Digital Commons Network^™

One Health Integration To Control And Prevent Zoonoses: Application Of Organizational Theory Literature, Lisset M. Dumet Poma, Sherril Gelmon, Julia M. Goodman, Seth E. O’Neal

Hatfield Graduate Journal of Public Affairs

Zoonoses are infectious diseases transmitted between animals and people that disproportionately affect low- and middle-income countries (LMICs). The One Health (OH) approach aims to integrate systems, incentivizing collaboration among animal, human, and environmental systems to address zoonoses and improve health. Innovative solutions for effectively and sustainably achieving systems integration are needed. Organizational theories can facilitate the study of the context of OH implementation, applying comprehensive approaches that recognize the interconnections among organisms, the environment, and social systems, including the diverse entities needing integration (e.g., policy, community, public organizations). This narrative review examines organization and systems literature to provide recommendations for …

Pluriversal Energy Justice Through An Intersectional Feminist Lens: Analyzing Rural Electrification Injustices And Policy Pathways At Kenya's Garissa Solar Park, Carolyne M. Musyoka

Dartmouth College Master’s Theses

Located approximately 4 km from Raya village in Garissa County, the Garissa Solar Park spans

85 hectares and was envisioned as a flagship renewable energy project. Yet, despite its scale and proximity, the marginalized pastoralist community of Raya continues to face acute energy poverty, limited irrigation capacity, and exclusion from the material and socio-ecological benefits of the green energy project. This study critically examines the systemic energy injustices embedded within the Garissa Solar Park—specifically procedural, distributive, and recognition-based inequalities—and critiques the project’s failure to deliver on principles of equity, local meaningful and democratic participation, and gender inclusion.

The research assesses …

Developing Indicators For Comprehensive Evaluation Of Equity In Transportation Systems, Ruqaya Emad Alfaris

Theses and Dissertations

Achieving transportation equity is essential for social inclusion, access to opportunities, and reducing disparities. However, traditional evaluation methods are often fragmented and fail to capture equity’s multidimensional nature. This dissertation develops a comprehensive framework for creating indicators to evaluate transportation equity effectively. It begins with a literature review to comprehend the theoretical background, followed by expert interviews highlight gaps in current evaluation practices. Statistical modeling and machine learning analysis was conducted to first explore indicators’ impact on transportation equity, and then investigate transportation safety disparities in underserved communities. Findings from literature review, interview with professionals, and analysis results are used …

The Adoption And Implementation Of Lean And Six Sigma In State Governments And Its Impact On Efficiency, Effectiveness, And Equity, Jin Hong Kim

All Faculty Scholarship

This research explores the contextualized use of Lean and Six Sigma (LSS) practices in the state governments in the United States. It analyzes LSS’s capacity to innovate public service administration to improve efficiency, effectiveness, and equity in government.
This study employed the Grounded Theory Method to analyze 2,048 LSS project reports from 32 state governments between 2003 and 2024, aiming to identify systematic patterns in the adjustment and application of LSS within state service administration and its outcomes.
Thirty-two states applied LSS across 24 service areas, adapting it in five ways: strategic programming, production efficiency, customer focus, internal accountability, and …

The Employment Situation Of Veterans: May 2025, Institute For Veterans And Military Families At Syracuse University

Institute for Veterans and Military Families

In May 2025, U.S. employment grew by 139,000, with gains in health care, leisure, and social assistance, while the unemployment rate held steady at 4.2%. Veteran unemployment rose slightly overall, with notable increases among younger and mid-aged veterans, while female veterans and Black veterans saw improvements; trends continued to vary across demographic groups.

Self-Collection For Cervical Cancer Screening In A Safety-Net Setting: The Prestis Randomized Clinical Trial, Jane R Montealegre, Susan G Hilsenbeck, Shaun Bulsara, Susan L Parker, Trisha L Amboree, Matthew L Anderson, Maria Daheri, Maria L Jibaja-Weiss, Kathleen M Schmeler, Ashish A Deshmukh, Elizabeth Y Chiao, Michael E Scheurer

Center for Medical Ethics and Health Policy Staff Publications

Importance: There are limited data on the effectiveness of mailed self-collection to increase cervical cancer screening (CCS) participation in underresourced health care settings.

Objective: To compare the effectiveness of mailed self-collection kits, with and without patient navigation, to telephone reminders to increase CCS in a safety-net health system.

Design, setting, and participants: This pragmatic, parallel, single-blinded, randomized clinical trial within a publicly funded safety-net health system in Houston, Texas, compared (1) telephone reminder (TR) for clinic-based screening, (2) TR with mailed self-collection (SC), and (3) TR with mailed SC and patient navigation among a random sample of CCS-eligible patients not …

Iep Process As An Avenue Or Barrier To Inclusion For Autism Spectrum Students: The Importance Of Collaboration, Stephanie C. Holmes

Tapestry: Journal of Research in Education

Decades of research concerning the implementation of Individual Education Plans (IEPs) have shown that building and implementing an IEP for a student with additional needs can be adversarial between the child’s parents and the school system. In 1975, when Public Law 94-142 was passed, the idea behind the law was not only to provide a free and appropriate public education (FAPE) for children with needs and disabilities but also to give parents of these children a voice in the process of creating the child’s IEP. Autism Spectrum Disorder (ASD) was not added to the list of needs to be served …

Understanding The Persistence And Retention Factors Among First-Generation Online College Students: A Comprehensive Study, Lakeeta Q. Prunty, Tana Palafox

Tapestry: Journal of Research in Education

This qualitative descriptive study examined the impact of internal institutional support on retention, as perceived by first-generation Black, Indigenous, and People of Color (BIPOC) online undergraduate students at a private Christian university. Institutional support encompasses academic advising, tutoring services, mental health counseling, career guidance, financial aid, diversity and inclusion programs, faculty support, and technological resources for online learning. The virtual learning environment presented unique challenges, particularly for first-generation BIPOC students, who navigate multiple layers of identity requiring specialized institutional support. Factors influencing online student attrition, including school policies, instructional methods, and personal circumstances, warrant collaboration among administrators, advisors, and faculty …

Agglomeration Economies In Social Economy Clusters: The Role Of Networks, Mina Kim

Dissertations and Theses

The social economy is an economic framework that prioritizes social value over profit, emphasizing cooperation, solidarity, and community-based solutions to the failures of neoliberal market systems. In East Asia, the development of the social economy is often government-led, raising concerns about resource dependency and the long-term sustainability of Social Economy Organizations (SEOs). This dissertation investigates how network structures and diversity within a policy-driven social innovation cluster shape SEO survival, and how agglomeration economies operate differently compared to conventional industrial clusters. The case of Seoul Innovation Park (SI Park) in South Korea provides the empirical basis for the analysis.

A mixed-methods …

United Through Reading: Longitudinal Evaluation 18-Month Findings, Erica M. Hawvermale, Cassidy J. Cooper, Bonnie Chapman Beers

Institute for Veterans and Military Families

This report details the findings from the first eighteen months of a longitudinal evaluation of United Through Reading's (UTR) programs and services across four outcome areas: 1) child literacy, 2) child wellbeing, 3) adult wellbeing, and 4) family connection.

The Startup Ecosystem In Southern Nevada: Growth, Energy, And Emerging Entrepreneurship In 2025, Len Jessup, Sean Curry

Policy Briefs and Reports

The startup ecosystem in Southern Nevada has undergone significant transformation during the past decade, evolving from a fragmented and nascent environment into a dynamic and increasingly coordinated landscape. This study examines the growth of the Southern Nevada startup ecosystem, analyzing key components such as funding sources, incubators, accelerators, and public-private collaborations. Utilizing both quantitative and qualitative data, including investment trends, economic impact reports, and interviews with over 100 stakeholders, this policy brief provides a comprehensive assessment of the strengths and gaps within the ecosystem. Key findings indicate that while the region has made substantial progress, particularly in fostering early-stage investments …

Prediction Of Methotrexate Neurotoxicity Using Clinical, Sociodemographic, And Area-Based Information In Children With Acute Lymphoblastic Leukemia, Rachel D Harris, Olga A Taylor, Maria Monica Gramatges, Amy E Hughes, Mark Zobeck, Sandi Pruitt, M Brooke Bernhardt, Ashley Chavana, Van Huynh, Kathleen Ludwig, Laura Klesse, Kenneth Heym, Timothy Griffin, Rodrigo Erana, Juan Carlos Bernini, Ashley Choi, Yuu Ohno, Melissa A Richard, Alanna C Morrison, Han Chen, Bing Yu, Philip J Lupo, Karen R Rabin, Michael E Scheurer, Austin L Brown

Center for Medical Ethics and Health Policy Staff Publications

Background: Methotrexate is a critical component of pediatric acute lymphoblastic leukemia (ALL) therapy that can result in neurotoxicity which has been associated with an increased risk of relapse. We leveraged machine learning to develop a neurotoxicity risk prediction model in a diverse cohort of children with ALL.

Methods: We included children (age 2-20 years) diagnosed with ALL (2005-2019) and treated in Texas without pre-existing neurologic disease. Clinical information was obtained by medical record review. Neurotoxicity occurring post-induction and prior to maintenance therapy was defined as neurologic episodes occurring within 21 days of methotrexate. Suspected cases were independently confirmed by 2 …

Women's Learning For Community Peacebuilding, Robin Neustater

Peace and Conflict Studies

Around the world, every day, women work on building peace in their communities. Through various roles, paid and unpaid, women’s community care work is significant to the lives of individuals, families, communities, and the women themselves. Understandings of peace are varied, and often nuanced to the context and experience of who is defining peace. How women define peace will inform how they think about peacebuilding. Women engage in learning about peace and for their peacebuilding work, through nonformal and formal programs, and through experience and role models. Their learning to do peace is vital to getting things done. This article …

‘You’ And ‘We’ In #Womanlifefreedom: A Corpus-Based Discourse Analysis Of Collective Identities And Speech Acts In The Twitter’S Discourse Of Iranian Protests, Kimiya Roohani

Peace and Conflict Studies

This paper applies corpus linguistic discourse analysis to approach the social media discourse of a recent political movement in Iran, known as #WomanLifeFreedom and Mahsa Amini. The movement included vast protests in different parts of Iran and went viral on an international scale. Protesters relied heavily on social media, particularly Twitter, to determine strategies and support each other during the expansive calls. To address the discourse shaped in that platform, a corpus was compiled from the Twitter posts, named Mahsa Amini Tweets Corpus (MATC). Using this data collection and analysis method, the endeavour was to obtain a balance between quantitative …

A Study Of The Management Of The Herders-Farmers Conflict-Induced Internal Displacement In Nigeria, Rita Iorbo, Dick Taverishima Andzenge

Peace and Conflict Studies

The management of the herdsmen-farmers conflict-induced internal displacement in Nigeria was characterised by remote factors that affected the protection and assistance of internally displaced persons (IDPs). This qualitative study was conducted on 12 participants comprising humanitarian workers, IDPs, and lawmakers who were conversant with the persistent herdsmen-farmers conflict-induced internal displacement. The study explored the inter-connected relationship among stakeholders within the humanitarian ecosystem. It found that though the herdsmen-farmers conflict led to mass displacement, remote factors such as unwillingness of government, data challenges, the undiplomatic approach of government in the management of the displacement failed to win support of other stakeholders …

Social Capital And Protests In The United States, Carolyn Chisadza, Matthew Clance, Rangan Gupta

Peace and Conflict Studies

In the last decade we have witnessed rising protests in the United States associated with issues that form part of society’s social fabric that can either facilitate or break down collective behaviour. Rising social inequalities can cause people to no longer share the same values and force individuals to work against each other. This breakdown in social capital can be a key driver for protests as the marginalised attempt to voice their grievances. Using social capital data from the Social Capital Project and protest data from the GDELT Project for U.S counties, we find that higher social capital is negatively …

The Effect Of Ex-Ante Government Responsibility For Health On Public Health Financing In Post Pandemic Budgets, Denis Granados, Rylee Roman, Hallie Sidman

Working Papers Series

This paper investigates how pre-pandemic levels of government responsibility for public health financing influenced post-pandemic health spending across selected OECD countries. Using a combination of descriptive analysis and regression modeling, the study examines changes in public health expenditure per capita between 2019 and 2022, focusing on key variables such as the government’s share of health financing, the Total Pandemic Policy Intensity (PPI) index, and GDP per capita. Findings suggest that while all countries increased health spending post-COVID-19, the scale of change varied significantly based on economic capacity, institutional readiness, and political will. Notably, countries with higher pre-pandemic public health investment …

Functional Resilience Of Healthcare In The Critical Juncture Of The Covid-19 Pandemic, Avner Kronisch, Christian Bongiorno, Kerane Smith, John Baker

Working Papers Series

This paper offers a comparative analysis of eight national healthcare systems—spanning democracies, autocracies, and various institutional models—to evaluate resilience during the COVID-19 pandemic. Drawing on Shvetsova et al.’s framework of informational and authority redundancies, and Parker & Klein’s “choke point” theory of healthcare rationing, we examine how institutional structure shaped pandemic response, system adaptability, and continuity of non-COVID services. Using indicators like life expectancy, under-five mortality, hospital capacity, cancer survival, and excess mortality, we explore how systems absorbed shock and maintained essential care. We find that decentralized and polycentric governance structures, when paired with coordination and resource adequacy, enhanced resilience—exemplified …

Covid-19 & Healthcare (Re)Privatization? A Comparative Analysis Of High And Medium Per Capita Gdp Countries, Kristina Donders, Kaitlyn Matthews, Brittany Reyes, Frank. H. Rizzo

Working Papers Series

This paper examines whether the COVID-19 pandemic accelerated healthcare privatization in high- and medium-GDP countries. Drawing on political economy theories of path dependence and privatization, we analyze changes in public and private healthcare expenditures in eight countries: Canada, Chile, Denmark, Georgia, Luxembourg, Norway, the Philippines, and South Korea—comparing data from 2019 and 2022. Using World Bank indicators on healthcare financing, GDP, aging populations, and food insecurity, we find that although healthcare expenditures generally increased during the pandemic, this increase was primarily in public, not private, spending. Case studies of Georgia and South Korea reveal that local economic and demographic pressures, …

Xbp1s-Edem2 Prevents The Onset And Development Of Hfpef By Ameliorating Cardiac Lipotoxicity, Oveena Fonseka, Rida Raja, Claire Ross, Sanskruti R Gare, Jiayan Zhang, Susanne S Hille, Katharine King, Andrea Ruiz-Velasco, Namrita Kaur, Xinyi Chen, Jessica M Miller, Riham R E Abouleisa, Qinghui Ou, Zhiyong Zou, Xiangjun Zhao, Cristian Sotomayor-Flores, Derk Frank, Eileithyia Swanton, Martin R Pool, Sara Missaglia, Daniela Tavian, Gabriele G Schiattarella, Tao Wang, Luigi Venetucci, Christian Pinali, Martin K Rutter, Bernard D Keavney, Elizabeth J Cartwright, Tamer M A Mohamed, Oliver J Müller, Wei Liu

Center for Medical Ethics and Health Policy Staff Publications

Background: Morbidity and mortality of heart failure with preserved ejection fraction (HFpEF) is increased in metabolic disorders. However, options for preventing and treating these prevalent outcomes are limited. Intramyocardial lipotoxicity contributes to cardiac dysfunction. Here, we investigate the mechanisms underlying EDEM2 (endoplasmic reticulum degradation-enhancing alpha-mannosidase-like protein 2) regulation of cardiac lipid homeostasis and assess strategies that inhibit the incidence and progression of HFpEF.

Methods: Metabolic stress was induced in C57BL/6 male mice using a high-fat diet and Nω-nitro-L-arginine methyl ester. The recombinant adeno-associated virus 9 delivery system was used for loss- and gain-of-function studies. Palmitic acid and oleic acid …

Maternal Loss Of Mouse Nlrp2 Alters The Transcriptome And Dna Methylome In Gv Oocytes And Impairs Zygotic Genome Activation In Embryos, Zahra Anvar, Michael D Jochum, Imen Chakchouk, Momal Sharif, Hannah Demond, Alvin K To, Daniel C Kraushaar, Ying-Wooi Wan, Michael C Mari, Simon Andrews, Gavin Kelsey, Ignatia B Van Den Veyver

Center for Medical Ethics and Health Policy Staff Publications

Background: NLRP2 is a subcortical maternal complex (SCMC) protein of mammalian oocytes and preimplantation embryos. SCMC proteins are encoded by maternal effect genes and play a pivotal role in the maternal-to-zygotic transition (MZT), early embryogenesis, and epigenetic (re)programming. Maternal inactivation of genes encoding SCMC proteins has been linked to infertility and subfertility in mice and humans, but the underlying molecular mechanisms for the diverse functions of SCMC proteins, and specifically the role of NLRP2, are incompletely understood.

Results: We profiled the DNA methylome of pre-ovulatory germinal-vesicle (GV) oocytes from Nlrp2-null, heterozygous (Het), and wild-type (WT) female mice and assessed the …

A Novel Cardiomyopathy Phenotype Linked To A Chd7 Missense Variant, In Young Park, Chih-Wei Hsu, Karim Bouazoune, Christina E Espindola, Madeline Hannah Mclaughlin Armond, Cristian Coarfa, Sandra L Grimm, James F Martin, Donna M Martin, Cheryl Lyn Walker

Center for Medical Ethics and Health Policy Staff Publications

Loss of function in the chromatin remodeler CHD7 causes CHARGE syndrome, characterized by variable penetrance and diverse abnormalities. However, establishing genotype-phenotype correlations has been challenging, as most CHD7 inactivating mutations are null alleles. Through CHD7 missense variant analysis at potential phosphorylation sites, we identified T730 (T720 in mice) as a critical residue associated with pathogenesis. Using a CHD7 T730 missense variant (Chd7T720A) and a frameshift null allele (Chd7fs) in a mouse model, we found that Chd7fs/fs mice were non-viable, while Chd7fs/+ mice exhibited haploinsufficiency-related circling behavior. Notably, Chd7fs/T720A mice died before postnatal …

How Far-Right Populism Harms Ethnic Minorities’ Health: The Case Of The United States, Dina Rosenberg

Working Papers Series

Public health is a political issue, and the health of ethnic minorities is a key component of it. We argue that far-right populism, whether grassroots or elitist, harms the health of immigrants and minorities. Anti-minority attitudes and policies—such as health chauvinism promoted by far-right populists—along with hate rhetoric and ensuing personal and institutional discrimination create a climate of hostility that negatively affects health outcomes in underprivileged communities. We hypothesize that immigrants and ethnic minorities living in such a climate are more likely to experience health problems and underutilize healthcare. To test this, we leverage the significant variation between U.S. states …

Is Ride-Hailing A Potential Solution For Older Adults After Driving Cessation? The Role Of Objective And Perceived Accessibility, Minju Kim Song

Dissertations and Theses

Due to age-related physical and cognitive changes, older drivers have a greater risk of crashes and are restricted by age-dependent regulation. Nonetheless, many older adults in the United States maintain a car-dependent lifestyle and still prefer driving. When driving cessation or reduction becomes necessary, a primary concern is finding suitable alternative transportation modes. However, the availability of alternative transportation modes does not guarantee their actual use of these options.

As a relatively new transportation mode, ride-hailing services, such as Uber and Lyft, offer on-demand, door-to-door transportation and may be a feasible transportation solution for older adults who stop driving. While …

Ocular Phenotyping Of Knockout Mice Identifies Genes Associated With Late Adult Retinal Phenotypes, Abraham Hang, Andy Shao, Michael Shea, Michel J Roux, Denise M Imai-Leonard, David J Adams, Takanori Amano, Oana V Amarie, Zorana Berberovic, Raphaël Bour, Lynette Bower, Brian C Leonard, Steve D Brown, Soo Young Cho, Sharon Clementson-Mobbs, Abigail J D'Souza, Mary Dickinson, Mohammad Eskandarian, Ann M Flenniken, Helmut Fuchs, Valerie Gailus-Durner, Jason Heaney, Yann Hérault, Martin Hrabe De Angelis, Chih-Wei Hsu, Shundan Jin, Russell Joynson, Yeon Kyung Kang, Haerim Kim, Hiroshi Masuya, Ki-Hoan Nam, Hyuna Noh, Lauryl M J Nutter, Marcela Palkova, Jan Prochazka, Miles Joseph Raishbrook, Fabrice Riet, Jason Salazar, John Richard Seavitt, Radislav Sedlacek, Mohammed Selloum, Kyoung Yul Seo, Je Kyung Seong, Hae-Sol Shin, Toshihiko Shiroishi, Tania Sorg, Michelle Stewart, Masaru Tamura, Heather Tolentino, Uchechukwu Udensi, Sara Wells, Wolfgang Wurst, Atsushi Yoshiki, Hamid Meziane, Glenn Yiu, Paul A Sieving, Louise Lanoue, K C Kent Lloyd, Colin Mckerlie, Ala Moshiri, International Mouse Phenotyping Consortium (Impc)

Center for Medical Ethics and Health Policy Staff Publications

Purpose: Analyze phenotypic data from knockout mice with late-adult retinal pathologic phenotypes to identify genes associated with development of adult-onset retinal diseases.

Methods: The International Mouse Phenotyping Consortium (IMPC) database was queried for genes associated with abnormal retinal phenotypes in the late-adult knockout mouse pipeline (49-80 weeks postnatal age). We identified human orthologs and performed protein-protein analysis and biological pathways analysis with known inherited retinal disease (IRD) and age-related macular degeneration (AMD) genes using Search Tool for the Retrieval of Interacting Genes/Proteins (STRING), PLatform for Analysis of single cell Eye in a Disk (PLAE), Protein Analysis Through Evolutionary Relationships (PANTHER), …

United Seas For Resilient Reefs: A Blueprint For Coral Conservation Through International Cooperation, John J. Bohorquez, Maoz Fine, Dana I. Grieco, David A. Gill, Ali Al-Swalimih, Jacqueline Padilla-Gamino, Isaiah W. Bolden, Margaux Hein, Callum Backstrom, Melanie Mcfield, Raphael Martinez, Benjamin Midberry, Fahd Al-Guthmy, Ellen K. Pikitch, Natalia Benejam, Chen Azulay, Britt Ronen, Oren Levy, Anne Mcelroy, Karine Kleinhaus

School of Marine & Atmospheric Sciences Faculty Publications

Coral reefs are one of Earth’s most vital and threatened ecosystems. They protect coastlines, generate billions of dollars of tourism revenue, support valuable fisheries, and contribute to the development of vital medicines. Yet half of the world's coral reefs have been lost in the last 50 years, and 90% of remaining reefs are projected to die off by the middle of this century, mainly due to warming seas from climate change.

Despite these challenges there is reason for hope. Some coral reefs – such as in the northern Red Sea and Gulf of Aqaba – have demonstrated remarkable resilience to …

An Assessment Of Maine's Capacity To Support Transitions Of Care Through The Substance Use Disorder Continuum, Mary Lindsey Smith Phd, Sarah Mclaughlin Mph, Rachel M. Gallo Mph

Substance Use Research & Evaluation

This report evaluates Maine's capacity to support effective transitions of care across the substance use disorder (SUD) treatment continuum. Using data collected from a statewide survey of 65 SUD providers, conducted from February to April 2025, the study examines organizational practices, inter-provider communication, and coordination strategies related to transitions between levels of care: medically supervised withdrawal, inpatient, and outpatient treatment programs. Key findings reveal strong intra-organizational communication, widespread understanding of ASAM criteria, and a general commitment to patient-centered care. However, gaps persist in coordination between care levels, particularly in withdrawal management programs, which rarely conduct follow-ups or collaborate with outpatient …

Resilience Of Women Entrepreneurs In Mindanao And The Impact Of Access To Finance And Digital Technologies, World Bank, Ateneo Center For Social Entrepreneurship, Social Enterprise Development Partnerships Inc.

Ateneo Center for Social Entrepreneurship (ACSEnt)

Executive Summary

This report examines the resilience of women nano- entrepreneurs in Mindanao and explores the impact of access to finance and digital technologies on their business sustainability. Utilizing data from the Social Enterprise Development Partnerships Inc. (SEDPI) and focus group discussions (FGDs), the study identifies key challenges and coping mechanisms employed by women-led nano- enterprises. The findings provide actionable insights for policymakers and microfinance institutions (MFIs) to design targeted interventions that strengthen the sustainability of these enterprises, particularly in the face of economic and environmental shocks. Women-led nano-enterprises in Mindanao typically operate informally, with assets ranging from PhP3,000 to …

Withdrawal Management In Maine: Capacity Challenges And Opportunities For Improvement, Mary Lindsey Smith Phd, Katie Rosingana Ba, Tyler Egeland Ba, Sarah Mclaughlin Mph

Substance Use Research & Evaluation

This summary report presents findings from healthcare provider interviews conducted in 2024 to assess the current landscape of withdrawal management (WM) services in Maine. Sixteen providers, across eight counties and representing a range of substance use disorder (SUD) service types, were interviewed to evaluate capacity, challenges, and opportunities for improvement across the continuum of care. Thematic analysis identified widespread gaps in withdrawal management capacity, especially in ASAM Levels 1.7 to 4.0, with critical shortages in ambulatory and low-intensity residential services. Key barriers included geographic inequities, insufficient infrastructure, long waitlists, inadequate reimbursement, and workforce shortages exacerbated by stigma and provider discomfort. …

Feedback On Withdrawal Management Services In Maine From Persons With Lived Experience, Mary Lindsey Smith Phd, Katie Rosingana Ba

Substance Use Research & Evaluation

This summary report presents findings from interviews with twelve persons with lived experience of substance use disorder (PWLE). The interviews asked persons in recovery about their experiences accessing withdrawal management and broader substance use treatment services across Maine. Participants identified key barriers to treatment including high costs, limited bed availability, long wait times, geographic inaccessibility, and lack of centralized information. Gaps in service infrastructure, particularly for opioid withdrawal management, long-term treatment, and transition supports post-detox, were widely reported. Participants emphasized the critical need for more localized and individualized services, particularly for parents, rural residents, and low-income individuals. Recommendations include expanding …