BACKGROUND At least 2·7 million children worldwide are estimated to live in institutional care, w... more BACKGROUND At least 2·7 million children worldwide are estimated to live in institutional care, with former Soviet Union countries having the highest rates of child institutionalisation in the world. In response, many countries are supporting family reunification as a primary de-institutionalisation strategy. Previous literature shows that the family offers a better environment for children and adolescents, yet little is known about the challenges and opportunities encountered by families upon reintegration. Research on how traumatic experiences associated with institutionalisation and de-institutionalisation affect family reunification is also scarce. METHODS Children and adolescents aged 8-16 years and their parents or next of kin (n=47) were recruited through five child institutions in Azerbaijan. Semi-structured interviews included questions about children's and caregiver's experiences during the readjustment process. Four coders thematically coded the interviews. FINDINGS Both adolescents and caregivers emphasised a desire to be reunited. Conversely, young people often manifested behavioural issues (ie, social withdrawal, emotional dysregulation, and overtly aggressive behaviours) after reunification; caregivers further struggled to respond to these reactions. Accordingly, family members discussed their goals and challenges associated with reunification, primarily focusing on a desire to build a better sense of familial trust and communication. Family members also highlighted the importance of learning to manage unexpected role conflicts and contradictory conceptions of authority, particularly among male adolescents. INTERPRETATION To improve the emotional and psychosocial wellbeing of reunifying children and their caregivers, deinstitutionalisation strategies can incorporate culturally responsive, trauma-informed, and attachment-based interventions, which can heal relational traumas and further equip children and caregivers with coping, stress management, and emotional regulation skills. FUNDING The study was funded by the Center for Health Administration Studies at the University of Chicago.
Individuals with a history of opioid use are disproportionately represented in Illinois jails and... more Individuals with a history of opioid use are disproportionately represented in Illinois jails and prisons and face high risks of overdose and relapse at community reentry. Case management and peer recovery coaching are established interventions that may be leveraged to improve linkage to substance use treatment and supportive services during these critical periods of transition. We present the protocol for the Reducing Opioid Mortality in Illinois (ROMI), a type I hybrid effectiveness-implementation randomized trial of a case management, peer recovery coaching and overdose education and naloxone distribution (CM/PRC + OEND) critical time intervention (CTI) compared to OEND alone. The CM/PRC + OEND is a novel, 12-month intervention that involves linkage to substance use treatment and support for continuity of care, skills building, and navigation and engagement of social services that will be implemented using a hub-and-spoke model of training and supervision across the study sites. At least 1000 individuals released from jails and prisons spanning urban and rural settings will be enrolled. The primary outcome is engagement in medication for opioid use disorder. Secondary outcomes include health insurance enrollment, mental health service engagement, and re-arrest/recidivism, parole violation, and/or reincarceration. Mixed methods will be used to evaluate process and implementation outcomes including fidelity to, barriers to, facilitators of, and cost of the intervention. Videoconferencing and other remote processes will be leveraged to modify the protocol for safety during the COVID-19 pandemic. Results of the study may improve outcomes for vulnerable persons at the margin of behavioral health and the criminal legal system.
Tracing explanatory narratives of mask-wearing throughout COVID-19, we argue that multiple narrat... more Tracing explanatory narratives of mask-wearing throughout COVID-19, we argue that multiple narratives contribute to the global experience of COVID-19, making it as much a social and political object as it is a scientific one. This assumption drives our commitment to take seriously alternative narratives that do not conform to dominant ones in order to examine how structures of power might privilege particular types of ‘truths’ and with what consequences. We see this reflective piece as a re-articulation of social work’s historic call to interrogate dominant ways of knowing, particularly the ways in which science obscures its own power and politics and sidelines other narratives in the process.
Deinstitutionalization reforms in the post-Soviet region-the region with the highest rate of inst... more Deinstitutionalization reforms in the post-Soviet region-the region with the highest rate of institutional care worldwide-are aimed at reducing the number of children in institutions. To develop context-specific gatekeeping strategies and prevent new cohorts of children from entering institutions, it is crucial to understand the local factors that contribute to institutional placement. Using a phenomenological approach, this qualitative study explores the contexts of institutional placement of children in Azerbaijan from their caregivers' perspectives. We conducted semi-structured qualitative interviews of the parents and primary caregivers (N = 26) of children placed in the institutional care system in Azerbaijan. Using systematic thematic analysis with inductive coding, we identified caregivers' reasons for placing children in the system, and inferred the life circumstances that led parents-women in particular-to be more likely to place their children in institutions. Our findings reveal multiple, gendered pathways that contribute to such placement. The majority of caregivers were single mothers, many of whom had divorced their husbands in response to domestic violence (often attributed to the husband's substance addiction). The strong stigma against divorce led women to be ostracized by close family members, often leaving them without economic and social support. Because of the limitations of public benefits available in the region, publicly-funded child institutions are often the only remaining way to provide education and care for their children. This qualitative study shows the importance of addressing the social and economic needs of parents, single mothers in particular, to prevent child institutional placement in the post-Soviet Caucasus region.
The evaluation of mental health services is an important tool for understanding treatment efficac... more The evaluation of mental health services is an important tool for understanding treatment efficacy, aswell as for engaging clients in their treatment. Because adolescents are often more reluctant consumers ofmental health services relative to adults, progress monitoring and evaluation may be particularly importantwith these clients. Standardized assessment tools are useful, but the use of open-ended questionsaddressing perceived change and progress made toward recovery is likely to yield important information ina developmentally appropriate way. This mixed-method exploratory study captured adolescents' (N=74)perceptions of their mental health status in their own words, as well as specific changes they have noted intheir mental health at six months following a brief psychiatric hospitalization. Adolescents' qualitativedescriptions of their mental health status were classified: "improved," "worse," "mixed," and "same." Theseoutcome classifications corresponded well with baseline and follow-up scores on several standardizedmeasures of mental health and wellbeing. In articulating their perceptions of change over time, participantsdiscussed symptoms, interpersonal relationships, coping, and future orientation. Our findings revealadolescents' perspectives on recovery and well-being, and suggest ways that treatment evaluation can beadapted to better meet the developmental needs of young people.
The capacity to regulate emotional states is a key building block of human development and one th... more The capacity to regulate emotional states is a key building block of human development and one that is impaired among many children involved in the child welfare system. This article explores how the literature on emotion regulation can inform child welfare practice. While the concept of emotion regulation and its measurement suffer from a number of problems, the literature provides a scientifically validated, if complicated, view of how some children in the child welfare system are left ill prepared to handle their emotions effectively. The article offers a number of concepts that can inform the application of current clinical perspectives in use in child welfare. A number of already-developed clinical protocols to increase emotion regulation competence can be imported into child welfare settings, and the emotion regulation literature offers a rich array of new targets and strategies from which to build new interventions and programs.
BACKGROUND At least 2·7 million children worldwide are estimated to live in institutional care, w... more BACKGROUND At least 2·7 million children worldwide are estimated to live in institutional care, with former Soviet Union countries having the highest rates of child institutionalisation in the world. In response, many countries are supporting family reunification as a primary de-institutionalisation strategy. Previous literature shows that the family offers a better environment for children and adolescents, yet little is known about the challenges and opportunities encountered by families upon reintegration. Research on how traumatic experiences associated with institutionalisation and de-institutionalisation affect family reunification is also scarce. METHODS Children and adolescents aged 8-16 years and their parents or next of kin (n=47) were recruited through five child institutions in Azerbaijan. Semi-structured interviews included questions about children's and caregiver's experiences during the readjustment process. Four coders thematically coded the interviews. FINDINGS Both adolescents and caregivers emphasised a desire to be reunited. Conversely, young people often manifested behavioural issues (ie, social withdrawal, emotional dysregulation, and overtly aggressive behaviours) after reunification; caregivers further struggled to respond to these reactions. Accordingly, family members discussed their goals and challenges associated with reunification, primarily focusing on a desire to build a better sense of familial trust and communication. Family members also highlighted the importance of learning to manage unexpected role conflicts and contradictory conceptions of authority, particularly among male adolescents. INTERPRETATION To improve the emotional and psychosocial wellbeing of reunifying children and their caregivers, deinstitutionalisation strategies can incorporate culturally responsive, trauma-informed, and attachment-based interventions, which can heal relational traumas and further equip children and caregivers with coping, stress management, and emotional regulation skills. FUNDING The study was funded by the Center for Health Administration Studies at the University of Chicago.
Individuals with a history of opioid use are disproportionately represented in Illinois jails and... more Individuals with a history of opioid use are disproportionately represented in Illinois jails and prisons and face high risks of overdose and relapse at community reentry. Case management and peer recovery coaching are established interventions that may be leveraged to improve linkage to substance use treatment and supportive services during these critical periods of transition. We present the protocol for the Reducing Opioid Mortality in Illinois (ROMI), a type I hybrid effectiveness-implementation randomized trial of a case management, peer recovery coaching and overdose education and naloxone distribution (CM/PRC + OEND) critical time intervention (CTI) compared to OEND alone. The CM/PRC + OEND is a novel, 12-month intervention that involves linkage to substance use treatment and support for continuity of care, skills building, and navigation and engagement of social services that will be implemented using a hub-and-spoke model of training and supervision across the study sites. At least 1000 individuals released from jails and prisons spanning urban and rural settings will be enrolled. The primary outcome is engagement in medication for opioid use disorder. Secondary outcomes include health insurance enrollment, mental health service engagement, and re-arrest/recidivism, parole violation, and/or reincarceration. Mixed methods will be used to evaluate process and implementation outcomes including fidelity to, barriers to, facilitators of, and cost of the intervention. Videoconferencing and other remote processes will be leveraged to modify the protocol for safety during the COVID-19 pandemic. Results of the study may improve outcomes for vulnerable persons at the margin of behavioral health and the criminal legal system.
Tracing explanatory narratives of mask-wearing throughout COVID-19, we argue that multiple narrat... more Tracing explanatory narratives of mask-wearing throughout COVID-19, we argue that multiple narratives contribute to the global experience of COVID-19, making it as much a social and political object as it is a scientific one. This assumption drives our commitment to take seriously alternative narratives that do not conform to dominant ones in order to examine how structures of power might privilege particular types of ‘truths’ and with what consequences. We see this reflective piece as a re-articulation of social work’s historic call to interrogate dominant ways of knowing, particularly the ways in which science obscures its own power and politics and sidelines other narratives in the process.
Deinstitutionalization reforms in the post-Soviet region-the region with the highest rate of inst... more Deinstitutionalization reforms in the post-Soviet region-the region with the highest rate of institutional care worldwide-are aimed at reducing the number of children in institutions. To develop context-specific gatekeeping strategies and prevent new cohorts of children from entering institutions, it is crucial to understand the local factors that contribute to institutional placement. Using a phenomenological approach, this qualitative study explores the contexts of institutional placement of children in Azerbaijan from their caregivers' perspectives. We conducted semi-structured qualitative interviews of the parents and primary caregivers (N = 26) of children placed in the institutional care system in Azerbaijan. Using systematic thematic analysis with inductive coding, we identified caregivers' reasons for placing children in the system, and inferred the life circumstances that led parents-women in particular-to be more likely to place their children in institutions. Our findings reveal multiple, gendered pathways that contribute to such placement. The majority of caregivers were single mothers, many of whom had divorced their husbands in response to domestic violence (often attributed to the husband's substance addiction). The strong stigma against divorce led women to be ostracized by close family members, often leaving them without economic and social support. Because of the limitations of public benefits available in the region, publicly-funded child institutions are often the only remaining way to provide education and care for their children. This qualitative study shows the importance of addressing the social and economic needs of parents, single mothers in particular, to prevent child institutional placement in the post-Soviet Caucasus region.
The evaluation of mental health services is an important tool for understanding treatment efficac... more The evaluation of mental health services is an important tool for understanding treatment efficacy, aswell as for engaging clients in their treatment. Because adolescents are often more reluctant consumers ofmental health services relative to adults, progress monitoring and evaluation may be particularly importantwith these clients. Standardized assessment tools are useful, but the use of open-ended questionsaddressing perceived change and progress made toward recovery is likely to yield important information ina developmentally appropriate way. This mixed-method exploratory study captured adolescents' (N=74)perceptions of their mental health status in their own words, as well as specific changes they have noted intheir mental health at six months following a brief psychiatric hospitalization. Adolescents' qualitativedescriptions of their mental health status were classified: "improved," "worse," "mixed," and "same." Theseoutcome classifications corresponded well with baseline and follow-up scores on several standardizedmeasures of mental health and wellbeing. In articulating their perceptions of change over time, participantsdiscussed symptoms, interpersonal relationships, coping, and future orientation. Our findings revealadolescents' perspectives on recovery and well-being, and suggest ways that treatment evaluation can beadapted to better meet the developmental needs of young people.
The capacity to regulate emotional states is a key building block of human development and one th... more The capacity to regulate emotional states is a key building block of human development and one that is impaired among many children involved in the child welfare system. This article explores how the literature on emotion regulation can inform child welfare practice. While the concept of emotion regulation and its measurement suffer from a number of problems, the literature provides a scientifically validated, if complicated, view of how some children in the child welfare system are left ill prepared to handle their emotions effectively. The article offers a number of concepts that can inform the application of current clinical perspectives in use in child welfare. A number of already-developed clinical protocols to increase emotion regulation competence can be imported into child welfare settings, and the emotion regulation literature offers a rich array of new targets and strategies from which to build new interventions and programs.
Uploads
Papers by Emily Claypool