Arizona 2016 Presentation Portfolio: Behavioral Science by Center for Scholastic Inquiry

Center for Scholastic Inquiry (CSI) offers electronic presentation portfolios as a courtesy to the attendees of our conferences. Materials are the sole Intellectual property of the presenters and are displayed only with their permission. All questions about content should be directed to the presenters. Pages

Table of Contents

3‐33

An Over Representation of Incarcerated Youth and Adults with Traumatic Brain Injury: How Should They Be Indentified and Served ‐ Dr. Kourtland Robert Koch

34‐58

An Outcome Evaluation Study of International Service Learning Abroad Program: Summer 2015 in Seoul, South Korea ‐ Dr. Kui‐Hee Song

59‐74

Enhancing the Science of Social Work through Doctoral Education and How Social Work Research in Transitional Countries Can Be Expanded ‐ Dr. James T. Decker

75‐90

Study of a Social Support Program Designed to Maintain LGBT Clients with Mental Illness in the Community ‐ Dr. Eileen Klein

91‐109

Beliefs and Behavior of Nurses Providing Healthcare Services to Gay and Lesbian Individuals ‐ Dr. Michelle Morgan

110‐116

Improving the Health and Safety Behaviors of Home Care Workers ‐ Dr. Linda Mabry

An Over Representation of Incarcerated Youth and Adults with Traumatic Brain Injury: How Should They Be Identified and Served? Kourtland Koch, Ph.D. Professor of Special Education Ball State University

What We Will Cover • Brain injury in Corrections research • What is brain injury – Types of brain injury – Causes and prevalence – Common effects of brain injury • Impact of brain injury in Corrections • Brain injury screening/Neurocognitive Assessment • NeuroResource Facilitation for brain injury

New MRI Reveals Mysteries of Brain Injuries

Brain Injury in Adult Corrections • HRSA reports that 60% of inmates have had a history of brain injury prior to incarceration • At 2 million incarcerated offenders, that would tell us we have 1.2 million people living with brain injury in our prisons. • Prevalence in the population on the whole is 4.5 % which would predict 90,000 in prisons.

Brain Injury in Juvenile Justice • Fatos, et. Al, 2013, report in a study of adolescents in the NY City Jails that 67.4% of screened detainees reported a history of at least one brain injury • Most frequent causes were assaults (55.5%) followed by falls (41%) • Inmates with brain injury were more likely to be users of mental health services • Emotional dysregulation and impaired processing speed are likely linked to criminal justice involvement.

Acquired Brain Injury • Any injury to the brain that occurs after birth as a result of: ▫ ▫ ▫ ▫ ▫ ▫

Physical force (due to an accident) Violent Acts (e.g. gunshot wound) Tumors Strokes Infectious Diseases (e.g. encephalitis) Anoxia (due to cardiac arrest, near drowning, or strangulation)

• ABI is the broadest category and includes all brain injuries that occur after birth

Acquired Brain Injury Traumatic Brain Injury • An insult to the brain caused by external physical force. • Not all blows or jolts to the head result in a TBI • Severity range from – “mild” with a brief change in mental status or consciousness – “severe” with an extended period of unconsciousness or amnesia after the injury • Youth with brain injury – Once you have initial brain injury, you are at risk for sustaining another – history of multiple TBIs is associated with dropping out of school, drug and alcohol abuse, delinquency

Cranium Design â&#x20AC;˘ The skull is a rounded layer of bone designed to protect the brain from penetrating injuries. â&#x20AC;˘ The base of the skull is rough, with many bony protuberances. â&#x2013;Ť These ridges can result in injury to the temporal and frontal lobes of the brain during rapid acceleration

Brain Behavior Relationships • Frontal Lobe ▫ Problem solving ▫ Judgment ▫ Reasoning

• Parietal Lobe ▫ Sense of touch ▫ Differentiation: size, shape, color ▫ Spatial and visual perception

• Occipital Lobe ▫ Vision

• Cerebellum ▫ Balance ▫ Coordination ▫ Skilled motor activity

• Brain Stem ▫ Breathing ▫ Heart rate ▫ Attention/concentration

Levels of Severity of TBI • Mild ▫ ▫ ▫ ▫ ▫ ▫

Brief or no loss of consciousness Shows signs of concussion Vomiting Lethargy Dizziness Lack of recall of injury

▫ ▫ ▫ ▫ ▫

Coma < 24 hours duration Neurological signs of brain trauma Skull fractures with contusion (tissue damage) Hemorrhage (bleeding) Focal Findings on EEG or CT scan

• Moderate

• Severe

▫ Coma > 24 hours duration

What is a Concussion? • Traumatic Brain Injury (TBI) • A blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull. • Cannot “see” a concussion Disruption to how the brain works on a cellular level – MRIs and CT Scans may show normal result even with a concussion • Causes of a concussion - Hit, bump, blow, jolt to body transmitted to head – Even a “ding” or getting “your bell rung” can be a concussion

Brain Injury… • …can occur even if there is no loss of consciousness • …does not require a blow to the head • …does not always show on CT or MRI

If you have a brain injury, you are: â&#x20AC;˘ 3 times more likely to get another. After the second injury, the risk for the third injury is 8 times greater

What are the Long-term Consequences of Brain Injury? • Short- or long-term problems and requiring help in performing activities of daily living • A wide range of problems in thinking, sensation, memory, learning, language, behavior, emotions • Mental health problems – severe depression – anxiety – difficulty controlling anger – alcohol or substance abuse • Other Disorders – Epilepsy – Increased risk for both Alzheimer’s and Parkinson’s diseases – Other brain disorders associated with increasing age, Chronic Traumatic Encephalopathy (CTE)

Implications for Those Detained Youth with Brain Injuries • May be misdiagnosed as having mental illness • More likely to have disciplinary problems during incarceration or poor adjustment to prison life or rules • Tend to get kicked out of groups • Fail at programs or parole

How should the Problem of Brain Injury in the Criminal Justice System be Addressed?

• A recent report from the Commission on Safety and Abuse in America’s Prisons recommended: ▫ Increase health screenings and evaluations ▫ Treatment for inmates ▫ Development of partnerships with community health providers to assure continuity of care ▫ Case management for released inmates

Undiagnosed Brain Injuries • Systems that have primary functions other than Brain Injury will not document Brain Injury ▫ Unless medical documentation available ▫ Brain Injury screening is in place

• Many brain injuries are undiagnosed • A need for screening exists

Undiagnosed Brain Injuries • Undiagnosed Brain Injury often referred to as the “hidden” disability • Individuals may ▫ ▫ ▫ ▫ ▫ ▫ ▫

Drop out of school Start abusing substances Fail at relationships Become victims End up in Mental Health System Become homeless Be unable to obtain or maintain a job

• Results in incarceration in adult and juvenile justice systems

Potential Cost to Society • Brain Injury left untreated can lead to: ▫ ▫ ▫ ▫ ▫ ▫ ▫

Academic failure and dropping out Un-employment or under-employment Homelessness Use of illegal drugs Psychiatric problems Repeated brain injury Criminal Justice involvement

Impact of Brain Injury in the Correctional System • Effects of brain injury can appear to be lack of cooperation or disrespect • Failure to respond quickly to directives • Inability to initiate requests for assistance • Difficulty remembering prior discussions • Inconsistent attention • Difficulty following directions • Difficulty learning routines • Difficulty expressing needs • Impulsivity, emotional dyscontrol

How can the Problem of Brain Injury be Addressed in Prisons Before Release? • 1. Screening for identification of brain injury • 2. Assessment for identification of cognitive impairment • 3. NeuroResource Facilitation to identify potential long term services and supports

Traumatic Brain Injury Questionnaire (TBIQ) • Designed to screen for traumatic brain injury among offenders in a criminal justice setting • Semi-structured interview instrument • Administered by a trained staff person who is familiar with TBI and has training in basic interviewing techniques • Does not cover non-trauma

NeuroCognitive Testing â&#x20AC;˘ Administered to individuals who screen positive for an event that could have caused a brain injury â&#x20AC;˘ Goal is to determine whether there are impairments associated with the events that are likely to interfere with success in the community

NeuroResource Facilitation • Brain injury education and training of facility staff and community resource organization staff members • Cognitive support to assist person to maximally benefit from the content of other treatment • Identification of programs in the community that the person would like to pursue upon re-entry and determine steps to pursue them • Determine the person’s goals and needs regarding a productive daily activity pattern when released from prison. • Identify community resources to support these goals and facilitate connections to them • Coordinate Re-Enty efforts between OVR, DOC and parole staff

Pilot Program Identifies Brain Injuries in Inmates

NeuroRehabilitation Services that can Help • Post Acute Rehabilitation Services

▫ Outpatient including PT, OT, SP, NeuroPsych

• Community Re-Entry Services

▫ Including Return to School, Return to Work, Return to Life

• Community Residential Programs ▫ Structured Day Programs

• Vocational

▫ Supported Employment Programs, including Job Development, Job Placement, Job Coaching

Common Barriers to Access to TBI Care • Lack of information regarding available services and supports • Shortage of healthcare professionals who have training in TBI (specifically, an ability to identify TBI and treat the resulting symptoms) • The absence of a TBI diagnosis or the assignment of an incorrect diagnosis • TBI services spread across a variety of agencies resulting in services being difficult for families to find and/or navigate

Populations at High Risk for TBI • Children 0 – 4

▫ African American children have the highest rate for this age group

• Youth aged 15 -19 • • • •

▫ African American youth have the highest rate for this age group

The elderly Athletes of all ages Homeless individuals of all ages Incarcerated individuals, including juvenile detainees • Individuals harmed by domestic violence

A person may be more likely to have ongoing problems if they have any of the following: • WORST

▫ There has been one moderate or severe TBI (i.e., any TBI with 30 minutes or more loss of consciousness)

• FIRST

▫ TBI with any loss of consciousness before age 15

• MULTIPLE

▫ Had 2 or more TBIs close together, including a period of time when they experienced multiple blows to the head even if apparently without effect

• RECENT

▫ A mild TBI in recent weeks or a more severe TBI in recent months

• OTHER SOURCES

▫ Any TBI combined with another way that their brain has been impaired.

AN OUTCOME EVALUATION STUDY OF INTERNATIONAL SERVICE LEARNING ABROAD PROGRAM: SUMMER 2015 IN SEOUL, SOUTH KOREA

PRESENTER: KUI‐HEE SONG, PH.D. SCHOOL OF SOCIAL WORK, CALIFORNIA STATE UNIVERSITY, CHICO

PRESENTATION TIME : FROM 10‐10:30 AM, THURSDAY, OCTOBER 6, 2016 ANNUAL ACADEMIC BUSINESS, BEHAVIORAL SCIENCE RESEARCH CONFERENCE CENTER FOR SCHOLASTIC INQUIRY IN SCOTTSDALE, ARIZONA

INTRODUCTION I am Associate Professor in the School of Social Work, California State University, Chico.

I hold a Ph.D. in Clinical Social Work from Loyola University Chicago. I have carried out multicultural and international social work education, research, and practice with a focus on human rights and social–economic justice‐based empowerment approaches to culturally‐ linguistically‐relationally underprivileged groups in the local and global communities.

My interests include: practice with children and families and their community, and community‐participatory human services program development and evaluation.

RESEARCH TOPIC & WHY IMPORTANT •

My research presentation focuses on an outcome evaluation of Intercultural Social Work Education Abroad Program implemented during June 1 to 27, 2015 in Seoul, South Korea.

•

The majority of research on service learning has focused on student outcomes in home country communities (Gerstenblatt, 2014) with little study done on the hosting local communities abroad where home students work.

• •

There is no scholarly literature on studies of service-learning programs abroad in Seoul, South Korea.

• •

Second, nation-specific data are useful for the design and implementation of service-learning programs in Asian.

•

First, this study fills a gap in the scholarly literature on understanding the hosting local community field agencies’ perspectives on proper service-learning programs abroad in South Korea.

Third, qualitative findings in the study will make a significant contribution to the field of cross-national reciprocal partnership model of short-term based service-learning program studies in an effort to advance the mutually benefiting working relationship and outcomes for student participants and hosting local community agency partners. Finally, this study plays an important role in helping university administrators and faculty understand and negotiate the multiple realities involved with developing and implementing successful service-learning programs abroad.

BACKGROUND INFORMATION

• Special Topic: SWRK 498/698 (4 units) • Travel Dates: June 1-27, 2015 • This course is designed to provide students with a four week international learning opportunity aimed at stimulating and expanding students’ perspectives in cross-cultural and cross-national human services systems.

• This course has total 180 hours contact that is divided in to three parts: 1) 110 hours Service Learning; 2) 30 hours Human Services Organization Visitations; and 3) 40 hours Interactive Discussions (daily group meeting at evening) • Additional Weekend Cultural activities

BACKGROUND INFORMATION The four local Service Learning Field Sites: • Two to three students were assigned to a local human service agency to work from Monday through Thursday during the four weeks of the program  Guru Community Mental Health Center Community–based integrated recovery and rehabilitation services for youth/young adults with mental health problems (daily programs/activities engagement; outdoor activities; a special summer camp program for 2 nights/3 days)

Good Friend Disability Day Care Center Community-based services for children and youth with intellectual/developmental disabilities (daily programs/activities engagement; various outdoor activities; educating for different Korean culture (Confucianism)/Disabilities Acts & Social Services Systems for the disabled people)

National Assembly Office of Congressman Choon‐Jin Kim

Involved in research, report, conferences on primarily social welfare and public health and other social issues of education, labor, employment, agriculture/ocean resources, human trafficking, etc.( National Health and Welfare Committee-involved with

national and cross-national research on policies and programs of public diseases, health and safety issue of MRSA virus, as well as gender equality)

Open Radio for North Korea

Works for human rights and the social-economic justice of North Koreans through shortwave radio broadcasting/ production of Human Rights Protection and Cultural Education of North Koreans (students’ real life stories were made as an international case about human rights and social and economic justice from the global perspective)

BACKGROUND: PROGRAM INTRODUCTION

• The Five Local Human Services Organizations visited were: 1. Seoul Foundation of Women and Family —students learned Korean gender equity policies and programs and were introduced to various NGOs’ work with the agency facility support. 2. Department of Social Welfare in the Seoul National University —students participated in very interesting group discussions with ten host university students and a faculty member about the similarities and differences in social work education such as practice fields and curriculums. 3. Community Chest of Korea —students learned about the unique way of collective successful fundraising models and its Korean cultural impact on the ideas of fundraising, such as sharing even a small bean in a half. 4. Seoul Association of Social Workers —students learned about the current empowerment movement of social worker wages and nationwide social welfare advocacy. 5. UNHCR (UN Refugee Agency) Korea —students learned about the history and current challenges in global refugees’ rights and advocacy.

BACKGROUND: PROGRAM INTRODUCTION Additional Weekend Cultural Activities

â&#x20AC;˘ Gian an appreciation and understanding of Korean culture and history, as well as society. 1. KBS (Korean Broadcasting System) where students were given a live TV and radio broadcasting facility tour; K-Pop (Live Music Bank Performance); 2. Temple-stay experience at the International Seon Center where students experienced Korean Zen Buddhist culture and practices; 3. Kyungbukgung/Museum where students had an English tour guide show them the Korean historic heritage site in Seoul; 4. SK Telecom Ubiquitous Museum where students were exposed to high information technology-based products and enjoyed testing a high technology running car, a wall screen projector, and global marketbased shopping demos for the future.

BACKGROUND: PROGRAM INTRODUCTION COURSE ASSIGNMENTS Evaluation Criteria Professional Conduct in Human Service Learning Practice/Field Agency Visitations/Cultural Activities International Human Services Diversity Project (a group of 23 students) Reflective Journal Writing (Four weekly based) Total

Points 40

Deadlines 6/2-6/27

PresentationsThursday, 6/25 Paper-Friday, 6/26 Fridays (6/5, 6/12, 6/19, & 6/26)

20 (5 /each)

100

Background: Program Introduction Student Participants

• Eleven students traveled with the lead faculty to Seoul, South Korea (June 1-28, 2015).

• The group stayed at International Seon Center in Seoul. • There were ten undergraduate (8 social work & 2 Psychology) students from CSU, Chico and one social work graduate student from Ohio State University.

• Ten students took the academic credit (four units) while one took it for non-credit. • Ten student participants completed the whole program. • One Social Work student for academic credit did withdraw during the second week of the program due to medical reason. • During the program implementation, both home university key administrators and host country collaborators were involved with the lead faculty in managing the program operation and building collaborative partnerships in a joint action.

METHODOLOGY: DATA COLLECTION I. Quantitative data were collected from host country local practitioners using a survey questionnaires. Self‐administrated questionnaires were distributed in paper and by electric form (email attachment) to the participating agency director or supervisor. Especially, the directors gave the questionnaires in paper to their staff to answer and returned them to the researcher for both pre‐test and post –test.

Pre‐test was done June 3‐7, 2015 before the students began the service learning practice. Post‐test was done July 7‐14, 2015 after the program over. ` • Eleven participants (i.e., local professional practitioners: directors, supervisors, and staff who worked closely with student participants) reported the responses pertaining to student participants’ level of course competencies in relation to specific Practice Behaviors using four different levels in the ordinal scale 1‐4.

II. Qualitative data were gathered from multiple sources of data, including responses of host country local practitionersʹ survey open‐ended questions, student participants’ reflective journals entries, and international social justice diversity projects, and direct observation.

Qualitative data with open‐ended questions as part of the program outcome evaluation research. • Eleven local professional practitioners of Four different human services agencies in Seoul, South Korea:

METHODOLOGY: DATA ANAYSIS I.

Quantitative data were analyzed using a paired samples t-test to see pre and post-test differences for the responses to compare the responses between before and after the student participation in the program.

II. Qualitative data were analyzed using coding and thematic analysis methods Qualitative data were sorted according to textual content into four distinct categories:

 Student participants’ effects,  Effects on hosting local community partners abroad,  Challenges facing participants in the program, and  Suggestions for the improvement of future programming

Table 1: Participants Summaries Case

Local Partner Agency

Age

Gender

Role

male

staff

Community Mental Health

female

director

Community Mental Health

female

staff

Community Mental Health

female

staff

Disabled Daycare Center

female

staff

Disabled Daycare Center

female

staff

Disabled Daycare Center

female

staff

Disabled Daycare Center

female

director

Disabled Daycare Center

male

staff

female

director

female

Supervisor

Congressman Office

Open Radio for N. Korea

Total (N)

MEASUREMENT OF QUANTITATIVE FINDINGS

• Data were drawn from data collected from the host country local practitioners using survey questionnaires with an ordinal scale of 1-4 (ascending) as follows: • 4 – The student thoughtfully and thoroughly discussed multicultural diversity clearly demonstrating an understanding of its importance to the multicultural social justice project case. • 3 – The student discussed multicultural diversity in some detail, demonstrating a good relationship to the impact on the multicultural social justice project case. • 2 – The student included a basic discussion of a relevant diversity issue and was able to describe why it was important to the multicultural social justice project case in a basic way. • 1 – The student did not discuss cultural diversity at all or discuss it in a way that was not relevant to the multicultural social justice project case.

Student Participants’ 15-Course Competencies • The quantitative findings' the levels of student participants’ 15-course competencies in relation to specific practice behaviors: Recognize the extent to which a culture’s structures and values may oppress, marginalize, alienate, as well as create or enhance privilege and power in South Korea. 2. Understand the forms and mechanisms of oppression and discrimination in South Korea. 3. Advocate for human rights and social and economic justice in South Korea. 4. Engage in practices that advance social and economic justice, and empowerment in South Korea. 5. Gain sufficient self-awareness to eliminate the influence of personal biases and values in working with diverse in South Korea. 6. Use empathy and other interpersonal skills in South Korea. 7. Collect, organize, and interpret client or consumer or population information in South Korea. 8. Assess client or consumer or population strengths and limitations in South Korea. 9. Use service learning practice experience to inform evidence-based scientific inquiry in South Korea. 10. Use evidence-based knowledge to inform service learning practice in South Korea. 11. Critically analyze, monitor, and evaluate interventions in South Korea. 12. Recognize and communicate their understanding of the importance of cultural difference in your life experiences in South Korea. 13. View yourself as a learner and engage those whom they work with as informants in South Korea. 14. Make ethical decisions by applying standards of one of the following: NASW Code of Ethics, the International Federation Social Workers, International Association of Schools of Social Work Ethics in Social Work, and Statement of Principles in South Korea. 1. Apply strategies of ethical reasoning to arrive at principled decisions in South Korea. 1.

FINDINGS: I. QUANTITATIVE FINDINGS

• The result shows the improvements of all 15 questions relating to course objectives and practice behaviors from all respondents.

• The improvement is statistically significant with less than .5 significance. • The findings suggest that there is a real effect of the program on all 15 questions for student participants from two different means.

TABLE 2: Pair 1 Pair 2 Pair 3 Pair 4 Pair 5 Pair 6 Pair 7 Pair 8 Pair 9 Pair 10 Pair 11 Pair 12 Pair 13 Pair 14 Pair 15

q1pre q1post q2pre q2post q3pre q3post q4pre q4post q5pre q5post q6pre q6post q7pre q7post q8pre q8post q9pre q9post q10pre q10post q11pre q11post q12pre q12post q13pre q13post q14pre q14post q15pre q15post

PAIRED SAMPLES T-TEST

Mean 1.22 2.67 1.33 2.44 1.33 2.67 1.25 2.75 2.00 3.00 1.67 3.22 1.67 2.67 1.56 3.11 1.33 2.67 1.56 2.67 1.44 2.78 1.78 2.89 2.00 3.33 1.56 2.78 1.33 3.00

N 9 9 9 9 9 9 8 8 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9

Std. Deviation .441 .707 .500 .527 .500 .500 .463 .707 .707 .707 .707 .441 .707 .707 .527 .782 .707 .500 .527 .500 .527 .833 .667 .782 .707 .707 .527 .833 .500 .707

Std. Error Mean .147 .236 .167 .176 .167 .167 .164 .250 .236 .236 .236 .147 .236 .236 .176 .261 .236 .167 .176 .167 .176 .278 .222 .261 .236 .236 .176 .278 .167 .236

TABLE 3: PAIRED SAMPLES CORRELATIONS Pair 1 Pair 2 Pair 3 Pair 4 Pair 5 Pair 6 Pair 7 Pair 8 Pair 9 Pair 10 Pair 11 Pair 12 Pair 13 Pair 14 Pair 15

q1pre & q1post q2pre & q2post q3pre & q3post q4pre & q4post q5pre & q5post q6pre & q6post q7pre & q7post q8pre & q8post q9pre & q9post q10pre & q10post q11pre & q11post q12pre & q12post q13pre & q13post q14pre & q14post q15pre & q15post

N 9 9 9 8 9 9 9 9 9 9 9 9 9 9 9

Correlation -.535 .316 .000 .218 .250 -.134 .000 -.775 .000 -.632 -.032 .426 .000 .032 -.354

Sig. .138 .407 1.000 .604 .516 .732 1.000 .014 1.000 .068 .936 .252 1.000 .936 .351

II. QUALITATIVE FINDINGS:

 Student participants’ effects 1. direct practice experience, 2. personal growth, 3. critical thinking/problem solving skills, 4. cross-national civic engagement, and 5. increasing sensitivity and awareness of cross-cultural diversity in human services field areas.

 Effects on hosting local community partners abroad  Challenges facing participants in the program  Suggestions for the improvement of future programming

Thames emerged

Student Participants’ Outcomes identified Direct practice experience

• • • • •

Personal growth

• •

Active practice engagement and positive interaction with client and projects. Experience with working through a process in the program. Thinking and working like a professional. Becoming knowledgeable in the professional fields Expand the width of the ideas through experience and contacts with a new culture. Increase in self-knowledge and personal-efficacy Be helpful for future job/education.

Critical thinking/problem solving skills • Reflection on a process of acting in practice.

• Finding solutions to the social problems/issues of the service area

Cross-national civic engagement

• •

Rewarding opportunity Invaluable contribution to the agency from the students.

Increasing sensitivity and awareness of cross-cultural diversity in human services field areas

• • • •

Immersion in unfamiliar cultures and settings. Increase in deeper understanding of cultural differences Experience and appreciation of different cultures. Appreciation of the fact that people of other cultures are “just like us.”

Thames emerged

Effects on Hosting Local Community Service Learning Partners Abroad • •

New mutual opportunity of learning/care New opportunities for interactions in the practice

•

Preparation undertaken by the hosting agencies participating in the program.

Overweighed Benefit

•

Outweighed benefits to students than clients in the agency.

The Challenges facing Participants in the Program

• • • •

Difficulty in verbal communication. Educational learning level limitations. Limited In-country daily program schedule. Difficult work situations in hosting local agencies

Reciprocity

SUGGESTIONS FOR THE IMPROVEMENT OF FUTURE PROGRAMMING: SHORT-TERM FACULTY-LED STUDY ABROAD PROGRAM

Building a Cross-National Partnership Team •

needs a high degree of central communication, cooperation, and arrangements at the host country local and home university levels.

Cultural and Physical Environment of Accommodation Facility • • •

be a religiously and spiritually neutral place. Allow student participants to discuss any issues of different religions. Have a short-term daily living place in a familiar and comfortable environment to minimize frustrations and maximize the learning experience for student participants.

Rotation of Service Learning Field Sites •

rotate a team of students to different agencies in two different time frames to provide diverse field experience.

Integration of Korean Language and Culture Class •

Considering the very serious problem our student participants encountered when trying to communicate with local people during the program, a Korean language and culture class should be integrated into the program.

DISCUSSION WITH EMPHASIS ON USABILITY & APPLICABILITY



Today social and behavioral sciences and business take a wide range of social-culturallinguistic environments into account.



It takes an integrated-sustainable team of educators and administrators to build & sustain a good shot-term based intercultural social work education program abroad.

 This study suggests that unfamiliarity and risks of complications be minimized and maximize learning the Korean language/culture, becoming familiar with the living/learning environments, and build a cross-national collaborative partnership team.



The presentation discusses issues of human services organizational and academic institutional challenges in establishing international collaborative partnership during the intercultural social work education program implementation.

IMPLICATIONS FOR INTERCULTURAL ORGANIZATIONAL-INSTITUTIONAL BEHAVIOR

• With shared governance as an underlying guide, intercultural

organizational-institutional behavior should build upon a mutual development model.

• This places differential and equal decision–making power of key

administrators in a mutually empowering process between the host country’s local human services organizations and home universities.

QUESTION & ANSWER

Enhancing the Science of Social Work and Expanding Social Work Research in Transitional Countries

James T. Decker, Ph.D., LCSW Professor Department of Social Work California State University, Northridge 18111 Nordhoff Street Northridge, California 91330-8226 jdecker@csun.edu 818-677-3710

• This paper compares the status of social work as a science within American and European contexts and examines methods of increasing the visibility of social work as a science in transitional countries. • Insight into doctoral education and its influence on the development of science in social work is explored. • Focusing on Georgia, the former Soviet Union Country where social work is a newly established discipline, we highlight the needs and priorities for social work doctoral education and its influence on development of the profession and science of social work. • Strategies for developing social work research scholarship, expanding the mission of social work within professional organizations to include science, and augmenting the responsibilities of the profession to include rigorous practice informed, evidencedbased translational research are provided.

Social Work is made up largely of master's-level practitioners who, as a group, do not have the research sophistication that is found among doctoral graduates from other fields (Witkin, 1995). One of the strengths of a profession depends on its empirically derived knowledge base as it informs its practice and empowers practitioners through research. Despite its venerable history, Social Work still struggles with its professional identity, remaining sensitive to the allegation that it lacks a unique subject matter or methodology, which creates a void in creating evidence based practices. The social work profession is made up of knowledge, values and skills, but also includes science (Fong, 2012).

Social Work as an Integrative Scientific Discipline

While Social Work education has historically been grounded in professional practice, reconsideration of Social Work as a science has recently been urged (Fong, 2012). This dilemma is present within social work domestically and internationally. One indicator of Social Work lacking scientific shape is that social workers are charged with not contributing to the scientific advances and evidence based treatments as much as other professionals such as psychologists, psychiatrists, public health, and sociologists. The Social Work professional mission statement, code of ethics and accreditation documents lack references to itself as a â&#x20AC;&#x153;scienceâ&#x20AC;? (Fong, 2014; Brekke, (2012); Marsh, 2012). This trend towards increased practitioner/researcher alliances has been observed in both Britain and the United States (Cheetham, 1997; Mullen, 2002; Webb, 2002). Guerrero (2014) asserts that the situational context offers more opportunities than challenges for Social Work to become a scientific enterprise.

The aim of transdisciplinary action science of social work is to enable the profession and professional practitioners to make responsible and informed choices that would become a solid ground for legitimacy of professional social work. A critical task is to distinguish social work from other integrative scientific disciplines. Social work has three functions: (1) therapeutic, which may promote change on an individual bases; (2) problem solving in human relationships, promoting interpersonal and social â&#x20AC;&#x153;harmonyâ&#x20AC;? and (3) promoting social development and/or social change (Adams, Dominelli & Payne, 2009, p.2). Social work education and practice must include a solid foundation of science, core skills and social justice.

Institutional Response to Development of a Profession and Science of Social Work in the United States and Europe

Fong (2012) suggests that revising the mission statements of NASW and CSWE would strengthen the scientific status of social work by reflecting qualities that are crucial to the science of social work, including: (1) scientific inquiry, (2) transdisciplinary scope, (3) scientific methodology, (4) evidence-based practice, and (5) translational science Issues of social work research not being introduced as science in the United States where schools of social work at universities have had long traditions of teaching research and demanding research from its professors to acquire tenure is well documented. However, the conflict of social work research not being defined as or grounded in science remains an issue of contention. In comparison with social work in Europe, the status of the social work discipline is described as poor and struggling for acknowledgement (Erath & Littlechild, 2010; Sommerfeld, 2014,).

Despite the different approaches of the European nations towards social work (e.g. English social work highlights “accountability” and “evidence”; German social work underlines notion of “social justice”; Czech and Slovakian social work rely on consistent identification of the occupational group, similar to Sweden, Finland and Norway) nothing has considerably contributed to an improvement of the status of social work in the European countries (Erath and Littlechild, 2010). However, social work holds stronger position in those countries in which it has developed comprehensively both theoretically and practically. In the Nordic countries where social work is merely understood as a practice, it holds a less favorable position (e.g. in the United Kingdom, France). In the Czech Republic and Slovakia, social work is seen only as a science. In Germany, Austria, and Switzerland, social work does not have a strong position as a science nor as a practice. In 1996, Social Work Education sponsored by the Council of Europe concluded that in the context of significant changes in education and training for social work, “social work research seems underdeveloped in Europe” (Council of Europe, 1996, p. 25).

Social work researchers in the US are focused more on quantitative and positivistic approaches than their European colleagues (Garvin, 2010). However, the differences of social work doctoral programs and research paradigms between countries within Europe were also very significant and reflected the stages of development from the discipline of social work in each European country

The Characteristics of Social Work Research Social workâ&#x20AC;&#x2122;s commitment to rigorous research is the major indicator for defining social work as a science. Social work research benefits consumers, practitioners, policy-makers, educators, and the general public through the examination of societal issues such as health care, substance abuse, and community violence; family issues, including child welfare and aging; well-being and resiliency; and the strengths and needs of underserved populations. Social work research provides empirical support for best practice approaches to improve service delivery and public policies (NASW, 2015). However, questions remain regarding social workerâ&#x20AC;&#x2122;s preparedness for the rigor of academic research. Social work research is considered as anti-oppressive research and it should be assessed from an anti-oppressive social work perspective (Strier, 2007).

Strier (2007) argues that in order to match the liberating mission of the profession, social work research should defy the dominant traditions of social science research. This poses a very real concern: Are critics of social work research questioning the methods or scientific rigor or are they not aligned with social workâ&#x20AC;&#x2122;s anti-oppressive ethical perspective? The philosophical foundations of this model are purposive, inclusive, empowering, and action oriented. Moreover, in concert with the contemporary trends for accountability and evidence-based practice, action orientation using this model is well informed by sound and participatory inquiry. Social work needs to make a greater investment in producing scientific knowledge to enable community change (Coulton, 2005) Strategies include: social work research agendas with rigorous research designs, drawing on matching, time series, and other principals of experimentation; the use of multilevel statistical analyses to examine community influences; spatial statistics can be incorporated into community intervention studies; engage systematic and comparable methods of documenting community interventions and boundaries; social work should invest in ecometrics as well as psychometrics; and social workers can employ more complicated measurement procedures with social work research.

The notion of importance of building a translational science agenda in social work research became very actual issue (Brekke, Ell & Palinkas, 2007; Fong, 2012). The goal of translational science is to support research that will build the models and methods needed to bridge the science and service communities, and thereby directly affect the provision of services in all of these usual care settings across sectors and populations. Translational science takes both research informing practice competency and the practice informing research competency and operationalizes them to tie the researcher and the practitioner more closely together (Fong, 2012).

Priorities for Doctoral Education in Transitional Countries

The social work profession is a newly emerging discipline in Georgia, the former Soviet Union country which developed as a response to the severe socio-economic crises following the collapse of the USSR. Originating in 2006, bachelor’s, master’s and doctoral programs were established to prepare professionals in social work. Bachelor’s and master’s prepare social workers to be practitioners, while social work doctoral education prepares social work professionals to teach at higher-level institutions. However, the social work profession is significantly challenged within European academia and is not seen as a science or research discipline. It is important to develop and sustain sound Ph.D. programs to highlight the importance of academic research and academic rigor for doctoral education in social work in the context where social work is not considered as a science. . Sound doctoral education in social work can support long-term social work research capacity.

Doctoral education needs multiple mentors from different disciplines to understand and use a multidisciplinary approach, and doctoral programs should incorporate team-taught courses presenting multidisciplinary framework (Fong, 2012). For instance, a best practice strategy involves designing multi-professional teaching clinics, bringing together expertise from different social sciences/disciplines, e.g. psychology, public health, mental health, social policy.

Conclusion and Recommendations

Despite the comprehensive content of social work doctoral curriculum, there are several tasks to be undertaken for establishing social work as a science in the post-communist countries. Like the United States, science is not regarding as an essential element consistently within the field, impacting perceptions, education and research within the social work discipline. Recommendations include: Firstly, social work doctoral programs should build capacity by preparing qualified social work doctoral students who will be able to plan, propose, and implement research that contributes to the profession's knowledge base. Secondly, doctoral programs should have high standards in developing funding institutions that will support building a research infrastructure for schools of social work. The creation of social work research centers is essential. These centers will integrate a multidisciplinary team of faculty, scientists, researchers, and students committed to advancing solutions to social issues in the region.

Thirdly, schools of social work need to establish the fiscal resources necessary to help faculty members establish productive research programs (such as course releases, class buyout policies, and proposal development funds). Finally, promotion of social work research within the academia community, and broader society including politicians should help the former Soviet Union countries to build better social welfare and health policies, disseminate innovative approaches for ameliorating and preventing social problems, facilitate evidence-based, sustainable solutions to emerging public health and social challenges affecting vulnerable populations.

Study of a Social Support Program Designed to Maintain LGBT Clients with Mental Illness in the Community

Eileen Klein, Ph.D., L.C.S.W. October,2016

Why do we need a program? • Mental Health consumers have a sexual identity that is not acknowledged • When they identify as LGBT they often risk loss of valued cultural, familial or community connections • These losses can impact mental health and result in readmission to the hospital

NASW Code of Ethics •

“…identify ways to eliminate homophobic social work practices…[and to]…promote the development of knowledge, theory and practice as related to gay, lesbian, bisexual [and transgender] issues…”

National Association of Social Workers Committee on Lesbian, Gay, Bisexual and Transgender issues

•

LGBT consumers with mental illness have unique needs

•

They are victims of a dual stigma

•

Lesbian, gay, bisexual and transgender (LGBT) people have poor access to mental health care because of no or lower rates of insurance

•

Studies have long found that LGBT people are more likely to experience depression, suicide, anxiety and other mental illnesses

•

They are more likely to use substances, including nicotine and alcohol‐ 1.5 times more likely

•

Some studies have suggested that this is due to the greater stress that LGBT people experience

SURVEY LGBT Health and Human Service Needs in NYS 2009

• •

Estimated that 4.1% of people in New York City identify as lesbian, gay or bisexual; The survey did not ask about transgender identities.

•

42% said that community fear or dislike of LGBT people limited their access to health care Participants in their Needs Assessment were very interested in utilizing LGBT‐ specific services as well as service providers who are culturally competent in LGBT issues. Nearly 50% reported to have used such services when available

•

No Insurance • 20.6% Gay and Lesbian • 23.5 % Bisexual • 14.9% Heterosexual

Service Needs • 27% reported fear that if medical personnel found out they were LGBT they would be treated differently • 10% reported that they had been to healthcare workers who refused to provide services • 13%reported anti‐LGBT sexual assault or violence requiring hospitalization • 39% reported a lack of LGBT support groups

Why is this important? • People who feel unsafe or unwelcome in mental health treatment settings are unlikely to develop the trust necessary to form a deep therapeutic alliance. • The stress of navigating unsafe feelings and experiences often results in lack of engagement, retraumatization, and refusal of crucial mental health services • LGBT individuals are 2.5% more likely to have a mental health disorder than their heterosexual counterparts • 28.0% of gay and lesbian people reported having had depression in the past 6 months vs 14.2% of heterosexual people reported depression

Dual Stigma • • • • •

Oppressive history Life experiences‐minority stress Beliefs and values Formal and informal help‐seeking pathways Traditional healing practices

What do you do when you are not t work?

Peer Support

Social Isolation • Need to have a community/ family for support • Negative effects of social isolation on health • Need connection and validation for quality of life, self esteem, better health outcomes • LGBT seniors more likely to experience financial exploitation, neglect, loneliness

Rainbow Heights Club • • • • • • • • • • • • •

Fun Committee Golden Girls and Boys Lesbians’ Group Gay Men’s Group Life Skills Discussion (Wellness & Recovery Action Plan) Stitch and Bitch Trans/Gender Explorers Alcohol and Substance Abuse Group Thoughts & Feelings Group Too Much Group (Too much drinking, too much sex, too much eating, etc) Community Meeting /Consumer Advisory Board Meeting (2nd Friday) Harm Reduction Group KarAoke Dating and Relationships

•

OPEN MONDAY – FRIDAY 12:30‐7:30 EVENING MEAL 4pm

RHC Member Survey • 93% of the members have a psychiatrist, 84% of those reported they had seen the psychiatrist in the past month •

91% of the members have a therapist, 94% saw the therapist in the past month

• 94% reported that they are prescribed psychiatric medications, 78% reported ‘always’ take them, 15% reported ‘often’ take them, for a total of 93% • 80% of the members reported seeing a medical doctor in the past 6 months, 9.4% reported seeing a medical doctor in the past 6‐12 months • 75%reported being more consistent with medical and psychiatric follow up since joining the Club •

94.4% reported they have stopped or reduced substance and/or alcohol abuse

Quality of Life • 84.6% reported more hope • 76.9% reported increased self esteem • 83.8% reported increased social support

Member Testimonials • https://www.youtube.com/watch?v=G7hhq28 pKlI&feature=plcp

Beliefs and Behavior of Nurses Providing Healthcare Services to Gay and Lesbian Individuals Michelle Morgan, DNP, RN, ANP‐BC

Background • LGBT‐ Lesbian, Gay, Bisexual and Transgender – Minority population with health disparities (Healthy People, 2013; IOM, 2011; TJC, 2011)

– Discrimination from healthcare providers (Crisp, 2006; Chapman et al. 2011; Eliason et al., 2010; Fredriksen‐Goldsen et al., 2012; IOM, 2011; Lamda Legal, 2010; Makadon et al., 2015; Mullins, 2012; TJC, 2011)

• Nurses are in a key position to decrease health disparities by providing culturally competent care • First, nurses must assess their own beliefs and behavior working with lesbians and gay patients

Purpose To assess nursing beliefs and behavior when providing healthcare services to gay and lesbian individuals using the Gay Affirmative Practice (GAP) scale.

Significance • Provides opportunity for nurses to reflect on the potential impact of their beliefs on to their behavior with lesbian and gay patients • Change‐ with same‐sex marriage legal in the United States, nurses will have patients and families who are openly gay • Policy and Law are changing rapidly, but public opinion, beliefs and behaviors may not be (Chapman et al., 2011)

Retrieved from http://www.freedomtomarry.org/ - with permission to reprint

Conceptual Framework: A Model for Nursing Gay Affirmative Practice

Adapted from “Gay Affirmative Practice Scale (GAP): A new measure of assessing cultural competence with gay and lesbian clients,” by C. Crisp, 2006, Social Work Education, 51(2), p.117.

Research Questions Research Question One: What are the demographic characteristics (e.g., age, gender, ethnicity, education level, and years of employment) of nurses who provide healthcare to lesbian and gay individuals? Research Question Two: What are the beliefs and behavior of nurses who are employed in a hospital system in the Southwestern region of the United States as determined by the Gay Affirmative Practice Scale? Research Question Three: What percentage of nurses reported they could benefit professionally from a course in cultural competence in the care of LGBT?

Nursing Practice, Research & Policy Assessing your beliefs and behavior working with lesbian and gay individuals is a first step in becoming culturally competent. This is one of the first research studies to assess registered nurses’ Gay Affirmative Practice with potential lesbian and gay patients.

Methods • Descriptive non‐experimental design • Urban setting, multiple sites, 3,500 nurses • Convenience sample • Anonymous Qualtrics survey

Survey Instruments • Demographic Survey • Gay Affirmative Practice Scale (30 items) –Belief Domain (15 item) –Behavior Domain (15 item)

Data Analysis • Frequencies and percentages of the demographics • Mean scores of the GAP scale Percent of willingness to take a cultural competence course

Research Question 1: Demographic Results • 70 survey responses in varying degrees of completion

• 89% were female, 91% Caucasian, 90% heterosexual, 84% Christian, average age 49 • • • • •

40% BSN and 36% MSN; 71% have a nursing certification; 86% have friend or family member who is gay or lesbian 71% had a cultural competence class in nursing school 61% perceived a cultural competence course would benefit them professionally

Research Question 2: GAP Score Results • GAP scores (n = 61) – Mean GAP score was 110 – Range of 36 (n=1) to 150 (n=1) – 19 GAP scores below 100, 3 below 75 • Mean Belief score of 63 (n=65) – Range 21‐75 • Mean Behavior score of 49 (n=63) – Range 15‐75

Research Question 3: GAP scores with past cultural competency course and perceived benefit of course Previous Perceived Course Benefit

Score Range ______________________

Yes Yes No No

Yes No Yes No

32 20 11 7

70–150* 36–140 97–146** 82–127**

Note: * Five respondents had no GAP scores. **One respondent had no GAP score.

61% of respondents perceived a professional benefit in a cultural competence course

Years of Experience; Friend or Family LGBT; and GAP score ranges Years 0–5 5–10 11–15 16–20 21–25 26–30 31–35 > 35

Yes (n) 0–110 (3) 82–132 (8) 36–120 (7) 0–130 (9) 0–146 (10) 66–134 (5) 67**–150 (7) 0–142 (11)

No (n) 140 (1) 0–119 (3) NA* NA* 99 (1) 101 (1) 70–89 (3) 111 (1)

Note. *All the respondents in the ranges of 11–15 and 16–20 had a friend or family member who identifies as LGBT; therefore there are no GAP score ranges in the section where the respondent does not have a friend or family member who is LGBT. **Only answered the belief domain questions.

Recommendations and Discussion • Provide education for nurses in the system (Crisp 2006; Dinkel et al., 2007; Mayer, et al., 2008; Makadon, et al., 2015; Röndahl, 2011; & Sirota, 2013)

– Conduct a pre‐post test analysis of effectiveness of education • Repeat study on a national level‐ with nurses from non‐ Caucasian nurses • Develop a nurse evaluation of belief and behavior, which is inclusive of bisexual and transgender (Strong & Folse , 2015) • Work with the Chief Nursing Informatics Officer to get sexual orientation and gender identity questions into the electronic medical record (IOM, 2011; TJC, 2011)

References Chapman, R., Watkins, R., Zappia, T., Nicol, P., & Shields, L. (2011). Nursing and medical students’ attitude, knowledge and beliefs regarding lesbian, gay, bisexual and transgender parents seeking healthcare for their children. Journal of Clinical Nursing, 21(7–8), 93–945. doi:10.1111/j.1365‐2702.2011.03892.x Crisp, C. (2006). The Gay Affirmative Practice Scale (GAP): A new measure for assessing cultural competence with gay and lesbian clients. Social Work, 51(2), 115–126. doi:10.1093/sw/51.2.115 Dinkel, S., Patzel, B., McGuire, M. J., Rolfs, E., & Purcell, K. (2007). Measures of homophobia among nursing students and faculty: A Midwestern perspective. International Journal of Nursing Education Scholarship, 4(1), article 24. Eliason, M. J., Dibble, S., & DeJoseph, J. (2010). Nursing’s silence on lesbian, gay, bisexual, and transgender issues: The need for emancipatory efforts. Advances in Nursing Science, 33(3), 206–218. doi:10.1097/ANS.0b013e3181e63e49 Fredriksen‐Goldsen, K. I., Elmer, C. A., Kim, H., Muraco, A., Erosheva, E. A., Goldsen, J., & Hoy‐ Ellis, C. P. (2012). The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: The role of key health indicators and risk and protective factors. Gerontologist, 53(4), 664–675. doi:10.1093/geront/gns123 Healthy People. (2013). Lesbian, gay, bisexual, and transgender health. Washington, DC: U.S. Department of Health and Human Services. Retrieved from http://www.healthypeople.gov/2020/topics‐ objectives/topic/lesbian‐gay‐bisexual‐and‐transgender‐health Institute of Medicine. (2011, March 31). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding [Report brief]. Washington, DC: National Academy of Sciences. Lambda Legal. (2010). When health care isn’t caring: Lambda Legal’s survey on discrimination against LGBT people and people living with HIV. Retrieved from http://www.lambdalegal.org/health‐care‐report

References Makadon, H. J., Mayer, K. H., Potter, J., & Goldhammer, H. (2015). Fenway guide to lesbian, gay, bisexual, and transgender health (2nd ed.). Philadelphia, PA: American College of Physicians. Mullins, M. H. (2012). The relationship of practice beliefs and practice behaviors among social workers with l esbian and gay clients. Journal of Human Behavior in the Social Environment, 22, 1050–1064. doi:10.1080/10911359.2012.707959 The Joint Commission. (2011). Advancing effective communication, cultural competence, and patient‐ and family‐centered care for the lesbian, gay, bisexual, and transgender (LGBT) community: A field guide. Oakbrook Terrace, IL: The Joint Commission. Röndahl, G. (2011). Heteronormativity in health care education programs. Nurse Education Today, 31(4), 345– 349. doi:10.1016/j.nedt.2010.07.003 Sirota, T. (2013). Attitudes among nurse educators toward homosexuality. Journal of Nursing Education, 52(4), 219–227. doi:10.3928/01484834‐20130320‐01 Strong, K. L., & Folse, V. N. (2015). Assessing undergraduate nursing students’ knowledge, attitudes and cultural competence in caring for lesbian, gay, bisexual and transgender patients. Journal of Nursing Education, 54(1), 45–49. doi:10.3928/01484834‐20141224‐07

Questions

Improving the Health and Safety Behaviors of Home Care Workers International Academic Research Conference Scottsdale, AZ – October, 2016

Linda Mabry Washington State University Vancouver

mabryL@wsu.edu Ryan Olson, Kelsey N. Parker, Katrina Bettencourt, Kristy Luther Oregon Health & Science University

Sharon V. Thompson University of Illinois at Urbana-Champaign

Afsara Haque University of Southern California

Rob R. Wright Brigham Young University-Idaho

Jennifer A. Hess University of Oregon, Labor and Education Research Center

National Institute of Occupational Safety and Health NIOSH # U19OH010154 Oregon Healthy Workforce Center: Creating Health and Safety ‘Communities of Practice’ for Home Care Workers

home care worker

= provides in-home care to disabled or elderly consumer employers

• • • •

(HCW)

predominantly women often previously cared for family member low income low levels of social support

* Research participants

Avg

Female

• • • •

work in isolated and stressful conditions many live-in caregivers or 24-hour shifts limited access to training or other support regulations designed to protect CEs

(CEs)

Percent 83 %

Age

Other jobs in previous 3 months

48 %

Type of home-care work: - Hourly - Live-in

74 % 14 % * Licensed and employed

• at risk of developing depression and anxiety • injury rate nearly 4 times the national average

by state of Oregon

COMPASS = the program (intervention) COMmunity of Practice And Safety Support •workshops to promote health and safety •diet and exercise information •demonstrations of safety equipment and communication •peer-led collaborative discussion and problem-solving

COMPASS – the research 1.Randomized control trial (RCT) 2.Qualitative follow-up study Triangulation in data collection •

• • •

by method – • pre-/post- medical tests • survey • qualitative interviews by observer – multiple observers of COMPASS sessions by time – data collection at different periods by data source – interviews of 24 participants, documents

Triangulation in data analysis •

multiple perspectives through independent analyses followed by a series of analytic group discussions

Thematic data analysis

Physical and social isolation •No assistance with difficult tasks •No backup when CEs demand unapproved work •Increased safety hazards •Case managers are often overloaded and unavailable •Case managers advocate for CEs, not HCWs Jasper: “We are a one-on-one type job, we rarely get to talk to other people. I talk to my dog, my car, my computer.” Lillian: “I can talk with [another COMPASS participant] because . . . she understands.”

Chains of working relationships •Difficult situations with CE and family (HCW may be out-numbered) •Difficult situations with case managers •Cycle of obligation to help vulnerable CEs, so: o work longer hours than they are paid for o work outside of their official task list o help CEs’ family members, too Clara: “My CE’s husband treats me like I am also his caregiver [she was not], repeatedly asking me to do things that are not on my task list.”

High stress, need for social support •Job stress intensifies social support needs •Confidentiality preempts talking with friends or family Hadley: “People who are abusive, verbally and physically – we still have to work with and for them.” Jasper: “We live under this black cloud . . . [For] 90% of our clients . . . we're going to come to work one day, and they aren't going to be there anymore. Every day I go to my client's house and I open the door. I always call out to him. And if he doesn't answer, I panic.”

Thematic data analysis Double vulnerability •HCWs – medical conditions

COMPASS impact

– financially unstable (low wages) – disposition to help others •CEs – vulnerable without HCWs

COMPASS was beneficial to HCWs in terms of: • Provision of training, awareness of safety equipment and procurement procedures • Increased health awareness and exercise • Not in terms of measurable health impact, as originally predicted

Jasper: “I think caregivers, because of our nature, are pretty good at heart. We want to help people . . . so, we tend to let them walk on us.” Leighton: In order to keep her job, one HCW “felt as though she had to do everything that a CE told her regardless of whether it compromised her own values.”

Annika: reported becoming more active and losing 20 lbs. Cooper: “a large personal change is in posture and walking and posture in sitting. . . . I've had a client fall twice during COMPASS, and I was able to get them up without stressing my joints” Oswald: “I would say I became more hopeful. Maybe my depression become a little bit less.”

Research Findings Findings A multi-stage process improved the health and safety of HCWs: •Building a safety- and health-related knowledge-base •Providing social support for work and personal problems •Setting goals for behavioral change, with social accountability for achieving change •Registering measurable safety and health improvement

Significance and generalizability Many professions involve physical and social isolation. Reducing social isolation empowers isolated workers to advocate for themselves.

Improving the Health and Safety Behaviors of Home Care Workers

for more information:

Linda Mabry Washington State University Vancouver

mabryL@wsu.edu