Mental and Social Health Commons^™

What's In Your Cup? Increasing Transparency And Confidence In Alcohol Use Screening And Brief Intervention, Dylan C. Koundakjian

Family Medicine Clerkship Student Projects

19% of Vermonters report drinking alcohol at levels which puts their health at risk, but many healthcare providers do not feel confident in addressing their patients' usage. This can stem from lack of experience with alcohol use, worries about stigma, and time constraints. However, data has shown that even 5-15 minute interventional conversations can significantly reduce a patient's risky drinking. This project aims to provide real-world, practical advice for having conversations around alcohol, and provides a conversion chart converting popular alcoholic beverages into standard drink equivalents.

How To Improve A Medication-Assisted Treatment Program For Opioid Use Disorder: First, Look At The Evidence, Collin York

Family Medicine Clerkship Student Projects

The prevalence of Opioid Use Disorder (OUD) in the United States has been described as an epidemic, and rural areas have been affected in particular. A treatment paradigm called Medication-Assisted Treatment (MAT) has been demonstrated to be effective at treating OUD, and more and more rural, primary care clinics are establishing MAT programs. One such clinic is Hudson Headwaters Health Network, a FQHC in Upstate New York. I wrote a literature review and distributed it to staff involved in MAT program design, and I also wrote a practical evidence guide for MAT providers. Providers completed a survey assessing the evidence …

Improving Awareness Of Opiate Support Programs In Lamoille County, Samantha Bissonette

Family Medicine Clerkship Student Projects

Despite Vermont having doubled the rate per 10,000 people ages 18 to 64 receiving Medication Assisted Treatment (MAT) for Opiate Use Disorder (OUD) since 2012, there are still numerous barriers preventing patients from seeking treatment, including confusion about how to go about entering a treatment program, fear of stigma, and many others. Lamoille County has started to expand outreach to people struggling with OUD by having emergency services personnel, outpatient medical offices, and recovery centers hand out a county-specific information card with clear information about how to enter treatment and support programs. This project builds upon this existing initiative.

Substance Use Disorder Treatment Decision Aid For Adults In Chittenden County Vermont, Elizabeth V. Mcleod

Family Medicine Clerkship Student Projects

Substance Abuse Disorders (SUDs) are a prevalent public health concern in both the national and local arena resulting in millions of dollars in pubic health costs and loss of life. Navigating the treatment options available in Chittenden County can be time consuming, difficult, and delay treatment. In order to help guide adult patients and their families in Chittenden County along their journey towards recovery from SUDs, a treatment decision aid was developed for choosing the right level of care.

Intimate Partner Violence: Updated Screening Tool And Approach To Screen Positive Patients, Michael J. Hall

Family Medicine Clerkship Student Projects

Intimate partner violence screening is recommended in all women of child-bearing age. Ensuring validated screening tool utilization and employing strategies to identify risk while providing non-judgmental support is critical to identifying patients and optimizing appropriate resource referral.

Smoking Prevention Program For Adolescents: A Hands-On Approach, Sean Closs

Family Medicine Clerkship Student Projects

This project is an initial pilot idea for hands-on experiences to reinforce smoking prevention in adolescents. The proposed idea is to have students specifically those identified 'at-risk', being given opportunities to interact with pathology specimens on-site at the hospital, introduce spirometry, and real-world panel discussions. The resources of the hospital provide a unique opportunity for promotion of this public health goal.

Perinatal Depression: Breaking Barriers To Treatment, Florence Lambert-Fliszar

Family Medicine Clerkship Student Projects

Depression in the perinatal period is a common medical issue in Vermont, affecting about 10% of women. Multiple and severe consequences of depression during this time are seen for both mothers and babies, including lower breastfeeding rates, fewer healthcare visits for the child, and psychopathology in the child later on. The goal of this project is to identify and address some of the barriers we currently face in identifying and treating women for depression. Major barriers women encounter in seeking help involve poor recognition of symptoms facing increasing stress of motherhood, stigma, as well as neglecting to attend to mental …

Marijuana And The Teenage Brain: Public Health Impact, Katie C. Warther

Family Medicine Clerkship Student Projects

This project explores the neurobiological impact of teenage marijuana use, and the ways that public health interventions can help educate adolescents and delay the onset of use.

Out-Of-Pocket Cost For Individuals Being Treated For Opioid Dependence In Rutland County, Vermont, Christopher T. Veal

Family Medicine Clerkship Student Projects

Each day more than 140 Americans die from drug overdoses, 91 specifically due to opioids. In Vermont, more than 50 people die each year from opioid poisoning. With insurance coverage being a critical component of Opioid Dependence Recovery, many people seeking treatment are unaware of the financial barriers to recovery- namely the out-of-pocket costs associated with treatment. This study sought to provide insight on the financial impact of Opioid Dependence Treatment on the patient, and provide financial assistance information to the Rutland County community.

The Association Of Hormonal Contraception With Depression, Pamela Derickson

Family Medicine Clerkship Student Projects

Hormonal contraceptives are widely used by women during their reproductive years. Currently, over 100 million women worldwide use the pill, and 82% of sexually active women in the USA will use oral contraceptive pills at some time during their reproductive years (Carrol, 2017). Oral contraceptive use, especially among adolescents, is associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression may be a potential adverse effect of hormonal contraceptive use (Skovlund, 2016). This project focused on educating health care providers at the Community Health Center of Burlington, VT (CHCB) about the association of depression and oral …

Physical Activity And Fall Prevention In Older Adults, An Educational Intervention, Caleb Daniel Knight

Family Medicine Clerkship Student Projects

Falls in adults over 65 years of age constitute a significant health burden in our country, and this age group is growing rapidly. Falls are addressed with a multifactorial approach, addressing comorbidities, medications, and the physical environment, however, an effective point of intervention accessible by most older adults is physical activity. A brief educational presentation about the morbidity and mortality associated with falls, and the protective effects of physical activity, was provided to Meadowbrook Healthcare subacute nursing home residents in Plattsburgh, NY. Questions were encouraged and answered afterwards, and copies of the presentation were left for the residents to review …

Increasing Advance Directive Knowledge Among Healthcare Professionals, Laura K. Donnelly

Family Medicine Clerkship Student Projects

Advance Directives (ADs) have been shown to be associated with increased patient satisfaction with end-of-life care, decreased in-hospital deaths, and decreased end-of-life costs in high-cost regions. Nationally, prevalence of ADs has increased over the last 20 years, but the majority of patients still have not completed an AD. A significant obstacle to completion is lack of awareness. A presentation to increase knowledge regarding ADs among primary care staff was created to address this.

Intimate Partner Violence In Immigrant/Refugee Populations, Lisa H. Wang

Family Medicine Clerkship Student Projects

Intimate partner violence (IPV) is the most common type of violence affecting women. Globally, Central Africa and South Asia have some of the highest rates of IPV. In Vermont, the majority of refugees are from these regions. Individual, interpersonal, and especially cultural values play critical roles in the definition/appraisal and decision to seek help in these women. This study examines ways to mitigate challenges that healthcare professionals have in identifying women who need help and barriers preventing these women from seeking help.

Nutrition And Exercise Resources For Clinton County, Paige M. Wood

Family Medicine Clerkship Student Projects

The obesity epidemic is a nation wide problem that has increased prevalence in Clinton County, NY when compared to the surrounding areas. Obesity leads to many co-morbid health conditions and is associated with a large increase in health care spending costs. This brochure tackles the limited resources, such as limited number of fitness centers, lack of nutrition education and an overall lower socioeconomic status, that is present in the Clinton County area. This brochure offers help in these areas through free phone applications which cover nutrition education, healthy shopping guidance, at home exercise routines, motivation, habit trackers and mindfulness exercises.

Management Of Prenatal Depression, Soraiya Thura

Family Medicine Clerkship Student Projects

Depression affects many women during and after pregnancy. As many as 1 in 5 women will experience a depressive episode during their pregnancy, however, studies have shown that less than 20% of these women will discuss their symptoms with their healthcare provider and receive care. Barriers to treatment include poor screening, lack of understanding about safe treatment, and stigma against mental illness in pregnant women. This project aimed to address this issue locally, by presenting to a group of family medicine providers in Vermont on the topic of prenatal depression screening and treatment. The presentation was received well and developed …

Indirect Approach To Intimate Partner Violence, Jasmine Y. Robinson

Family Medicine Clerkship Student Projects

Discussing Intimate Partner Violence can be difficult, and has many barriers. An indirect approach to speaking with patients about domestic violence, whether is is sexual, physical, emotional or financial can be achieve with patient's trust in a physician if they withhold judgement.

Hidden Adolescent Risks: Provider Education On Non-Suicidal Self-Injury, Bailey Fay

Family Medicine Clerkship Student Projects

Non-suicidal self-injury (NSSI) has been shown to be a strong risk factor for suicidal ideation and suicide attempt. One study has shown over 50% of people engaging in NSSI have at least one suicide attempt in their lifetime. The 2015 Vermont Youth Risk Behavior Survey found 17% of high school students reported non-suicidal self-injury at least once in the past year. This reflects roughly one in four females and one in ten males. Furthermore, these numbers have increased significantly since 2013. In an effort to promote awareness of NSSI in the primary care setting, a handout was created for providers …

Provider Education: Managing Depression In Cancer Patients, Nicole Leonard

Family Medicine Clerkship Student Projects

Depression is more prevalent and less often treated in cancer patients compared to the general population. Cancer can increase the risk of depression in multiple different ways, but depression can also increase the risk of cancer. Untreated depression in cancer patients can increase the risk of metastasis and worsen prognosis. The purpose of this project is to educate providers on the connection between mental health and cancer as well as provide them resources on how to approach and manage patients with cancer and depression.

Evaluation Of Screen Time In Children, Mohammad Mertaban

Family Medicine Clerkship Student Projects

An evaluation of screen time and media use in children. This project looks to education healthcare practitioners about the effects of current media practices in the United States on children. A presentation was given to healthcare practitioners at a family medicine practice and a brochure was created to distribute to families in the waiting room. Practitioners reported an increase in knowledge regarding the subject of screen time in children, an increase in their comfort level in in discussing these effects with patients, and increase in their ability to effectively communicate the media guidelines of the American Academy of Pediatrics.

Improving Breastfeeding Support At A Multi-Service Federally Qualified Health Center, Elisabeth P. Lucas

Family Medicine Clerkship Student Projects

A student project exploring how breastfeeding is addressed among different patient care teams in a federally funded clinic and using Electronic Health Record data to determine patient needs. Future recommendations included.

Psychotherapy: Skills And Resilience Through Self-Knowledge, Gilana Finogenov

Family Medicine Clerkship Student Projects

At least 20% of all primary care visits are related to mental health. A limited number of patients are being referred to therapy, even though therapy is shown to be as effective as medication for disorders like depression and anxiety. A pamphlet was designed to explain what psychotherapy is to patients and to describe several common therapy modalities.

Creating A Welcoming Clinical Environment For Lgbt Patients, Samy S. Ramadan

Family Medicine Clerkship Student Projects

The aim of this project was to develop a welcoming clinical environment for Lesbian, Gay, Bisexual, and Transgender (LGBT) patients at Northern Counties Health Care (NCHC) and to serve as a model for community health centers across the nation that want to provide their LGBT communities with patient centered care that is affordable, compassionate and accessible. This was achieved by revising non-discrimination policies and new patient forms to be more inclusive of sexual orientations and gender identities, incorporating LGBT health learning modules into yearly provider and staff mandatories, and adding LGBT inclusive material into all waiting and exam rooms. The …

Evaluating Access And Barriers To Mindfulness Among Opioid-Dependent Patients In Bangor, Maine, Gwendolyn E. Warren, Jia Xin Jessica Huang

Family Medicine Clerkship Student Projects

Mindfulness has been shown to aid in addiction recovery and can help prevent relapse. The Family Medicine Center & Residency Program at Eastern Maine Medical Center (EMMC) in Bangor, Maine has provided mindfulness resources to their opioid-dependent patients; however, the center has no quantitative data on the current understanding and utilization of mindfulness techniques among this patient population. A survey tool was created and distributed to opioid-dependent patients in the clinic to identify barriers to practicing mindfulness. The collected data was submitted by one of the clinic providers in a grant proposal. Grant funding could go toward addressing these barriers.

Childhood Obesity: A National Emergency, Elaine E. Wang

Family Medicine Clerkship Student Projects

Childhood obesity rates and the related public health costs are rising every year. Many projects have addressed family education on the importance of diet and exercise. However, though patients reportedly understand this concept, they are still have challenges implementing their knowledge. We seek to address this discrepancy with an educational brochure based on suggestions for parents from the American Academy of Pediatrics.

Improving Healthy Habits In Berlin, Vt, Amy I. Triano

Family Medicine Clerkship Student Projects

A significant percentage of patient’s at Berlin Family Practice have diagnoses of Type II Diabetes, hypertension, high cholesterol, and/or obesity. Essential to treatment and management of these conditions are a healthy diet and exercise. There are many local and national resources available but no single place where patient’s can find links to national as well as local resources in the Central Vermont community. There is also insufficient time for physicians or nurses to counsel patients on relevant resources. This project involved creation of a website with community and national resources for healthy living that providers could refer patients to. A …

Community Perception Of Electronic Cigarettes And Their Role As Smoking Cessation Aids, Alejandro Velez

Family Medicine Clerkship Student Projects

The popularity of electronic cigarettes is increasing, yet the research is lagging behind. In an effort to better understand, and therefore better advice our patients, a small number of current daily cigarette smokers were surveyed on their understanding of electronic cigarettes and their usage. Two smoking cessation counselors were also interviewed to better contextualize the role of electronic cigarettes as possible smoking cessation aids. Finally, a review of the available research was done to produce a poster, and possibly a handout, in hopes to educate all patients (regardless of their current smoking habits) regarding electronic cigarettes.

Drug Treatment Court: The Power Of Understanding Addiction, Asaad Traina

Family Medicine Clerkship Student Projects

The Drug Treatment Court in Burlington is one of about 3000 drug treatment courts nationwide. They were developed as an “alternate sentencing court”, a method of restorative justice that would allow people who had multiple criminal charges related to substance abuse to overcome their addiction, have their criminal charges dismissed, and pursue a fuller life. As part of this program, many participants attend an Intensive Outpatient Program (IOP). As a third year medical student, I lead an educational session with the aim of helping participants understand the neurophysiology behind their addiction.

Mental Health Screening In Nursing Homes, Meghan Breen

Family Medicine Clerkship Student Projects

Depression and dementia are two of the most common mental health conditions in nursing homes. Screening for these conditions does not have to be difficult or time consuming, but doing it can significantly improve the health of nursing home residents. The WHO-Five for depression and the Mini-Mental Status Exam are both sensitive, specific, and time-sensitive. Using these screening in a nursing home in rural Vermont helped improve the accuracy of patient records and impacted medical care.

Lyme Disease Awareness In Downeast Maine, Justin L. Genziano

Family Medicine Clerkship Student Projects

Lyme disease is caused by the bacteria Borrelia burgdorferi and is transmitted by the deer tick (Ixodes scapularis). Lyme disease is endemic in the state of Maine with 1,399 probable and confirmed cases reported in 2014. The rate in coastal Hancock County has doubled since 2012, and has the third highest rate of infection in the state.

Medical providers in Hancock County have observed an increase in anxiety and concern about Lyme disease in the community, and have found that much of this is driven by hearsay or unreliable information from the internet. The goal of this project …