Medicine and Health Sciences Commons^™

Early Childhood Support Specialist Evaluation Report, Emilie Swenson Msw, Rachel Gallo Mph

Children, Youth, & Families

The Early Childhood Support Specialist (ECSS) at MaineHealth builds relationships with families who have children aged birth to three, a timeframe when infants and toddlers are rapidly developing, learning, and benefiting from family and community connections. The ECSS assesses a family’s strengths and needs to understand how that family can be supported and connected. The ECSS connects families to resources, provides referrals, coaches families on children’s social and emotional development, and generally serves as a point of contact to assist families with social, emotional, and medical needs. Ultimately, the intended outcome of this model is to increase family connections, decrease …

The Effect Of Contingency Management On The Recovery Of Patients With Substance Use Disorder: A Systematic Review Of The Literature, Emily A. Gilman, Alexis Mccrossin, John R. Massey

Thinking Matters Symposium

Substance use disorder (SUD) is traditionally managed with behavioral therapy and medication. Contingency management (CM), a therapeutic method that reinforces positive behaviors with incentives, may be a useful adjuvant to enhance treatment engagement and efficacy for those who struggle with SUD. This systematic review of literature was conducted using databases CINAHL, Cochrane, and PubMed from January 2010 to July 2021. The search yielded 132 initial records. Studies were included if they were written in English, peer reviewed, and randomized control trials. Six final studies rendered results for 650 patients with varying substance use disorders including cannabis, tobacco, and opioids. Studies …

Navigating Post-Covid A Guide For Young Adults Recovering From Mild To Moderate Cases Of Covid-19, Chesley Ferris

Muskie School Capstones and Dissertations

COVID-19 is a new strain of the Human Coronavirus. There are many types of Human Coronavirus, with COVID-19, or the Coronavirus Disease, being discovered in December 2019. COVID-19 is classified as a mild to severe upper respiratory illness. It can affect people differently, with some being asymptomatic, or having no symptoms, and others having mild, to moderate or severe symptoms. Symptoms can also present differently in each person. One person may not have the same symptoms as another.The virus is easily transmittable, meaning it can travel from person to person quickly and easily. This is why it is important to …

Examining The Effect Of Provider Bias On Pain Management In Black Patients: A Systematic Literature Review, John Massey, Monica Gambilado

Thinking Matters Symposium

Black Americans face unequal treatment for pain management when seeking care. The aim of this systematic literature review is to examine the impact of provider bias on Black patients receiving appropriate pain management interventions in the clinical setting. This review followed the Preferred Reporting Items for Systematic Literature Reviews and Meta-Analysis guidelines. CINAHL and PubMed were searched with the following key search terms: Black/African American, bias, prejudice, discrimination, unconscious bias, pain management, pain reduction, pain control and analgesic. A self-developed Critical Appraisal Tool was used for quality assessment of the studies included in the review. A total of 101 probable …

Lincoln County Community Paramedicine Data Collection Initiative, Katie Rosingana Ba, Evelyn Ali Bs, Karen Pearson Mlis, Ma

Substance Use Research & Evaluation

No abstract provided.

Preventive Health Service Use Among Rural Women, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Nathan Paluso Mph, Jaclyn Janis Bsn, Rn

Access / Insurance

Preventive health services and screenings are an important component in the continuum of care provided to individuals across all ages. Yet, research has shown that rural residents generally use fewer preventive health services and screenings. This study used the National Health Interview Survey to examine receipt of preventive health services (cholesterol check, fasting blood sugar test, mammogram, pap smear, and receipt of the HPV vaccine) by rural and urban women over the age of 18. Findings indicate that rural women were less likely than their urban peers to receive preventive health services, and that some of the differences may be …

Substance Use Prevention: Communication And Strategies To Reduce Alcohol, Marijuana, And E-Cigarette Use Among College Students, Emily Bauer

Muskie School Capstones and Dissertations

Substance use among college students impacts universities, communities and student outcomes across the United States. Based on the Monitoring the Future study (MTF), college students have a higher prevalence of past 30-day alcohol use at 63% than their non-college peers (59%) (2016). Nearly one-third of college students (32%) have had five or more drinks in a row in the past two weeks (2016). Monthly marijuana use for college students has remained steady at 22% (2016). Electronic cigarette (e-cigarette) use is 6.9%, which is gaining in popularity but still lower than traditional cigarettes (8.9%) (2016). There are many prevention communication strategies …

Identifying Challenges Different Provider Group Encounter In Managing Opioid Use Disorder, Chinonye Anumaka

Muskie School Capstones and Dissertations

The Centers for Disease and Control (CDC) describes opioid use disorder (OUD) also known as opioid addiction as the problematic pattern of opioid use leading to clinically significant impairment or distress. In 2016, about 2.1 million people were diagnosed of OUD in the US. In Maine, York County has the third highest drug overdose response and had 166 deaths occurring between 2012-2016. York County is a designated medically underserved area and has a shortage of provider workforce and limited treatment infrastructure. To further understand the challenges providers in York County encounter in managing patients with OUD, 6 focus groups was …

Interrupted Progress: Water And Sanitation In Haiti, Emily Bauer

Thinking Matters Symposium Archive

Haiti has faced damaging environmental and social impacts, which have interrupted progress towards clean drinking water and adequate sanitation facilities for its over 10 million people. Natural disasters, disease outbreak, political corruption and economic instability have contributed to poor health and social outcomes for the small, island nation. This study used the most recent data from the World Health Organization and United Nations Children’s Fund Joint Monitoring Programme (WHO/UNICEF JMP) to assess national trends in water source and sanitation facility improvements from 1990-2015. WHO/UNICEF JMP defines water improvements as piped or non-piped protected water, and sanitation improvements as networked, flushed …

Opioid Use Treatment Via Telemedicine: Treatment Options For Rural Maine, Benjamin Knapp

Thinking Matters Symposium Archive

The ongoing opioid crisis has overwhelmed the traditional opioid use disorder (OUD) treatment resources across America. The treatment resources in rural communities have been especially hard hit as geographic and financial barriers limit service capacity. Telemedicine, or medicine delivered via remote means, has been proposed as a potential solution to the lack of conventional opioid treatment resources in rural Maine. Current legalities in the US prohibit telemedicine being used to prescribe opioid agonist drugs, and insurance reimbursement for telemedicine remains a major barrier. This qualitative content analysis looks at the existing research on telemedicine's treatment efficacy for use with OUD …

The Role Of Rural Hospitals In Addressing Opioid And Other Substance Use Problems, John A. Gale Ms

Mental Health / Substance Use Disorders

Webinar presentation to the Small Rural Hospital Transition project addressing issues of rural opioid and other substance use issues, focusing on the role of rural hospitals, and the importance of community engagement. Component parts of an effective opioid/substance use system of care include prevention, treatment, and recovery. Models must be adapted to the geographic, resource, and cultural realities of rural areas. Examples of strategies are provided.

Community Paramedicine Pilot Programs: Lessons From Maine, Karen B. Pearson Mlis, Ma, George Shaler Mph

Emergency Medical Services (EMS)

Community paramedicine programs are beginning to flourish across the nation, and the need to provide demonstration or pilot programs is essential to providing a consistent and high-level standard for this model of care. While the overarching goals are to align with the Triple Aim, piloting a community paramedicine program also allows each community to develop and implement a program tailored to the healthcare needs of their specific community. A successful program builds the evidence base that can then be used to create legislative change necessary to financially sustain this model of care across the healthcare delivery system. This article provides …

A Guide For Assessing Older Adults’ Needs On Maine Islands, Beatrice Byrne

Muskie School Capstones and Dissertations

This template may help Maine island communities identify older adults’ needs and island resources, in order to allow older adults to age in the island communities.

Three interviews with island health leaders, one community conversation with older islanders, and one pilot test provided information about what to include in the template.

The template includes a demographic survey, guides for conducting semi-structured interviews and group conversations with older adults and caregivers, a guide and worksheet for analyzing the data, a guide for assessing community resources, a guide for dissemination, and a list of additional resources.

Prevention Of Drug Use And Treatment Of Drug Use Disorders In Rural Settings, John A. Gale Ms

Mental Health / Substance Use Disorders

This Guide on Prevention of Drug Use and Treatment of Drug Use Disorders in Rural Settings was prepared by the United Nations Office on Drugs and Crime (UNODC) Drug Prevention and Health Branch (DHB), in the context of the global project Treatnet II: OFID-UNODC Programme to prevent HIV/AIDS through Treatnet Phase II, with the aim of providing an awareness-raising tool and guidance for policymakers, public health officials, local authorities and other stakeholders in dealing with substance use issues in rural settings in their respective countries. This Guide will serve as an awareness-raising tool and guidance for policymakers, public health officials, …

Urine Cotinine In Children And Parental Behavior Modification: A Pilot Study, Teresa Lachance

Muskie School Capstones and Dissertations

“Urine Cotinine in Children and Parental Behavior Modification” was designed by Dr. Deirdre Burns, a pediatrician at the Barbara Bush Children’s Hospital (BBCH). It was implemented as a pilot study to determine whether urine cotinine testing in children who are admitted to the hospital for respiratory illness and tracking parental smoking behaviors over time was feasible. Parents were given a brief survey to assess their current smoking behaviors and to understand their readiness to quit smoking. They received smoking cessation materials provided by the Breathe Easy Coalition of Maine. These materials outline information about second-hand and third-hand smoke, and encourage …

Development Of Health Education Materials To Prevent Sexually Transmitted Infections Among University Of Southern Maine Students, Lily Parenteau

Muskie School Capstones and Dissertations

The purpose of this project was to develop health education materials that can be used to educate college students about the risks, symptoms, and prevention measures associated with chlamydia and gonorrhea infections, as well as provide information about current disease information in the state of Maine.

A Secondary Analysis In Support Of The Community Health Needs Assessment For Oasis Free Clinics, Jillian Wheeler

Muskie School Capstones and Dissertations

Oasis Free Clinics offer free medical and dental services to uninsured, low income adults living in Sagadahoc County, Maine (with the exception of the town of Richmond) and the towns of Brunswick, Freeport, and Harpswell in Cumberland County and Durham in Androscoggin County. Oasis has filled a critical need in providing affordable health care to the working poor with the absence of Medicaid expansion in the state of Maine. The clinic offers wellness checks, women's wellness, prenatal care, chronic disease management, limited mental health counseling, a prescription assistance program and dental care.

Oasis Free Clinics will conduct a Community Health …

Analysis Of The Efforts Of Urban And Rural Health Systems To Achieve Accountable Care Organization Target Goals For Dilated Eye Exams In Individuals With Diabetes, Michele Gilliam

Muskie School Capstones and Dissertations

This capstone project was designed to understand and analyze the completion rates for diabetic dilated eye exams within four different health systems participating in the MaineHealth Accountable Care Organizations (ACO). This research is valuable within the current US health care climate as health care providers have sought to evaluate the cost of care in terms of their value to payers. Moreover, many providers have elected to join the ACO in order to demonstrate better outcomes, improve the cost of care and to share programmatic content and tools to standardized care. Within this capstone, system level workflows and processes were evaluated …

Are Rural Older Adults Benefitting From Increased State Spending On Medicaid Home And Community-Based Services?, Andrew F. Coburn Phd, Eileen Griffin Jd, Deborah Thayer Mba, Zachariah T. Croll Mph, Erika C. Ziller Phd

Long Term Services and Supports

In a shift away from institutional long term services and supports (LTSS), the federal government and states have pursued an array of strategies for expanding access to home and community-based services (HCBS) over the past few decades. Yet, little is known about variations in the availability or use of Medicaid HCBS within states, across rural and urban areas. This study used the national Medicaid Analytical Extract claims data file (2008) to examine differences in HCBS use and expenditures among rural and urban older adult Medicaid beneficiaries receiving LTSS. The study found that rural Medicaid LTSS users were less likely to …

Health Information Exchange: A Strategy For Improving Access For Rural Veterans In The Maine Flex Rural Veterans Health Access, Karen B. Pearson Mlis, Ma, Amanda Burgess Mppm, John A. Gale Ms, Andrew F. Coburn Phd, Anush Yousefian Hansen Ms, Ma

Access / Insurance

This paper reports on the design and implementation of a first-in-the nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers. The paper reviews key factors that have contributed to implementation challenges and successes and lessons relevant to efforts to create interoperable health IT systems across multiple, complex organizational settings.

Population Health Improvement Through Coordination Of Care, Trevey Davis

Muskie School Capstones and Dissertations

The objective of this Capstone Project is to work with the Mercy Gap in Care Coordinators (GCCs) to document the value of the care coordination at Mercy Health System. A key element of this project was to develop a workflow diagram alongside the GCC in order to track patient outcomes. Additionally, the team developed a system for documenting patient outcomes that is crucial to measuring the impact of care coordination. From the data collected there are a number of outcomes that can be measured. The number of patients who are contacted for screening is measurement of patient experience. Following initial …

Rural Opioid Abuse: Prevalence And User Characteristics, Jennifer D. Lenardson Mhs, John A. Gale Ms, Erika C. Ziller Phd

Mental Health / Substance Use Disorders

This study examined the prevalence of non-medical use of pain relievers and heroin in the past year in rural and urban areas and the socio-demographic and economic characteristics associated with their use. Additionally, we examined opioid use by age at first use as well as dependence and abuse; treatment history and perceived need for treatment; use of alcohol and other drugs; perceived risk of using drugs and availability of drugs; problems resulting from the use of drugs; driving under the influence; and illegal activities and arrest records.

Access To Oral Health For Children On Mainecare In The Lakes Region Towns Of Bridgton, Casco, Sebago, And Naples, Carissa L. Parent

Muskie School Capstones and Dissertations

Although we know that children covered by Medicaid often do not receive needed dental services, the extent of the problem in Maine is not fully understood. In particular, rural communities in Maine may face challenges for families to access dental services for their children given low reimbursement rates and fewer available providers. This project addresses these gaps in knowledge by examining MaineCare- funded utilization and dental care access for children with MaineCare in four rural Maine towns in the Lakes Region.

Rural Adults Delay, Forego, And Strategize To Afford Their Pre-Aca Health Care, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Access / Insurance

About 40% of non-elderly adults reported problems paying medical bills or cost-related barriers to obtaining needed medical care in 2012, difficulties that are especially pronounced for the uninsured and underinsured, the chronically-ill, and those with low incomes. Given their lower incomes and higher uninsured rates compared to urban residents, rural residents may face particular cost barriers in accessing health care. Past research has shown that, compared to urban residents, rural residents are more likely to experience higher out-of-pocket costs and delayed or foregone care as a result of cost, even when covered by private health insurance. This study provides detailed …

Out-Of-Pocket Spending Among Rural Medicare Beneficiaries, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Access / Insurance

The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey …

Maine Ems Community Paramedicine Pilot Program Evaluation, Karen B. Pearson Mlis, Ma, George Shaler Mph

Emergency Medical Services (EMS)

In November 2014, the Muskie School of Public Service at the University of Southern Maine was awarded a contract to evaluate the implementation of the statewide CP Pilot Program in Maine. This report presents process level results from the evaluation. The report includes findings from interviews with the twelve community paramedicine pilot sites in Maine and with the state of Maine EMS office.

The layout of the report follows the key themes and categories from our interviews:

• Staffing
• Training
• Stakeholders and Partners
• CP Services
• CP Event
• Data Collection
• Funding
• Challenges
• Successes
• Sustainability

The report concludes with lessons learned which may …

Promoting Active Living In Rural Communities, Anush Yousefian Hansen Ms, Ma, David Hartley Phd, Mha

Population Health

This brief summarizes current research on elements of the rural built environment that may be related to obesity or physical activity. Much of this research is qualitative in nature, including evidence and conclusions drawn from rural focus groups, PhotoVoice studies, policy statements, observations from the field, and lessons learned from rural active living interventions.

Policy Considerations For Community Health Workers In An Era Of Health Reform, Sara Kahn-Troster

Muskie School Capstones and Dissertations

In order to better understand how CHWs are being integrated in state health reform initiatives, including facilitating care coordination, enhancing access to community-based services, and addressing social determinants of health, the author, working in collaboration with the National Academy for State Health Policy (NASHP), developed a nation-wide scan of CHW policy activity, published online as State Community Health Worker Models in February, 2015. The CHW chart gives a comprehensive look at how states are utilizing CHWs as part of quality improvement, health care reform, and expanded models of public health.

Portland Bicycle Share Health Impact Assessment, Nicole A. Anderson

Muskie School Capstones and Dissertations

The findings of this project have shown the potential health impact for implementing a bike share program in Portland, including improved air quality and rates of physical activity for bike share users. The recommendations to create the most health-conscious bike share program include basic requests of the bike share vendors that will provide the program to Portland including: recommending the use of helmets, distributing bike share stations throughout the City, tracking bicycle crashes, tracking minutes of physical activity, etc. The findings and recommendations show the importance of a potential bike share program, while creating a program that is safe and …

Issues Of Sovereignty In Wabanaki Communities And Impacts On Health Outcomes, Ralph E. Cammack

Muskie School Capstones and Dissertations

The purpose of this capstone is to explore how Wabanaki communities of Maine experience sovereignty as it relates to the dominant culture of Maine and how this interaction has led to current health outcomes and disparities. I do this by examining how the communities view sovereignty and understanding how internalized anger impacts these communities.