Trends Of Pediatric Psychotropic Polypharmacy In Massachusetts Before And During The Covid-19 Pandemic, Gianna D'Ambrozio

Graduate Doctoral Dissertations

Youth in the U.S. and internationally are increasingly being diagnosed with depression and related psychiatric conditions (Murthy, 2021) many of whom are being subjected to non-evidence-based, or what has been termed irrational, psychotropic polypharmacy (Barnett & Concepcion Zayas, 2019). Psychotropic polypharmacy can be defined as “the use of 2 or more psychiatric medications in the same patient,” (Zito et al., 2021) though definitions can vary. Using data from the Center for Health Information Analysis’ Massachusetts All-Payer Claims Database, this study examined the sociodemographic factors associated with high rates of polypharmacy, a hypothesized increase in pediatric psychotropic polypharmacy rates in Massachusetts …

Barriers To Mental Health Access Among Immigrant Populations In The U.S., Cecilia Menzinger

Capstones

No abstract provided.

Exploring Transgender And Gender Expansive Youth's Experiences With Vicarious Minority Stress, Erin T. Pereida

Graduate Doctoral Dissertations

In the United States (U.S.), transgender and gender expansive (TGE) youth experience elevated rates of depressive symptoms, self-harm behaviors, and suicidality compared to cisgender peers. Mental health professionals and researchers often use the gender minority stress model to explain these elevated rates, positing that stressors related to minority identity experienced above and beyond normative daily stress contribute to adverse mental health outcomes. One emerging component of the model requiring further investigation is vicarious minority stress; stress experienced indirectly through witnessing or learning of gender minority stressors affecting other TGD individuals or the community more broadly. The present study explored this …

Implementing Universal Adult Depression Screening In A Rural Maine Free Medical Clinic, Karen Hussion

Doctor of Nursing Practice Scholarly Projects

Abstract

BACKGROUND: Depression in adults is a leading cause of disability, morbidity and mortality worldwide with an estimated prevalence of 20% in the US population. Despite estimates that one out of every five Americans suffers from depression, less than 50% of adult primary care patients with depression are identified, and less than 5% of all adult primary care patients are screened. To increase early detection and management of depression, the United States Protective Service Task Force (USPSTF) recommends routine depression screening for adults older than 18 years in primary care settings.

LOCAL PROBLEM: This project site was a rural, free, …

Hack24f: Ai And Mental Health: Addressing The Therapy Gap, Samatrai Piam, Digvijay Mahawar, Meric Kinali, Luxman Surentha, Jackson Comeau, Gail Rauch, Cody Turner

Paul English Applied Artificial Intelligence (AI) Institute Publications

Real-World Problem: There is a global shortage of mental health professionals, especially in underserved areas. AI-based chatbots could help fill this gap, but there are serious ethical concerns about the quality of care and efficacy of such chatbots.

Solution: This is a non-technical project that involved conversing with existing chatbots in an effort to develop a normative framework that could be used by future AI therapy bot developers. This framework seeks to build on, and operationalize, some of the insights from the recently published whitepaper on the ethics of chatbot therapy by the UMass Boston Applied Ethics Center. This presentation …

Implementing Universal Depression Screening In A College Health Clinic, Marilyn J. Grabau

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: College students are at high risk for depression, and this carries a considerable burden. The American College Health Association supports depression screening on college campuses recognizing that early identification leads to better outcomes.

LOCAL PROBLEM: The project site is a public university located in New England. The college campus health center incorporates medical and counseling services. From August 2019 to December of 2019, 67% of students seen in the counseling center described depressed mood as the presenting concern. Currently there is no routine depression screening in place.

METHODS: This QI project implemented universal depression screening at the student health …

Determined Wellness: The Influence Of Mental Illness Models Upon Treatment Outcome Expectancies And Treatment Engagement, Francisco I. Surace

Graduate Doctoral Dissertations

Multiple campaigns geared towards reducing public and self-stigma associated with depression, and increasing help-seeking behaviors have been launched in the past two decades. There has been an increase in promoting psychoeducation on the biological bases of mental illness. Recent international studies have documented that this increase in public knowledge has not reduced stigma. Indeed, growing evidence suggests that biological models, in comparison to other causal models of mental illness, decrease people’s sense of self-efficacy and self-control, and decrease positive expectancies of treatments and prognosis–among those with and without mental illness. Individuals who have come in contact with health services, however, …

Finding Solutions To Institutional Corruption: Lessons From Cognitive Dissonance Theory, Lisa Cosgrove, Robert Whitaker

Counseling, School Psychology & Sport Faculty Publication Series

The American Psychiatric Association and academic psychiatry in the United States have two conflicts of interest that may affect their assessment of psychiatric drugs and their development of diagnostic and clinical care guidelines: payments from pharmaceutical companies and guild interests. Until recently, the proposed solution to industry-academic relationships has been transparency. However, cognitive dissonance research reveals that disclosure is not a solution because cognitive biases are commonplace and difficult to eradicate. Indeed, bias is most often manifest in subtle ways unbeknownst to the researcher or clinician, and thus is usually implicit and unintentional. Also, recent studies suggest that disclosure of …

Diagnostic Interaction: First-Person Patient Narratives On Hacking's Looping Effects And The Normative Status Of Psychiatric Nosology, Corinne Jager

Honors College Theses

What is the interaction between a psychiatric patient and their diagnosis? How do they respond to being classified? A number of philosophical theories attempt to explain the interaction between the diagnosed patient and their classification. Ian Hacking develops an account of interaction which holds that objects of human science classification are influenced by the awareness of the classification in a way that changes both the classification and its object. Hacking thinks that psychiatric patients are “interactive kinds” whose awareness of their classification causes changes in the individuals' experience of themselves, and thus changes in their classification. Hacking claims that these …

Data Note: People Served In Community Mental Health Programs And Employment, Stephanie Wallace, Frank A. Smith

Data Note Series, Institute for Community Inclusion

State mental health agencies provide a wide range of supports, including rehabilitation services and vocational and pre-vocational training, as well as supported and competitive employment supports. This Data Note explores how states vary in number and percentage of individuals who are employed among those served in Community Mental Health Programs (CMHPs), i.e., programs with all services provided in the community, rather than in an inpatient setting. It also explores national trends that occurred from 2002 to 2011.

Predictors Of Accessing Substance Abuse Services Among Individuals With Mental Disorders Released From Correctional Custody, Stephanie Hartwell, Xiaogang Deng, William Fisher, Julianne Siegfriedt, Kristen Roy-Bujnowski, Craig Johnson, Carl Fulwiler

Sociology Faculty Publication Series

Objective

In the context of an increasing correctional population and corresponding rates of mental illness and substance abuse among this population, this study focuses on describing the predictors of substance abuse service utilization for ex-inmates with dual disorders. Our aim is to assess the likelihood and characteristics of ex-inmates with mental disorders who access substance abuse treatment services within two years of correctional release.

Methods

Using merged administrative data on all ex-inmates with open mental health cases released from Massachusetts Department of Corrections and two County Houses of Corrections from 2007 to 2009 (N=2,280) and substance abuse treatment outcome data …

Evaluating Effectiveness Of A Public Mental Health Re-Entry Program: Strategic Statewide Partnerships, Stephanie Hartwell

Office of Community Partnerships Posters

This study is the first ever initiative to merge administrative data base in Massachusetts to evaluate an important public mental health program. It examines post-incarceration outcome of adults with serious mental illness (SMI) enrolled in the Massachusetts Department of Mental Health (DMH) Forensic Transition Team (FTT) program. The Program began in 1998 with the goal of transitioning offenders with SMI released from state and local correctional facilities utilizing a core set of transition activities. In this study we evaluate the program's effectiveness using merged administrative data from various state agencies for the years 2007 - 2011, comparing FTT clients to …

Antidepressants And Breast And Ovarian Cancer Risk: A Review Of The Literature And Researchers' Financial Associations With Industry, Lisa Cosgrove, Ling Shi, David E. Creasey, Maria Anaya-Mckivergan, Jessica A. Myers, Krista F. Huybrechts

Counseling, School Psychology & Sport Faculty Publication Series

Background

Antidepressant (AD) use has been purported to increase the risk of breast and ovarian cancer, although both epidemiological and pre-clinical studies have reported mixed results [1]–[6]. Previous studies in a variety of biomedical fields have found that financial ties to drug companies are associated with favorable study conclusions [7].

Methods and Findings

We searched English-language articles in MEDLINE, PsychINFO, the Science Citations Index and the Cochrane Central Register of Controlled Clinical Trials (through November 2010). A total of 61 articles that assessed the relationship between breast and ovarian cancer and AD use and articles that examined the effect of …

Research To Practice: The Influential Role Of The Job Developer: Increasing Self-Determination And Family Involvement During The Job Search, Jaimie Ciulla Timmons, Ashley Wolfe

Research to Practice Series, Institute for Community Inclusion

Job developers can influence decision-making during the job search and placement process. For a study exploring the employment decisions of people with intellectual and/or developmental disabilities (IDD), researchers interviewed 16 individuals with IDD, their family members, and professionals involved in their job search. Participants were asked what factors, circumstances, or people affected their decisions about work. The job developer was consistently named the most influential person in the job-search process.

Conflicts Of Interest In Clinical Practice Guidelines, Lisa Cosgrove, Allen F. Shaughnessy

Counseling, School Psychology & Sport Faculty Publication Series

Clinical practice guidelines are used increasingly across medical specialties and settings, making evaluation of their utility and validity a critical public health issue. In this paper, we describe some of the challenges that specialty organizations face as they try to ensure that their guidelines are trustworthy and useful. We examine the practice guidelines for Major Depressive Disorder recently published by the American Psychiatric Association (APA), identify five sources of potential bias that may affect the guideline development process and offer suggestions based on our review. For example, even for mild depression, this guideline privileges pharmacotherapy over other interventions, despite questions …

Psychiatric Taxonomy, Psychopharmacology And Big Pharma, Lisa Cosgrove

Counseling, School Psychology & Sport Faculty Publication Series

Clinicians practicing today need to be aware of the ways in which the current industry-dominated climate may undermine the integrity of the scientific process and, thus, may compromise patient care. In the mental health field, corporate sponsorship bias can affect psychiatric taxonomy and clinical Practice Guidelines (CPG). Financial conflicts of interest (FCOI) can occur when there are financial associations between researchers, authors, or panel members developing psychiatric diagnostic and treatment guidelines, and the pharmaceutical industry, or when randomized clinical trials (RCTs) are industry funded. Therefore, clinicians need to be especially vigilant about the informed consent process when patients are prescribed …

Research To Practice: Comparison Of Vr Outcomes For Clients With Mental Illness Across System Indicators, Joe Marrone, Frank A. Smith, Susan Foley

Research to Practice Series, Institute for Community Inclusion

The argument that people with psychiatric disabilities cannot work is an empty one, as anecdotal and research data have shown (Bond, 2004). Recently, there has been a plethora of information on evidence based employment strategies, prominently connected with the research on the Individual Placement and Support (IPS) model associated with Drake and colleagues at Dartmouth College (Drake, 1998).

Data Note: Persons Served In Community Mental Health Programs And Employment, Frank A. Smith, Samita Bhattarai

Data Note Series, Institute for Community Inclusion

State Mental Health Agencies provide a wide range of supports to consumers including rehabilitation services, vocational and pre vocational training, and supported and competitive employment supports. This Data Note explores how states vary in number of individuals served in Community Mental Health Programs, i.e., all services not provided in an inpatient setting, who are employed as well as the percentage of individuals served in Community Mental Health Programs who are employed.

Data Note: State Mental Retardation And Developmental Disabilities Agencies Expenditures For Integrated Employment Services, Jean E. Winsor, Frank A. Smith, Brooke Dennee-Sommers

Data Note Series, Institute for Community Inclusion

In FY2004, the average expenditure per person for integrated employment as reported by state Mental Retardation and Developmental Disabilities (MR/DD) agencies was $6,251 (Table 1). This figure has increased steadily since the mid-1990s indicating that states have slowly begun allocating additional resources towards integrated employment. However, growth in expenditures is likely a result of changes in federal law as opposed to changes in the amount of state dollars available to fund integrated employment.

Massworks: Quality Employment Services: Where Research And Practice Meet, Rick Kugler, Cindy Thomas

MassWorks Series, Institute for Community Inclusion

Providing quality employment services to people with disabilities requires a substantial commitment of time, energy, and resources. Given this investment and our obligation to individuals with disabilities, we as providers must deliver the most effective services possible.

Research To Practice: Self-Determination And Struggle In The Lives Of Adolescents, Mairead Moloney, Jean Whitney-Thomas, Danielle Dreilinger

Research to Practice Series, Institute for Community Inclusion

As students of all ability levels move into adulthood, they seek to define themselves and develop goals for the future. This study identifies four categories of students and offering targeted suggestions for support.

Research To Practice: The Most Important Member: Facilitating The Focus Person's Participation In Person Centered Planning, Jean Whitney-Thomas, Jaimie Ciulla Timmons

Research to Practice Series, Institute for Community Inclusion

This brief summarizes research that explored the participation of young people in person centered planning, and gives specific recommendations to assist facilitators in maximizing student participation.

Research To Practice: Building Authentic Visions: How To Support The Focus Person In Person Centered Planning, Jean Whitney-Thomas, Jaimie Ciulla Timmons

Research to Practice Series, Institute for Community Inclusion

This brief summarizes research on behavior during a planning session that increased or decreased participation of the focus person. Recommendations challenge team members to think about how their own behavior influences the focus person's participation.

Research To Practice: Unrealized Potential: Differing Outcomes For Individuals With Mental Retardation And Other Disability Groups, Sheila Fesko

Research to Practice Series, Institute for Community Inclusion

A national study examined job search practices used by community rehabilitation providers and state vocational rehabilitation counselors. Employment outcomes for individuals with mental retardation are contrasted with those for individuals with other disabilities.

Research To Practice: Responding To The Needs Of Youth With Disabilities Who Are Runaway Or Homeless, Sheila Fesko, David Temelini

Research to Practice Series, Institute for Community Inclusion

Results from a national survey of Family Youth and Service Bureau-funded agencies regarding their knowledge of the needs of youth with disabilities who are runaways, homeless, or at risk for running away.

Research To Practice: Consumer And Family Perspectives On The Meaning Of Work, Sheila Fesko

Research to Practice Series, Institute for Community Inclusion

Findings from a study that obtained the perspectives of people with significant disabilities and their family members about their employment experiences, outcomes, and expectations.

Program Design And Clinical Operation Of Two National Va Initiatives For Homeless Mentally Ill Veterans, Robert Rosenheck, Catherine A. Leda, Peggy Gallup

New England Journal of Public Policy

In 1987, in response to reports of large numbers of veterans among America's homeless, the Department of Veterans Affairs established two new national health care initiatives, which have seen over 40,000 homeless veterans since their inception. We present here evaluation and treatment data on a sample of 14,000 of them. Because of differences in their design, the two programs vary in the degree to which they emphasize community outreach, homelessness prevention, and the provision of aftercare services to patients discharged from other VA programs. In spite of these differences, veterans treated in the two programs have similar health care problems …

The Manufacture Of Dependency: Shelterization Revisited, Kostas Gounis

New England Journal of Public Policy

Emergency shelters have been the most comprehensive and enduring response to homelessness in the United States, with New York City leading the way since the early 1980s. Shelters have emerged as a hybrid between a degraded type of "public housing" and a new form of "institutionalization." The persistence of shelter dependency, or "shelterization," is an intractable problem that frustrates policymakers and service providers. Popular among certain circles of professional pathologists is the view that shelterization is a form of "adaptation" to the violent, anomic, and generally antisocial environment of the shelter. This explanation of shelter dependency is theoretically flawed and …

The Pendulum Swings: How Changes In Federal And State Policy Have Affected The Status Of Homeless People With Mental Illness In Ohio, Kim Bryant

New England Journal of Public Policy

Public policy in the problem areas of homelessness and mental illness has been reactive, rather than proactive, for the past thirty to forty years. As a result of this approach, federal and state policies have swung, like a pendulum, from one extreme to the other, taking the homeless mentally ill population on a most difficult ride. Public policies concerning these issues must become proactive, even if it means a complete overhauling of federal and state social service systems. Only with proactive policies will mentally ill individuals, and all people, have the housing, food, and health care they need, and the …

Mentally Ill Persons In Emergency And Specialized Shelters: Satisfaction And Distress, Russell K. Schutt, Stephen M. Goldfinger

New England Journal of Public Policy

Emergency and specialized mental health shelters represent different service philosophies and are meant to appeal to different segments of the homeless and homeless mentally ill population. This article describes the different characteristics and needs of users of emergency and specialized mental health shelters for homeless persons in Boston. Service satisfaction is described in relation to these characteristics and needs as well as in terms of shelter type. Implications are identified for social and mental health service policies for the homeless.