Social Work Faculty Publications

Children in Foster Care and Excessive Medications

Jill l. Littrell — Mon, 15 Apr 2013 08:02:44 PDT

Children in foster care system are more likely to receive diagnoses of major mental illness and to be medicated with powerful medications such as antipsychotic drugs. Reasons for the increased risk of the actual mental illnesses and for the diagnoses of illness among children in foster care are reviewed. The reliabilities of various diagnoses are considered. The legitimacy of the rationale for early medications to prevent later disability is discussed. The very real hazards of medicating with antipsychotics, anticonvulsants, stimulants, mood stabilizers and antidepressants are reviewed. A discussion of advocacy efforts occurring around the United States on behalf of medicated children in the foster care system is presented. Finally, changes being instituted by the federal government through the Department of Health, Education, and Welfare and the Government Accounting Office (GAO),following the hearing of December 1, 2011 convened by Senator Thomas Carper,are discussed.

Inequality and Its Discontents

Jill Littrell et al. — Fri, 15 Mar 2013 05:57:16 PDT

In the last two decades, the income and security of the individual middle class worker has declined and the gap between the rich and the poor has widened. We will examine those policies that strengthened the middle class after World War II, which included strengthening the bargaining power of labor. We will proffer suggestions for reviving the middle class now with particular focus on empowering labor. We will offer suggestions for the role of the practitioner in this endeavor.

Incorporating Information from Neuroscience and Endocrinology Regarding Sexual Orientation Into Social Work Education

Jill Littrell — Wed, 13 Mar 2013 11:12:25 PDT

The brains of heterosexual males and heterosexual females are different. Moreover, the brains of gay men are similar to heterosexual females whereas the brains of lesbians are similar to heterosexual males. Neuroscience research supporting these postulates is reviewed. The gestational processes that might explain the differences in brain structure and function corresponding with gender are reviewed. Following a discussion of the physiological bases for sexual orientation, a discussion of the physiological bases for the expression of gender related traits and a discussion of factors contributing to sexual identity are provided. Throughout the article, alternative ways to think about gender are suggested. The importance of integrating the information presented in this article into the curriculum of Social Work Education is explained.

The Mind-Body Connection: Not Just a Theory Anymore

Jill Littrell — Wed, 13 Mar 2013 11:00:30 PDT

The field of psychoneuroimmunology has witnessed an explosion of empirical findings during the last two decades. Research has documented the mechanisms through which stressful emotions alter white blood cell function. Stress diminishes white blood cell response to viral infected cells and to cancer cells. Moreover, vaccination is less effective in those who are stressed and wounds heal less readily in those who are stressed. While stress decreases the activity of some white blood cells, stress does not compromise the function of all types of white blood cells. Indeed, some types of autoimmune disease, which involve particular subsets of white blood cells, are exacerbated by stress.

The literature documents the efficacy of talk-therapy interventions in altering immune system parameters and enhancing the body’s ability to combat disease. The literature also documents the impact of the chronic stress of poverty on immune system function.

New Developments in Understanding Cardiovascular Disease and the Implications for Social Work

Jill Littrell — Wed, 13 Mar 2013 10:44:54 PDT

Cardiovascular disease is now viewed as an inflammatory disease. An index of chronic inflammation (viz., C-Reactive Protein) is as good a predictor of heart attacks as are fats in blood. The data suggest that stressful events are so closely associated with chronic inflammatory states, that the body’s stress response can be viewed as an inflammatory state. This paper summarizes and explains the link between stress and cardiovascular disease. Negative health outcomes, particularly for cardiovascular diseases, are higher among those of lower socio-economic status. Differential stress among socio-economic tiers is considered as an explanation for the disparities. The literature linking cardiovascular risk factors to the stressors of workplace unfairness and lack of control over working conditions is reviewed. The role of the stressor of racism in explaining the higher rates of cardiovascular mortality in African Americans is discussed. Finally, for societies with wider gaps in income between the rich and the poor, increased stress is explored as a possible explanation for the diminished health outcomes found across all socio-economic tiers. The implications for social work direct practice and macro-practice are considered.

Perspectives Emerging From Neuroscience On Why People Become Addicted And What To Do About It

Jill Littrell — Wed, 13 Mar 2013 05:21:29 PDT

This paper reviews the new ideas emerging from neuroscience regarding the question of why some people are compelled to use drugs. During the process of drug exposure, the brain’s motivational system is changed in ways that co-opts the individual’s motivational system. Changes in the brain’s motivational structures along with changes in the brain’s self-regulatory structures compel an individual to drug use. Ways to reverse those changes in an addicted brain have been identified, as have ways to enhance self-regulatory control. The information from neuroscience offers a new perspective on “loss of control” as well as offering implications for treatment.

Can a Diagnosis Be Epidemic, with Therapeutic Efforts the Catastrophe?

Jill Littrell — Tue, 12 Mar 2013 06:57:46 PDT

The diagnosis of Bipolar Spectrum Disorders (BSD) given for office visits has risen 40 fold for children and has risen dramatically for adults as well. Some of the growth may have been fueled by re-categorization of individuals who would previously have received diagnoses of major depression along with the widening of diagnostic criteria for BSD. Concomitant with the rise in BSD diagnoses, the number of adults and children receiving atypical antipsychotics has increased dramatically. Recent evidence finds that atypical antipsychotics cause considerable reduction in brain volume. It is thus imperative to ensure that those with diagnoses comprising BSD—Bipolar I, Bipolar II, and Bipolar Not Otherwise specified (NOS)—actually share a common etiology and are being appropriately treated. This paper reviews the history, evidentiary support, and implications associated with the expansion of the Bipolar Spectrum.

In Defense of the Community Reinvestment Act

Jill Littrell et al. — Tue, 12 Mar 2013 06:32:35 PDT

In the wake of the 2008 global financial crisis, the Community Reinvestment Act (CRA) of 1977 has probably received more media attention in the past two years than it garnered cumulatively over the previous 30 years. Numerous conservative pundits and commentators have blamed the CRA for the subprime crisis and the subsequent world-wide financial meltdown. Most social workers are probably unaware that the CRA is probably responsible for more investment, loans, and wealth creation in low and moderate income neighborhoods than any other single piece of federal legislation over the past 40 years. This paper highlights the following features about the CRA that social workers need to know: the CRA was created and passed only because of grassroots community organizing; the CRA has been directly or indirectly related to eight trillion dollars of investments, mortgage and small business loans in low income neighborhoods since 1977; community organizing has always been the primary enforcement mechanism of the CRA; contrary to widespread right-wing media accounts, the CRA was not responsible for the housing bubble and worldwide financial crisis in 2008. In this paper, we will articulate the veridical factors contributing to the financial collapse. Presently Congress is debating reforms for the financial sector and the way banking functions will be transacted in the future remains unclear. Regardless of the eventual restructuring of finance, moving forward, social workers should continue to advocate for legislation that will ensure housing for low and moderate income people.

The Controversy Over Antidepressant Drugs in an Era of Evidence-Based Practice

Jill Littrell et al. — Mon, 11 Mar 2013 13:46:21 PDT

Questions regarding the efficacy of antidepressant drugs have been a recent focus of attention in the national news both in print and in the television media. Many clients will have questions regarding what they can believe and how they can address mood problems. Social workers constitute a greater percentage of the mental health work force than any other profession. Thus, social workers will probably be asked by clients about these issues. This article presents information on the efficacy of antidepressants for both the short and long term. It covers adverse effects and withdrawal symptoms. Clients' self-determination should be honored. However, social workers can be of assistance in supplying facts relevant to decision making.

Community Organizing in Egypt During and After the Revolution

Fred Brooks et al. — Fri, 08 Mar 2013 08:05:02 PST

The Egyptian revolution that took place over 18 days in January and February of 2011 attracted international attention and coverage for several reasons. Not only was the world excited and inspired by the massive crowds in Tahrir Square, standing up, uncompromisingly, for their beliefs, but it instilled in people the sense that justice and change are truly possible. The Organizers' Forum provided a unique opportunity for North American organizers to hear from their brothers and sisters in Egypt, not only exhilarating stories about the strategies and tactics they used to oust Mubarak, but also the sobering challenges facing organizers today during the slow transition to democracy.

New Turf for Organizing: Family Child Care Providers

Fred Brooks — Fri, 08 Mar 2013 06:34:20 PST

Child-care providers are among the lowest paid wageworkers in the United States. Nationwide, less than 5 percent of child-care providers are represented by labor unions. This article addresses the question: How can family child-care providers be effectively organized? The author describes and analyzes Local 880 Service Employees International Union's effort to organize family child-care providers in Illinois. Adapting the grassroots-organizing model that they developed to organize homecare workers, Local 880 has over 2,200 signed authorization cards and over 1,500 members in the family child-care union. Even without formal recognition, the union won a pay increase for providers in 1999 and has filed numerous successful grievances about disputed back pay. Keys to 880's success in organizing family child-care providers were: (1) prior experience in homecare organizing, especially non-NLRB organizing, (2) experience with grassroots organizing, and maintaining unions without recognition, and (3) ability to influence statewide elections and legislative issues by becoming involved in direct politics and joining coalitions.

Don't Be a Blockhead: ACORN, Protest Tactics, and Refund Anticipation Loans

Robert Fisher et al. — Fri, 08 Mar 2013 06:18:53 PST

The recent proliferation of community-based responses to urban problems has been characterized by a shift away from protest tactics to more moderate approaches of building community and consensus, developing social capital, and identifying and improving local assets. This case study examines the persistence and effectiveness of protest tactics in a campaign by the Association of Community Organizations for Reform Now against H&R Block around predatory tax preparation practices. It reveals the potential of direct action, especially when local protests are coordinated nationally. This combination helps to transcend the inherent limits of both community-based activism and national-oriented advocacy efforts.

Resident Perception of Housing, Neighborhood, and Economic Conditions After Relocation From Public Housing Undergoing HOPE VI Redevelopment

Fred Brooks et al. — Thu, 07 Mar 2013 13:46:56 PST

Objective: This study evaluates participant perception of neighborhood, economic, and housing well-being of residents four and five years after forced relocation from a public housing complex in Atlanta, Georgia. Method: The study utilized a mixed-method posttest-only design with two data points. Focus groups with 93 participants combined qualitative, open-ended questions with quantitative measures. Results: Four years after relocation, residents living in homes/apartments found with Section 8 housing vouchers were faring better than residents who moved to other public housing projects. A majority of voucher users believed their house, neighborhood, and overall global living situation had improved since relocation. In the year between the first and second wave of focus groups 40% of voucher users had moved to a new house/apartment. Moving was associated with residents perceiving their situations improving in many categories. Implications: Our findings suggest HOPE VI developments are more likely to accomplish their objectives if the current administration continues full funding of the voucher program rather than implements the cutbacks it is currently proposing.

ACORN’s Accelerated Income Redistribution Project: A Program Evaluation

Fred Brooks et al. — Thu, 07 Mar 2013 13:34:54 PST

Objective. This study evaluated the community organization ACORN’s efforts to increase the uptake of families claiming the Earned Income Tax Credit (EITC) through door-to-door canvassing and managing free tax preparation clinics in three pilot cities. Method. The mixed-method program evaluation included administrative record review; a telephone survey (N = 1063), and individual and focus group interviews. Results. During the 2003 tax year ACORN prepared taxes at no charge for 3,850 families who collected a total of $4 million in EITC and other tax credits. In two pilot cities ACORN led all other free sites in number of returns filed. Canvassing and word of mouth were the most productive marketing tools for the free tax preparation sites. Conclusions. Canvassing appears to be effective outreach in getting families to take advantage of free tax preparation. ACORN’s approach to combining services and direct action organizing appears to be a good fit and sustainable.

Voucher Users and Revitalized Public Housing Residents Six Years After Displacement

Fred Brooks et al. — Thu, 07 Mar 2013 13:20:43 PST

Six years after displacement by a HOPE VI project this research examines residents who returned to the redeveloped community and residents who decided to keep their vouchers and were living in private sector housing. Respondents were compared on the following variables: application process and decision to move back, satisfaction with housing, material hardships, and perception of economic well-being. The study employed a static group comparison research design. Quantitative and qualitative data were collected from 56 respondents through five focus groups. Residents who moved back to the revitalized public housing were highly satisfied with their housing, had significantly fewer material hardships, and perceived their economic well-being more positively compared to residents remaining in the voucher program. Our results both support and expand upon previous empirical findings on the complex comparisons between voucher users and revitalized public housing residents.

The Status of Freud’s Legacy on Emotional Processing: Contemporary Revisions

Jill Littrell — Thu, 07 Mar 2013 08:17:36 PST

This paper evaluates, in light of current empirical data, several of the assumptions contributed to our field by Freud about how emotions operate. The idea that expression of emotions dissipates these emotions is evaluated. The idea that bottling up emotion results is ill health is reviewed. The idea that pain of trauma and loss needs to be confronted will be examined. Additionally, the assumption that traumatic events invariably result in distress will be discussed. It is argued that empirical findings reject the Freudian model of emotion as energy that must be discharged. Empirical findings also support the view that revisiting painful emotion can be helpful when the result is to find a new perspective on painful events. Thus, empirical literature rejects Freudian rationale for confronting prior trauma and loss, while offering new perspectives for how to handle distress resulting from trauma and loss.

Expression of Emotion: When It Causes Trauma and When It Helps

Jill Littrell — Thu, 07 Mar 2013 08:10:55 PST

The idea that clients should be encouraged to express strong emotion regarding the traumas they have suffered is widely assumed. This paper asks whether the empirical literature supports the underlying assumption that emotional expression leads to positive outcomes (better health and dissipation of distress). Studies in which individuals who have been given an opportunity to express emotions about past traumas are compared with subjects placed in appropriate control conditions are reviewed. The empirical literature suggests that eliciting emotion is harmful when it is not associated with reappraisal of past trauma, but helpful when the reappraisal occurs. The following guideline emerges: if trauma is to be revisited, it should be accompanied by reappraisal. Since this is sometimes difficult to engineer, alternative approaches for working with victims of trauma, not involving revisiting the trauma, are offered. Additionally, it is suggested that it can be helpful to identify the nature of the problem arising from the traumatic experience, and then provide therapeutic intervention that addresses the problem.

Is there Evidence for the Bipolar Spectrum and the Safety of Pharmaceutical Interventions?

Jill Littrell — Thu, 07 Mar 2013 07:59:30 PST

Social workers constitute a high proportion of mental health professionals and a high percentage of social workers provide mental health care. Thus, psychiatric diagnoses and pharmaceutical interventions are relevant for many social workers. This paper reviews the rise in the diagnoses of Bipolar spectrum disorders for both children and adults. It considers the safety of antipsychotic medications, a mainstay of treatment for children and adults, which, in addition to other well-documented negative side effects, have recently been shown to decrease brain volume by a significant percent. These issues are particularly relevant for children in the foster care system.

How Addiction Happens, How Change Happens, and What Social Workers Need to Know to Be Effective Facilitators of Change

Jill Littrell — Wed, 06 Mar 2013 08:04:43 PST

During the last two decades, neuroscience research has proliferated examining brain mechanisms that explain why some people are compelled to pursue drugs and alcohol. The findings suggest that addiction is independent of pleasure, and that drug seeking can be triggered outside of conscious awareness (Berridge, Robinson, & Aldridge, 2009; Goldstein et al., 2009; Kalivas, Volkow, & Seamans, 2005). The observations and conclusions from this research can be used to advantage in treating addiction. The use of social psychological principles, in the context of motivational interviewing, offers a platform for taking advantage of these new insights. After a brief sketch of the latest understanding of the physiological forces operating in addiction, the author examines those ways to interact with substance dependent clients that promote change without provoking resistance in this article. Action plans are later described that can supplant automatic, addiction-induced behaviors (Gollwitzer, Fujita, & Oettingen, 2004). Mechanisms such as building coping skills are discussed, that help in maintaining new behaviors. Some of these mechanisms are efficacious because they bolster the brain's self-regulatory capacity (Baumeister, Vohs, & Tice, 2007; Littrell, 2010). Thus, for every step in the change process, from resistance to change maintenance, validated guidelines for altering the outcome from addiction will be provided.

Why You Should Care About the Threatened Middle Class

Jill Littrell et al. — Tue, 19 Feb 2013 12:47:00 PST

In the last two decades, the income and security of the individual middle class worker has declined and the gap between the middle class and the wealthy has widened. We explain how this is bad for democracy, the economy, and the aggregate health of the nation. We examine the governmental policies and interventions that increased the middle class following the depression and maintained its vigor through the post-World War II period. The impetus for these changes in governmental policies in the 1930s was to end the Great Depression. We pose the question of whether a nation can recover from a depression without invigorating the middle class. We conclude that in order to recover from the current economic and financial crisis, the middle class must be strengthened.