The Michigan Stroke Transitions Trial (MISTT)
Investigators: Mathew Reeves (PI), Department of Epidemiology, College of Human Medicine; Paul Freddolino (Co-PI), School of Social Work; Anne Hughes (Co-PI), School of Social Work; Amanda Woodward (Co-PI), School of Social Work
Funder: Patient Centered Outcomes Research Institute (PCORI) – ($2.1 million from 2014-2017)
Description: One million stroke patients are discharged from US hospitals every year. Most of them return home, but the transition comes with many emotional, social, and health-related challenges for both stroke patients and their caregivers. These challenges are intensified by the abrupt nature of stroke, short hospital stays, and the multiple care settings that patients may use after leaving the hospital such as rehabilitation, skilled nursing, and home health care. If the transition is too difficult, stroke patients are often readmitted to the hospital, are slow to recover, and experience poor quality of life and dissatisfaction with care. Caregivers also experience significant stress.
Social workers play a vital role in healthcare systems by advocating for clients, providing counseling, and coordinating services to bridge the transition from hospital to home. Access to accurate information is also critical to patients and caregivers during the transitional care period. In this three-year study, we are testing the efficacy of two complementary interventions – a patient- and caregiver-centered case management program delivered by Social Work Case Managers (SWCM) and a patient-centered website that provides resources for communication, information, and support.
We are working with four Michigan hospitals to enroll 480 acute stroke patients as they are discharged. Patients will be randomly assigned to one of the following three groups: (1) usual care, (2) the SWCM program, and (3) the SWCM plus the website.
In the spirit of PCORI’s mission (www.pcori.org), patients, caregivers, and health care providers have been involved in the research process from the start. We are using data from a series of focus groups to inform our choice of outcome measures, the construction of the website, and the structure of the intervention. Patients and caregivers will participate in usability testing of the website before the intervention begins. We also have an advisory panel that includes members of all of these stakeholder groups that we meet with regularly for feedback.
International Comparison of Elder Care
Investigators: Amanda T. Woodward, School of Social Work and Ulla-Maija Koivula, Tampere University of Applied Science (Finland)
Description: Although rates vary across countries, globally the population is aging. As we live longer, the need for more and different types of services will continue to grow. At the same time, many countries are facing work force shortages in health care and social services as well as economic changes that require them to renegotiate their social welfare systems in politically acceptable ways. The goal of this project is to compare services for older adults across a variety of countries to identify individual, organizational, and societal factors that shape approaches to elder care and distill lessons from these comparisons to inform the development and delivery of services moving forward.
Initial comparisons focus on the United States and Finland. Future work will include Estonia and Romania as well as other countries in which the investigators develop connections.
The following questions guide the research:
- What are the cultural, historical, political, and social forces that shape service systems in each country?
- What influence do these forces have on the way services are structured and delivered, including who does and does not receive services and who delivers them?
- What can we learn from each country to help improve the structure and delivery of care for older adults globally?
The project draws on the work of other scholars, available national statistics, popular and social media, and focus groups and interviews with older adults, informal caregivers, and professionals involved in the development and implementation of policy and service provision.
Developing a Patient Assessment Tool to Optimize Telehealth Outcomes in Home Health Care Settings
Investigators: Paul P. Freddolino, School of Social Work and Amanda T. Woodward, School of Social Work
Description: A growing body of research suggests that the delivery of health-related services and information via a range of information and communication technologies (ICTs) such as email, the Internet, text messaging, Skype, and environmental and motion sensors (i.e., telehealth) can positively impact a variety of post-discharge outcomes by improving provider/patient communications. The use of these tools can depend on patient knowledge and skills to operate equipment; the particular tool’s user friendliness; and the extent to which patients perceive threats to autonomy, independence and quality of life, and to security, privacy, and confidentiality. At the same time, research by the investigators and others has found that many older adults are able and willing to learn new technologies.
Providers in community and home health care settings have not had access to reliable and valid assessments of patients’ readiness to engage with telehealth resources. The goal of this project is to develop and test such a tool that can help health care and social service providers identify appropriate telehealth resources, as well as the relevant training and support needed for individual patients and their caregivers to improve their likelihood of success in utilizing these resources.
Initial data collection is addressing respondents’ needs and potential barriers to technology-based support, as well as their level of comfort with and use of technology ranging from email, Smart phones, and webcams to electronic medical records and in-home telehealth units that remotely monitor patient symptoms. Two specific examples are presented to patients for them to react to: 1) a mock health support website with links to a variety of health information and related services; and 2) an in-home telehealth unit for monitoring data points such as weight, blood sugar, blood pressure, and oxygen levels. Based on these data, we will develop and test an assessment tool.
Piloting the Life History Calendar to Examine Dating Violence Predictors, Types, and Dynamics over Time
Investigators: Angie Kennedy, School of Social Work (PI) and Deborah Bybee, Department of Psychology (co-I). Students: Kristen Prock (PhD), Eva Palma Ramirez (PhD), Jennifer Onwenu (MSW)
Funding: MSU Faculty Initiatives Fund
Description: We are using a life history calendar approach to measure cumulative victimization and adversity over time as predictors of adolescent intimate partner violence within a sample of 150 young adult women ages 18-24. Study participants were recruited from MSU (n = 50), Lansing Community College (n = 50), and a variety of community sites (n = 50). We are assessing cumulative victimization (community violence, witnessing IPV within the family, physical maltreatment by a caregiver, and sexual victimization) beginning at age five, and capturing physical violence, coercive control, and sexual violence victimization and perpetration for each dating relationship reported by participants.
The life history calendar approach yields both quantitative and qualitative data. Key quantitative research questions will be addressed using cluster analysis, multilevel modeling, and multinomial regression. These questions include:
- Do dating violence dynamics vary across multiple relationships, and do these patterns change from early to late adolescence?
- Can meaningful types of dating violence, à la Johnson’s adult IPV typology, be identified?
- Are adverse childhood experiences such as cumulative victimization differentially predictive of dating violence types, and does childhood SES moderate these relationships?
Key qualitative research questions will be addressed using a grounded theory approach, with a sub-sample of 30 participants. The questions include:
- What are the key situational and contextual factors that shape young women’s use of violence?
- How do young women understand and cope with sexual violence within their relationships?
Early Care & Education for Child Welfare-Supervised Children: Outcomes & Cross-system Collaboration
Investigators: Sacha Klein, School of Social Work (Principal Investigator)
Funder: U.S. Administration for Children and Families, Office of Planning, Research & Evaluation ($18,000 during 2015)
Description: Through this contract, Dr. Klein is developing two research briefs regarding:
- the effects of early care and education (ECE) on child welfare-supervised children’s safety, permanency and well-being outcomes, and
- best practices for forming and sustaining early care and education – child welfare partnerships.
The first of these briefs describes the mounting empirical evidence that ECE can help the child welfare system achieve its goals of safety and well-being for young, maltreated children, but the effects of ECE on child permanency (foster placement stability) is less clear. Formal collaborations between child welfare and ECE service systems may increase opportunities for maltreated children to benefit from ECE, but the second brief highlights the fact this hypothesis has yet to be empirically tested. Further, there is very little research evidence available about the effects of cross-sectoral social service system collaborations of any kind on client outcomes.
The Effects of Early Care and Education Services on the Likelihood of Foster Placement: Evidence from a National Study of U.S. Children Referred to the Public Child Welfare System, 2015-2016
Investigators: Sacha Klein, School of Social Work (Co-Principal Investigator); Dr. Lauren Fries, recent graduate of Michigan State University School of Social Work (Co-Principal Investigator)
Funder: Project ABC - U.S. Substance Abuse and Mental Health Services Administration ($10,000)
Description: This contracted study is with the Project ABC care initiative in Los Angeles County, which is focused on service integration for young children 0-5 years old with emotional-behavioral problems. Dr. Klein and her collaborators are analyzing data from the second National Survey of Child and Adolescent Well-being. The goal of this research project is to determine if young children reported to the child welfare system who receive early care and education (ECE) services are less likely to be placed in foster care.