Health Services Research Commons^™

Risk Factors For Homelessness Among Community Mental Health Patients With Severe Mental Illness, Rupert Talmage Van Wormer

Dissertations and Theses

The purpose of this study was to identify risk factors associated with homelessness, assess the relationship between housing status and consumption of costly publicly funded resources, to identify characteristics associated with service retention, and to evaluate whether length of treatment is associated with better outcomes. The target population was homeless and formerly homeless adults with SMI enrolled in community mental health services at the Downtown Emergency Service Center SAGE mental health program located in Seattle. The sample consisted of 380 SAGE patients who had continuous enrollment in 2005. These patients formed the cohort for the study. Agency records for these …

The Referral Process: Rural Primary Care Physicians' Perspectives On Providing Counseling Referrals, Casey N. Tallent

College of Education and Human Sciences: Dissertations, Theses, and Student Research

The advantages to collaborative care between physicians and mental health care providers have been known for many decades. Rural primary care physicians (RPCPs) are the first professionals that most patients contact when they have a mental health concern, particularly in rural communities. It is therefore important to understand the process that occurs when a referral for counseling is made from a RPCP and the subsequent collaboration that occurs. The purpose of this qualitative study was to generate a model that provides a better understanding of the counseling referral process from the perspective of RPCPs in private practice in the Midwest. …

Playing With Fire Or Arson? Identifying Predictors Of Juvenile Firesetting Behavior, Mary Ellen Britt

UNLV Theses, Dissertations, Professional Papers, and Capstones

Firesetting is a complex behavior that spans a wide range of developmental stages in childhood and adolescence and involves varying motivations and intents. A better understanding of this destructive behavior is critical to developing strategies to control its devastating effects. The purpose of this research project was to identify potential predictors of juvenile firesetting behavior by studying youth who were enrolled in a regional firesetting intervention program. Data collected from firesetting assessment instruments completed by parents or guardians of program participants were examined. In the analyses, special emphasis was placed on evaluating associations between juvenile firesetting behavior and the socioeconomic …

Substance Abuse In Georgia, The Burruss Institute Of Public Service And Research

Georgia Journal of Public Policy

In order to create a snapshot of substance use and abuse in Georgia, the Burruss Institute of Public Service and Research requested access to data from the National Survey on Drug Use and Health conducted on behalf of the Substance Abuse and Mental Health Services Administration (SAMHSA), a unit of the Department of Health and Human Services (HHS).  SAMHSA would not provide access to the raw data; instead, the Institute was given a series of tables with estimates of the average annual number of users of various substances among Georgians ages 12 and older between the years 2002 and 2008. …

Access To Mental Health Services And Family Impact Of Rural Children With Mental Health Problems, Jennifer D. Lenardson Mhs, Erika C. Ziller Phd, David Lambert Phd, Melanie M. Race Ms, Anush Yousefian Hansen Ms, Ma

Mental Health / Substance Use Disorders

Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children are more likely to go without access to all parent-reported needed mental health services and their families spend more time coordinating their care. This working paper and policy brief provide information on prevalence …

Chhs August Enewsletter, Dr. John Bonaguro, Dean, Vashon S. Wells, Editor, Wku College Of Health & Human Services

College of Health & Human Services Publications

No abstract provided.

Examining The Interrater Reliability Of The Comprehensive Inventory Of Mental Health And Recovery And Rehabilitation Services (Cimhrrs), Robert W. Johnson

Department of Psychology: Dissertations, Theses, and Student Research

This dissertation is one step in the continuing development, evaluation, and validation of the Comprehensive Inventory of Mental Health and Recovery and Rehabilitation Services (CIMHRRS). The CIMHRRS is an instrument to guide comprehensive assessment of programs that provide integrated services to people with serious mental illness (SMI).

The project described in this dissertation evaluated three key aspects of its performance in real world application: practical feasibility, internal consistency and reliability, and ability to distinguish between different programs. Investigators utilized a combination of principles and methods, associated with psychometric scale development, field methods, and program evaluation. Using a structured site review …

Opportunities For Intervention: Characteristics Of Alcohol Related Visits To United States Emergency Departments, 2003 - 2007, Jonathon Lavalley

UNLV Theses, Dissertations, Professional Papers, and Capstones

The cycle of alcohol intoxicated patients passing through United States (US) emergency departments (ED) and repeated inpatient detoxification for alcohol inebriates is costly, as these patients are continually exposed to injury and other health and legal consequences of their continued at risk alcohol use. The high proportion of ED resources used by these alcohol intoxicated patients has contributed to increased patient wait times, increased ambulance diversions, forced closures of US EDs, increased numbers of patients leaving without being seen, and an overall reduction in the quality of medical services provided in the ED. In order to contribute to efforts towards …

Elder Abuse: A Policy Analysis, Cortni Davis

Undergraduate Research Conference

Elder abuse is a growing social problem in the United States. It takes on many forms, and is prevalent throughout various cultures. Elder Abuse Reporting Laws have been enacted throughout various states to prevent and intervene in elder abuse cases. California’s Financial Abuse Reporting Act of 2005 is one among many laws in the United States which was formed to help ensure social justice for the elderly citizens of America.

A Geospatial Approach For New Perspectives On Satisfaction With Health Services In Malawi, Gideon Mazinga

Loma Linda University Electronic Theses, Dissertations & Projects

This dissertation explored the spatial pattern of user satisfaction with health services and factors, including policies that potentially explain the variation in the district-level of user satisfaction with health services. Nationwide secondary data was extracted from the 2002 Core Social Welfare Indicators Survey and the National Health Services Statistics databases obtained from National Statistics of Malawi. The National Health Facilities inventory obtained from the Malawi diffusion project was also geocoded to display the distribution of health care facilities in the country. Spatial autocorrelation and regression modeling techniques were applied on the national representative data set.

The spatial autocorrelation test revealed …

Primary Care: A Mandatory Requirement For Effective Health Care, Waris Qidwai

Department of Family Medicine

No abstract provided.

Diagnostic Classifications And Resource Utilization Of Decedents Served By The Department Of Veterans Affairs, Sonia A. Duffy, Laurel Copeland, Faith Hopp, Robert J. Zalenski

Social Work Faculty Publications

Background: Given the volume and cost of inpatient care during the last year of life, there is a critical need to identify patterns of dying as a means of planning end-of-life care services, especially for the growing number of older persons who receive services from the Veterans Health Administration (VHA).

Methods: A retrospective computerized record review was conducted of 20,933 VHA patients who died as inpatients between October 1, 2001 and September 30, 2002. Diagnoses were aggregated into one of five classification patterns of death and analyzed in terms of health care resource utilization (mean number of inpatient days and …

Day Of Dialogue—Insights And Evidence From Product Introduction: Lessons For Microbicides, Martha Brady, C. Elizabeth Mcgrory

HIV and AIDS

This report summarizes key issues and themes emerging from a Population Council Day of Dialogue held in March 2007. The Council convened this meeting of experts in the fields of product development, introduction, and social marketing; clinical trials; and reproductive health and HIV/AIDS in order to identify key features that can be used to guide efforts to introduce microbicides.

Chronic Care At The Crossroads: Exploring Solutions For Chronic Care Management. Report On The Us Summit., Janice L Clarke

College of Population Health Faculty Papers

Report on the US Summit

Outcomes Associated With A Home Care Telehealth Intervention, Faith Hopp, Peter Woodbridge, Usha Subramanian, Laurel Copeland, David Smith, Julie Lowery

Social Work Faculty Publications

To determine whether adding telehealth technology to traditional home care services increases health-related quality of life (HRQOL) and home care satisfaction, and decreases resource utilization among home care patients. This trial included 37 home care patients receiving services in a Veterans Affairs medical center, randomized into intervention and control groups. Outcome measures included patient satisfaction and HRQOL at baseline and 6-month follow- up, and the use of inpatient and outpatient services before and during the 6-month study period. Intervention group patients reported greater improvement in the mental health component of HRQOL, (t = 2.27; df = 15; p = …

Perceived Smoking Environment And Smoking Initiation Among Multi-Ethnic Urban Girls, Tracy R. Nichols, Amanda Birnbaum, Sara Birnel, Gilbert J. Botvin

Department of Public Health Scholarship and Creative Works

Purpose

To examine associations between the perceived smoking environment and smoking initiation among urban multi-ethnic adolescent girls in New York City.

Methods

Self-report surveys completed in grades 7, 8, and 9 assessed girls’ (n = 858) smoking initiation, and perceived smoking environment (family smoking, friends’ smoking, smoking norms, and cigarette availability). Carbon monoxide breath samples were collected from girls using a variation of the bogus pipeline procedure.

Results

Differences were found in smoking prevalence with white girls reporting the highest prevalence of smoking at baseline and the greatest increase in smoking prevalence from seventh to eighth grade. Black girls reported …

Barriers To The Dissemination Of Four Harm Reduction Strategies: A Survey Of Addiction Treatment Providers In Ontario, Karen L. Hobden, John A. Cunningham

Wayne State University Associated BioMed Central Scholarship

Abstract

A sample of service providers at addictions agencies' in Ontario were interviewed by telephone to assess attitudes toward, anticipated internal and external barriers to implementing, and expected benefits of four harm reduction strategies: needle exchange, moderate drinking goals, methadone treatment, and provision of free condoms to clients. Respondents were also asked to define harm reduction, list its most important elements, and describe what they find most troubling and most appealing about harm reduction. Attitudes toward harm reduction in general and the services provided at each agency were also assessed. Results indicated that the service providers surveyed had positive attitudes …

Re-Engineering Systems For The Treatment Of Depression In Primary Care: Cluster Randomised Controlled Trial, A. J. Dietrich, Thomas E. Oxman, John W. Williams Jr., Herbert C. Schulberg, Martha L. Bruce, Pamela W. Lee, Sheila Barry

Dartmouth Scholarship

Objective: To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources.

Research In Home-Care Telemedicine: Challenges In Patient Recruitment, Usha Subramanian, Faith Hopp, Julie Lowery, Peter Woodbridge, David Smith

Social Work Faculty Publications

This study reports challenges in recruiting patients for a randomized controHed trial of home-care telemedicinae. Descriptive statistics on patient eligibility for home-care telemedidne services and patient refusals for participation are provided. Frequency counts of reasons for study exclusion and participant refusal and Chi-square tests to compare race and age-related differences are given. Of 302 home-care patients reviewed, 197 (65.2%) did not meet inclusion criteria. The most common reasons for study exclusion were patients either needing <2 visits per month (n = 59, 30%) or >3 skilled nurse visits per week (n = 46, 23.4%). Of the eligible patients (n = 105), 79 …

Predictors That Affect The Caregiver's Health Status And The Role Of Social Support On The Caregiver's Health Status, Hong Wang

All-Inclusive List of Electronic Theses and Dissertations

This study examines whether the caregiver's self-rated health status is affected by the caregiver's demographic characteristics (age, education level, and income), caregiver's stressor (the number of ADL and IADL), mediating variables of the caregiver's appraisal (willingness to help non-family members, level satisfaction with life, and financial burden), of and mediating variable of social support (information and/or advice from other family members or friends). Data were drawn from Chronic Illness and Caregiving, a national telephone survey conducted by Harris Interactive Inc. on behalf of The Robert Wood Johnson Foundation, Johns Hopkins University, and Partnership for Solutions. The sample size of caregivers …

The Relationship Of Attitude, Social Influence, And Self-Efficacy To Diabetes Type Ii Outcomes, Autumn L. Keefer-Ward

All-Inclusive List of Electronic Theses and Dissertations

The purpose of this study was to investigate the Attitude-Social Influence-Self Efficacy model and its relationship to Type II diabetes outcomes. One hundred-twelve adults ages 55-75 with Type II diabetes were recruited from a physician's office in West Central Indiana. Participants completed instruments that assessed (a) attitude, (b) social influence of the physician, (c) diabetes-specific self-efficacy, and (d) diabetes-specific quality oflife. A measurement of metabolic control was also obtained. Multiple regressions were performed using ( a) quality of life, and (b) metabolic control as criterion variables. Only one subscale of the self-efficacy variable scale, Managing the Psychosocial Aspects of Diabetes, …

Depression: A Decade Of Progress, More To Do, Veronica V. Goff

National Health Policy Forum

This issue brief discusses the most recent findings on depression prevalence and cost; examines trends in outpatient treatment, including the dramatic growth in antidepressant use; discusses efforts to improve treatment in primary care; and explores possible public policy avenues for improving treatment access and quality.

Devolpment Of A Scale To Assess Home Health Care Aides' Ability To Recognize Depression In Older Adults, Tina M. Nerney

Community & Environmental Health Theses & Dissertations

Depression afflicts 20% to 40% of people 65 and older. Depression in older adults is frequent and chronic. The challenge of a hospital stay and the knowledge of having a long term disability may increase the risk for a depressive episode. In today's health care environment older adults are being released from hospitals after a short length of stay and are frequently dependent on home health services for assistance with activities of daily living. Home health care aides are given the responsibility of providing these services to the older adult in the home environment and need to be aware of …

Measuring Hospital Use Without Claims: A Comparison Of Patient And Provider Reports., R E. Clark, S K. Ricketts, G J. Mchugo

Dartmouth Scholarship

We compared the validity of hospital admission and length of stay reports from patients, outpatient providers, and hospitals, and we examined possible sources of error. Data were collected from people enrolled in a randomized trial of treatment for severe mental illness and substance use disorders, from community mental health centers (CMHCs), and from hospitals. Reports for each of the 74 study participants covered two-year time periods beginning and ending at various times between 1989 and 1993. We compared reports from the various sources and constructed a hybrid with data from all three sources. Using parametric and non-parametric statistics, we compared …

A Model Of Costs Of A Cbd Programme, Saumya Ramarao, John Townsend, M.E. Khan

Reproductive Health

This study is a collaborative effort of the Population Council, New Delhi, and the Centre for Development and Population Activities, New Delhi. Cost analysis is an analytical tool that provides program managers and planners with information about existing and potential programs. Existing programs can be evaluated for efficiency and effectiveness, while the resource requirements of future programs can be estimated. In the context of family planning (FP) programs, cost analysis provides policymakers and program managers with sufficient data on efficient ways to meet the demand for FP services with available resources. As FP programs mature and requirements for the resources …

A Descriptive Study Of Commitment Practices In A Selected Jurisdiction, Louis A. Pesnicak

Community & Environmental Health Theses & Dissertations

This study examines the application of commitment procedures in one urban community in Virginia. The study investigated: the concordance rates of clinical recommendation for treatment and the outcome of the commitment hearing. the time lapse between detention of an individual and the hearing outcome. the presenting symptomatology and outcome. and the pre-detention compliance to treatment and outcome. The study's findings showed a concordance rate of 64% between clinical recommendation and outcome. It provided no significant differences in symptomatology/outcome, compliance/outcome, and time lapse/outcome. The lack of any significant findings seems to suggest that application of commitment laws might benefit from institution …

Trends In Hospital And Nursing Home Care Expenditures, Maine, 1982 To 1986, Maine Department Of Human Services

Maine Collection

Trends in Hospital and Nursing Home Care Expenditures, Maine, 1982 to 1986

Maine Department of Human Services - Office of Data, Research, and Vital Statistics

John R. McKernan, Jr., Governor, Rollin Ives, Commissioner, Brenda Smith, Planning and Research Associate, May, 1989.

"This report produced under Appropriation No. 1310-4010."

Contents: Introduction / Hospital Care Expenditures / Nursing Home Care Expenditures / Comparison of Hospital and Nursing Home Care Expenditure Trends / Concluding Remarks / References

Tardive Dyskinesia: A Prevalence Study In An Outpatient Population, Virginia J. Ravizza

Community & Environmental Health Theses & Dissertations

The purpose of this prevalence study was to assess the occurrence of tardive dyskinesia among a chronically mentally ill sample of a suburban mental health clinic. The participants in this study were selected from clients of a suburban mental health clinic who agreed to participate in this prevalence study. There were 45 participants--17 males and 28 females.

The Abnormal Involuntary Movement Scale (AIMS) was selected as the instrument to measure the abnormal involuntary movements exhibited by the participants of the study on the day of testing. The testing occurred during a specific time period, June 8, 1987 to July 2, …

The Effectiveness Of Stimulation Therapy For The Cognitively Impaired Elderly, Sylvia H. Old

Community & Environmental Health Theses & Dissertations

The effectiveness of stimulation therapy for the cognitively impaired elderly living in an institution was assessed. Residents with varying degrees of cognitive impairment were treated with twenty, thirty-minute daily periods of reality orientation, reminiscence, resocialization, remotivation, and other stimulating therapies and were compared with a control group_ receiving no intervention. Treatment effects were assessed with a variety of instruments reflecting functioning across several domains. Included were ability to perform both basic self-care functions and activities of daily living, cognitive performance, affect, and satisfaction with the care received and the living environment in the nursing home. The experimental group was divided …

Trends In Health Care Expenditures, Maine 1974-1978, Bruce Armstrong

Maine Collection

Trends in Health Care Expenditures, Maine 1974-1978

by Bruce Armstrong, Research Consultant

Maine Department of Human Services, Bureau of Health Planning and Development, Division of Data and Research, Augusta, Maine (August 1981).

Contents: Preface / Highlights / List of Tables and Figures / Yearly Tables / Trend Illustrations and Tabular Descriptions