Torres-Hostos

School of Social Work Faculty Publications and Presentations

Despite robust knowledge regarding the socio-economic and cultural factors affecting Latino* access to healthcare, limited research has explored service utilization in the context of comorbid conditions like diabetes and depression. This qualitative study, embedded in a larger mixed-methods project, aimed to investigate perceptions held by Latinos and their social support systems (i.e., family members) regarding comorbid diabetes and depression and to identify barriers and facilitators to their help-seeking behaviors and treatment engagement. Bilingual and bicultural researchers conducted eight focus groups with 94 participants in a large U.S. metropolitan area and were primarily conducted in Spanish. The participants either had a …

Ambulatory Intensive Care For Medically Complex Patients At A Health Care Clinic For Individuals Experiencing Homelessness The Summit Randomized Clinical Trial, Brian Chan, Christina Nicolaidis, Meg Devoe, Priya Srikanth, P. Todd Korthuis, Samuel T. Edwards, Devan Kansagara, Rachel Solotaroff, Somnath Saha

School of Social Work Faculty Publications and Presentations

Importance Intensive primary care interventions have been promoted to reduce hospitalization rates and improve health outcomes for medically complex patients, but evidence of their efficacy is limited.

Objective To assess the efficacy of a multidisciplinary ambulatory intensive care unit (A-ICU) intervention on health care utilization and patient-reported outcomes.

Design, Setting, and Participants The Streamlined Unified Meaningfully Managed Interdisciplinary Team (SUMMIT) randomized clinical trial used a wait-list control design and was conducted at a health care clinic for patients experiencing homelessness in Portland, Oregon. The first patient was enrolled in August 2016, and the last patient was enrolled in November 2019. …

Centering Communities Of Color In The Modernization Of A Public Health Survey System: Lessons From Oregon, Daniel F. López-Cevallos, Kusuma Madamala, Mira Mohsini, Andres Lopez, Roberta Hunte, Ryan Petteway, Tim Holbert

School of Social Work Faculty Publications and Presentations

Context: Public health survey systems are tools for informing public health programming and policy at the national, state, and local levels. Among the challenges states face with these kinds of surveys include concerns about the representativeness of communities of color and lack of community engagement in survey design, analysis, and interpretation of results or dissemination, which raises questions about their integrity and relevance.

Approach: Using a data equity framework (rooted in antiracism and intersectionality), the purpose of this project was to describe a formative participatory assessment approach to address challenges in Oregon Behavioral Risk Factor Surveillance System (BRFSS) and Student …

Evaluating The Feasibility Of Implementing A Prescription Drug Misuse Prevention Intervention In The Community: A Mixed Methods Study, Tamara Al Rawwad, Vaishnavi Tata, Matthew A. Wanat, Danielle Campbell, Douglas Thornton

School of Social Work Faculty Publications and Presentations

Background

This study is part of a state-wide effort to promote the safe disposal of prescription medications and mitigate prescription drug misuse. The objective of this study was to evaluate the implementation of a two-component prevention intervention through Community Prevention Organizations (CPOs) in Texas. The first component involved the distribution of in-home disposal products (IHDP) and the second focused on providing education of the risks of prescription drug misuse.

Methods

This study followed a mixed methods sequential explanatory study design. In the quantitative phase, the extent to which CPOs carried out the intervention was determined by the distribution rate – …

“It’S Embarrassing. I Get Angry. I Get Frustrated.”: Understanding Severe Hypoglycemia And Glucagon Usage From The Perspectives Of People With Type 1 Diabetes, Allyson S. Hughes, Katherine Chapman, Jeoffrey Bispham, Jeannett Dimsits, Stuart Weinzimer, Wendy Wolf, Nazanin M. Heydarian

School of Social Work Faculty Publications and Presentations

Introduction

This study characterized the emotional impact of severe hypoglycemia, views of glucagon, and barriers to glucagon use from the perspective of adults with type 1 diabetes (T1D).

Methods

Participants included individuals recruited from the T1D Exchange online community. The current study conducted 7 focus groups consisting of adults with T1D (N = 38, average age 49.4, SD = 16.11 years). Average duration of diabetes was 34.4 years (SD = 17.3) and average self-reported A1c was 6.8 % (SD = 0.7). Focus group interviews were recorded, transcribed, and thematically analyzed.

Results

A range of emotions was expressed about severe …

The Role Of Community Factors In Predicting Depressive Symptoms Among Chinese Workforce: A Longitudinal Study In Rural And Urban Settings, Wanlian Li, Guanghan Gao, Fei Sun, Lin Jiang

School of Social Work Faculty Publications and Presentations

Background: The dual urban-rural division system in China has led to distinguishes in economic development, medical services, and education as well as in mental health disparities. This study examined whether community factors (community cohesion, supportive network size, foreseeable community threat, and medical insurance coverage) predict the depressive symptoms of Chinese workers and how community factors may work differently in rural and urban settings.

Methods: This secondary data analysis was conducted using data from the 2014 and 2016 China Labor-force Dynamics Survey (CLDS). The sample of this study includes 9,140 workers (6,157 rural labors and 2,983 urban labors) who took part …

The Texas Community-Engagement Research Alliance Against Covid-19 In Disproportionately Affected Communities (Tx Ceal) Consortium, Rebecca A. Seguin-Fowler, Chris Amos, Bettina M. Beech, Robert L. Ferrer, Lorna Mcneill, Jasmine J. Opusunju, Emily Spence, Erika L. Thompson, Luis R. Torres-Hostos, Jamboor K. Vishwanatha

School of Social Work Faculty Publications and Presentations

The coronavirus disease 2019 (COVID-19) pandemic requires urgent implementation of effective community-engaged strategies to enhance education, awareness, and inclusion of underserved communities in prevention, mitigation, and treatment efforts. The Texas Community-Engagement Alliance Consortium was established with support from the United States’ National Institutes of Health (NIH) to conduct community-engaged projects in selected geographic locations with a high proportion of medically underserved minority groups with a disproportionate burden of COVID-19 disease and hospitalizations. The purpose of this paper is to describe the development of the Consortium. The Consortium organized seven projects with focused activities to address COVID-19 clinical and vaccine trials …

Do Nursing And Pharmacy Students Practice What They Preach On Safe Drug Storage And Disposal? A Cross-Sectional Study, Tamara Al Rawwad, Patrici K. Schrader, Andrea Brooks, Lillian Duong, Douglas Thornton

School of Social Work Faculty Publications and Presentations

Background: Research has confirmed a lack of knowledge regarding the risks of unused medications including diversion, misuse, or accidental overdose among health care professionals (Abdulmajeed, 2020). Nurses and pharmacists are often who patients interact with the most regarding medications; therefore, early education on proper storage and disposal is vital (Bowen, Rotz, Patterson, & Sen, 2017; Celio, Ninane, Bugnon, & Schneider, 2018).

Objectives: The study's objective is to explore safe drug storage and disposal knowledge, attitudes, and practices of professional pharmacy (Pharm.D.) and nursing students.

Design: This research is an exploratory cross-sectional study from May to September 2019.

Methods: An anonymous …

Integrating Occupation-Based/Focused Assessments During The Evaluation Process. Opportunity To Revisit The Topic In A Post Covid-19 Practice Setting?, John S. Luna

School of Social Work Faculty Publications and Presentations

Occupational therapists treat clients across the lifespan, and every successful intervention begins with a successful evaluation. Incorporating a variety of norm-referenced standardized assessments into the assessment process has become increasingly important to justify services to third party payors identification of goals, and intervention strategies. However, occupational therapists tend to select assessments that are focused and measuring performance skills and client factors versus occupations and performance of occupations. The purpose of this article is to examine the topic of occupation based and occupation focused assessments. While using occupation-based/ occupation-focused assessments is not a new topic, the COVID-19 pandemic has changed how …

Shifting Coronavirus Disease 2019 Testing Policy And Research To Include The Full Translation Pipeline, Joseph Catania, Jeffrey Martin, M. Margaret Dolcini, E. Roberto Orellana, Jeffrey Henne

School of Social Work Faculty Publications and Presentations

The current severe acute respiratory syndrome coronavirus 2 testing policy and practice limits testing as a prevention tool. Radical shifts are required to increase the scale of rapid testing strategies and improve dissemination and implementation of venue-based and self-testing approaches. Attention to the full translation pipeline is required to reach high-risk segments of the population.

Healthy Birth Initiatives: The Road Toward Reproductive Justice, Roberta Hunte, Susanne Klawetter, Sherly Paul

School of Social Work Faculty Publications and Presentations

This study concerns racialized experiences of reproductive oppression among Black women and the efforts of one organization - Multnomah County’s Healthy Birth Initiatives (HBI) - to combat this oppression and move towards Reproductive Justice. This study explores how Black women experience and respond to racism-related stress and its impacts on their health during and after pregnancy and subsequent parenting. The project was informed by a pilot focus group conducted in 2016 by Drs. Jenna Ramaker and Roberta Hunte in partnership with HBI, which asked HBI clients about the role of toxic stress and racism-related stress in their lives. The current …

Toxic Stress Among Black And African American Oregonians, Roberta Hunte, Margaret J.F. Braun

School of Social Work Faculty Publications and Presentations

Toxic stress is a reaction to ongoing adversity such as abuse, neglect, poverty, racism, discrimination, and exposure to violence; it is powerful enough to change brain chemistry and architecture. Toxic stress and associated changes to the brain can lead to poor health outcomes later in life. Adverse childhood experiences (ACEs), racism*, and discrimination can trigger toxic stress and have long term consequences for the health of many people, particularly those in the Black and African American community.

The current project examined toxic stress and its impact on the health of Black and African American Oregonians. We looked at two indicators …

Differences Between Pharmacists’ Perception Of Counseling And Practice In The Era Of Prescription Drug Misuse, J. D. Thornton, Precious Anyanwu, Vaishnavi Tata, Tamara Al Rawwad, Marc L. Fleming

School of Social Work Faculty Publications and Presentations

Objective: This study was conducted to assess pharmacists' practices when counseling patients on their prescription medications, and their preferences for training.

Methods: Five focus group discussions of community pharmacists (n=45, with seven to eleven participants in each group) were conducted in a major metropolitan city in the southern United States. Participants were recruited via email using a list of community pharmacists provided by the Texas State Board of Pharmacy. All focus group discussions were structured using a moderator guide consisting of both discrete and open-ended questions. Qualitative analysis software was used to analyze the data with a thematic analysis approach. …

Prevalence And Correlates Of Transactional Sex Among Women Of Low Socioeconomic Status In Portland, Or, Timothy Menza, Lauren Lipira, Amisha Bhattarai, Victoria Cali-De Leon, E. Roberto Orellana

School of Social Work Faculty Publications and Presentations

Background: Women who report transactional sex are at increased risk for HIV and other sexually transmitted infections (STIs). However, in the United States, social, behavioral, and trauma-related vulnerabilities associated with transactional sex are understudied and data on access to biomedical HIV prevention among women who report transactional sex are limited.

Methods: In 2016, we conducted a population-based, cross-sectional survey of women of low socioeconomic status recruited via respondent-driven sampling in Portland, Oregon. We calculated the prevalence and, assessed the correlates of, transactional sex using generalized linear models accounting for sampling design. We also compared health outcomes, HIV screening, and knowledge …

Using “Remote” Training And Coaching To Increase Providers’ Skills For Working Effectively With Older Youth And Young Adults With Serious Mental Health Conditions, Janet S. Walker, Caitlin Baird

School of Social Work Faculty Publications and Presentations

Since about the turn of the century, a growing awareness of the poor outcomes resulting from “as usual” community mental health care has led to increasing efforts to implement programs and interventions with empirical evidence of effectiveness. However, these efforts have encountered numerous barriers, in particular the high cost of implementation, which has severely limited uptake and sustainment of empiricallysupported programs and interventions. Typically, the largest contributor to cost is the training and coaching required to ensure provider competence and fidelity to the intervention or program model. This paper describes a social innovation that aims to provide high-quality training and …

Quality Of Life And Stigma Among People Living With Hiv/Aids In Iran, Mohammad Ebrahimi Kalan, Jian Han, Ziyad Ben Taleb, Kristopher P. Fennie, Mohammad Asghari Jafarabadi, Maryam Dastoorpoor, Nima Hajhashemi, Mitra Naseh, Shahnaz Rimaz

School of Social Work Faculty Publications and Presentations

Background: Stigma against HIV profoundly affects the quality of life (QOL) of people living with HIV/AIDS (PLWHA). We aimed to assess the factors associated with QOL in PLWHA in Iran, specifically HIV-related stigma, sociodemographic and clinical characteristics.

Methods: Two hundred PLWHA participated in this cross-sectional study. Data were collected using sociodemographic, stigma, and WHO-QOL-BREF questionnaires. Correlations, ANOVAs, and Student’s t-distribution tests were performed as bivariate analyses. We employed stepwise multiple linear regression analysis to explore the main factors associated with QOL domains.

Results: Six domains of QOL were negatively correlated with three domains of stigma (p < 0.001 for all). Stepwise multiple linear regression revealed that, after adjusting for con-founders, lack of healthcare insurance, having no basic knowledge of HIV/AIDs prior to diagnosis, low monthly income of participants and family, and stigma (blaming and distancing, discrimination, and fear) were associated with low mean score of different domains of QOL.

Conclusion …

Emerging Strategies For Engaging Young People In Systems Of Care, Research And Training Center For Pathways To Positive Futures, Portland State University

School of Social Work Faculty Publications and Presentations

Systems of care are increasingly serving older youth and young adults up to age 24, and in our research and training work with providers, we hear about the challenges of engaging young people in typical services. Many providers are responding to the unique developmental needs of this population by adapting the design and delivery of their services to better engage and retain young people in system of care supports. Overall, strategies include expansion of drop-in center programming, adaptations to practice models like Wraparound, and new outreach efforts using social media and other technologies. Our purpose here is to share some …

Development And Testing Of An Assessment Of Youth/Young Adult Voice In Agency-Level Advising And Decision Making, Janet S. Walker, Brie Masselli, Jennifer E. Blakeslee, Caitlin Baird, Kristin Thorp

School of Social Work Faculty Publications and Presentations

There is a range of stakeholder benefits when youth- and young adult-serving agencies include service recipient “voice” in advising and decision making regarding agency policies and programming. Yet many agency stakeholders lack awareness of strategic best practices to ensure the consistent and meaningful participation of young people in decision-making processes, and few tools exist to evaluate agency efforts. This paper describes the development and validation of the Youth/Young Adult Voice at the Agency Level (Y-VAL), an assessment of the extent to which agencies have implemented best practices for supporting meaningful participation. The Y-VAL is intended for research purposes, as well …

Lifetime Economic Burden Of Intimate Partner Violence Among U.S. Adults, Cora Peterson, Megan C. Kearns, Wendy Likamwa Mcintosh, Lianne Fuino Estefen, Christina Nicolaidis, Kathryn E. Mccollister, Amy Gordon, Curtis Florence

School of Social Work Faculty Publications and Presentations

Introduction: This study estimated the U.S. lifetime per-victim cost and economic burden of intimate partner violence.

Methods: Data from previous studies were combined with 2012 U.S. National Intimate Partner and Sexual Violence Survey data in a mathematical model. Intimate partner violence was defined as contact sexual violence, physical violence, or stalking victimization with related impact (e.g., missed work days). Costs included attributable impaired health, lost productivity, and criminal justice costs from the societal perspective. Mean age at first victimization was assessed as 25 years. Future costs were discounted by 3%. The main outcome measures were the mean per-victim (female and …

Help-Seeking On Facebook Versus More Traditional Sources Of Help: Cross-Sectional Survey Of Military Veterans, Alan R. Teo, Heather E. Marsh, Samuel B.L. Liebow, Jason I. Chen, Christopher W. Forsberg, Christina Nicolaidis, Somnath Saha, Steven K. Dobscha

School of Social Work Faculty Publications and Presentations

Background: The media has devoted significant attention to anecdotes of individuals who post messages on Facebook prior to suicide. However, it is unclear to what extent social media is perceived as a source of help or how it compares to other sources of potential support for mental health problems.

Objective: This study aimed to evaluate the degree to which military veterans with depression use social media for help-seeking in comparison to other more traditional sources of help.

Methods: Cross-sectional self-report survey of 270 adult military veterans with probable major depression. Help-seeking intentions were measured with a modified General Help-Seeking Questionnaire. …

Building Competencies And Skills Among Service Providers Working With Young People Who Experience Serious Mental Health Conditions: State Of The Science, Janet S. Walker, Pauline Jivanjee, Eileen M. Brennan, Leigh Grover

School of Social Work Faculty Publications and Presentations

This paper explores what is currently known about the most promising strategies for increasing providers’ capacity to deliver effective behavioral health services and supports. The paper also describes how this information has been—or could be—applied to the design of cutting-edge approaches for building skills and competencies among providers that work with young people who experience serious mental health conditions.

Mitigating Early Loss Of Community Participation In Early Psychosis Services: State Of The Science, Tamara G. Sale, Dora M. Raymaker, Mariam Rija, Veronica Gould, Christina Wall, Ryan P. Melton

School of Social Work Faculty Publications and Presentations

In the early stages of treatment for psychosis, community engagement and social networks are threatened through a combination of symptomology and negative messages and reactions from the environment which may result in internalized stigma, disempowerment, and prolonged isolation. While treatment programs attempt to mitigate these factors, ambivalence toward treatment and the basic concept of psychosis, along with difficulty engaging in conversation, make initial engagement more difficult. Self-determination theory and growing recovery literature point to the importance of maintaining a sense of community relatedness and connection, and developing a sense of agency and competence as important to active recovery and retention …

Planning And Designing The Improving Addiction Care Team (Impact) For Hospitalized Adults With Substance Use Disorder, Honora Englander, Melissa B. Weimer, Rachel Solotaroff, Christina Nicolaidis, Benjamin Chan, Christine M. Velez, Alison Noice, Tim Hartnett, Ed Blackburn, Pen Barnes, P. Todd Korthuis

School of Social Work Faculty Publications and Presentations

People with substance use disorders (SUD) have high rates of hospitalization and readmission, long lengths of stay, and skyrocketing healthcare costs. Yet, models for improving care are extremely limited. We performed a needs assessment and then convened academic and community partners, including a hospital, community SUD organizations, and Medicaid accountable care organizations, to design a care model for medically complex hospitalized patients with SUD. Needs assessment showed that 58% to 67% of participants who reported active substance use said they were interested in cutting back or quitting. Many reported interest in medication for addiction treatment (MAT). Participants had high rates …

A Qualitative Examination Of Pain Centrality Among Veterans Of Iraq And Afghanistan Conflicts, Samantha D. Outcalt, Christina Nicolaidis, Matthew J. Bair, Laura J. Myers, Edward J. Miech, Marianne S. Matthias

School of Social Work Faculty Publications and Presentations

Objective. Centrality of pain refers to the degree to which a patient views chronic pain as integral to his or her life or identity. The purpose of this study was to gain a richer understanding of pain centrality from the perspective of patients who live with chronic pain.

Methods. Face-to-face interviews were conducted with 26 Veterans with chronic and disabling musculoskeletal pain after completing a stepped care intervention within a randomized controlled trial. Qualitative data were analyzed using an immersion/crystallization approach. We evaluated the role centrality plays in Veterans’ lives and examined whether and how their narratives differ when centrality …

The Development And Evaluation Of An Online Healthcare Toolkit For Autistic Adults And Their Primary Care Providers, Christina Nicolaidis, Dora Raymaker, Katherine E. Mcdonald, Steven K. Kapp, Michael Weiner, Elesia Ashkenazy, Martha Gerrity, Clarissa Kripke, Laura Platt, Amelia E.V. Baggs

School of Social Work Faculty Publications and Presentations

BACKGROUND: The healthcare system is ill-equipped to meet the needs of adults on the autism spectrum.

OBJECTIVE: Our goal was to use a community-based participatory research (CBPR) approach to develop and evaluate tools to facilitate the primary healthcare of autistic adults. DESIGN: Toolkit development included cognitive interviewing and test–retest reliability studies. Evaluation consisted of a mixed-methods, single-arm pre/postintervention comparison.

PARTICIPANTS: A total of 259 autistic adults and 51 primary care providers (PCPs) residing in the United States.

INTERVENTIONS: The AASPIRE Healthcare toolkit includes the Autism Healthcare Accommodations Tool (AHAT)—a tool that allows patients to create a personalized accommodations report for …

Introduction To The Special Section: Positive Developmental Strategies For Engaging Emerging Adults And Improving Outcomes, Janet S. Walker, Celeste Seibel, Sharice Jackson, John D. Ossowski

School of Social Work Faculty Publications and Presentations

As compared to any other age cohort in the US population, young people in late adolescence and early adulthood have a higher rate of unmet need for mental health services. Not only are these young people (from about 16 to 25 years old, and referred to here as “emerging adults”) more likely to experience a serious mental health condition (SMHC), but they are also less likely to engage in services. Furthermore, when emerging adults do engage in services, they face multiple barriers to service continuity, particularly as they come up to “milestone” ages at 18, 21, and 24.

There is …

Structural Factors That Increase Hiv/Sti Vulnerability Among Indigenous People In The Peruvian Amazon, E. Roberto Orellana, Isaac E. Alva, Cesar P. Cárcamo, Patricia J. García

School of Social Work Faculty Publications and Presentations

We examined structural factors—social, political, economic, and environmental—that increase vulnerability to HIV among indigenous people in the Peruvian Amazon. Indigenous adults belonging to 12 different ethnic groups were purposively recruited in four Amazonian river ports and 16 indigenous villages. Qualitative data revealed a complex set of structural factors that give rise to environments of risk where health is constantly challenged. Ferryboats that cross Amazonian rivers are settings where unprotected sex—including transactional sex between passengers and boat crew and commercial sex work—often take place. Population mobility and mixing also occurs in settings like the river docks, mining sites, and other resource …

Conceptualization Of Autism In The Latino Community And Its Relationship With Early Diagnosis, Katharine E. Zuckerman, Brianna Sinche, Martiza Cobian, Marlene Cervantes, Angie Mejia, Thomas Becker, Christina Nicolaidis

School of Social Work Faculty Publications and Presentations

Objective—Early identification of autism spectrum disorders (ASD) has been linked to improved long-term developmental outcomes. However, Latino children are diagnosed later than white non- Latino children. We aimed to qualitatively assess the understanding and conceptualization of ASD in the Latino community in order to understand potential community barriers to early diagnosis.

Method—We conducted 5 focus groups and 4 qualitative interviews with 30 parents of typicallydeveloping Latino children in Oregon. Participants were asked structured questions concerning video vignettes that follow a Latina mother from the time she begins to worry about her 3-year-old son's behaviors to the time he receives an …

Strengthening A Social Justice Lens For Addictions Practice: Exploration, Reflections, Possibilities And A Challenge To Our Shared Work To Promote Recovery Among The Most Vulnerable, Laura Burney Nissen

School of Social Work Faculty Publications and Presentations

Addiction is commonly conceptualized as a personal problem, a family problem, a neighborhood problem, a community problem, and even a social problem. But how might addiction be understood as a social justice problem?

Substance abuse problems, addictions, and addiction treatment and the related preparation of professionals to fill its treatment ranks exist within an ideological and political infrastructure. Issues of social justice are often conspicuously absent as a primary consideration of the experience of people seeking treatment (acknowledging the treatment gap that impacts some people more than others), for communities ravaged by addiction (acknowledging that some communities are affected more …

Motivational Interviewing At The Intersections Of Depression And Intimate Partner Violence Among African American Women, Stéphanie Wahab, Jammie Trimble, Angie Mejia, S. Renee Mitchell, Mary Jo Thomas, Vanessa Timmons, A. Star Waters, Dora Raymaker, Christina Nicolaidis

School of Social Work Faculty Publications and Presentations

This article focuses on design, training, and delivery of a culturally-tailored, multi-faceted intervention which used motivational interviewing (MI) and case management to reduce depression severity among African American survivors of intimate partner violence (IPV). We present the details of the intervention and discuss its implementation as a means of creating and providing culturally appropriate depression and violence services to African American women. We used a CBPR approach to develop and evaluate the multi-faceted intervention. As part of the evaluation, we collected process measures about the use of MI, assessed MI fidelity, and interviewed participants about their experiences with the program.