Centering persons who use drugs: addressing social determinants of health among patients hospitalized with substance use disorders.

Social workers have emerged as leaders within Addiction Consult Services (ACS) due to their ability to provide a wide range of services, from crisis work and brief therapeutic interventions to connecting patients to community resources. Many hospitals have implemented ACS to address the overdose crisis and the sharp rise in drug use-related infections, including skin and soft tissue infections, osteomyelitis, and endocarditis; a result of unaddressed systemic social determinants of health (SDOH). Yet, despite social workers being at the forefront of inpatient substance use work, little guidance exists regarding social work's role in leading person-centered addiction care and addressing SDOH in the hospital setting. The authors of this paper are licensed clinical social workers who have worked across five different health systems, engaging persons who use drugs (PWUD) in the context of an ACS. This paper examines five practice interventions of social work practice within hospitals that represent key points for innovation. Drawing on social work's unique commitments to social justice, strengths, and person-in-environment, these interventions operate within eco-social approaches to help us grapple more effectively with ways that health - and disease - are socially and economically produced by multiple interacting factors. We provide a clinical roadmap of interventions for social workers in hospital settings with PWUD to demonstrate how social work leadership within inpatient care models can help us better address the impacts of various intersecting SDOH on the care of PWUD.

Daily experiences and strategies for psychological survival during the 2014 assaults in Gaza: a retrospective analysis of chronological diaries.

BACKGROUND: Public health research suggests that multiple factors contribute to the mental health sequalae of political violence, but the daily experiences and ongoing strategies of psychological survival during active warfare are not clearly understood. We analysed retrospective chronological diaries from Palestinian women in Gaza, occupied Palestinian territory, to explore their lives during Operation Protective Edge in 2014, when a series of aerial bombardments killed over 2000 Palestinians and left around 500 000 displaced from their homes. METHODS: 20 Palestinian female teachers in Gaza were recruited via an intervention for trauma recovery 1 month after the end of Operation Protective Edge, in September, 2014. Following the experience sampling method, women were asked to chronicle specific memories and affective responses associated with their experiences. Data were imported into qualitative data analysis software, coded line by line, and analysed using content analysis, with special attention to the causes of mental distress associated with political violence. FINDINGS: The women's narratives included memories of exposure to bombings, injuries, death, and destruction of vital infrastructure and systems. Their experiences of flight were described as exhausting and demoralising. Their temporary shelters lacked their basic needs for sanitation, food, and privacy. These experiences resulted in intense terror, grief, exhaustion, hopelessness, and isolation. Strategies of psychological survival included reframing; trying to appreciate "being able to escape death", a sense of solidarity within families and neighbourhoods, and pride and satisfaction found in a context of resistance and global attention to the suffering in Gaza. INTERPRETATION: Our results reveal the importance of tracing the events of warfare, its psychosocial consequences, and the distinct patterns of emotional and logistical survival in Gaza. This study was limited by the representativeness of our study population and the small sample size. Future studies should explore this topic in larger populations. Limitations notwithstanding, in drawing out the unique contribution of reflective narratives of women survivors of war, our study highlights the need to solicit and analyse reflective and chronologically grounded narratives within global mental health epidemiology. FUNDING: None.

Human (in)security and psychological well-being in Palestinian children living amidst military violence: A qualitative participatory research using interactive maps.

BACKGROUND: Research has widely evidenced the effects of war and political violence on the functioning of children, with a great accord in diagnosing children's psychological burdens related to their exposure to violence. Yet, within this literature, the influence of the chronic sense of insecurity on their psychological functioning during and after hostilities remains unexplored. METHODS: The present study aimed at exploring interrelated relationships between the perceived insecurity and the children's psychological well-being and their adjustment to trauma. Based on drawings and walk-along interviews with 75 Palestinian children, residents of both the West Bank and Gaza Strip, we offer an analysis of human security-related risks and protective factors that contribute to either promoting or undermining the child's psychological functioning in a context characterized by chronic instability and political violence. RESULTS: A complex network of sources of security and insecurity emerged from the narratives depicting an ecological portrait encompassing the determinants of children's mental health and psychological functioning. The TCA led to the identification of eight main themes: school and associativism; social relations and house as a source of security/insecurity; military occupation as a source of insecurity; national and political identity as a source of safety; mosque and spirituality as a source of safety/unsafety; environment as a source of security/insecurity; and mental health. DISCUSSION: An approach encompassing human security as an explicative model can help in exhaustively portraying the complexity of the Palestinian children's suffering and their competence in adjusting to their traumatic reality. The study draws attention to social, political, environmental and economic determinants of children psychological well-being.

Parental Resilience in Contexts of Political Violence: A Systematic Scoping Review of 45 Years of Research.

Families suffer in particular ways during the violence and targeted deprivation of freedom and resources within political violence (PV), which includes wars, armed conflicts, and military occupations-all part of political violence (PV). While evidence is accumulating about the disproportionate impacts of PV on parents and children, we lack a clear, globally integrated understanding of how families suffer-and survive-PV. There is an urgent need to synthesize existing work to refine our understanding of parental experiences within PV-with particular attention to both how PV creates suffering for parents, and how parents strategize, caring for their families within the most horrendous of circumstances. In this systematic scoping review, authors explore how political violence impacts parenting. Using predetermined search strategies and inclusion criteria (peer-reviewed, empirical articles, published in English), searches within multiple databases, and tests of interrater reliability, 112 articles (quantitative, qualitative, and mixed method) were identified. Authors organized and coded findings, determined common themes, and built a conceptual model connecting and integrating findings. Findings point to two crucial areas of parenting within PV: parenting efficacy and parenting practices, demonstrating how these are simultaneously compromised by and amplified within PV. Results uncover how much parenting within PV is intertwined with parental psychological and social well-being, and that parents cope with a variety of internal and external resources, including culture, community, religion, activism, flight, and emotional and logistical reconfiguration. Implications include that, within and after PV, interventions must focus on parental well-being, as well as the social and political situatedness of parents.

Political violence, collective functioning and health: a review of the literature.

Political violence is implicated in a range of mental health outcomes, including PTSD, depression, and anxiety. The social and political contexts of people's lives, however, offer considerable protection from the mental health effects of political violence. In spite of the importance of people's social and political environments for health, there is limited scholarship on how political violence compromises necessary social and political systems and inhibits individuals from participating in social and political life. Drawing on literature from multiple disciplines, including public health, anthropology, and psychology, this narrative review uses a multi-level, social ecological framework to enhance current knowledge about the ways that political violence affects health. Findings from over 50 studies were analysed and used to build a conceptual model demonstrating how political violence threatens three inter-related domains of functioning: individual functioning in relationship to their environment; community functioning and social fabric; and governmental functioning and delivery of services to populations. Results illustrate the need for multilevel frameworks that move beyond individual pathology towards more nuanced conceptualizations about how political violence affects health; findings contribute to the development of prevention programmes addressing political violence.

"No safe place": Applying the transactional stress and coping model to active warfare.

OBJECTIVE: The mental health consequences of political violence arise within active, dynamic processes of appraisal and coping. Understanding the psychological sequela of war is an urgent task; yet, we have little on the ground exploration of the quotidian events within and the accompanying psychological responses of the totalizing experience of war. Using a transactional-based model of stress and coping, in this study, we use a novel method-retrospective diaries-to explore the shifting, unpredictable, and traumatic nature of life during a major military operation. METHOD: Our sample consisted of 21 Palestinian women recruited via an intervention for teachers in Gaza. Women's retrospective chronological diaries were analyzed using content analysis. RESULTS: Our analysis drew out the cyclical process of coping within political violence, demonstrating five essential temporal dimensions: warning; bombings, with injuries, death, and destruction; reintegrating within flight and resettlement; ongoing political insecurity within precarious truces and rampant loss and destruction; and persevering: restarting life amid pervasive trauma. CONCLUSION: Our findings draw attention to vital temporal dimensions and the cyclical nature of stress and coping that underlie the sequela of mental health in a highly charged context. In tracing warfare, its psychosocial consequences, and distinct patterns of emotional and logistical survival, our study contributes to the growing field of psychological epidemiology of war. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

What Do We Know After Decades of Research About Parenting and IPV? A Systematic Scoping Review Integrating Findings.

This systematic scoping literature review synthesizes scholarship about intimate partner violence (IPV) and parenting into a conceptual model. We integrate findings from across 136 studies. To be included, studies had to consider how IPV influenced one's parenting and/or how parents responded to the violence they encountered in terms of their practices related to their children. Studies had to be peer-reviewed, empirical articles, done using quantitative, qualitative, or mixed methods, and published in English. There were no limits on the dates or locations of studies. Using these predetermined criteria, authors screened over 6,000 articles, finally selecting 136 studies to be coded and analyzed. Results demonstrate IPV undermines maternal well-being and parenting practices. Our findings also highlight multiple ways that mothers struggle to realize the complex tasks of parenting within IPV, including through emotional coping, action-based coping, and social support. By systematically bringing together and analyzing existing data on the topic, this study helps build the knowledge base around how women facing IPV plan for physical and psychological safety of themselves and their children. Our synthesis of the literature helps expand theoretical frameworks, and stregthen prevention practices and policies so they reflect both the suffering and the resilience of mothers who grapple with IPV. Our review draws attention to the need to focus interventions on promoting the mental health and parenting self-efficacy of mothers who suffer from the direct effects of IPV and its attacks on their mental health and parental role.

Reconsidering the role of place in health and welfare services: lessons from the COVID-19 pandemic in the United States and Canada.

Places-the meaningful locations of daily life-have been central to the wellbeing of humans since they first formed social groups, providing a stable base for individuals, families, and communities. In the United States and Canada, as elsewhere, place also plays a foundational role in the provision of critical social and health services and resources. Yet the globally destabilizing events of the COVID-19 pandemic have dramatically challenged the concept, experience, and meaning of place. Place-centered public health measures such as lockdowns and stay-at-home orders have disrupted and transformed homes, neighborhoods, workplaces, and schools. These measures stressed families and communities, particularly among marginalized groups, and made the delivery of vital resources and services more difficult. At the same time, the pandemic has stimulated a range of creative and resilient responses. Building from an overview of these effects and drawing conceptually on theories of people-place relationships, this paper argues for critical attention to reconsidering and re-envisioning prevailing assumptions about place-centric policies, services, and practices. Such reappraisal is vital to ensuring that, going forward, scholars, policymakers, and practitioners can effectively design and deliver services capable of maintaining social connections, safety, and wellbeing in contexts of uncertainty, inequality, and flux.

Risk and Protective Factors Among Palestinian Women Living in a Context of Prolonged Armed Conflict and Political Oppression.

Research has widely documented the effects of war and political violence on the functioning and well-being of adults and children. Yet, within this literature, women's agency in the face of war-related adversity and political violence remains underexplored. The present study was conducted in the Gaza Strip in the aftermath of the most recent war on Gaza in 2014, with the aim of investigating the consequences of war and political violence for women's mental health and psychological functioning. Based on interviews with 21 Palestinian women exposed to extreme war-related traumatic events, the article offers an analysis of the risk and protective factors affecting their well-being and enhancing (or diminishing) their agency. Human Security, Family Ties, Psychosocial Resources, Individual Resources, and Motherhood emerged from the women's narratives as key factors contributing to the maintenance of positive psychological functioning and the ability to adjust to traumatic war events in the aftermath of acute armed conflict. These exploratory findings suggest that Palestinian women display a high level of functioning and resources for adjustment that is preserved after periods of devastating armed conflict. The study draws attention to a set of protective factors for the well-being of women and their families when living with chronic political violence.

Survival and Resilience Among Palestinian Women: A Qualitative Analysis Using Individual and Collective Life Events Calendars.

Responding to the need for more information concerning the mental health and psychological well-being of women living amid political oppression and war, this study aimed to explore specific factors that contribute to women's individual and collective perceptions about war and the associated traumatic life events that occurred during their lives. Moving from a socioecological and culture-informed perspective, we used narrative timelines elicited from 21 Palestinian women in Gaza, both individually and collectively, as a tool for both data collection and intervention. A deductive, top-down, thematic content analysis procedure was used to categorize data. The main events outlined by the women in their historical accounts, both individual and collective, were linked to political events in and surrounding Palestine. The life events' calendars reflect a constant attempt in balancing and compensating traumatic events with sources of well-being related to social support and family. Individual and collective narrative activities contributed to generate a significant reframing in the attribution of meaning and emotional perceptions of the participants. Women articulated how they build resilience through transgenerational and daily practices of resistance that encompass indigenous strategies of coping and skills of survival.

Shaping the Future of Social Work Practice in Healthcare: Addressing COVID-19 Needs through Integrated Primary Care.

COVID-19 has illustrated the urgency of promoting integrated healthcare as the model of the future, with social workers not only supporting the physical and mental health of providers and patients, but also leading efforts to transform systems, policies, and social work education. Primary care, where the role of social workers is continuing to grow, is a central location for integrating the treatment of medical, social, and behavioral problems. In these settings, social workers can take the lead to meet community needs, assist in public health efforts, and bolster the frontline medical workforce. The following article reflects upon what we as social workers have learned a year into the global pandemic and how we can apply this knowledge to shaping the future of social work in primary care. Authors consider how the multiple medical and psychosocial needs of patients affected by COVID-19 are addressed in primary care through three core functions of social work: providing behavioral healthcare, coordinating care, and undertaking population health-based interventions. Article ends with a discussion about how social work can respond to the urgent task of transforming health within the context of social work practice, policy, and education for the next generation of healthcare social workers.

The Relationship Between Exposure to Violence in the Family of Origin During Childhood, Psychological Distress, and Perpetrating Violence in Intimate Relationships Among Male University Students.

Witnessing or experiencing violence early in childhood is a significant risk factor for later perpetration of intimate partner violence (IPV) by men against women. Despite a large body of research on the topic, there is a need for more specific information about how differing patterns of family violence might pose distinct risks of later mental health problems and violence perpetration. Using a self-administered questionnaire, a cross-sectional survey was conducted among 745 male university students in Israel (age = 21-43, M = 25.56, SD = 3.172) to examine the effects of their exposure to family violence (i.e., parent-to-child psychological aggression [PA] and physical violence [PV] and witnessing interparental PA and PV) on their use of IPV. This study also examined whether psychological distress mediates the relationship between family violence exposure (witnessing or experiencing) and later IPV perpetration. Results indicate that experiencing PA and PV in childhood and current psychological distress predict significantly current IPV perpetration. Results also revealed that psychological distress mediates only the relations between participants experiencing parental violence and their PA against intimate partners. However, results showed that higher rates of participants witnessing interparental violence correlate significantly with lower rates of their PV against intimate partners; this relationship was not mediated by their psychological distress. It was also found that experiencing parental violence has significant direct and indirect positive effect on participants' PV against intimate partners. The limitations of the study and the implications of its results are discussed.

Spatial agency as a source of resistance and resilience among Palestinian children living in Dheisheh refugee camp, Palestine.

Research has widely documented the effects of war and political violence on the functioning and well-being of children. Yet, children's agency in the face of political violence remains underexplored. The present study aimed at exploring the sources of spatial agency that children draw on to counteract the harmful consequences of ongoing exposure to trauma. Based on drawings and walk-along interviews with 29 Palestinian children from Dheisheh refugee camp, we offer an analysis on how children use domestic and social spaces to actively maintain positive function and subjective well-being. Five themes were identified: the mosque as a place of spiritual resistance, the school as a source of happiness and personal improvement, internal spaces as a safe place for growing and developing, community spaces as places where children have fun and play an active role, and inhabiting the outdoor spaces in the camp despite environmental dangers and the Occupation. The study draws attention to spatial activities as forms of embodied resistance through which children promote their subjective well-being and maintain positive functioning.

'Most importantly, I hope God keeps illness away from us': The context and challenges surrounding access to health care for Syrian refugees in Lebanon.

The influx of 1.5 million Syrians into Lebanon has created an increased demand for health services, which is largely unmet, due to cost, a highly fragmented and privatised system, and crises around legal documentation and refugee status. The aim of this study was to use a constant comparison analysis of qualitative data to explore how Syrian refugees living in Lebanon describe their experiences accessing healthcare (N = 351 individuals within 46 families). Pervasive fear, lack of confidence in the medical system, and high costs all hinder access to healthcare for Syrians in Lebanon. Findings demonstrate the need for attention to the costs and accessibility of care, and for stronger coordination of care within a centrally led comprehensive emergency plan. While we attend to understanding and alleviating the barriers surrounding refugee healthcare, we must also address the underlying cause of health crisis: the brutal realities caused by armed conflict.

Place as a Social Determinant of Health: Narratives of Trauma and Homeland among Palestinian Women.

Despite calls for greater social work attention to the centrality of place in human life, the profession has yet to hone frameworks that fully capture the role of place in individual-collective identity and well-being. To move this agenda forward, this article draws on data from a series of focus groups to explore the placed experiences of women in Palestine. Analytically, it is informed by critical place inquiry, which emphasises the deeply interactional relationships between people and places, views place-centred practice and research as catalysts for active responses to the spatialised nature of power and injustice, and focuses centrally on the geographic and spatial dynamics of colonisation, and particularly settler colonialism, as key determinants of individual and collective well-being. Women's spatial narratives revolved around individual-collective identity and sovereignty, focusing in particular on three interdependent factors: freedom of movement; possession and dispossession; and continuity of place. Findings also illuminated spatial practices of resistance by which women defend and promote identity and sovereignty. We conclude with recommendations for more explicit, critically informed attention to place in social work practice, education and research.

The Co-Occurrence and Unique Mental Health Effects of Political Violence and Intimate Partner Violence.

The global mental health ramifications of political violence and intimate partner violence (IPV) are well established. There also exists a growing body of evidence about the increased risks for IPV within situations of political violence. Yet, except for a few studies, there is little literature that simultaneously examines how political violence and IPV might result in unique risks for particular types of mental health sequela. Delineating possible divergent patterns between specific mental health conditions resulting from political violence and IPV takes on an increased urgency given that, although they are related, the two most commonly reported outcomes of these two types of violence-post-traumatic stress disorder (PTSD) and depression-not only require different types of treatment, but may in fact be generated or maintained by disparate paths. Using survey data from adult women in Palestine ( n = 122), this study explores the relationships between IPV and political violence (both lifetime and past-month exposure) and tests their independent relationships to PTSD and depressive symptomology. After controlling for the other form of violence exposure, political violence was correlated with PTSD and not with depressive symptomology, while IPV was correlated with depressive symptomology and not with PTSD. Findings demonstrate that distinct forms of violence exposure might indeed be associated with specific mental health outcomes. Results illustrate the need to assess for both political violence and IPV when researching and designing interventions related to violence.

Direct and indirect effects of child abuse and environmental stress: A lifecourse perspective on adversity and depressive symptoms.

There is a great deal of evidence about the mental health implications of physical child abuse and environmental stressors, or hardships that people experience at the household and neighborhood level (e.g., neighborhood violence; economic hardship, substance abuse, or conflict among family members). Yet, studies often focus on either abuse or environmental stress, not both, or examine abuse and environmental stressors as a combined set of experiences. Less is known, therefore, about how child abuse and environmental stress might work as either distinct or interrelated risks to diminish mental health over time. In this longitudinal study, we used path analyses to examine the cumulative effects of physical child abuse and environmental stressors on adult depressive symptoms among a sample of children followed into adulthood (N = 356). The goal was to assess whether chronic physical child abuse remains an independent predictor of adult outcomes once we accounted for the cumulative effects of household and neighborhood stressors across the lifecourse. Cumulative measures of physical child abuse and environmental stress each independently predicted a higher likelihood of adult depressive symptoms (ß = .122, p < .01 and ß = .283, p < .001, respectively). After accounting for adolescent depressive symptoms, only cumulative environmental stressors independently predicted depressive symptoms (ß = .202, p < .001). Tests of the indirect effect of cumulative environmental stress on the relationship between cumulative physical abuse and adult depressive symptoms were marginally statistically significant. Results add to literature that examines child abuse, adversity, and lifecourse perspectives on health. (PsycINFO Database Record

Dwelling within political violence: Palestinian women's narratives of home, mental health, and resilience.

Political violence is increasingly played out within everyday civilian environments, particularly family homes. Yet, within the literature on political violence and mental health, the role of threats to home remains under-explored. Using focus group data from 32 Palestinian women, this paper explores the implications of violations to the home within political violence. Threats to the privacy, control, and constancy of the family home - key dimensions of ontological security (Giddens, 1990) emerged as central themes in women's narratives. Surveillance, home invasions, and actual or threatened destruction of women's home environments provoked fear, anxiety, grief, humiliation, and helplessness, particularly as women struggled to protect their children. Women also described how they mobilized the home for economic, familial and cultural survival. Study findings illuminate the impact of threats to intimate environments on the well-being of women and their families living with chronic political violence, and underscore the importance of attention to violations of place and home in research on civilian experiences of and responses to political violence.

Political violence, health, and coping among Palestinian women in the West Bank.

Political violence poses a considerable threat to the health of individuals. Protective factors, however, may help people to build resilience in the face of political violence. This study examined the influence of lifetime and past 30-day experiences of political violence on the mental and physical health of adult Palestinian women from the West Bank (N = 122). Two hypotheses were examined: (a) Reports of political violence exposure would be related to reports of poorer physical and mental health and (b) several coping variables (proactive coping; self-reliance; reliance on political, family, and religious support; and political or civic engagement) would function as moderators of the effects of political violence, buffering or weakening its effects on physical and mental health outcomes. Both lifetime and past 30-day measures of political violence were positively correlated with posttraumatic stress disorder symptoms. Proactive coping, reliance on self, and political or civic engagement significantly interacted with political violence to affect health in a counterintuitive direction; those with higher scores on these more internalized and individualistic coping strategies demonstrated worse health as political violence increased. Reliance on religious support, and, in particular, support from and participation in activities of religious institutions, emerged as a significant protective factor. Results underscore the importance of looking not only at whether political violence affects health, but also at how the relationships between political violence and health might occur, including the potential protective influence of resources within people's social environments.