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.
Now showing 1 - 10 of 192
PublicationExperiences and Utilization of Certified Peer Support Specialists Employed on Dialectical Behavior Therapy Teams(2016-08-21) Schutt, MeganThe purpose of this dissertation is to explore the experiences and utilization of Certified Peer Support Specialists employed on Dialectical Behavior Therapy teams. Trends in the literature regarding peer support include the challenges faced by Peer Support Specialists, the benefits peers gained by employment, and solutions for ongoing peer program development. There is also an abundance of studies supporting the use of Dialectical Behavior Therapy (DBT) for treating Borderline Personality Disorder and other DBT adaptations for specific populations. Currently, there is limited literature available that discusses the training of line staff in DBT and no published studies that discuss the use of Certified Peer Support Specialists (CPSS’s) on DBT teams specifically. The State of Michigan mandates that DBT teams include a CPSS. Data were collected through the use of in-depth key informant interviews with thirteen CPSS’s working on DBT teams throughout Michigan. A thematic analysis was completed on the resultant transcripts. The analysis identified four salient themes that include: 1) the benefits of CPSS’s employment on themselves and their clients, 2) the challenges CPSS’s face, 3) the responsibilities and functions of those roles being filled by the CPSS’s, and 4) the supervision and support provided to CPSS’s. Further research on this topic is encouraged and this study recommends how CPSS’s can be used on DBT teams. PublicationTechnology as the Third Spouse - The Impact of Smartphones on Newlywed Couples(2021-05-15) Mandel, SarahBackground Recent research has explored the impact of technology and smartphone use on relationships. This is the first study to address smartphone use in the newlywed stage of marriage. The newlywed time period is the foundational phase of a marital relationship. Technological changes have become part of our culture and smartphone technology has become central to individuals’ lives. The accessibility and size of the smartphone, along with the features it provides, is different from all other devices, thus creating a more intimate and dependent relationship with it. Methods The aim of this study was to expand upon the existing research related to smartphone technology by addressing the gap in the literature on smartphone use during the newlywed time period. This qualitative study explored the experiences of smartphone use in newlywed couples when in each other's presence and how smartphones were part of a newlywed couple’s interaction. Twenty newlywed couples, married between one and four years were interviewed separately, totaling a sample of 40 participants. Data were collected from June 2020 through July 2020 until saturation was met. Results The five themes that were illuminated in this study were, Vehicle, Mindset, Phone Rules, Interface, and Circular Use. The themes were developed based on the appreciation of the common experience of all the participants within their newlywed marriage in relation to their smartphone use (n=40). The results indicated that the smartphone is a neutral reflection of its user and is a vehicle that can be used to either magnify or minimize the value of the couple’s interaction when together. The user’s needs and mindset drive the use of the smartphone. Depending on the spouse’s mindset, the smartphone was used to either enhance bonding or to create a momentary outlet within the relationship. The unexpected finding that a person’s mindset effected their smartphone use informed the reason why individuals used their smartphone object in the moment when with their spouse. Discussion These findings support that when the newlywed couple either employed rules or made quality time a priority by putting the brakes on their smartphone consumption, smartphone use did not have a negative effect on their feelings of attachment to each other. This study suggests the importance of understanding a spouse’s mindset as a motivating factor for smartphone use during shared interactions in order for the couple to better acknowledge each other’s needs and support their developing marital bond. This research has provided information that stresses the importance of helping couples exchange their seeking of connection to their devices in exchange for live and conscious connection to their partner. PublicationThe 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. PublicationTHE 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. PublicationPARENTAL "SENSE OF AGENCY": A QUALITATIVE STUDY OF PARENTS EXPERIENCES ASSISTING THEIR CHILDREN IN OUTPATIENT COMMUNITY MENTAL HEALTH TREATMENT.(2022-08-05) Erickson, Eric GParental “Sense of Agency”: A Qualitative Study of Parents Experiences Assisting their Children in Outpatient Community Mental Health Treatment. ABSTRACT In the United States, there are approximately 17 million children under the age of 17 that have commonly diagnosed mental health disorders which include ADHD, behavior problems, anxiety, and depression (Bitsko et al., 2019). In efforts to provide access to mental health treatment, there are approximately 11,682 mental health facilities as of 2018, 62% of which are comprised of community mental health centers and outpatient mental health clinics that provide mental health services for children and families (SAMSHA, 2018). The purpose of this qualitative phenomenological study is to explore the experiences of parents and/or primary caregivers “sense of agency” in reference to working with mental health professionals in outpatient community mental health settings. For the purposes of this study, “sense of agency” is defined as actions that are experienced as voluntary and in which we may not feel as simply happening to us rather, we experience agency when we are in control of our actions (Synofzik et al., 2008; Moore, 2016). The assumption in the study is that parents “sense of agency” is a critical aspect of parents being able to effectively engage and implement evidenced based interventions utilized for their children in outpatient community mental health settings. Furthermore, parents increased or improved “sense of agency” would have a lasting impact on their ability to assist their children with mental health conditions even after their children are no longer receiving mental health treatment. The theoretical framework that was utilized in the study to explore parents “sense of agency” was Bowen’s Family Systems Theory. The study was comprised of N=10 participants who had one or more children participating in one outpatient clinic in Central Harlem. Parents engaged in a one-hour semi-structured interview which explored their experiences assisting their children in mental health treatment and their interactions with their child, mental health practitioners and other supports. After the study was completed, four major themes emerged. The four themes included: parents locus of control, parental activation, parental attributions, and issues related to the utilization of psychotropic medication by some of the children in the study. These themes impacted parents “sense of agency” in how they were able to engage in their child’s treatment, what they believed were potential causes of their child’s mental health condition, their orientation of control (whether external or internal) in reference to their child’s progress in treatment, as well as, navigating their children’s resistance to psychotropic medication. Social work practice implications would incorporate interventions that can increase parents “sense of agency”, specifically due to its relational nature which may lead to a transmission of agency to future generations considering the ongoing systemic challenges that families may face in their own communities. The implications for future studies may focus not only on parents “sense of agency” during their child’s mental health treatment but parents “sense of agency” before the start of their child’s treatment process in relation to their capacity to implement interventions that are formulated alongside the mental health practitioner. Furthermore, studies may seek to follow up with parents after their child’s completion of treatment in efforts to understand parents’ experiences or changes in their “sense of agency” as it relates to their children’s mental health. These studies would further allow to improve the understanding between parents “sense of agency” and long-term outcomes in mental health treatment for their children. PublicationA Comparative Effectiveness Study of the Trauma Recovery Empowerment Model (TREM) and an Attachment-Informed Variation of TREM(2017-05-15) Masin-Moyer, MelanieAbstract A Comparative Effectiveness Study of the Trauma Recovery Empowerment Model (TREM) and an Attachment-Informed Variation of TREM (ATREM) Melanie Masin-Moyer, University of Pennsylvania Dr. Phyllis Solomon, Dissertation Chair, University of Pennsylvania Dr. Malitta Engstrom, Dissertation Committee Member, University of Pennsylvania Objective: An evidenced-based women’s trauma group was modified to create a new protocol, Attachment-Informed Trauma Recovery Empowerment Model (ATREM), which included attachment-based concepts and strategies to determine if well-being could be enhanced beyond the Trauma Recovery Empowerment Model (TREM). A quasi-experimental design was used to test the hypothesis that ATREM would be associated with greater improvement in attachment security, perceived social support, emotion regulation, substance use, depression, anxiety, and PTSD symptoms than TREM. Methods: Sixty-nine women completed the group interventions (n = 37 ATREM; n = 32 TREM), along with pre- and-post-test questionnaires. The questionnaires included sociodemographic questions and the following standardized scales: Relationship Scale Questionnaire, Social Group Attachment Scale, Social Support Scale, Difficulties in Emotional Regulation, Brief Symptom Inventory 18, PTSD Symptom Scale, and modified versions of the Lifetime Stressor Checklist Revised and the Addiction Severity Index. The continuous variables were analyzed using paired t-tests for within-group comparisons and independent t-tests for between-group comparisons, and the categorical variables were analyzed using Chi-Square or Fisher’s Exact Test. Results: Both ATREM and TREM were associated with statistically significant within-group improvement in individual and group attachment styles, perceived social support, emotion regulation capacities, depression, anxiety, and PTSD. Only ATREM was associated with statistically significant improvement in individual attachment avoidance. The gains associated with ATREM did not exceed those associated with TREM as hypothesized. Conclusion: This pilot study extends prior findings on TREM by demonstrating that novel infusions of attachment-focused strategies into this evidence-based practice can facilitate comparable growth across a variety of measures of well-being. ATREM was also able to promote significant reductions in individual attachment avoidance, a style of interacting often considered challenging to modify. ATREM’s integrated design with cognitive-behavioral and psychodynamic elements holds potential to enhance responsiveness and effectiveness of TREM in meeting the diverse needs of women who have experienced trauma. Further, this study demonstrates the effectiveness of brief trauma-focused group therapy and provides insight into the emerging concept of group attachment style. PublicationIt’s the Journey: The Developmental and Attachment Implications of Animal Assisted Play Therapy(TM) for Children in Emergency Housing(2018-05-14) Wenocur, Katharine PBACKGROUND: Child homelessness is correlated with a wide range of health and psychosocial challenges including poor school performance, juvenile justice involvement, and heightened risk of exposure to early-life violence and trauma. Despite this, participation in therapy tends to be low. Animal Assisted Play TherapyTM (AAPT), a comprehensive model that systematically integrates trained therapy animals into play therapy, serves as a compelling modality for engaging this population into treatment. The tenets of AAPT are aligned with several clinical goal areas that homeless children might address in therapy, including the strengthening of attachment relationships with primary caregivers. METHODS: The study integrated analysis of projective drawings and accompanying narratives with the treatment records of 11 children (ages 6-11) who received canine assisted therapy while residing in an urban, mid-Atlantic family homeless shelter. All children worked with a clinician trained in AAPT and participated in at least three therapy sessions with a qualified therapy dog present. Each child created a drawing in response to the prompt: “Draw a picture of a child and a dog”, and told a story based on the contents of their drawing. Parent/caregivers of each child participated in a qualitative interview that elicited feedback and reflections on the therapy process. Grounded constructivist theory and interpretive description were used to conduct both individual and cross-participant analysis. Analysis was further informed by children’s case history files and parent interviews about children’s developmental history. RESULTS: The projective drawings communicated aspects of homeless children’s relationships with the therapy dog and, in turn, with their primary caregivers. Developmentally, children drew at lower levels than would be expected for their age. Each child personalized their drawing, either by identifying the protagonist as their gender, or including a physical characteristic (e.g. clothing, hairstyle) unique to the child; this suggests that the children tapped into their personal experience. Several themes emerged from analysis of the drawings and narratives including representations of lived and wished-for attachment experiences. Children depicted relationships between the characters in their drawings and narratives that were characterized by emotional closeness as well as frequent separations and reunions. Children also highlighted the importance of learning tasks related to training and caring for the dogs. These themes were reflected in the children's treatment records and the parent/caregiver interviews. Parent/caregivers described their child's experience in therapy positively, and identified the therapy dog as a component of the treatment's success. IMPLICATIONS: Projective drawings enabled homeless children to communicate their attachment experiences in a manner sensitive to their developmental needs. Themes that emerged from this study inform further research on specific benefits of animal assisted therapy. Specifically, the themes of lived and wished-for attachment experiences suggest that further research on this modality might focus on the ways that the modality allows children to build new relationships and strengthen existing ones. The drawings created during this study are a valuable tool in understanding the experiences of homeless children, and lay the groundwork for further study of the use of projective drawings for exploring children's experiences in therapy. PublicationTRAUMA-INFORMED CASE MANAGEMENT PRACTICE FOR YOUTH EXPERIENCING HOMELESSNESS: CONNECTION, HEALING AND TRANSFORMATION(2018-05-14) McAlpin, FrankYoung people experiencing homelessness in the United States are some of the most resilient individuals in our society. They, like all young people, are filled with extraordinary potential. However, the multiple and chronic trauma that these young people experience, caused by systemic injustices such as poverty, violence and oppression, both before and while experiencing homelessness, deeply violate their dignity and human rights. For youth experiencing homelessness, their very survival physically, mentally, emotionally, spiritually and economically is threatened daily. Experiences such as: abuse, neglect, poverty, housing instability, loss, family and community violence, victimization, exploitation, hunger, illness, criminalization, social isolation, rejection and marginalization profoundly influence a young person’s sense of safety and ultimately their health and wellbeing. The purpose of this project is to create a response to youth homelessness that restores and enhances dignity and provides opportunities for connection, healing and transformation. This will be accomplished by the creation of a Trauma-Informed Case Management Toolkit for case managers working with youth experiencing homelessness. In short, this response addresses the individual needs of young people experiencing homelessness while also encouraging social change. The trauma-informed case management toolkit, a holistic guide in delivering case management services, connects theory to practice for case managers, infusing principles of trauma-informed care, attachment theory, youth development and social justice into case management practice with youth experiencing homelessness. The intention is that the trauma-informed case management toolkit can be used as part of the larger response in addressing youth homelessness from an individual, community, societal, and policy perspective. PublicationClient-Clinician Texting: An Expansion of the Clinical Holding Environment(2015-05-19) Innocente, Gina MWhile there has been a surge in the texting literature related to the innovative uses of mobile technology in clinical social work practice, there is a dearth of knowledge related to the use of texting between clients and clinicians. Regardless of a clinician’s individual preference for using texting, cultural paradigm shifts in communication and interpersonal expectations will require incorporation of texting technology to meet client demands. This two-part dissertation provides a critical review of the literature that chronicles the rapid diffusion of texting into American culture and identifies its current use in psychotherapy. It demonstrates a significant gap related to its impact on the therapeutic relationship, as well as the absence of theoretical evolution to guide practice. An accompanying article expands relational theory as a way to conceptualize texting and texting behaviors in order to make responsible and purposeful decisions when integrating this technology. Composite case vignettes will demonstrate how “theoretical knowing” can be translated into “clinical doing” to address this current gap between theory and practice. PublicationEXPLAINING THE LONG-DISTANCE PARENT CAREGIVING BURDEN OF THE UNITED STATES FOREIGN SERVICE AND MILITARY(2022-08-05) Holmes, Christine DPurpose: To respond to global trends in aging, healthcare, technology and mobile labor markets, this cross-sectional, correlational study examined the burden of long-distance parent caregivers, or adults coordinating parent care remotely, by using a convenience sample of U.S. active-duty military personnel and Foreign Service Officers. Methods: 79 respondents completed an anonymous online survey containing standardized scales. The relationship between variables was tested using multiple regression analysis and One-way Analysis of Variance (ANOVA). Results: Preparedness for caregiving was negatively correlated with subjective and objective caregiving burden in multiple regression analysis. One-way ANOVA revealed a statistically significant difference in subjective burden based on caregiving intensity. There was also a significant difference in objective burden based on the reason the recipient needed care, but post-hoc analysis found no inter-group differences that passed the Bonferroni adjusted cutoff for significance. Multiple regression analysis demonstrated that the gender of the caregiver, availability of a sibling support network and instrumental support were not significantly correlated with burden. Conclusions and Implications: Preparedness for caregiving had the strongest relationship to distance caregiving burden in this study. Findings may inform intervention strategies to limit the strains of caregiving and support other distance caregiver subgroups, such as other U.S. Government employees and other Americans living overseas. Future longitudinal research is needed to understand causality and the relationship between variables in the long-distance caregiving trajectory over time.