Doctorate in Social Work (DSW) Dissertations
This series contains dissertations from Penn's Doctorate in Social Work program. For more information about University of Pennsylvania dissertation requirements and guidelines, please consult the dissertation manual.
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Publication The Invisible Epidemic: Educating Social Work Students towards Holistic Practice in a Period of Mass Incarceration(2013-05-13) james, kirk aThe Bureau of Justice Statistics (BJS) reported in 2011 that more than 2 million Americans are incarcerated. The report also indicates that 1 in 32 Americans are under some form of criminal justice supervision (parole, probation or prison), with statistics prognosticating that more than half will return to prison once released. Most of the individuals incarcerated are disproportionately poor people of color. Many have christened the period from the 1970’s to present as “Mass Incarceration” (Alexander, 2010). Social Justice is often described as the “organizing value” or catalyst that drives the profession of social work. The National Association of Social Workers (NASW, 2008) Code of Ethics as well as the curriculum policy statement of the Council on Social Work Education (CSWE) mandate that social workers and schools of social work education target their efforts towards economic and social justice inclusive of at-risk populations, paying particular attention to issues of diversity and oppression. Yet it is startling that critical discourse in schools of social work pertaining to mass incarceration, is marginal, or in some cases completely absent (Cnaan, Draine, Fraizer, & Sinha, 2008; Davis, 1978; Pray, 1949; Reamer, 2004; Roberts, 1997; Scheyett, Pettus-Davis, McCarter & Brigham, 2012; Wormer, Roberts, Springer & Brownell, 2008). Through a thorough examination of the history of the U.S. criminal justice system and an analysis of both the historical and contemporary relationship of criminal justice and social work, this dissertation introduces a two-semester MSW curriculum. The curriculum infuses social work education with issues relating to mass incarceration and it’s various intersections with social work practice. The first semester illuminates the historical evolution of the criminal justice system in the United States and the current state of incarceration, including punitive policies such as the Rockefeller Drug Laws, Truth in Sentencing and 3 strike legislations. The second semester highlights systemic and personal challenges to practicing within, and around the criminal justice system. The second semester pays particular attention to evidence based clinical practice theories and interventions. The curriculum utilizes the Council of Social Work Educational Policy and Accreditation Standards to create an amalgamation of clinical and macro competencies. The output is the introduction of a criminal justice infused macro history, and a micro clinical practice course to the social work pedagogy in an attempt towards holistic practice and advocacy more in line with the profession’s organizing value of social justice.Publication Beyond the Loss of a Child in the NICU: The Social Worker's Role(2017-08-04) Quann-Walker, Anniesha DThe following is a two-paper dissertation exploring the role of social workers in the Neonatal Intensive Care Unit (NICU). The classical and contemporary perspectives of grief theory provide the framework for understanding emotional responses of bereaved parents to the death of a child. The academic social work, medical, and nursing literature reviewed support the hypothesis that social workers are an insufficiently tapped resource in working with bereaved parents who have experienced perinatal loss in the NICU and revealed contributing factors for current medical social work practices. The accompanying article discusses the role of social workers and the areas that demonstrate their expertise. The article also conceptualizes the design of a bereavement program for perinatal loss using the established adult and pediatric hospice and palliative care models. This dissertation contributes to social work practice in the NICU and grief literature knowledge base by acknowledging the disenfranchisement of bereaved parents who have experienced perinatal loss in the NICU, supporting collaborations with other professionals on the NICU interdisciplinary team, and proposing a prospectus program design.Publication Hearing His Story: A Qualitative Study of Fathers of Pediatric Stroke Survivors(2014-03-28) Robbins, Lois J.Abstract Hearing His Story: A Qualitative Study of Fathers of Pediatric Stroke Survivors Stroke is seen as a condition that only happens within the elderly community; however, this is not accurate. Most people are unaware that infants, children, and young adults can and do suffer from strokes. According to various researchers, pediatric stroke affects 25 in 100,000 newborns and 12 in 100,000 children younger than 18 years of age. Most pediatric stroke survivors will be left with some physical, behavioral, and/or cognitive impairment. While child rearing has traditionally been viewed as the mother’s forte, many fathers wish to be involved in sharing the responsibility of raising their son or daughter. Fathers of children with disabilities are rarely researched. This qualitative study inquired into the experiences of fathers of pediatric stroke survivors including their reactions and ways of coping. In-depth interviews were conducted with 13 fathers whose children are part of the Pediatric Stroke Program at the Children’s Hospital of Philadelphia. Findings include the impact on the life of the fathers;; the fathers’ use of various support systems;; the need for the fathers to make meaning out of the devastating event; finding gratitude; and, the effect of their religious and/or spiritual beliefs in coping with their child’s stroke. Fathers also shared their advice for professionals who work with children with special needs and for other fathers facing a similar situation. Included is a discussion of how the significant findings of the study compared to previous research, theories, and the Stress, Appraisal, and Coping framework of Folkman and Lazarus. Some additional relevant theories are also evaluated in regards to understanding the reactions and coping abilities of the fathers. Clinical implications for working with fathers of children with special health care needs and/or disabilities, limitations of the study, and suggestions for needed research in the future are also presented.Publication The Life Stories of Individuals Who as Adults Were Identified as Experiencing the Effects of Fetal Alcohol Spectrum Disorder(2015-05-18) Erb, Anna CKThe teratogenic effects of prenatal alcohol exposure (PAE) can cause irreversible physical and neurological impairments that are present at birth and can have lifelong implications (McGee & Riley, 2007). One’s capacity to interact productively and effectively with one’s surroundings can be influenced further by positive and negative life events and access to appropriate social support services (Center for Disease Control and Prevention, 2004). Fetal Alcohol Spectrum Disorder (FASD) is a term used to describe a group of diagnoses and effects related to prenatal alcohol exposure (Center for Disease Control and Prevention, 2004). Since the effects of alcohol on a fetus were not recognized formally until the mid- twentieth century, it is likely there are generations of people who are affected by this condition but remain unidentified because they were born before the sequelae of gestational alcohol exposure were understood and well documented (Massey, 2011). Few scholarly works exist that accurately represent the subjective experience of adults who have lived with the unidentified characteristics of prenatal alcohol exposure and the social and cultural factors that influence the development of their individual identity. A narrative-style qualitative research methodology was used to explore the identity of adults living with FASD, in particular those who learned about this during adulthood. The researcher interviewed four adults living with the effects of FASD who became aware of their FASD as adults and reviewed several published autobiographical accounts as additional data sources. Upon analysis, themes of identity emerged and parallels between the life stories of the participants and other studies that address the psycho-social effects of FASD were identified. The research results suggest implications for social work practice, bring positive attention to a disenfranchised group, identify areas of needed study and shed insight into how adults living with the effects of FASD conceptualize their identity.Publication The Impact of the Therapeutic Alliance, Therapist Empathy and Perceived Coercion on Engagement in Outpatient Therapy for Individuals with Serious Mental Health Conditions(2020-05-18) Mallonee, Jason RPurpose: Individuals with serious mental health conditions disengage from treatment at a higher rate than other populations. Factors associated with treatment engagement for this population in other contexts, or in outpatient therapy for other populations, include the therapeutic alliance, therapist empathy, and perceived coercion. This study tested the hypothesis that a stronger therapeutic alliance, a greater degree of therapist empathy, and a lower degree of coercion will be associated with a higher degree of engagement in outpatient therapy for individuals with SMHC when controlling for other factors found to be associated with engagement. Methods: 131 participants completed an anonymous web-based survey measuring the study’s constructs with established scales. The relationship between variables was tested using hierarchical multiple regression analysis. Results: After separating the therapeutic alliance and therapist empathy in the multivariate analysis due to multicollinearity, both the therapeutic alliance and therapist empathy were found to be significant predictors of change in client engagement. Perceived coercion was not found to be a significant predictor of change in client engagement. It was also found that participant treatment utilization at the time of survey completion was significantly less intensive than their historical treatment utilization, and that participants reflect a range of symptoms and levels of impairment. Conclusions and Implications: The therapeutic alliance and the quality of therapist-client interactions are the most important factors in maintaining engagement in outpatient therapy for individuals with SMHC. Individuals with SMHC are managing their conditions with less intensive and less restrictive treatments, despite a varying range of symptom severity and functional impairment. Additional research is needed to better understand engagement in therapy for individuals with SMHC and to develop more sensitive measures for evaluating these constructs.Publication TEACHERS’ EXPLICIT AND IMPLICIT ATTITUDE TOWARD HOMOSEXUALITY: THE ROLE OF INTERNAL AND EXTERNAL MOTIVATION TO RESPOND WITHOUT PREJUDICE(2012-12-01) Graham, Christina C.Research has shown that lesbian, gay, and bisexual youth have increased rates of physical and mental health problems primarily due to the chronic stress incurred by the levels of prejudice and isolation experienced in their environment, especially in Southern States. Teachers are the most available and sought after adults by sexual minority students, helping them to mitigate such toxic environments. In this study, the aim was to examine the relationship between implicit and explicit attitudes of homonegativity and the moderating role of motivation to control prejudiced reactions among teachers in Southern states. Additional information was gathered about the teachers’ school environment in regard to protective factors that were or were not in place for sexual minority students and possible resources that they perceived would be helpful in establishing a more positive environment for these students. Correlations were found between the Implicit Association Test (IAT), Modern Homonegativity Scale (MHS), and the Internal (IMS) and External (EMS) Motivation to Respond without Prejudice measure among other variables. Further, information was obtained that verified that the majority of these schools lacked needed protective factors to help sexual minority students navigate their environment safely.Publication Exploring the Dynamics of High-Challenge Encounters in Residential Substance Abuse Treatment Settings(2014-05-16) Ayyagari, AnnapoornaIn 2012, 4 million people aged 12 or older received help for alcohol and illicit drug use in the United States with approximately 2.5 million treated as inpatients (SAMHSA, 2012). Studies show the majority of women, men, and adolescents obtaining substance abuse residential treatment have been traumatized before entering treatment. Traumatic events span past sexual abuse, physical abuse and victimization from violence; trauma also include experiences from disasters and war. Yet, trauma-informed treatment is not mandated for substance abuse treatment facilities, and the manner in which clients are handled upon entering substance abuse residential treatment facilities is largely unknown. In a survey reflecting the most comprehensive national data on treatment delivery, Capezza and Najavits (2012) found that 66% of the 13,233 substance abuse treatment facilities examined reported the use of trauma-related counseling with clients. However, a considerable 33.4% of these facilities rarely or did not provide trauma counseling. Alarmingly, similar residential structures such as nursing homes report rising annual abuse of patients while in care in a third of their institutions throughout the U.S. (U.S. House of Representatives, 2001), and client re-traumatization has been documented in psychiatric inpatient wards (Cusack et al., 2003; Freuh et al., 2000). This dissertation explores the triggers and consequences of high-challenge moments that occur within residential drug treatment settings; high-challenge moments are escalated moments between staff and clients that result in potential emotional and/or physical harm to clients. Client harm from high-challenge moments appears related to the absence of trauma-informed facilities, lack of staff training in client symptomatology, enactment of authoritarianism by staff, and inappropriate maintenance of staff-client boundaries. A qualitative study was conducted in which nine staff members working for at least six months in adult and adolescent residential substance abuse treatment milieus of varying treatment lengths engaged in intensive semi-structured interviews. Data were analyzed utilizing open-coding and category formation from grounded theory and theme formation surrounding a common concept from phenomenology. Subjects confirmed high-challenge moments do occur in residential substance abuse treatment settings. Results signify training as useful in preventing re-traumatization, overidentification, lack of staff understanding of trauma, client exploitation, use of shame, and excessive enforcement of residential setting rules. Implications indicate a need for trauma-informed facilities in treating substance abuse and an emphasis on changing hiring practices, training, supervision, and client treatment.Publication Effectiveness of an Intergenerational Service-Learning Program on Increasing Knowledge on Aging, Creating Attitude Change Regarding Older Adults, and Reducing Ageism(2020-12-22) Bartlett, SaraBackground and Purpose. This study evaluated the efficacy of an intergenerational service-learning program administered to undergraduates to determine if it would increase knowledge about aging, improve attitudes about older adults, and reduce ageism more than a predominately didactic course with limited service activity. An important goal of effective intergenerational service-learning is to generate interest in pursuing social work careers in aging with the underserved older adult population. Methods. The sample consisted of students in an undergraduate Psychology of Aging course. A quasi-experimental design using a convenience sample compared pre-test and post-test scores between an experimental intervention (N=68) and a comparison (N=71) group over the course of two academic quarters. The Facts on Aging Quiz (FAQ) Multiple Choice version, Aging Semantic Differential (ASD), and Fabroni Scale on Ageism (FSA) were administered before and after a service-learning intervention and comparison predominantly didactic course with limited service activity. Participants also answered open-ended experiential questions. Analysis included descriptive statistics, within group equivalence between quarters, and equivalence of intervention and comparison groups using T-tests or Chi-square tests. No significant differences were found between intervention and comparison groups at pre-test other than relationship to grandparents. Hypotheses were tested using multiple regression analyses to determine significant difference in outcome scores between intervention and comparison groups, controlling for relationship to grandparents. Qualitative analysis consisted of thematic analysis. Results. The hypothesis was partially supported. The intervention group had a significantly higher reduction in Net Bias on the FAQ and a significantly lower score than the comparison group on the FSA Antilocution sub-scale. On other outcome measures, the two groups did not significantly differ. Qualitative analysis showed those in the experimental intervention placed more emphasis on intergenerational relationships and expressed more behavioral intentions related to aging. Conclusions and Implications. There was a significant effect for the intervention on the outcome of bias and ageism. Programs that are more relational, in-depth, and longer than didactic courses may be useful for consideration in undergraduate psychology or social work programs in reducing ageism. Such courses may have the potential for increasing interest in careers in the fields of aging and social work.Publication FROM PARTIAL TO FULL-ENOUGH RECOVERY: A DEVELOPMENTAL MODEL OF RECOVERY FROM EATING DISORDERS(2012-05-14) verba, martinaQuestions about the nature of recovery from eating disorders have long divided the field. While one view purports that eating disorders are chronic conditions, other viewpoints maintain that full recovery from eating disorders is possible. The literature suggests the existence of levels of recovery: a) “partial” recovery, which includes remission of behavioral and physical of symptoms, in the absence of psychological remission, and b) “full” recovery, which includes remission of behavioral, physical and psychological symptoms. In-depth interviews with women in long-term recovery from anorexia and/or bulimia were conducted, transcribed and analyzed in order to develop a grounded theory of the progression within the recovery process. This dissertation considers the phenomenology of phases of recovery; individual experiences of levels of recovery; and, how change, specifically from early recovery going forward, occurs. Findings suggest a developmental process of recovery with central themes defining each stage. Participants’ in the study described nuanced experiences of recovery that lay between chronicity and complete freedom from all vestiges of the disorder. The dissertation proposes a model comprised of three-stages: 1) early recovery, which is dominated by a focus on behavioral change and seeking guidance from external sources, 2) transitional recovery in which change processes that introduce an inward focus emerge; and, 3) “full-enough” recovery, a stage marked by the presence of a flexible sense of self-trust. The term, “full-enough” recovery was developed to convey the participants’ experiences of a recovery that allows them both to acknowledge the presence of occasional mental remnants of the disorder and engage fully in their lives.Publication THE DEVELOPMENT OF A SYSTEMIC, TRAUMA-INFORMED GROUP MODEL TO REDUCE SECONDARY TRAUMATIC STRESS AMONG VIOLENCE INTERVENTION WORKERS(2019-05-20) Vega, LauraABSTRACT THE DEVELOPMENT OF A SYSTEMIC, TRAUMA-INFORMED GROUP MODEL TO REDUCE SECONDARY TRAUMATIC STRESS AMONG VIOLENCE INTERVENTION WORKERS Laura Vega, MSW, LCSW Lani Nelson-Zlupko, Ph.D., LCSW Secondary Traumatic Stress (STS) among violence intervention workers is pervasive and increases the risk of negative psychosocial and health outcomes. Compelling evidence demonstrates the virulent impact of STS on individual workers, clients, and organizations (Bride, 2007; Figley, 1995; Pearlman & Saakvitne, 1995). STS is an occupational hazard and organizations have an ethical obligation to implement strategies to address it, ultimately protecting workers and clients. However, research is limited on effective interventions to address this issue, with existing interventions focusing narrowly on self-care strategies. Due to the significant and consistent trauma exposure inherent in violence intervention work, it is essential for STS interventions to be proactive, ongoing, and agency-based. This dissertation identifies key risk and protective factors, reviews existing interventions, and describes gaps in those interventions. The development of a group model, Stress-Less Initiative, is presented, an evidence-informed, theoretically grounded intervention that is proactive, ongoing, and embedded within the organization to prevent secondary trauma. The Stress-Less Initiative is a team-based model that provides a safe context to reflect on the impact of trauma work while increasing collegial support, coping strategies, team cohesion and resilience. Recommendations for agency use of this intervention are provided and implications for practice, research and policy are presented.