Bilingual Social Workers Research Articles

Achieving Equitable Lung Cancer Screening Implementation in a Texas Safety Net Health System

IntroductionA lung cancer screening program using low dose CT (LDCT) in a Federally Qualified Health Center (FQHC) in Central Texas was developed and assessed for equitable implementation. MethodsFrom 11/2020-8/2023, patients aged 55-77 years who currently smoked or quit within 15 years with ≥ 20 pack-years of exposure were identified through EHR query and mailed outreach, or through direct provider referrals. A bilingual social worker confirmed eligibility, provided tele-care shared decision-making (SDM), coordinated screening, and offered smoking cessation. To assess equity, LDCT completion across demographics was compared, in 2023. Results6,486 patients were mailed outreach materials; 479 patients responded, of whom 108 (22.5%) were eligible and 71 (65.7%) participated in SDM. 629 eligible patients were referred internally; 579 (92.0%) completed SDM. Of the 650 patients who completed SDM, 636 (97.8%) agreed to screening.Mean age was 61.7; 38.1% were female. The population was diverse: 35.8% identified as Latino, 17.8% as African-American, 26.8% had Medicare or Medicaid, 48.0% used the county medical assistance program, 14.2% were uninsured, and 76.7% currently smoked.Overall, 528 (83.0%) patients completed LDCT. There were no statistically significant differences in completion by age, gender, race/ethnicity, or insurance status. Spanish-speaking patients were more likely to complete the CT than English speakers (OR 2.22, 95% CI 1.22, 4.41) and those who formerly smoked were more likely to complete the CT than patients who currently smoked (OR 1.93, 95% CI 1.12, 3.51). ConclusionsThe navigator-centered program achieved equitable implementation of lung cancer screening in a diverse FQHC system.

Educating Bilingual Social Workers for the Child Welfare Workforce

Spanish/English bilingual (SEB) speaking social workers are in high demand, particularly in the area of Child Welfare. Most require training and institutional support to increase their cultural and linguistic competence, yet the majority receive no specific education or support. As a result, many encounter inequities in the workforce. Research points to several elements that are essential to the education and development of SEB social workers. They include professional terminology, supervision in Spanish, and the opportunity to integrate theory and practice. To respond to the needs of a growing Spanish-speaking population, the UConn BSW Program has added a Child Welfare and Protection (CWP) track. CWP is designed to provide BSW SEB speaking students with specialized knowledge and experience to meet the needs of Latinx families served by the Connecticut Department of Children and Families (CT DCF). This paper describes how the UConn BSW program and DCF collaborated to re-envision social work education for SEB students and contribute to distributive justice for client and worker. The CWP Track prepares BSW students to work with a range of Spanish-speaking clients while facilitating institutional support including incentives to create a much-needed workforce pipeline for SEB social work students interested in child welfare.

Intergenerational group work and mask making in the Asian American community in a time of COVID-19 and COVID-19-related racism

ABSTRACT During the COVID-19 pandemic, Asian Americans faced multiple challenges due to COVID-19 and COVID-19 related racism. The Korean American Association of Greater Philadelphia (KAAGP), in Pennsylvania, decided to work together to fight against COVID-19 from the earliest stages of the pandemic in 2020. Intergenerational group work by more than 350 volunteers empowered the Korean community and promoted public health through the process of making and donating face masks to the broader community. These efforts were transitioned to other marginalized communities that shared a mutual understanding: “We are in this (pandemic) together.” It became clear that the Asian American community needs more culturally nuanced services to be delivered by bicultural and bilingual social workers who understand group work and its potential benefits and impacts on ethnically diverse communities.

Interpreting in Sexual and Reproductive Health Consults With Burma Born Refugees Post Settlement: Insights From an Australian Qualitative Study

Interpreters work with health care professionals to overcome language challenges during sexual and reproductive (SRH) health discussions with people from refugee backgrounds. Disclosures of traumatic refugee journeys and sexual assault combined with refugees’ unfamiliarity with Western health concepts and service provision can increase the interpreting challenges. Published literature provides general guidance on working with interpreters in primary care but few studies focus on interpretation in refugee SRH consults. To address this, we explored the challenges faced by providers of refugee services (PRS) during interpreter mediated SRH consultations with Burma born refugees post settlement in Australia. We used qualitative methodology and interviewed 29 PRS involved with migrants from Burma including general practitioners, nurses, interpreters, bilingual social workers, and administrative staff. The interviews were audio-recorded, transcribed, and subjected to thematic analysis following independent coding by the members of the research team. Key themes were formulated after a consensus discussion. The theme of “interpretation related issues” was identified with six sub-themes including 1) privacy and confidentiality 2) influence of interpreter’s identity 3) gender matching of the interpreter 4) family member vs. professional interpreters 5) telephone vs. face-to-face interpreting 6) setting up the consultation room. When faced with these interpretation related challenges in providing SRH services to people from refugee backgrounds, health care providers combine best practice advice, experience-based knowledge and “mundane creativity” to adapt to the needs of the specific patients. The complexity of interpreted SRH consultations in refugee settings needs to be appreciated in making good judgments when choosing the best way to optimize communication. This paper identifies the critical elements which could be incorporated when making such a judgement. Future research should include the experiences of refugee patients to provide a more comprehensive perspective.

Using the Age-Friendly 4Ms Framework to Redesign a Community Clinical Experience

The Age-Friendly 4Ms Framework (IHI/Hartford Foundation) was used to redesign an existing undergraduate nursing community experience, teaching students how to evaluate what matters to the individual, medications, mentation, and mobility. As part of the NJ Geriatric Workforce Enhancement Program (NJGWEP), a 5-year grant supported by DHHS-HRSA, ten senior nursing students joined a team of bilingual social workers, APNs, and a PharmD in an affordable housing urban highrise. This paper will describe the implementation and evaluation of a redesigned clinical experience using the 4Ms framework. Students visited older residents with bilingual social workers, performed health assessments and developed person-centered plans of care. Students presented resident cases during weekly interprofessional conferences to promote team collaboration and planning. Residents who screened positive for dementia were referred to an interprofessional Memory Assessment Program. Medications were reviewed using the Beers criteria, reconciled, and referred to primary care providers if appropriate. Fall risk was assessed and managed using the STEADI toolkit (CDC). Students were evaluated on attainment of geriatric-specific competencies, including medication review, cognition and depression screening, and fall risk assessments, by direct observations and interview. Following the semester-long experience, students completed a retrospective pretest/posttest survey to evaluate achievement of objectives based on the 4Ms. Mean scores for achievement of learning objectives ranged from 4.7-4.9 on a Likert scale of 1-5. Students identified barriers that older diverse individuals face when managing chronic health problems in the community. Students also valued the partnership with the social workers, stating, “We learned from each other.”

Language as resource and challenge among bilingual social workers in the Swedish social services

ABSTRACT This article explores how language informs work practice from the perspective of bilingual social workers in the Swedish social services. The analysis is based on empirical data from three focus group interviews. The article concludes that, on the one hand, social workers’ bilingualism has the potential of contributing to relationship building with clients; facilitating clients’ democratic participation; and destabilizing power asymmetries between social worker and client. On the other hand, social workers’ bilingualism runs the risk of being a marker of ‘difference’, disrupting relationship building with clients; becoming a source of self-consciousness in relation to oral and written performances at work; and finally, evoking a sense of responsibility of educating colleagues about clients’ vulnerable positions. Bilingualism is a professional skill that should be officially valued, but social service organizations also need to be responsive to the needs of bilingual social workers and address upcoming issues on an individual as well as organizational level. As bilingual social workers compose a significant part of the social services’ workforce today, it is necessary to further explore the meanings of bilingualism in various social work settings, and among various professional groups.

Using the 4Ms framework to teach geriatric competencies in a community clinical experience

As the population of older adults in the US steadily increases and becomes more diverse, there is an urgent need to integrate geriatric competencies into baccalaureate nursing education. To integrate the Institute for Healthcare Improvement 4 Ms Framework into an existing baccalaureate nursing community clinical experience to build geriatric and interprofessional competencies and promote positive health outcomes. As part of the Geriatric Workforce Enhancement Program, 15 students worked with bilingual social workers and community health workers in an affordable housing urban highrise, assessed building residents and implemented personalized plans of care using the 4Ms framework (what matters to the individual, medications, mentation, and mobility). Students demonstrated competence conducting cognition and depression screening, medication review, and functional and fall risk assessments. Student self-rated achievement of learning objectives ranged from 4.3 to 4.8 (1-5 scale). A retrospective pretest-posttest survey suggested learning about the importance of interprofessional teamwork, and integration of person-centered values when providing care to older adults in the community. Students reflected on barriers to health for older adults in low socioeconomic states and the importance of improving care across the continuum. The 4Ms framework provided a valuable construct to guide the community experience and teach geriatric evidence-based practice to nursing students.

The Social Worker as Language Worker in a Multilingual World: Educating for Language Competence

ABSTRACTSocial work is language work, and yet the profession has operated without a fully critical theory of language difference. Rather, a model of language as merely a neutral conduit of communication has prevailed, with the result that language issues have been addressed mostly as problems of translation. But a more rigorous approach to language as an active social practice points toward a reconceptualization of research, practice, and education. An autoethnography explores issues of language identity and power differentials implicit in the choice of language, showing that even bilingual social workers face dilemmas in how to approach client language issues. In social work education, language competence is not mere proficiency in speaking but rather, even for monolinguals, the ability to operate in a critical third place between one’s own linguistic frame and that of a client. Learning objectives are proposed for social work education in language issues: address critical theories of language to help students move toward a resource model of language difference; help students envision how to apply these theories in practical situations; and help all students develop a conscious and critical awareness of their own language identity and how it may affect their education and their future practice.

FEASIBILITY OF A FAMILY-CENTERED PRIMARY CARE DEPRESSION INTERVENTION IN A SAFETY-NET CLINIC

AbstractBackground: Mobilizing family members to support depression treatment is a novel and promising approach to improve outcomes for older men, a group at higher risk for depression under-treatment and suicide. The goal of this study was to test the feasibility and acceptability of a family-centered depression intervention in primary care. Methods: A randomized controlled trial comparing enhanced usual care to a manualized family-centered depression intervention in a safety net, federally qualified health center in California’s Central Valley. Inclusion criteria: male, age ≥ 50, PHQ-9 score of ≥ 10, speak Spanish or English, and willing to involve a family member in treatment. The intervention was delivered over 3–6 months by a bilingual social worker who engaged both men and family members in depression psychoeducation, behavioral activation, medication management, and supporting patients during primary care physician visits. Results: Of the 45 men referred for the study, 31 were eligible and 23 agreed to randomization (2:1 allocation to active intervention vs usual care). 57% of the enrolled men were Hispanic. Among the 23 men randomized, 2 dropped out prior to their first intervention session. Of the 13 men who completed 1 or more intervention sessions, 11 (85%) successfully engaged a family member, 7 (54%) had ≥ 4 joint family sessions, and 8 (62%) experienced a significant reduction in symptoms (i.e. PHQ-9 score ≤ 10). The mean number of intervention sessions was 6.8. Conclusions: Engaging family members to support depression treatment appears feasible in a sub-group of low-income, depressed, and predominantly Hispanic older men.

Depression remission, receipt of problem-solving therapy, and self-care behavior frequency among low-income, predominantly Hispanic diabetes patients.

This study explored whether depression remission and problem-solving therapy (PST) receipt are associated with more frequent self-care behaviors via cross-sectional and prospective analyses. We analyzed data from a randomized clinical trial (N=387) that tested collaborative depression care among predominantly Hispanic patients with diabetes in safety-net clinics. Data at 12-month follow-up, measured with the Patient Health Questionnaire-9 and Hopkins Symptom Checklist-20, were used to define depression remission. PST was provided by a bilingual social worker. Multivariate regression analysis was used to examine associations between predictors and frequency change of each self-care behavior (healthy diet, exercise, self-blood glucose monitoring, and foot care between baseline and 12-month (N=281), 18-month (N=249), and 24-month (N=235) follow-up surveys. Inconsistent relationships were observed depending on the instrument to identify depression remission, type of self-care behaviors, and time when self-care behavior was measured. Significant associations were more likely to be observed in cross-sectional analyses. PST receipt was not associated with self-care behaviors. Depression remission or the receipt of PST may not be a reliable antecedent for more frequent self-care behaviors among this group. A few recommendations for studies were offered to enhance existing depression care for diabetes patients.

Spanish-English Bilingual Social Workers: Meeting the Linguistic Needs of Latino/a Clients

Speaking with clients in Spanish is one aspect of providing culturally appropriate services among the growing Latino population in the United States; however, the lack of Spanish-English bilingual social workers in rural communities in the Midwest necessitates an examination of social service providers. In this practice corner article, the author (a) reviews background information on bilingual social workers and (b) examines social service providers in the state of Minnesota who employ bilingual social workers. One significant implication is social service providers collaborating with social work educators in the development of specific curricula for students who will work with Latino clients.

Spanish Language Self-Efficacy Beliefs Among Spanish-Speaking Social Workers: Implications for Social Work Education

Limited research exists about Spanish-speaking social workers that provide bilingual social work services. To date, studies have not exclusively focused on actual language competence of bilingual social workers or even their self-perceived language beliefs. This study reviews the results of a cross-sectional Internet-based survey exploring self-perceived Spanish language skills of bilingual social workers. The nationwide sample consisted of 321 participants who self-rated their self-efficacy Spanish language skills in relation to 5 social work competency categories. Results indicate that the language that participants reported speaking at home versus at work was significantly associated with the self-efficacy ratings. These associations along with implications for social work education are discussed.

Abstract P3-08-13: Short-term impact of a breast cancer survivorship clinic in a public hospital setting

Abstract Background: Breast cancer survivors struggle with physical and emotional changes from their cancer treatment. Despite growing momentum of survivorship care nationally, many still fail to receive appropriate long-term care. The Avon Cares for Life Survivorship Clinic, based at Olive View-UCLA Medical Center, a university-affiliated county hospital serving socioeconomically disadvantaged patients, provides care for breast cancer patients. The clinic is run by a bilingual nurse practitioner who provides comprehensive survivorship care including a needs assessment, on-going medical management, and consultative referrals. Our goals were to assess a cohort of indigent breast cancer survivors treated in the clinic and describe their burden of active morbidities along with the short-term impact a survivorship consultation had on pain, mental health and healthy behaviors. Methods: 43 consecutive breast cancer survivors receiving survivorship consultation were enrolled (May-Dec 2011). A bilingual research assistant administered a formal needs assessment (baseline, n = 43), and measured changes in pain (scale 0-10), mental health (Mental Health Inventory-5), perceived health (World Health Organization), and healthy behaviors (adapted from Memorial Sloan Kettering questionnaires) at baseline and 3 month follow-up (n = 36). For one quarter of patients this was the first survivorship clinic visit. Results: 62.8% were Hispanic, mean age was 54 years (sd 9.2), and mean time from diagnosis was 6.9 years (sd 4.4). The majority suffered from emotional changes (74%), over half had fatigue (55.8%), and numbness/tingling (58.1%). Pain was reported in 39.5% with mean score of 5.4 (scale 0-10). Most patients (95%) reported more than one symptom (n = 4). 50.0% reported poor or fair quality of health and only 11.1% had excellent or very good quality of health. Positive as well as negative short-term changes were noted from baseline as compared to the 3 month follow-up. Outcomes Assessed: 3 month Follow-upOutcomeImprovedNo ChangeWorsenedPain16.7%77.8%5.5%Mental Health50.0%8.3%41.7%Perceived Quality of Health47.2%47.2%5.6% Five patients were referred to social work at the time of the baseline clinic visit. All patients reported that the services received from the clinical social worker were helpful. There were no significant differences in health behaviors at the 3 month follow-up (exercise and nutrition). Conclusions: Formal assessment shows broad needs and high burden of morbidities present in indigent breast cancer survivors. Incorporating a bilingual social worker to address psychosocial concerns had a positive impact on the mental health status. This is one example of how referring to essential consultative services is paramount. Thorough assessment of this population helps provide a comprehensive patient-centered approach to addressing survivors’ physical and emotional needs in this post-treatment phase. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-13.

Bilingual Social Workers in Mental Health Service Provision: Cultural Competence, Language, and Work Experience

Many agencies actively recruit bilingual social workers. This study presents the reactions of 10 Chinese bilingual social workers to the expectations and demands of their agencies. The study employed a qualitative design with a phenomenological approach. The participants’ responses provide insight into how they manage ethnic and cultural mental health issues in Chinese populations. This study aims to improve social service delivery for clients with limited English proficiency by identifying effective, culturally competent services. The findings suggest that when hiring bilingual social workers, it is just as important for them to be culturally competent as it is for them to be an ethnic or language match with the client base. Having all of these qualities will result in staff members who can provide more effective services by making accurate diagnoses and identifying appropriate treatment plans. In addition to employing bilingual social workers, it is important to maintain good supervision as this will allow supervisees to have a unique perspective on what is involved in providing effective delivery of services to clients with limited English proficiency. Implications for research, practice, and policy are discussed.

“Oh, you've got such a strong accent”: Language Identity Intersecting with Professional Identity in the Human Services in Australia

AbstractLanguage operates as a form of differentially valued cultural capital that is an influential factor in educational and employment outcomes. English in particular represents a valuable form of linguistic capital in both the broader world market and many regional and local contexts. This article, focusing on one group of professionals, draws on an exploratory study carried out with overseas‐born bilingual social workers residing in Australia, who reflect on how their language identities intersect with their professional identities in the human services workplace. Although most informants identified tangible benefits associated with being bilingual, especially in terms of working with a diverse clientele, they were equally aware of how being categorized as a ‘non‐native’ speaker of English could diminish their professional credibility and thwart their chances of upward mobility in the workplace. In this regard, this article highlights inconsistencies in how difference is valued in the human services workplace, implicating a more covert process of linguistic othering.

Bilingual Social Workers: Language and Service Complexities

Bilingual social workers deal with a range of language and service complexities. However, little is known about how their language skills are used by agencies. This paper reports on a qualitative study of the work experiences of 26 bilingual social workers in San Diego County. The findings suggest that agency administrators need to identify and test for the language skill set that bilingual workers need to possess. Moreover, bilingual workers need ongoing training to enhance their professional language skills. Finally, for the purpose of retention and workload equity, pay differentials and workload adjustments should be considered for bilingual workers.

Psychiatric Care in a Primary Care Clinic

Psychiatric Care in a Primary Care Clinic

Do Culturally Sensitive Services for Chinese In-Patients Make a Difference?

Hospitals in large cities provide services to an increasingly diverse linguistic and cultural clientele. Some strategies adopted to improve services to non-English speaking populations include the use of bilingual social workers, interpreters and printed translation tools. In order to identify gaps in culturally sensitive care in a Canadian teaching hospital, this study surveyed a consecutive sample of 279 Chinese in-patients to determine satisfaction with hospital experience, levels of information about hospital routines and awareness of on-site Chinese cultural services. Results were generally positive. However, satisfaction and information levels were significantly higher among those patients who were aware of culturally appropriate Chinese resources such as social workers, cultural interpreters, and culturally specific reference tools. Of particular interest are the 121 patients (44%) who were less comfortable with English, since awareness of culturally specific resources tended to make a greater difference to this sub-group. These results can potentially help health care providers improve services to patients and families from diverse cultural and linguistic groups.

Language as a Problem, a Right or a Resource?

• Summary: Although many `Anglophone' countries now host significant linguistic diversity, minimal attention has been paid to language policy in social work. This paper examines how language policy in both its overt and covert forms infiltrates social work via three `orientations' to linguistic diversity: language as a problem; language as a right; and language as a resource. The utility of this framework for viewing linguistic diversity in social work is explored with reference to an exploratory study that canvassed the views of overseas-born bilingual social workers practising in Australia. • Findings: The participants strongly identified with a problem orientation to language, where a lack of English constitutes a significant barrier to participating in the social, economic and political domains. While a rights orientation to language was endorsed, it was seen to have limitations in terms of the inadequacies of legislation for challenging `monolingual' language attitudes. All informants supported a resource orientation to language, but claimed that linguistic diversity is often devalued in English-dominant locations. • Applications : Rather than privileging one particular lens on language, the study concludes that a flexible framework that allows for movement between different language orientations is necessary given the context-dependent nature of language use.

Perspectives of Bilingual Social Workers

Bilingual social workers are often crucial in offering services to clients who cannot communicate effectively in English. Little research exists on the issues such workers face with in working with limited English proficiency (LEP) clients. This qualitative research study used snowball sampling and ethnographic interviews to examine the perspectives of 26 bilingual social workers in San Diego. Participants consider LEP clients' cases more complicated and more time-consuming than those of English-speaking clients. Participants further stated that their bilingual and bicultural abilities enhanced their understanding of LEP clients and made their work more effective. The findings suggest that bilingual social workers need additional language resources and workload adjustments.