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The willingness to engage: A factorial survey of clinical social workers' adherence to the value of client autonomy in treating the severely mentally ill.
- Format:
- Book
- Thesis/Dissertation
- Author/Creator:
- Lukens, Jonathan M.
- Language:
- English
- Subjects (All):
- Medical ethics.
- Social service.
- Mental health.
- Health Sciences, Mental Health.
- Social Work.
- Health Sciences, Medical Ethics.
- 0347.
- 0452.
- 0497.
- Local Subjects:
- Health Sciences, Mental Health.
- Social Work.
- Health Sciences, Medical Ethics.
- 0347.
- 0452.
- 0497.
- Physical Description:
- 121 pages
- Contained In:
- Dissertation Abstracts International 74-02A(E).
- System Details:
- Mode of access: World Wide Web.
- text file
- Summary:
- Objective. The purpose of this study was to determine the factors that influence social workers' support for client autonomy, and how support for client autonomy impacts the willingness to engage in shared decision making. Shared decision making creates a decisional partnership intended to promote client autonomy while also addressing concerns regarding client safety and decisional capacity.
- Methods. This study employed a randomized factorial survey of social workers employed working with adults with severe mental illness. The study was designed to test: (1) the degree to which the clinical characteristics such as diagnosis, symptomology, treatment adherence and environmental context such as housing and homeless history of individual clients, and the practice values and experience of social workers influence the social worker's support for a particular client's autonomy and, (2) the degree to which those same factors predict the willingness of a social worker to engage the client in shared decision making. The study also tested whether the willingness to engage in shared decision making was mediated by support for autonomy. In total, 87 social workers responded to the survey yielding 435 vignettes for analysis.
- Results. The hypotheses were partially supported by the data. Diagnosis, symptomology, threats of harm, treatment adherence, and drug and alcohol use all predicted support for autonomy, and also the willingness to engage in shared decision making. A diagnosis of schizophrenia, psychotic symptoms, or poor treatment adherence predicted reduced support for autonomy by social workers, and a diminished likelihood that social workers would utilize shared decision making. Social worker's values and experience also predicted support for autonomy and willingness to utilize shared decision making. The willingness to engage in shared decision making was mediated by support for autonomy, though the effect was modest.
- Implications. The results of this study indicate greater need for interventions targeting social work students designed to reduce stigma surrounding severe mental illness, and also the need for ongoing clinical supervision for early career social workers. Helping social workers avoid bias in their decision making is critical to the overall goal of supporting autonomy, building client capacity, minimizing client disempowerment, and promoting recovery oriented services.
- Notes:
- Source: Dissertation Abstracts International, Volume: 74-02(E), Section: A.
- Adviser: Phyllis L. Solomon.
- Thesis (Ph.D.)--University of Pennsylvania, 2012.
- Local Notes:
- School code: 0175.
- ISBN:
- 9781267714152
- Access Restriction:
- Restricted for use by site license.
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