Welcome to the IUPUI Center for Translating Research Into Practice, Monthly Scholar of the Month Series, whether we have conversations with IEPI faculty who are doing amazing work here on campus. My name is Steve V Weg. I'm the Associate Director of the Center for Translating Research into Practice. My pleasure to welcome you all here. And to let you know that my trustee assistant Nuri McLucas, who's the glue behind all of this is here taking care of all the technical work. So thank you for your work, Nuri in making these things happen. And let me pull up my screen to share with you some important information as we get started. Today, we are welcoming doctor Professor David Wilkerson from the IU School social work to talk to us about a very interesting topic. But we like to remind you that our center was the brain child of Professor Emeritus Sandra Petronio, who is a research translational researcher herself, who was intrigued by the work of information and how we share that. So she's created a whole framework about privacy management and has had a whole career around better understanding how we share information. And when she and Chancellor Emeritus Charles Banz came to campus, they noted that a lot of the work that happens at IEPY is what we would call translational. Is generating or taking generated ideas and applying them to solve complex problems in our community. And so we are all about promoting that and having conversations about it. As we begin our conversation today, a few reminders about Zoom. Hopefully everybody's familiar with Zoom, but please keep your microphones muted, and you're welcome to turn on your cameras at any point. Some point later, we will have conversation, and then we do invite you to turn on your cameras and unmute to be part of the conversation, but you are also welcome to put your comments and questions into the chat, and we'll keep track of that. We are recording this presentation, so you could see it in the future or share it with others, and you will, of course, receive a post event evaluation. We love to hear about your experience to help us plan for things in the future. You can click that link anytime. It's in the chat now because we'd love to just know about your experience and to give us ideas for the future. You can keep up to date with us in lots of ways. These sessions are available for continuing education units, and you can go visit I U Expand to learn more about that. There's many ways to keep up to date with the Center. We're available on Instagram. We have a YouTube page, like us on Facebook. You can follow us on Twitter. We try to share information about the exciting things going on. Another great way to find out about our scholars is to look at their page on the website at trip PY dot edU. And you can find more information specifically. For example, today, you could go to this featured scholar page, look for doctor Wilkerson. You can click on his beautiful picture, and then it will bring up his page that has some more information about his work, including works that he has listed in IUPI Scholar works. This is our way at IUPY of making journal articles available to the public in a free way. If you click on the IUPI link, you can see more information from scholar works at the library and see all of his works there. And please share this with the community as a way for folks to learn more about the work that's happening that makes it accessible. Next month, we have several things happening. October starts just tomorrow, but at the end of the month, we're delighted to have doctor Katherine Mosher with us, who will be talking about supportive care for adults with advanced cancer and their family caregivers. So that'll be a lively and informative conversation. We also are very happy to announce that we have our annual fall showcase and Awards program, which is scheduled for Wednesday, October 19, 3-5 in the campus center. You'll want to come and hear from doctor Score, who is the Bans Petronio Trip Faculty Award winner. And then we've got our featured scholars this year from the Fellowship and the Scholar Award program. So Lonnie Silva and Richard Brandon Freeman will be available and talk about their work. We'll hear from Interim Chancellor Andrew Klein, who will give us a welcome, and we'll also hear from our executive director there. And then we have some other IUPUI scholars who will be available at the showcase to share their work. This is a great opportunity to learn more what's going on, and it will be in person. We will be able to have the awards presentation and the presentation by doctor Score online for those that can't come, but this is a chance for us to get back together and be in person. So we hope you'll join us. But today, we're very excited to have with us doctor David Wilkerson, who, as I said, is the associate professor in the IU School of Social Work at the IUPY campus, and he's also an affiliate research scientist with Recon Strief Institute. And he has a very intriguing presentation for us, today, I'm going to stop sharing and invite doctor Wilkinson to join us and to bring up his PowerPoint presentation. So he can share some ideas with us before we dive into a conversation. So welcome, David. We can't wait to hear what you have to say. T hanks, Stephen. Hello, everyone. And again, thanks again. My name is David Wilkerson. I'm an associate professor and the Director of the Office of E Social Work Education and Practice at IU School As Social Work. And today, I'm presenting a paper that I've contributed to a book titled Social Work in an online World, a guide book for Digital Practice. It's currently in production, and it will be published in early 2023. So my agenda I have three agenda items. The first two will provide context for the model I'll discuss. However, before I get started, I'd like to ask that you participate in some real quick polls. And I think, No, you're going to put the polls up for them now. Okay. So that has to do with delivery of psycho education, whether you do that in the office or whether you do that online. And we'll discuss the poll results at the end of the presentation. David, while people are answering the poll, because they might not be able to read the entire definition, why don't you share that with us as so people can hear it as well as read it? Here's the definition of psycho education. Right. I was going to suggest, let's read it so people could hear it. Psycho education, as you define it, is a professionally delivered treatment modality, which integrates and synergizes therapeutic and educational interventions. It looks like several people have had a chance to participate in the poll, so we hope you'll take a moment to answer that question. Polls. Okay. All. Moving So, first off, I want to talk about social works move to digital practice. And location location location, you've all heard that. It's a catch phrase for what drives real estate sales. And in the same way we could say COVID COVID COVID. That can also be a catch phrase for what drives the move to digital practice. So the COVID 19 pandemic Al but halted analog practice delivery. So that's where the practitioner and the client have to be in the same physical location at the same time. Also resulted in many new state and federal legislative policies, surrounding regulation, surrounding reimbursement for digital services. And as you can imagine, it also created a big demand for training. So, for instance, in April of 2020, we created at the University of School of Social work, we created and delivered a telepractice basics continuing Ed course through I U Expand. As of September, we've had nearly 10,000 participants enroll, and it's still there, if any of you haven't seen it or want to participate. So as we follow in the wake of COVID's impact on digital practice, so this training demand has also resulted in another demand, and that's for digital intervention platforms and programs, translating analog practice to digital spaces, which it turns out it's easy to say, but it's very difficult to do. Ku and colleagues interviewed users about their experiences with a computerized intervention authoring system. They identified three barriers. And the first was a lack of cross disciplinary understanding. So the subject matter experts didn't understand the costs and the time that go into the demands technology development. And another issue for them was that they didn't often recognize other usages that they could use technology for in terms of delivering services. On the other side of this is those with technology knowledge, they had a limited understanding of how interventions could be delivered. The second challenge is variability in the recipients technology access, infrastructure, and their digital literacy. So these include internet self efficacy, internet anxiety, privacy concerns, access to broadband, usable broadband, upload and download speeds. So for example, paravdals, and colleagues studied an online intervention that was developed for family caregivers of persons with dementia. And they discovered that most of the users had very low levels of participation. They found that users were really cautious about privacy, security concerns, and then they were reluctant to access a new and unfamiliar online program. And the third challenge is evidence based in person interactions don't translate directly to digital interactions. And they give a number of really interesting examples of that. However, at this time, or at this point, I'd like to go ahead and turn to the issues that I'm discussing and the challenges of translating group based interventions. And by the way, I'm teaching a digital practice course right now. And the students who have experience in online delivery. I've heard them say that synchronous group interventions is something that they have learned to steer clear of. They don't want to do that. So I'm going to turn this discussion to Asynchronous groups as that's what I used for my model. And each of the following researchers have investigated programs that included web based individual training, and then asynchronous group discussion boards. So Steed researched and online family life education program, and roughly half of the participants chose to either go to the web based training or go to the Discussion Board. However the ones that visited the Discussion Board didn't continue to participate because of limited engagement, limited content contributions. And so the next is Taylor and colleagues. And so in their intervention, an optional discussion forum for mutual support was developed alongside individual online delivery of parent management training. Only a few participants contributed content to the forum, most lurked. They only read post without contributing content by replying or posting their own messages. And so those researchers hypothesized that participation through group forums really requires a subscriber threshold of several hundred participants before interaction can really emerge. Cristanco Lacroix and colleagues delivered a psycho ed program for caregivers of people with Alzheimer's disease. Participation in the individual psycho education was facilitator directed. And then the discussion program or forum was self directed, voluntary. They wrote that, though most of the participants found the psycho ed program useful, overall, they expected something that was a lot more dynamic, and they wanted further interaction with staff and peers. However, and then they also wrote that the most frequently visited section was the forum. However, there were only ten messages and ten answers posted in the forum. So you can see again, lots of observers, but not very many participants. Last excuse me, gins and colleagues. So they investigated a web based training and community interaction program for parents of children with chronic kidney disease. And prior to delivering the intervention, they did a needs assessment, and it showed that online peer support was a number one need. Have of the 146 participants, only a minimal number actually used the intervention. So the group discussion forum was ineffective in each of these programs. And let me see what you think could be the common element for group delivery in all these programs. So if I could ask all of you this question, can you detect a common element for all four of these? Any takers? Okay. I have some interesting issues about these things particularly when it was to or not. So The question that I that I had was that there seemed to be this what I called almost ghosty you know, that was going on am I right? That's in all of these studies? In all of them, right. So it's almost like they wanted information but didn't want to share any and Sandra's interest in privacy, obviously, that raises that observation. Are they did that appear to be why they were Just not participating. Just watching not participating. I what I find it's not just these studies, but in other studies where where there's web based training, individual training, and then a group is that the groups are optional, involuntary. The web based training pieces are facilitated. Often folks need to enroll to participate. However the group discussion is made available with the assumption that because we have this space available for you, you're going to use that space to receive support, and it doesn't appear that that works. But I have another I have another explanation for it. And it's called the rule of participation inequality. So Nielson, who's known as a usability Guru. So he has said that the vast majority of people observe within social media. They don't interact. And so, according to Nielson, 90% of the postings in social media, come from only 1% of users. And and 90% don't post at all. And then the other 9% just intermittently post. So that brings me to a question that I have for this group. And No, if you could say, Yeah, there's the poll right there. I want to see how much this group conforms to Nielsen's 991 rule. So there's the results for you. So it's a bit different, isn't it? So according to Nielsen, it should be 90% never, 9% once in a while. And the daily would be 90%. I mean, I'm sorry, the daily would be 1%. That part is a little closer. Well, looking at so we can look at this rule though, and we can see how well you can apply it to interventions, like we've been talking about webs training and discussion forums. And so Ven Merlo I've got the I've identified some of what he found in his research. So he studied four programs, alcohol abuse, depression, panic, nicotine addiction. And you can see that there was a combined 63,990 participants. There was a total of 578,000 posts between 2001 in 2012. And in this time, we do see it really conforms to the 991 rule that 90% of combined site participants accounted for only 1.3% of the posts. So I'm going to so that's as a possibility for why folks don't participate or contribute content in one online programs that have discussion forums. But I also I want to continue with Markou and colleagues their work in terms of the barriers to translation, because I'd like to add a fourth barrier. And that there's really an absence of clear definition or if there's an absence of clear definition of an interventions components and its mechanisms or mechanics of change. It's difficult for us to perform reliable research. Replicability is a problem, and certainly the development of our practice knowledge becomes limited. And I just here you can see the trans theoretical model for change, and I just put this up as an example of a particular model where you do see mechanics and actions. And even with their particular model, if you're able to ass or assess that someone's in contemplation, then that brings a number of interventions that you might apply versus if someone's in pre contemplation. So works great. I can feel the cold already. So if we go to psycho education, there is a what's been called a theoretical black box that is occurring. And some examples of this are from Lukins and McFarlane. And they see psycho education's flexibility and its inclusiveness to result in varying definitions of the intervention. Percy and colleagues. They studied analog and digital psychoeducation programs. They found that they were effective for unipolar depression, but as their quote says, the mechanism is unknown. And then Brock and Cues definition, this could also define bibliotherapy, and I could cite several others that provide similar definitions. So I really varies widely what is psycho education, and the mechanics of change are not well known. And if we turn to group based psycho education, there's even a bigger issue here for understanding change mechanisms of change. And that's unlike individual psychotherapy or group psychotherapy, when we think about those, I mean, we can see a clear distinction, and we know that there's a clear difference in terms of techniques and operation, but group based psycho education, it isn't even defined separately from psycho education. It's just seen as another way of delivering. I. So again, it creates several questions in terms of mechanics of change, barriers for translating analog group psycho education to digital group psychoeducation, kind of like the research examples I gave earlier. So with that context, I'll share a model for digital hybrid psycho education that attempts to address two questions that I see is needed for translating from analog to digital intervention. So first, what are the mechanics of chains that develop if you integrate individual and group work with in digital psycho education? And we saw we'll talk about that in a minute in terms of the integration. And can integrating online group work with individual training amplify the practice components of intervention, like we like the web based individual skills training? So my model definition is digital hybrid psycho education. It's professionally facilitated intervention that integrates, synergizes, amplifies, and personalizes individual web based training with online group work. And those are the five key concepts. The dependent. So the case I'm using to demonstrate these key concepts is a pilot study for PMT psycho education. And for those interested, I've included a link in the reference page, and it's also available through scholar works. Have to summarize the outcomes, the pretest post test surveys, demonstrated moderate changes for increased parenting self efficacy, moderately large changes for decreased likelihood of opposition and defiant behavior or disorder. Excuse me. The elements of the individual web based training and the group work were joined and integrated. So this is this is quite a bit different than the examples I gave earlier. So as you can see in Week one, there's individual web based PMT module. And then parents are moved to a discussion group. And so participation in the group isn't voluntary or self directed. It's professionally facilitated, and then folks are moved from one component of the intervention into the next week three back to individual web based training. And so this is the most basic method for integrating F. Two components in facilitating alternating participation. The group participation was also professionally facilitated. So materials for discussion were prioritized and sequenced based on the training goals. And then facilitation for the group discussion included e mailing participants to ensure they observe new posts, new post or replies, or relevant observations related to their own posts, as well as scheduling these begins, the beginnings of Week one, the beginnings of Week two. H. Next, key a key concept is synergizing and the method was problem based learning. So discussions began with a video vignette for troubleshooting. And I'll go ahead and show an example. It in here. What? What's the meaning of this? I don't know. Yeah, I guess. So we see that what happens here is that so this particular video began Week two, the discussion. So at the end of Week one, in terms of the individual training, they went right into the discussion group, and then they were asked questions about the video. In this of problem based learning, comes from the seminal work of Cunningham and colleagues, and they provided a method for synergizing components that was guided by attributional questions. So Cunningham and colleagues found that problem based learning resulted, and they used in their parent management training. They found that PBL resulted in better attendance, homework completion, program satisfaction. And it replaces didactic instruction with the presentation of a problem that the group participants assess, they explain, evaluate, and solve, So critical to this process is that the problem addresses participant real life concerns in relevant learning domain, which in this intervention was parent management training. So, again, the participants went through the individual training module, and then they went into the group discussion. There there was no questioning about what they learned in the training module. Instead, they received they saw this video, and then they were asked to troubleshoot it. And here's some examples of, how troubleshooting questions are developed. And again, this comes from Cunningham. So you might for that particular video, we looked at parenting skill, and then we looked at communication. We looked at long term outcome. So what would be the long term effect of the strategy? What message from a social learning perspective, what lesson are you teaching your child with that behavior? And it's a nice way based on your group and the video you choose for troubleshooting, it's a nice way for guiding discussion. But again, the group creates the solutions. Another another part of the key concepts was personalizing and amplifying. So a standard element of psycho education is a self assessment in whatever the area of challenge that a participant is facing. So it might move a person from contemplation to preparation for action this self assessment. So one of three parenting styles could be identified through the assessment in the program. Task centered parenting or relationship focused parenting. So they were developed to provide the participants with a more engaging interpretation of authoritarian or harsh parenting, which would be this regulation pathway or lax parenting, which would be the connection pathway. And then a third term balanced style was then presented with video vignettes to create a goal for change that joined the ta task centered and relationship focused parenting in a more intuitively effective style to balance an over emphasis on either one of the other two styles. Amplification refers to the use of identification of parenting styles in the PBL group discussions, and participants apply the individual training. They seek to achieve a balanced style, and you can see that in their discussions, which I'll show a few of these posts. These are four different posts, and you can so within the individual training module, module, the participants identified what kind of parenting style they had. And they also identified what their compliance rate was. And so you can see a couple of these folks are identifying task centered or harsh parenting. And so this would be the kind of thing that would be stigma inducing also to talk about in a group, have or with the we felt that by personalizing it and making task centered, not a horrible thing, but something you need to balance with connection and relationship that folks would feel comfortable about talking and reaching a goal of balance. I'll let you read a few of these. And I will share another example. So this is a single post from a participant that joined the program with her husband. And it illustrates the personalization, and again, the amplification of web based training in her discussion. She identifies herself as she was task focused or a harsh parent. And she was able to increase her compliance rate following instruction 25-50%. And part of that was by balancing and creating more connection, more relationship. And in this last paragraph, she describes she describes changing her beliefs, changing her attitudes, and changing her behaviors. So I think are we at 20 minutes? Yeah, we have about 10 minutes left before we would begin to wrap up. So Ray for Pool results in discussion. Good time. Yeah, so in here. So we can look at the pool results and have discussions. So quite a few people deliver individual psycho education in the office. Interesting. Quite a few deliver online. And so I'm wondering, the ones that are delivering Let's see. Who delivers based online? 14%. I'm wondering for the ones that deliver group based psychoeducation, is that asynchronous or synchronous? Which I might have asked. Anyone want to share that? Their experiences with the group based online intervention or any type of psycho education in terms of this move that we're making from analog practice to digital practice. So this would be a time to share our screen and then invite people to turn on their cameras and engage in some conversation to perhaps talk about some of these questions. There is a question in the chat doctor Mata. So, David, doctor Matata is asking if there was a desegregation according to ethnicity and or race. This wasn't for this particular group, there were 19 participants 23 participants enrolled, 19 completed the program and the 19 participated in four small groups. I'm really wondering about those that do online group psycho education, if any of you are doing that with discussion forums, and if you are doing asynchronously, how well that's working for you. Well, again, we'll invite people to turn on their cameras and to to let us know. If you've had these experiences and what your experience is like, I know, as I'm listening to you talk, it raises a lot of questions about how to maybe do this or some of the challenges. Paul, I see you've joined us. Were you did you have a comment? You you were being good and turning on your camera. Thank you. Yeah. Can you hear me? Yeah. Okay. This is a new device. I know. I'm just starting my job at the I U Simon Cancer Center, and so I don't have any feedback yet as far as, you know, any groups. I mean, I know I'll be out in the community doing things, so I know that much. But I'm just starting like just in my sixth week or something like that, but I did want to turn on my camera. To let you know someone is alive and here for you. Thank you. Thank you. I think one of the things that I know often I hear. I've often had conversation with folks that are planning to do online interventions. And I do and I often hear that hear that statement that they plan on offering a group so people can get support from one another. And I guess my experience is that it just doesn't work that way that you have that there is a that these other kinds of in terms of mechanisms for change, that these other activities need to be a part of the intervention, at least in the case of using an asynchronous discussion forum as a part of psycho education. Thank you so much for this presentation, doctor Wilkinson. We are running a program where we're tutoring and mentoring young children across the state. And we're working with a number of the parents or adult caregivers, because in many cases it's not so much the parent, but an adult caregiver who is responsible for the social emotional well being of the young people. And so we've had synchronous workshops. And we're finding that the participation rate is good, but it also varies. And that's why I asked in regards to the disaggregation. We found that some of the adult caregivers were often ready to share their talk, but they're not necessarily seeing themselves as being harsh. Or necessarily being relationship building. You know, they see themselves in lots of different ways, but they want guidance in whatever way. And so we didn't necessarily assess what their style was, but more because that's not our background, our background in education, thinking through what we might do to support those adults and parents really supporting their young people's well being. Mm hmm. And so my question really came to and why I posted it was because if you're starting to see anything that really does speak to the disaggregation of ethnicity and language and race, because we are becoming such a diverse. All right. Country. How do we attend to that? It it certainly wasn't a part of this particular research, I think that in terms of desegregation, I think it is important, it would be important, at least from my experience, to look at the audience or look at your participants and find ways again, find ways that you can personalize that content for them. I in some very straightforward simple ways. And so when we I mean, there's lots of literature around parenting styles. There's some new literature that's beginning to discount some of that, too. But but we really simplified it into just those two basic types because in terms of coming coming into mental health practice, Well, it's so parents are challenged by their child, but when you begin learning more about the parental their behavior, a lot of times, it's either an issue of harsh parenting or lax parenting, or you've got a couple where one is harsh and the other is lax. And there may be all kinds of couple dynamics that would account for why those behaviors were occurring, too. Um. But so we personalized it. We made it really simple, and then we created that go for being balanced. I really appreciate that recommendation of having it straightforward. It just seems that coming out of COVID, and we're not coming completely out. But as we come out of COVID, more and more young people are experiencing the social emotional aspects of I mean, just the challenge of coming back into a school setting. Those parents trying to figure out how to work with them and support them. And I keep saying adult caregiver, because more and more grandparents are raising young people, too. Yeah. So how do we attend to that and offer those straightforward but simple supports for their well being, too. Thank you so much. Thank you. Yeah. Thank you for the question. Go ahead. Haley, yes. I just I have a question. So I am a social worker at a school, and we have been struggling with, like, just getting parents to participate in events, like really engage with their kids. So can you talk a little bit about the process of how you recruited those parents? Like, kind of got them enrolled in the system or anything on the lines of the engagement. The recruitment was done a lot of it was done with flyers, and we were at we were looking for we were looking for parents that were was having problems with challenging behavior like oppositional defiance. So we put up flyers at psychiatry, child adolescent psychiatry offices, general practitioner offices, And we also did some advertisement We did some advertisement through a newsletter, local newspaper. For school. Yeah, I I've done some research looking at that, too. I remember a teacher talking about we have a lot of sleeping parents was her phrase. How do you engage parents? I mean, it's a big task. Are you wanting to engage them synchronous? You want to engage them physically at the school or online? Mostly physical for now at least. I think that's kind of like step one into, like, getting back pre COVID, into the swing of things. Like this is kind of the first normal year that we've had since COVID. So just trying to get I mean, we have trouble just connecting with them in general, like phone calls, anything. That's why I asked about part. Sure. Yeah. I have Well, I think it's I think it's I don't think it's necessarily just an issue following COVID. I think I mean, pre COVID. I had would offer large scale parenting management training programs in school systems. And so it was free. It was and the way this particular analog intervent psycho ed program worked was, I wanted as many as 50 parents there, and we would break into small groups. But I was taught this method in Canada. It's very successful in Canada. And then I delivered it to a rural school at a rural school system, suburban school system, urban. And I had the same problem with getting parents engaged. Part of part of it I thought had to do with. So we did this in the evening. It was difficult for parents to get to the school itself. And some of that experience was what led me to want to want to learn more about digital interventions. At least I mean, we can conquer space. I mean, with that particular intervention, you'd have to do it synchronously. But again, that's why I wanted to do it with asynchronously, too, so we can overcome both of those obstacles. But I just so one of the things I did learn from doing those kinds of groups was that something had to come in front of the parent at least ten to 12 times before before it finally kind of connected with them. So the more ways that you can mark it, you can get it across, let parents know that I have this really great thing that you're going to love. I think that can make a difference. Well, there are a couple more questions in the chat, but we do want to take a pause here, and thank you for participating in Sharon and talking about what seems to be a pretty important topic, as many of us in our work are trying to figure out how do we, as doctor Martado, talks about, sort of post COVID. We're not out yet. We are still in our work seeing the impact that people are having around trying to get back to whatever the new normal is, but the impacts, particularly in our kids and struggling around how they function? How do their families function? How do they do in school and or childcare, wherever they are? This is very important work and has a lot of opportunity to help us figure out the best ways to move forward. But we do want to pause here. And thank everybody for coming. Those that need to leave to move on for their 1:00 and need a little break. We invite you to go ahead and take off and leave. Those that want to stick around for a little bit longer and have more conversation or answer these couple of questions. Please stay on. And we can talk with doctor Willison for a few more minutes before we finish, but we hope we'll see you at future Center for Trip events. Don't forget next month is our annual showcase and Awards program. Of course, we'll also at the end of the month, have our scholar of the month program. So thank you for joining us.