School of Social Policy & Practice Dissertations
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Publication Understanding the Barriers faced by African American Licensed Clinical Social Workers (LCSWs) to Medicaid Network Provider Participation(2024-05-18) Smith, Cassandra DeniseUNDERSTANDING THE BARRIERS FACED BY AFRICAN AMERICAN LICENSED CLINICAL SOCIAL WORKERS TO MEDICAID NETWORK PROVIDER PARTICIPATION Cassandra D. Smith, MSW, LCSW-BACS Committee: Sara S. Bachman, PhD and Tamara Cadet, PhD LICSW MPH Purpose: African Americans’ mental illness is more untreated than that of white Americans (Snowden, 2012). Studies also show that African Americans are more likely than white Americans to develop chronic mental illness (Snowden, 2012) and compared to their white counterparts, African Americans are more likely to be misdiagnosed (Office of the Surgeon General et al., 2001). Results from studies show that African Americans prefer African American providers, have more positive perceptions of African American providers, and that racial congruence does positively impact treatment outcomes for this population (Cabral & Smith, 2011). Ensuring a racially and ethnically diverse Medicaid provider network can impact those treatment outcomes for Medicaid consumers. This study aims to identify and understand the barriers faced by African American (AA) Licensed Clinical Social Workers (LCSW) to Medicaid Network Provider Participation. Methods: Data collected via an online survey was analyzed using descriptive statistics. Means, standard deviations, and range of scores were calculated for all continuous variables including age and number of years as an LCSW in Louisiana. Frequencies were summarized for all categorical variables including race; work status; practice setting; Medicaid provider (yes/no); reasons for not accepting Medicaid; MCO credentialing agencies; reasons for non-accreditation; level of satisfaction with Medicaid payment rates; level of satisfaction with the contracting and credentialing process; level of satisfaction with regulations, oversight and administrative burden associated with being a Medicaid provider; most impactful consideration in decision to become a Medicaid provider; level of difficulty in obtaining a $50,000 line of credit for credentialing; and level of difficulty in obtaining National Accreditation. Each variable was also separated by race (Black or AA and White) to provide context using cross tabulation tables. 5 Semi structured interviews were conducted as a qualitative pilot with original coding in categories aligned with the quantitative variables. Results: A total of N=128 social workers participated in the study. The sample as a whole ranged in their experience as Licensed Clinical Social Workers (LCSW) from 0-54 years, with an average of 19 years (SD=14). Overall, respondents ranged in age from 22-87, with an average age of 52 (SD=14). 60% of AA respondents reported that they do provide Behavioral Health services to Medicaid clients. AA respondents largest reported reason for this outside of not working for an agency that provided Medicaid service was “I do not have the capacity or resources to do so (time, finances, knowledge, etc.)” at 23%. The second largest reported reason amongst this demographic at 15% was “Medicaid reimbursement was too low”. Other reasons reported were non system related responses related to work setting or position. 83% of AA respondents reported being “Dissatisfied to Very Dissatisfied’ with Medicaid Reimbursement rates, 55% of AA respondents reported being “Dissatisfied to Very Dissatisfied” with the Contracting and Credentialing Process and 72% of AA respondents reported being “Dissatisfied to Very Dissatisfied” with the Regulations, Oversight, and Administrative Burden, etc.) Solutions for barriers identified through the literature and through pilot qualitative interviews included amendment of regulation to remove the requirement for additional licensure, alternative payment methods, identification of alternatives to National Accreditation; MCOs providing provider grants, as well as administrative support through technology and centralized billing platforms, and the creation of an ombudsman to address ongoing provider issues are other possible solutions. Additional solutions offered were streamlining of the billing and authorization processes to create uniformity across MCOs in the state. African American LCSWs also believe that additional local staff should be hired by MCOs to address provider concerns. Lastly, of course, raising reimbursement rates for Medicaid Behavioral health services was a central theme in the data. Conclusions: This study’s data on barriers AA LCSWs have to Medicaid Provider Network participation provides valuable information to guide regulatory policy and to develop strategies for implementing interventions to build the capacity of AA social workers. Improving Medicaid reimbursement rates, addressing concerns with contracting and credentialing, as well as concerns with regulatory requirements can help to increase the number of AA LCSWs in the Medicaid Provider Network. Recommended areas for further study include examining the potential disproportional impact these barriers may have on AA providers and implementation study of the effectiveness of capacity building interventions targeting AA LCSWs who desire to provide Medicaid services. Additionally, future research examining the possible connection between AA LCSWs access to capital and their ability to meet quality standards should also be considered. Lastly, comparing AA LCSW experiences in the workforce and in Medicaid networks across states could provide valuable knowledge.Publication The Dynamic Construction of Belonging: A Grounded Theory Investigation of Military Spouses(2024) Reynolds, MarinelleFrequent relocations and disruptions to social support systems are just one of many factors inherent to military life that underscore the importance of cultivating a sense of belonging. Other challenges, such as adapting to new cultures and environments, managing family dynamics, and navigating the uncertainty of deployment schedules, further complicate establishing roots and a sense of community. A robust body of research has explored important links between belonging and various physical and mental health outcomes for military service members, with research focused on military spouses remaining notably sparse. Utilizing Social Constructivist Grounded Theory, this qualitative study addressed this significant gap through in-depth interviews conducted with a purposive sample of 40 military spouses, including those from marginalized and underrepresented groups. Findings shed light on how military spouses construct a sense of belonging against the backdrop of ever-changing social environments. The impact of interactions across ecological layers on belonging is explored, introducing a new theoretical framework that distinguishes between enduring (trait) and situational (state) belonging. This framework examines the intersectionalities of rank dynamics, racial disparities, and gender stereotypes and emphasizes the fluidity of belonging. Implications for military communities, social work theory, policy, and practice with military families are discussed.Publication A TWO PAPER EXAMINATION OF THE SOCIAL DETERMINANTS OF HEALTH THROUGH CULTURALLY RESPONSIVE INTERVENTIONS IN HEALTHCARE SOCIAL WORK(2024-08-01) Victoria FilingeriThe following is a two-paper exploration of the cultural assessment of the social determinants of health (SDOH). Social circumstances have a significant impact on health outcomes. Medical care alone is estimated to account for approximately 20% of health outcomes, whereas social circumstances, deemed the SDOH, account for nearly 80-90% of health outcomes (Magnan, 2017; Hood et al., 2016). The SDOH are defined as the non-medical and non-physiological factors which influence health behaviors and health outcomes. The utilization of the SDOH in health care requires acknowledgement that the structural, social, and cultural conditions are not independent from health, rather are enmeshed within health outcomes (Hood et al., 2016). The mitigation of health disparities requires acknowledgement of racism as a social driver of health with intervention in addressing the cultural and social determinant of health. This study was conducted in two phases: the first phase utilized quantitative methods to explore the assessment of the social and cultural determinants of health and the second phase utilized qualitive semi-structured interviews to explore culturally responsive antiracist care in hospital-based social work practice. Aims for the study include: examining the frequency and degree to which social workers in a large urban pediatric hospital address the SDOH and CDOH: their degree of comfort in addressing the CDOH, utilizing cultural humility, and providing culturally appropriate services; and elucidate facilitators and barriers to delivering culturally responsive antiracist interventions that address socially and culturally determined health outcomes. Independent t-test and analysis of variance (ANOVA), thematic analysis and sensitizing concepts, were utilized to analyze the data. Findings emphasized the effects of field work experience on assessment of the SDOH and CDOH. Comfort with the CDOH, cultural humility, and provision of culturally responsive antiracist care was higher in those with minoritized identities. Social workers are also engaging in antiracist care at the structural, institutional, and interpersonal levels in the provision of their practice. Implications are emphasized for social work education, healthcare social work practice, and for future research.Publication COLONIALITY & SOCIAL WORK PRAXIS: A TWO–PAPER EXAMINATION ON COLONIALITY IN SOCIAL WORK TO INTEGRATE A ‘DECOLONIAL TURN’ IN CLINICAL SOCIAL WORK PRACTICE(2024-08-01) Irazábal de Sánchez, AnaThe current polarized sociocultural and political climate and discourse in the United States demonstrate the importance of understanding our humanity across racial and minoritized groups while fostering deeper cross-cultural relationships. While there has been some research on the state of mental health for Latines in the United States and effective therapeutic interventions offered to date, no studies have taken into consideration coloniality’s impact on social work mental health practices for Latines. This two-paper theoretical and conceptual dissertation aims to identify the ways coloniality exists within clinical social work practices, its impact on Latine mental health, and present how therapists could engage in a ‘decolonial turn’ in practice. Paper one reviews the literature on the current state of Latine mental health within the United States, outlining supportive factors and barriers to effective treatment outcomes. Additionally, this paper examines the literature on coloniality and social work utilizing clinical vignettes to discuss coloniality’s impact on clinical social work practice with Latine clients. The second paper is focused on clinical application by presenting a clinical guidebook for therapists. This guidebook illustrates a decolonial framework to assist in incorporating coloniality in case conceptualization and treatment planning with Latin clients. Paper two utilizes the same clinical vignettes introduced in paper one to illustrate how therapists may work towards a decolonial practice.Publication PROJECT LISTEN: FOUNDATIONS AND PRELIMINARY DEVELOPMENT OF A PEER EMPOWERMENT PROGRAM FOR CAREGIVERS OF CHILDREN WITH VARIATIONS OF SEX CHARACTERISTICS(2024-05-18) Scranton, BonniePoor societal understanding of human sex development contributes to social isolation and stigma experienced by the 1.7% of people born with innate variations of sex characteristics (VSC), referred to by some as intersex traits. Caregivers of children with VSC have inadequate access to accurate information and evidence-based social support, resulting in disempowerment which negatively impacts children’s quality of life. Methods: Semi-structured interviews with 11 caregivers and 11 adults with VSC analyzed phenomenologically generated formative research. A working group of six VSC community leaders co-designed a preliminary psychosocial support intervention blueprint for caregivers of children with VSC, inspired by the six steps of Intervention Mapping (IM). Results: Intergenerational and peer support and wisdom from experienced VSC community members can de-stigmatize the process of learning of a child’s variation by increasing families’ confidence in their content knowledge and skills, improving their communication with providers, and emphasizing the importance of a child’s right to self-determination and authenticity, while deepening relationships and experiencing unforeseen personal growth and joy. Conclusions: Findings contribute to emerging literature regarding experiences and constructive programming for the psychosocial support needs of caregivers of children with VSC. Community-based peer support for VSC may improve children’s lives by fostering social connections and increasing knowledge and advocacy skills of their caregivers to safeguard their human rights and prioritize their authenticity.Publication The Intentions of Clinical Social Workers in the Treatment of Obsessive-Compulsive Disorder(2024-08-09) Amasa SmithObjective: The purpose of this study was to examine the effect of an informational fact sheet intervention on the effectiveness of Exposure and Response Prevention (ERP) for the treatment of OCD on knowledge, subjective norms, perceived behavioral control, attitudes, and behavioral intention to use ERP among a sample of social workers. This study aimed to test if the efficiency of a fact sheet intervention could result in a greater change in behavioral intention amongst social workers in the experimental group compared to control. Additionally, the study investigated the extent to which subjective norms, attitudes, knowledge, and perceived behavioral control explain social workers’ intention to employ ERP in treating clients with OCD. Methods: Clinical social workers (N = 168) completed an online survey and were randomized to view the fact sheet either before (experimental group) or after (control group) being administered the Intension Scale for Providers-Direct Items (ISP-D14). The ISP-D14 measured behavioral intention, attitudes, subjective norms, and perceived behavioral control. This study hypothesized that social workers provided the informational fact sheet would endorse higher behavioral intention of using ERP to treat OCD, more positive attitudes, greater perceived behavioral control, more favorable social norms, and greater knowledge than the control group. Independent t-tests examined mean differences in intention and purported mechanisms of action between experimental and control groups. One-way ANOVA tests and regression analysis examined influences on behavioral intention. Results: Findings did not support the hypothesis, as there were no significant differences between the treatment and control groups in attitudes, perceived behavioral control, subjective norms, behavioral intention, or knowledge. However, through secondary analysis, a statistically significant relationship was found for these factors explaining behavioral intention to use ERP. Conclusion: A less intensive implementation strategy was not supported but displayed efficacy as a primer to encourage social workers to seek information and training in ERP. A greater understanding of interpersonal and intrapersonal factors influencing clinical decision-making in treating OCD was achieved.Publication THE VOICES OF DETERMINATION: A TWO ARTICLE EXPLORATION OF AFRICAN AMERICAN FATHERS' EXPERIENCE WITHIN THE CHILD WELFARE SYSTEM.(2024-05-18) Randall L. WilsonThe journey of African American fathers involved in the child welfare permanency process is influenced by the intersection of institutional betrayal, race, and gender. These societal norms work together within the context of the child welfare system to impact the reality of African American fathers. This is due to the absence of equitable child welfare policies and the pervasiveness of informal interpersonal practices that are rooted in unfounded stereotypes, attitudes, and assumptions toward African American males. African American fathers who find themselves engaged in the child welfare permanency process seldom have the opportunity to express their narrative. The "Voices of Determination" study seeks to gain a rich understanding of the individual experiences of African American fathers that stem from persistent societal beliefs about racial and gender inferiority. Its focus is on examining the impact of negative portrayals of African American men's family roles on their children's experiences within the child welfare system. The "Voices of Determination" study utilizes photovoice, a form of participatory photography, as the primary qualitative method and explores the impact of institutional betrayal, race, and gender on the experience of African American fathers aged 18-55 years engaged in the child welfare permanency process in Philadelphia, Pennsylvania. Using an attachment theoretical lens, the relationship between the child welfare system and African American fathers was examined. To ensure cultural relevance, African American Male Development Theory was integrated to articulate African American men's unique social, intellectual, spiritual, and systems engagement experiences. As part and parcel of the photovoice, participant-centered methods were used to explore the experiences that supported or challenged the child welfare permanency process for 10 African American fathers. Photovoice captioned images and interview transcripts were analyzed using thematic analysis. In this exploratory study, African American fathers consistently demonstrated the theme of narrative coherence when discussing their negative relationships with the child welfare system. They coherently described their personal experiences of feeling rejected or neglected by the child welfare system's policies and practices. When they had consistent positive encounters that provided a secure working model, the study participants were able to demonstrate the earned-secure attachment characteristic of narrative coherence. For this study, the secure working model necessary for the coherent narrative was derived through the interactions with the facilitators of the parenting education and support groups and continued with the researcher. The findings of this study shed light on the fourth tenet of the African American Male Development Theoretical perspective. Through their narratives, the fathers defined themselves beyond any socially constructed ideas of innate biological or cultural deficiencies, and instead emphasized their resilience and resistance within the permanency planning process. Although the results of this exploratory study cannot be generalized beyond the men who participated, it offers valuable insight into the experiences of African American fathers who are involved in the process of reuniting with their children within the child welfare system's permanency process. The study suggests areas that require further exploration and research and recommends policy and practice changes within the child welfare system based on the personal experiences of these men who are affected daily. Keywords: AFRICAN AMERICAN FATHERS, CHILD WELFARE PRACTICE, PHOTOVOICE, QUALITATIVE RESEARCH, AFRICAN AMERICAN MALE DEVELOPMENT THEORY, ATTACHMENT THEORYPublication A RANDOMIZED CONTROLLED TRIAL (RCT) OF A SELF-HELP PARENTAL GUIDANCE BOOK ON PARENTS’ SENSE OF COMPETENCY AND REDUCING PARENT-REPORTED CHILD BEHAVIOR SYMPTOMS(2024-05-14) Yehuda Tanuri-LeemanPurpose: In light of the increasing demand for accessible mental health resources and the specific challenges associated with engaging adolescents in traditional therapy, it is crucial to evaluate alternative interventions that empower parents to manage child behavior and enhance parental competency effectively for which there has been limited research. This study evaluates the effectiveness of a self-help parental guidance book in enhancing parents' sense of competency and reducing parent-reported child behavior problems. Methods: Utilizing an experimental design, this study involved a heterogeneous convenience sample of 128 parents across various regions of Israel. Participants were given a pretest and then randomly assigned to an experimental or control group. The treatment group read a self-help guidebook within 4 weeks of the pretest after which both groups were then re-assessed using a post-test one month later. The "Me as a Parent" and "TOPSE Child Behavior Scales" measured parental sense of competency, and the "Disruptive Behavior Disorders Rating Scale" assessed the frequency of child disruptive behaviors as perceived by parents. Data analysis was conducted using regression analyses. Results: Parents who engaged with the self-help book reported significant improvements in parental competency and a reduction in child behavior symptoms compared to the control group. Regression analyses confirmed the book’s positive impact, highlighting substantial effect sizes (Cohen’s d = 0.68 for parental competency and Cohen’s d = 0.63 for reduction in child behavior symptoms). The analysis found that while the frequency and number of strategies used by parents did not predict a greater change in reducing behavioral problems, it did predict an increase in parents' sense of competency. Specifically, using strategies more frequently was linked to a higher general sense of competency (measured by MaaPS) and a sense of competency specifically related to discipline (measured by TOPSE). A greater sense of control (also measured by TOPSE) was observed with an increase in the number of strategies used. Implications: These results underscore the potential of self-help resources as effective tools for parental education in behavior management. The substantial effect sizes indicate that structured, self-administered guidance can significantly and substantively benefit parenting practices and outcomes. This study supports the broader implementation of such interventions, particularly in settings where traditional therapeutic resources are scarce or inaccessible. Future research should further explore the long-term effects of these interventions and the specific elements that most effectively boost parental efficacy and child behavior modification.Publication The Impact of Caregiver Belief and Support on Childhood PTSS Presentation in Substantiated Child Sexual Abuse Cases(2024-05-20) Daniels, VictoriaBackground: Children and adolescents who have been sexually abused are at a greater risk for physical, emotional, and behavioral problems throughout their life. However, the literature on outcomes of child sexual abuse contains many underexplored domains, especially those relating to children’s families. This is a critical element when considering the dependency that children innately have on their families, only increased while recovering from a trauma. The present study examined the impact of caregiver belief and support on child outcomes, as well as the relationship between caregiver belief and support, in substantiated sexual abuse cases. Methods: Data from 94 extended forensic interview cases was retrospectively analyzed. The analysis evaluated the influence of child factors, abuse factors, and family factors on child trauma symptom scores (as measured by the Trauma Symptom Checklist for Children [TSCC] and Trauma Symptom Checklist for Young Children [TSCYC]) and child behavior problem scores (as measured by the Child Behavior Checklists [CBCL] for ages 1.5-5 and 6-18). Results: Caregiver belief was predictive of lower trauma symptom scores measured by the TSCC (p=0.02). Girls had lower trauma symptom scores than boys, as measured by the TSCYC (p=0.02), and lower problem behavior scores measured by the CBCL 6-18 (p=0.05). In a post-hoc analysis of independent t-tests, TSCC trauma symptom scores were lower in children whose caregiver believed their allegation (p=0.02) and supported them in the aftermath (p=0.04). However, TSCYC trauma symptom scores were reported as higher in children whose caregiver supported them (p=0.05). Overall, caregiver belief and support appeared to have a significant correlation (p<0.001). Conclusions: Future research in the risk and resilience of child sexual abuse survivors should consider caregiver belief and support as distinct yet related concepts. Caregivers who believe and support the child may be more aware of potential trauma symptoms and child behavior problems. Different perspectives (i.e. child-report, caregiver-report) should be used to assess trauma symptoms and child behavior problems in research and practice.Publication A CORRELATIONAL STUDY REGARDING THE IMPACT OF MATERNAL AND INFANT CHARACTERISTICS ON MATERNAL-INFANT-ATTACHMENT IN A NEONATAL INTENSIVE CARE UNIT(2024) FowlerA premature delivery is an atypical, adverse experience for a mother and her baby. Advances in neonatal medicine and technology have prompted new parameters of viability for this fragile population. Less is known, however, about the impact of high-risk characteristics on the formative attachment between mother and baby. This study tested the hypothesis that mothers and infants with higher-risk characteristics (post-partum depression, infrequent NICU visitation, low gestational age, low birthweight, and extended NICU stays) experience a lesser degree of maternal attachment than mothers and infants with lower-risk characteristics (no post-partum depression, frequent visitation, moderate-to-late preterm status with higher birthweights and shorter lengths of stay) when controlling for civil status and number of siblings. This study utilized a correlational design and a nonprobability convenience sample of N= 101 mother-infant dyads in a NICU at a university hospital in a large metropolitan area of the southern US. Measurements included the Maternal Attachment Inventory, Edinburgh Postnatal Depression Scale, and data from electronic medical records. Hypothesis was tested using regression analyses with n=77, given missing outcome data. Due to the ceiling effect of the DV (Maternal Attachment) each item of the scale was explored via a post hoc series of One-Way ANOVAs to anatomize attachment domains and clarify specific areas of attachment challenge. The hypothesis was unsupported; however, post hoc results yielded some insight into the impact of postpartum depression on a mother’s thought capacity for her baby. Additionally, four of the items from the MAI were more normally distributed than the overall score, suggesting specific attachment challenges in understanding one’s baby, thought capacity for one’s baby, and having fun with one’s baby. baby. Researchers explore these results in greater detail, considering environmental constraints and traumatic circumstances that are unique to the NICU and these specific areas of attachment. Clinical interventions are suggested, which may support staff and parents in navigating NICU/postpartum trauma, including dissociative or avoidant behaviors that negatively impact maternal attachment.