This study distinguishes clinically and theoretically meaningful subgroups of people experiencing homelessness based on their endorsement of personality difficulties, using nationally representative data of the civilian, noninstitutionalized population of the United States, inclusive of those reporting past-year homelessness ( = 704). A bias-adjusted three-step latent class analysis was used to estimate latent class measurement models; classify cases into the optimal class solution; and, using a maximum likelihood method, test the association between demographic and behavioral health covariates with class membership. Results show that the four-class solution was optimal. The largest class (35.44%) had high probability of endorsing each personality difficulty and had high rates of behavioral health disorders. The second class (26.51%) had higher levels of antisocial traits and greater probability of endorsing substance use disorders relative to third and fourth classes. The third-largest class showed minimal personality difficulties (24.40%) and had the lowest probability of meeting criteria for each behavioral health disorder considered. The final class showed high levels of relational instability and identity diffusion (13.65%) and had higher levels of mood and anxiety disorders and suicide attempt relative to second and third classes. In conclusion, personality difficulties are commonly endorsed by adults experiencing homelessness and show differential relationships to behavioral health conditions.

Instruments currently utilized in research on secondary traumatic stress (STS) fail to measure distress and impairment. To fill this gap, this article describes the development and initial validation of a new instrument designed to measure distress and impaired functioning related to work-related secondary trauma exposure. The Secondary Trauma Impact Scale (STIS) is a brief screening measure consisting of six items, each measuring a different domain of distress and impairment. Domains include social, occupational, familial, sexual, psychological, and physical functioning. Secondary analysis was conducted on data collected from 577 master's-level social workers for a previously reported study. Results strongly support the reliability and factorial, convergent, and discriminant validity of the STIS. The ability to explicitly measure secondary trauma-related distress and impairment with a reliable and valid instrument will allow social workers to obtain more precise estimates of the prevalence of STS, identification of risk and resilience factors, and evaluation of interventions targeting the impact of STS on individuals and organizations.

The National Institute on Alcohol Abuse and Alcoholism's (NIAAA) definition of alcohol use disorder (AUD) recovery stipulates two criteria: remission from DSM-5 AUD and cessation of heavy drinking. Importantly, these criteria allow for consideration of nonabstinent alcohol treatment outcomes. However, researchers have yet to assess potential predictors of the NIAAA recovery outcome. The current study examined associations between mental health and coping predictors of NIAAA recovery status in an AUD treatment sample. At baseline (BL) and end-of-treatment (EOT) research interviews in a clinical trial, participants ( = 118) completed questionnaires assessing alcohol dependence, mental health, and confidence levels in reducing heavy drinking, as well as alcohol use and DSM-5 AUD symptom endorsement. Logistic regression models tested the associations between chosen predictors and the odds of achieving NIAAA recovery. Twenty-four percent of individuals ( = 28) met both criteria for NIAAA recovery at EOT. Higher levels of BL state anxiety and anxiety sensitivity predicted lower odds of achieving NIAAA recovery, while greater confidence to reduce heavy drinking predicted increased odds of NIAAA recovery. Social workers are encouraged to continue assessing and addressing mental health in AUD treatment to help individuals with alcohol problems achieve their AUD recovery goals.

Black American adults often report higher rates of obesity and caregiving compared with other racial or ethnic groups. Consequently, many Black American caregivers and care recipients are obese or have obesity-related chronic conditions (e.g., diabetes, hypertension). This study investigated associations between caregiving and obesity among Black Americans, including the role of health behaviors and chronic conditions. The sample included data from 2015 and 2017 Behavioral Risk Factor Surveillance System for non-Hispanic Black (NHB) or African American adult caregivers ( = 2,562) and noncaregivers ( = 7,027). The association between obesity (dependent variable) and caregiving status, fruit consumption, vegetable consumption, physical activity, and number of chronic conditions (independent variables) were evaluated using hierarchical binomial logistic regressions. Caregiving, being female, and chronic conditions were associated with higher odds of obesity, while physical activity was associated with lower odds of obesity. Physical activity, diet, and chronic conditions did not account for differences in obesity among caregiving and noncaregiving Black Americans. Increasing understanding of health behaviors and chronic disease burden of NHB caregivers has implications for programs aiming to improve obesity-related outcomes for caregivers and recipients. Future research should investigate multilevel factors that contribute to observed differences.

Anxiety, depression, and psychological distress are public health concerns for Black emerging adults ages 18-29, given their prevalence in this population. However, we have scant empirical research investigating the prevalence and correlates of negative mental outcomes among Black emerging adults with a history of exposure to police use of force. Thus, the current study examined the prevalence and correlates of depression, anxiety, and psychological well-being and how they vary among a sample of Black emerging adults with a history of direct or indirect exposure to police use of force. Computer-assisted surveys were administered to a sample of Black emerging adults ( = 300). Univariate, bivariate, and multiple linear regression analyses were conducted. Black women with a history of direct or indirect exposure to police use of force had significantly less favorable scores on the depression and anxiety scales compared with Black men. Study findings suggest that Black emerging adults, particularly women, with a history of exposure to police use of force are at risk of experiencing adverse mental health outcomes. Future research with a larger and ethnically diverse sample of emerging adults that examines the prevalence and correlates of adverse mental health outcomes and how they vary by gender, ethnicity, and exposure to police use of force is warranted.

Housing plays a critical role in the care outcomes of individuals living with a HIV, yet few studies have examined the unique housing profiles of women living with HIV (WLH), especially among those belonging to low-income racial/ethnic minority groups. In this study, authors conducted a latent class analysis to generate latent profiles of women ( = 1,501) according to their housing status and household characteristics and assessed associations between classes and sociodemographic and behavioral characteristics and between classes and three HIV care outcomes: retention in care, viral suppression, and sustained viral suppression. A three-class model was selected using five dichotomized housing indicators: housing status, head of household status, living with minors, living with another adult, and disclosure of HIV status to adults with whom they live. While class 1 and class 2 had comparable HIV care outcomes, women in class 3-who were predominately unstably housed, living alone, and did not disclose their HIV status with those with whom they lived-had significantly lower crude odds of successful care outcomes. When accounting for sociodemographic and behavioral factors, significant differences in retention in care persisted. Findings underscore the need for tailored interventions for subgroups of low-income WLH and provide contextual details around the role of housing experiences.

Social isolation is common among individuals with schizophrenia spectrum and other psychotic disorders. Research indicates that social isolation relates to poorer mental health outcomes, depression, and negative symptoms, with less known about its relationship with positive symptoms. This study examined depression as a mediator in the relationships between positive symptoms (i.e., hallucinations and delusions) and social isolation among an early treatment phase sample in the United States. Data were obtained from the Recovery After an Initial Schizophrenia Episode project of the National Institute of Mental Health's Early Treatment Program. Participants ( = 404) included adults between ages 15 and 40 in a first episode of psychosis. Data were analyzed using structural equation modeling in Mplus (Version 8). The study showed that delusions ( = .095, = 0.04, < .05) and hallucinations ( = .076, = 0.03, < .01) were directly related to depression, and that both delusions ( = .129, = 0.06, < .05) and depression ( = .254, = 0.09, < .05) were directly related to social isolation. Findings of this study determined that depression functioned as a mediator in the relationships between positive symptoms and social isolation. Targeting psychosis symptomatology and depression in treatment, improving social skills and social support networks, and considering the role of stigma in social isolation are of great importance in the prevention of poorer mental health outcomes.

Multiply disadvantaged youths exhibit worse health and academic success than their less disadvantaged peers, possibly due to greater exposure to social status-based discrimination. Models that capture the additive burden of disadvantage in tandem with multiple forms of discrimination are needed to explicate the unique and combined impact of these factors on adolescent health and academic outcomes. In addition, protective factors like positive family and peer relationships may attenuate these relationships. This study used data from the Beyond High School Study ( = 9,658), which looked at the transition to adulthood among senior class cohorts from 12 high schools in western Washington state, to investigate the influence of multiple disadvantage, four types of discrimination, and protective resources on student physical and mental health and school grades. Results show that both increased multiple disadvantage statuses and experienced discrimination are associated with decrements across outcomes; however, effects are attenuated when protective resources are considered. Yet, as disadvantages mount, the buffering effect of peer and family resources are dampened. No interaction was found between experienced discrimination and protective resources on outcomes.

Guided by Bronfenbrenner's ecological systems framework and informed by the rejection-identification model, this study examined the relationship between acculturation, discrimination, and ethnic-racial identity (ERI) searching and affirmation among a sample of Latino youths ( 830; mean age = 12.2 years). Results revealed that higher levels of acculturation were associated with lower levels of searching and affirmation. Furthermore, higher perceived discrimination was associated with higher affirmation, but unrelated to searching. Finally, perceived discrimination significantly attenuated the negative associations between acculturation and adolescents' ERI searching and affirmation. The article concludes with a discussion of practice implications.

Relocation in older adulthood may occur due to triggering events, such as widowhood. Guided by Kahn and Antonucci's convoy model, this study explores the influence of volunteering on decision to relocate following the death of a spouse. Using three waves of data from the Health and Retirement Study (2006, 2008, and 2010), 5,146 community-dwelling married older individuals who were 65 years or older in 2008 were included. Findings from two multinomial logistic regression models showed that widows and widowers who were not volunteering in 2008 were more likely to move out of area in 2010 than their married counterparts, whereas the relationship between widowhood and relocation was not detected among those involved in volunteering. This article emphasizes the interdependency of social relationships and residences, a fundamental of one's material convoy, for older adults. Volunteering experiences may not only affect instrumental and emotional support after the loss of a key anchor in one's social convoy, but may also facilitate a widowed older adult to age in place rather than relocate.

Online research methodologies may serve as an important mechanism for population-focused data collection in social work research. Online surveys have become increasingly prevalent in research inquiries with young people and have been acknowledged for their potential in investigating understudied and marginalized populations and subpopulations, permitting increased access to communities that tend to be less visible-and thus often less studied-in offline contexts. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) young people are a socially stigmatized, yet digitally active, youth population whose participation in online surveys has been previously addressed in the literature. Many of the opportunities and challenges of online survey research identified with LGBTQ youths may be highly relevant to other populations of marginalized and hard-to-access young people, who are likely present in significant numbers in the online environment (for example, ethnoracialized youths and low-income youths). In this article, the utility of online survey methods with marginalized young people is discussed, and recommendations for social work research are provided.

Research has consistently documented lower colorectal cancer (CRC) screening rates for racial and ethnic minority populations, with the lowest screening rates among American Indians (AIs). Given the low CRC screening rates among AIs residing in the Northern Plains region, the objective of this research was to identify CRC screening correlates for Northern Plains AIs. With a sample of 181 AIs age 50 years or older, the authors used Andersen's behavioral model to examine the following factors related to receipt of CRC screening: (a) predisposing factors-age, education, marital status, and gender; (b) need factors-personal and family history of cancer; and (c) enabling factors-having a particular place to receive medical care, annual health checkup, awareness of the availability of CRC screening, knowledge of CRC, and self-efficacy of CRC. Nested logistic regression identified the following correlates of receipt of CRC screening: (a) predisposing factors-older age; (b) need factors-having a personal history of cancer; and (c) enabling factors-having an annual health checkup, greater awareness of CRC screening, and greater self-efficacy of CRC. Given the findings, prevention and intervention strategies, including public awareness and education about CRC screening, are promising avenues to reduce cancer screening disparities among AIs.

The term "milieu therapy" (MT) is commonly used in mental health literatures. However, because MT has historically encompassed a wide range of practices, it has invited the criticism that it is simply an attractive theoretical packaging of the time clients spend between other specified interventions, such as individual and group therapies. Some have suggested that, because of its conceptual ambiguity, MT should be abandoned altogether. Despite these challenges, MT endures as a common approach to social work practice in a range of clinical settings. This article describes a study that used ethnography to investigate the perspectives of workers from two mental health organizations that claim to provide MT. By analyzing four themes common to both sites, this article brings exploratory empirical findings to bear on the question of what constitutes MT in contemporary mental health organizations. Participants reported that (a) everything in the physical and social milieu has the potential to affect therapeutic change; (b) the milieu itself functions as a therapeutic agent; (c) the milieu provides a context for modeling and practicing desired behaviors; and (d) MT is a principle-based ethos, rather than a set of specific interventions. Implications of these findings for social work research, practice, and funding are discussed.

Using a nationally representative U.S. sample, this study examined the extent to which neighborhood characteristics affected length of inpatient stay (LOS) in the United States. Data were obtained from the 2012 Area Health Resource Files. A total of 3,148 U.S. counties were included in the study. Generalized linear models and the geographically weighted regression model were used to examine the extent to which neighborhood characteristics affected LOS and its spatial variation. Exploratory spatial data analysis was also conducted to examine the geographic patterns in LOS. Hospital bed capacity was found to be the strongest predictor of LOS. Counties with a lower poverty rate, a lower uninsured rate, a higher proportion of female residents, a higher proportion of residents living in urban areas, and more diverse racial groups had a longer LOS. Significant spatial clustering pattern of LOS was also found. Findings suggest that social work professionals should be aware of spatial disparity in health care resources and develop ways of providing equitable health care for vulnerable populations in socioeconomically disadvantaged neighborhoods.

This article seeks to establish time-based trajectories of health and behavioral health services utilization for community corrections-involved (CCI) adults and to examine demographic and clinical correlates associated with these trajectories. To accomplish this aim, the authors applied a latent class growth analysis (LCGA) to services use data from a sample of rural CCI adults who reported their medical, mental health, and substance use treatment utilization behavior every 60 days for 1.5 years. LCGA established 1.5-year trajectories and demographic correlates of health services among rural CCI adults. For medical services, three classes emerged (stable-low users, 13%; stable-intermediate users, 40%; and stable-high users, 47%). For mental health and substance use services, three classes emerged (stable-low, 69% and 61%, respectively; low-baseline-increase, 10% and 12%, respectively; high-baseline decline, 21% and 28%, respectively). Employment, gender, medication usage, and depression severity predicted membership across all services. Results underscore the importance of social workers and other community services providers aligning health services access with the needs of the CCI population, and highlight CCI adults as being at risk of underservice in critical prevention and intervention domains.

Support from research assistants (RAs) is often framed as a resource to facilitate faculty research productivity, yet most assistant professors have received minimal training on how to effectively make use of this resource. This study collected data from a national sample of assistant professors to examine tasks RAs are asked to perform, satisfaction with RA work, challenges in working with RAs, and lessons learned to be successful. Authors used a sequential mixed-methods design, first conducting a Web-based survey with 109 assistant professors in social work schools with doctoral programs, then qualitative interviews with a subset of 13 respondents who volunteered to talk more about their experiences. Evidence indicated low levels of satisfaction regarding the preparation of students for RA work, particularly among those assistant professors working with first-year doctoral students. Primary challenges included lack of student skills and commitment and sufficient time to supervise and train students. Recommendations include careful assessment of student skills at the start of the relationship and setting clear expectations. Social work programs can improve faculty-RA relationships by training new assistant professors on how to support and manage RAs and training incoming students on basic research skills for their work as RAs.

The Short Employment Hope Scale (EHS-14) has been developed in the United States to assess an individual's level of psychological self-sufficiency-a complementary measure to the widely used economic self-sufficiency in workforce development programs. This study examined the comparability of the EHS-14 between U.S. and South Korean low-income job seeker groups. A multisample confirmatory factor analysis (CFA) and a series of invariance tests were conducted to validate EHS-14 using two independent samples. A latent means analysis (LMA) was used to test the latent mean difference between the two samples. The results indicate that CFAs on both U.S. and South Korean samples verified the four-factor structure of EHS-14. The study also found evidence for cross-national equivalence, based on satisfying configural, metric, scalar, and factor covariance invariance. LMA results found no significant difference between the two samples. EHS-14 was found to be a reliable and valid measure with cross-cultural applicability in the South Korean socio-politico-economic context. EHS-14 can be used to benchmark the client empowerment process and monitor individualized human development paths to employment success.

Recently revised standards for social work practice in schools encourage data-informed school climate interventions that implicitly require invariant measures of school climate. Invariant measures have the same meaning, scale, and origin across different groups of respondents. Although noninvariant measures bias statistical analyses and can lead users to erroneous conclusions, most school climate measures have not been tested for invariance. This study examines the invariance of the Tripod School Climate Index. Exploratory, confirmatory, and multiple-group confirmatory factor analyses were conducted on data collected from 66,531 students across 222 schools. Results indicate that the index is an excellent fit for the data and invariant by student grade level, demographic background, prior achievement, and dropout risk. Results imply that student responses can be validly aggregated to create school-level scores. The index will not bias studies of school climate interventions or bivariate analyses comparing perceptions of school climate across subgroups of students attending the same school. Given the centrality of school climate interventions to social work practice in schools and the consequences of noninvariance, the development of an index with these properties is an important contribution to the field.

This article examines the tangible needs and external stressors experienced by Chinese American families with a member living with schizophrenia, in the context of a six-month pilot study of family psychoeducation. Therapists' notes from 117 family and group sessions were analyzed. The families expressed concerns regarding housing, finance, work, study, and the shortage of bilingual psychosocial services. Interacting with government offices and social services agencies caused anxiety and frustration, partly due to the high stakes involved given their low socioeconomic status, and partly due to the bureaucracy. As immigrants, study participants had needs for language translation, knowledge about resources, and advocacy by case managers. This study also highlights the importance of interventions beyond the micro individual level to the mezzo and macro levels, where changes in organizations and policies are necessary.