UMBC School of Social Work

Permanent URI for this collectionhttp://hdl.handle.net/11603/14023

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“She Didn’t Know [What] She Was Talking About, Because She Was a Woman”: The Perspective of Service Providers on Rohingya Refugees’ Adjustment to US Gender Roles
(Springer, 2025-04-02) Deshwal, Shivangi; Evans, Kerri
When Rohingya refugees first started to arrive to the Unaccompanied Refugee Minor (URM) Program in the USA around 2013, the service providers felt ill prepared to provide for their nuanced needs because of the lack of information available and therefore an inability to appropriately tailor services to this new minority population. Therefore, this study seeks to understand (1) how service providers navigate conflicting gender roles during the teenage years among Rohingya refugees and (2) what strategies the service providers found effective in working with individuals from patriarchal societies. The qualitative data come from 10 focus groups (consisting of 23 people) who work in URM foster care programs across the USA. Our results show that service providers note the patriarchal society and upbringing as protectionist ideology; that youth often stay within traditional gender roles; that youth need to navigate the conflicting laws and norms between Islam and US culture; that there are nuances among Islam and the role of women; and that service providers struggle to fully understand these strict traditional gender roles and how they manifest in youth behavior. Additionally, our results indicate that effective strategies in working with refugees from patriarchal societies include the need for cultural and religious welcome in public schools, and assisting youth with the adjustment to a more open society. Implications for clinical and macro social workers are provided.
Foster Care for Unaccompanied Immigrant and Refugee Children and Youth
(Oxford University Press, 2024-10-23) Iii, Robert G. Hasson; Evans, Kerri; Crea, Thomas M.
Unaccompanied children are immigrants under 18 years old without a parent or guardian at their time of arrival to their host countries. In the United States, the numbers of unaccompanied children arriving at the Southern border have steadily increased since 2012, with a record number arriving in 2023. Many unaccompanied children migrate to the US to escape extreme poverty and community violence, or to reunite with family members. Like other displaced populations, unaccompanied children are vulnerable to further violence and exploitation during their migration journeys and after arrival to the US. Yet, this population is uniquely vulnerable given their developmental needs and often complicated health and mental health challenges.The vast majority of unaccompanied children (98.9%) are placed with community sponsors and are essentially lost to follow up. A small number enter foster care under the auspices of the Office of Refugee Resettlement (ORR), either through the long term foster care program or the unaccompanied refugee minors program. Theis introduction of the paperpaper provides an overview of the foster care process and policies in place to ensure the safety and wellbeing of unaccompanied children who require foster care in the US. There are sections ofs of paper begins with analysis of key policies impacting unaccompanied children, presents information related to ORR’s foster care system in the US, followed by in-depth analysis of the placement process and well-being outcomes from the existing empirical literature. The paper conclusion includesdes with a discussion of future policy developments to ensure the best interests of unaccompanied children are identified and met in the context of rapidly changing circumstances related to global migration.
Considerations for Unaccompanied Immigrant Children in the Child Welfare Reform Debate
(Sage, 2025-02-08) Lyon, Zayna; Evans, Kerri; Mack, Linda-Jeanne M.; Pardue-Kim, Morgan
Unaccompanied immigrant children represent a growing portion of children involved in the U.S. child welfare system (CWS). Yet, the abolition or reform of the CWS debate has overlooked the system that serves unaccompanied children—the Office of Refugee Resettlement . This paper examines unaccompanied children’s needs within this debate, and applies key concepts to issues including preemptive investigations, reunification, community strengthening, and balancing monitoring with independence. Given the dearth of literature necessary to argue for one side or another, we do not take a stance in the debate. We instead discuss implications for policy, practice, and research, including the need for access to ORR data and more participatory research.
Exploring the Relationship Between Nursing Staff and Family Members' Appraisal of Resident Care in Nursing Homes: The Role of Facility Ownership
(MDPI, 2025-02-11) Millar, Roberto; Diehl, Christin; Kusmaul, Nancy; Stockwell, Ian
Background/Objectives: To address long-standing staffing challenges and elevating care standards in the United States, new legislation will require a minimum of 0.55 h per resident day (HPRD) of registered nurse (RN) care, 2.45 HPRD of certified nursing aide (CNA) care, and a combined total of 3.48 HPRD across any combination of nursing staff. We examine differences in family members? views of care quality between facilities meeting the minimum staffing requirements and those that do not and whether there is any difference in those associations by facility ownership. Methods: This cross-sectional study utilized public data from 218 Medicare and Medicaid-certified nursing facilities in Maryland, collected in 2023. We used regression analyses to examine the association between staffing requirements and quality of care ratings, considering facility ownership status as a potential moderator. Results: Compared to facilities with CNA staffing levels below the cut off, facilities that met the CNA staffing requirement were rated more favorably by family members in overall quality and across the subdomains of staffing, care, activities, and security. In contrast, meeting the RN 0.55 cut off was not associated with family ratings across any quality domain. A facility for-profit status did not moderate the relationship between staffing and family ratings. Conclusions: These results suggest that CNA staff time is a significant driver of care quality and that non-profit facilities may already be closer to meeting new federal requirements. These findings highlight the need for regulations that support the minimum nursing staffing requirements to enhance care quality. Future research should identify the specific factors contributing to higher quality care in non-profit facilities and explore ways to implement these practices in for-profit settings.
Women's Formal Help-Seeking Before and After Their Abusive Partner Initiates Relationship Violence Treatment
(Sage, 2023-02-01) Murphy, Christopher; Nnawulezi, Nkiru; Ting, Laura
Intimate partner violence survivors (N=122) reported on formal help-seeking before and after their male partners enrolled in a Relationship Violence Intervention Program (RVIP). At baseline, only 20% of survivors had ever received domestic abuse (DA) counseling. DA counseling was more common among survivors with more extensive partner abuse exposures, and for black women residing in suburban versus urban communities. New help-seeking was associated with survivor perceptions of the abusive partner's stage of change. RVIP impact may be enhanced through culturally sensitive survivor outreach that is responsive to a broad range of needs and includes repeated contact over time.
The effects of treatment for substance use problems on intimate partner violence: A review of empirical data
(Elsevier, 2010-09-01) Murphy, Christopher; Ting, Laura
Population and clinical studies document an association between intimate partner violence (IPV) and substance use problems. The current review addressed the question of whether, and to what extent, treatment for substance use problems is associated with reductions in partner abusive behavior. Data from naturalistic studies were used to examine the prevalence and frequency of IPV before and after substance use treatment, IPV among stably remitted versus relapsed cases after treatment, and factors that may explain observed reductions in partner violence. On average, the prevalence of IPV was 2-3 times higher before substance use treatment than after treatment, and the relative risk for IPV after treatment was 2-3 times greater for relapsed versus remitted cases. Small to moderate effect sizes were observed for reductions in the frequency of IPV after substance use treatment, with large effects observed for reductions in psychological aggression. Both reduced alcohol consumption and improved relationship functioning appear to account for observed reductions in partner abuse.
Nursing Facility Characteristics Are Differentially Associated With Family Satisfaction and Regulatory Star Ratings
(Southern Gerontological Society, 2025-01-08) Millar, Roberto J.; Diehl, Christin; Kusmaul, Nancy; Stockwell, Ian
Research suggests that nursing facility structural characteristics are important contributors toward residents’ quality of care. We use 2021 data from 220 Maryland nursing facilities to examine associations between two different quality-of-care metrics: family satisfaction and Care Compare five-star quality ratings. We used descriptive statistics to explore differences in quality metrics across facility ownership (for-profit vs. non-profit), geographic location (urban vs. rural), and resident census (1–60, 61–120, and 121+). Relationships were examined across overall ratings, as well as across subdomains of the two frameworks (e.g., staffing). Family members of residents in non-profit, rural, and low-census facilities rated facilities higher. Non-profit and low-resident census facilities were more likely to be rated four or five stars, while no significant association was observed across geographic location, or interactions across structural factors. Findings emphasize the need for comprehensive quality-of-care frameworks that explore quality care across stakeholders and types of facilities.
Use of Design Thinking to Develop Approaches to Collect and Use Person-Centered Dementia Care Measures in Low-Resource Long-Term Care Settings
(Wiley, 2024) Corazzini, Kirsten; Lepore, Michael; Kusmaul, Nancy; Wang, Jing; Rataj, Alison; Kim, Yoon Chung; Murray, Briana; Davie, Laura; McConnell, Eleanor S; Holmes, Sarah D
Background Low-resource residential long-term care (LTC) settings, including settings located in medically underserved and health professional shortage communities, have fewer environmental resources to support high-quality, robust data collection and use of measures to support person-centered dementia care (PCC). Further, such settings are more likely to serve older adults from populations that have experienced historic harms related to misuse of personal data, including low-income and minoritized populations. Design thinking engages community-members to understand a problem from the end-user抯 perspective (empathize and define), brainstorm new solutions (ideate), and develop proposed solutions (prototype and test). This study describes the development of user-design workshops to co-develop, with residents living with dementia (RLWD), their family members and care staff, a person-centered measurement collection and data sharing infrastructure in low-resource residential dementia care settings. Methods The overall approach is a multi-method, community-based, participatory research study with design thinking principles. Stakeholders in each of four low-resource LTC settings provided in depth perspectives on collecting and sharing data about RLWD to support PCC. Results from qualitative thematic analysis informed the development of user-design workshops to co-design feasible and acceptable data collection and use protocols. Results Residents, relatives, and staff community members (N = 68 participants) were recruited from 4 low-resource residential LTC settings (N = 2 rural, 2 urban settings). Journey maps were developed to capture community-member perspectives by drawing upon themes in each of four key areas: identifying information for care; accessing information for care; sharing information for care; and prioritizing information for care. Journey maps provided the structure to develop co-design workshop protocols to re-engage community-members to empathize, define, ideate, and prototype acceptable and feasible data collection and data sharing protocols of PCC measures. Conclusion Findings from this study capture multiple facilitators and barriers to robust data collection and use protocols in resource-constrained LTC environments. However, findings also demonstrate the potential for user-centered design approaches to generate novel solutions in ways that honor the perspectives of RLWD, their family members, and the staff who care for them. Ultimately, such approaches contribute to the growth of inclusive research infrastructure to grow capacity for high quality, person-centered dementia care.
Stakeholder Perspectives on Providing Person-Centered Dementia Care in Low-Resource Long-Term Care Settings
(Wiley, 2024) Holmes, Sarah D; Rataj, Alison; Kusmaul, Nancy; Wang, Jing; Kim, Yoon Chung; Murray, Briana; Davie, Laura; Lepore, Michael; Corazzini, Kirsten
Abstract Background There is a growing number of residents living with dementia (RLWD) in long-term care (LTC) settings, but dementia care access and quality are more limited in communities with fewer health resources and these limitations are exacerbated by current dementia care workforce shortages. Low-resource LTC settings, including poorer urban and rural settings, serve older adults who are at high risk for health inequities in dementia care. These settings can experience barriers in providing quality dementia care due to their limited ability to capture pertinent information about residents’ needs and preferences and ensuring that information is known by dementia care staff. Although there is evidence about the consequences of care inequities for RLWD in low-resource LTC settings, less is known about stakeholders’ perspectives about key issues and opportunities for improving dementia care. This study describes stakeholder perspectives regarding the collection and sharing of information about RLWD for supporting quality dementia care in low-resource LTC settings. Method This was a community-based, participatory research study in four low-resource LTC settings (two rural, two urban) in the United States. All four settings were in medically underserved areas with two rural settings in New Hampshire and two urban settings in Maryland. In-depth semi-structured interviews were conducted with a purposive sample of participants (8 administrators/leaders, 20 care staff, 20 RLWD, and 20 care partners). Interviews were audio recorded, transcribed, and thematically analyzed in NVivo12. Result Themes were identified in four core topic areas: 1) identifying information about RLWD to support quality care; 2) finding and accessing information by the care team; 3) sharing information with RLWD; and 4) describing quality measures most relevant for RLWD. Within each theme, subthemes were identified providing greater detail of the process for identifying, collection, and sharing information for supporting quality dementia care. Conclusion This study revealed complexities in providing care for RLWD in diverse low-resource communities and generates directions for addressing dementia care inequities. The findings shed light on practical strategies used by low-resource LTC settings and motivate future research on measuring dementia care quality and advancing capacity among RLWD, their families, and care staff for inclusive, person-centered dementia care.
Care Compare Star Ratings and Family Satisfaction in Maryland Nursing Facilities: A Comparison by Facility Structure
(2024-02-22) Millar, Roberto; Diehl, Christin; Kusmaul, Nancy; Stockwell, Ian
These findings were presented at the Gerontological Society of America’s (GSA) 2023 meeting in Tampa, Florida. Part of a Center and Institute Departmentally-Engaged Research (CIDER) award, this is part of several studies focused on examining quality of care in Maryland nursing facilities.
Nurse Staffing in Nursing Facilities and Family Members' Appraisal of Resident Care
(2024-06-29) Millar, Roberto; Diehl, Christin; Cannon-Jones, Stephanie; Kusmaul, Nancy; Stockwell, Ian
Racial differences in the quality of care interactions among nursing home residents with dementia
(Taylor & Francis, 2024-05-20) McPherson, Rachel; Resnick, Barbara; Galik, Elizabeth; Gruber-Baldini, Ann L.; Holmes, Sarah; Kusmaul, Nancy
The resident population in nursing homes is increasingly racially diverse. The purpose of this study was to assess racial differences in the quality of care interactions among nursing home residents with dementia. The study utilized baseline data from the Testing the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD), a randomized controlled pragmatic trial. The Quality of Interaction Scale (QuIS) was used to measure quality of staff-resident care interactions. The sample included 531 residents. An analysis of covariance was conducted to address the aim. The majority of interactions were positive social (42%) or positive care (37%). Black residents living with dementia had higher QuIS scores (M = 5.98, SD = 1.66) than White residents with dementia (M = 5.40, SD = 1.75), whereas higher QuIS scores indicating more positive interactions. However, the results of the analysis of covariance indicated that there was not a significant difference in QuIS scores between Black versus White residents living with dementia (p =.203). The findings suggest that care interactions in nursing homes are consistent between Black residents and White residents. Future research should evaluate the impact of staff race on the quality of care interaction among nursing home residents.
The Sibling Leadership Network: Ethical Considerations and Policy Recommendations Impacting Sibling Caregivers
(Sibling Leadership Network, 2024-08-20) Banks, Tiffany; DeVries, Lindsey; Saxena, Mamta; Weaver, Gracie Lee; Gregory, Emma
The Sibling Leadership Network (SLN) is a non-profit organization dedicated to supporting siblings of individuals with disabilities. Siblings play an important role as caregivers in the disability community, but also deserve to be recognized as individuals with their owns needs, identities, and roles. One area in which we support siblings is through advocacy and support for sibling caregiver roles.Caregiving is misunderstood. It is providing someone with formal and informal care that may take the form of emotional, physical, or financial support. Caregiving can occur daily or even temporarily, depending on the experience of the individual. There is no one-size-fits-all definition of caregiving, but all care is essential and valued.The Family Medical Leave Act (FMLA) is a policy that allows employees to take unpaid time from work to care for themselves, their spouse, their parent, or their child. Siblings are not included, unless they are providing caregiving for an individual whose disability prevents them from caring for themselves. We believe that this needs to change to acknowledge the important role siblings play in each other’s lives.Home and Community Based Services (HCBS), funds services that allow people with disabilities to live in their community. HCBS is currently struggling with limited funding and a shortage of direct service providers. Investing in HCBS would decrease demands on family caregivers like siblings.
Measuring Perception of College Welcome Provided to Foreign-Born Students: Validation with Pilot Data
(BON VIEW PUBLISHING, 2024-05-06) Evans, Kerri
Immigrant and foreign-born students are one of the fastest growing populations in higher education across the US, and yet there is a dearth of research around their sense of belonging on campus and in the classroom. Therefore, this paper will cover the development and evaluation process for a scale designed to evaluate the perception of college welcome provided to immigrant students. Data from 94 college students was used to conduct a series of factor analyses to assess the survey questions and their utility for measuring college welcome. The scale is made up of four factors. The Cognitive awareness of college welcome factor showed a Cronbach's alpha of 0.72, the Emotional college welcome factor showed a Cronbach's alpha of 0.732 Behaviors of college welcome showed a Cronbach's alpha of 0.75 and the Relational college welcome showed a Cronbach's alpha 0.767. Overall, Cronbach's alpha is 0.864 for the perception of college welcome which is excellent. While the results are promising that this scale could indeed be measuring college welcome, it is important that more data be collected, reflect a higher percentage of immigrant students, and that future research be done to continue to assess the reliability and validity of this scale. This scale is the first step in better understanding the perception of welcome provided to foreign-born students, which is critical so that social workers can intervene and help improve the social and emotional well-being of students.
Developing and Testing a Model of the Assisted Living Environment
(Taylor & Francis, 2020-07-21) Holmes, Sarah; Resnick, Barbara; Galik, Elizabeth; Kusmaul, Nancy
The assisted living (AL) environment plays an important role in supporting residents’ satisfaction and helping them to age in place. The AL environment is multidimensional and has many interrelated components including staffing (e.g. direct care workers, nursing, activity staff), services provided (e.g. medical, mental health, pharmacy), amenities offered at the setting (e.g. beauty salon, library, exercise facilities), and the physical environment. Evidence suggests that aspects of the AL environment can enhance or detract from the physical function, well-being, social engagement, and behavioral outcomes among residents. The purpose of this study was to develop and test a multidimensional AL environment measurement model that includes indicators of staffing, services, amenities, and the physical environment. Baseline data was used from a study testing the Dissemination and Implementation of Function Focused Care in AL. A total of 54 AL facilities across three states were included in the sample. Settings ranged in size from 31 to 164 beds with an average size of 82.2 (SD = 26.2) beds and the majority were for profit facilities (n = 41, 74.5%). Structural equation modeling was used to test the proposed model. Results showed that the model fit the data (χ²/df = 1.861, p < .05; CFI = .858, RMSEA = .126). Having a comprehensive AL environment measurement model will advance future research that explores the impact of the environment on resident outcomes. Findings from this study will inform interventions and programs designed to modify AL environments to optimize residents’ satisfaction with AL.
My loved one might need more care than I can provide. What do I do?
(The University of Alabama, 2022-07-07) Kusmaul, Nancy
Caring for another person can be rewarding, challenging, and overwhelming . Many caregivers choose to care for family members and friends out of a sense of love, or paying someone back for care they have received earlier in life. But what happens when you can no longer provide that care?
Professional Social Workers in the Nursing Home
(ELSEVIER, 2022-11-01) Hector, Paige; Kusmaul, Nancy
The International Federation of Social Work defines social work as “a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. Underpinned by theories of social work, social sciences, humanities and indigenous knowledges, social work engages people and structures to address life challenges and enhance wellbeing” (“Global Definition of Social Work,” IFSW, July 2014, https://bit.ly/3TsJszN). Social work practice is also shaped by a professional code of ethics that focuses on person-directed care and competent practice that supports ethical decision-making when there are conflicts of interest.
Discharge Planning Best Practices to Avoid Hospital Readmissions
(American Association of Post-Acute Care Nursing, 2023-09-19) Stewart, Amy; Kusmaul, Nancy
In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Dr. Nancy Kusmaul, PhD, MSW, associate professor in the baccalaureate social work program at the University of Maryland, Baltimore County, discuss discharge planning best practices to avoid hospital readmissions.
Addressing the Needs of an Aging Population Through Health Professions Education: Proceedings of a Workshop
(National Academy of Sciences, 2023-10-12) Cuff, Patricia A.; Forstag, Erin Hammers; Kusmaul, Nancy
Guide to Elder Abuse and Home Safety
(Today's Homeowner, 2024-04-15) Bennett, Alexis; Kusmaul, Nancy; Mosqueda, Laura
Our respected elders, who harbor a lifetime of experiences and wisdom, are a vital part of our communities. Unfortunately, it’s a sobering reality that approximately one in six individuals aged 60 and above experienced some form of abuse in 2021. The COVID-19 pandemic exacerbated the problem, with incidents of elder abuse seeing a concerning increase. It’s high time we took a closer look at the issues surrounding elder abuse and how we can ensure safety at home for our seniors.

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