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Implementation Of Psychiatric Collaborative Care Management In Rural Primary Care Practices, Ryan Dean Kruis

MUSC Theses and Dissertations

Behavioral health (BH) disorders are highly prevalent in the United States and especially concerning in rural communities which disproportionately lack access to BH services. While models for integrating BH into primary care, such as psychiatric collaborative care management (CoCM), have shown promise in mitigating the BH crisis, implementation in rural communities has proved challenging.
This dissertation examines implementation of CoCM nationally and in rural settings through three distinct aims. First, a claims-based retrospective cohort study was used to determine whether commercially insured patients receiving CoCM had lower acute BH care utilization and cost as compared to similar patients not receiving …

A Population Health Approach To Workplace Mental Health: Rationale, Implementation And Engagement, Kaylee T. Woodard, Allison M. Bailey, Aaron I. Esagoff, Maren S. Fragala, Joanna I. Hayward, Jennifer L. Hunter, Yea Jen Hsu, Paul M. Kim, Matthew E. Peters, Susan M. Carr

School of Medicine Faculty Publications

Objectives: To describe a population health-based program to support employee and dependent mental health and learn from engagement trends. Methods: Retrospective analysis of a program utilizing an assessment of mental health risk. For scoring “at risk,” a Care Concierge is offered to connect users with resources. Results: Participation was offered to 56,442 employees and dependents. Eight thousand seven hundred thirty-one completed the assessment (15%). Of those, 4,644 (53%) scored moderate or higher. A total of 418 (9%) engaged the Care Concierge. Factors that negatively influenced the decision to engage care included bodily pain, financial concerns. Positive influences were younger age, …

Family Medicine’S Role In Addressing The Intersections Of Redlining And Climate Change, Daryl O. Traylor, Eboni E. Anderson, Brianna Clark, Alex M. Smith, Cooper K. Allenbrand

Journal of Sustainable Social Impact

Redlining, the practice of discriminating against specific neighborhoods based on race and socioeconomic status, leads to persistent environmental hazards and socioeconomic inequalities that have lasting adverse health effects on their populations. Health disparities are further exacerbated through the concentration of environmental hazards, as well as the escalating impact of climate change, which poses an increased risk of respiratory illness, cardiovascular disease, mental health issues, heat-related illness, infectious diseases, food insecurity, and socioeconomic difficulties in redline neighborhoods.

This paper examines the interplay of redlining, climate change, and health disparities, with an emphasis on the enduring consequences for these marginalized communities. Through …

Reducing Sexually Transmitted Infection In African American Teenage Adolescents: Developing A Culturally Competent Health Program For Underserved Communities, Brandolyn I. Burks

Doctoral Dissertations and Projects

Proper education and programming can help reduce Sexually transmitted infections (STIs) among adolescents. This research aimed to help lay the framework for determining ways to ensure African American young adult adolescents aged 18–19 years have the necessary information and resources to make healthy decisions regarding their sex lives and experiences. The purpose of this grounded theory study was to understand what lived experiences and gaps of knowledge contribute to the contracting of STIs to develop a culturally competent health program to reduce the high rate of infections among African American 18–19-year-old adolescents living in underserved communities. The theory guiding this …

Exploring The Experience Of Healthcare-Related Epistemic Injustice Among People With Myalgic Encephalomyelitis / Chronic Fatigue Syndrome, Joanne Hunt, Jessica Runacres, Daniel Herron, David Sheffield

The Qualitative Report

Myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) is a chronic, disabling yet clinically “contested” condition, previously theorised through a lens of epistemic injustice. Phenomena conceptually close to epistemic injustice, including stigma, are known to have deleterious consequences on a person’s health and life-world. Yet, no known primary studies have explored how people with ME/CFS experience healthcare through a lens of epistemic injustice, whilst a dearth of research explicitly exploring healthcare-related injustice from a patient perspective has been noted. This qualitative study seeks to address this gap. Semi-structured interviews and interpretative phenomenological analysis (IPA) were used to explore the experiences of …

Lai Antipsychotics Vs. Oral Antipsychotics: Treatment Adherence, Relapses, And Readmissions, Natalie N. Lewis Bsn, Rn, Mallory F. Johnson Bsn, Rn-Bc, Tyler N. Halle-Todd Bsn, Rn, Natalie N. Ragland Bsn, Rn, Sharon H. Little Dnp, Aprn, Fnp-Bc, Jacqueline Sharp Dnp, Aprn,Pmhnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Schizophrenia is a lifelong illness with recurrent and often debilitating symptoms that may impair daily functioning, cognition, behaviors, socialization, emotions, and expression. It is recognized as a global mental health burden that affects the individual, their family, and society. Medication nonadherence and resulting relapse detrimentally affect the patient’s physical and mental health and quality of life. They are associated with increased hospitalization and emergency room visits, substance use, suicide, and homelessness. Current guidelines endorse second-generation antipsychotics such as Risperidone and Aripiprazole as the first-line treatment for most cases of psychosis. However, long-acting injectable (LAIs) atypical antipsychotics are a promising …

Playing It Sun Safe: A Quality Improvement Project, Sarah P. Tarr, Kathryn K. Dambrino, R. David Phillippi, Ashley Karpinos

DNP Projects

Background: Athletes who play outdoor sports have multiple risk factors for the development of skin cancer. Literature highlights the need for the use of evidence-based strategies to improve the knowledge and utilization of sun protection practices in this high-risk population. Methods: Playing it Sun Safe was a multifaceted skin cancer prevention initiative implemented in a population of collegiate soccer athletes in collaboration with a university athletic department and campus health clinic. Evidence-based interventions were designed through application of the Health Belief Model (HBM) and were implemented using the Institute for Healthcare Improvement (IHI) quality improvement framework. Purpose: The two-fold aim …

Identifying Multilevel Predictors Of Behavioral Outcomes Like Park Use: A Comparison Of Conditional And Marginal Modeling Approaches, Marilyn E. Wende, S. Morgan Hughey, Alexander C. Mclain, Shirelle Hallum, J. Aaron Hipp, Jasper Schipperijn, Ellen W. Stowe, Andrew T. Kaczynski Ph.D.

Faculty Publications

This study compared marginal and conditional modeling approaches for identifying individual, park and neighborhood park use predictors. Data were derived from the ParkIndex study, which occurred in 128 block groups in Brooklyn (New York), Seattle (Washington), Raleigh (North Carolina), and Greenville (South Carolina). Survey respondents (n = 320) indicated parks within one half-mile of their block group used within the past month. Parks (n = 263) were audited using the Community Park Audit Tool. Measures were collected at the individual (park visitation, physical activity, sociodemographic characteristics), park (distance, quality, size), and block group (park count, population density, age structure, racial …

Adolescent Perceptions Of Weighted Blankets And Quality Of Sleep: A Mixed Method Design, Tara D. S. Summers

The Open Journal of Occupational Therapy

Background: The purpose of this mixed methods case study was to describe the perceived sleep quality experience of an adolescent, without a pre-identified sleep need, when they used a weighted blanket during sleep.

Method: Adolescents (n = 5) 11 to 16 years of age completed a sleep diary for 7 days, sleeping with a self-selected weighted blanket for at least 3 days. A semi-structured individual interview was held after Day 7.

Results: The majority of the participants would like to continue using a weighted blanket for sleep. Eighty percent of the adolescents choose to sleep with a …

Longitudinal Regression Of Covariance Matrix Outcomes, Yi Zhao, Brian S Caffo, Xi Luo

Faculty, Staff and Student Publications

In this study, a longitudinal regression model for covariance matrix outcomes is introduced. The proposal considers a multilevel generalized linear model for regressing covariance matrices on (time-varying) predictors. This model simultaneously identifies covariate-associated components from covariance matrices, estimates regression coefficients, and captures the within-subject variation in the covariance matrices. Optimal estimators are proposed for both low-dimensional and high-dimensional cases by maximizing the (approximated) hierarchical-likelihood function. These estimators are proved to be asymptotically consistent, where the proposed covariance matrix estimator is the most efficient under the low-dimensional case and achieves the uniformly minimum quadratic loss among all linear combinations of the …

Effects Of Family Dignity Interventions Combined With Standard Palliative Care On Family Adaptability, Cohesion, And Anticipatory Grief In Adult Advanced Cancer Survivors And Their Family Caregivers: A Randomized Controlled Trial, Nannan Wang, Kun Wang, Xinyu Lu, Shuyu Zhang, Xuhan Sun, Yuxi Zhang

Faculty, Staff and Student Publications

BACKGROUND: Family involvement and comfort are equally important in palliative care. Dignity undertook a new meaning and novel challenges as a result of restrictions on visits and companionship during the pandemic. Family-centered family dignity interventions have been shown to be effective in increasing patients' sense of dignity, increasing levels of hope, and reducing psychological distress; however, the effectiveness in enhancing family adaptability and intimacy in the survivor-caregiver binary and reducing expected grief have been inconclusive.

OBJECTIVES: The primary objective of this study was to assess the efficacy of family dignity interventions on family adaptability and cohesion. The secondary objective was …

Relationship Between Knowledge, Years Of Licensure, And Attitudes Of Midwives About Female Genital Mutilation And Its Prevalence Among Their Patients In Bawku, Ghana, Frank Debrah

Walden Dissertations and Doctoral Studies

Female genital mutilation (FGM) is one of the hindrances to girls' development. FGM is often a rite of passage between childhood and adulthood. This cross-sectional study examined the relationship between the knowledge, years of licensure, and attitudes of midwives regarding FGM and the prevalence of FGM among their patients in Bawku, Ghana. Bronfenbrenner's social ecological model served as the theoretical framework to describe the link between midwives' knowledge, attitude, years of licensure, and FGM prevalence. The knowledge and attitude of midwives were classified as exosystem factors. Hence, their direct interaction with patients is likely to affect the patient's practice of …

Implementation Of A Standardized Suicide Screening Process In A University Student Health Clinic: A Quality Improvement Project, Addie Grace Strong, Kathryn Dambrino, R. David Phillippi, Linda Wofford

DNP Projects

Background: Suicide is a leading cause of death among college age students, prompting the need for evidence-based screening tools like the Columbia Suicide Severity Rating Scale (C-SSRS) to enable early detection and timely intervention. Inconsistencies in suicide screening may pose a risk of missed intervention opportunities. This Doctor of Nursing Practice project specifically aimed to improve the quality and consistency of suicide screening in a university student health clinic by implementing the C-SSRS tool into the clinic workflow during mental health appointments. Methods: Employing a quality improvement framework, this scholarly project followed the Institute for Healthcare Improvement Model for Improvement …

Perceptions Of Patient-Healthcare Provider Relationships In The Management Of Type 2 Diabetes, Desiree D. Lacey

Walden Dissertations and Doctoral Studies

The patient-healthcare provider relationship (PPR) is the foundation of clinical care: it is established as a human relationship and has a profound effect on health outcomes. Though PPR has been studied in multiple health domains, there is very little on its role in managing Type 2 diabetes mellitus (T2DM). The purpose of this phenomenological qualitative research study was to better understand the challenges faced by healthcare providers (HCP) and T2DM patients within the clinical PPR for diabetes selfmanagement. The health belief model served as the theoretical framework and the diabetes self-management education program as the conceptual framework. Participants were recruited …

Childhood Cancer Survivorship: Navigating A New Normal In Middle Tennessee, Karli M. Beaumont

OTD Capstone Projects

Monroe Carell Jr. Children’s Hospital at Vanderbilt in partnership with Vanderbilt-Ingram Cancer Center offers REACH for Cancer Survivorship, a pediatric cancer survivorship clinic. REACH provides a full range of follow-up care designed to meet the physical, emotional, and practical needs of survivors and continuous surveillance of deleterious effects of cancer and its treatments. The purpose of this project was to meet population and agency needs through research of long- and late-term sequela while advocating for occupational therapy’s role in the oncology population through the proactive therapy and prospective surveillance models. The process of creating this project included synthesizing the literature, …

Latent Classification Of Multi-Model Non-Homogeneous Continuous-Time Markov Chains, Joonha Chang

Dissertations and Theses (Open Access)

The continuous-time Markov chain (CTMC) model and latent clustering models are commonly used to study longitudinal measures of categorical outcomes. Because of its simple but powerful Markovian property, CTMC models have been widely used in medical and public health researches. Due to limitations in the standard CTMC model, there have been some studies on non-homogeneous continuous-time Markov chain (NH-CTMC) that utilized time-dependent rates, but the progresses have been limited. NH-CTMC can be more powerful than CTMC by its default nature of time-dependent rate that can be fitted to a wider range of applications in medical studies. In this study, we …

Prevalence And Severity Of Adhd Among Children With Second-Hand Smoke Exposure – A Us Population-Based Study, Saral R. Desai, Edward Lin

Tower Health Research Day

No abstract provided.

Perceptions Of Dengue Risk And Acceptability Of A Dengue Vaccine In Residents Of Puerto Rico, Coral Rosado-Santiago, Carmen L. Pérez-Guerra, Nicole M. Velez-Agosto, Claudia Colón-Burgos, Karla M. Marrero-Santos, Susanna K. Partridge, Amy E. Lockwood, Cathy Young, Steve H. Waterman, Gabriela Paz-Bailey

Psychological Science Faculty Publications

Dengvaxia is the first dengue vaccine recommended in the United States (U.S.). It is recommended for children aged 9–16 y with laboratory-confirmed previous dengue infection and living in areas where dengue is endemic. We conducted focus groups with parents and in-depth interviews with key informants (i.e. practicing pediatricians, physicians from immunization clinics, university researchers, and school officials) in Puerto Rico (P.R.) to examine acceptability, barriers, and motivators to vaccinate with Dengvaxia. We also carried out informal meetings and semi-structured interviews to evaluate key messages and educational materials with pediatricians and parents. Barriers to vaccination included lack of information, distrust toward …

Patient Characteristics Of, And Remedial Interventions For, Complaints And Medico-Legal Claims Against Doctors: A Rapid Review Of The Literature, Timothy J Schultz, Michael Zhou, Jodi Gray, Jackie Roseleur, Richard Clark, Dylan A Mordaunt, Peter D Hibbert, Georgie Haysom, Michael Wright

Faculty, Staff and Student Publications

BACKGROUND: It is uncertain if patient's characteristics are associated with complaints and claims against doctors. Additionally, evidence for the effectiveness of remedial interventions on rates of complaints and claims against doctors has not been synthesised.

METHODS: We conducted a rapid review of recent literature to answer: Question 1 "What are the common characteristics and circumstances of patients who are most likely to complain or bring a claim about the care they have received from a doctor?" and Question 2 "What initiatives or interventions have been shown to be effective at reducing complaints and claims about the care patients have received …

Decreasing Influenza Vaccination Disparity Rates By Utilization Of Hotspot Deployments Of A Mobile Health Vehicle, Geneveve Deasis Tejada

Student Scholarly Projects

Practice Problem: Influenza vaccination for Black/African American patients is historically lower than White patients across all healthcare organizations (Quinn, 2018). In the organization’s 2022 performance, only 13.98% of Black/African American patients ages 19 and older were vaccinated compared to 27.81% of White/Caucasian patients.

PICOT: The PICOT question that guided this project was for Black/African American patients ages 19 and older receiving care from primary care clinics in Southeast San Diego (P), what is the impact of adding access to influenza vaccinations through hotspot-driven MHV deployments (I) compared to usual vaccination delivery in the medical office building (MOB) (C) on influenza …

Unlv Mental Health Initiatives: Unifying Through Innovation And Collaboration, The Lincy Institute, Unlv Practice, Behere Nv, Unlv Department Of Psychology

Lincy Institute Events

Nevada persistently ranks at or near the bottom in the country for overall access to mental health services despite the need (Mental Health America, 2015-2023). UNLV faculty are developing initiatives to change this unacceptable situation. The Lincy Institute, in partnership with UNLV PRACTICE, BeHERE Nevada, and researchers from the Department of Psychology, offered a community forum showcasing three mental health initiatives harnessing faculty collaboration and innovation to drive overdue changes in Nevada’s mental-health landscape. Following the presentations policymakers engaged in open discussion with UNLV presenters and the audience. The three main initiatives showcased in this forum …

Predictors Of Prep Uptake By Black Gay And Bisexual Men In Ohio, Ade Elisha

Walden Dissertations and Doctoral Studies

No abstract provided.

Risk And Preventive Factors Of Asthma In Children In Texas, Yvonne A. Deen

Walden Dissertations and Doctoral Studies

No abstract provided.

Role Of Pregnancy Intention And Substance Use In Postpartum Depression Among Black Women, Asaye Birhanu Mekonnen

Walden Dissertations and Doctoral Studies

No abstract provided.

Gender Affirming Surgery And Pain In Adolescents: Teen And Parent Experiences, Corrin Murphy, Eleanor Battison, University Of Rhode Island, Anna Wilson Phd

OHSU-PSU School of Public Health Annual Conference

Background: Adolescents seeking gender affirming medical care face unique biopsychosocial challenges, including experiences of discrimination and stigma. Transgender and gender diverse (TGD) adolescents often undergo gender affirming surgery (GAS). While there is an increase in GAS for TGD adolescents in the U.S., little is known about the pain experiences in the post-surgical period among these youth. There have been no studies to our knowledge that examine the psychological functioning of parents and their ability to handle their child's distress, which may be affected by their child's post-GAS pain experiences. Parental responses to their children’s pain and distress may, in turn, …

Impact Of Two Shift Schedules On Post-Shift Blood Pressure In Firefighters, Ayeisha H. Haswarey

OHSU-PSU School of Public Health Annual Conference

Background: Firefighters have an increased risk of cardiometabolic disease compared to the general population. Blunted blood pressure (BP) dipping during nocturnal sleep is associated with increased cardiometabolic disease morbidity/mortality. Shift work can alter diurnal BP oscillation, but the extent of alteration by different schedules remains debated. No study to date has examined firefighting shift schedules, necessitating a longitudinal evaluation to begin to understand their implications for cardiometabolic health. Thus, this preliminary analysis compares how two common schedules (24/48 hours on/off vs. 1/3/2/3 days on/off) impact post-shift BP and dipping in 20 firefighters.

Methods: 20 participants (10% female; 25-54 years of …

Exploring Decolonial And Indigenous Mental Health Framework And Practice To Address Complex Trauma Among Palestinian Youth Living Under Violence Of Settler-Colonialism, Vivian L. Duong, Corrin Murphy

OHSU-PSU School of Public Health Annual Conference

The growing settler colonial project of Israel forced indigenous Palestinians to flee from their homeland to further the Zionist movement of establishing a Jewish-majority state. The forced dispossession and displacement of Palestinians at this time was referred to as the Nakba, or catastrophe (Masalha, 2002). From 1947 and 1949, approximately 750,000 Palestinians from a population of 1.9 million were made refugees (Al Jazeera, 2017). Also referred to as the ethnic cleansing of Palestine, Zionists forcibly took over 78 percent of Palestine, destroyed about 530 villages and cities, and killed around 15,000 Palestinians including more than 70 massacres (Al Jazeera, 2017). …

Inequities In Chronic Stress Exposure At The Intersection Of Race, Gender, And Sexual Identity In A Nationally Representative Sample Of U.S. Adults, Jordan M. Lancaster, Efrain H. Chavez Martinez

OHSU-PSU School of Public Health Annual Conference

Background

Social inequity rooted in systemic oppression is robustly associated with mental and physical health; chronic stress is highlighted as a key mechanism. Limited research examining the association between sexual identity alone and C-reactive protein (CRP) – an upstream biological marker of chronic stress exposure – has yielded mixed results.

Purpose

To examine whether race/ethnicity, gender, and sexual identity interact to produce unequal levels of CRP.

Methods

Using cross-sectional data from the 2003-2010 waves of the National Health and Nutrition Examination Survey, we examined intersectional (self-reported race*gender*sexual identity) patterns in log-transformed CRP levels using a multivariable linear model among 10,885 …

The Association Between Acculturation & C-Reactive Protein In U.S. Immigrants: A Cross-Sectional Study, Jessica Kilinski Bs, Rosol Mikail Bs, Kelly M. Reavis Phd, Mph, Deborah Karasek Phd, Mph

OHSU-PSU School of Public Health Annual Conference

Purpose: Immigrants undergo acculturation as they assimilate to a different culture, potentially leading to immense stress. Our objective was to examine the association between acculturation and C-reactive protein (CRP), a marker of stress-induced inflammation. We hypothesized that U.S. foreign-born adults 20 years and older with higher degrees of acculturation would have higher CRP levels compared to those with lower acculturation.

Method: We used 2017-2018 National Health and Nutrition Examination Survey (NHANES) data from 1526 participants to conduct a cross-sectional analysis. We measured acculturation as language spoken at home (categorized as low, moderate, and high) and examined its association with CRP …

Impact Of Preexisting Hypertension And Demographic Factors On Pandemic-Era Anxiety Using The Coronavirus Anxiety Scale, Chukwuemeka Ogbonnaya Okpom

Walden Dissertations and Doctoral Studies

No abstract provided.