Social and Behavioral Sciences Commons^™

The Brigade Combat Team (Bct): A Revolution In Organizational Structure, Adam Davis

Muskie School Capstones and Dissertations

This paper explores the U.S. Army’s force reorganization around the Brigade Combat Team (BCT), which began in 2002. The BCT shifted how various army units interacted by changing the echelon at which different types of units report to a single commander, essentially creating self-sufficient units of about 2,500 soldiers instead of the previous self-sufficient units of about 15,000 soldiers. This paper utilizes existing organizational theories and research to better understand the implications for such a dramatic change in organizational structure. It contextualizes the army’s reorganization by applying the Rational Actor, Political, and Bureaucratic Models outlined in Essence of Decision by …

Outdoor Recreation, Greenspace, And Covid-19 In Maine, Jayne Marie Foley

Muskie School Capstones and Dissertations

In this report we are exploring the significance of outdoor recreation and usage in response to the COVID-19 pandemic. We will discuss the importance of green space and outdoor recreation as a part of sustainability and what we can do for the future to provide sustainable and safe spaces for the public. I will be looking at the response of 119 individuals from a survey collected and three interviews from stakeholders in Maine on their experiences with the outdoors during COVID-19 and comparing these results to other similar findings. We can use this information from the COVID-19 experience to better …

Substance Use Prevention: Communication And Strategies To Reduce Alcohol, Marijuana, And E-Cigarette Use Among College Students, Emily Bauer

Muskie School Capstones and Dissertations

Substance use among college students impacts universities, communities and student outcomes across the United States. Based on the Monitoring the Future study (MTF), college students have a higher prevalence of past 30-day alcohol use at 63% than their non-college peers (59%) (2016). Nearly one-third of college students (32%) have had five or more drinks in a row in the past two weeks (2016). Monthly marijuana use for college students has remained steady at 22% (2016). Electronic cigarette (e-cigarette) use is 6.9%, which is gaining in popularity but still lower than traditional cigarettes (8.9%) (2016). There are many prevention communication strategies …

A Framework For Cooperative Housing In Portland, Me: Lessons From 13 Existing Cooperative Houses In The U.S., Cyndi Gacosta

Muskie School Capstones and Dissertations

Cooperative housing may be a viable and financially-sound alternative for individuals and families of low to moderate income, as Portland, Maine’s downtown area becomes gentrified raising property values to unaffordable heights. Of the 13,546 family households in Portland, 8.7% earn below $25,000, which for an average family of four $24, 250¹ is considered to be in poverty, and 18.4% earn between $25,000 and $50,000. Meanwhile, 13.2% of the 16, 561 non-family households are below the poverty line, and 27.5% earn between $25,000 and $50,000 (US Census Bureau, 2014).

As it becomes increasingly difficult for low to moderate income earners …

Early Data From The Maine Ombudsman’S Hospital Advocacy Program: A Deeper Look At Difficult To Place Patients, Joseph Zamboni

Muskie School Capstones and Dissertations

There is little data available on the complex cause and effect of delayed hospital discharge; however, some evidence suggests that long-stay patients tend to be complex, older, and sicker. In Maine, a 2014 Maine Health Association report found complex hospital patients were waiting weeks, months and sometimes over a year in Maine Hospitals before accessing long-term services and supports. In response to these concerns around delayed discharge from hospitals, the First Regular Session of the 127th Maine Legislature created the Commission to study Difficult to Place Patients. The Commission ultimately passed Legislation that gave the Maine Long- Term Care Ombudsman …

Hepatitis C In Injection Drug Users: A Study Of A Detoxification Program In Maine, Meghan Rousselle

Muskie School Capstones and Dissertations

The opiate epidemic has had an impact on the lives of millions of people in this county. As we explore ways to address this issue, it is important to consider the long-term consequences that the epidemic will have. One long-term consequence is the spread of the hepatitis C virus (or HCV). Approximately 3.2 million people in the United States are chronically infected with this virus. Without consideration about ways to treat this virus and prevent its transmission, there will be large numbers of people who will die from complications of HCV in the future. These losses will contribute to the …

The Affordable Care Act’S Medicaid Expansion And Food Insecurity Rates, Mary Moran

Muskie School Capstones and Dissertations

Many Americans face difficult financial decisions, often regarding the allocation of limited resources. Household resources may be split among the costs of food, clothing, housing, transportation, childcare, utilities, and health care. For some households, this allocation may present a challenge to purchasing sufficient food, leading to food insecurity. Defined by the United States Department of Agriculture (USDA) as “a household-level economic and social condition of limited or uncertain access to adequate food” (2017), food insecurity may decrease when other financial-related aspects of life improve. An improvement in access to affordable health care, as seen through the recent Medicaid expansion under …

Direct Care Nursing Aide Turnover In Long-Term Care Facility, Qilian Luo

Muskie School Capstones and Dissertations

This capstone project, Direct Care Nursing Aide Retention in a Long-Term Care Facility, will uses both qualitative and quantitative analyses to identify the possible contributors to high nursing aide turnover rates in Maine. The quantitative analyses of this project are based on the staffing payroll data of one Maine assisted living facility. The final product of this capstone project will be shared with the study facility, in the hope that they may find uses for its content.

A Qualitative Assessment Of New Graduate Nurse Practitioners First Year Of Practice, Alex Beggs Rn, Msn

Muskie School Capstones and Dissertations

This project serves as a Capstone and final requirement for the Master of Public Health Degree at the University of Southern Maine Muskie School for Public Service. The project is a qualitative inquiry into the experience of new graduate nurse practitioners’ in their first year of practice, and their transition from the registered nurse (RN) into the nurse practitioner (NP) role. Using the theoretical constructs of Benner’s “From Novice to Expert” and the Burch’s “Conscious Competence model” new graduate nurse practitioners’ experiences will be analyzed. Risk and protective factors for role confidence will be identified through the use of qualitative …

New Outpatient Experience Survey Design: A Quality Improvement Case Study, Nathan Paluso

Muskie School Capstones and Dissertations

The purpose of this capstone project is to evaluate the implementation process for a new survey methodology introduced by Maine Medical Partners (MMP), by following the Plan-Do-Study-Act (PDSA) quality improvement cycle framework. This new survey has been implemented to collect data on patients’ experiences in the MMP outpatient facilities, and is offered to the patients via iPad at check-out after their appointment. Through observation at MMP practices and MMP staff interviews, strengths and weaknesses of the implementation process have been identified. Evidence-based solutions pertaining to the identified weaknesses have been selected through a literature review and are incorporated in recommendations …

A Guide For Assessing Older Adults’ Needs On Maine Islands, Beatrice Byrne

Muskie School Capstones and Dissertations

This template may help Maine island communities identify older adults’ needs and island resources, in order to allow older adults to age in the island communities.

Three interviews with island health leaders, one community conversation with older islanders, and one pilot test provided information about what to include in the template.

The template includes a demographic survey, guides for conducting semi-structured interviews and group conversations with older adults and caregivers, a guide and worksheet for analyzing the data, a guide for assessing community resources, a guide for dissemination, and a list of additional resources.

Assessment Of The Use Of Overdose Education And Naloxone Distribution By Maine Buprenorphine/Naloxone Prescribers, Stephen Kirsch

Muskie School Capstones and Dissertations

Background: Overdose deaths, specifically related to opioids, have been identified as a public health problem both nationally and in the state of Maine. Overdose Education and Naloxone Distribution (OEND) is an innovative model of patient education that has been shown to be effective in increasing knowledge of overdose risk and has the potential to help reduce opiate related overdose deaths.

Methods: A 28-item web-based survey examining clinician attitudes, OEND practices and characteristics was distributed to 196 Maine based physicians with a Drug Enforcement Agency waiver to prescribe burprenorphine/naloxone. Facilitators and barriers to the provision of OEND were also assessed. Surveys …

Urine Cotinine In Children And Parental Behavior Modification: A Pilot Study, Teresa Lachance

Muskie School Capstones and Dissertations

“Urine Cotinine in Children and Parental Behavior Modification” was designed by Dr. Deirdre Burns, a pediatrician at the Barbara Bush Children’s Hospital (BBCH). It was implemented as a pilot study to determine whether urine cotinine testing in children who are admitted to the hospital for respiratory illness and tracking parental smoking behaviors over time was feasible. Parents were given a brief survey to assess their current smoking behaviors and to understand their readiness to quit smoking. They received smoking cessation materials provided by the Breathe Easy Coalition of Maine. These materials outline information about second-hand and third-hand smoke, and encourage …

Monhegan: A Prescription For Resilience, Kenneth Paul Kiel Gross

Muskie School Capstones and Dissertations

Monhegan, like many island communities, is threatened by the loss of population as its young adults migrate to the mainland. The purpose of this study is to develop a resilient population on Monhegan Island.

Knowing the problem is easy, as is asking the obvious question, “How do we get people to move to this area?” This is a problem that confronts not only Monhegan, but also other Maine islands and even Maine itself.

Several factors make Monhegan’s future uncertain. The first is the gradual shift from commercial fishing, the mainstay of its economy, as it becomes more reliant on tourism …

Implementing A Good Catch Program In Nursing Homes, Leigh Raposo

Muskie School Capstones and Dissertations

Rationale and processes for reporting near misses and evidence-based tools were collected by a literature search, seminal works by Sidney Dekker and James Reason, and websites for the Agency for Healthcare Research and Quality (AHRQ), the Institute for Healthcare Improvement (IHI), and the Centers for Medicare and Medicaid Services (CMS). Tools, information, and strategies found in this research were evaluated for implementation in Maine nursing homes. The tools provide a communication vehicle for nursing home staff to safely report to management near misses, or mistakes that do not harm residents. To emphasize a positive approach, the project replaces the term …

Capstone Summary Report, Kayla Blais

Muskie School Capstones and Dissertations

Leadership is vital to the practice of public health. The following review of current literature delves into present understanding of leaders that the public health field needs. As leadership within public health is being explored, specific skills required of future leaders, different types of leaders, and the impacts we can expect to see are being defined.

An Analysis Of Women’S Access To Acute Opioid Detoxification Services In Maine: Identifying The Barriers To Treatment, Karen E. Conley

Muskie School Capstones and Dissertations

The lack of treatment facilities and services for opioid use disorder in Maine, combined with an increased prevalence of addiction, creates a potential for health inequity between men and women that may be intensified by barriers in access to care. This capstone study utilized detoxification screening inquiry forms and data obtained from the Milestone Foundation’s acute opioid detoxification program to assess and categorize barriers to access by gender. A barriers model was developed based on existing literature and was to identify potential associations among and between the known barriers to accessing treatment. Barriers were described as internally or externally based, …

Expanding Access To Naloxone In Maine: Opportunities And Barriers, Kate E. Richardson

Muskie School Capstones and Dissertations

The Centers for Disease Control and Prevention have declared prescription drug abuse a national epidemic (Office of National Drug Control Policy, 2014). In addition to strategies designed to prevent opioid abuse and misuse, many public health officials, policy makers, healthcare providers and harm reduction task forces seek to increase access to naloxone, a prescription drug known to reverse the effects of an opioid overdose. This report provides an overview of the barriers and opportunities for the state of Maine to expand access to the opioid antagonist, naloxone, in an effort to reduce fatal opioid drug overdose rates.

Policy Options For Recruiting And Retaining Rural Primary Care Physicians In Maine, Casey Lancaster

Muskie School Capstones and Dissertations

Maine faces a challenge providing primary care services to over half of its residents, as they live in rural areas – even though Maine has enough primary care physicians practicing in the state to service the needs of the population. Maine has a primary care physician distribution problem. Androscoggin, Oxford, Sagadahoc, Somerset, Waldo, Washington, and York Counties, all fall well below the national average of primary care physicians per 100,000 residents. Maine has no true financial incentive program to help rural area’s recruit and retain primary care physicians, though Maine does have two programs that attempt to get primary care …

Foodborne Illness Risk Factor Study, Kathi-Anne M. Fortin

Muskie School Capstones and Dissertations

The initial purpose of this capstone was to establish a baseline for the occurrence of the top five foodbome illness risk factors, to write a report on the baseline findings and to develop a plan to repeat this study at least once every 60 months for the Portland Environmental Health & Safety Program. It soon became clear, however, that the scope was too broad. An extensive effort was required to integrate national methodology and comparability principles with the State and local restaurant inspection structure. Subsequently, the focus of the capstone shifted to the development of a comprehensive data collection manual. …

Why Waste Waste? A Strategic Plan To Achieve Zero Waste In Portland, Maine, Nathan J. Broaddus

Muskie School Capstones and Dissertations

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An Assessment Of The Built Environment And Inclusivity Of Older Adults In Community Planning In Portland, Maine, Elizabeth A. Bissonnette

Muskie School Capstones and Dissertations

This paper focuses on this assessment specific to four: civic participation, housing, transportation, and outdoor spaces and buildings. Four others targeted for study by others include respect and social inclusion, communication and information, community and health services, and social participation. Each domain is reviewed from the perspective of older adults and older although this assessment also benefits people of all ages and abilities. Some data and references were only available with population breakouts of those aged 65 years and older and are noted appropriately.

Visualizing Road Network Congestion To Inform Regional Planning In Southern Maine, G Andrew Smith-Petersen

Muskie School Capstones and Dissertations

In this analysis, road traffic volumes and capacity estimates are used in conjunction with population data and population change forecasts to visualize the potential for congestion at present, and to project the potential for congestion in 2030. The areas most and least at risk of congestion are identified, so as to inform thought and effort around planning on a regional scale in southern Maine. The area of study includes large portions of York and Cumberland Counties, as well as a small portion of Androscoggin County, in the Greater Portland region.

Using Chipra Immunization Measures For Primary Care Quality Improvement: Leveraging Registry Data From The State Of Maine’S Immunization Information System To Calculate Practice-Level Quality Measures, Kyra Chamberlain

Muskie School Capstones and Dissertations

This report describes key challenges and successes of a federally-funded, cross-organizational effort to use registry data from the State of Maine’s Immunization Information System to calculate childhood and adolescent immunization measures in support of a nine-month, multi-practice learning collaborative which resulted in significant increases in immunization rates and adoption of recommended immunization-related office system procedures. Also highlighted are lessons learned about promoting the use of standardized immunization measures for quality improvement (QI), supporting primary care practices in using and understanding data for QI activities, and emphasizing the value of public-private collaboration in achieving shared goals.

Characteristics Of Working Supplemental Nutrition Assistance Program Recipients In Maine, According To The 2011 American Community Survey, Victoria Ryan

Muskie School Capstones and Dissertations

The Supplemental Nutrition Assistance Program (SNAP) is a federal program administered by the United States Department of Agriculture (USDA). SNAP is designed to provide assistance in purchasing food to low income households in the United States. In Maine, individual benefits are administered by the Maine Department of Health and Human Services. Formerly (and still colloquially) known as the Food Stamp program, SNAP makes a dollar-value benefit, based on income, household size, household expenses, and a host of other factors, available to households via a debit or Electronic Benefit Card for the purchase of unprepared food from grocery and convenience stores, …

Human Trafficking In Maine: Protection, Prevention, And Prosecution: The Need For A Stand-Alone Statute, Laura M. Cyr

Muskie School Capstones and Dissertations

The United States enacted the Trafficking Victims Protection Act (TVPA) of 2000 to combat the crime of organized firms engaging in the trafficking of humans. The TVPA has resulted in competing definitions and competing agendas which contribute of a public misunderstanding of the nature and scope of human trafficking as a domestic policy issue. Early goals of protection of victims, prevention of future trafficking crimes, and prosecution of traffickers have not been met with empirically driven success. This paper outlines obstacles facing evidence-based legislation in the state of Maine which currently has no stand- alone law protecting victims of sex …

The Price Of A Healthy Diet: For Whom Is It Affordable?, Katheryn L. Harkleroad

Muskie School Capstones and Dissertations

This exploratory study addressed the gaps that current research has ignored. What have been missing are studies that focus on tangible costs of realistic, practical, and healthy meal plans. This study was not intended to measure a national average cost of eating a healthy diet. Rather, its focus was to examine the cost of healthy diet in a specific location.

Strategic Planning In The Non Profit Sector: Creating A Strategic Plan For Affinity 2014-2017, Emilee Taplin-Lacey

Muskie School Capstones and Dissertations

The purpose of engaging in the creation of a strategic plan for Affinity is to integrate knowledge acquired through participation in the Public Policy and Nonprofit Management Master’s Degree program at the Muskie School of Public Service. In addition, my facilitation of a strategic planning process for Affinity is meant to meet the requirements of graduation and represents my capstone project in this regard.

Recreation And Tourism In Maine’S Moosehead Lake Region: A Survey Of Summer Visitors, Erica Kaufmann

Muskie School Capstones and Dissertations

This study hoped to shed light on the overall importance of outdoor recreation to attracting overnight visitors to Maine’s Moosehead Lake region, including how many come to participate in outdoor recreation and what kinds of activities they participate in. The study also hoped to learn where visitors recreate most in the region, how they obtain information about where to recreate, and whether visitors distinguish between public and private lands that are accessible for recreation.

Improving Home Suitability For Aging In Place: A Review Of Programs To Assist Maine's Seniors Make Necessary Home Repairs And Energy Efficiency Updates, Andrea Westbye

Muskie School Capstones and Dissertations

With its median age of 42.7 years, Maine is the oldest state in the nation and it is getting older. The population 65 and older is growing at a rapid pace and this expansion presents many challenges to communities, particularly in the area of housing. Most seniors want to stay in their homes for as long as possible and adequate, accessible, safe, and affordable housing is a primary factor for successful aging in place. Low income seniors face additional difficulties when aging in place. This paper looks at the availability of home repair/modification and energy efficiency programs for Maine’s low …