Digital Commons Network^™

Implementing Measurement-Based Care In Virtual Mental Health Services For Rural Veterans: Provider Insights From A Pre-Implementation Evaluation, Amanda Heeren, Kimberly Mccoy, Lindsey Fuhrmeister, Natalie Suiter, Jan A Lindsay, Chloe Hoang, Laura Marsh, John Fortney, Carolyn Turvey

Faculty, Staff and Students Publications

Background

Measurement-Based Care (MBC) uses repeated standardized psychological assessments to monitor treatment progress and guide clinical decision-making. Although MBC improves outcomes when results are discussed collaboratively, adoption across the Veterans Health Administration (VHA) remains below 50%, particularly in virtual and rural settings. This pre-implementation evaluation explored provider perspectives to inform development of a digital MBC workflow for rural tele-mental health settings.

Methods

Using the Alacrity Center’s Discover, Design, Build, and Test model and User Centered Design, we conducted a pre-implementation survey of mental health providers at a VHA Medical Center providing care to rural and highly rural Veterans in South …

Mental Health Consequences Of Sex Trafficking, Brenda Myers-Powell

Dignity: A Journal of Analysis of Exploitation and Violence

No abstract provided.

The Phoenix Trauma Response Model (Ptrm): An Integrative And Innovative Approach To Trauma Recovery And Growth, Latesha S. Holloman, Lauren B. Robins, Tammie Willis, Courtney V. Morris

Journal of Human Services Scholarship and Interprofessional Collaboration

Trauma is increasingly understood as a developmentally consequential experience that shapes identity, regulation, and relational functioning across the lifespan. Although trauma-informed care, resilience theory, posttraumatic growth, and narrative approaches have expanded understanding of recovery, few frameworks articulate a structured developmental progression that integrates prevention, intervention, and intergenerational transformation within a unified model. The Phoenix Trauma Response Model (PTRM) addresses this gap by introducing a cyclical, phase-based framework organized around four interrelated processes: Recognition, Reframing, Reclamation, and Replication of Strength. Central to the model is the construct of conversion potential, defined as the structured capacity to translate distress into purposeful …

Substance Use Stigma: Examining The Role Of Social Work Education., Eboni Burton

Doctor of Social Work Capstone Projects

This study explored the extent of substance use related stigma among social work students and professionals (i.e., BSW, MSW, PHD and DSW) and its relationship to specialized education/training in substance use and professional practice with people who use drugs (PWUD)/live with a substance use disorder (PWSUD). Stigma was measured using the Opening Minds Provider Attitudes Toward Opioid Use Scale and the Medical Condition Regard Scale. The final sample size was 263. Results indicate that current enrollment in a social work program, post degree or non-curriculum related substance use related training, and personal and professional experience with substance use specifically, mitigate …

Emergency Department Boarding For Psychiatric Care: The Effect Of Pointclickcare Integration., Chris Rowan

Doctor of Social Work Capstone Projects

Emergency Department Boarding for Psychiatric Care: The Effect of PointClickCare Integration

Abstract

For many individuals in psychiatric crisis, the emergency department has become the first place to seek help, highlighting gaps in how behavioral health care is accessed and coordinated. In Massachusetts, PointClickCare's Behavioral Health Treatment and Referral Platform (BH TRP) was implemented to centralize and streamline referrals between emergency departments and inpatient psychiatric facilities. This capstone evaluates whether implementation of the BH TRP was associated with changes in psychiatric boarding time at a community hospital emergency department. Using a mixed-methods program evaluation design, this study analyzed de-identified electronic medical …

The Unexplored Relationship Between Adverse Childhood Experiences, Burnout, And Resiliency Among Hospital Staff., Elizabeth Davis

Doctor of Social Work Capstone Projects

This study addresses the critical issue of staff turnover at Baptist Health Floyd, where rates exceed national hospital averages. While prior research connects burnout to workplace stressors, less is known about the role of adverse childhood experiences (ACEs) and resilience among hospital staff. Understanding these relationships is essential for improving workforce stability and patient care outcomes. A cross-sectional survey design was used, with convenience sampling of hospital employees and providers (n=207). Data were collected via a Qualtrics survey using validated instruments: the Maslach Burnout Inventory (Maslach et al., 2016), the ACE questionnaire (Felitti et al., 1998), and the Brief Resilience …

Diagnostic Trends And Service Enhancements In Deaf Mental Health: A Longitudinal Analysis, Kent Schafer, Steve Hamerdinger, Frank Wu, Rie Sakai Bizmark, Charlene Crump

JADARA

A longitudinal study investigated mental health diagnostic trends and patterns among Deaf and Hearing individuals using a comprehensive dataset from Alabama Department of Mental Health spanning 2004-2024 (Deaf=4,547; Hearing=2,056,188). Chi-square analysis revealed significant proportional differences in diagnoses between the groups. Deaf individuals showed significantly higher proportions of psychotic (12.93% vs. 8.33% Hearing), mood (20.76% vs. 18.84% Hearing), and personality (0.58% vs. 0.43% Hearing) disorders. These findings suggest that increased access to specialized and competent mental health services for individuals who are Deaf, particularly following the increase of staffing patterns for the Office of Deaf Services in 2015,contributed to more accurate …

Bridging Ipv And Sud For Pregnant And Postpartum Women: A Case Report Of Interdisciplinary Programming In Mississippi, Catherine Poehling, Masoumeh Karimi, Chinedu Chukwu, Jerome R. Kolbo, Xiaoshan Gordy, Saijun Zhang, Matthew Morris, Andrew Voluse, Erin Dehon, Michelle Brassfield, Danielle Lahn, Lisa Slade, Deanna Howington, Kathleen Rhodes, Tearsanee Davis, Sonja Fuqua, Mary M. Wesley, Lei Zhang

Journal of Public Health in the Deep South

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) adolescents in the U.S. South experience disproportionately high rates of bullying, discrimination, depression, and suicidality. Supportive and inclusive school climates are identified as key protective factors that can mitigate these risks and function as primary prevention against violence. This systematic narrative review synthesizes peer-reviewed research and high-quality survey reports published between 2015 and 2024 that assess school climate, mental health, and violence-related outcomes among LGBTQ+ youth with representation from Southern states, including Mississippi, Alabama, and Louisiana. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 1,167 records …

Roles And Strengths Of Therapeutic Recreation Professionals In Service Provision: A Strengths-Based Approach, M. Rebecca Genoe, Linda Ostryzniuk, Kathy Park, Sherri Nelson, Douglas G. Cripps, Donna Boser

The Qualitative Report

Therapeutic Recreation professionals work in healthcare and community-based settings where they utilize recreation and leisure to improve quality of life. Despite their contributions, Therapeutic Recreation often goes unrecognized as an important component of the healthcare team. The purpose of this study was to explore the strengths and successes of Therapeutic Recreation professionals. We aimed to explore how Therapeutic Recreation professionals identify and perceive their roles, and what strengths they use within their roles. Data was collected through 19 individual interviews and eight focus groups with Therapeutic Recreation professionals and analyzed thematically. The theme of “nurturing well-being through leisure” was generated …

Teaching Multicultural Counseling: A Phenomenological Exploration Of Counselor Educators’ Voices, Cameka Hazel, Paul Leheste, Raymond Blanchard

Journal of Counselor Preparation and Supervision

This study explored the perceptions of counselor educators who taught the graduate level multicultural counseling course. Six participants shared experiences, leading to four themes: personal and professional rewards, who is fit to teach? dealing with resistance and difficult conversations and limited time and class size. Implications for counselor education are discussed.

Dismantling Racism In The Classroom: Recommendations For White Male Counselor Educators, Jason L. Vannest, Rebecca J. Vannest, Lorise D. Grey

Journal of Counselor Preparation and Supervision

In response to the historical tradition of Eurocentrism and Whiteness in counseling programs in the United States, the American Counseling Association (ACA) and the Association for Counselor Education and Supervision (ACES) have challenged their members to confront implicit bias, become allies with Black Indigenous People of Color (BIPOC), and commit to challenging racism and implicit bias. Despite these robust calls to disrupt racism and implicit bias, counselor educators - specifically White male counselor educators (WMCEs) - may wonder how to effectively take action due to their own racial identity. Several factors may contribute to WMCEs' reticence to deconstruct racism and …

The Feminist Impostor Phenomenon Approach (Fipa): A Feminist Approach To Addressing Impostor Phenomenon In Novice Counselors, Isabel Springer, Kelly Emelianchik-Key

Journal of Counselor Preparation and Supervision

Impostor Phenomenon (IP) is known to affect new professionals in health professions, yet there is little to no academic literature available on how it affects early career counselors and how it can be addressed. Novice counselors (NC) frequently experience extreme anxiety and feelings of fraudulence around their professional performance. Feminist mentorship and interventions can help alleviate IP and foster self-efficacy and confidence in new counseling professionals. The Feminist Impostor Phenomenon Approach (FIPA) consists of a three-hour workshop educating participants through a feminist lens about IP and relevant coping strategies, and subsequent weekly consciousness-raising groups where coping strategies are reinforced, and …

Experiences Of Stigma And Barriers To Care Among Transgender And Gender Expansive Populations Seeking Mental Healthcare, Amanda Veldorale-Griffin, Elizabeth Banks, Elizabeth Patrick, Judith Cannon, Caidan Thomas Smith

Marriage and Family Therapy Faculty Articles and Research

Transgender and gender expansive (TGGE) people experience increased risk for mental health issues and suicidality, as well as significant barriers to mental healthcare, due to stigma and discrimination, including from mental healthcare providers. A sample of 945 TGGE participants completed self-report surveys, measuring experiences of stigma and barriers to care, and counselor competence. Data were divided into two groups by age and analyzed through linear regressions and one-way ANOVAs. Across groups, participants (approximately 58% of younger participants and 49% of older participants) reported experiencing stigma from a healthcare provider, and all reported some barriers to care, with more than half …

Older Adults And Suicide: Protective Pathways To Apply Shores In Counseling, Anna A. Ellenson, Jenny L. Cureton

Adultspan Journal

Older adult suicide (OAS) is a growing concern as the U.S. population continues to age and access to counseling expands. Despite legal and ethical requirements, counselors are often underprepared to address suicide in later life, especially through the lens of suicide protective factors (SPFs). This conceptual article introduces SHORES, a research-informed mnemonic (Skills and strategies for coping, Hope, Objections to suicide, Reasons for living/Restriction of means, Engaged care, and Support), to help counselors assess, intervene, and plan treatment with older adults. We review literature on OAS, highlight gaps in counselor training, and provide an application guide for using SHORES with …

Sit, Stay, And Teach: Exploring Teachers' Perceptions Of Facility Dogs' Impact On Stress And Retention, Dennis Powers

Graduate Student Dissertations, Theses, Capstones, and Portfolios

The teaching profession remains at a high level of workplace stress, a factor contributing to teacher burnout and turnover. The study examines how teachers in K-12 public education perceived that facility dogs might reduce stress, increase job satisfaction, and aid in teacher retention in public schools of a southeastern state. The study employed a qualitative, cross-sectional survey that was emailed to 112,546 educators from a LISTSERV request. A total of 1,242 individuals provided informed consent and completed the survey, which consisted of Likert-scale measurement items, open-ended questions, and an informational video inserted to achieve a common understanding of the facility …

College Students' Barriers To Mental Health Support Services: A Practitioner's Perspective, Rebecca C. Johnson

Dissertations, Theses, and Projects

The purpose of this study was to identify barriers to accessing mental health support for college students from the perspective of college faculty counselors. In 2022, research indicated that over 60% of college students met the criteria for one or more mental health conditions (Lipson et al., 2022), though data published in the same year revealed that practitioners employed at colleges and universities are only supporting an average of 12.2% of the student population (Bruns et al., 2023). While college counseling centers have reported increasing usage rates, there remains a gap in the number of students utilizing services versus those …

Socioecological Stressors During Covid-19 Among Urban Refugee Youth In Kampala, Uganda: A Qualitative Descriptive Analysis, Sikky Shiqi Chen, Carmen H. Logie, Frannie Mackenzie, Moses Okumu, Robert Hakiza, Brenda Katisi, Daniel Kibuuka Musoke, Aidah Nakitende, Isha Berry, Bay Bahri, Peter Kyambadde

Journal of Social, Behavioral, and Health Sciences

Limited studies have examined pandemic-related stressors among urban refugee youth in low and middle-income humanitarian countries (LMICs), such as Uganda. We explored the lived experience of COVID-19-related stressors among urban refugee youth in Kampala, Uganda. We analyzed qualitative data (text messages, WhatsApp chats, photos) collected in an interactive mobile health intervention with 346 refugee youth aged 16–24 in Kampala. Findings revealed stressors across socioecological levels: individual (e.g., financial-related distress), social (e.g., limited social interactions), community (e.g., food insecurity), and policy (e.g., unprecedented lockdowns). Findings can inform social work organization pandemic preparedness strategies for economic empowerment and social cohesion with youth.

Bridging Theory And Self-Development In Human Services And Counselor Education, Kristy Carlisle

Journal of Human Services Scholarship and Interprofessional Collaboration

Counselor and human services education increasingly recognize self-awareness as a core component of professional competence and ethical practice. This conceptual manuscript presents a pedagogical framework that integrates major helping theories as tools for structured self-reflection and self-development among students and practitioners. Drawing from experiential learning theory, reflective practice, and models of counselor identity formation, the approach encourages learners to view themselves through theoretical lenses such as person-centered, cognitive-behavioral, and existential frameworks, paralleling the very lenses through which they will view their clients in practice. By engaging in guided reflective activities, students examine personal beliefs, emotions, and behaviors to enhance self-understanding, …

Interprofessional Collaboration In Inpatient Rehabilitation For Patient With Thiamine Deficiency-Related Sensorimotor And Cognitive Deficits – Case Report, Christina Thomas, Tahreem Hashmi, Joanne Delgado-Lebron, Rania Massad

Journal of Interprofessional Practice and Collaboration

Purpose: We aim to describe the clinical presentation, interprofessional management, and functional outcomes of a patient with thiamine deficiency. Problem: Thiamine deficiency can result in peripheral polyneuropathy and cognitive deficits that limit function and participation. Despite deficits that warrant interprofessional neurorehabilitation, previous reports focus narrowly on medical management. Case: A 36-year-old female was admitted to inpatient rehabilitation with a diagnosis of Guillain Barre. She underwent evaluation by the interprofessional team that revealed cognitive deficits inconsistent with Guillain Barre. Further medical workup identified a thiamine deficiency. Comprehensive treatment included supplementation managed by the physiatrist; promotion of motor learning and neuroplasticity to …

Integrating Clinical Reasoning Into Mental Health Diagnosis: A Conceptual Framework For Counseling Practice, Ashley F. Waddington, Alexander M. Fields, Haley Ault

Journal of Human Services Scholarship and Interprofessional Collaboration

Clinical reasoning has long guided diagnostic accuracy in nursing and medical fields, but its application in mental health counseling remains limited. This paper presents a conceptual diagnostic decision-making (DDM) process to embed clinical reasoning into the diagnostic process for counselors, incorporating two vital constructs: counselor self-efficacy and counselor bias (implicit and explicit). Grounded in Bandura’s theory of self-efficacy (1977) and Carvalho et al.’s (2017) clinical reasoning model, the framework highlights the cognitive, behavioral, and contextual factors that shape diagnostic decision-making in early-career counselors, including counselor biases. The paper calls for reform in counselor training, emphasizing curriculum enhancements as pathways to …

Counseling And The Neurodiversity Paradigm: A Call To Action, Emily Goodman-Scott, Rawn Boulden, Aaron Albright, Jenna Alvarez, Betsy M. Perez

Counseling & Human Services Faculty Publications

The counseling profession is rooted in prevention, wellness, mental health, and a critical social justice approach to serving historically marginalized communities, including people with disabilities. The overarching construct of disability comprises subtypes, such as neurodivergence. Given the prevalence of neurodivergent individuals worldwide (approximately 15%-20%), the counseling profession must be prepared to support this community. At the same time, there is a dearth of peer-reviewed literature on neurodiversity specifically for the counseling profession. In this article, we address a timely topic in the profession. We discuss utilizing a critical counseling lens and centering marginalized identities, such as people with disabilities; prominent …

Feeding Missoula: Food Insecurity In Rural Children And Youth, Chani Brammer, Braelee Cheeks, Jordin Holland, Rayne Mccollough, Laurel Palmer, Therese Solomon

Undergraduate Theses, Professional Papers, and Capstone Artifacts

In Montana, approximately one in seven children live in a food-insecure household, with rural Montanans in particular facing significant barriers. Existing needs-based food assistance programs, such as SNAP and WIC, have structural weaknesses: SNAP benefits are often not sufficient to last through the month, and those eligible for these programs face a confusing application process, shame and stigma, and logistical hurdles, such as limited transportation.

“Feeding Missoula” began with an evaluation of how current food assistance programs met or failed to meet the needs of rural youth. Our methodology integrated a comprehensive review of existing literature and structured interviews with …

Legislative Debate-Attributed Suicidality Among Lgbtq+ Adults: The Buffering Effect Of Community Belongingness, Keith J. Watts, Shawndaya S. Thrasher, Laneshia R. Conner, Nicole Campbell, Louis G. Baser, Dekeitra Griffin, Sydney P. Howard, Missy Spears, Justin X. Moore

Counseling & Human Services Faculty Publications

Background: In recent years, the sociopolitical landscape in the United States has shifted due to an increase in state-level legislation regarding LGBTQ+ rights, a trend that has been particularly pronounced in the Commonwealth of Kentucky. While the mental health impacts of enacted laws are increasingly documented, a critical gap remains in understanding the psychological toll of the legislative debates themselves—the prolonged periods of public discourse surrounding the restriction of rights. Methods: Utilizing data from the 2025 Queer Kentucky Survey (N = 817), this exploratory study examined the association between LGBTQ+ community belongingness and acute suicidality attributed specifically to anti-LGBTQ+ legislative …

The Use Of Visual Autobiographies In First, Second, And Third-Generation Children Of Immigrants In Navigating Belonging And Identity, Sorprisela Martinez

Art Therapy | Master's Theses

This study explored how autobiographical artmaking supports adolescents of immigrant-origin in understanding identity and sense of belonging through visual and narrative reflection on personal stories. The qualitative research approach was guided by three research questions examining: (1) the ways autobiographical work expresses complexities of immigrant heritage and multiple identities; (2) how narrative lens supports a deeper interpretation of autobiographical expressions; and (3) how adolescents’ understanding of their parents’ migration stories contributes to their own identity formation and self-presentation. Seven adolescents participated in a two-session, arts-based process that included creating autobiographical books, discussion of their images, and reflection on their cultural …

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

The Influence Of Familial Substance Use Disorder On Perceptions And Attitudes Towards Substance Use Disorders And Participant Substance Use Behavior Among Emerging Adults, Elijah M. Lefeld, Jennifer Stanley

Williams Honors College, Honors Research Projects

This research project explores how the lived experience of having an immediate family member with a substance use disorder (SUD) influences a person’s perceptions, attitudes, and behaviors related to substance use. Rather than focusing on the individual diagnosed with SUD, the study examines the reciprocal impact on family members within the social subsystem. Using a quasi-experimental design, the project will compare participant responses using with and without a familial connection to SUD. Data will be collected through Qualtrics surveys distributed via SONA. These measures will record demographic information, personal substance use habits, attitudes toward addiction, perception of substance use disorders, …

Social Determinants Of Health Affecting Cardiovascular Health Among South Asian Americans, Ann Mary Thomas

Honors Undergraduate Theses

Background: South Asian Americans experience disproportionately high rates of cardiovascular disease, yet the social determinants contributing to these disparities remain understudied.

Objective: This systematic review examines the role of social determinants of health (SDOH) in shaping cardiovascular outcomes among South Asian Americans.

Methods: A systematic literature search was conducted across PubMed, MEDLINE, and Web of Science using predefined search terms related to South Asian populations, cardiovascular health, and SDOH. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting guidelines, and study screening and management were performed using Covidence. A total …

Association Between Caregiver Status And Physical And Mental Health Among National Senior Games Athletes, Chibuzo Uchechukwu Victor Obasi

Graduate Research Theses & Dissertations

As the population ages, more people rely on informal caregivers, which puts many older adults at risk for health problems. Caregiving can be meaningful and strengthen family bonds, but it often leads to more psychological stress, especially for older adults who also have their own health concerns. Research shows that regular physical activity can help older adults build resilience and improve their mental well-being. Still, we know little about the health of older caregivers who stay very active. This study examines the health effects of caregiving among members of the National Senior Games Association (NSGA), a group of highly active …

Transition To Home Guideline For Patients With Diabetes, Kathleen R. Burgner

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Diabetes is a leading contributor to preventable hospital readmissions. These hospital readmissions often result from fragmented discharge planning, poor care coordination, and limited post-discharge support. At a 915-bed academic medical center in Southern California, the diabetes-related readmission rate was 13.3%, compared with 11.4% among patients without diabetes. This project aimed to develop an evidence-based Transition-to-Home (TTH) guideline for hospitalized patients with diabetes and evaluate the strength of its recommendations through multidisciplinary stakeholder review.

Methods: An evidence-based guideline development project was conducted over 8 weeks. A comprehensive literature search in CINAHL, MEDLINE, PubMed, and ScienceDirect identified current evidence on transitional …

Family- And Cultural-Level Influences For Latine Adolescent Nicotine Use: A Qualitative Study Informing Prevention, Cindy M. Hernandez Castro

Theses and Dissertations

Early tobacco use among Latine adolescents represents a critical public health concern, with 23.8% reporting current use and exceeding rates among other racial/ethnic groups (Birdsey et al., 2023; Gaddy et al., 2022). This early initiation elevates risks for nicotine dependence and related morbidity in adulthood (Tsao et al., 2023). Guided by Structural Ecosystems Theory (Szapocznik & Coatsworth, 1999) and contemporary grounded theory analysis (Braun & Clarke, 2006; Charmaz, 2006; Noble & Mitchell, 2016), this study examined multilevel influences on nicotine-related attitudes among Latine youth, including: (1) familial factors (i.e., parental monitoring, caregiver-youth communication), (2) cultural dynamics (i.e., cultural values and …