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 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.Publication UNDERSTANDING THE PERSPECTIVES OF SOCIAL WORKERS AND CLINICIANS WORKING WITH SPIRITUAL AND RELIGIOUS AFRICAN AMERICAN STUDENTS RECEIVING CLINICAL SERVICES FROM UNIVERSITY AND COLLEGE COUNSELING CENTERS(2024-05-18) White, BrianThe purpose of this study was to understand the perspectives of clinicians and social workers providing clinical services to religious and spiritual African American students at various universities and colleges in the United States to understand their perspective when providing clinical treatment to spiritual and religious African American college students on college and university campuses. This study utilized a grounded theory approach using thematic analysis. Each participant participated in semi-structured interviews. Thematic analysis was the chosen data analysis method to identify themes that emerged from the data. This study included 12 participants (n=12) who work as social workers, psychologists, and professional counselors who provide clinical services to spiritual and religious African American students at universities and counseling centers in the United States. The method utilized to identify participants was purposeful sampling and snowball sampling. Ten themes emerged from the data set: (a) Clinician Self-Disclosure, (b) Stigma, (c) To Cope, “Just Pray About It,” (d) Fear of Rejection from Family, (e) Reconciliation of Sexual Orientation/Identity, (f) Empathetic Probing, (g) Benefits of Utilizing Faith-Based Organizations, (h) Sense of belonging, (i) Open Communication Amongst Providers, and (j) The ‘Clinically Trained and Educated Chaplain.’ Results of this study demonstrate that clinicians can help students honor their religious and spiritual beliefs while also helping them navigate the challenges that arise when these beliefs conflict with their identity, attitudes toward clinical treatment, and other challenges faced in the college and university setting. Clinicians can also collaborate with religious and spiritual groups and leaders to assist with helping spiritual and religious African American students deal with these challenges. One implication for clinical social work practice is engagement and the clinician’s responsibility for seeking to understand the worldview of the student who identifies as spiritual and religious. Another is incorporating the student’s religious and spiritual beliefs in the assessment and treatment process and understanding their background, family involvement, stigma, and other issues that arise in the therapeutic space. In addition, social workers and clinicians should also find ways and opportunities to educate and collaborate with chaplains and faith-based organizations on college and university campuses.Publication "Well, I think it's institutional racism:" How pediatric dialysis and transplant social workers explain racial disparities for black children in access to kidney transplantation(2024-05-18) Kristin L. StockardExisting research has repeatedly shown that Black children with end stage kidney disease (ESKD) have significantly increased mortality risk, decreased transplant rate, and spend more cumulative time on dialysis than other children. When interdisciplinary team members are asked to explain similar disparities in adult patients, over 80% name “patient level attributes” and psychosocial factors. Missing from the literature is an exploration of how providers understand these health inequities in pediatric kidney care. This study aimed to understand pediatric dialysis and transplant social workers’ explanations of existing disparities for Black children in the transplant process. Semi-structured interviews were conducted with 16 pediatric dialysis and transplant social workers recruited from across the US through professional listservs and direct mailings. The sample was largely White (81%) and 100% female with an average of 6. 8 years in the specialty field of nephrology social work. Using an integrated conceptual framework of the ecological systems theory and critical race theory (CRT), thematic analysis was used to code and analyze the interviews, resulting in 4 primary themes: lack of resources, family composition, distrust, and systemic racism. Second order coding was then used to conduct a deeper examination of the theme of systemic racism. The barriers to transplant Black children face are not limited to the patient-level microsystem as previously described in the literature, but persist across all system layers (micro-, meso-, exo-, macro-, and chronosystem). Specifically, the inability to access adequate health insurance represents a “lack of resources” at the exosystem level. For “family composition,” Black children with single parents and multiple siblings face practical microsystem level barriers to transplant and mesosystem level provider bias. Providers view “distrust” as a microsystem level attribute that prevents a smooth transplant evaluation process, but social workers acknowledged the chronosystem level historical medical harms and medical racism that inform that distrust. Finally, social workers named “systemic racism” as a barrier that transcends all levels of the ecological system, from microaggressions to provider bias to race “corrections” in eGFR calculations to White supremacy values to the legacy of slavery. From the second order coding process, three new themes emerged to explain “systemic racism” in the context of pediatric kidney transplantation: 1) racism across all levels of the healthcare system, 2) institutional racism, and 3) gatekeeping. The resulting themes raise concern that the transplant selection process may reinforce structural racism in healthcare for Black children. These results diverge from previous studies in acknowledging that explanations for existing disparities fall not on the individual patient but on the healthcare system itself. The CRT construct of “centering the margins” provides some guidance for addressing these disparities. The unique role of social work in ESKD care paired with our professional obligation to social justice suggest that pediatric dialysis and transplant social workers are ideally situated to take a prominent position in dismantling racial disparities for Black children in kidney transplant access. Future research is recommended to quantify barriers for Black children and to develop intervention strategies.Publication Attitudes and Experiences of Parents of Children Diagnosed with Autism Toward Parent-child Interaction Therapy(2024) Alisha FletcherBackground: The National Autism Center's National Standards Project (Steinbrenner et al., 2020) highlights parent-implemented interventions as evidence-based, behaviorally focused practices in which parents take the lead in using interventions with their child. Parent-Child Interaction Therapy (PCIT) is a behavioral parent training program designed for young children exhibiting disruptive behaviors (McNeil & Hembree-Kigin, 2010). PCIT has demonstrated effectiveness in addressing disruptive behavior disorders in children, and recent research indicates promising results when incorporating aspects of PCIT with children with autism. Purpose: The current study employed a qualitative methodology to gain in-depth insight into parents’ experiences and perspectives on participation in PCIT with their autistic child. Purposive sampling was used and participants were recruited from the PCIT clinical listserv. Participant conversation was guided by a semi-structured interview and conducted over a tele-conferencing platform. Interviews were transcribed and then examined using thematic analysis. Methods: Eleven parents of children with autism participated in the study, comprising eight females and three males. Seven participants self-identified as White, three as Black, and one as Hispanic. Eight had completed PCIT, two were in treatment, and one had discontinued treatment. The overarching theme of this research reveals parental satisfaction with PCIT as an intervention for addressing behavioral challenges in autistic children. Participants reported being satisfied with the neurodivergent-affirming therapy space, sharing how it positively influenced their lives by offering practical strategies to manage challenging behaviors and improve the parent-child relationship. Results: Using thematic analysis, four sub-themes emerged to clarify various aspects contributing to participants’ overall satisfaction with PCIT: (1) child-directed interactions strengthens the parent-child relationship, (2) parent-directed interaction’s impact on challenging behaviors, (3) PCIT’s applicability to autism and (4) the therapist’s contribution to the process. Conclusion: The findings from this study can help guide future PCIT clinical practice by assisting therapists in making autism-informed modifications and adjustments to PCIT while maintaining the therapy’s core components.Publication FAMILY ENMESHMENT AND MENTAL HEALTH HELP-SEEKING ATTITUDES OF FILIPINO AMERICANS: A CORRELATIONAL STUDY(2024-05-18) Brion Neely, EdenLiterature shows a disparity between Filipino American mental health needs and mental health help-seeking, with Filipino Americans historically showing lower mental health service utilization than the general population. Due to the unique significance of family, cultural values, and colonialism to Filipino Americans, this study examined the following question: Among Filipino American individuals with a need for mental health services, to what extent is the degree of family enmeshment, enculturation, and colonial mentality associated with mental health help-seeking attitudes? Using a correlational design, a final sample of eighty three eligible adult Filipino Americans responded to sociodemographic questions and established instruments. SPSS Statistics software was used to generate descriptive statistics and multiple regression analyses to test the hypothesis: Among Filipino American individuals with a need for mental health services, the higher the degree of family enmeshment, enculturation, and colonial mentality will be associated with a lower level of mental health help-seeking attitudes. Study results suggest that family enmeshment, colonial mentality and enculturation were associated with lower levels of mental health help-seeking attitudes. Findings from the multiple regression analyses conducted for both of the proposed models yielded mixed results. As expected, family enmeshment and colonial mentality significantly predicted changes in mental health help-seeking attitudes, with increases in both associated with decreases in mental health help-seeking. Contrary to expectations, findings suggested that enculturation was not statistically significant in predicting changes in mental health help-seeking attitudes. Unexpectedly, 25% of consenting study respondents were seeking or in treatment and were ineligible to participate. The researcher hopes that the study will contribute to the knowledge base about Filipino American mental health and will guide the development of culturally appropriate interventions, programs, and policies aimed at enhancing the quality of life for Filipino Americans.Publication “Me, My Selfie and I” A Qualitative ‘Visual Social Work’ Scholarship Presented in Filmic Modality from Selfie-Video Footage: How Millennial Generation Adults Experience the Stigma Associated With Social Media Messages Used to Describe Their Generation(2024-05-18) Melissa "Issa" EssmanIt is of particular interest to examine from within the birth cohort known as “Millennials” how stereotypical messages and stigma about their generation have a perceived impact on their lives. Cohort-based stereotypes may be more impactful than the traditional age-related stereotypes because they tend to be long-lasting and members continue to be associated with them (Arnett, 2013; Trzesniewski et al., 2014). In order to gain ethnographic perspective about the possible impacts, this qualitative study examined the following questions: How do adults (with the birth year 1981-1996) experience the stigma associated with the social media messages used to describe the Millennial Generation? What effects, if any, has this propensity to stereotype “Millennials” had in the lives of adults defined as “Millennials”? A few main concepts ground the conceptual framework of this research and the IPA analysis of the study, namely, stigma, stereotype internalization and stereotype embodiment. Perspective gathered from Millennial Generation Adults (MGAs) suggests that disparaging media discourse used to describe them has been reflected in their interactions with employers, family members and general public from the generation before and after them. As expected, these negative impressions have impacted their work environment, decision making and perspective of self and others in their generation. Contrary to expectations, Millennial Generation Adults (MGAs) tend to blame themselves, rather than others, for the consequences related to this stigma. The aim of this research is to open the dialogue of public perception and present new knowledge to consider about the contributing factors to the current trends among the Millennial Generation Adults (MGAs). This dissertation, titled “Me, My Selfie and I” is a qualitative investigation presented in filmic modality to emphasize the precedent that media messages are impactful in shaping public opinion.