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This article was downloaded by: [University of Connecticut]On: 09 October 2014, At: 14:37Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Religion & Spirituality inSocial Work: Social ThoughtPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/wrsp20
Program Characteristics as FactorsInfluencing the Implementation ofMindfulness Meditation in SubstanceAbuse Treatment AgenciesHeather Larkin PhD a , Eric R. Hardiman PhD a , Tricia Weldon MSW a
& Hee Chul Kim MSW aa School of Social Welfare , University at Albany, The StateUniversity of New York , Albany , New YorkPublished online: 17 Oct 2012.
To cite this article: Heather Larkin PhD , Eric R. Hardiman PhD , Tricia Weldon MSW & Hee ChulKim MSW (2012) Program Characteristics as Factors Influencing the Implementation of MindfulnessMeditation in Substance Abuse Treatment Agencies, Journal of Religion & Spirituality in Social Work:Social Thought, 31:4, 311-327, DOI: 10.1080/15426432.2012.716284
To link to this article: http://dx.doi.org/10.1080/15426432.2012.716284
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Journal of Religion & Spirituality in Social Work:Social Thought, 31:311–327, 2012
Copyright © Taylor & Francis Group, LLCISSN: 1542-6432 print/1542-6440 onlineDOI: 10.1080/15426432.2012.716284
Program Characteristics as Factors Influencingthe Implementation of Mindfulness Meditation
in Substance Abuse Treatment Agencies
HEATHER LARKIN, PhD, ERIC R. HARDIMAN, PhD,TRICIA WELDON, MSW, and HEE CHUL KIM, MSW
School of Social Welfare, University at Albany, The State University of New York,Albany, New York
This article discusses lessons learned from a study on mindfulnessmeditation (MM) within a substance abuse treatment agency. Partsof the study are cited as the source of lessons learned. Themes fromthe qualitative data include: scheduling, time factors, discomfort inthe group setting, and group composition. Integral Theory (Wilber,2006) is offered as a useful way to conceptualize spirituality-re-lated interventions that incorporate the organizational context. Theauthors’ experience calls for increased partnership with organi-zations, engaging the interest of providers in spirituality-relatedinterventions that could be studied within the agency setting.
KEYWORDS organizational context, mindfulness meditation,spirituality-related interventions, Integral Theory, researchpartnerships
With a biopsychosocial–spiritual perspective, social work practice claimsto focus on the whole person within the social context (Keefe, 1996;Larkin, 2006b; NASW, 2008). The National Association of Social Workers’(NASW) Code of Ethics (2008) calls upon social workers to facilitate orga-nizational responsiveness to social problems in a way that serves thewhole person. Although research is a social work activity that ideally sup-ports social change efforts and practice competency expectations set forthin the Code (NASW, 2008), there are unique challenges to introducing
Received July 3, 2011; accepted February 13, 2012.Address correspondence to Heather Larkin, PhD, 135 Western Ave., Albany, NY 12222.
E-mail: [email protected]
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and researching spirituality-related interventions in agency settings. Thecurrent article presents a number of lessons learned in conducting agency-based research involving meditation, a spirituality-related intervention. Ourresearch on a mindfulness meditation (MM) intervention offered within asubstance abuse treatment program is presented as an example of the chal-lenges to overcome when carrying out this kind of research in an agencysetting. The current article begins with a focus on spirituality-related inter-ventions, agency-based research challenges, and the conceptual frameworkguiding the research. We then briefly describe the MM study, presenting qual-itative findings related to organizational factors within the study site. Thesethemes are offered within the larger story of lessons learned and followedby discussion of implications for social workers carrying out agency-basedresearch on spirituality-related interventions.
SPIRITUALITY-RELATED INTERVENTIONS
Recently, mindfulness and other spirituality-related interventions havereceived increased attention among social workers and within the scien-tific community. Meditation and contemplation are commonly employedpractices within the spiritual traditions. Through these modalities, practi-tioners access states that can enhance awareness and contribute to overalldevelopment. Some of the profound spiritual aspects of meditation includeexperiences of consciousness, deep peace, and wholeness (Wilber, 2006).A growing body of research has suggested that mindfulness-based thera-pies may be effective in the reduction of chronic pain, anxiety, preventionof depression, and in the treatment of substance abuse disorders (Carlson& Larkin, 2009; Kabat-Zinn et al., 1992; Marlatt et al., 2004). The influ-ence of mindfulness-based stress reduction on positive mental health maybe mediated by an increase in day-to-day spiritual experiences (Greesonet al, 2011). Many practitioners and recovering addicts report that spiritualityis a vital part of a person’s recovery process (Appel & Kim-Appel, 2009). Forexample, past research has suggested that in comparison to individuals whoonly chose to receive professional services for substance dependence, thosewho received professional treatment and attended spirituality-based sup-port programs were significantly more likely to remain sober (CASA, 2001).Among younger people and high-risk minority groups, spirituality-relatedintervention services have proposed that involvement in spiritual activitiescan significantly and positively affect cessation of drug use (Nasim, Utsey,Cornoa, & Belgrade, 2006; Stone, Whitbeck, Chen, Johnson, & Olson, 2006;Sussman, Skara, Rodriguez, & Pokhrel, 2006).
Although social work practitioners are increasingly interested in employ-ing spirituality-related interventions within agencies, they have often receivedlittle professional training on these techniques (Hodge, 2011; Sheridan,
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Program Characteristics and Meditation 313
2009). This may pose unique considerations to social workers interested inresearching spirituality-related interventions within real world agencies. Staffmembers create the culture and structure within which services are offered,and a growing body of literature explores how these factors shape treatment.
ORGANIZATIONAL CONTEXT
Although it is challenging to assess the impact of complex organizationalvariables on programming (Livet, Courser, & Wandersman, 2008), existingresearch demonstrates that organizational characteristics have a powerfulinfluence on agency services. For example, among substance abuse treat-ment agencies, goals, resources, program philosophy, staffing and leadershipcharacteristics, affiliation, ownership, location, and structure have all beenfound to influence the types of treatment provided to clients (D’Aunno& Vaughn, 1995; Friedmann, Alexander, Jin, & D’Aunno, 1999; Knudsen,Roman, Ducharme, & Johnson, 2005). Services research in the fields ofcorrections, mental health, and child welfare also demonstrates the power-ful influence of organizational context upon treatment provision (Gotham,Claus, Selig, & Homer, 2010; Oser, Knudsen, Staton-Tindall, Taxman, &Leukefeld, 2009; Yoo & Brooks, 2005).
Researchers have also studied organizational dynamics and the adop-tion of evidence-supported interventions (ESI). A qualitative study revealedthat ESIs were more likely to be adopted by organizations through a cul-tural exchange involving compromise and negotiation, suggesting that bothcultural characteristics of the organization and client characteristics are con-nected to the adoption of interventions by programs (Palinkas et al, 2009).Another qualitative study associated with the National Institute on DrugAbuse (NIDA) Clinical Trials Network (CTN) demonstrated a variation ofopinions about adoption of evidence-based practices (EBP) within the CTN,suggesting a need for more research on organizational dynamics (Jessup,Guydish, Manser, & Tajima, 2008).
Similarly, organizational culture can influence the adoption of programs;a number of qualitative studies have explored this process. For example,participatory action research has revealed that the adoption of innovationsnecessitated an organizational learning culture that facilitated critical reflec-tion and learning by practitioners (Baldwin, 2008). Focus groups with staffinvolved in the adoption of the Sanctuary Model show the complexity ofengaging staff members with unique backgrounds and organizational rolesin an intervention implementation process (Prchal, 2005). Qualitative inter-views and focus groups identified the way in which organizational culture,policy limitations, and collateral services can pose challenges associatedwith implementation of family-centered practice (Wright, Hiebert-Murphy,& Trute, 2010). Organizational characteristics explored through a multiple
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case study design of community-based organizations providing HIV preven-tion programs suggest that different types of adoption (complete programs,components and practices, or common ideas) were characterized by levelsof organizational maturity, commitment, and resources (Miller, 2001). Thus,it becomes clear that organizational culture, which is created by staff mem-bers, works together with agency policies to facilitate, or pose obstacles to,the implementation of new interventions or programs.
Leadership can play a key role in setting the tone of an organiza-tional culture that supports learning and innovation. Leaders must be ableto involve staff and other key players in decision making regarding theimplementation of new plans in order to gain their commitment in carryingthem out (Edwards & Eadie, 1994). Leadership style has also been associ-ated with staff turnover (Donoghue & Castle, 2009; Smith, 2005). Researchdemonstrates that staff empowerment is increased by leaders who createorganizational cultures supportive of learning and innovation, which resultsin greater trust and commitment to the organization (Latting et al., 2004). Thismight suggest that an important aspect of carrying out research and support-ing the integration of research findings in agency settings would involve thedevelopment of strong partnerships between outside researchers and agencyleaders in order to intentionally support the development of agency culture.
CONCEPTUAL FRAMEWORK
A thorough review of the literature indicates that organizational contextplays an important role in treatment provision, but there is a gap in knowl-edge of the influence of organizational context on social work interventionresearch within agency settings. Furthermore, concepts framing clinical inter-vention research often do not include organizational context. Yet, with abiopsychosocial–spiritual perspective, social workers ideally take a morecomprehensive approach (NASW, 2008). Spirituality-related interventionsintroduced within agency settings pose additional conceptual considerations.We sought to carry out MM intervention research within a secular substanceabuse treatment program. Meditation is a methodology familiar to many spir-itual traditions, revealing the subjective data of various types of spiritualexperience to the practitioner (Wilber, 2006). Recognizing that agency staffand clients had diverse spiritual backgrounds and experiences, we sought toexplain the intervention in a way that built upon the existing literature andused simple, non-faith-based language.
Although Integral Theory (Wilber, 2006) thoroughly elucidates medita-tive state experiences and consciousness development, Kabat-Zinn (1990)has successfully introduced mindfulness meditation (MM) to mainstreamaudiences by setting forth the stress and coping framework, developedby Lazarus and Folkman (1984), in an Integrally-informed manner (www.integralinstitute.org). We therefore developed our MM group intervention
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model for treatment of addiction following review of limited research onmeditation interventions in substance abuse treatment and research on thesuccessful use of mindfulness meditation helping people with the stressassociated with medical problems (Carlson & Larkin, 2009). Lazarus andFolkman’s (1984) stress and coping framework was used to present theclinical use of meditation for “emotion-focused coping” (Carlson & Larkin,2009). Yet, the stress and coping framework limited our ability to addressspiritual aspects of meditation with staff and clients (perhaps missing anopportunity to connect the MM modality to diverse spiritual traditions andpast experiences), and the framework did not guide us to intervene with theorganizational context (focusing only on MM as an ancillary substance abusetreatment modality).
Integral Theory (Wilber, 2000, 2006) is a meta-theoretical frameworkinclusive of both clinical and organizational concepts, which is being appliedacross professions and disciplines (Esbjorn-Hargens, 2009). By explainingthe complexity of biopsychosocial–spiritual development within the con-text of culture and systems, Integral Theory is relevant to social work andcan be helpful for a comprehensive approach to research within agencysettings (Larkin, 2006a, 2006b; Larkin, Beckos, & Martin, in press). This meta-theoretical framework includes concepts guiding spirituality-related interven-tion research carried out in the agency setting as well as theories supportingour understanding of the organizational culture and structure that influencesservices (Larkin, 2006a; Larkin, 2010; Larkin, Beckos, & Martin, in press).
Thus, in addition to transcending and including concepts of stressand coping to address spiritual experiences, Integral Theory (Wilber, 2006)brings attention to the organizational context within which an interventionis introduced and demonstrates the interplay between agency leadership,policy/structure, and culture (Larkin, 2006a; Larkin, Beckos, & Martin, inpress). The current focus on lessons learned from agency-based researchon MM is articulated through an Integral perspective. Next, we describe ourstudy of the MM intervention and present the data we collected to point tokey lessons learned that can inform researchers carrying out agency-basedresearch on spirituality-related interventions.
THE PRESENT STUDY
The Mindfulness Meditation Intervention
The MM group was designed as an “ancillary coping intervention” for thetreatment of addiction with men and women in substance abuse treatmentagency settings. In the present study, the MM intervention group consistedof 12 weekly, 90-min sessions, run by co-leaders who were members of theresearch team. After an introductory psycho-educational session on the roleof stress in relation to drug and alcohol abuse and recovery, the format ofeach 90-min session involved: approximately 30 min to discuss members’
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experiences during the past week meditating, including discussion of anybarriers or problems experienced; 30 min of meditation; and approximately30 min of group discussion regarding the meditation experience duringthe session. Specifically, members were encouraged to discuss the kindsof thoughts that intruded on the meditation process, any emotions theyexperienced, and physical sensations they may have experienced. Groupco-leaders facilitated semistructured discussion of these experiences. Severaldifferent forms of MM were introduced, based on the standard MM programof the Stress Reduction Clinic at the University of Massachusetts.
Participants in this study were receiving services from a substance abusetreatment program. The agency, known for its broad continuum of care anda commitment to making programs available to those in need regardlessof ability to pay, serves a poor, multiproblem population in early recovery.All participants were at least 18 years of age and willing to make an initialcommitment to the meditation group being piloted. Participants were dividedinto two groups based on gender. Participation in the meditation group wasvoluntary, a point that was also emphasized to staff. Male participants wereliving in one of two residential programs (a halfway house and a three-quarter house). The women were clients of an intensive outpatient program.The women’s program was small and only six women expressed an interestin the group intervention. Twenty men expressed an interest, for a total of26 participants.
Similar to many social work clients, the participants’ lives were char-acterized by multiple challenges and few resources. Although agencyleadership allowed the researchers to carry out this on-site study and staffhelped refer potential participants to recruitment meetings, there was avery high attrition rate among participants. This high drop-out rate madeit impossible to thoroughly evaluate the intervention. However, the qualita-tive data collected over the 12 weeks of implementation provided us withrich information to develop a set of lessons that hopefully will assist othersin designing agency-based spirituality-related intervention research.
Data Collection and Analysis
Twenty-six individuals were recruited to participate in the MM intervention.Of these, seven completed the 12-week group sessions. Each session wasrecorded and transcribed. Participants completed daily logs, and group lead-ers provided notes following each group intervention session. Participantswho remained in the groups at the end of the intervention and key staffpersons were interviewed. We proceeded with analysis of qualitative databased on transcribed sessions and interviews, exploring themes relevant toorganizational context.
All focus group meetings were audio recorded, transcribed by researchteam members, and entered into the Atlas-TI qualitative software program.
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After transcription, coding was completed, with 12 parent codes, each ofwhich included subcodes. A total of 108 codes were established, usingthe template analysis method of coding (King, 1998). The data cited hereto present lessons learned pertain only to comments by participants thatwere relevant to organizational context. These codes included issues relatedto organizational structure, group structure, program recommendations andcomments regarding the group environment. Two researchers then reviewedall transcriptions to identify codes related to organizational issues. Quotationswere examined separately by each researcher to identify themes and increaseinterrater reliability. The researchers then met to examine, compare, andcontrast themes identified as well as clarify terms to be used. High levelsof consistency were found between the researchers regarding themes, andconsensus regarding terms was established.
FINDINGS
The themes that emerged from the research question on the influence oforganizational or program characteristics on client participation in mind-fulness meditation (MM) demonstrate the need for adequate planning andpreparation for MM implementation: scheduling, time factors, discomfort inthe group setting, and group composition. These themes are illustrated withquotes from client interviews and interpreted from an Integral perspective(Wilber, 2006).
The Need for Adequate Planning and Preparation
The participating agencies had agreed to allow the researchers to carryout the MM intervention research within their settings, helped advertise therecruitment session, and reminded clients of group meetings. Yet, the themespresented here point to the value of researchers investing additional time upfront to anticipate and accommodate a range of organizational factors thatcreate challenges to research on spirituality-related interventions in the realworld. For example, staff members were unable to answer many questionsabout MM and were unclear about how this intervention might enhanceother program elements. Meditation practice was not built into the program-ming, and the structure was not altered to integrate MM practice. Researchersmay need to be especially mindful to engage staff persons in spirituality-related interventions, involving practitioners in understanding and learningthe technique as well as examining how program culture and structure mightfacilitate client participation. This approach is supported by Integral Theory,which points out that agency leadership sets the tone of the culture that isshaped by staff members, and cultural values are reflected in organizationalpolicies, procedures, and program structures (Larkin, 2006a; Wilber, 2000).
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Because meditation was not practiced or well-understood within theagency prior to the researchers’ implementation of MM as an intervention forclients, meditation was not included or considered in the program design.Clients experienced tightly scheduled days with activities and other typesof group work that were of value to the agency, posing an obstacle to thetime commitment involved in MM groups and daily MM practice. As a result,with all of their other requirements, participants found it hard to schedulethe time for group participation and regular practice even though some feltthat 12 sessions was a reasonable amount of time over which to learn thetechnique. Participant attendance in groups varied. Furthermore, becausemeditation was not well-understood or valued, the agency culture and phys-ical environment were not conducive to a MM group intervention or regularpractice. The lack of physical comfort, combined with the client character-istics associated with being in early recovery (such as fidgetiness), also hadimplications for group composition.
Scheduling
Client difficulties in scheduling for the group itself and regular meditationpractice were important themes associated with program structure. The pro-gram requirements challenged ongoing MM group participation and practice.During sessions and interviews, participants discussed their busy days. Oneof the men stated,
. . . the guys at the halfway house, they can’t even go into their roomuntil 4:00 then they have dinner at 5:00 and then after that they haveto go to a meeting—they don’t have time to go in and lay down andmeditate really, that much.
The women’s group met on Wednesday, and the following quote indicateschallenges related to programming length, “ . . . And I think Wednesday isthe longest day, that’s what I meant to say, it’s the longest day of the week forme.” Participants also spoke about the assignments related to other aspects ofthe program, as well as the daily meditation logs assigned for the MM group:“I have assignments to do—I was supposed to start my assignment todaybut I couldn’t, I had to come here.” Participants also described co-occurringhealth concerns and challenges with scheduling a variety of outside appoint-ments. One participant stated, “Well then I can’t have appointments duringthe treatment either and I can’t have it during my volunteer time either.”
Participants spoke directly to the time constraints of the program,discussing how difficult it was to carry out the daily meditation practice:
Didn’t have time, we didn’t have any time. By the time we get done todo this, you’re tired, you know? We got to outpatient clinic, then we do
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work here, and go to meetings here, you know? . . . And they get us upat like 6:00 in the morning, you know. It’s not much sleep.
Becoming involved in the MM intervention was viewed as demanding: “Ittook a lot of time out from what we’ve got to do around here, you know,because we’ll be busy all day . . .”
Those who did not drop out of the intervention altogether frequentlymissed sessions:
. . . and I missed that last group before this—I mean if you can get outof here you want to get out of here. So having it at a time where youcouldn’t leave anyway (would help). Like if it’s at 10:00 in the morning,and then you still have like another group at 1:00 so you can’t leave.
Suggestions for adding MM in substance abuse treatment included workingthe daily meditation assignments, and the group, into the overall programstructure. For example: “Put it into their schedule as part of their group. Likeyou know you have meditation you know? And then naps.”
Time Factors
Although meditation can be a daunting new practice for anyone to learn andincorporate into daily life, the busy program schedule seemed to influenceclients’ assessments of the length of time required for group participationand ongoing practice. Rather than supporting an adjustment to meditation,the time required by other program elements hindered client MM groupparticipation and practice. Yet, while some felt 12 sessions was too long(and many dropped out before completing the 12 sessions), other commentsindicated that 12 sessions was a good amount of time in which to offer thegroup. This suggests that MM might be feasibly introduced within 12 sessionsfor this population if other supports were in place.
For some residents, the length of the MM group intervention seemed tobe overwhelming: “Just the thought, ‘twelve weeks, I’m not going to do thisfor twelve weeks.’” Others felt that twelve weeks was reasonable, stating,
I think it was about right because you don’t want them to get tired of themeditation, because I know a lot of them are tired of doing the groups.So it’s like get it done, over in the twelve sessions, and let them seewhere they go from there.
At the same time, it is important to fit the MM intervention within the pro-gram structure, considering the way in which groups are typically included:“Yeah, I’d say, three months, yeah that seems quarterly. They do groups herequarterly, every twelve weeks you’re supposed to switch groups, so yeah.”
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Discomfort in the Group Setting
The agency environment was not designed to support a meditation compo-nent to programming. Lighting was harsh, chairs were uncomfortable, therewere no cushions, and a lack of calming artwork, paint colors, or other phys-ical supports to meditation practice. The space provided for the men’s groupwas a room connecting two others, contributing to noise and interruptions.Although the groups were offered in the summer, the rooms were oftencold, with no way to adjust the air conditioning temperature. Participantsdiscussed, “I’m feeling cold, too. It’s cold in here, I’m not gonna lie, it’s coldin here.” The lack of physical comfort was not conducive to carrying outa meditation group: “These chairs really suck on your body, it’s frustrating.It’s not just frustrating for somebody who has a problem with their backsor anything, everybody complains about these chairs.” Another stated, “ . . .
you have the light just glaring at you, so it’s like you’re squinting almost butthey’re closed—just to try to shut it out.”
Group Composition
Group composition concerns seemed to flow from the lack of environmentaland cultural supports for this population. For example, there was the sug-gestion to keep the groups small because of the external noise and howthis combined with characteristics of early recovery, such as fidgeting. Therewas also mention of the need for participants who were serious about thepractice to counteract a peer culture that is not supportive of meditation.Suggestions to create distinct groups for those in early recovery versus thosein longer recovery may be reasonable regardless of organizational context.However, one can also see how an agency tone that values and supportsthe practice might lend itself to a situation in which group members furtheralong in recovery could mentor those newer to recovery. Smaller groupsmay have been more helpful to people in early recovery:
Keep them small, not too many people because then there is more noisein the room. Four or five is pretty good, but when you get ten or morethat would be hectic as could be because everybody is fidgeting and stufflike that; it’s hard to focus.
Others indicated that the make-up of the group itself is important, stating,“Like I’m still early recovery but I have a year, but some people have like two,three months they’re not ready to sit still yet and they’re not in a position tosit still.” At least one participant addressed the need for a supportive culture,
Because no matter where you go you’re going to find people mightjoke about it, they’ll play around with it, you know what I mean? Otherpeople are serious about it, and the ones that are serious about it might
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get aggravated because his buddies are still hanging around, you knowwhat I mean?
Learning to meditate and developing an ongoing practice is counter to a cul-ture of using alcohol and other substances to feel better and therefore speaksto the important role relationships can play as a foundation to reinforce thenew practice.
IMPLICATIONS
The themes from the qualitative data cited above suggest that organiza-tional characteristics, including both program structure and culture, playan important role in carrying out meditation intervention research withinan agency setting. By partnering with agency leadership, researchers canhelp to foster a culture of inquiry and engage staff members in researchprocesses. This is likely to facilitate research as well as supporting a par-allel process of empowering staff in the way in which staff are called toempower clients (Duffee, 2010; Larkin, Beckos, & Martin, in press). If direc-tors, supervisors, and staff members conceptually understand and appreciatethe value of an intervention, the next step to optimally study how the inter-vention works in a specific setting involves consideration of the programstructure to incorporate the new practice, including physical supports andscheduling. In fact, spirituality-related interventions are often developed bypractitioners who seek relationships with researchers to evaluate their effec-tiveness, providing opportunities for partnerships that build on their owninterests and bring practice to research (Larkin, Felitti, & Anda, in press).Integral Theory (Wilber, 2006) offers a route to explaining spirituality-relatedinterventions and connecting them back to past experiences within diversespiritual traditions while attending to organizational context.
In addition to starting with provider interests in spirituality-related inter-ventions, offering spirituality-related techniques for practitioner self-care maybe a useful way to engage practitioners in understanding and learning them.Because program culture and the way activities are carried out can createa parallel process to the clinical services provided, organizations are begin-ning to appreciate the benefits of supporting agency staff in their own selfcare practices because this facilitates the ability of staff persons to buildrelationships with clients, provide role modeling, and set the tone for the cul-ture within which services are offered (Larkin, Beckos, & Shields, in press).There is increasing concern about the need to prevent burnout and vicarioustraumatization among helping professionals (Badger, Royse, & Craig, 2008;Kim & Stoner, 2008), and meditation has been offered as a way to supporthelping professionals in self-care (Brenner & Homonoff, 2004; Christopher,Christopher, Dunnagan, & Schure, 2006).
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In the case of meditation research, the practice could easily be intro-duced to staff as a support to their own self-care while they learned aboutthe potential benefits to clients. Provider attitudes and their own engage-ment in spiritual practices are among factors that predict the likelihood thatthey will offer spirituality-related interventions (Sheridan, 2004). By learn-ing the practice, staff would also become prepared to offer the interventionto clients themselves and engage in the research process. The therapeuticrelationship is likely to be positively affected by the therapist’s own use ofmindfulness, and research demonstrates the benefits of mindfulness practiceby social workers (Davis & Hayes, 2011; Thomas & Otis, 2010).
Another way to empower the social workers who create agency contextsis by recognizing them as experts in partnership with researchers (Wade &Neuman, 2007). By partnering with agencies, exploring the new spirituality-related intervention with staff through support in their own self care, andcreating a culture of inquiry about the practice, this approach sets the stagefor an organizational context supportive of the new intervention. It may beuseful to introduce and research the spirituality-related intervention offeredfirst in support of self-care for staff persons. This would bring the prac-tice into the foreground of the agency milieu, influencing agency cultureand positioning staff to offer it to their own clients if they find it valu-able. For example, staff persons who learn to regularly meditate themselveswould also best know how to incorporate the new intervention into theprogram structure. As a next step to researching the intervention with staffpersons, the staff could be engaged in the research process as they introducemeditation to clients within their own agency.
These are important considerations for social work intervention researchthat is relevant to the agency settings through which we serve vulnerablegroups experiencing multiple problems. By including measures of organiza-tional context within intervention research geared to the whole person, weare better able to address organizational responsiveness as called for in theNASW Code of Ethics (2008). Wilber’s (2000, 2006) Integral Theory offers auseful framework that can capture these considerations. Scholars have begunto recognize the importance of organizational context in the adoption of ESIs,and our experience with MM intervention research in agency settings sug-gests it may be even more important to include agency context as an aspectof research on spirituality-related interventions.
The introduction of research on spirituality-related interventions willinvolve partnerships with agencies and the development of processes toengage leaders and staff members. This is consistent with an increasingcall within the social work profession for researchers to partner with prac-titioners to engage in research informed by the realities of practice (Berger,2010; Dziegielewski, Wodarski, & Feit, 2005; McMillen, Lenze, Hawley, &Osborne, 2009; Osterling & Austin, 2008). Just as university-agency partner-ships can lead to cultures within social service settings that are amenable
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to the adoption of ESIs (Johnson & Austin, 2008), we have the opportu-nity to consider how we can work together to carry out relevant researchon spirituality-related interventions within social service settings. Our expe-rience with MM intervention research in a substance abuse treatment agencyserves as an example. The inclusion of organizational context within socialwork intervention research is in keeping with our biopsychosocial–spiritualperspective and requires a conceptual framework that lives up to this broaderview (Larkin, 2006b; NASW, 2008).
CONCLUSION
Although there has been increasing exploration of organizational characteris-tics associated with innovation adoption, there is a gap in research exploringthe influence of organizational context in carrying out biopsychosocial–spiritual practice and agency-based research. Presenting lessons learned fromthe study of a MM group within a substance abuse treatment program, wepropose that research on spirituality-related interventions in agency set-tings calls for an increased investment of time to engage staff membersin the new practice. Scheduling, time factors, discomfort in the group set-ting, and group composition were themes that surfaced from qualitativedata analysis. Integral Theory (Wilber, 2006) is offered as a useful way toconceptualize spirituality-related interventions that incorporate the organiza-tional context and begin with provider interests. Through partnership withagencies around MM research, there is also an opportunity to offer medita-tion as a way to support staff. Once familiar with the practice, staff personscould offer MM interventions for clients and become involved in the ongo-ing intervention research process. This is in keeping with increasing calls foruniversity–agency and researcher–practitioner partnerships to engage in rel-evant research informed by the reality of practice in agency settings (Duffee,2010).
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