This article was downloaded by: [University of Cambridge] On: 29 December 2014, At: 22:44 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Social Work in Health Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wshc20

USE OF RESEARCH IN SOCIAL WORK PRACTICE Philip Starr ACSW

a

a

Chief of Social Research, HK Cooper Institute for Oral-Facial Anomalies and Communicative Disorders, Lancaster Cleft Palate Clinic, Lancaster, PA, 17602 Published online: 26 Oct 2008.

To cite this article: Philip Starr ACSW (1977) USE OF RESEARCH IN SOCIAL WORK PRACTICE, Social Work in Health Care, 2:3, 305-309, DOI: 10.1300/J010v02n03_06 To link to this article: http://dx.doi.org/10.1300/J010v02n03_06

PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

USE OF RESEARCH IN SOCIAL WORK PRACTICE

Downloaded by [University of Cambridge] at 22:44 29 December 2014

Philip Starr, ACSW

ABSTRACT. Research findings were used to identify patients experiencing interpersonal difficultiesfor whom it was felt social work intewention would be beneficial. Research utilizing a preschool and teenage patientpopulation in a regional center for cleft lip and/or palate is outlined with regard to clinical identification purposes. These examples suggest that research and practice can work together to meet the needs o f our patients.

The following is a report of how research findings were used t o identify high-risk individuals experiencing interpersonal difficulties who could benefit from social work intervention. I t demonstrates how research and practice can help meet the total rehabilitative needs of our patients.' The setting is the social service/research department of the H. K. Cooper Institute for Oral-Facial Anomalies and Communicative Disorders. The Institute was organized in the late 1930s primarily to serve patients with oral-facial clefts and their families. A cleft lip is a congenital failure o f fusion which normally occurs in the upper lip during the fifth week o f embryonic development. A cleft palate occurs during the seventh and eighth week o f embryonic development and is the failure o f the right and left palatal shelves to meet and fuse in the midline.2 A cleft lip may or may not be associated with a cleft palate. Conversely, a cleft palate may or may not be associated with a cleft lip.

Numerous issues ranging from corrective surgery t o total rehabilitation of the patient require at least the skills of a plastic surgeon, dentist, prosthodontist, orthodontist, speech therapist, audiologist, otologist, Mr. Starr is Chief o f Social Research, H . K. Cooper Institute for Oral-Facial Anomalies and Communicative Disorders and the Lancaster Cleft Pllate Clinic, 24 North Lime Street, Lancaster, P A 17602. This study was supported in part by PHS Research Grant, National Institute o f Dental Research, DE-02172. The author wishes to thank Mary Jean Fisher and Shellie Rudnick, for their assistance in collecting and analyzing data; Dr. Wilton M . Krogman, for his critical comments and suggestions; and Dr. James Beittel, for the preschool comparison group. Tables showing detailed findings are available upon request from the author. Social Work in Health Care. Vol. 2(3), Spring 1977 305

SOCIAL WORK IN HEALTH CARE

geneticist, and social ~ o r k e r .The ~ treatment services for a cleft lip and/or palate patient and his family are long-term in nature, and cover both the physical and psychosocial spectrum of helping services. PRESCHOOL STUDY

Downloaded by [University of Cambridge] at 22:44 29 December 2014

Subjects and Data Collection This report is an outgrowth of two research studies focusing on the behavioral functioning of preschool and teenage popul a t i o n ~ The . ~ sample for this study consisted of thirty preschoolers with oral-facial clefts. Six were cleft lip only (CLO), eleven were cleft lip and palate (CLP) and thirteen were cleft palate only (CPO). The comparison group consisted of thirty noncleft children who were private patients of our staff pediatrician. The two groups were matched on age, sex, and family socioeconomic status so that the two groups did not differ significantly in these variables. The data were collected from January t o July of 1975. The behavior of the children was measured by the Missouri Children's Behavior Checklist,' which provides scores in six areas: aggression, activity level, sociability, inhibition, somatization, and sleep disturbance. The forms were completed by the children's mothers, and consist of 70 behaviorally descriptive statements that can be answered in a yes of no manner.

Results and Utilization The findings indicated that there were no significant differences in the behavior of preschool children with oral-facial clefts as compared with the behavior of noncleft children without physical handicaps. The analysis also revealed that there was no significant difference in the behavioral functioning of the preschoolers with oralfacial clefts on the basis of cleft type. A behavioral profile analysis of the thirty preschoolers with oralfacial clefts was undertaken t o determine whether any of them were experiencing interpersonal difficulties. By examining the mean and standard deviation scores for each factor of the Missouri checklist for the thirty children and comparing them with the scores for each individual child, it was possible t o identify which children were rated extremely high or low on a particular factor. The criterion of obtaining a high or a low score on at least three of the six factors was used t o identify those six children who were experiencing interpersonal problems and whose parents could probably benefit from social work counseling. For example, K. K. was four years old at the time of data collection. He has a repaired cleft of the lip only, and is the youngest child in a

Philip S t a r

Downloaded by [University of Cambridge] at 22:44 29 December 2014

family of four children. His scores on the Missouri Children's Behavior Checklist indicated that he was high on aggression, activity level, somatization, and sleep disturbance. These high scores suggested that K. K. was a child in need of self-control (too physically aggressive), had a short attention span, had somatic complaints, and was having trouble sleeping. An interview with his parents confirmed the validity of the behavioral profile, and that the parents were primarily concerned about K. K.'s sleeping problem. In addition t o our patient, they were also worried about the behavior of another of their children. Their concerns, and our inability t o provide weekly counseling sessions because of the distance the family had t o travel in order to come t o the Institute, led us t o refer the family t o a family and children's agency in their local community. This referral was successfully implemented.

TEENAGE STUDY

Subjects and Data Collection Another example of high-risk identification is provided by our teenage study.6 The sample consisted of 72 teenagers with oral-facial clefts. Eight were CLO, 39 CLP, and 25 were CPO. The comparison group consisted of 48 noncleft teenage students from a local high school. Both groups were matched on the variables of age, sex, and family socioeconomic status. The data were collected from January t o July of 1975. The measures used in this study were a modification of the Linkowski Acceptance of Disability Scale,' the Simmons et al. Self-Esteem S ~ a l e ,and ~ the Missouri checklist. These measures were completed by the teenagers themselves. The Acceptance of Disability Scale is a 50-item inventory with a six-point scale of agreement-disagreement following each item. The author modified this scale for use with patients with oral-facial clefts by substituting this disability term for the more generalized concept of disability used in the original instrument. The Self-Esteem Scale is a six-item scale in which the subjects' general, overall feelings toward self are assessed. The Missouri checklist has already been described. Results and Utilization The findings indicated that there was only one significant difference in the behavior of teenage children with oral-facial clefts as compared with the behavior of noncleft children without physical handicaps. The children with oral-facial clefts had a mean aggression score of 6.38, while the noncleft group had a mean score of 8.65. The t test analysis was performed ( t = 3.66) indicating that the differences between the means were statistically significant @ < .01);therefore, the teenagers with clefts were less aggressive than were the noncleft group.

SOCIAL WORK IN HEALTH CARE

Downloaded by [University of Cambridge] at 22:44 29 December 2014

The findings of the teenage study also indicated that there were no significant differences in attitudes toward clefting, behavior, and selfesteem by cleft type. At the same time, there were significant differences bktween an 'extremely favorable attitudinal group and an extremely unfavorable attitudinal group in relation to self-esteem and behavior as measured by the Missouri checklist. The children in the latter group scored significantly lower in self-esteem and higher in aggression and activity level than did the children in the more favorable group. Because of this, the group with unfavorable attitudes was considered high-risk and in need of social work counseling. One patient in this extremely unfavorable attitudinal group was P. H., a thirteen-year-old girl. She has a repaired cleft lip and palate, and is currently involved in an orthodontic treatment regime. Her scores indicated low self-esteem and high aggression. An interview with the patient's mother confirmed our behavioral profile and revealed that she was supportive of our efforts t o help her daughter. Because of the patient's regular visits t o our Institute for orthodontic treatment, we have seen P. H. regularly and have begun t o involve her in resolving her behavioral problems.

CONCLUSIONS The f i s t conclusion is that significant behavioral differences are not present at the preschool age. The second conclusion is that they are present a t the teenage period in the area of aggression. , ~ provides support This is consistent with the findings of R i ~ h m a n and for Westlake and Rutherford's observation that behavioral problems may increase with age.'' The third conclusion is that there is no relationship between the cleft type per se and the dependent variables employed in both studies. It provides support for the premise that physical severity per se is not a factor in explaining- a person's attitude toward his oral-facial cleft. Conversely, it supports the idea that complex psychosocial issues are important factors in a person's acceptance of his oral-facial cleft. The fourth concluiion is that-the attitude toward clefting is a significant variable in determining the self-esteem and behavioral functioning of teenagers with oral-facial clefts. This conclusion supports Wright's premise that a person's acceptance of his disability is likely to be associated with better adjustment." Finally, the results of the research can be used to identify high-risk individuals who are experiencing interpersonal difficulties and who could benefit from social work intervention. These questionnaires, if used properly, can serve as a screening device for clinicians. Further support is provided by the fact that the behavioral pattern for our subjects was similar to the outpatient clinic group being treated for emotional problems, as described by Sines et al.

Philip Starr

Downloaded by [University of Cambridge] at 22:44 29 December 2014

REFERENCES 1. Seymour J. Kreshover, Foreward to The National Institute of Dental Research Directory of U.S Facilities Providing Cleft Lip and CleftPalate Seruices, ed. K. Kenneth Hisaoka (Washineton. - . D.C.: U.S. D e ~ a r t m e n tof Health. Education and Welfare, 1969). 2. C. S. Harkins e t al., "A Classification of CL and CLP," Plastic and Reconstructiue Surgery 29 (January 1962): 21-39. 3. Harold Westlake and David Rutherford. Cleft Palate fEnelewood Cliffs. N.J.: ~ a n a ~ e r n efor nl Prentice-Hall, 1966;M. Mazaheri, "~rosthod&cs," i n ~ i a m the Cleft Palate Patient, ed. H. K. Cooper, Sr. (Lancaster, Pa.: Lancaster Cleft Palate Clinic, 1974), pp. 33-38. 4. Philip Starr and Mary Jean Fisher, "Intrafamilial Dimensions of Pre-Schoolers With Oral-Facial Clefts" (paper presented at the Annual Meeting of the American Cleft Palate Association, San Francisco, Calif., 1976). 5. J. L. Sines e t al., "Identification of Clinically Relevant Dimensions of Children's Behavior," Journal of Consulting and Clinical Psychology 33 (1969): 728-34. 6. Philip Starr and Kitty Heiserman, "Acceptance of Disability by Teen-Agers With Oral-Facial Clefts," Rehabilitation Counseling Bulletin, in press. 7. D. C. Linkowski, "A Scale t o Measure Acceptance of Disability," Rehabilitalion Counseling Bulletin 14 (1971):236-44. 8. R. G. Simmons e t a]., "Disturbance in the Self-Image a t Adolescence,"American Sociological Review 38 (October, 1973): 553-68. 9. Lynn C. Richman, "Behavior and Achievement of Cleft Palate Children" (paper presented a t the Annual Meeting of the American Cleft Palate Association, New Orleans, 1975). 10. Westlake and Rutherford, Cleft Palate. 11. B. A. Wright, Physical Disability: A Psychological Approach (New York: Harper, 1960).

Use of research in social work practice.

This article was downloaded by: [University of Cambridge] On: 29 December 2014, At: 22:44 Publisher: Routledge Informa Ltd Registered in England and W...
196KB Sizes 0 Downloads 0 Views