Presenting Methodological Resilience for Conducting Research with Vulnerable Populations During Current and Future Pandemics: A Case Study with IPV Shelters and Survivors in the United States.

Purpose: In this brief report, we highlight the challenges that we experienced while attempting to conduct primary data collection with intimate partner violence (IPV) survivors living in an IPV emergency shelter throughout the prolonged COVID-19 pandemic and our strategies to overcome them. Method: In the summer of 2021, we began collecting data on a study investigating maternal-child bonding while living in IPV emergency shelters. We proposed a 14-day electronic daily diary methodology with follow-up semi-structured interview. The purpose of the study was to understand what factors affect maternal-child bonding to support survivors' relationships with their children while living in an emergency shelter. Results: We encountered two global obstacles to study implementation: the Institutional Review Board (IRB) pausing in-person data collection and low IPV shelter utilization. In what we term methodological resilience, we engaged in innovative and flexible team work to overcome these barriers. Specific strategies centered on creating an entirely remote data collection process and expanding our geographic area and participant eligibility criteria. Conclusions: Implications for researchers include greater communication with IRB offices, planning for multi-state recruitment, triangulated recruitment methods, reminder texts for participants and incremental incentives to ensure continued engagement with the study.

Social workers as members of burn care teams: A qualitative thematic analysis.

BACKGROUND: Social workers on interprofessional teams contribute to treating the psychosocial sequelae of burn trauma patients in cooperation with many other burn-treatment team members. However, the roles and skills exercised by social workers can vary between burn units as well as the skills social work students are taught in their academic programs. METHODS: A purposive sample of 13 burn unit social workers were interviewed online using semi-structured questions. This qualitative thematic analysis of data was conducted to identify how social workers perceive their roles, responsibilities, and knowledge as they relate to their work with patients and their families in a burn unit. RESULTS: Skills, challenges and barriers to rehabilitation, and resources were identified during thematic analysis within and across participant data as factors social workers found to be important for their work in burn units. CONCLUSION: By expanding the body of knowledge about factors that impact social work care for burn patients, Social work academic programs may better understand how to prepare medical social work students for best practices in the care of burn-injured patients, survivors, and families at inpatient and community levels.

Measures Evaluating Patient Satisfaction in Integrated Health Care Settings: A Systematic Review.

Integrated health care includes joint, outpatient delivery of medical and behavioral health services. Traditional patient satisfaction measures might fail to capture the discrete delivery approaches in this model. To identify patient satisfaction measures used in integrated health care settings, a systematic review was conducted of US-based studies conducted in adult outpatient integrated care settings from 1999 through 2020. Study quality was assessed using standards recommended by the COSMIN guidelines. The review yielded a sample of 23 studies, consisting of 10 standardized measures and 6 self-developed tools. All studies/measures met at least one of the identified COSMIN guidelines, demonstrating quality of the measures. While most measures evaluated key elements of integration, including access, communication, and relationships, only one standardized measure evaluated elements of care specific to practice in integrated care. Findings suggest a need for a comprehensive patient satisfaction measure that captures important aspects of the integrated health care experience.

Relationship Between Volunteering and Perceived General Health of Individuals with Serious Mental Illness.

Volunteering has been found to be a significant predictor of improved health among the general population. Yet, little is known about the relationship between volunteering and perceived general health among individuals with serious mental illness (SMI). Using data obtained from the 2014 California Health Interview Survey (N = 1127), this study examined the extent to which volunteering is associated with perceived general health of individuals with SMI. Study findings indicate that individuals who engage in volunteering are more likely to report better health status when compared to those who do not engage in volunteering.

Factors Associated with Telehealth Service Utilization among Rural Populations.

A major barrier to high-quality health care for individuals living in rural communities is specialty care access. Telehealth has emerged as an alternative approach to improving access to specialty care providers. Data on 3,618 adults who reported living in rural areas was analyzed from the 2015 California Health Interview Survey (CHIS). Logistic regression was used to examine predisposing, enabling, and need factors associated with telehealth service use among rural populations. Individuals who were insured or who reported their health status as excellent, very good, or good were more likely to use telehealth services. While telehealth has the potential to address a number of health care access barriers, lack of insurance appears to remain a barrier even when using telehealth care. Further, telehealth may not address the access needs of individuals who have the greatest need for health care services-those with poorer health status.

Differences in Maternal Risk Factors Among Undocumented Latinas in Nebraska by Country of Origin.

OBJECTIVE: This study compared maternal risk factors by country of origin for 4,188 Mexican and Guatemalan unauthorized immigrants. METHOD: Data were drawn from 2007 to 2011 public birth certificate records of unauthorized immigrant mothers residing in Nebraska at the time of delivery. The study sample included 4,188 women ages 18 years or older and originating from either Mexico or Guatemala. Risk factors, including age risk, preexisting health risks, pregnancy health risks, and prior pregnancy risks, were examined by country of origin. Stata 11.0 was used to compute descriptive statistics and conduct χ2 test for binary variables and Student t test for continuous variables. RESULTS: Analyses found that Mexican and Guatemalan participants have distinct maternal risk factors. Mexican participants were older and at greater risk of obesity and excessive weight gain during pregnancy, while Guatemalan participants were more likely to receive inadequate prenatal care. CONCLUSION: Findings suggest that both Mexican and Guatemalan immigrants encounter maternal risk factors that could threaten not only their own health but that of their infants as well. Health and social service providers can tailor education and outreach efforts that are specific to Latina subgroups by origin. Furthermore, targeted strategies to delivering prenatal care to unauthorized immigrants are essential for the well-being of mothers and newborns.

Feasibility of a computer application to develop social workers knowledge of integrated healthcare concepts.

Disseminating evidence-based knowledge and strengthening the education program of the healthcare workforce is an essential step toward achieving transformation of the U.S. healthcare delivery system to integrated healthcare. Computer applications may be an effective approach for social workers to learn integrated concepts. A feasibility study using an experimental research design was used to compare instructional approaches among MSW students (N = 15) composed of experimental (N = 7) and control (N = 8) group participants. Students completed a pre-test on integrated healthcare concepts and screening measures along with a post-test on screening measures. While ANCOVA results suggest no significant differences on post-test scores between the two groups, dependent sample t-test revealed a significant increase for both groups. Results suggest training on an integrated healthcare topic using a computer application is feasible. Future research should be conducted to determine if the computer application is comparable to other instructional methods.

The impact of expanded health insurance coverage for unauthorized pregnant women on prenatal care utilization.

OBJECTIVE: The objective of this study was to investigate the effect of expanding Medicaid health insurance coverage for unauthorized women on prenatal care utilization. DESIGN AND SAMPLE: A natural experiment design was used. We examined the prenatal care utilization of 20,876 unauthorized women from Nebraska, which expanded Medicaid coverage for unauthorized women, and South Carolina, which has never expanded coverage. MEASURES: Measurements of prenatal care utilization included adequate prenatal care using the Kotelchuck Index and the number of prenatal care visits. The policy independent variable of interest was an interaction between the policy years (2007-2009) and Nebraska residence. Demographic characteristics were included as covariates. Analysis entailed a difference-in-difference approach to compare prenatal care utilization by state, both before and after legislation was passed to fund care among unauthorized women in Nebraska. RESULTS: Women with insurance coverage were more likely to utilize prenatal services. Unauthorized women living in Nebraska during Medicaid expansion were 28% more likely to receive adequate prenatal care (OR = 1.28, p < 0.01) and had about one more prenatal care visit (IRR = 1.05, p < 0.01) than women who did not have expanded Medicaid coverage. CONCLUSIONS: Findings have important public health policy implications to support improved birth outcomes among native-born infants of unauthorized women.

Developing a Computer Application to Prepare Social Workers for Integrated Health Care: Integrated Healthcare (Version 1.0).

Integrated health care (IHC) is a proposed change to the U.S. health care system to address health care disparities for individuals with mental and physical health conditions. Computer applications may provide an effective strategy to prepare social workers for the transition to IHC. An Internet-based tool, Integrated Healthcare (Version 1.0) was developed and tested through rapid prototyping to access knowledge required for behavioral health providers to practice in IHC settings. Two focus groups (N = 5, N = 7) and individual interviews (N = 5) were conducted with social work professors and students. Nielsen's usability heuristics were used to evaluate data from focus groups and interviews, and changes were incorporated in development. The final computer application is an introduction to IHC concepts, reinforces the integrated nature of physical and behavioral health, and puts evidence-based knowledge at the point of care.

Correlates of Social Support Among Latino Immigrants.

Latino immigrants encounter considerable stressors that pose risks to health and well-being during settlement in the USA. Social support serves as a protective factor that can help to buffer the negative effects of stress. Despite the importance of social support, we know little about how Latino immigrants differentially experience this protective factor. The current study analyzed data from 100 Latino immigrants residing in Tennessee. Hierarchical multiple regression analysis was employed to examine variation in self-reported social support by immigrant characteristics and immigration-related factors. Females, immigrants who are not married/cohabitating, and those who reported experiencing a greater number of discrete stressors in the USA each reported lower levels of social support. Implications for practice include an increased emphasis on assessing levels of social support and designing services to strengthen support for the most vulnerable immigrants. Future research should consider a longitudinal analysis and specific types of social support.

Cardiovascular risk screening for individuals with serious mental illness.

Cardiovascular disease (CVD) is a significant health risk for individuals with serious mental illness (SMI). Screening for CVD risk factors is a key strategy to reduce this health disparity. This study examined medical, lifestyle, and access predictors for comprehensive screening. Data on 1036 adults were analyzed from the 2015 National Health Interview Survey. Multivariate multinomial logistic regression was used to examine factors associated with individuals with SMI receiving CVD risk screening in the past 12 months. The presence of a metabolic disorder (diabetes or high cholesterol), increased age, increased outpatient visits, and seeing a primary care provider, either alone or in conjunction with a specialty care provider, were significantly associated with receiving all screening measures. Increasing provider awareness of additional CVD risk factors is an essential step to improving early detection of health risks for individuals with SMI. Integrated health settings that combine traditional primary care and mental health services may reduce the health disparity for this population by increasing odds of early detection and ongoing monitoring for high-risk populations.

Nursing Unit Environment Associated with Provision of Language Services in Pediatric Hospices.

BACKGROUND: Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services. METHODS: Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1251 pediatric hospice agencies. Variable selection was guided by structural contingency theory, which posits that organizational effectiveness is dependent upon how well an organization's structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services. RESULTS: The majority of hospices provided translation services (74.9 %) and interpreter services (87.1 %). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services. CONCLUSIONS: Findings indicate that nursing unit environment predicts provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staffs who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency and ultimately reduce ethnic disparities in end-of-life care for children and their families.

Discrimination and mental health among Latinos: variation by place of origin.

The US Latino population experiences high rates of discrimination, which may contribute to psychiatric disorders. Yet, little is known about the distinctions in this relationship for Latino subgroups. Using data from the National Latino and Asian American study, we examined the association between discrimination and mental health for 2503 Latinos. Logistic regression analyses were used to examine variation in the relationship by place of origin (Cuba, Puerto Rico, Mexico, or Other). Results suggest that perceived discrimination increased the probability of having a psychiatric disorder. The effect of discrimination on having a psychiatric disorder was greater for Mexicans than Puerto Ricans. The findings of this study suggest that variation exists in the relationship between discrimination and mental health by origin. Implications for practice include increasing awareness of place of origin, in addition to discrimination, as a risk factor for mental illness. Future research should examine this relationship longitudinally and consider immigration status.

Social Capital and Well-Being: Structural Analyses of Latina Mothers by Nativity.

Objective This study examined the direct and mediating effects of maternal social capital on health and well-being for native- and foreign-born Latina mothers and their children. Methods Data were drawn from the baseline and nine-year follow up waves of the Fragile Families and Child Well-being Study. The study included a sample of 874 Latina mothers. Mplus7 was used to perform structural equation modeling to determine whether exogenous indicators (age, education, and economic well-being) predicted social capital, whether social capital predicted mother and child well-being, and whether mediating effects helped explain each relationship. Results For native-born Latinas (n = 540), social capital did not predict maternal or child well-being. However, social capital significantly mediated the effects of age, education, and economic well-being on maternal well-being. For foreign-born Latinas (n = 334), social capital was a significant predictor of maternal well-being. Social capital also mediated the effects of age, education, and economic well-being on maternal, but not child well-being. Younger and foreign-born Latinas who report higher educational attainment and economic well-being have greater social capital, and thus better self-reported health. Conclusion Findings suggest that social capital is particularly relevant to the health of foreign-born Latinas. For all Latina mothers, social capital may serve as a protective mitigating factor to better health. Health service providers should evaluate the potential to integrate programs that promote social capital accumulation for Latinas. Further research should examine factors to improve the health of Latinas' children.

Variation in mental health service use among U.S. Latinos by place of origin and service provider type.

OBJECTIVE: This study examined variation in mental health service use among U.S. Latinos by place of origin and service provider type. METHODS: Data were obtained from the National Latino and Asian American Study. The sample for this study consisted of 2,533 Latino adults, including Cubans, Puerto Ricans, Mexicans, and other Latinos. Use of services from specialty mental health providers, general medical providers, and other providers was examined. Guided by Andersen's behavioral model of health service use, logistic regression models were conducted. RESULTS: Although over one-fifth of the sample (21.3%) had a psychiatric disorder, only 9.6% reported that they received any mental health services in the past 12 months. Overall, Puerto Ricans were more likely than the other Latino subgroups to use any mental health services. Respondents with a psychiatric disorder were more likely to use mental health services from all provider types, but the effect of having a psychiatric disorder on use of general medical care providers was greater among Mexicans than among Puerto Ricans. CONCLUSIONS: Findings suggest the existence of variations among Latino subgroups in mental health service use by provider type and place of origin. Mental health professionals should provide tailored outreach and services to this vulnerable population, which underutilizes mental health services. Further research should examine variation in mental health service use by immigrant legal status.