Mental and Social Health Commons^™

Community Resilience In Vermont After The 2023 Flooding Event, Alex Poniz

Family Medicine Clerkship Student Projects

Between July 10th-11th 2023 Vermont experienced catastrophic flooding after receiving prolonged heavy rainfall of up to 9” over 48 hrs. Damage from the 2023 event rivals the historic destruction of Hurricane Irene in 2011 and is exceeded only by the Great Vermont Flood of 1927, an event predating modern flood controls. We collected oral histories from Vermonters to better understand their lived experience of the flood and its impacts, and identifed common themes related to community and individual resilience.

Screening For Ptsd In Veterans And Expanding Awareness Of Ptsd Resources, Audree S. Baroni, Bradford Clark

Family Medicine Clerkship Student Projects

PTSD is a prevalent mental health disorder that is especially prominent in the veteran population. Often veterans go without diagnosis and subsequently without treatment due to lack of awareness, screening, and a stigma they will loose benefits from the VA. This project aimed to identify the number of veterans with PTSD and provide alternative treatment methods for symptom management.

Creation Of A Parent-Directed Toolkit To Prevent Youth Vaping, Corinne Webb

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Vaping rates among adolescents are at an all-time high. Misperceptions about the harms of vaping may limit parents’ ability to impact youth vape use. This project developed and tested an evidence-based toolkit to educate parents of adolescents about the risks of vaping.

Methods: The toolkit’s creation was informed by published evidence and multimedia content delineating the scope of the vaping crisis. The toolkit was reviewed and revised by content experts. Pre- and post-implementation assessments were created and tested with faculty members, public health professionals, teachers, and parents. Assessments were utilized to evaluate parental vaping knowledge before and after implementation …

Improving Access To Medication Assisted Treatment For Opioid Use Disorder In A Rural Emergency Department, Warren Grunvald

Family Medicine Clerkship Student Projects

Opioid Use Disorder (OUD) is a growing epidemic throughout the United States and Maine has not been sparred by this. As the Emergency Department is a frequent location for people with OUD to interact with physicians it has been targeted as an opportunity to initiate Medication-Assisted Treatment (MAT) with Suboxone. This project details an effort to streamline this process and improve outcomes for patients interested in MAT.

More Than A Meal : A Resource For Communities Striving For Food Sovereignty Through The Charitable Food System, Kaitlin J. Robertson

Food Systems Master's Project Reports

The 2020 pandemic and economic crisis showcased the fragility of the American food system. In the months of quarantine and lockdowns, a growing number of Americans searched for ways to feed themselves and their families. Community-based and volunteer-supported feeding programs worked to bridge the divide between the hungry and their next meal. In many cases, these programs rely on an unpaid workforce and donations – of time, food, and facilities. With limited resources, volunteer-led programs often lack centralized training options; this guidebook seeks to fill that void. This project is a streamlined, introductory-level guide for volunteers and community members working …

Preliminary Analysis Of Vermont's Ems Naloxone Leave-Behind Program, Samantha J. Bissonette

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

Background: Naloxone is well known to effectively reverse the effects of unintentional opiate overdose and reduce mortality from opiate overdose (12, 18). Despite activation of emergency medical services (EMS) after an overdose, many patients choose against transport to a hospital for further treatment and initiation of support services. These patients were previously left on scene without any additional support or services, despite encountering emergency medical personnel. To supplement the state's naloxone distribution efforts, Vermont initiated an EMS protocol allowing all levels of providers to provide naloxone leave-behind kits to patients and/or their family or friends when a patient is identified …

Updating Evidence-Based Patient Education Resources For Sleep: Sleep Hygiene And Benzodiazepine Discontinuation, Carolyn Geraci, Madeline Fritz

Family Medicine Clerkship Student Projects

There is a major need for patient education around the topics of sleep hygiene and benzodiazepine sleep aid discontinuation in the family medicine clinic setting. Current patient-focused educational materials need updating and are not comprehensive enough. We therefore created new handouts and smartphrases which integrate into the electronic medical record system with the goal of educating patients on these topics.

Increasing Patient Access To Lgbtq+ Healthcare Through Expanding The Vermont Diversity Health Project, Rachel Harrison

Family Medicine Clerkship Student Projects

Numerous studies have documented various disparities in health outcomes and barriers to healthcare access for LGBTQ+ individuals. One major way to combat this is to increase access to healthcare for LGBTQ+ patients and increase provider knowledge of how to best care for them. Through expanding the Vermont Diversity Health Project database of providers and having providers participate in LGBTQ+ Best Practices trainings (both hosted by Pride Center of Vermont), we may reduce LGBTQ+ health disparities in our local community.

Evaluating Patient And Provider Knowledge Of Safe Pharmaceutical Disposal Procedures In Vermont Through A Public Health And Environmental Lens, Emily R. Straley

Family Medicine Clerkship Student Projects

Patient and provider knowledge of safe pharmaceutical disposal procedures is crucial from both a public health and environmental standpoint. Unfortunately, studies have shown that Vermont residents are largely unaware of safe drug disposal programs in their communities. This project evaluated patient knowledge of drug disposal practices and awareness of safe pharmaceutical disposal procedures at Hinesburg Family Medicine. A short phrase was created to better disseminate information about safe drug disposal in Hinesburg, which can be added to a patient’s after visit summary. Many patients report never discussing medication disposal with their physician. Therefore, increased provider communication regarding leftover and unused …

Medication-Assisted Withdrawal And Alcohol Use Disorder Treatment In The Ambulatory Setting, Jacob Okie Weiss, Javad Mashkuri Md, Marissa Patrick Aprn

Family Medicine Clerkship Student Projects

Alcohol use disorder (AUD) represents a significant burden of disease in central Vermont, but receives little attention and resources compared to other drivers of morbidity and mortality. As part of a community health improvement project, primary care providers in central Vermont were surveyed regarding current practices and perceived barriers related to the effective treatment of AUD. 69% of respondents reported treating alcohol withdrawal syndrome (AWS) and 83% reported treating AUD. Respondents indicated concern about the safety and efficacy of the medications they currently prescribe and expressed interest in learning about other evidence-based treatments for AWS and AUD. The most frequently …

Understanding The Profiles Of Adolescents Engaged In Intentional Self-Poisoning With Suicidal Intent And The Role Of Primary Care In Early Intervention In Vermont, Rachael Comeau

Graduate College Dissertations and Theses

Suicide prevention is a top public health priority in Vermont. It is a complex issue, requiring a multi-faceted response from many different public and private stakeholders. Because intentional self-poisoning with suicidal intent is rarely lethal, it presents a particularly good opportunity for secondary interventions in the primary care setting. Extensive research has been done on intentional self-poisoning with suicidal intent and its relationship to subsequent risk of death by suicide, but gaps exist in research utilizing poison center data in the primary care setting. This dissertation employs an explanatory sequential mixed method research design to (a) develop a profile of …

Harm Reduction In The Emergency Department, Alexa J. Golden

Family Medicine Clerkship Student Projects

The number of overdose deaths in Vermont has been trending up over the past several years. A majority of these fatalities involved synthetic opioid fentanyl. The Emergency Department (ED) at Central Vermont Medical Center delivers medication assisted treatment (MAT) through the Rapid Access to MAT (RAM) program. This program has connected many people in the region to treatment for opiate use disorder. However it was identified that we lacked connection to harm reduction services for those not interested in MAT. Harm reduction education was provided for recovery coaches and ED nursing staff. Harm reduction kits containing life-saving supplies such as …

Addressing Adolescent And Young Adult Mental Health During The Covid-19 Pandemic, Megan Boyer

Family Medicine Clerkship Student Projects

This quality improvement project at South Burlington Family Medicine aimed to investigate the mental health of individuals ages 13-25 in our practice during the COVID-19 pandemic. Eligible patients received a PHQ-9 questionnaire with two additional questions related to COVID-19. Recommendations for future interventions to serve this population were made based on these preliminary findings, with the goal of doing a full PDSA cycle in the near future.

Promoting Physical Activity In School-Aged Children During The Covid-19 Pandemic, Abigail H. Belser

Family Medicine Clerkship Student Projects

Due to the COVID-19 pandemic, children and adolescents are engaging in less physical activity and are increasing their sedentary behavior. These changes can lead to long-lasting negative lifestyle behaviors, which increases risk of health complications.

To ensure safety during the pandemic, guidelines have created restrictions on physical education and sports, which are both primary physical activity outlets for children and adolescents. Children and adolescents have to find alternate ways and resources to meet the recommended 60 minutes of physical activity daily.

An informational pamphlet was created to educate parents and children of current physical activity recommendations, with resources and ideas …

Adolescent Alcohol Usage In Vermont State: A Review Of Underage Drinking And Its Associations With Suicidality, Cecilia Idman-Rait, Karly Fischer, Shirley Callaghan, Rachel Danis, Caitlin Rettenmaier, Michelle Shepard

Master of Public Health Culminating Projects

Objective To understand adolescent alcohol usage in Vermont and its associations with suicidality.

Methods A cross-sectional study, utilizing 2017 high school VT YRBS data. Multiple logistic regression and chi-square tests were run using SPSS 25 software. Two groups of survey respondents were selected to represent alcohol usage, Binge Drinkers and Non-Binge Drinkers. Suicidality was analyzed by group, controlling for the predictor variables: age of first drink, grade level, gender, mental health/depression diagnosis, other drug usage, socioeconomic status, and ease of access to alcohol.

Results This study provides state-specific data regarding increased likelihoods of suicide and underage drinking in Vermont. Conclusions …

Associations Among Healthcare Utilization And Binge Drinking, Ethan Grey, Chad Phalon, Anna Greene, Patricia Harmeyer, Kalyn Rosenberg, Cristine Griffing, Tom Delaney

Master of Public Health Culminating Projects

Objective. To examine associations among routine healthcare services and binge drinking in Vermont adults.

Methods. We analyzed a cross-sectional sample of randomly selected 6516 adults who participated in the self-reported 2017 Vermont Behavioral Risk Surveillance System survey. We estimated odds ratios for responses indicative of binge drinking in association with length of time since last routine checkup using a bivariate logistic regression model.

Results. Participants who reported binge drinking were 31% (OR = 0.69, 95% confidence interval [CI] = 0.56, 0.83) less likely to engage in a healthcare visit within the past year controlling for age, employment status, annual household …

Automated Identification Of Unhealthy Drinking Using Routinely Collected Data: A Machine Learning Approach, Levi N. Bonnell, Benjamin Littenberg, Safwan R. Wshah, Gail L. Rose

Larner College of Medicine Faculty Publications

Background: Unhealthy drinking is prevalent in the United States and can lead to serious health and social consequences, yet it is under-diagnosed and under-treated. Identifying unhealthy drinkers can be time-consuming for primary care providers. An automated tool for identification would allow attention to be focused on patients most likely to need care and therefore increase efficiency and effectiveness.

Objectives: To build a clinical prediction tool for unhealthy drinking based solely on routinely collected demographic and laboratory data.

Methods: We obtained demographic and laboratory data on 89,325 adults seen at the University of Vermont Medical Center from 2011-2017. Logistic regression, …

Improving Contraception Among Female Syringe Exchange Clients: A Reproductive Needs Assessment, Gena Zollman

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Women with opioid and other substance use disorders have a high rate of unintended pregnancy and a low rate of effective contraceptive use. Integrating family planning (FP) services into medication-assisted treatment (MAT) clinics has increased rates of initiation and adherence to contraception among this population. This study assesses the reproductive health needs of female clients in a syringe exchange program (SEP)to assess if integrating FP services would improve access to contraception.

Methods: Female clients of a SEP voluntarily completed an anonymous survey to determine demographics, FP needs, and barriers to accessing care, and were compensated with $20 gift cards. …

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.

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 …

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.

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.

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.

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.

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.

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 …