Medicine and Health Sciences Commons^™

Standardizing Behavioral Health Triage: Using The Heads-Ed Tool, Sarah K. Peifer

Doctor of Nursing Practice (DNP) Projects

Background: In the past two years emergency departments across the country have experienced an increase in pediatric patients requiring behavioral health care. It is essential to provide efficient, early intervention to these vulnerable patients. The use of a standardized tool can improve management of pediatric patients and allow access to resources in a timely manner.

Purpose: To evaluate the implementation of the HEADS-ED in a community hospital ED, to provide rapid behavioral health assessment.

Methods: Education for staff was provided through various platforms and involved regular support for staff throughout the intervention. It was hypothesized that implementation of …

Psychoeducation Intervention For Stress Management In Adolescents, Gold E. Okoeka

Doctor of Nursing Practice (DNP) Projects

Background: Stress reduction techniques (SRT) such as yoga, exercise, deep breathing, positive self-talk, sleep hygiene among others, have shown to be effective in stress reduction in adolescents. SRTs are effective in lowering stress levels, improving mood, reducing anxiety levels as well as promoting overall health.

Purpose: This DNP project aimed to implement a psychoeducation intervention using e-brochures to reduce stress levels among adolescent’s ages 16-18 years old.

Methods: A total of 15 adolescents who agreed to participate in the program received a psychoeducation intervention using e-brochures on the impact of stress on their mental health and a few SRTs including …

A Co-Parent Intervention To Reduce Prenatal Depression In Low-Income Couples: A Pilot Study, Rachel J. Herman

Doctoral Dissertations

Significant health disparities in the U.S. place low-income and racial and ethnic minority families at greater risk for parental depression, stress and poorer outcomes for children. The goal of this quasi-experimental pilot study was to assess the initial feasibility, acceptability, and efficacy of an intervention aimed at reducing stress and depression in a sample of low-income expectant parents early in pregnancy. Twenty-four couples (48 participants) were assigned to the 6-week PREParing for Parenthood (PREP) intervention and 22 couples (46 participants) were assigned to a treatment-as-usual comparison group. The group intervention consisted of six sessions during pregnancy and was taught by …

Cultural Communication For New Nurse Residents: K.I.N.D Communication Toolkit, Jennifer Caraballo

Doctor of Nursing Practice (DNP) Projects

Background: Microaggressions can create a hostile work environment and decrease rapport and functioning in clinical and personal relationships. Exposure to micro aggression and implicit bias results in micro trauma and possible compassion fatigue by medical staff. Symptoms can include headaches, poor sleep, depressions, and anxiety, similar to compassion fatigue.

Purpose: To develop a toolkit for healthcare staff to use as educational material to facilitate for cultural communication and cultural humility.

Methods: Nurses that were enrolled in a nurse residency program at a level 1 trauma center participated in the education of a communication toolkit related to K.I.N.D …

Consensual Qualitative Research: Replicability Of Results And Social Reliability Of Process, Nicholas Morrison

Doctoral Dissertations

To solidify further their scientific footing, qualitative approaches would ideally demonstrate that they yield replicable information about a phenomenon under study. Although consensual qualitative research (CQR; Hill, 2012) proposes a rigorous, multistep method to enhance interjudge reliability and instill confidence in the results, it remains unclear if multiple uniformly trained teams analyzing the same stimulus set would arrive at similar analytic output (i.e., replicability—a high form of trustworthiness). Moreover, it is unclear if replicability (or lack thereof) might be influenced by the process through which CQR judges arrive at their output (i.e., social reliability). Addressing these gaps, this …

The Impact Of Ptsd And History Of Involvement In The Criminal Justice System On Medication Treatment Success In Opioid Use Disorder, Kirk Sanger

Doctoral Dissertations

This analysis examined the impact of post-traumatic stress disorder (PTSD), history of trauma, and a history of involvement in the criminal justice system (CJS) on treatment outcomes related to medication treatment for opioid use disorder. This study employed a secondary analysis of data derived from a multi-state, multi-site treatment center focused on substance abuse and more specifically opioid use disorder treatment. The total sample size was 19,970 patients. The majority of the sample received treatment in Massachusetts, was white, and non-Hispanic. Those with PTSD accounted for 9.5% of the sample, while 12% had a history of trauma. Just under 1/4 …

Maternal Postpartum Depression And Father Involvement Across The Transition To Parenthood, Katie Newkirk

Doctoral Dissertations

Maternal postpartum depression is a common complication of childbirth that affects the whole family. Fathers’ greater involvement in childcare can buffer children from the negative effects of mothers’ depression, and aid in mothers’ recovery, so it is important to understand under what conditions fathers become more or less involved when mothers are depressed. Prior research has supported both a compensation hypothesis, whereby fathers compensate for the effects of mothers’ depression on mothers’ parenting by being more involved in parenting, and a spillover hypothesis, whereby mothers’ negative emotionality causes fathers to pull back from family life and be less involved in …

Association Of Follicle-Stimulating Hormone And Depression And Depressive Symptoms In Older Postmenopausal Women, Dana Fritz

Masters Theses

Worldwide, between 5 and 18% of postmenopausal women experience depression. While the associations of estrogens with depression have been researched extensively, relations with other postmenopausal hormones remain unclear. We evaluated the association of follicle stimulating hormone (FSH) levels with prevalent depression the Kuopio Ischaemic Heart Disease Risk Factor Study (n = 588). Study participants were postmenopausal women aged 53 to 73 years and not using hormone therapy at enrollment (1998-2001). FSH was measured by radioimmuno-assays. Depression symptoms were measured using a scale based on DSM-III criteria (score range = 0-12), with a score ≥5 indicative of probable depression. We assessed …

Does The Way Parents Fight Matter? Parents' Conflict Resolution Styles And Children's Internalizing And Externalizing Problems, Alexandrea L. Craft

Masters Theses

Although the negative associations between marital conflict and children’s adjustment are well documented, less is known about how marital conflict styles (e.g., engagement, withdrawal, problem solving and compliance) are related to children’s developmental outcomes. The present study seeks to determine what types of parents’ conflict styles, during the child’s first year of life, are related to children’s behavioral outcomes in the first grade. Analyses examine the hypothesis that more conflictual conflict resolution styles of parents during a child’s infancy will predict poorer child outcomes over time. In addition, given the growing literature documenting the first year of life as a …

Sleep, And Its Relation To Non-Motor Deficits In Patients With Cerebellar Ataxia, Akshata Sonni

Doctoral Dissertations

The cerebellum is a highly connected structure, and its involvement in sleep – which is a dynamic process that is modulated by a complex set of neural systems – can come about through a number of neural pathways. We conducted two studies aimed at furthering our understanding of cerebellar involvement in sleep behavior and physiology, as well as measuring the impact of poor sleep on mood and cognition in patients with cerebellar degeneration. First, by means of an online battery including measures of sleep and neuropsychiatric function, we collected data from 176 patients with cerebellar ataxia. We found strong evidence …

Testing A Skills Training Course For Use In A Peer-Delivered Mental Health Intervention, Samantha L. Bernecker

Doctoral Dissertations

Millions of people who could benefit from mental health services do not receive treatment. If non-professional peers could learn to administer basic psychotherapeutic interventions to each other, taking turns as care provider and care recipient, this unmet need for mental health care could be partially filled. This study sought to test whether non-professionals could learn supportive psychotherapy skills from a massively scalable, free online course. Thirty pairs of individuals who were experiencing psychological distress or who wished to increase their mental well-being were enrolled in the study, and 19 pairs completed the prototype online course. Objective raters assessed participants’ skills …

Identification And Ptsd Screening Of Military Veteran Patients In Community Healthcare: A Quality Improvement Project, Caitlin Rose Budrewicz

Doctor of Nursing Practice (DNP) Projects

Background: Military veterans are at an increased risk for post-traumatic stress disorder (PTSD) related to their prior military service. Establishing veteran status of patients cared for in civilian healthcare and screening for PTSD will increase the likelihood of identifying symptoms and prompt appropriate treatment. Purpose: The focus of this project is to increase practitioner awareness and knowledge of PTSD in veteran patients as well as to identify and screen veteran patients for PTSD symptoms utilizing the primary care PTSD screen (PC-PTSD). Method: To determine veteran status, patients over the age of 18 years in an internal medicine clinic will be …

Bidirectional Relationships Between Maternal Parenting Behaviors And Conduct Disorder Symptoms In Preschool Children, Benjamin Rolon Arroyo

Doctoral Dissertations

Conduct disorder (CD) symptoms emerge in preschool children, and some evidence for bidirectional effects between maternal parenting behaviors and these symptoms has been found in school-age children and adolescents. However, the strength and pattern of these effects are unknown during the preschool years. The present study examined the bidirectional relationships between several key maternal parenting behaviors (negative affect, warmth, overreactivity, and laxness) and CD symptoms across the preschool years. Participants were 197 preschool children (M = 44.24 months, SD = 3.37; Girls = 92) exhibiting significant behavior problems and their mothers who participated in a 3-year longitudinal study. Maternal …

Assessment Of Gambling And Co-Occurring Mental And Behavioral Health Disorders: Implications For Public Health, Nene C. Okunna

Doctoral Dissertations

Gambling is a very popular form of entertainment and socialization in the US and is generally considered a safe form of recreational activity. There is some evidence of associations between positive health outcomes, as well as poor behavioral and mental health conditions with gambling. However, the relationship between recreational gambling and risk health behaviors has been under researched and thus poorly understood. The 2011 Massachusetts Expanded Gaming Act provides the impetus to understand gambling related problems prior to the introduction of new gambling opportunities. The objectives of the study are twofold: (1) examine associations between recreational gambling and, behavioral and …

Management Of Adolescent Depression In The Primary Care Setting: An Educational Program For Providers, Kelly Clow

Doctor of Nursing Practice (DNP) Projects

Background: The prevalence of adolescent depression is estimated at 15-20% in the general population and often under-treated. The primary care provider is in a prime position to identify and treat depression in this age group. However, many providers feel uncomfortable with treating and managing depression in adolescents, due to a lack of education or experience. Purpose: The focus of this quality improvement project was to educate primary care providers on the current recommendations for the management of adolescent depression and provide an education sheet for both the medical and non-medical treatment of adolescent depression. An educational intervention was presented to …

The Human Intruder Test: An Anxiety Assessment In Rhesus Macaques (Macaca Mulatta), Emily J. Peterson

Masters Theses

The human intruder test (HIT) is a noninvasive tool widely used for assessing anxiety in rhesus macaques (Macaca mulatta). This thesis explores the HIT procedure and applies it to a population of monkeys with a self-injurious behavioral pathology. Individual variation on this test can be used to assess anxiety and temperament. The first experiment of this thesis applied two different procedures of the HIT to 17 monkeys at UMass. Monkeys displayed little response to the intruder, and no significant differences were detected for the two procedures. To determine whether these responses were unique to the UMass monkeys, their …

Differential Microglial Activation Following Immune Challenge In Peripubertal And Adult Outbred Mice, David J. Placzek

Masters Theses

Pubertal development is a time of growth and development in the brain, leading to high sensitivity during this period. Past research in our lab has shown that shipping female inbred and outbred mice during pubertal development alters their sensitivity to steroid hormones in adulthood, thus affecting sexual receptivity, cognition, depression-like behavior, and anxiety-like behavior. Here, we test the hypothesis that mice treated with lipopolysaccharide during pubertal development would have more active microglia, the brain's immune cells, after injection than mice treated with lipopolysaccharide in adulthood. No significant interactions were observed between treatment and age between any brain area measured, suggesting …

Associations Between Alexithymia And Executive Function In Younger And Older Adults, Gennarina Diane Santorelli

Masters Theses

The prevalence of alexithymia, a condition characterized by difficulties identifying and verbalizing one’s emotions, increases across the lifespan, with older adults reporting greater alexithymic features than young and middle-aged adults. This late-life increase in alexithymia may be the product of age-related decline in prefrontal brain circuitry implicated in emotional awareness and executive processes, notably in the anterior cingulate cortex (ACC). There is a dearth of research on the link between executive function and alexithymia in healthy adults. This study determined associations between alexithymia and executive function in healthy younger and older adults. Higher alexithymia scores were predicted to be associated …

Parents' Gender Ideology And Gendered Behavior As Predictors Of Children's Gender-Role Attitudes: A Longitudinal Exploration, Hillary Paul Halpern

Masters Theses

This longitudinal study examined the association between parents’ early and concurrent gender ideology and gendered behaviors and their children’s gender-role attitudes at age six. Specifically, parents' global beliefs about women's and men's "rightful" roles in society, as well as their work preferences for mothers, were considered in relation to the gender-role attitudes held by their first-graders. In addition, parents’ gendered behaviors, including their division of household and childcare tasks, division of paid work hours, and job traditionality were examined as predictors of children’s gender-role attitudes. Based on previous research, it was hypothesized parents’ early and concurrent behavior and ideology would …

Longitudinal Trajectories And Predictors Of Functional Impairment In Mild Cognitive Impairment, Alzheimer’S Disease, And Vascular Dementia, Lauren Z. Chisholm

Doctoral Dissertations

Functional disability in older persons with cognitive impairment is associated with reduced quality of life and greater mortality, health care utilization, and caregiver burden. Episodic memory, executive function, apathy, depressive symptoms, and medical burden have been identified as cross-sectional predictors of functional disability but have received little longitudinal investigation in a way that explicates how changes in these variables relates to functional disability. Functional disability also drives the distinction between the diagnoses of Mild Cognitive Impairment (MCI) and dementia; however, little is known about the rates of functional decline in these groups over time. This study utilized multi-level modeling to …

Investigating Teenage Drivers' Driving Behavior Before And After Lag (Less Aggressive Goals) Training Program, Jingyi Zhang

Masters Theses

Motor vehicle crashes are a leading cause of death during adolescence, with the fatal crash rate per mile-driven for 16-19 years old drivers being nearly 3 times larger than the rate for drivers age 20 and older. High gravitational events among teenage drivers, such as quick starts, and hard stops, have been shown to be highly correlated with crash rates. The current younger driver training programs developed in the late 1990s, however, do not appear to be especially effective in regard to many skills which are critical to avoiding crashes. With this in mind, a simulator-based training program aimed at …

Predictors Of Discrepancies Between Informants’ Ratings Of Preschool-Aged Children’S Behavior: An Examination Of Ethnicity, Child Characteristics, And Family Functioning, Elizabeth Harvey, Candice Fischer, Julie L. Weieneth, Sara D. Hurwitz, Aline G. Sayer

Elizabeth (Lisa) Harvey

The present study examined predictors of discrepancies between mothers’, fathers’, and teachers’ ratings of 3-year-old children’s hyperactivity, attention problems, and aggression. Participants were families of 196 3-year-old children who took part in child and family assessments. Ethnicity was one of the most consistent predictors of discrepancies. African American mothers and fathers were more likely to rate their children’s hyperactivity, attention problems, and aggression lower than teachers. In contrast, Latina mothers were more likely to rate their children as more hyperactive and inattentive than teachers. ADHD/ODD diagnoses, parental depression, number of children, and children’s pre-academic skills were also predictive of discrepancies …

The Longitudinal Relation Between Academic/Cognitive Skills And Externalizing Behavior Problems In Preschool Children, Lindsay A. Metcalfe, Elizabeth Harvey, Holly B. Laws

Elizabeth (Lisa) Harvey

Objective—Existing research suggests that there is a relation between academic/cognitive deficits and externalizing behavior in young children, but the direction of this relation is unclear. The present study tested competing models of the relation between academic/cognitive functioning and behavior problems during early childhood Method—Participants were 221 children (120 boys, 101 girls) who participated in a longitudinal study from age 3 to 6 Results—A reciprocal relation (Model 3) was observed only between inattention and academic achievement; this relation remained controlling for SES and family stress. The relation between inattention and cognitive ability was consistent with Model 1 (cognitive skills predicting later …

Theory Of Mind And The Ability To Make Emotional Inferences Among Children With High-Functioning Autism Spectrum Disorders, Abigail Leibovitch

Open Access Dissertations

Perspective-taking skills are central to the successful navigation of social situations. Children need perspective-taking skills to help them correctly interpret different cues and accurately assess social situations so they can determine how to best respond. Children with Autism Spectrum Disorders (ASD) exhibit marked impairments in this area. In order to develop successful social skills interventions for this population, it is critical that we have a strong understanding of the nature of their deficits. While there is robust evidence that children with ASD experience difficulty making inferences about the beliefs of others, research on their ability to infer emotions has had …

The Role Of Parent Psychopathology In The Developmental Trajectories Of Preschool Children With Behavior Problems, Rosanna P. Breaux

Masters Theses 1911 - February 2014

This study investigated associations among different parental psychopathology dimensions and child functioning. Mothers and fathers of preschoolers with behavior problems (n = 132) completed psychopathology questionnaires when children were 3 years old. Children’s externalizing, internalizing, and social problems, academic achievement, and cognitive ability were assessed at annual home visits from age 3 to 6. In general, maternal psychopathology symptoms were associated with mothers’ reports of externalizing, internalizing, and social problems at age 3 and 6. Additionally, paternal psychopathology symptoms were associated with fathers’ reports of externalizing and internalizing problems at age 3 and 6. Mothers with more elevated psychopathology …

Associations Of Childhood Family Adversity And Pubertal Timing With Depressive Symptomotology In Adulthood, Jeffrey P. Winer

Masters Theses 1911 - February 2014

To date, no prior research has examined the combined roles of childhood family adversity and pubertal timing in longitudinal pathways to depressive symptomatology in adulthood. The present study was conducted with 225 men and 225 women to explore the unique and combined roles of childhood family adversity and pubertal timing on depressive symptoms in a community sample of married adults. Results for both men and women indicated significant main effects of a cumulatively risky family environment on depressive symptoms, as well as main effects of families with higher levels of abuse and neglect, chaos and disorganization, and interpersonal family conflict. …

Locating The Source Of Approach/Avoidance Effects On Natural Language Category Decisions, Matthew Zivot

Open Access Dissertations

In this dissertation, two exemplar-based models of categorization, the General Context Model (GCM) and the Exemplar Based Random Walk model (EBRW), were used to describe between-group categorization differences in artificial and natural language categories. Prior research has shown that political Conservatives in avoidance mode are more exclusive categorizers of natural language category members than Conservatives in approach mode, but this effect was absent for Liberals (Rock & Janoff-Bulman, 2010). In Experiment 1, experimenter-generated stimuli were used to show that the EBRW could account for between-group differences in categorization decisions. In Experiment 2, the data collected by Rock and Janoff-Bulman were …

A Formative Program Evaluation Of Treatment Integrity Practices, Assessments And Attitudes Within A Specialized School Setting, Lin Tang

Open Access Dissertations

The purpose of this study, a formative program evaluation, was to provide an overview of treatment integrity rates, attitudes, and assessment methods within a specialized school for children and adolescents with Autism Spectrum Disorder. The study utilized a partnership model whereby the evaluators worked collaboratively with primary stakeholders (school administrators) to determine areas of focus for the evaluation. The program evaluation was conducted between August 2009 and August 2010, spanning one school year. The evaluation participants were the school's teachers. The evaluation was based on an exploratory case study design and included both quantitative and qualitative data. Quantitative data consisted …

The Interplay Among Preschool Child And Family Factors And The Development Of Odd Symptoms, Elizabeth Harvey, Lindsay A. Metcalfe

Elizabeth (Lisa) Harvey

Objective—The present study examined (a) the interactions between early behavior, early parenting, and early family adversity in predicting later ODD symptoms, and (b) the reciprocal relations between parent functioning and ODD symptoms across the preschool years. Method—Participants were 258 3-year-old children (138 boys and 120 girls) and their parents from diverse backgrounds who participated in a 4-year longitudinal study. Results—Early child behavior, parenting, and family adversity did not significantly interact in the predicted direction. Reciprocal relations between ODD symptoms and parent functioning were observed for maternal and paternal depression, and maternal warmth. Paternal laxness at age 4 predicted ODD symptoms …

A Longitudinal Study Of The Relation Between Depressive Symptomatology And Parenting Practices, Paula A. Errazuriz, Elizabeth Harvey, Dhara A. Thakar

Elizabeth (Lisa) Harvey

This longitudinal study examined whether mothers’ depressive symptomatology predicted parenting practices in a sample of 199 mothers of 3-year-old children with behavior problems who were assessed yearly until age 6. Higher maternal depressive symptoms were associated with higher overreactivity and laxness and lower warmth when children were 6 years old. Higher maternal depressive symptoms were also related to increases in overreactivity across the preschool years. Moreover, depression and parenting practices (overreactivity and laxness) covaried over time within mothers. These results provide evidence of a strong link between maternal depression and parenting during the preschool years.