THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
SCHOOL OF SOCIAL WORK
COURSE NUMBER: SOWO 845
COURSE TITLE: HEALTH: THEORY AND PRACTICE
ROOM: TTK - 107
INSTRUCTOR: MIMI V. CHAPMAN, MSW, PH.D., LCSW
EMAIL: MIMI@EMAIL.UNC.EDU
OFFICE PHONE: 919-843-8282
HOME PHONE: 919-942-8280 (USE WITH DISCRETION – PLEASE DO NOT CALL BETWEEN 5 AND 8 PM.)
OFFICE HOURS: ALL DAY FRIDAYS OR BY APPOINTMENT.
COURSE DESCRIPTION:
This course is a seminar on social work practice in healthcare covering both the social context of
health problems and theories and interventions to facilitate both prevention of and coping with
health problems.
COURSE OBJECTIVES:
1.
2.
3.
4.
5.
Understand the impact of social context on health and illness.
Understand frameworks that address health and help seeking behavior.
Use the considered frameworks to create assessment and intervention plans.
Consider the impact of difference on how we understand particular symptoms and illnesses.
Understand particular legal issues that apply in health settings that promote and limit
confidentiality for particular populations.
6. Develop skills in assisting with decision-making in health care settings.
7. Understand the importance of interdisciplinary work in health care settings and develop skills in
collaboration for team work.
8. Develop skills in particular intervention models commonly used in health settings.
SKILLS TO BE ACQUIRED IN THIS CLASS:
1. The ability to go beyond information gathering to create a nuanced assessment and treatment
plan.
2. The ability to consider and identify cultural understandings of illness that may impact treatment;
3. The ability to identify and employ evidence-based psycho-social interventions for particular
health conditions.
REQUIRED TEXTS
N.M.P. King, R.P. Strauss, L.R. Churchill, S.E. Estroff, G.E. Henderson, J. Oberlander (Eds.).
(2005). The social medicine reader: Patients, doctors, and illness. Vol. 1. (2nd ed.).
Durham, N.C.: Duke University Press.
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N.M.P. King, R.P. Strauss, L.R. Churchill, S.E. Estroff, G.E. Henderson, J. Oberlander (Eds.).
(2005). The social medicine reader: Vol. 2. Social and cultural contributions to health,
difference, and inequality. (2nd ed.). Durham, N.C.: Duke University Press.
Rollnick, Miller, W., Butler, C. (2007). Motivational Interviewing: Helping Patients Change
Behavior. New York: Guilford Press.
REQUIRED TEXTS ARE AVAILABLE IN THE HEALTH AFFAIRS BOOKSTORE. OTHER REUQIRED
READINGS ARE AVAIALABLE ON THE CLASS BLACKBOARD SITE.
Other Texts to Consider for Your Professional Library:
Kerson, Toba Schwaber (2002). Boundary Spanning: An Ecological Reinterpretation of Social
Work Practice in Health and Mental Health Systems. New York: Columbia University Press.
Rolland, J.S. (1994). Families, Illness, & Disability: An Integrative Treatment Model. New
York: Basic Books. ISBN: 0-465-02915-9. 5
TEACHING METHODS
We will be addressing cognitive, emotional, and experiential aspects of working in health
settings. To do this, we will have exercises related to self-reflection, deepening our empathy for
the clients with whom we work, and role plays to practice and understand the techniques used in
particular models. We will also be privileged to hear from some expert guest speakers and we
may use various audio-visual aides to understand concepts and techniques. To be enjoyable, our
class should be interactive. Comfort and cohesion in this class will be created by interactions
that reflect social work values. You are encouraged to state your point of view. At the same time,
please keep in mind that supportive learning conditions are created and fostered by listening to
the ideas and beliefs of others and reflecting upon those which may be different from your own.
Your contributions to making this a safe and respectful classroom environment are appreciated.
CLASS ASSIGNMENTS
A. MINI-ETHNOGRAPHY: THIS ASSIGNMENT IS REQUIRED FOR ALL STUDENTS AND IS DUE AT THE
TH
BEGINNING OF CLASS ON OCTOBER 5 . IT IS WORTH 25% OF YOUR GRADE.
This is an assignment in two parts. Both parts are to be turned in together as one assignment
but you are to complete them in the order specified.
Part One: Please choose a person who has experienced an acute life-threatening injury or
illness, or lives with a chronic illness or condition. This experience may have happened to
them or a close family member (spouse, life partner, child, or parent). The subject of the
interview may be someone you know in your personal life, a client, or even a family
member. Interview them about their illness from an ethnographic point of view. The
information below will tell you more about the ethnographic approach.
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Kleinman (1988)1 writes that by using the mini-ethnography the clinician is allowed to
“place himself in the lived experience of the patient’s illness… By putting himself in the
position of the family members and important people in the wider social circle, one can
also empathically witness the illness as they do. This experiential phenomenology is the
entrée into the world of the sick person.”
In order to deepen our understanding and empathy for our clients experiencing a
physical or mental illness, this paper will ask you to construct a mini-ethnography of a
person who has experienced an acute or chronic illness/injury.
An ethnography differs from a “case formulation” in that your purpose is to understand your
client through their own eyes: not to look with a clinical lens with the purpose of creating a
treatment plan, looking for diagnostic clues etc. Your goal is simply to understand the world
as they see it and their illnesses’ place in that world. Here are some areas to explore:
First, explore the story of the illness. What did the person notice first about their illness?
How did they manage the symptoms before professionals became involved? What did they
think their symptoms meant? What was the experience of involving others in understanding
their symptoms? How did the different systems involved treat them? Who did they perceive
to be helpful or not and why?
Next, explore how the illness or injury has changed their relationships with others including
family, friends, and strangers. What messages did/does the person receive from the larger
society about their illness?
Then, what impact did/does the illness have on their daily life? What is their perceived
quality of life? What are their hopes for the future? What role does the illness play in their
expectations?
As a final piece, reflect on the process of doing this interview and compare it to how you
usually interact with clients. Did this process teach you anything new? Was it harder or easier
than clinical interviews that you have experienced? Why? Will you change your clinical
interviewing in any way as a result of this experience?
Some Tips:
Adapted from Anne-Linda Furstenberg, 1996 & Denise Gammonley, 2000.
The goal of the mini-ethnography is to capture this person’s perception of their world and the
illnesses’ role in that world. Your goal is to engage the interviewee in a focused discussion of
what it means to be a person who has experienced a particular illness or injury.
1
Klienman, A. (1988). The Illness Narratives: Suffering Healing, and the Human Condition. New York: Basic
Books.
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The interview process is open-ended and emphasizes asking questions that elicit rich detail.
Toward this end, develop an interview guide to focus the discussion. Many of the questions
listed above may be a part of your interview guide. The guide should contain a list of broad
topic areas you want to cover. Some useful strategies for formulating questions and
conducting an in-depth interview include:
1) Explain the purpose of the interview and assure confidentiality.
2) Use descriptive questions and encourage vivid detail – probe by asking follow-up
questions about the sequence of events, the locations, who else was there and what were
they doing.
3) Avoid evaluative questions: What kinds of things does your family do together versus
how do you get along with your family.
4) Begin broad and focus more narrowly.
5) Check to make sure you understand the meaning behind what is being said. Ask them to
explain language you don’t understand. Restate what they have said to make sure you are
clear on what they mean.
6) Give permission to discuss difficult areas or NOT if preferred.
Conduct and write up this interview first. Submit your write up to me and I will send you the
second part of the assignment. Part 1 length 5-7 pages with an attached interview guide.
The second part of the assignment will be due on October 5th. It will add an addition 3 to 4
pages to the assignment. The write up should be double-spaced and should use APA citation
style if needed.
B. Mix and Match: Choose a combination of the assignments listed below to make up 60% of
your grade.
1. Read the book The Spirit Catches You and You Fall Down. Discuss your observations about
the health care system, collaboration, and working with different cultures with regard to the child
and family described. What are the implications for you own work with clients from other
cultures? What lessons would you take away about understanding any given patient or family’s
health belief and what specific questions would you ask to get at these beliefs. (This paper
should be no more than 6 double spaced pages.) It is worth 20% of the mix and match
2. Read the book, Still Alice by Lisa Genova. . Describe your reactions to the following
characters in this book: Alice, John, and Anna. First acknowledge and consider your personal
responses to these characters and their choices. Reconsider your responses as you put yourself
fully in each of their places and describe how you think they came to make the choices they
make. Reflect on this process. This assignment is worth 20% of the mix and match.
2. Quizzes: Five quizzes will be posted for completion on the blackboard site and will ask ten
questions about specific readings. Each quiz will be worth 5% of your grade.
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3. Journaling: Below are several journal questions which you should respond to with two to
three page well-written papers. Please use academic English and cite in APA style when
appropriate. Journal entries should between one and three pages long. Each journal is worth
10% of the mix and match.
QUESTION 1: Go to http://www.pbs.org/wgbh/pages/frontline/aids/view/ and watch this
series on HIV and AIDS. Our conception of this virus has changed over the years. Were there
things that you did not know prior to watching this series? What are the implications for
thinking about context and how it shapes the health care experience? What about stigma?
QUESTION 2: Go to http://www.pbs.org/wgbh/pages/frontline/parkinsons/view/and explore the
items related to this frontline program. Begin your journal with your reactions to what you saw
on the site. What surprised you? What shocked you? And to what did you have the strongest
reaction – positive or negative? Why do you think you reacted to particular parts of these reports
and not others?
QUESTION 3: Go to http://www.pbs.org/wgbh/pages/frontline/clinic/ and explore the items
related to this frontline program. Begin your journal with your reactions to what you saw on the
site. What surprised you? What shocked you? And to what did you have the strongest reaction
– positive or negative? Why do you think you reacted to particular parts of these reports and not
others?
QUESTION 4: Bearing witness to grief challenges us to tolerate strong emotions. Read some of
the articles in the folder labeled “Grief” on the blackboard site. In the context of these articles,
describe your experiences with grief thus far in your professional work. How do you think your
personal experiences impact the way you have or will handle grief with your clients? Do you
think it will make a difference if your client is a child who is grieving versus and adult?
QUESTION 5: Many of the readings from the Social Medicine Reader are moving and
evocative of experiences in health care. Pick one that has been particularly meaningful to you
and write about your personal and professional experiences that make this reading particularly
salient. (Note: You can choose to do this for more than one journal assignment using different
readings.)
QUESTION 6: Go to
http://www.pbs.org/wgbh/pages/frontline/vaccines/view/?utm_campaign=homepage&utm_medi
um=proglist&utm_source=proglist. Watch “Vaccine Wars” and explore the website. Then
answer the following questions: Prior to watching this program, what has your experience with
vaccines been? Specifically, were you aware that immunization is on the decline? Is this an
issue with which you have personal involvement or opinions? What did you learn from the
program that you did not know before? Do you think the program was balanced in its
presentation – why or why not? In light of our discussion on understanding people’s health
beliefs, how do you think one should integrate science and personal choice around vaccines?
There are a variety of settings in which social workers might come into contact with parents who
have not had their children vaccinated. In child welfare circles, not being up to date on
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immunizations is a fact often cited as one of several problems that might indicate neglect. Is the
issue the same if a parent doesn’t manage to show up for well-child care visits but a personal
health choice if the parent has a Ph.D. and says they are making a personal choice for their
children? Explain your answer.
Please submit hard copies of your journal articles to me and keep a copy for yourself. When
they are returned, please keep them until the semester is over.
ALL MIX AND MATCH ASSIGNMENTS MUST BE COMPLETED BY THE START
OF OUR LAST CLASS.
C. S-BIRT: I would like you to complete the on-line S-BIRT training course found at
http://www.bu.edu/act/mdalchoholtraining/curriculum_top.html. Complete the pre-test/exercises
and post-test and provide me with a copy of your pre and post test along with a brief one page
reaction to the course. S-Birt is worth five percent of your grade. The training must be
completed and your documentation turned into me on or before November 1, 2010.
D. Class Attendance and Participation
Attending and participating in class are important. Five percent of your grade will be
awarded for consistent attendance. Contributions to large and small group activities and your
participation in class discussions will add an additional 10% to your over all grade. Points
will be deducted if you are late, come unprepared or unwilling to participate in class.
GRADING SYSTEM
The total points for each assignment will be added to determine the final grade.
94 and above
80 – 93
70 – 79
69 and below
H
P
L
F
POLICY ON INCOMPLETE GRADES AND LATE ASSIGNMENTS: Assignments should be completed
on time. If a situation arises that prohibits you from completing the assignment on time, a request
for an extension must be done in advance of the due date. Approved extensions will not affect
the grade. Any unapproved delays, or assignments completed after an approved extension date,
will begin to accrue a 1 point reduction every 24 hours that the assignment is late. No make-up
exams will be given unless the student has an emergency. If the student is allowed to take a
make-up exam, the exam may be in a different format or have different questions than the
regular exam. If you face unavoidable obstacles, discuss the circumstances with me and we will
decide together whether a grade of incomplete should be considered. Incomplete grades will be
given only in compliance with University policy.
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POLICY ON ACADEMIC DISHONESTY: Please refer to the APA Style Guide, The SSW Manual,
and the SSW Writing Guide for information on attribution of quotes, plagiarism and appropriate
use of assistance in preparing assignments. All written assignments should contain a signed
pledge from you stating that, "I have not given or received unauthorized aid in preparing this
written work".
In keeping with the UNC Honor Code, if reason exists to believe that academic dishonesty has
occurred, a referral will be made to the Office of the Student Attorney General for investigation
and further action as required.
POLICY ON ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES
Students with disabilities that affect their participation in the course and who wish to have
special accommodations should contact the University’s Disabilities Services at the beginning of
the semester and provide documentation of their disability. Disabilities Services will notify the
instructor that the student has a documented disability and may require accommodations,
Students should discuss the specific accommodations they require (e.g. changes in instructional
format, examination format) directly with the instructor.
POLICY ON THE USE OF ELECTRONIC DEVICES IN THE CLASSROOM
Students are asked to silence cellular phones and pagers during class time. Your PDA’s, smart
phones, etc. should remain in your purse, backpack, coat pocket, etc. It is not appropriate to
update your calendar, surf the web, text other people, do Sudoku, twitter, or otherwise disengage
during class. If you have an extenuating situation that means you will likely be receiving a phone
call that you must take during class, please let me know in advance.
COURSE OUTLINE
FOUNDATIONS FOR THINKING ABOUT HEALTH: PERSPECTIVES INFLUENCING ASSESSMENT
CLASS 1
8/24/10
INTRODUCTIONS, REVIEW OF SYLLABUS, INTRODUCTION TO THE COURSE.
CLASS 2
8/31/10
THE EXPERIENCE OF ILLNESS AND DISABILITY
Readings:
Frank A. (2005). Betting your life. In N.M.P. King, R.P. Strauss, L.R. Churchill, S.E. Estroff,
G.E. Henderson, J. Oberlander (Eds.), The social medicine reader: Vol. 1. Patients,
doctors, and illness. (2nd ed. pp.33-40). Durham, N.C.: Duke University Press.
Feudtner, C. (2005). The want of control: Ideas and ideals in the management of diabetes. In
N.M.P. King, R.P. Strauss, L.R. Churchill, S.E. Estroff, G.E. Henderson, J. Oberlander
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(Eds.), The social medicine reader: Vol. 1. Patients, doctors, and illness. (2nd ed. pp.4159). Durham, N.C.: Duke University Press.
Rapp, R. (2005). Extra chromosomes and blue tulips: Medico-familial interpretations. In N.M.P.
King, R.P. Strauss, L.R. Churchill, S.E. Estroff, G.E. Henderson, J. Oberlander (Eds.),
The social medicine reader: Vol. 2. Social and cultural contributions to health,
difference, and inequality. (2nd ed. pp. 50-69). Durham, N.C.: Duke University Press.
Trillin, A.S. (2005).The Cost of Appearances. In N.M.P. King, R.P. Strauss, L.R. Churchill, S.E.
Estroff, G.E. Henderson, J. Oberlander (Eds.), The social medicine reader: Vol. 1.
Patients, doctors, and illness. (2nd ed. pp. 26-31). Durham, N.C.: Duke University Press.
CLASS 3
9/07/10
THE IMPACT OF ILLNESS AND DISABILITY: FACTORS THAT PREDICT COPING
Readings:
Rolland, J.S. (1994). Families, illness, & disability: An integrative treatment model. New York:
Basic Books. (pp. 19-100)
CLASS 4
9/14/10
THE HEALTHCARE ENVIRONMENT: CONTEXT AND SOCIALIZATION
Readings:
Gawande, A. (2005). The learning curve. In N.M.P. King, R.P. Strauss, L.R. Churchill, S.E.
Estroff, G.E. Henderson, J. Oberlander (Eds.), The social medicine reader: Vol. 1.
Patients, doctors, and illness. (2nd ed. pp.102-120). Durham, N.C.: Duke University
Press.
Kerson, Toba Schwaber (2002). Boundary Spanning: An Ecological Reinterpretation of Social
Work Practice in Health and Mental Health Systems. New York: Columbia University
Press. Chapter 2.
Konner, M. (2005). Basic clinical skills: The first encounters. In N.M.P. King, R.P. Strauss, L.R.
Churchill, S.E. Estroff, G.E. Henderson, J. Oberlander (Eds.), The social medicine
reader: Vol. 1. Patients, doctors, and illness. (2nd ed. pp.89-101). Durham, N.C.: Duke
University Press.
2ND HALF OF CLASS: PANEL PRESENTATION “A DAY IN THE LIFE OF SOCIAL WORKERS IN HEALTH
CARE SETTINGS.
CLASS 5
9/21/10
HEALTH BEHAVIOR AND HEALTH BELIEFS
Readings:
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Dyche, L., & Zayas, L. (2001). Cross-cultural empathy and training the contemporary
psychotherapist. Clinical Social Work Journal, 29, 245-258.
Fausto-Sterling, A. (2005). The five sexes revisited. In N.M.P. King, R.P. Strauss, L.R.
Churchill, S.E. Estroff, G.E. Henderson, J. Oberlander (Eds.), The social medicine
reader: Vol. 2. Social and cultural contributions to health, difference, and inequality. (2nd
ed. pp. 202-210). Durham, N.C.: Duke University Press.
Hunt, L.M. (2005).Beyond cultural competence: Applying humility in clinical settings. In
N.M.P. King, R.P. Strauss, L.R. Churchill, S.E. Estroff, G.E. Henderson, J. Oberlander
(Eds.), The social medicine reader: Vol. 2. Social and cultural contributions to health,
difference, and inequality. (2nd ed. pp. 133-137). Durham, N.C.: Duke University Press.
Petrie, K.J. & Pennebaker, J.W. (2004). Health-Related Cognitions. In S. Sutton, A. Baum, & M.
Johnston (Eds). The sage handbook of health psychology. (pp.127-142). Sage, London.
CLASS 6
9/28/10
ASSESSMENT
Meet in the lobby of the Ackland Art Museum at 9 a.m. Note: Coffee/drinks are allowed in the
lobby but not in the galleries or study area. No pens can be used for note-taking, only pencils.
Readings:
Kerson, Toba Schwaber (2002). Boundary Spanning: An Ecological Reinterpretation of Social
Work Practice in Health and Mental Health Systems. New York: Columbia University
Press. Chapters 5 and 6
Sanders, L. Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis. New York:
Broadway Books. Chapter 5.
CLASS 7
10/05/10
LEGAL CONSIDERATIONS: HIPAA , INFORMED CONSENT, CONFIDENTIAL CARE FOR MINORS
Readings:
Basson, M.D, Dworkin, D., & Cassell, E.J. (2005). Case study: The “student doctor” and a wary
patient. In N.M.P. King, R.P. Strauss, L.R. Churchill, S.E. Estroff, G.E. Henderson, J.
Oberlander (Eds.), The social medicine reader: Vol. 1. Patients, doctors, and illness. (2nd
ed. pp.121-142). Durham, N.C.: Duke University Press.
Groopman, J. (2005). God at the bedside. In N.M.P. King, R.P. Strauss, L.R. Churchill, S.E.
Estroff, G.E. Henderson, J. Oberlander (Eds.), The social medicine reader: Vol. 1.
Patients, doctors, and illness. (2nd ed. pp.154-158). Durham, N.C.: Duke University Press
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Hilifiker, D. (2005). Facing our mistakes. In N.M.P. King, R.P. Strauss, L.R. Churchill, S.E.
Estroff, G.E. Henderson, J. Oberlander (Eds.), The social medicine reader: Vol. 1.
Patients, doctors, and illness. (2nd ed. pp.145-153). Durham, N.C.: Duke University Press
Kerson, Toba Schwaber (2002). Boundary Spanning: An Ecological Reinterpretation of Social
Work Practice in Health and Mental Health Systems. New York: Columbia University
Press. Chapter 3
Pernick, M.S. (2005). Defining the defective: Eugenics, aesthetics, and mass culture in early 20th
century America. In N.M.P. King, R.P. Strauss, L.R. Churchill, S.E. Estroff, G.E.
Henderson, J. Oberlander (Eds.), The social medicine reader: Vol. 2. Social and cultural
contributions to health, difference, and inequality. (2nd ed. pp. 29-48). Durham, N.C.:
Duke University Press.
Lyren, A., Kodish, E. Lazebnik, R., & O’Riodan, M.A. (2006). Understanding confidentiality:
Perspectives of African-American adolescents and their parents. Journal of Adolescent
Health, 39, 261-265.
Marcell, A.V., & Halpern-Felsher, B.L. (2007). Adolescents’ beliefs about preferred resources
for help vary depending on the health issue. Journal of Adolescent Health, 41, 18-61.
Guest Speaker: Jill Moore, J.D.
NOTE: 10/12/09 NO CLASS - UNIVERSITY DAY
CLASS 8
10/19/10
INTERVENTION: PROBLEM-SOLVING AND CRISIS
Readings:
Kerson, Toba Schwaber (2002). Boundary Spanning: An Ecological Reinterpretation of Social
Work Practice in Health and Mental Health Systems. New York: Columbia University
Press. Chapters 7 and 8
HTTP://SBIRT.SAMHSA.GOV/INDEX.HTM
CLASS 9
10/26/10
INTERVENTION TO CHANGE BEHAVIOR
Readings:
Rollnick, Miller, W., Butler, C. (2007). Motivational Interviewing: Helping Patients Change
Behavior. New York: Guilford Press. Chapters 1 – 2
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Guest Speaker: Worth Bolton
CLASS 10
11/2/10
PRACTICING MI SKILLS
Readings:
Rollnick, Miller, W., Butler, C. (2007). Motivational Interviewing: Helping Patients Change
Behavior. New York: Guilford Press. Chapters 3 - 6
CLASS 11
11/09/10
LIVING WITH CHRONIC ILLNESS: SOME CONSIDERATIONS
Readings:
Leventhal, H. Halm, E., Horowitz, C., Levanthal, E., & Ozakinci,G. (2004). Living with chronic
illness: A contextualized, self-regulation approach. In S. Sutton, A. Baum, & M. Johnston
(Eds). The sage handbook of health psychology. (pp.197-240). Sage, London.
Guest Speaker:
Tiffany Washington
CLASS 12
11/16/10
MINDFULNESS INTERVENTIONS IN HEALTH CARE
Readings:
Baer, R. (2003). Mindfulness training as clinical practice intervention: A conceptual and
empirical review. Clinical psychology: science & practice. 10, 2, 125-143. DOI:
10.1093/clipsy/bpg015.
Ludwig, D.S. & Kabat-Zinn, J. (2008). Mindfulness in medicine. Journal of the American
medical association, 300 11: 1350-1352. doi: 10:1001/jama.30011.1350.
Siegel, D.J., Siegel, A.W., Amiel, J.B. (2006). Mind, brain, & behavior. In D. Wedding &
Stuber, M.L. Behavior and medicine, 4th edition. (pp. 3-22). Hogrefe, Cambridge, Mass.
Guest Speaker: Bud Lavery, MSW
11/23/10
Class 13
11/30/10
No Class – Happy Thanksgiving
A Few Thoughts on Grief, Loss, and Self-Care in the Health Care
Environment
Please choose two readings from the folder labeled “Grief” on the blackboard cite to read
in preparation for today’s class.
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CLASS 14
12/7/10
COURSE WRAP UP
All Mix and Match Assignments Due
Good Work! Happy Holidays!
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