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 Friendship in Transition: An Interpretative Phenomenological Analysis of the Role of Peer Support on Student Service Members and Veterans(2025-05-19) Moore, Dylan AnthonyFriendship serves as a vital pillar of academic success, providing crucial support and fostering resilience among college students. For student service members and veterans (SSM/V), the transition to college life presents unique challenges that can hinder their ability to form these vital connections. While the importance of friendship is well-documented for traditional college students, there is limited research on how SSM/V experience friendship during their academic transition. This qualitative investigation aims to explore the role of friendship in SSM/V journey from military service to college life through semi-structured interviews with 10 participants. An interpretative phenomenological analysis, informed by the theoretical framework of Self-Psychology and Veteran Critical Theory, was conducted to interpret these narratives. The findings reveal four key themes: a) friendships as a valuable support system in the transition to college life, b) friendship dynamics and experiences within the college environment, c) navigating unique considerations when establishing friendships, and d) barriers to friendship-building. The study highlights how friendships contribute to SSM/V adaptation to college life and academic success. Recommendations include fostering collaboration among faculty, staff, administrators, and veteran resource centers to develop targeted programs that facilitate friendship-building, such as social events and peer mentoring initiatives. Additionally, universities should prioritize creating inclusive environments that encourage interaction between SSM/V and their civilian peers. This research also calls for further studies on the unique experience of SSM/V in building and maintaining meaningful relationships.Publication Psychosocial Predictors of Disordered Eating in Adolescents with Celiac Disease: Body Image Dissatisfaction, Anxiety, Depression, and Family Eating Environment(2025-05-19) Rowen, KaitlinPurpose/Objective: Research suggests a high prevalence of disordered eating in adolescents with celiac disease, however research on vulnerability factors is limited. To address this gap, this study tested the hypothesis that a higher level of body image dissatisfaction, greater severity of anxiety symptoms, greater severity of depression symptoms, and poorer quality of family eating environment predicts greater disordered eating behaviors, attitudes, and feelings in U.S. adolescents with celiac disease. Methods: A correlational design with a nonprobability convenience sample of N = 187 was used. Participants were U.S. adolescents, 13 to 18 years old, with celiac disease. Data was collected via a one-time, online survey. Measures included Celiac Dietary Adherence Test, Eating Attitudes Test-26, Appearance and Weight subscales of the Body Esteem Scale for Adolescents and Adults, Depression and Anxiety subscales of the Revised Child Anxiety and Depression Scale-25, and Family Eating Habits survey. Multiple and logistic regression analyses were used to test hypotheses. Results: Findings partially supported the hypothesis, indicating a higher level of body image dissatisfaction (measured as weight dissatisfaction), greater severity of depression symptoms, and poorer quality of the family eating environment (measured as atmosphere) predicted greater disordered eating behaviors, attitudes, and feelings when measured as 1. dieting; 2. bulimia and food preoccupation; and 3. composite of behaviors, attitudes, and feelings about dieting, bulimia and food preoccupation, and oral control. No differences in disordered eating were found among groups defined by race, body mass index, or co-occurring diet and health related conditions. Post-hoc analysis indicated that transgender males scored significantly higher than cisgender males on disordered eating behaviors, attitudes, and feelings regarding dieting. However, no other gender group differences were significant under Bonferroni cutoff. Conclusions: Filling a research critical gap, results enhanced understanding of potential psychosocial vulnerabilities for disordered eating in adolescents with celiac disease. Clinical recommendations are made for targeted assessments and individual and family-based interventions that allow for early detection, treatment, and prevention of disordered eating in this high-risk population.Publication An Officer and a Therapist: How Active-Duty Social Workers Navigated the Ethical Hazards of Their Dual Agency(2025-05-19) Dickinson, SamuelActive-duty LCSWs bear a simultaneous legal obligation to two entities that often have conflicting values and requirements for them to satisfy (the National Association of Social Workers and the Department of Defense), and this concurrent commitment routinely forces them to prioritize one side of their dual agency as both an officer and a therapist. The experience of having to navigate the ethically hazardous “mixed-agency dilemmas” that result from these competing prioritizations has been left unexamined in academic social work research. To respond to this gap in the literature, this qualitative pilot study examined the stories of seven formerly active-duty LCSWs using a reflexive thematic analysis. Common participant experiences included being subject to military medicine’s prioritization of DoD obligations over the NASW code of ethics, experiencing unavoidable dual relationships resulting from the intimate and boundaryless practice settings of operational medicine, and secondary gain issues of service members seeking mental health treatment as a way out of the military. While analyses of participants’ interviews revealed that LCSWs were often pressured to resolve mixed-agency dilemmas by favoring the officer side of their dual agency, participants overwhelmingly recommended navigating the mixed-agency dilemmas of their positions by prioritizing their identities as social workers, and by using the values and ethics of their licensure as a guiding heuristic while seeking out peer support and practicing self-care. This study recommends that MSW programs, the NASW, and military officer development schools increase their efforts to educate social workers on the reality of mixed-agency dilemmas in active-duty settings.Publication “I don’t belong to either side. I lost my identity”: A Thematic Analysis Study on Chinese International Students’ Interpersonal Experiences During the COVID-19 Pandemic(2024-11-19) Fan, LinlinBackground and Purpose: The COVID-19 pandemic has had tremendous impacts on everyone’s life globally. However, Chinese international students (CIS) are not only susceptible to challenges brought about by COVID-19 but also endure stigma and discrimination for being “virus carriers” due to their Chinese nationality. As international students, they face additional challenges because of travel restrictions and visa issues, which exacerbate their social isolation and precipitate psychological distress. This study aims to inform practice to promote anti-discriminatory and culturally competent interventions that support this population’s mental health. Research Questions: What are CIS’s interpersonal experiences during the COVID-19 pandemic? Does CIS face stigma and discrimination related to COVID-19 in their interpersonal encounters with the non-Chinese population? How do they cope with mental health challenges during the pandemic? In what ways do family and ethnic/national identity shape CIS’s experiences? Methods: Ten in-depth, semi-structured interviews were conducted with CIS (aged 20 to 28) who resided in the United States for at least 10 months during the COVID-19 pandemic (March 2020 to May 2022). Purposive sampling was employed, recruiting participants through social media advertisements, including a Chinese students’ association WeChat group in a university and Facebook. Interviews were conducted in Mandarin Chinese via Zoom. Reflective thematic analysis, following Braun and Clarke's (2012, 2013, 2014, 2020) framework, was employed using NVivo for coding and analysis. Findings: The findings suggest that CIS employed mostly active coping strategies to address the challenges they faced during the pandemic. They struggled to deal with discrimination because of their ethnic and national identity, with some participants coping with direct confronting and providing information to counter stereotypes, whereas others resorting to secrecy and withdrawal. The findings also shed light on the emergence of Chinese nationalism among some participants, spurred by perceived discrimination by the non-Chinese population in the host country and satisfaction with their home country’s government's handling of the pandemic. Conversely, others expressed a loss of national identity, stemming from marginalization experienced both in their home country (othered Chinese-ness) and the host country. Conclusions and Implications: This study highlights the complex challenges faced by CIS during the pandemic, including the experiences of stigma, discrimination, mental health struggles, and issues related to national and ethnic identity. Most participants employed active coping strategies, such as self-care and seeking support from others. Among different types of support, peer support emerged as particularly crucial, while family support was more nuanced—sometimes highly beneficial but at other times counterproductive due to high expectations and cultural values that discourage giving up. Despite their active coping efforts, the combination of social isolation, experiences of discrimination and stigma, and confusion surrounding their identity significantly impacted their overall well-being and triggered mental health crises. These findings underscore the importance of creating inclusive, anti-racist campus environments to address discrimination and racism within academic settings. The findings also suggest that the Yin and Yang philosophy, with its emphasis on dialectical thinking and a process-oriented worldview, can serve as an effective coping mechanism for managing crisis and pandemic-related stress.Publication Contextualizing Suicide Risk Assessment and Prevention in the Military: A Qualitiative Study of Mental Health Clinicians(2024) Trinity SalazarBackground: Suicide rates among military personnel have steadily increased in the most recent decades. The role of clinicians’ personal beliefs about suicide and their impact on clinical judgment, treatment planning, and adherence to military protocols is not well understood. Further, the impacts of these policies and perspectives on building a therapeutic alliance are understudied. This study aims to explore how these beliefs influence clinical decision-making and suicide intervention practices within military healthcare settings. Methods: This study used phenomenological methods to understand the core experiences of providing therapeutic care to service members exhibiting suicidal behavior in the unique military context. Qualitative interviews were conducted with clinical social workers and psychologists with at least one year of experience working with active-duty service members. Participants were recruited from various branches of the military. The interviews focused on their philosophies and approaches regarding suicide risk assessment, the influence of military doctrine, and the challenges they face when navigating patient care within the constraints of military policies. Verbatim transcripts were coded and analyzed for core elements of the phenomenon in question. This included attention to participant reports and researcher experiences with military protocol regarding the care of service members exhibiting suicidal behaviors for a rich and detailed picture of the phenomenon. Finally, this researcher evaluated participant-reported challenges in establishing therapeutic relationships using the tenets of Relational Cultural Theory. Results: Analysis of the interviews revealed three distinct clinician typologies regarding personal beliefs, which influenced clinical judgment and at times conflicted with military protocol: autonomy advocates, pro-life determinists, and nuanced navigators. Autonomy advocates struggled with the complexity of self-determination within the military institution. Pro-life determinists aligned their actions with life preservation, often guided by religious or spiritual ethos. Nuanced navigators emphasized situational context while adhering strictly to military doctrine. These varying belief systems shaped clinicians’ decision-making processes regarding suicide intervention, revealing challenges in balancing ethical complexities with military requirements. Participants shared that within the hierarchies, policies, and procedures of the military complex, connection and power imbalances challenged clinicians to create the space for authentic relationships. They worked to balance the requirements of their role with the ethics of their profession. Conclusions: Clinicians’ personal beliefs intersected with their clinical judgment and approaches to suicide intervention within military settings. Understanding these perspectives—autonomy advocacy, pro-life determinism, and nuanced navigation—offers insights into the complexity of providing mental health care in a structured military environment. The findings contribute to a broader understanding of how personal beliefs intersect with clinical practice and provide recommendations for enhancing clinician training and support to improve care quality for military personnel facing suicidal challenges. Approaches to care that utilize relational cultural theory methods that explicitly address the challenges of therapeutic care in the military context may facilitate building robust therapeutic relationships that address power differences and chronic disconnection while engaging authenticity towards connection.Publication ASSOCIATIONS BETWEEN CULTURAL VALUES AND CAREGIVER SUPPORT AS PERCEIVED BY LATINE TRANSGENDER YOUNG ADULTS(2024) Covarrubias, NorahBackground: Transgender Latine people are rarely focused on, however, this population is growing and lives at the intersection of identities repeatedly targeted by conservative policies. Social workers, who often engage with marginalized populations, are likely to interface with Latine transgender youth due to the unique challenges they face. Parental support is widely recognized as a primary protective factor for transgender youth, significantly influencing their mental health and well-being. While previous qualitative studies identify key cultural factors that influence Latine LGBTQ+ experiences of family and community acceptance, much of the existing research focuses on sexual minority groups and is approached through a deficit/harm lens, overlooking the distinct challenges and strengths held by Latine transgender individuals and their families. The process of acculturation further shapes these experiences. This study aims to fill that gap by focusing specifically on Latine transgender young adults and their perception of how these cultural factors influence parental support. Methods: Adults ages 18-25 who identify as Latine and transgender were recruited to complete an online survey (N=75). Existing scales were used to measure the study’s variables of interest: religiosity (Behavioral Religiosity Scale), familismo (Attitudinal Familism Scale), gender norm traditionalism (Marianismo and Machismo/Caballerismo scales) and experienced parental support (Parental Reactions to Adolescent Distress [PRAD] and Parental Attitudes of Gender Expansiveness [PAGES-Y] scales). Answers to one open-ended question were analyzed to identify other factors of interest for future research (N=67).Results: Every 1-point increase in Marianismo predicted a 0.03 of a point increase PRAD scores (negative parental reactions) (B=0.03, p=0.01). Every 1-point increase in Caballerismo predicted a 0.02 of a point decrease in PRAD scores (B= -0.02, p=0.02). This suggests a negative impact of constraining gender expectations on people AFAB and the parent-child relationship. Acculturation (control), significantly predicted an increase of 0.15 points in PAGES-Y scores, signifying increased perceived parental support in relation to adolescent gender expansiveness with every 1-point increase in acculturation (B=0.15, p=0.01). Acculturative stress and an acculturation gap between within families may contribute to the perception of decreased capacity to engage in conversations related to gender. Responses to the open-ended question identified additional factors: parent-child relationship, socio-economic class, and media influence. Implications: Mental health professionals should contextualize the experiences of Latine families within the greater sociopolitical climate of the U.S. While holding an awareness of these cultural concepts, clinicians should explore individual, family and youth needs in order to strengthen experienced parental support.Publication Character Strengths-Based Intervention for Adolescent Nonsuicidal Self-Injury: A Scoping Review(2024-11-18) Debbie Hudak-JockinAdolescent nonsuicidal self-injury (A-NSSI) is a significant mental health problem that is stigmatized with limited treatment interventions. Positive psychotherapy (PPT) (Seligman et al., 2006), a humanistic modality, provides a character strengths (CSs) approach that can be integrated with current evidence-based interventions to contribute to effective treatment. This scoping review maps the literature on treatment interventions for A-NSSI that integrate CSs and specifically investigates the extent to which PPT has been used for this problem. Peer reviewed studies published between January 2004 and June 2024 were identified using five databases- PsycINFO, Scopus, CINAHL, PubMed, and Embase- with keywords (“nonsuicidal self-injury” AND “intervention” AND “adolescent”) AND each of the 24 universal CSs in separate searches. Inclusion criteria were the following: adolescents aged 10-19 years having the disorder NSSI as defined by DSM-5 (2013); intervention present in study design with CS from the 24 universal CSs (Seligman & Peterson, 2004) associated with a treatment intervention; dates of studies between 2004-2024; peer reviewed journal articles; English language source. Studies were analyzed using a five-phase review process developed by Arksey and O’Malley’s (2005). A total of 2,063 records were retrieved with 25 (1.2%) of the studies meeting the inclusion criteria. Inclusive studies used interventions in methodology with CSs of self-regulation (80%), open-mindedness (8%), hope (4%), hope with self-regulation (4%), and open-mindedness with self-regulation (4%) implemented in treatment modalities. Treatment interventions utilizing CSs were the following: dialectical behavior therapy (DBT) (28%), emotion regulation therapy (ERT) (20%), cognitive behavioral therapy (CBT) (16%), mentalization (4%), mindfulness-based (4%), expressive (4%), and miscellaneous eclectic-based (24%). PPT as a stand alone approach or integrated modality was not identified in the research as a current intervention for A-NSSI.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.