_________ Katherine M. McCarthy, PhD, LCSW, Associate Professor, and E. Susana Mariscal, PhD, Professor, Indiana University School of Social Work, Indianapolis, IN. Elizabeth A. Wahler, PhD, MSW, affiliated research faculty and previous director of the School of Social Work, University of North Carolina, Charlotte, NC. Nina C. Johnson, MSSW, doctoral student, Indiana University School of Social Work, Indianapolis, IN. Copyright © 2024 Authors, Vol. 24 No. 2 (Summer 2024), 442-454, DOI: 10.18060/27149 This work is licensed under a Creative Commons Attribution 4.0 International License. Does Proactive Stress Management Increase MSW Students’ Training Satisfaction and Substance Misuse Practice Readiness? Katherine M. McCarthy E. Susana Mariscal Elizabeth A. Wahler Nina C. Johnson Abstract: Social work educators aim to increase the goodness of fit between student preparation and the needs of the community. Because working with individuals with substance use disorders (SUD) can be emotionally challenging, training MSW students to do this well does require not only development of skills and knowledge but also a capacity to maintain personal wellness. The purpose of this study is to better understand how wellness strategies affect MSW students’ preparation. This study examined two strategies to maintain wellness used by MSW students, pro-active stress management and classmate support network, and their relationship to training satisfaction and student readiness to assist clients struggling with substance use. Thirty-three MSW students in the final month of their degrees completed program evaluation surveys in Spring and Summer 2020. We conducted linear regressions to assess how proactive stress management and classmate support network contributed to student satisfaction and practice readiness. While both proactive stress management and supportive classmate networks were significantly predictive of training satisfaction, only pro-active stress management also predicted several measures of student readiness to address substance misuse. Findings highlight the importance of student wellness in preparing students for practice, particularly the value of fostering student capacity for proactive stress management. Keywords: MSW students, social work education, wellness, substance misuse Social workers in many practice settings are prone to burnout, secondary traumatic stress, and compassion fatigue (Shepherd & Newell, 2020; Travis et al., 2016; Wilson, 2016), particularly when working with individuals who have substance use disorders (Baldwin-White, 2016; Tartakovsky & Kovardinsky, 2013). The chronicity of substance use disorders, risk of client relapse or overdose, and high rates of trauma and abuse experienced by individuals with substance use disorders (Cosden et al., 2016; Fahy, 2007; Gielen et al., 2012) exacts a heavy emotional toll on their social workers. MSW students working with clients who misuse substances may face an even higher risk of vicarious trauma than those working in other fields (Cosden et al., 2016). Workforce shortages and developing a skilled workforce to address substance misuse have long been a concern in the United States (Hoge et al., 2013), and is expected to continue to be a growing concern due to the increase of rates of substance misuse observed with the COVID-19 pandemic (Horigian et al., 2021). It is essential that social work education adequately prepares students for this work and for strong, sustained, and balanced growth, increasing their predisposition for longevity in the field. about:blank McCarthy et al./MSW STUDENT WELLNESS 443 Vicarious Trauma and the Need for Self-Care Although social workers, including those serving individuals who struggle with substance misuse, are in positions where they could be at great risk of encountering distress-inducing situations, the social work code of ethics states …social workers should not allow their own personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties to interfere with their professional judgment and performance or to jeopardize the best interest of people for whom they have a professional responsibility. (National Association of Social Workers [NASW], 2021, Ethical Standards, 4.05) To assist clients, social workers are expected to maintain sufficient personal wellness and prevent distress from interfering with their work. However, vicarious trauma is a serious risk for social workers in substance use disorder treatment settings (Gielen et al., 2012), and vicarious trauma not only impacts the professional self but can also impact the social worker’s personal functioning (Ashley-Binge & Cousins, 2020). Self-care is one strategy for maintaining social workers’ personal wellness, and recent literature emphasizes self-care as a crucial part of the social work role (Willis & Molina, 2019), so much so that it was recently added to the revised National Association of Social Workers (NASW) code of ethics (NASW, 2021). Self-care can protect social workers from the hazards of burnout, compassion fatigue, and vicarious trauma (Martin et al., 2020). Social Work Education and Student Wellness There is a clear need to build capacity around social work students’ strategies for affective regulation, empowerment, and stress management that can support their ethical and competent practice as well as their personal wellbeing. This is particularly important to build a skilled, sustained, and growth-oriented workforce to effectively address substance use disorders. Accrediting standards promoted by the Council on Social Work Education recognize that self-regulation is a skill that social work students are expected to gain and demonstrate (CSWE, 2015). The first social work competency articulates the need for students to manage their personal reactions, noting graduating students must be able to “use reflection and self-regulation to manage personal values and maintain professionalism in practice situations” (CSWE, 2015, p. 7). Not only are social work students expected to manage emotional reactions sufficiently well to earn the degree, but this skill also helps them navigate school if gained earlier in their educational process, since the demands of graduate school can be difficult to balance (Diebold et al., 2018). For example, a recent study of graduating MSW students found that feelings of being overwhelmed and stressed frequently interfered with student learning in field placement. In fact, personal distress was identified as a more frequent barrier to learning than concerns about learning opportunities, supervisors, class concerns, or agency issues (Grady et al., 2020). Variation in privilege can also contribute to differential experiences of personal distress. Food insecurity is correlated with impaired academic performance (Martinez et al., 2020). Racially minoritized individuals and students on financial assistance are more ADVANCES IN SOCIAL WORK, Summer 2024, 24(2) 444 likely to experience food insecurity (Weaver et al., 2020). Students who have experienced more trauma may experience more impaired wellbeing and greater likelihood of secondary traumatic stress, but also demonstrate resilience (Bishop et al., 2024). COVID-19 also exacerbated student mental health distress, access to resources, and capacity for learning (Apgar & Cadmus, 2022; Cummings et al., 2023; Scheffert et al., 2021). Assisting students with managing stress and self-regulation can improve all students’ learning as well as their ability to practice as social workers in the substance use disorder field. Pro-active stress management skills are intentional efforts to be cognizant of personal stress level and take steps to reduce it. Effective stress management techniques can help to decrease anxiety, depressive symptoms, and enhance overall emotional well-being (Benjet, 2023). O’Neill et al. (2019) found that social work students who engaged in daily self-care practices experienced less perceived academic stress. Social work students who perceive adequate self-care also report greater personal wellbeing (Bishop et al., 2024). Classmate support networks are the social connections a student has with their peers that can help them manage challenges. Student peer networks contribute to a sense of community and enjoyable classroom learning experiences, which can ease stress (Grady et al., 2020; Grady et al., 2014; Hunt et al., 2012) and student compassion fatigue decreases when students communicate their distress to peers (Knight, 2010). Both proactive stress management skills and classmate support networks may contribute to MSW student capacity to maintain wellness. How proactive stress management skills and classmate support networks relate to student readiness to assist individuals struggling with substances has not been explored. Thus, this study explores the relationship between student wellness indicators (proactive stress management and classmate support networks), student perceived readiness to assist clients misusing substances, and student satisfaction with their MSW training. This study’s research questions are, for MSW students enrolled in a mental health and addictions curricular area: 1. Does a relationship exist between proactive stress management and perceived readiness to assist individuals who misuse substances (e.g., role adequacy, role legitimacy, and role support)? 2. Does a relationship exist between proactive stress management and training satisfaction? 3. Does a relationship exist between classmate support and perceived readiness to assist individuals who misuse substances (e.g., role adequacy, role legitimacy, and role support)? 4. Does a relationship exist between classmate support and training satisfaction? Methods This quantitative study examined the relationship between student wellness, readiness to assist clients who misuse substances, and training satisfaction. This study used a convenience sample consisting of MSW students entering a specialized mental health and addictions-related curricular area in the Fall 2019 semester at a Midwest public school of social work. Fifty-five MSW students enrolled in this curricular area were invited to McCarthy et al./MSW STUDENT WELLNESS 445 complete a program evaluation survey at the end of their final semester. The survey was anonymous and distributed online through Qualtrics. Students responded to closed-ended questions (e.g., Likert scales) about their tendency to monitor and address their stress, their connection with classmates, their readiness for practice, and their satisfaction with their MSW education. Regression analysis was used to determine potential relationships between variables. Since the original data collection was done for program improvement purposes, no identifying information were collected. The university’s institutional review board reviewed the study procedures and identified minimal risk to the participants, qualifying this research as exempt from further federal regulation by the federal policy Participants Thirty-three out of 55 invited MSW students completed the survey, representing a 60% response rate. The mean age was 30.58 years (range of 22-56 years). Most students identified as white (n=24, 73%) and cisgender female (n=28, 75%). These demographics are similar to the university’s MSW population which is 72% white and 88% female. An intention to pursue a clinical social work license after graduation was reported by 90.1% of these students. Instruments Student Wellness Two aspects of student wellness are considered in this study: proactive stress management and peer support. Pro-active Stress Management Scale. Pro-active stress management involves awareness of personal stress and taking steps to reduce it. The authors developed a statistically reliable scale to assess student tendency to reflect on their stress and actively engage in self-care, creating questions from literature on needed social work self-care skills (Lee & Miller, 2013; Willis & Molina, 2019). Students were asked to use a 0 to 10 scale to respond to the following questions: “How knowledgeable are you about how to address the stress that may come with being a social worker?,” “How often do you monitor your levels of wellness (physical, emotional, mental, social, spiritual)?,” “How often do you take proactive steps to address personal wellness needs (physical, emotional, mental, social, spiritual)?,” “How aware are you of your personal reactions to internship or social work challenges?” Higher numbers indicated greater amounts (range = 5.25-10, M = 8.061, α = 0.835). Exploratory factor analysis of the Proactive Stress Management Scale was conducted to demonstrate reliability of this measure using principal components and direct oblimin rotation to assess the underlying structure of the scale. Four criteria were used to determine the appropriate number of components to retain: Eigenvalue, variance, scree plot, and residuals (Watson, 2017). The results of these assessments indicated that one component should be retained, accounting for 67.94 % of the variance. All variables had positive loadings ranging from .705 to .900, indicating all questions correspond to proactive stress management. See Appendix A. ADVANCES IN SOCIAL WORK, Summer 2024, 24(2) 446 Classmate Support Network Scale. The classmate support network is the extent to which students rely upon each other to manage challenges. The authors used three questions to measure quality of students’ classmate support networks: “I work well with my classmates,” “My classmates encourage and support me,” and “I am likely to reach out to my classmates in the future.” These questions were informed by Lee and Miller’s (2013) self-care framework for social workers, which describes the need to access professional support, including peer support. Each question was measured on a 7-point Likert scale ranging from 1 (Strongly Disagree) to 7 (Strongly Agree; range = 5-7, M = 6.365, α = 0.786). Again, exploratory factor analysis of the scale was conducted, which indicated that one component should be retained accounting for 70.37% of the variance. All variables had positive loadings ranging from .753 to .898, indicating that all questions correspond to classmate support. See Appendix B. Satisfaction With Training One question measured students’ satisfaction with training to address issues of substance misuse, “Please describe your satisfaction level with your education and training to assist clients with substance use disorders between 0 and 100, with 0 meaning ‘unsatisfied’ and 100 meaning ‘extremely satisfied’” (range = 20-100, M=69.39). Readiness for Practice In 2003, Watson and colleagues developed the Drug and Drug Problem Perception Questionnaire (DDPPQ), as an adaptation of a comparable scale around alcohol concerns (AAPPQ; Cartwright, 1980). The retested 20-point scale was used (Watson et al., 2007) to examine student attitudes towards individuals abusing substances, with the word “drug(s)” replaced with “substance(s)” per the recommendation of previous researchers who adapted the scale for MSW students (Senreich & Straussner, 2013). Three subscales were used: The role adequacy subscale assesses an individual’s experience of being able to perform effectively as a substance misuse counselor, the role legitimacy subscale measures the individual’s conviction of their right to be in a counselor role, and the role support subscale measures the experience of support felt by the individuals from supervisors and colleagues (Watson et al., 2007). All items were measured on a scale of 1-7, with items being summed for the total subscale score. Higher scores indicated higher levels of role adequacy, legitimacy, and support. In this study, role adequacy mean was 5.823 and had strong internal consistency (range = 3-7, α = 0.945); role legitimacy mean was 5.439 and had adequate internal consistency (range = 3-7, α = 0.767); and role support mean was 6.1 and had strong internal consistency (range = 4.33-7, α = 0.907). Analysis Factor analyses were conducted to examine the underlying structure of the two scales developed for this study: Proactive stress management and classmate support network scales. Linear regressions were conducted to assess if there were associations between readiness for practice and proactive stress management and/or classmate support network McCarthy et al./MSW STUDENT WELLNESS 447 and whether there were associations between training satisfaction and proactive stress management and/or classmate support network. Assumptions for linear regressions were assessed and met, including linearity, homoscedasticity, residual normality, no multicollinearity, no autocorrelation, and independence (Mertler & Vannatta, 2013). A sensitivity analysis was conducted to determine that an outlier was not influencing results. SPSSv27 was used for the analysis. Results Linear regression analyses assessed if there were relationships between the wellness variables (proactive stress management and classmate support) and the outcome variables training satisfaction and readiness for practice (role adequacy, role legitimacy, role support). The Bonferroni correction (Mertler, & Vannatta, 2013) was used to ensure that power was not inflated with multiple linear regressions and a significance criterion of .0125 was established. Proactive stress management has significant positive associations with role adequacy with β = .489 (t=2.978, p=.006), role support with β = .553 (t=3.555, p=.001), and training satisfaction, β = .610 (t=4.620, p<.001). Indicating that students who reported higher levels of proactive stress management tended to report higher levels of role adequacy (effective role performance) and role support (perceived support in role from supervisors and colleagues). Students who reported higher proactive stress management tended to report also higher levels satisfaction with their MSW training. Proactive stress management was not significantly associated with role legitimacy. There were no significant associations between classmate support network and student readiness for practice (role adequacy, role support, role legitimacy), or training satisfaction. See Table 1 for specifics. Table 1. Linear Regression Estimates Proactive Stress Management Classmate Support B SE B β B SE B β Training Satisfaction 10.681 2.312 .610* 8.929 4.187 .282 Readiness for Practice Role Adequacy .386 .130 .489* -.031 .235 -.022 Role Legitimacy .169 .161 .193 .142 .291 .090 Role Support .333 .094 .553* .044 .170 .040 * Significance identified at the 0.0125 level Discussion The aim of this study was to identify if proactive stress management and supportive classmate networks, two indicators of MSW student wellness, were related to student readiness to assist clients struggling with substances and/or MSW training satisfaction. Students who reported proactive stress management use reported feeling more prepared to work with individuals who misuse substances, as they reported increased confidence in their ability to perform effectively in the substance use disorders (SUD) field and higher levels of support from supervisors and colleagues in their roles at their internships. ADVANCES IN SOCIAL WORK, Summer 2024, 24(2) 448 However, students who felt more connected to their classmates were not necessarily more prepared for this work. These findings highlight two important points. First, using stress management skills intentionally can help students maintain the interest and energy needed to learn and invest in their field experiences. Student capacity to reflect upon and intentionally manage personal stress could assist them in feeling confident and supported in assisting individuals struggling with substances. Our findings corroborate literature that indicates that by supporting student development of self-care strategies, social work programs can strengthen students’ overall wellness, reduce their level of academic stress, and improve their work with clients (Cuartero & Campos-Vidal, 2019; Diebold et al., 2018; Newell & Nelson-Gardell, 2014; O’Neill et al., 2019). Although our findings suggest that these stress management skills aid students in their practicum placements, future research should examine what factors impact the continued use of stress management skills post-graduation to help social workers maintain longevity in the SUD field. Future research should also explore additional factors contributing to student perceived readiness, and role legitimacy, in particular. The second major point is that despite evidence that peer connections can be beneficial for MSW students (Grady et al., 2020; Grady et al., 2014; Hunt et al., 2012; Knight, 2010), this classmate support may not directly relate to students feeling more effectively prepared as social workers. It is possible that students with strong peer networks may connect with peers around pro-education and internship factors, such as sharing resources and support, or they could connect in ways that interfere with learning such as modeling problematic behaviors. Thus, while close classmate networks may help students feel connected, they may not lead directly to field readiness. If educators want to nurture peer connections as a method of supporting student efforts, it may be necessary to provide opportunities for students to pro-socially support or model responses to challenging situations. Our findings do not corroborate recent studies that suggest that the role of relationships with fellow students, faculty, and supervisors is strongly associated with MSW student satisfaction with their training (Grady et al., 2020). Future research should examine the type and quality of the social network to determine whether there are related factors which could impact training satisfaction and career preparedness. Related future research could also explore how MSW students perceive their personal wellbeing and to what extent they feel distressed when working with clients who misuse substances. Implications Considering the positive relationship between MSW student proactive stress management and both training satisfaction and readiness to assist clients with substance use concerns, this study highlights the importance of training students in proactive stress management skills. Students and social workers who are intentional with monitoring and addressing their stress may feel better prepared to work with clients, especially folks misusing substances. Both the explicit and implicit CSWE curriculum could serve to hone these skills in MSW students to prepare them to navigate challenging situations and be successful in the SUD field. Some strategies found in the literature include course-based McCarthy et al./MSW STUDENT WELLNESS 449 efforts to train students in mindfulness (Bonifas & Napoli, 2014; Decker et al., 2019) and goal articulation of stress management techniques (Grise-Owens et al., 2018). In addition, this study provides preliminary psychometric information, including internal consistency and construct validity, corresponding to the Proactive Stress Management scale and the Classmate Support Network scale. Measuring student utilization of active efforts to reduce and manage their stress load could be incorporated into class contexts and guide advisors or students to pinpoint growth areas and/or track progress. Validation of these scales with larger samples of social work students would contribute to the literature by providing a practical tool. This could support the 2022 EPAS (CSWE, 2022) which emphasizes self-care for social work students. Limitations This study has some limitations to consider: First, it used a small convenience sample of MSW students and, second, it used new scales. Conducting this study with a larger and more diverse sample of students would increase our understanding of the relationship between proactive stress management and readiness to work with clients who misuse substances, as would evaluating students post-graduation. While the instruments we used were new, the concepts were anchored in the literature and demonstrated adequate psychometric properties. However, data were cross-sectional, so it was not possible to know the time order of the variables tested. While the assumption of independence of observations was met to the best extent of our knowledge, the study did not explicitly investigate potential relationships between respondents where the value of one observation could influence the value of another observation, which could potentially violate this assumption. However, it is worth noting that such violations, while unlikely, are possible. Considering the information that was collected, we could not differentiate whether students built these capacities during their time in the MSW program or if they came to the program with such varied ability, resources and support to attend to personal wellness, so generalizations are limited. Notably, results were gathered in the Spring or Summer of 2020 as students were also experiencing increasing stressors related to the COVID 19 pandemic. During this time, social work students were known to experience additional mental health complaints and familial concerns (Cummings et al., 2023), trouble with food access, increased stress, and income loss (Apgar & Cadmus, 2022). There is also evidence to suggest that the pandemic prompted social work students to try out new coping skills (Apgar & Cadmus, 2022). So, it is unclear if the multiple new and overwhelming stressors experienced and coping strategies employed when these data were gathered exacerbated the relationship between stress management, readiness, and training satisfaction or if the period of increased isolation altered their experience of their classmate support network. Information on students’ exposure to oppression, economic security, access to health insurance, or other indicators of privilege were not assessed or controlled for but can certainly play a role in general student wellness or the development of proactive stress management techniques and should be included in future research. Working to strengthen student readiness for enjoyable and effective careers in the SUD field should include both enhancing student awareness and proactive capacity to reduce stress and altering social conditions that inequitably overburden some students. ADVANCES IN SOCIAL WORK, Summer 2024, 24(2) 450 Conclusions This study highlights the positive relationship between MSW student proactive stress management skills, readiness to assist clients struggling with substances, and student satisfaction with their MSW training. Fostering self-awareness and intentional efforts to reduce one’s stress is relevant throughout the curriculum and encourages interactive growth (Martin et al., 2020). Amidst limited curriculum space, social work education should support students’ intentional efforts to proactively manage their stress and balance their work demands as a key factor in their preparation to effectively treat their clients, particularly clients struggling with substances. 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Email: mccartka@iu.edu https://doi.org/10.1080/07481756.2017.1336931 https://doi.org/10.1080/07481756.2017.1336931 https://doi.org/10.1080/07448481.2019.1600522 https://doi.org/10.1080/07448481.2019.1600522 https://doi.org/10.1093/sw/swy049 https://doi.org/10.1093/sw/swy049 https://doi.org/10.1080/23761407.2016.1166856 https://doi.org/10.1080/23761407.2016.1166856 mailto:mccartka@iu.edu ADVANCES IN SOCIAL WORK, Summer 2024, 24(2) 454 Appendix A. Pro-active Stress Management Scale On a scale of 0 to 10, with 0 meaning "not at all" and 10 meaning "extremely knowledgeable," how knowledgeable are you about how to address the stress that may come with being a social worker? 1. How knowledgeable are you about how to address the stress that may come with being a social worker? 0 Not at all 1 2 3 4 5 6 7 8 9 10 Extremely knowledgeable On a scale of 0 to 10, with 0 meaning "never" and 10 meaning "regularly," how often do you monitor your levels of wellness (physical, emotional, mental, social, spiritual). 2. How often do you monitor your levels of wellness (physical, emotional, mental, social, spiritual)? 0 Never 1 2 3 4 5 6 7 8 9 10 Regularly On a scale of 0 to 10, with 0 meaning "never" and 10 meaning "regularly," how often do you take proactive steps to address personal wellness needs (physical, emotional, mental, social, spiritual). 3. How often do you take proactive steps to address personal wellness needs (physical, emotional, mental, social, spiritual)? 0 Never 1 2 3 4 5 6 7 8 9 10 Regularly On a scale of 0 to 10, with 0 meaning "not at all” and 10 meaning "highly aware," how aware are you of your personal reactions to internship or social work challenges? 4. How aware are you of your personal reactions to internship or social work challenges? 0 Not at all 1 2 3 4 5 6 7 8 9 10 Highly aware Appendix B. Class Network Scale Indicate how much you agree or disagree with each statement. 1 St ro ng ly D is ag re e 2 D is ag re e 3 So m ew ha t D is ag re e 4 N ei th er A gr ee no r D isa gr ee 5 So m ew ha t A gr ee 6 A gr ee 7 St ro ng ly A gr ee 1. I work well with my classmates 1 2 3 4 5 6 7 2. My classmates encourage & support me 1 2 3 4 5 6 7 3. I am likely to reach out to my classmates in the future 1 2 3 4 5 6 7