Social and Behavioral Sciences Commons^™

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 …

Safe Routes For Portland: A Comparative Analysis Of The Walking School Bus Model For Maine Schools., Rebecca Spitko

Muskie School Capstones and Dissertations

This purpose of this paper is to identify the effects an increase in active transportation to and from school would have on both commuters and communities, and to examine how to create a successful environment for active transportation models in Maine.

An Assessment Of The Health Needs Of Maine Veterans And Their Access To Veterans Administration Health Care Services, Kristin Brawn

Muskie School Capstones and Dissertations

On a state level, only a few assessments have been conducted, which indicate that Maine veterans are also experiencing similar mental and physical health issues; however, it does not appear that the adequacy of Maine’s VHA services to meet the needs of Maine’s veterans has been comprehensively evaluated. It is unknown whether the physical and mental health needs of Maine’s veterans are currently being met. Therefore, this project proposes to determine if there is a similar problem among Maine’s veterans in regard to health issues and lack of access to VHA health services, as has been reported at the national …

Maine Child Welfare Ncands Data: An Available Tool In Efforts To Reduce Child Maltreatment, Leah A. Bruns

Muskie School Capstones and Dissertations

By not developing programming interventions in recognition of these evidence supported predictive variables, we risk the inevitable continuation of rising child abuse rates and fatalities. The importance of accurate Child Welfare Data cannot be underscored, if we can predict with great accuracy which children will likely be victimized, then we should be able to design targeted abuse prevention programs that will have a greater impact. In light of this research this capstone attempts to better understand child maltreatment, recurrence, and the current 4 child welfare service structure in Maine.

A Comparison Of A Value-Added Status Model Versus A Value-Added Growth Model For Identifying High Performing Maine Middle Schools, Ida A. Batista

Muskie School Capstones and Dissertations

This study focuses on the model developed for funding purposes since it is a high stake identification and has been the consistent method used for funding purposes within the state for at least the last ten years. The purpose of this study is to explore identification of higher performing Maine middle schools (grade 6 – grade 8) using student longitudinal data in a growth model evaluating growth versus the current value-added model of identification.

Super Pacs 2012, Joseph Miller

Muskie School Capstones and Dissertations

The 2010 Supreme Court ruling in the case of the Citizens United vs the Federal Election Commision dramatically changed how elections are financed in the United States. That landmark case let to the creation of Super Political Action Committees (Super PACs). These organizations have the ability to raise limitless amounts of money and spend thses funds however they see fit on candidtaes of their choosing.

This case study will test six hypotheses. These hypotheses deal with two major actions. The first action is the conduct of Super PACs and the manner in which they went about choosing races to involve …

A Vision For Berwick: A Case Study Of The Citizen Initiated Visioning Process For Downtown Redevelopment In Southern Maine, John Stoll

Muskie School Capstones and Dissertations

This Capstone follows the downtown redevelopment visioning process in Berwick from the initial presentation to Town Officials up until formal adoption as an addendum to the Comprehensive Plan. Berwick has a monumental task ahead of it as the Town looks to redevelop an 11 acre abandoned factory site that is located directly where a downtown should be. Residents of Berwick had to work with Town Staff to navigate a considerable amount of lingering controversy and to rebuild trust between the public and local government. Members of the Downtown Vision Committee worked tirelessly to reach out to the community through education …