Social Work Faculty Research

Permanent URI for this collectionhttps://digital.lib.washington.edu/handle/1773/41944

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Infusing MSW programs with disability studies and disability justice: How to create explicit curriculum
(2022-03-02) Berridge, Clara; Ganti, Anjulie; Taylor, Dorian; Rain, Billie; Bahl, Seema
MSW students will work with a significant number of people with disabilities and thus need to learn about disability as both a descriptive and a political identity. While new curriculum resources and competencies developed by CSWE for teaching about disability are a critical step, little has been written about successful approaches to infusing disability content into social work curricula. We help address that need by describing our MSW curricula infusion process and lessons learned as a team of partnering faculty and disability justice activists. We describe the intersectional disability justice movement framework, arguing that this framework is needed to equip students to address urgent issues of social injustice.
Monitoring the Monitors: Medicaid Integration of Passive Remote Monitoring Technology.
(2019) Berridge, Clara
Implementation of passive remote monitoring is advancing faster than our knowledge base about appropriate and ethical use. For all the media and research attention these technologies are getting, there has been very little discussion about how they are positioned to be integrated into health plans, yet their integration is key to how they will be incorporated into social work practice. As coverage of passive remote monitoring technologies expands in Medicaid home and community-based services (HCBS), new policies that support informed decision-making, consenting processes, and regulations for ethical, appropriate use are urgently needed. Research translation often trails policy, but the rapid development and implementation of technologies that passively collect and transmit new information about older adults call for a more responsive approach. In this commentary, I describe passive remote monitoring technologies, their implementation in Medicaid HCBS, and ethical issues. I conclude with specific suggestions for policy and practice to start addressing these issues.
Assessing an Adapted Approach to Communities That Care for Child Maltreatment Prevention
(2019) Haggerty, Kevin P.; Catalano, Richard F.; Pecora, Peter J.; De Haan, Benjamin; Salazar, Amy M.
Objective: Communities That Care (CTC) is an evidence-based community mobilization model designed to prevent problematic adolescent behaviors such as delinquency and substance use by organizing community coalitions that choose and implement evidence-based practices to address community-specific risk and protective factors. This paper presents findings from the evaluation of Keeping Families Together (KFT)—an adapted CTC approach that targets community-wide prevention of child maltreatment in families with children ages 0–10. Method: We compared findings from 2 Oregon communities that implemented KFT with those from 12 communities that implemented traditional CTC as part of a site-randomized controlled trial. We analyzed data collected approximately 3.5 years into implementation to determine whether this adapted approach resulted in similar implementation quality, board functioning, community transformation, and perceived program sustainability as original CTC. Results: Board functioning, communities’ adoption of a science-based approach to prevention, and sustainability in the adapted KFT approach were equal or superior to traditional CTC sites 3.5 years into implementation. Conclusions: As an adaptation of the evidence-based CTC community mobilization approach, KFT offers the potential of a promising extension of CTC for prevention of child maltreatment.
Positive Youth Development Programs in Low- and Middle-Income Countries: A Conceptual Framework and Systematic Review of Efficacy
(2019-01-24) Catalano, Richard F.; Skinner, Martie L.
Purpose: Positive youth development (PYD) has served as a framework for youth programs in high-income countries since the 1990s and has demonstrated broad behavioral health and developmental benefits. PYD programs build skills, assets, and competencies; foster youth agency; build healthy relationships; strengthen the environment; and transform systems to prepare youth for successful adulthood. The goal of this article was to systematically review the impact of PYD programs in low- and middle-income countries (LMICs). Methods: Targeted searches of knowledge repository Web sites and keyword searches of Scopus and PubMed identified over 21,500 articles and over 3,700 evaluation reports published between 1990 and mid-2016. Ninety-four PYD programs with evaluations in LMICs were identified, of which 35 had at least one experimental or rigorous quasi-experimental evaluation. Results: Sixty percent of the 35 programs with rigorous evaluations demonstrated positive effects on behaviors, including substance use and risky sexual activity, and/or more distal developmental outcomes, such as employment and health indicators. Conclusions: There is promising evidence that PYD programs can be effective in LMICs; however, more rigorous examination with long-term follow-up is required to establish if these programs offer benefits similar to those seen in higher income countries.
CARING FOR WASHINGTON’S OLDER ADULTS IN THE COVID-19 PANDEMIC: INTERVIEWS WITH ORGANIZATION LEADERS ABOUT THE STATE OF SOCIAL AND HEALTHCARE SERVICES
(2020-10-09) Berridge, Clara; Parsey, Carolyn M; Ramirez, Maggie; Freitag, Callie; Johnson, Ian; Allard, Scott W
The COVID-19 pandemic presents significant and costly disruptions to social service and health care systems. Eight in ten deaths from the COVID-19 virus in the U.S. have occurred in people age 65 and older (CDC, 2020). In addition to the mortality risk, the pandemic presents grave health and economic risks by disrupting services to older adults that prevent institutionalization, emergency room visits, and other negative health outcomes. This report examines how the pandemic has affected the operation of social service and healthcare organizations that support Washington’s 1.7 million older adults (60+), including 107,000 people with Alzheimer’s disease and other dementias. Drawing on surveys and interviews with 45 senior leaders of social services and health care organizations serving older adults throughout Washington State, this report identifies current challenges confronting service delivery and client care, as well as those that will persist to shape future strategy and planning. Several key findings and themes emerge relevant to policy and practice.
Why older adults and their children disagree about in-home surveillance technology, sensors, and tracking
(2019) Berridge, Clara; Wetle, Terrie Fox
Background and Objectives: Despite the surveilling nature of technologies that allow caregivers to remotely monitor location, movements, or activities, the potential differences in comfort with remote monitoring between care givers and care recipients have not been examined in depth. On the dyad and aggregate level, we compare preferences of older adult women and their adult children for three remote monitoring technologies. Their assessments of each technology’s impact on privacy, safety, independence, freedom, relationship with family member, social life, and identity are also compared. Research Design and Methods: This dyadic study employed cognitive-based interview probing and value-centered design methods. Twenty-eight individual, in-depth structured interviews were conducted with 18 women who are Meals on Wheels clients and 10 of their adult children. Results: Meals on Wheels participants reported multiple chronic conditions and an average of 1.7 ADL and 3.3 IADL difficulties; two-thirds were enrolled in Medicaid. Adult children preferred each technology more than their mothers did and underestimated both their mothers’ ability to comprehend the functions of the technologies and the importance of engaging them fully in decision making. Most were confident that they could persuade their mothers to adopt. For both groups, privacy was the most-cited concern, and participants perceived significant overlap between values of privacy, independence, identity, and freedom. Discussion and Implications: Studying privacy in isolation overlooks privacy’s instrumental role in enabling other values. Shared decision-making tools are needed to promote remote monitoring use consistent with older adults’ values and to prevent conflict and caregiver overreach.
Monitoring the monitors: Medicaid integration of passive remote monitoring technology
(2019) Berridge, Clara
Implementation of passive remote monitoring is advancing faster than our knowledge base about appropriate and ethical use. For all the media and research attention these technologies are getting, there has been very little discussion about how they are positioned to be integrated into health plans, yet their integration is key to how they will be incorporated into social work practice. As coverage of passive remote monitoring technologies expands in Medicaid home and community-based services (HCBS), new policies that support informed decision-making, consenting processes, and regulations for ethical, appropriate use are urgently needed. Research translation often trails policy, but the rapid development and implementation of technologies that passively collect and transmit new information about older adults call for a more responsive approach. In this commentary, I describe passive remote monitoring technologies, their implementation in Medicaid HCBS, and ethical issues. I conclude with specific suggestions for policy and practice to start addressing these issues.
Promoting SBIRT Training for Social Work Students Across Field Settings
(2019) Tajima, Emiko A; McCowan, Kristin J; Lindhorst, Taryn; Haggerty, Kevin P; Rivara, J'May B; Schack, Steve; Ramey, Anastasia; Jackson, T Ron
We report on our experience of implementing an interprofessional social work SBIRT training program in which didactic content was integrated with field education opportunities to practice SBIRT in various practice settings. Mentored field instructors supervised SBIRT field learning activities in behavioral health clinics, primary care clinics, inpatient and outpatient psychiatry and mental health and addiction service settings. Input regarding program implementation was gathered from students and field instructors. Student use of SBIRT varied by field setting. We report on field instructors’ perceptions of site-specific challenges to successful implementation of SBIRT and describe lessons learned for social work training programs.
A Hard Pill to Swallow: Ethical Problems of Digital Medication
(2018-10) Dotolo, Danae; Petros, Ryan; Berridge, Clara
Late last year news broke that the U.S. Food and Drug Administration (FDA) approved the inaugural digital medication, Abilify MyCite (AMC) (FDA, 2017). AMC uses digital technology embedded in the medication to track ingestion with the purported goal of increasing adherence. As members of the field with diverse research and clinical interests, we were compelled to explicate ethical concerns regarding digital medication. Our areas of scholarship—collectively, social work practice, bioethics, gerontology, disability studies, health care technologies, and mental health interventions—are uniquely relevant to this topic. We argue that the introduction of AMC is ethically problematic and requires critical reflection by social workers and health care professionals broadly. We encourage social workers’ active participation in decision making related to adoption and...
Cameras on beds: The ethics of surveillance in nursing home rooms
(2019-02-22) Berridge, Clara; Halpern, Jodi; Levy, Karen
Surveillance cameras are increasingly being deployed in nursing homes and assisted living facilities, with insufficient attention to what is ethically fraught about this way of assuaging concerns about abuse and other personnel challenges. With seven state laws now regulating camera monitoring and more on the way, it is urgent for us to consider the ethical implications of how we use technology to keep older adults safe. Drawing on findings from the first facility survey on this topic, we address three ethical issues: the risk that in-room cameras pose to residents’ privacy and dignity, the risk of undermining care workers’ sense of being fiduciaries for residents, and the probable extension of camera use by facilities to monitor staff and residents. We argue that with an aging population, intensifying strain on the care workforce, and ease of access to Web-connected cameras, this is a critical moment to address these ethical challenges.
Why older adults and their children disagree about in-home surveillance technology, sensors, and tracking
(2019-05) Berridge, Clara; Wetle, Terrie
BACKGROUND AND OBJECTIVES: Despite the surveilling nature of technologies that allow caregivers to remotely monitor location, movements, or activities, the potential differences in comfort with remote monitoring between caregivers and care recipients have not been examined in depth. On the dyad and aggregate level, we compare preferences of older adult women and their adult children for three remote monitoring technologies. Their assessments of each technology's impact on privacy, safety, independence, freedom, relationship with family member, social life, and identity are also compared. RESEARCH DESIGN AND METHODS: This dyadic study used cognitive-based interview probing and value-centered design methods. Twenty-eight individual, in-depth, structured interviews were conducted with 18 women who are Meals on Wheels clients and 10 of their adult children. RESULTS: Meals on Wheels participants reported multiple chronic conditions and an average of 1.7 ADL and 3.3 IADL difficulties; two thirds were enrolled in Medicaid. Adult children preferred each technology more than their mothers did and underestimated both their mothers' ability to comprehend the functions of the technologies and the importance of engaging them fully in decision making. Most were confident that they could persuade their mothers to adopt. For both groups, privacy was the most-cited concern, and participants perceived significant overlap between values of privacy, independence, identity, and freedom. DISCUSSION AND IMPLICATIONS: Studying privacy in isolation overlooks privacy's instrumental role in enabling other values. Shared decision-making tools are needed to promote remote monitoring use consistent with older adults' values and to prevent conflict and caregiver overreach.
Technology-Based Innovation for Independent Living: Policy and Innovation in the United Kingdom, Scandinavia, and the United States
(Journal of Aging & Social Policy, 2014) Berridge, Clara; Furseth, Peder Inge; Cuthbertson, Richard; Demello, Steven
Interest in utilizing technology to help older adults remain living at home is growing; however, uptake remains low. We present a conceptual framework for understanding independent living technology innovation within health and social services. Public policy and innovation in the United States, the United Kingdom, and Scandinavia are profiled as case studies. In all profiled countries, independent living technology is more rapidly advancing than associated state policy, regulation, and payment systems. The findings from this comparative analysis reveal areas for further exploration, including policy subsystem environments in which technologies and services are regulated, as well as trends and desires of older adults and their caregivers within particular cultural contexts.
Successful Aging and Its Discontents: A Systematic Review of the Social Gerontology Literature
(The Gerontologist, 2015) Martinson, Marty; Berridge, Clara
Purpose of the Study: The purpose of this study was to analyze the range of critiques of successful aging models and the suggestions for improvement as expressed in the social gerontology literature. Design and Methods: We conducted a systematic literature review using the following criteria: journal articles retrieved in the Abstracts in Social Gerontology, published 1987–2013, successful aging/ageing in the title or text (n = 453), a critique of successful aging models as a key component of the article. Sixty-seven articles met the criteria. Qualitative methods were used to identify key themes and inductively configure meanings across the range of critiques. Results: The critiques and remedies fell into 4 categories. The Add and Stir group suggested a multidimensional expansion of successful aging criteria and offered an array of additions. The Missing Voices group advocated for adding older adults’ subjective meanings of successful aging to established objective measures. The Hard Hitting Critiques group called for more just and inclusive frameworks that embrace diversity, avoid stigma and discrimination, and intervene at structural contexts of aging. The New Frames and Names group presented alternative ideal models often grounded in Eastern philosophies. Implications: The vast array of criteria that gerontologists collectively offered to expand Rowe and Kahn’s original successful model is symptomatic of the problem that a normative model is by definition exclusionary. Greater reflexivity about gerontology’s use of “successful aging” and other normative models is needed.
An Integrated Model of Co-ordinated Community-Based Care
(The Gerontologist, 2015) Scharlach, Andrew E.; Graham, Carrie L.; Berridge, Clara
Purpose of the Study: Co-ordinated approaches to community-based care are a central component of current and proposed efforts to help vulnerable older adults obtain needed services and supports and reduce unnecessary use of health care resources. Design and Methods: This study examines ElderHelp Concierge Club, an integrated community-based care model that includes comprehensive personal and environmental assessment, multilevel care co-ordination, a mix of professional and volunteer service providers, and a capitated, income-adjusted fee model. Evaluation includes a retrospective study (n = 96) of service use and perceived program impact, and a prospective study (n = 21) of changes in participant physical and social well-being and health services utilization. Results: Over the period of this study, participants showed greater mobility, greater ability to meet household needs, greater access to health care, reduced social isolation, reduced home hazards, fewer falls, and greater perceived ability to obtain assistance needed to age in place. Implications: This study provides preliminary evidence that an integrated multilevel care co-ordination approach may be an effective and efficient model for serving vulnerable community-based elders, especially low and moderate-income elders who otherwise could not afford the cost of care. The findings suggest the need for multisite controlled studies to more rigorously evaluate program impacts and the optimal mix of various program components.
Staff Empowerment Practices and CNA Retention: Findings From a Nationally Representative Nursing Home Culture Change Survey
(Journal of Applied Gerontology, 2018) Berridge, Clara; Tyler, Denise A.; Miller, Susan C.
This article examines whether staff empowerment practices common to nursing home culture change are associated with certified nursing assistant (CNA) retention. Data from 2,034 nursing home administrators from a 2009/2010 national nursing home survey and ordered logistic regression were used. After adjustment for covariates, a greater staff empowerment practice score was positively associated with greater retention. Compared with the low empowerment category, nursing homes with scores in the medium category had a 44% greater likelihood of having higher CNA retention (odds ratio [OR] = 1.44; 95% confidence interval [CI] = [1.15, 1.81], p = .001) and those with high empowerment scores had a 64% greater likelihood of having higher CNA retention (OR = 1.64; 95% CI = [1.34, 2.00], p < 001). Greater opportunities for CNA empowerment are associated with longerCNA retention. This research suggests that staffing empowerment practices on the whole are worthwhile from the CNA staffing stability perspective.
Breathing Room in Monitored Space: The Impact of Passive Monitoring Technology on Privacy in Independent Living
(The Gerontologist, 2016) Berridge, Clara
Purpose of the Study: This study examines articulations of the relationship between privacy and passive monitoring by users and former users of a sensor-based remote monitoring system. A new conceptualization of privacy provides a frame- work for a constructive analysis of the study’s findings with practical implications. Design and Methods: Forty-nine in-depth semistructured interviews were conducted with elder residents, family members, and staff of 6 low-income independent living residence apartment buildings where the passive monitoring system had been offered for 6 years. Transcribed interviews were coded into the Dedoose software service and were analyzed using methods of grounded theory. Results: Five diverse articulations of the relationship between privacy and passive monitoring emerged. The system pro- duced new knowledge about residents and enabled staff to decide how much of that knowledge to disclose to residents. They chose not to disclose to residents their reason for following up on system-generated alerts for 2 reasons: concern that feelings of privacy invasion may arise and cause dissatisfaction with the technology, and the knowledge that many resident users did not comprehend the extent of its features and would be alarmed. Implications: This research reveals the importance and challenges of obtaining informed consent. It identifies where boundary intrusion can occur in the use of passive monitoring as well as how changes to technology design and practice could create opportunities for residents to manage their own boundaries according to their privacy needs. The diversity of approaches to privacy supports the need for “opportunity for boundary management” to be employed as both a design and practice principle.
Active subjects of passive monitoring: responses to a passive monitoring system in low-income independent living
(Ageing & Society 37, 2017) Berridge, Clara
Passive monitoring technology is beginning to be reimbursed by third-party payers in the United States of America. Given the low voluntary uptake of these technologies on the market, it is important to understand the concerns and perspectives of users, former users and non-users. In this paper, the range of ways older adults relate to passive monitoring in low-income independent-living residences is presented. This includes experiences of adoption, non-adoption, discontinuation and creative ‘misuse’. The analysis of interviews reveals three key insights. First, assumptions built into the technology about how older adults live present a problem for many users who experience unwanted disruptions and threats to their behavioural autonomy. Second, resident response is varied and challenges the dominant image of residents as passive subjects of a passive monitoring system. Third, the priorities of older adults (e.g. safety, autonomy, privacy, control, contact) are more diverse and multi-faceted than those of the housing organisation staff and family members (e.g. safety, efficiency) who drive the passive monitoring intervention. The tension between needs, desires and the daily lives of older adults and the technological solutions offered to them is made visible by their active responses, including resistance to them. This exposes the active and meaningful qualities of older adults’ decisions and practices.
Medicaid Becomes the First Third-Party Payer to Cover Passive Remote Monitoring for Home Care: Policy Analysis
(2018-12) Berridge, Clara
Background: Recent years have seen an influx of location-tracking, activity-monitoring sensors, and Web-cameras to remotely monitor the safety of older adults in their homes and to reduce reliance on in-person assistance. The state of research on these monitoring technologies leaves open crucial financial, social, and ethical cost-benefit questions, which have prevented widespread use. Medicaid is now the first large third-party payer in the United States to pay for these technologies, and their use is likely to increase as states transition to managed long-term services and supports (MLTSS). Objectives: This is the first study to examine how state Medicaid programs are treating passive remote monitoring technologies. This study identifies (1) which states allow location tracking, sensor systems, and cameras; (2) what policies are in place to track their use; (3) what implementation processes and program monitoring mechanisms are in place; and (4) what related insights Medicaid program stakeholders would like to learn from researchers. Methods: Interviews were conducted with 43 state, federal, and managed care organization (MCO) Medicaid program stakeholders about how these technologies are used in state waivers serving community-dwelling older adults in 15 states, and what policies are in place to regulate them. The interviews were analyzed by the research team using the framework analysis method for applied policy research. Results: Two-thirds of the states cover location tracking and activity-monitoring sensors and one-third cover cameras, but only 3 states have specific service categories that allow them to track when they are paying for any of these technologies, impeding regulation and understanding of their use at the state and federal level. Consideration of ethical and social risks is limited, and states struggle to understand which circumstances warrant use. They are further challenged by extreme resource restrictions and transitions to MLTSS by MCOs inexperienced in serving this growing “high-need, high-cost” population. Conclusions: Decisions about Medicaid reimbursement of technologies that have the potential to dramatically alter the way older adults receive supportive services are being made without research on their use, social and ethical implications, or outcomes. At a minimum, new service categories are needed to enable oversight. Participants prioritized 3 research aims to inform practice: (1) determine cost-effectiveness; (2) identify what type of information beneficiaries want to be generated and whom they want it to be shared with; and (3) understand how to support ethical decision making for beneficiaries with cognitive impairment. These findings provide direction for future research and reveal that greater interaction between policy makers and researchers in this field is needed.

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