CHOICES-TEEN: Reducing Substance-Exposed Pregnancy and HIV among Juvenile Justice Adolescent Females.

OBJECTIVE: The feasibility and acceptability of CHOICES-TEEN - a 3-session intervention to reduce overlapping risks of alcohol-exposed pregnancy (AEP), tobacco-exposed pregnancy (TEP) and HIV - was assessed among females in the juvenile justice system. METHODS: Females 14-17 on community probation in Houston, Texas were eligible if presenting with aforementioned health risks. Outcome measures - obtained at one- and three-months post baseline - included the Timeline Followback, Client Satisfaction Questionnaire-8, session completion/checklists, Working Alliance Inventory-Short, and open-ended questions. Twenty-two participants enrolled (82% Hispanic/Latina; mean age=16). RESULTS: The results suggest strong acceptability and feasibility with high client satisfaction and client/therapist ratings, 91% session completion, and positive open-ended responses. All youth were at risk at baseline, with the following proportions at reduced risk at follow-up: AEP (90% 1-month; 71.4% at 3-months; TEP (77% of smokers (n=17) at reduced risk at 1-month; 50% at 3-months); and HIV (52.4% 1-month; 28.6% at 3-months).

Integrating clients' religion/spirituality in clinical practice: A comparison among social workers, psychologists, counselors, marriage and family therapists, and nurses.

OBJECTIVE: This study was designed to describe and compare five helping professions' views and behaviors regarding the integration of clients' religion/spirituality (RS) in clinical practice. METHOD: A cross-sectional design was used to survey 3,500 licensed clinical psychologists, nurses, marriage and family therapists (LMFTs), clinical social workers, and professional counselors across Texas. A total of 550 responded to this online survey, which included the Religious/Spiritually Integrated Practice Assessment Scale and background questions. RESULTS: Attitudes concerning the integration of clients' RS did not differ by profession and were fairly positive. However, differences emerged regarding self-efficacy, perceived feasibility, and behaviors, with LMFTs reporting the highest scores for these subscales. CONCLUSION: This is the first comparison of these five professions' attitudes, behaviors, perceived feasibility, and self-efficacy regarding integrating clients' RS. These encouraging results not only indicate helping professionals' openness to integrating clients' RS, but also highlight key differences in training, self-efficacy, views of feasibility, and implementation.

Processes of change in preventing alcohol-exposed pregnancy: Replication of a mediation analysis.

OBJECTIVE: Further test mechanisms of the CHOICES intervention by replicating analyses of the experiential and behavioral processes of change (POC) for alcohol and for contraception as mediators of the intervention for reducing risk of alcohol-exposed pregnancy (AEP) using data from a more recent trial, CHOICES Plus (CP). METHOD: As in the prior study, replication models examined indirect paths from intervention to experiential POC for alcohol at 3 months, to behavioral POC at 9 months, to risky drinking and risk of AEP at 9 months and experiential POC for contraception at 3 months, to behavioral POC at 9 months, and to ineffective contraception and risk of AEP at 9 months. To test the temporal relationship, additional models examined the indirect path from behavioral POC for alcohol and POC for contraception at 3 months, to the experiential POC at 9 months, and to risk of AEP at 9 months. A final model tested the mediation of experiential and behavioral POC assessed at 3 months. RESULTS: There was an indirect effect of the intervention on risky drinking (total indirect effect = -.13, 95% confidence interval [CI] [-.32, -.02]) but not AEP via the alcohol POC. There was an indirect effect of the intervention on ineffective contraception (total indirect effect = -.27, 95% CI [-.55, -.07]) and AEP (total indirect effect = -.22, 95% CI [-.46, -.06]) via the contraception POC. CONCLUSIONS: This study completely replicated the prior indirect effects of the CHOICES intervention on the targeted risk behaviors through the experiential and behavioral POC for each behavior. Findings support the utility of the POC for informing health behavior change interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Characteristics and factors associated with the risk of a nicotine exposed pregnancy: expanding the CHOICES preconception counseling model to tobacco.

The preconception counseling model tested in the CDC funded Project CHOICES efficacy trial to reduce the risk of an alcohol-exposed pregnancy (AEP) could be extended to smokers to prevent a nicotine-exposed pregnancy (NEP), when pharmacotherapy can be provided safely and disclosure of these risk behaviors is more likely. The CHOICES model, which incorporates motivational interviewing, encourages reduction of AEP risk by decreasing risky drinking or using effective contraception; in the efficacy trial, most women chose both options. We conducted a secondary analysis of the CHOICES epidemiologic survey data (N = 2,672) (Project CHOICES Research Group in Am J Prev Med 23(3), 166-173, 2002) to identify the prevalence of risk of NEP and the factors associated with this risk using logistic regression modeling procedures. Conducted in six settings with women at risk for AEP, the percentage of AEP was 12.5% (333/2,672) among women of childbearing age (18-44). A total of 464 of the 2,672 (17.4%) were at risk for NEP. Among women at-risk of an unplanned pregnancy (n = 1,532), the co-occurrence of AEP and NEP risk was more prevalent (16.3%) than AEP risk alone (5.5%) or NEP risk alone (14.0%). In the multivariable model, statistically significant correlates for NEP risk included lifetime drug use, prior alcohol/drug treatment, drug use in the last 6 months, being married or living with a partner, having multiple sexual partners in the last 6 months, physical abuse in the last year, and lower levels of education. These findings suggest that preconception counseling for NEP could be combined with a program targeting AEP.

Licensed Master of Social Workers' Engagement in the Process of Evidence-Based Practice: Barriers and Facilitators.

Purpose:This article describes the qualitative responses from licensed masters-level social workers (LMSWs) regarding what they perceive as barriers and facilitators to consistently engaging in the process of evidence-based practice (EBP). Method:Two open-ended questions were posed to determine what helps social workers consistently use the EBP process and what inhibits them from regularly applying EBP to guide clinical decision-making. A total of 113 responses were recorded. Content analysis was used to identify emergent themes. Results:Facilitators to the consistent use of EBP included: the belief that EBP improves outcomes, research that was vetted and disseminated by trusted partners such as the National Association of Social Workers (NASW), and ethical mandates. Barriers included: time, lack of applicable research, client-specific factors, and cost. Factors identified as both facilitating and impeding the EBP process were lack of necessary technology, organizational context, provider beliefs, and research knowledge/training. Discussion and Conclusion: Providers identified a number of barriers and facilitators to engaging in the process of evidence-based practice, which guided the extent to which they consistently engaged in the process, and how difficult they perceived itto be.

Achieving Justice for Girls in the Juvenile Justice System.

Female involvement in the juvenile justice system has steadily increased in the United States over the past three decades. During this time, as male arrests have declined, female arrests have increased. Although many social workers have responded to these trends with a national call to identify and address the unique needs of these girls, we lack much high-quality research, including empirically supported interventions or programming to serve the needs of female youths involved in the justice system. This article provides a summary of the extant research that helps document the unique needs of these female youths and national policy efforts and practice considerations for social work practitioners. These needs and policy initiatives offer important opportunities for social workers to conduct research to improve the understanding of this population and also ways in which to provide services that address these youths' complex needs. The article concludes that these female youths-most of whom are not a danger to society-need services instead of involvement in the justice system.

Virtual Patient Simulations for Brief Assessment of Mental Health Disorders in Integrated Care Settings.

This mixed methods pilot investigation evaluated the use of virtual patient simulations for increasing self-efficacy and diagnostic accuracy for common behavioral health concerns within an integrated care setting. A two by three factorial design was employed to evaluate three different simulated training conditions with a sample of 22 Masters level behavioral health students. Results support engagement in virtual patient simulation training to increase students' self-efficacy in brief clinical assessment, and support the use of virtual patient simulations to improve diagnostic accuracy. Results further indicate that virtual patient simulations have sufficient levels of usability and acceptability as a tool for developing brief clinical interviewing skills, and that participants found this method of instruction to be a valuable adjunct to traditional classroom or field based training. Future directions and next steps for the integration of technology enhanced simulations in clinical social services education are explored.

Benchmarks for Evaluating Life Review and Reminiscence Therapy in Alleviating Depression among Older Adults.

The efficacy of reminiscence and life review (LR) therapy in alleviating depression among older adults is well established. However, providers in nonresearch settings might implement these interventions inadequately, and such settings rarely can evaluate their outcomes using control groups. Alternatively, evaluators in such settings can calculate a within-group effect size and then compare it with average within-group effect size benchmarks derived from the randomized clinical trials (RCTs) supporting the intervention's effectiveness. This study developed these within-group effect size benchmarks. A search of RCTs from five systematic reviews and meta-analyses, and more recent RCTs published through 2016, yielded 25 studies that met inclusion criteria. Hedge's g for LR recipients and waitlist controls were .598 and -.20, respectively, and .568 and -.012 for reminiscence theory. These benchmarks offer an approach for evaluating the implementation of LR and reminiscence therapy when control groups are infeasible.

We are at Full Capacity": Social care workers persisting through work-related stress in a new immigrant settlement context in the United States.

Cities without a prior established history of Latina/o migration are experiencing the fastest rate of growth in new immigrants in the United States (Wainer, A tale of two cities (and a town): Immigrants in the Rust Belt, 2013; Lichter & Johnson, Immigrant gateways and Hispanic migration to new destinations. International Migration Review, 43, 496, 2009). These new immigrant settlement cities experience the challenge of adapting their social care context to become more responsive to the needs of immigrants. Yet as cities and social care organisations struggle to keep up with the "lag" time in the availability of culturally and linguistically responsive resources and services, social care providers often work in conditions of scarcity in a social care context that is often lacking in its ability to fully respond to the needs of immigrants. Literature indicates that such conditions of scarcity can lead to work related stress, burn-out, and can have a negative impact on the quality of services delivered by social care workers. Yet little is known regarding social care providers' motivations and responses to work stress; and how providers may positively respond and persist in their jobs despite such stressors. This study conducted in the new immigrant settlement city of Baltimore from 2014 to 2016, utilises semi-structured interviews to qualitatively explore the personal motivational beliefs, workplace and demographic factors associated with buffering stress and frustration among social care workers in a new immigrant settlement city (N = 29). Findings highlight important motivational and work-related factors that appear to minimise the impact of stress and frustration for social care providers and can be used in the development of burn-out interventions as well as improving quality of services for vulnerable populations such as, immigrants, especially in low-resource new immigrant settlement contexts.

Preventing Alcohol and Tobacco Exposed Pregnancies: CHOICES Plus in Primary Care.

INTRODUCTION: Alcohol and tobacco use are common among U.S. women, yet if used during pregnancy these substances present significant preventable risks to prenatal and perinatal health. Because use of alcohol and tobacco often continue into the first trimester and beyond, especially among women with unintended pregnancies, effective evidence-based approaches are needed to decrease these risk behaviors. This study was designed to test the efficacy of CHOICES Plus, a preconception intervention for reducing the risk of alcohol- and tobacco-exposed pregnancies (AEPs and TEPs). STUDY DESIGN: RCT with two intervention groups: CHOICES Plus (n=131) versus Brief Advice (n=130). Data collected April 2011 to October 2013. Data analysis finalized February 2016. SETTING/PARTICIPANTS: Settings were 12 primary care clinics in a large Texas public healthcare system. Participants were women who were non-sterile, non-pregnant, aged 18-44 years, drinking more than three drinks per day or more than seven drinks per week, sexually active, and not using effective contraception (N=261). Forty-five percent were smokers. INTERVENTION: Interventions were two CHOICES Plus sessions and a contraceptive visit or Brief Advice and referral to community resources. MAIN OUTCOME MEASURES: Primary outcomes were reduced risk of AEP and TEP through 9-month follow-up. RESULTS: In intention-to-treat analyses across 9 months, the CHOICES Plus group was more likely than the Brief Advice group to reduce risk of AEP with an incidence rate ratio of 0.620 (95% CI=0.511, 0.757) and absolute risk reduction of -0.233 (95% CI=-0.239, -0.226). CHOICES Plus group members at risk for both exposures were more likely to reduce TEP risk (incidence rate ratio, 0.597; 95% CI=0.424, 0.840 and absolute risk reduction, -0.233; 95% CI=-0.019, -0.521). CONCLUSIONS: CHOICES Plus significantly reduced AEP and TEP risk. Addressing these commonly co-occurring risk factors in a single preconception program proved both feasible and efficacious in a low-income primary care population. Intervening with women before they become pregnant could shift the focus in clinical practice from treatment of substance-exposed pregnancies to prevention of a costly public health concern. TRIAL REGISTRATION: This study is registered at clinicaltrials.gov NCT01032772.

Processes of change in preventing alcohol exposed pregnancy: A mediation analysis.

OBJECTIVE: To examine mechanisms of the treatment effect for CHOICES, a motivational intervention to reduce risk of alcohol exposed pregnancy (AEP). Grounded in constructs from the transtheoretical model (TTM) and motivational interviewing (MI), the intervention targeted: risk drinking (>4 drinks/day or >7 drinks/week); ineffective contraception; and AEP risk (both behaviors). The experiential and behavioral processes of change (POC), posited to describe the mechanisms through which individual behavior change occurs, were examined. It was hypothesized that each of the targeted treatment outcomes at 9-month follow-up would be mediated by the experiential POC at 3 months, and that these would then be mediated by the behavioral POC at 9 months. METHOD: Eight hundred thirty women at-risk for AEP were randomized to CHOICES (information plus counseling; IPC) condition (n = 416) or information only (IO) condition (n = 414). Primary outcomes and proposed mediators (POC) were assessed at 3 and 9 months. Path analyses using weighted least squares estimation with mean- and variance-adjusted chi-square statistic were conducted separately for each outcome. RESULTS: Model fit indices indicated good fit, and the indirect effect of treatment on outcome via POC was significant for hypothesized models predicting risky drinking and ineffective contraception. The indirect effect of treatment on AEP risk through POC for ineffective contraception was significant, but the indirect effect of POC for risky drinking was not. CONCLUSIONS: These findings support the temporal relationship between experiential and behavioral POC consistent with the TTM. Opportunistic, motivation-based interventions may benefit from directly targeting experiential POC early in treatment and behavioral POC later in treatment. (PsycINFO Database Record

The patient portal and abnormal test results: An exploratory study of patient experiences.

Many health care institutions are implementing patient portals that allow patients to track and maintain their personal health information, mostly in response to the Health Information Technology for Economic and Clinical Health Act requirements. Test results review is an area of high interest to patients and provides an opportunity to foster their involvement in preventing abnormal test results from being overlooked, a common patient safety concern. However, little is known about how patients engage with portals to review abnormal results and which strategies could facilitate that interaction in order to ensure safe follow-up on abnormalities. The objective of this qualitative study was to explore patients' experiences related to abnormal test result notifications through patient portals. The authors conducted semi-structured telephone interviews with 13 participants, patients and primary caregivers, between February 2014 and October 2014. Using content analysis, the authors explored patient experiences accessing abnormal test results through their portals. Respondents strongly favored access to all types of abnormal test results, but they raised several concerns including need for more timely notification and not being able to interpret the exact relevance of the result. Respondents' personal experiences with physicians, test result notification, and the portal heavily influenced respondents' notification preferences. Patient experiences with portals could be improved by development of strategies to help patients understand and manage the information received. These findings suggest important considerations for health professionals and institutions aiming to better engage patients in follow-up of their test results.

The Integration of Clients' Religion and Spirituality in Social Work Practice: A National Survey.

This article describes the results of a cross-sectional study of licensed clinical social workers' (LCSWs') views and behaviors related to integrating clients' religion and spirituality in clinical practice. A total of 442 LCSWs from across the United States who advertised their services on the Internet provided anonymous responses to an online administration of the Religious/Spiritually Integrated Practice Assessment Scale. The results indicate that LCSWs have positive attitudes, high levels of self-efficacy, and perceive such integration as feasible, but report low levels of engagement in integrating clients' religious and spiritual beliefs into practice. Moreover, two variables emerged as significant predictors for LCSWs' overall orientation toward integrating clients' religion and spirituality in practice: practitioners' intrinsic religiosity and prior training (prior course work or continuing education). Implications and next steps for social work education and continuing training efforts are discussed.

Releasing test results directly to patients: A multisite survey of physician perspectives.

OBJECTIVE: To determine physician perspectives about direct notification of normal and abnormal test results. METHODS: We conducted a cross-sectional survey at five clinical sites in the US and Australia. The US-based study was conducted via web-based survey of primary care physicians and specialists between July and October 2012. An identical paper-based survey was self-administered between June and September 2012 with specialists in Australia. RESULTS: Of 1417 physicians invited, 315 (22.2%) completed the survey. Two-thirds (65.3%) believed that patients should be directly notified of normal results, but only 21.3% were comfortable with direct notification of clinically significant abnormal results. Physicians were more likely to endorse direct notification of abnormal results if they believed it would reduce the number of patients lost to follow-up (OR=4.98, 95%CI=2.21-1.21) or if they had personally missed an abnormal test result (OR=2.95, 95%CI=1.44-6.02). Conversely, physicians were less likely to endorse if they believed that direct notification interfered with the practice of medicine (OR=0.39, 95%CI=0.20-0.74). CONCLUSION: Physicians we surveyed generally favor direct notification of normal results but appear to have substantial concerns about direct notification of abnormal results. PRACTICE IMPLICATIONS: Widespread use of direct notification should be accompanied by strategies to help patients manage test result abnormalities they receive.

Patient access to medical records and healthcare outcomes: a systematic review.

OBJECTIVES: We conducted a systematic review to determine the effect of providing patients access to their medical records (electronic or paper-based) on healthcare quality, as defined by measures of safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. METHODS: Articles indexed in PubMed from January 1970 to January 2012 were reviewed. Twenty-seven English-language controlled studies were included. Outcomes were categorized as measures of effectiveness (n=19), patient-centeredness (n=16), and efficiency (n=2); no study addressed safety, timeliness, or equity. RESULTS: Outcomes were equivocal with respect to several aspects of effectiveness and patient-centeredness. Efficiency outcomes in terms of frequency of in-person and telephone encounters were mixed. Access to health records appeared to enhance patients' perceptions of control and reduced or had no effect on patient anxiety. CONCLUSION: Although few positive findings generally favored patient access, the literature is unclear on whether providing patients access to their medical records improves quality.

Online training on fetal alcohol spectrum disorders for court-appointed special advocates volunteers.

Fetal alcohol spectrum disorders (FASDs) are a leading cause of developmental disabilities. Children within the child welfare system are five to 10 times more likely than other children to experience these symptoms. Court Appointed Special Advocates (CASA) volunteers are uniquely positioned to identify these children and refer them for assessment and services. This study used a one-group pretest-posttest design to assess the impact of a three-hour online FASDs training on CASA workers' knowledge of FASDs and their comfort and confidence in identifying children with FASDs for referral, advocating for them, and linking them to services. The training and assessment measures were completed by 338 CASA volunteers and staff from 55 CASA locations in Texas. Wilcoxon matched-pairs tests and paired t tests were used to assess change in each of the dependent measures. All comfort and confidence items showed significant improvement from pretest to posttest; there was also a significant improvement in knowledge. These results support the potential of this online training to enhance CASA volunteers' ability to help children with FASDs.

Assessment of a service provider self-study method to promote interorganizational and community collaboration.

With an emphasis by both public and private funding sources on community-level service integration, many social service organizations have been required to shift from traditional "silo" models of service delivery to increased community-based collaboration and service coordination. There is a paucity of research to identify successful methods to achieve these goals. This article describes a self-study method used to engage service providers in a community development effort designed to meet the needs identified by local residents within their community and empower a rural, unincorporated community with scarce resources. It also reports qualitative outcomes that assessed the utility of a self-study method to achieve collaboration and community empowerment. Communication, ownership, input, and investment among providers appear to be key components to achieving long-term sustainability and success. Implications for the utility of the self-study method for achieving community service integration that aligns with basic principles of community development are discussed.

CHOICES: an integrated behavioral intervention to prevent alcohol-exposed pregnancies among high-risk women in community settings.

CHOICES is an integrated behavioral intervention for prevention of prenatal alcohol exposure in women at high risk for alcohol-exposed pregnancies. The intervention uses motivational interviewing and cognitive-behavioral strategies, and targets adoption of effective contraception and reduction of alcohol use. The CHOICES intervention includes four manual-guided counseling sessions delivered by behavioral health counselors and one contraceptive session with a family planning clinician. CHOICES's efficacy has been established through a series of randomized controlled trials in settings including primary care, university hospital-based obstetrical/gynecology practices, urban jails, substance abuse treatment settings, and a media-recruited sample in three large cities. This article describes the CHOICES line of research including the epidemiology, feasibility, and efficacy studies. It also details the CHOICES intervention and the components of each session. In addition, the authors describe current studies testing modifications of the CHOICES intervention, the dissemination efforts to date, and implications for social work practice.

Comparing social worker and non-social worker outcomes: a research review.

This article reports on a review of the literature comparing the outcomes of social workers with those of non-social workers. The review was commissioned by NASW's Texas Chapter to examine empirical evidence regarding the comparative effectiveness of social work to possibly support efforts to educate employers and the public about the value of social work. Because of the limited number of internally valid studies that have compared social workers and non-social workers on actual client outcomes, studies were also included if they examined practitioner variables that might be associated with client outcomes. The mixed findings point to a lack of compelling evidence supporting the superiority of social work in the child welfare field. However, in the mental health and aging fields, the limited evidence suggests that social workers do at least as well as non-social workers regarding practitioner retention, mental health court intervention, efforts to maintain older adult independence in the community, and attitudes toward evidence-based practice. Implications are presented to guide NASW in promoting rigorous research comparing social workers and non-social workers on actual client outcomes, especially in the field of child welfare.