Oxic methane production from methylphosphonate in a large oligotrophic lake: limitation by substrate and organic carbon supply.

IMPORTANCE: Methane is an important greenhouse gas that is typically produced under anoxic conditions. We show that methane is supersaturated in a large oligotrophic lake despite the presence of oxygen. Metagenomic sequencing indicates that diverse, widespread microorganisms may contribute to the oxic production of methane through the cleavage of methylphosphonate. We experimentally demonstrate that these organisms, especially members of the genus Acidovorax, can produce methane through this process. However, appreciable rates of methane production only occurred when both methylphosphonate and labile sources of carbon were added, indicating that this process may be limited to specific niches and may not be completely responsible for methane concentrations in Flathead Lake. This work adds to our understanding of methane dynamics by describing the organisms and the rates at which they can produce methane through an oxic pathway in a representative oligotrophic lake.

Investigating Correlates of Home Visitor Burnout, Compassion Fatigue, and Compassion Satisfaction in New York State: Implications for Home Visiting Workforce Development and Sustainability.

INTRODUCTION: Home visitor well-being is integral to delivering effective home visiting services and a core component of successful home visiting program implementation. While burnout (BO), compassion fatigue (CF), and compassion satisfaction (CS) have been studied extensively in physicians, nurses, and other health providers, little is known about the correlates of these phenomena in home visitors. METHODS: This cross-sectional study examined demographic characteristics (age, race, gender), health and personal experiences (anxiety, physical health, and adverse childhood experiences), and job-related factors (caseload, role certainty, job satisfaction) as correlates of BO, CF and CS among a sample of 75 home visitors employed across six MIECHV-funded agencies in New York State. Descriptive statistics were used to characterize our sample; linear regressions were employed to investigate correlates with outcomes of interest. RESULTS: Anxiety was significantly and positively associated with BO (ß = 2.5, p < 0.01) and CF (ß = 3.08, p < 0.01). Overall job satisfaction was significantly and inversely associated with BO only (ß = -0.11, p < 0.001). Participants who identified as white were less likely to report higher levels of CS relative to non-white counterparts (ß = -4.65, p = 0.014). Examinations of specific aspects of job satisfaction revealed significant associations between satisfaction with workplace operating conditions, nature of the work, and contingent rewards and select outcomes of interest. DISCUSSION: Prioritizing preventive measures that target correlates of BO and CF, such as higher levels of anxiety and lower levels of job satisfaction - particularly operating conditions - may improve workforce well-being, continuity of service delivery, and ultimately quality of care provided to clients.

"Treat Them Like a Human Being They are Somebody's Somebody": Providers' Perspectives on Treating Patients in the Emergency Department After Self-Injurious Behavior.

To understand ED providers' perspective on how to best care for individuals who present to US emergency departments (EDs) following self-injurious behavior, purposive recruitment identified nursing directors, medical directors, and social workers (n = 34) for telephone interviews from 17 EDs. Responses and probes to "What is the single most important thing ED providers and staff can do for patients who present to the ED after self-harm?" were analyzed using directed content analysis approach. Qualitative analyses identified four themes: treat patients with respect and compassion; listen carefully and be willing to ask sensitive personal questions; provide appropriate care during mental health crises; connect patients with mental health care. Participants emphasized treating patients who present to the ED after self-injurious behavior with respect and empathy. Hospitals could incentivize provider mental health training, initiatives promoting patient-provider collaboration, and reimbursement strategies ensuring adequate staffing of providers with time to listen carefully.

Race and COVID-19 among Social Workers in Health Settings: Physical, Mental Health, Personal Protective Equipment, and Financial Stressors.

Social work is an essential workforce integral to the United States' public health infrastructure and response to COVID-19. To understand stressors among frontline social workers during COVID-19, a cross-sectional study of U.S-based social workers (N = 1,407) in health settings was collected (in June through August 2020). Differences in outcome domains (health, mental health, personal protective equipment [PPE] access, financial stress) were examined by workers' demographics and setting. Ordinal logistic, multinomial, and linear regressions were conducted. Participants reported moderate or severe physical (57.3 percent) and mental (58.3 percent) health concerns; 39.3 percent expressed PPE access concerns. Social workers of color were more likely to report significantly higher levels of concern across all domains. Those identifying as Black, American Indian/Alaska Native (AIAN), Asian American/Pacific Islander (AAPI), multiracial, or Hispanic/Latinx were over 50 percent more likely to experience either moderate or severe physical health concerns, 60 percent more likely to report severe mental health concerns, and over 30 percent more likely to report moderate PPE access concerns. The linear regression model was significantly associated with higher levels of financial stress for social workers of color. COVID-19 has exposed racial and social injustices that that hold true for social workers in health settings. Improved social systems are critical not just for those impacted by COVID-19, but also for the protection and sustainability of the current and future workforce responding to COVID-19.

Predictors of burnout, compassion fatigue, and compassion satisfaction experienced by community health workers offering maternal and infant services in New York State.

Although burnout has been increasingly well studied among medical (nurses, physicians, residents) and mental health providers (psychologists, psychiatrists, social workers), there continues to be a lack of attention on the well-being of community-based providers, such as Community Health Workers (CHWs), within the United States. Using cross-sectional data from 75 CHWs employed in 14 agencies funded through the Maternal and Infant Community Health Collaboratives Initiative (MICHC) in New York, our study examined predictors (anxiety, physical health, adverse childhood experiences, job satisfaction, role certainty, demographic and work characteristics) of burnout, compassion fatigue (CF) and compassion satisfaction (CS). Descriptive statistics were used to characterize our sample and linear regression was employed to investigate the correlates of burnout, CF and CS. Results indicated that CHWs with higher levels of anxiety and lower job satisfaction were more likely to have higher burnout scores. CHWs with higher levels of anxiety, lower job satisfaction and fewer days of poorer health were more likely to report higher CF. Those who worked more than 35 h per week were less likely to report higher CS. The study provides recommendations for organizational-level interventions to address risk factors of burnout and CF and promote CS among CHWs, such as bolstering supervision, encouraging greater communication, offering recognition/appreciation of CHWs and creating opportunities for self-care. Findings should be considered when designing organizational-level preventive measures that mitigate burnout and CF and promote CS.

"We Are Not Taking a Backseat": Health Social Workers' Perspectives on COVID-19 Response and Recovery.

The COVID-19 pandemic has wrought widespread devastation across the United States, exacerbating existing health inequities rooted in the social determinants of health. Social work is the key workforce tasked with providing social care in healthcare settings. In September 2019, the National Academies of Science, Engineering, and Medicine released a landmark Consensus Study Report, Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. The report describes a framework for addressing key care needs that articulates five "As for action" (5As)-awareness, alignment, assistance, adjustment, and advocacy-that are critical to social care. Drawing from a series of focus groups conducted with 55 social workers employed in a large urban pediatric quaternary hospital, this study qualitatively examines the utility of this framework in characterizing social care activities during the pandemic response and recovery efforts. Findings suggest that the 5As framework is both applicable to pandemic social work practice and an accurate encapsulation of the core elements of hospital social work practice, even if social workers themselves may not necessarily be aware of that conceptualization. Future implications for social work practice in arenas of awareness, adjustment, assistance, alignment, and advocacy are also discussed.

Perception of Recovery Orientation as a Predictor of Clinician Turnover in Community Mental Health Clinics.

Turnover in community mental health clinics threaten the delivery of quality behavioral health services; recovery orientation has been shown to be associated with lower levels of burnout but its relationship with actual turnover has not yet been examined. This study aimed to examine the relationship between provider perceptions of recovery orientation and 12-month turnover status among community mental health providers. Secondary data analyses were conducted with data collected from 224 community mental health providers from ten organizations across 14 clinic sites participating in a larger effectiveness-implementation trial. Chi square analyses were used to examine between-site variation in 1-year turnover rates among the ten organizations. Logistic regression was used to examine effects of perceptions of recovery orientation along with known predictors of turnover among community mental health providers. Results revealed no between-site variation in organizational turnover rates. The logistic regression model was statistically significant, χ2(17) = 47.64, p < .0001 and explaining 30% (Nagelkerke R2) of within-site variance and correctly classifying 79% of cases. Perceptions of recovery orientation emerged as the sole significant predictor of 12-month turnover status, with higher levels of recovery orientation significantly associated with lower odds of turnover at 12 months [B = .90, p = .008, OR 2.47 (95% CI 1.23, 4.82)]. Perceptions of recovery orientation was protective against 12-month turnover status suggesting that a more person-centered and empowering approach to care may improve the provider experience. More research is needed to further understand how recovery orientation can contribute to workforce stability.

'We are essential:' Pediatric health care social workers' perspectives on being designated essential workers during the COVID-19 pandemic.

Continued provision of essential services is critical to maintaining society's functioning during a crisis. During COVID-19, lockdowns and restrictions designed to preserve the public's health forced an examination of what it means to be an essential worker. Drawing from thematic analyses of focus group data from 55 social workers employed in a large, urban, pediatric, quaternary hospital, this study examines the perspectives of hospital social workers on the meaning of the essential status designation of social work. Findings revealed themes pertaining the substance of social work, the ways in which essential status is carried out, and implications of the designation not only for the future of the profession but also for the populations who receive social work services. The discussion raised important questions about the essential role of social workers in broader health care settings. Our findings suggest that health care systems need to engage in ongoing discussions of how to maximize the efficacy of the social work workforce, both in terms of integration with medical teams and recognition of the important roles social workers play across the hospital system, and facilitate the performance of their essential functions.

Treating Pediatric and Geriatric Patients at Risk of Suicide in General Emergency Departments: Perspectives From Emergency Department Clinical Leaders.

STUDY OBJECTIVE: We explored emergency department clinical leaders' views on providing emergency mental health services to pediatric and geriatric patients with suicidal ideation and suicide attempts. METHODS: We conducted semistructured interviews with a total of 34 nursing directors, medical directors, and behavioral health managers at 17 general hospital EDs across the United States, using purposive sampling to ensure variation among hospitals. Interviews were audio-recorded, transcribed verbatim, and coded and analyzed using Atlas.ti and a directed content analysis approach. RESULTS: Respondents from across a range of ED types expressed concerns regarding the capacity of their EDs to meet mental health needs of children and older adults. They experienced emotional distress over the increasing number of pediatric patients presenting to EDs with suicidal ideation/suicide attempt and described EDs as inappropriate environments for young patients with suicidal ideation/suicide attempt. Similarly, leaders expressed feeling ill-equipped to diagnose and treat geriatric patients with suicidal ideation/suicide attempt, who often had medical comorbidities that complicated treatment planning. Respondents noted that pediatric and geriatric patients frequently boarded in the ED. Some felt compelled to use creative solutions to provide safe spaces for pediatric and geriatric patients. Respondents voiced frustration over the lack of outpatient and inpatient mental health services for these patients. CONCLUSION: Clinical leaders in EDs across the nation expressed distress at feeling they were not adequately equipped to meet the needs of pediatric and geriatric patients with suicidal ideation/suicide attempt. Future innovations to provide ED care for children and older adults with suicidal ideation/suicide attempt might include training for ED teams, access to specialist mental health clinicians through telehealth, and adaptations of physical spaces.

"This is not your Life and it becomes your Life": A Qualitative Exploration of Deployment-related Stress and Support needs in National Guard and Reserve spouses who are Mothers of Young Children.

The adverse effects of deployment-related stress (DRS) on military service members, spouses, and children are well documented. Findings from a recent Consensus Report on Military Families by the National Academies of Science, Engineering, and Medicine (2019) underscore the priority of gaining a more comprehensive understanding of the diversity of today's military families and their needs and well-being. While social support is generally regarded as helpful during times of stress, it has not been studied extensively in National Guard/Reserve spouses who are parents of young children. This qualitative study of 30 women examines the unique ways in which DRS affects women who are National Guard/Reserve spouses and mothers of young children, as well as the processes through which they encountered support to manage these stressors. Salient themes spanned experiences involving deployment cycle phases of separation and reintegration and included both anticipated and unanticipated changes in family-related division of labor, dynamics, and communication patterns. These were complicated by geographic, social, and cultural isolation and misguided efforts to support spouses initiated by civilians. Women managed these stressors primarily through seeking, acquiring, and repurposing existing sources of informal social support for themselves and formal supports for their children, with varying degrees of success.

Los efectos adversos del estrés relacionado con la movilización militar en los miembros del servicio militar, las esposas y los niños están bien documentados. Los resultados de un informe de consenso reciente sobre las familias de militares realizado por las Academias Nacionales de Ciencias, Ingeniería y Medicina [National Academies of Sciende, Engineering and Medicine (2019)] subrayan la prioridad de comprender de una manera más completa la diversidad de las familias de militares en la actualidad y sus necesidades y bienestar. Si bien el apoyo social generalmente se considera útil durante los momentos de estrés, no se ha estudiado ampliamente en las esposas de integrantes de la Guardia Nacional o de la Reserva Militar que son madres de niños pequeños. Este estudio cualitativo de 30 mujeres analiza las maneras únicas en las cuales el estrés relacionado con la movilización militar afecta a las mujeres que son esposas de integrantes de la Guardia Nacional o la Reserva Militar y madres de niños pequeños, así como los procesos por los cuales encontraron apoyo para manejar esos factores desencadenantes de estrés. Los temas destacados abarcaron experiencias relacionadas con las fases de separación y reintegración del ciclo de movilización militar e incluyeron los cambios tanto previstos como imprevistos en la división de los patrones de trabajo, de dinámica y de comunicación relacionados con la familia. Estos se complicaron por el aislamiento geográfico, social y cultural y los esfuerzos equivocados que hicieron los civiles para apoyar a las esposas. Las mujeres manejaron estos factores desencadenantes de estrés principalmente mediante la búsqueda, la adquisición y la readaptación de fuentes existentes de apoyo social informal para ellas y de apoyo formal para sus hijos, con diversos grados de éxito.

Strategies to Care for Patients Being Treated in the Emergency Department After Self-harm: Perspectives of Frontline Staff.

INTRODUCTION: Every year, approximately 500 000 patients in the United States present to emergency departments for treatment after an episode of self-harm. Evidence-based practices such as designing safer ED environments, safety planning, and discharge planning are effective for improving the care of these patients but are not always implemented with fidelity because of resource constraints. The aim of this study was to provide insight into how ED staff innovate processes of care and services by leveraging what is available on-site or in their communities. METHODS: A total of 34 semi-structured qualitative phone interviews were conducted with 12 nursing directors, 11 medical directors, and 11 social workers from 17 emergency departments. Respondents comprised a purposive stratified sample recruited from a large national survey in the US. Interview transcripts were coded and analyzed using a directed content analysis approach to identify categories of strategies used by ED staff to care for patients being treated after self-harm. RESULTS: Although respondents characterized the emergency department as an environment that was not well-suited to meet patient mental health needs, they nevertheless described 4 categories of strategies to improve the care of patients seen in the emergency department after an episode of self-harm. These included: adapting the ED environment, improving efficiencies to provide mental health care, supporting the staff who provide direct care for patients, and leveraging community resources to improve access to mental health resources postdischarge. DISCUSSION: Despite significant challenges in meeting the mental health needs of patients treated in the emergency department after self-harm, the staff identified opportunities to provide mental health care and services within the emergency department and leverage community resources to support patients after discharge.

"You never stop being a social worker:" Experiences of pediatric hospital social workers during the acute phase of the COVID-19 pandemic.

The COVID-19 pandemic has wrought widespread devastation upon children and families across the United States, widening existing health disparities and inequities that disproportionately affect communities of color. In health care settings specifically, social work is the key workforce tasked with responding to patient and family psychosocial needs, both of which have increased substantially since the emergence of COVID-19. There is a need to understand ways in which hospital social workers' roles, responsibilities, and integration within interprofessional teams have evolved in response to these challenges. In this qualitative study, focus groups were conducted with 55 social workers employed across multiple settings in a large, urban, pediatric hospital in Spring 2020. Thematic analyses revealed salient superordinate themes related to the pandemic's impact on social work practice and social workers themselves, institutional facilitators and impediments to effective social work and interprofessional practice, and social work perspectives on future pandemic recovery efforts. Within each theme, a number of interrelated subthemes emerged elucidating nuances of telehealth adoption in the context of remote work, the salience of social determinants of health, and the critical role of social work in social justice oriented pandemic preparedness and response efforts. Implications for interprofessional practice and the profession at large are discussed.

Prevention, Health Promotion, and Social Work: Aligning Health and Human Service Systems Through a Workforce for Health.

The seminal Consensus Study by the National Academies of Science, Engineering, and Medicine released in September 2019 describes the benefits of integrating health and social care service delivery, underscoring the central role of social determinants of health (SDOH) in health outcomes. Although the report's focus on the integration of health and social care contributes a much needed perspective to the national discourse on SDOH and offers a useful framework for organizing service delivery activities, the omission of prevention and health promotion throughout the report is a substantial limitation.We call for increased attention to and investment in prevention and health promotion in the proposed 5As framework. We contend that effectively addressing SDOH and improving alignment between health and social systems require reconceptualization of the traditional health care workforce and renewed state and national advocacy efforts.A paradigm shift encompassing a broader "workforce for health" that is well trained in prevention, health promotion, and advocacy is critical to addressing SDOH, improving population health outcomes, and achieving health equity. Given their professional mission, training, expertise, and scope of practice, social workers are well positioned to lead this effort.

Family-Based Crisis Intervention With Suicidal Adolescents: A Randomized Clinical Trial.

OBJECTIVE: In current practice, treatment as usual (TAU) for suicidal adolescents includes evaluation, with little or no intervention provided in the emergency department (ED), and disposition, usually to an inpatient psychiatry unit. The family-based crisis intervention (FBCI) is an emergency psychiatry intervention designed to sufficiently stabilize suicidal adolescents within a single ED visit so that they may return home safely with their families. The objective of this article is to report efficacy outcomes related to FBCI for suicidal adolescents and their families. METHODS: A total of 142 suicidal adolescents (age, 13-18 years) and their families presenting for psychiatric evaluation to a large pediatric ED were randomized to receive FBCI or TAU. Patients and caregivers completed self-report measures of suicidality, family empowerment, and satisfaction with care provided at pretest, posttest, and 3 follow-up time points over a 1-month period. RESULTS: Patients randomized to FBCI were significantly more likely to be discharged home with outpatient follow-up care compared with their TAU counterparts (P < 0.001). Families randomized to the FBCI condition reported significantly higher levels of family empowerment and client satisfaction with care at posttest compared with their TAU counterparts. Gains were maintained over the follow-up period. No completed suicides were reported during the study period in either condition. CONCLUSIONS: Family-based crisis intervention is a model of care for suicidal adolescents that may be a viable alternative to traditional ED care that involves inpatient psychiatric hospitalization.

Health Outcomes and Costs of Social Work Services: A Systematic Review.

BACKGROUND: Efforts to reduce expensive health service utilization, contain costs, improve health outcomes, and address the social determinants of health require research that demonstrates the economic value of health services in population health across a variety of settings. Social workers are an integral part of the US health care system, yet the specific contributions of social work to health and cost-containment outcomes are unknown. The social work profession's person-in-environment framework and unique skillset, particularly around addressing social determinants of health, hold promise for improving health and cost outcomes. OBJECTIVES: To systematically review international studies of the effect of social work-involved health services on health and economic outcomes. SEARCH METHODS: We searched 4 databases (PubMed, PsycINFO, CINAHL, Social Science Citation Index) by using "social work" AND "cost" and "health" for trials published from 1990 to 2017. SELECTION CRITERIA: Abstract review was followed by full-text review of all studies meeting inclusion criteria (social work services, physical health, and cost outcomes). DATA COLLECTION AND ANALYSIS: Of the 831 abstracts found, 51 (6.1%) met criteria. Full text review yielded 16 studies involving more than 16 000 participants, including pregnant and pediatric patients, vulnerable low-income adults, and geriatric patients. We examined study quality, health and utilization outcomes, and cost outcomes. MAIN RESULTS: Average study quality was fair. Studies of 7 social work-led services scored higher on quality ratings than 9 studies of social workers as team members. Most studies showed positive effects on health and service utilization; cost-savings were consistent across nearly all studies. CONCLUSIONS: Despite positive overall effects on outcomes, variability in study methods, health problems, and cost analyses render generalizations difficult. Controlled hypothesis-driven trials are needed to examine the health and cost effects of specific services delivered by social workers independently and through interprofessional team-based care. Public Health Implications. The economic and health benefits reported in these studies suggest that the broad health perspective taken by the social work profession for patient, personal, and environmental needs may be particularly valuable for achieving goals of cost containment, prevention, and population health. Novel approaches that move beyond cost savings to articulate the specific value-added of social work are much needed. As health service delivery focuses increasingly on interprofessional training, practice, and integrated care, more research testing the impact of social work prevention and intervention efforts on the health and well-being of vulnerable populations while also measuring societal costs and benefits is essential.

To Ask or Not to Ask? Opinions of Pediatric Medical Inpatients about Suicide Risk Screening in the Hospital.

OBJECTIVE: To describe opinions about suicide risk screening in a pediatric medical inpatient sample. STUDY DESIGN: As part of a larger instrument validation study, 200 pediatric medical inpatients (ages 10-21 years) were screened for suicide risk. Participants completed demographic self-report forms and were asked their opinions about suicide risk screening. Patient responses were recorded verbatim by trained research social workers. Qualitative data was analyzed using thematic analysis. RESULTS: The majority of adolescents who participated had not been previously asked about suicide (N = 101; 62.3%) and were supportive of suicide risk screening (81.0%). Five salient themes emerged from the qualitative analysis of patient opinions: prevention, elevated risk, emotional benefits, provider responsibility, and lack of harm in asking. CONCLUSIONS: The majority of youth screened for suicide risk on medical inpatient units were supportive of suicide risk screening. Opinion data have the potential to inform screening practices and assure clinicians that suicide risk screening will be acceptable to pediatric patients and their parents. Given the lack of screening in these patients' past experiences, the medical setting is a unique opportunity to capture youth at risk for suicide.

Race, Gender, and Conceptualizations of Fear.

This study used qualitative methods and quantitative statistical analyses to examine whether race and gender are associated with reasons for which adults perceive a situation or object as fearful. The sample consists of 197 African-American and White adults (ages 18-85) recruited through a convenience sample and community sources in the Midwest. A cognitive interviewing instrument was utilized to examine respondents understanding of words and phrases from a mental health instrument. Using qualitative methods, free-response answers were content coded using 5 "fear-codes" (i.e., harm/danger, external locus of control, self-perception, and past experience), developed by the researchers. Results from logistic regression analyses indicate that race significantly predicts usage of specific fear codes (p<.05). In addition, a race by gender interaction was found.

Predictors of Food Insecurity and Childhood Hunger in the Bronx During the COVID-19 Pandemic.

Using a community-based participatory research approach, we conducted a survey of 218 food pantry recipients in the south Bronx to determine predictors of food insecurity and childhood hunger. In adjusted multiple regression models, statistically significant risk factors for food insecurity included: having one or more children and not having health insurance. Statistically significant protectors against childhood hunger were: having a graduate degree, having health insurance and Spanish being spoken at home. Experiencing depression symptoms was positively associated with both food insecurity and childhood hunger. Frequency of food pantry use was not significantly associated with either food insecurity nor childhood hunger. This study suggests that targeting families with multiple children and without insurance will best help to promote food security among residents of the south Bronx. Social policy implications related to food security and benefit provision through the COVID-19 pandemic are also provided.