Health Services Administration Commons^™

The Program To Reduce Implicit Bias In Carroll Hospital Center Using The Implicit Association Test, Katherine E. Traynor

Capstone Showcase

Natural brain processes make all individuals susceptible to unconscious bias; however, stressful, fearful, or anger-evoking situations as well as the negative influence of media and social surroundings increase the risk of holding obstructive bias, and there is a greater risk of being negatively impacted by this phenomenon when belonging to a minority population (Rose & Flores, 2020). As a result, high rates of infant mortality (10.2 deaths per 1,000 live births for the Non-Hispanic Black population compared to 4.1 in the White population) and cardiovascular related diseases (190.0 cases per 1,000 in the Non-Hispanic Black population compared to 161.3 in …

Healthcare Equity For Transgender Individuals, Mollie Staggs

DSW Capstone Projects

In the field of social justice and integrity, Social Work has dedicated itself to improving the welfare of the world, in which we all participate and interact. There are countless issues in our society that warrant professional attention for the fundamental purpose of positively impacting the livelihood of subcategories of people. For this particular Capstone Project, the focus is on transgender individuals’ systemic healthcare barriers that cisgender people within the United States do not similarly experience. The purpose is to unveil these disparities to then pose progressive alterations within the healthcare system to make the navigation and accessibility better for …

The Ecology Of Mental Health And The Impact Of Barriers On Mental Health Service Utilization, Alisha Aggarwal

Theses & Dissertations

Mental health has emerged as a major public health concern in recent times with several disparities and barriers related to adequate health service utilization. Different age groups experience diverse symptoms and face distinct barriers in accessing and utilizing healthcare. Policies like Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act were launched to improve insurance coverage and delivery of mental health services. However, a large gap of unmet needs exists for adequate mental health service utilization in the country. This dissertation aims to describe the financial and non-financial barriers to mental health service utilization …

Training And Individual Predictors Of Attitudes Toward Serious Mental Illness Amongst Clinical Psychology Doctoral Students, Lauren K. O'Connor

Dissertations, Theses, and Capstone Projects

Clinical psychologists are grossly underrepresented in treatment provision for individuals with serious mental illness (SMI; Roe, Yanos, Lysaker, 2006). Systemic (e.g., emergence of managed care) and training-based (e.g., limitations to SMI specific training) factors contribute to the establishment of this underrepresentation, while mental health stigma amongst psychologists may play a role in perpetuating it. Many individual and experiential factors have been found to impact clinicians’ attitudes toward those with SMI (Henderson et al., 2014; Schulzes, 2007). Though many of these factors are present and relevant from the beginning of one’s career and may involve elements related to training, little research …

A Call To Action: Preventing Opioid And Substance Abuse In South Florida Youth, Julie A. Jacko, Katherine P. Cohen, Cathaerina Appadoo, Arkene S. Levy, Timothy F. Page, Michael J. Parker, Solina Pierre-Gilles, Francois Sainfort

HCA Healthcare Journal of Medicine

The opioid crisis poses a substantial threat to youth throughout the nation. This crisis has been exacerbated by the COVID-19 pandemic, reversing some of the positive national trends in the fight against the opioid epidemic. Some risk factors for youth opioid use have been identified nationally. The South Florida tri-county region of Miami-Dade, Broward and Palm Beach is a culturally distinct region which may not follow national trends and likely has unique risk and protective factors. To address the concerning spike in youth opioid use in South Florida, a community coalition was formed to identify factors unique to South Florida …

Moving Past The Binary: Transgender And Gender Non-Conforming Students’ Experiences Of And Perspectives On College Campus Fitness Centers, Rachel E. Petterson

Honors Projects

Transgender and gender non-conforming (TGNC) people face various mental and physical health disparities. Despite this, spaces related to health and wellness are not always inclusive. Similarly, college campuses are often not as inclusive or accommodating as they should be. This study looks at the experiences of TGNC students at campus fitness centers. Through both quantitative and qualitative data gathered through an online survey, it aims to better understand the following: the presence of inclusive facilities; the perceived importance of facility variables; use of campus fitness facilities by TGNC students; what improvements they would like to see; and how any of …

Covid-19 Related Physical And Mental Health Stressors In Families Using A Social Determinants Lens., Elizabeth Vasquez, Erin Bell, Melissa Tracy

Understanding and eliminating minority health disparities in a 21st-century pandemic: A White Paper Collection

Racial and ethnic minorities, those of lower socioeconomic status (SES), and older adults have experienced higher rates of infection, severity of illness, and mortality from COVID-19 than other groups. These populations are also disproportionately affected by financial and social disruptions caused by the pandemic, including job loss, reduction in community services, and disconnection from supportive networks critically important for the health and well-being of families. Further, these same populations often live in multi- generational households and rely on a family-dependent caregiver model. The aim of this project is to beta test an online questionnaire to identify individual and household risk …

Addressing The Needs Of African American Grandparents: An Intersectionality Perspective, Dorothy Smith-Ruiz, Kendra Jason

The Journal of Sociology & Social Welfare

This study seeks to demonstrate the intersecting structural and compounding challenges African American custodial grandparents experience collectively, rather than as separate non-competing factors, which has been modeled in prior studies. Using a mixed-method research design, the study explored the challenges faced by African American and white custodial grandparents. These challenges included difficulties attaining different types of support, respite care, and programs for teens and special needs grandchildren. Results showed that caregiving challenges among African Americans were more pervasive than their White counterparts. These findings have significant implications for the development of intervention programs for custodial African American grandmothers and their …

Behavioral And Enhanced Perinatal Intervention (B-Epic): A Randomized Trial Targeting Tobacco Use Among Opioid Dependent Pregnant Women, Amanda Fallin-Bennett, Michelle R. Lofwall, Teresa M. Waters, Paul Nuzzo, Janine Barnett, Letitia Ducas, Andrea Mccubbin, Niraj R. Chavan, Lisa Blair, Kristin Ashford

Nursing Faculty Publications

Background

Opioid use during pregnancy is a significant public health issue. The standard of care for treating opioid use disorder during pregnancy includes medications for opioid disorder (MOUD). However, tobacco use often goes unaddressed among pregnant women on MOUD. In 2018, our team received a National Institute on Drug Abuse (NIDA) funded R34 to conduct a three year-randomized trial to test the feasibility of a novel tobacco intervention for pregnant women receiving MOUD.

Aims

The aims of this study are: (1) to determine the impact of the B-EPIC intervention on maternal tobacco use and stage of change; (2) to determine …

Factors Associated With Binge Drinking During The Transition Into Adulthood: Exploring Associations Within Two Distinct Young Adult Age Ranges, Tamara Leech, Sarah Jacobs, Denis Watson

Department of Public Health Scholarship and Creative Works

Background:

Binge drinking among young adults aged 18-21 years has declined over the past decade, but binge drinking rates among people 22-25 years old have remained largely the same. This steady trend in later years represents a departure from the traditional course of maturing out of risky alcohol use, perhaps because young adults are delaying the transition into adulthood.

Aims:

This paper explores the relationship between binge drinking and aspects of the transition into adulthood that could inform interventions targeting these two distinct groups of young adults.

Methods:

We use survey data on 1,081 young adults aged 18-25 living in …

The Other Epidemic, Bruce Deighton

HCA Healthcare Journal of Medicine

The epidemic level of opioid abuse in the U.S. population continues to present a major challenge to our society and to the medical profession. Medical education has a significant role in improving screening, diagnosis, appropriate treatment and management of opioid use disorder. Addressing the problem of overprescribing opioids through physician education, surveillance and opioid management has resulted in significant improvement, translating to fewer overdose deaths from prescription opioids. Graduate medical education can increase access to care by training more addiction medicine specialists, and training other physicians to prescribe buprenorphine and provide access to medically assisted care.

Managing Stress In A Constantly-Changing Workforce, Lorri Burch-Hubbard

Electronic Theses and Dissertations

When staffing reductions occur in the workplace, staff left behind may face increased stress, may not be given the support they need to manage the feelings caused by the reduction. This study was conducted to evaluate the impact of stress caused by staffing reductions has on medical technologists (MT), medical technicians (MLT) and respiratory therapists (RT), and to identify any common methods of stress management used by those staff who remain in the organization.

Literature research showed the negative impact stress can have on individuals when it is not addressed, such as decreased work performance, health issues, and even the …

Medicaid Home Visitation And Maternal And Infant Care And Health: A Reassessment Of Program Effectiveness, Cristian Meghea, Zhiying You, Jennifer E. Raffo, Lee Anne Roman

Michigan Journal of Public Health

Introduction: The Maternal Infant Health Program, MIHP, is Michigan's largest home visiting program for Medicaid-eligible pregnant women and infants. Prior quasi-experimental propensity score matched MIHP evaluations were limited by the possibility of selection bias due to the limited available baseline characteristics. The purpose of this study was to assess the effectiveness of MIHP including previously unobserved baseline characteristics to mitigate the possibility of selection bias.

Methods: We analyzed health care and outcomes of mothers and their infants using linked administrative and screening data. All Medicaid pregnant women with a singleton birth in Michigan between 2009 and 2012 who were prenatally …

How Does Access To Healthcare Affect Life Expectancy?, Yara Mahmoud

Senior Honors Projects, 2010-2019

Access to health care is a pressing issue in the United States, whether it be the cost of care or not having enough of it. To emphasize the importance of this topic, this paper assesses the impact of access to health services on life expectancy. A comparison is made between the universal health systems in France and Spain and the mixed system in the United States. Even though the United States spends the most on health care in the world, its statistics fall below those of other developed countries. After addressing other risk factors, it was found that individuals under …

Call For Submissions Special Issue - July 2020: Patient & Family Experience In Behavioral Health, Patient Experience Journal

Patient Experience Journal

Patient Experience Journal (PXJ) is excited to announce the call for submissions for its July 2020 special issue on the topic of patient & family experience in behavioral health. With a continued focus on the critical role of behavioral health in society today and a growing recognition of the importance of experience for those in behavioral health settings, a conversation on the practices in place and the identification of evidence of efforts leading to positive outcomes will be essential expanding the experience conversation in this setting. This special issue is open to all authors conducting cutting-edge research, implementing innovative practices …

Depression Among Expectant And New Mothers: A Multi-Study Investigation Of Rates, Correlates, And Training For Healthcare Providers, Molly M. Long

Health Services Research Dissertations

Perinatal depression (PD) is a common concern among women. PD has been shown to have negative effects on the mother, child, and mother-child relationship. Screening for PD is inconsistent and low among healthcare providers. However, several governing organizations (e.g., The American College of Obstetricians and Gynecologists, The American Academy of Pediatrics) have provided guidelines for screening and treating PD, indicating the importance and utility of screening and treating PD by a variety of healthcare providers. Few studies, with low methodological rigor, have attempted to improve PD screening, treatment, and referral practices. Therefore, it is important to implement and assess additional …

Adverse Childhood Experiences, Homeless Chronicity, And Age At Onset Of Homelessness, Joseph T. Tucciarone Jr.

Electronic Theses and Dissertations

Childhood adversity is associated with numerous negative outcomes across multiple domains, including mental and physical health, interrelationships, and social functioning. Notably, research suggests that childhood adversity has a dose-response relationship with these outcomes; that is, greater numbers of adverse experiences in childhood are associated with worse outcomes. These outcomes overlap with many risk factors of homelessness. This study sought to address two questions: 1) Does a dose-response relationship exist between childhood adversity and chronic homelessness? 2) Does childhood adversity negatively predict the age at which homelessness first occurs? Adults experiencing homeless who are accessing homeless services in the Tri-Cities area …

Comparing Psychiatric Care Experiences Shared Online With Validated Questionnaires; Do They Include The Same Content?, Rebecca Baines, John Donovan, Samantha Regan De Bere, Julian Archer, Ray Jones

Patient Experience Journal

Patient feedback is considered integral to patient safety and quality of care. However, limited research has compared the content of validated questionnaires with subjective patient experiences shared online. The aim of this study was to therefore identify and compare the content of psychiatric care experiences shared online with validated questionnaires. All research was conducted in co-production with a volunteer mental-health-patient-research-partner. We analysed all reviews published on the United Kingdom’s leading health and social care feedback platform Care Opinion, between 2005-2017 that discussed adult psychiatric care and compared findings with two validated questionnaires (ACP360 and General Medical Council patient feedback questionnaire). …

Forgotten Children & Bonds That Heal: The Critical Nature Of Attachment, August Ashbaker

Lesley University Community of Scholars Day

Human attachment is one of the most critical factors in proper neurological and physiological development. Attachment is built through the mutuality of emotional impact, as well as the regular reception of physical touch. Infants and children who have been deprived of these vital necessities through the lacking initiatives of their caregivers—through neglect—display visible signs of its physiological, cognitive, emotional, and behavioral impact. Research has found neglect to be the highest risk factor for permanent damage to brain development in comparison to other forms of complex trauma (i.e. chronic caregiver interpersonal trauma in childhood); it is also the most prevalent …

Hospital-Based Services For Opioid Use Disorder: A Study Of Supply-Side Attributes, Kelsey Caroline Priest

Dissertations and Theses

The United States (U.S.) is in the midst of an opioid overdose epidemic. In the U.S., overdose deaths related to opioid exposure are the leading cause of accidental death, yet life-saving treatments, such as methadone or buprenorphine (opioid agonist therapy [OAT]), are underused. OAT underused is due, in part, to complex regulatory and health services delivery environments. Public health officials and policymakers have focused on expanding OAT access in the community (e.g. office-based buprenorphine treatment, and opioid treatment programs); however, an often-overlooked component of the treatment pathway is the acute care delivery setting, in particular hospitals.

Opioid use disorder (OUD)-related …

Peer Support For Addiction In The Inpatient Setting, Rebecca Sweeney

DNP Scholarly Projects

Background: In 2006 the Institute of Medicine reported that combined mental illness and substance use disorder was the second leading cause of disability and death in women and the highest cause in men. More recent data obtained from the 2016 National Survey on Drug Use and Health (Ahrnsbratz et al 2016) indicates in 2016 only one in ten of the people who need treatment, receive it. At Cambridge Health Alliance’s Everett Hospital, the site of this pilot project, opioid overdose and acute alcohol intoxication comprise one in every ten visits in the Emergency Department. In January of 2018, CHA partnered …

Impact Of Prescription Opioid Access Restrictions On Alcohol-Induced Mortality In Kentucky, Changwe Park

MPA/MPP/MPFM Capstone Projects

Prescription drug monitoring programs (PDMPs) are state policy tools to combat risky opioid prescribing. Since 2012, several states began to mandate PDMP use. As mandating use laws have settled down, evaluating potential adverse events becomes possible.

In this study, I focus on alcohol-induced mortality as a potential unintended consequence via substituting alcohol for prescription opioids, since alcohol and opioids are often concurrently misused as a part of pain self-management. Therefore, the aim of this study is to analyze the unintended consequences of prescription opioid access restrictions on alcohol-induced mortality.

I compare the alcohol-induced mortality among adults during pre- and post-revision …

Trends In Opioid Use In Pediatric Patients In Us Emergency Departments From 2006 To 2015, Daniel M. Tomaszewski, Cody Arbuckle, Sun Yang, Erik J. Linstead

Pharmacy Faculty Articles and Research

Importance The use of opioids to treat pain in pediatric patients has been viewed as necessary; however, this practice has raised concerns regarding opioid abuse and the effects of opioid use. To effectively adjust policy regarding opioids in the pediatric population, prescribing patterns must be better understood.

Objective To evaluate opioid prescribing patterns in US pediatric patients and factors associated with opioid prescribing.

Design, Setting, and Participants This cross-sectional study used publicly available data from the National Hospital Ambulatory Medical Care Survey from January 1, 2006, to December 31, 2015. Analysis included the use of bivariate and multivariate models to …

Syndemics Of Severity And Frequency Of Elder Abuse: A Cross-Sectional Study In Mexican Older Females, Mireya Vilar-Compte, Pablo Gaitán-Rossi

Department of Public Health Scholarship and Creative Works

Background: Elder abuse is a common phenomenon with important effects on the health and well-being of older adults. There are important gaps in elder abuse measurement, as it is usually reported as the absence or presence of elder abuse, disregarding its severity and frequency.

Objectives: Identify different ways of measuring severity and frequency of elder abuse and assess whether different experiences of severity and frequency suggest syndemic relationships.

Methods: Through a sample of 534 non-institutionalized Mexican older women, we assessed how severity (i.e., number of abusive experiences and number of types of abuses) and frequency (i.e., if abusive experiences had …

Finding The Narrative In Incident Reports, La'eeqa Aslam

Master's Projects and Capstones

The Progress Foundation, as licensed by the state of California and the Community Care Licensing, is required to use incident reports for internal audits and remain in compliance as a health facility. Incident reports are used to record events or accidents that have occurred within an organization. Often times, reports are made, handed off, and given from the residence home to the Community Care Licensing with little to no information of how an incident was managed. The Progress Foundation is working towards tracking information from the incident reports to improve internal management and understand the trends in the reports.

In …

The Critical Need For Mental Health Education To Be Mandated In New Mexico's Public Schools, Bonnie L. Murphy

Shared Knowledge Conference

Based on a review of research and best practices in mental health awareness and skills, this inquiry project argues for state legislative policies that would require mental health awareness and skills in the K-12 curriculum. Mental health affects individual accomplishments in every stage of people’s lives beginning in early childhood and throughout the life cycle. Prevention and treatment of mental illness plays a key role in the ability of an individual to cope with loss and develop resiliency and perseverance in challenging times and to make better decisions that improve the individual’s life and the lives of those around them. …

A Characterization Of The Medical-Legal Partnership (Mlp) Of Nebraska Medicine, Jordan Pieper

Capstone Experience: Master of Public Health

This research study was completed at Legal Aid of Nebraska’s Health, Education, and Law Project through the partnership it has formed working with Nebraska Medicine and Iowa Legal Aid. Traditionally, health and disease have always been viewed exclusively as "healthcare" issues. But with healthcare consistently growing towards holistic approaches to help patients, we now know there are deeper, structural conditions of society that can act as strong driving forces of a person's poor daily living conditions that can negatively impact health. The importance of a Medical-Legal Partnership is that it considers a patient's social determinants of health (SDHs). The goal …

Healthcare Utilization For Behavioral Health Disorders: Policy Implications On Nationwide Readmissions, And Outcomes In The States Of Nebraska And New York, Rajvi J. Wani

Theses & Dissertations

The main goal of this dissertation was to estimate national-level inpatient readmissions and state-level hospital-based emergency department (ED) visits with behavioral health (BH) conditions in the states of Nebraska and New York. The dissertation aims to assess the impact of the policy mandates under the Patient Protection and Affordable Care Act on these state and national estimates. The Nationwide Readmissions Database and the State Emergency Department databases maintained by the Healthcare Cost and Utilization Project were used for this dissertation. US Adult population with high-risk of readmissions in the inpatient departments for alcohol-related disorders (ARD) and of visiting ED for …

Identifying The Newly Insurable Medicaid Coverage Gap Population Under The Affordable Care Act: Who They Are And Where They Live, Samuel L. Woodruff

Capstone Experience: Master of Public Health

The goal of this Capstone Project is to better define and geographically locate the potential distribution of individuals who fall within the current Medicaid Coverage Gap and those populations who would be eligible for Medicaid under the expansion of Medicaid within the state of Nebraska. Using data from multiple United States Census Bureau sources, along with available data from the Health Resources and Services Administration (HRSA), this project looks to also locate populations of these individuals that may live within established Medically Underserved Areas (MUA's) or Health Professional Shortage Areas (HPSA's) within the state. American Community Survey 5-year Public Use …

An Exploration Of Barriers To Health Care Access Among Uninsured Patients: Using The Moderating Effect Of Patients’ Enablement, Enedelia L. Jessup

Electronic Theses and Dissertations

ABSTRACT On March 23, 2010, Congress passed the Patient Protection and Affordable Care Act (ACA) to increase value of care, improve clinical outcomes, decrease health care costs, and increase affordability in health care access. The purpose of the study attempts to examine the moderating effects of patient enablement impacting barriers, low socio economic status, and unmet basic needs, toward health care access in uninsured populations post ACA. Only certain aspects of patient enablement in self-management of an individual’s health care goals have been conducted with uninsured populations with barriers toward health care access. The research design was a quantitative, exploratory, …