Using the Rapid Assessment for Adolescent Preventive Services (RAAPS) to Screen for Risk Taking Behaviors of 13 to 18 Year-Olds in a Regional Family Practice Office

Risk-taking behaviors are a significant problem in the adolescent population and the three leading causes of mortality for adolescents are suicide, homicide, and unintentional injury (Heron, 2017). National organizations support screening for adolescent risk-taking behaviors and research demonstrates effectiveness of screening. This quality improvement (QI) project implemented the Rapid Assessment for Adolescent Preventive Services (RAAPS) screening tool at a regional family practice office as a vehicle to accomplish the objectives of increased identification of, and intervention for, risk-taking behaviors in adolescent patients. Included in the methods were baseline and implementation chart reviews that were used to assess the change in three measures related to intervention for risk-taking behaviors as a result of screening tool use: provider discussions with patients about RAAPS topics; follow-up appointment discussions; and referral discussions. The Promoting Action on Research Implementation in Health Sciences (PARiHS) Framework was utilized to guide implementation, which took place over 11 weeks. Discussions about helmet use and about having an adult to talk to increased significantly, and discussions about referrals to specialty providers increased significantly. It was found that using the RAAPS screening tool at this family practice office was feasible. Utilizing a team approach and identifying champions in implementation of the RAAPS was discovered to be beneficial for appropriate usage of the screening tool. An implication was that the RAAPS should become standard care at this office to best serve adolescent patients and potentially decrease rates of the top three leading causes of mortality in this age group

Depression in Low-Income Adolescents: Guidelines for School-Based Depression Intervention Programs

Adolescent depression is growing in interest to clinicians. In addition to the estimated 2 million cases of adolescent major depressive episodes each year, depressive symptoms in youth have become indicators of mental health complications later in life. Studies indicate that being low-income is a risk factor for depression and that socioeconomically disadvantaged teenagers are more than twice as likely to develop mental illnesses. Only an estimated 1 in 4 children with mental illnesses receive adequate help and 80% of these resources come through schools. Thus, this study focuses on establishing the importance of depression intervention programs in low-income high schools and designing novel guidelines for effective protocols. A compilation of expert opinion on depression screening, education, and treatment, as well as analysis of previously implemented school screening and awareness programs, are examined in order to understand key strategies. The results of this study finds that a multi-layered approach with screening, universal education, and interventions for those identified as being high-risk is most effective in addressing the mental health needs of low-income adolescents. To ensure feasibility and efficacy, screening should be conducted with a modified PHQ-a test and followed-up by timely clinical interviews by school psychologists. All students should receive universal depression education curriculum consisting of principles such as: depression literacy, asset theory, and promotion of help-seeking behaviors. Extending universal education to teachers would also be beneficial in promoting mental health communication and positive classroom environments. It is vital that those screening positive for depression or suicidality receive protocols geared towards high-risk youths, such as group Cognitive-Behavioral Therapy and facilitated mental health center referrals based on individual severity. Effectively addressing depression in school systems requires integration of mental health promotion, depression prevention, and psychotherapy—by taking this multidimensional approach, public health officials and school administrations can ensure that adequate resources are directed to those most in need

Feasibility and Comparative Effectiveness for the Delivery of the National Diabetes Prevention Program through Cooperative Extension in Rural Communities

The U.S. Cooperative Extension Service (CE) has potential to deliver the National Diabetes Prevention Program (NDPP) to rural residents with prediabetes. However, the CE remains underutilized for the delivery of NDPP. We compared the feasibility/effectiveness of the NDPP (0–6 mos.) delivered by CE personnel to rural residents with prediabetes using Zoom® (CE-Zoom®) or by our research staff using Facebook® (FB). Adults (n = 31, age ~55 years) were enrolled (CE-Zoom® n = 16, FB n = 15). Attendance did not differ significantly between groups (CE Zoom® = 69%, FB = 83%, p = 0.15). Participant retention was similar in the CE Zoom® (88%) and FB groups (87%). CE-Zoom® and FB® groups provided weekly, self-monitoring data for 83% and 84% of the 24 potential weeks, respectively. Six-month weight loss was not different between groups (CE-Zoom® = −5.99 ± 8.0 kg, −5.4%, FB = −1.68 ± 3.3 kg, −1.6% p = 0.13). Participants achieving ≥5% weight loss was greater in the CE-Zoom® (44%) compared with the FB group (7%, p = 0.04). Participants achieving the NDPP program goal for physical activity (≥150 min/week) did not differ (CE-Zoom® = 75%, FB = 67%, p = 0.91). This pilot trial demonstrated the potential feasibility and effectiveness of the NDPP delivered by CE personnel in a group remote format (Zoom®) to adults with prediabetes living in rural areas

Continuing care groups: long term treatment of substance use disorders

Master's Project (M.Ed.) University of Alaska Fairbanks, 2014Substance use disorders are chronic diseases that affect individuals, families, and communities. These illnesses frequently require several courses of treatment to achieve abstinence. Inpatient chemical dependency treatment, followed by continuing care, increases abstinence rates regardless of the interventions used within the continuing care program. The largest barrier to successful continuing care programs appears to be patients' attendance and participation. This project aims to create a continuing care program that focuses on increasing patients' attendance adherence in order to support them through their first year of recovery

Meaning and Hope in Health Behavior Change: An Examination of Health Coaching for Individuals with Disabilities

Introduction:In an effort to expand the reach of health-promotion efforts for people with disabilities, a one-on-one health promotion intervention titled Health My Way was piloted. This intervention incorporated health coaching and health-promotion curriculum designed specifically for people with disabilities. Purpose:The intervention was evaluated for its effects on health behavior change. Additionally, personal sense of meaning and hope were examined as potential mechanisms of influence in the hypothesized behavior change process. Methodology:A convergent-parallel mixed-methods research design was used to examine the research questions. Pre- and post-intervention surveys were used to evaluate changes in levels of meaning, hope, and health behavior. Qualitative interviews were conducted with a subset of research participants to better understand the interactions among these variables. Results: Survey responses were available for 39 participants, 12 of whom were interviewed. A main effect of the overall intervention was seen on physical activity. Additional effects on health responsibility, nutrition, and spiritual growth were seen for participants who engaged in relevant curriculum content. No mediational effects were found; however, correlations between pre- and post-test hope scores were low relative to the reliability of the measure, and a portion of the variance seen in physical activity change was associated with changes in hope. Qualitative analysis revealed both meaning and hope were important to health behavior change. The identification of sources of personal meaning was important to the identification of personally meaningful goals and for the initial motivation for health behavior change. Hope was an important component of sustained health behavior change. Increases in hope were seen in some participants, however most participants who achieved their goals or sustained health behavior change experienced an increased only the agency component of hope. Conclusions: Individualized health coaching in the current study was found to be an effective method for improving health behavior in people with disabilities, with the strongest effects in the domain of physical activity. Within this process, personal sense of meaning and hope both functioned as active components. The identification of personally meaningful goals and the generation and maintenance of hope appear to be vital to successful health behavior change via health coaching

Online communities of practice as a strategy for staff involvement in SWITCH

Comprehensive School Physical Activity Programs (CSPAP) target physical activity behaviors through the recommended “whole-of-school” approach which recommends staff from all areas of school should be involved in health promotion. The component of Staff Involvement is highly effective at improving student health behaviors; however, descriptive research in this area is limited. One program that focuses on supporting school staff to lead school wellness programing is SWITCH. It is recommended that school staff should be given opportunities for professional development that are ongoing and collaborative, and online communities of practice (CoP) have been shown to support staff in this way. Therefore, the purpose of this thesis is to examine the usefulness and feasibility of an online CoP as a resource for staff involvement in SWITCH. An online CoP was developed for school staff, extension members and the SWITCH team to interact and share resources and best practices. The sample consisted of 70 school staff and members of extension, ages 18-69, with the majority being classroom teachers (32.9%) and extension members (21.4%). Feasibility and usefulness of the CoP was measured with number of posts and comments (ning platform throughout the 12 weeks of SWITCH implementation); page views and average time of visits (Google Analytics throughout implementation); perceived value, support, sense of belonging and perceived barriers (Qualtrics survey upon completion of implementation); and self-reported use and importance (checkpoint survey midway and satisfaction survey upon completion of implementation). Descriptive statistics were used for all variables and correlations for intention, value, belonging, support, and obstacles Overall visits and average time spent per visit was high with 620 total sessions, 4.67 pages viewed per session, and 3.3 minutes average session duration. Thirty-seven percent of members showed somewhat to high engagement. The CoP was perceived as highly valued and interesting (M=4.32 on a 5-point scale). Members perceived a sense of belonging (M=4.09 on a 5-point scale) and reported intentions to use it in the future (79.1%). Intention to continue to use the CoP was significantly correlated with sense of belonging (especially with trust from the SWITCH team), as well as value and interest in the CoP and perceived support. Perceived obstacles for using the CoP were overall low (M=1.94 on a 4-point scale) with the highest obstacles relating to effort, usability, and self-competence. Significant negative correlations existed between all obstacles and support, belonging, value and interest, similarity, and trust. This thesis supports the usefulness and feasibility of an online CoP as a tool for SWITCH programming. Members perceived it as valuable and important, and overall obstacles were low. Communities of practice are viewed as a tool to support teachers and provide ongoing collaborative learning opportunities. The present thesis supports the use of online communities of practice in the implementation of SWITCH and their potential as a tool for staff involvement in CSPAP programming

A Group Protocol for Promoting Wellness in Rural Community-Dwelling Older Adults

Purpose: In the United States, there are currently 46 million citizens aged 65 and older. This number is projected to more than double by the year 2060 (Mather, 2016). As the elderly population continues to grow, the need for evidence-based, client centered prevention programs for community-dwelling older adults becomes more crucial to promote independence and preserve well-being in the community. Older adults living in rural areas are at an even higher risk of losing independence secondary to decline in activity tolerance, which further elevates their need for targeted interventions (Park, Kim, & Lee, 2015). Creating a preventative program to maintain independence will help increase engagement in meaningful occupations and prolong older adults’ ability to age in place (Harrell, Lynott, Guzman, & Lampkin, 2014). Therefore, the purpose of this scholarly project was to develop a group protocol to address the need for occupation-based interventions in rural community-dwelling older adults. Methodology: An extensive literature review on the rural community-dwelling older adult population and factors affecting the population’s wellness was conducted using the search databases PubMed and CINAHL. Government and non-profit centers for information regarding aging were also used for the literature review and the development of educational materials for older adults. To guide the creation of the product, the Model of Human Occupation (MOHO) was used. Results/Conclusions: A 12-week group protocol was created to promote independence and community engagement in older adults living in rural communities. Each session focuses on an occupation that research has shown plays a role in the wellness of older adults. This group protocol is intended to be implemented by occupational therapists working in rural communities as a community-based wellness promotion group intervention. Information is included for the facilitator regarding MOHO concepts and facilitation techniques

Enhancing Coping Skills in Adolescents: A Program Evaluation of the Middletip Program

In the last decade of the 20th century, several large-scale studies suggested that the developmental trajectory for students diagnosed with emotional disturbance is bleak. Middletip School (MTS) is an alternative day treatment program that serves emotionally disturbed (ED) students (ages 12-19) through a daily offering of academic classes, and counseling and treatment groups. Using individually tailored, strength-based programming, MTS is designed to help ED youth in the areas of emotion regulation and behavior management, with a focus on building coping, relational, social, and communication skills. This dissertation project was a program evaluation in a natural setting examining the processes of assessment, treatment, and integration of knowledge by MTS while serving their ED students. It examined whether MTS accounts for individual differences (IDs) when implementing their program to enhance coping skills. It was anticipated that results from the program evaluation will help MTS explore the extent to which their practices embody best practice standards in the field. The Utilization-Focused Evaluation (U-FE) model employed here was process-focused, improvement oriented, formative, and used primarily qualitative methods. Thirty-seven MTS staff members were recruited to describe assessments, educational and mental health interventions, and organizational communication practices at MTS. Results revealed that MTS appears to attain fidelity to best practice standards in their treatment process. Their prioritization of clinical services and inclusion of transitioned-aged services place them as innovators in the field. MTS also achieves fidelity in training; multidisciplinary inclusion throughout the assessment process; and their longitudinal approach to monitoring and reviewing student growth toward academic and clinical goals. MTS is a culturally competent program when engaging in assessments and treatment. MTS did not achieve fidelity in training for assessment or standardized methods of assessment. MTS needs to improve in their use of assessments through increased training on monitoring, measuring, and documenting clinical growth. MTS also needs to have extensive, in-depth training in assessment and use standardized assessment measures to determine program effectiveness. MTS would further benefit from continued development in the implementation of a multidisciplinary and longitudinal approach, more reliable informal methods of communication, and an enhanced supervision model

A comprehensive program plan for providing therapeutic recreation services in a private practice setting

The purpose of this project was to create a comprehensive program plan and operations manual as an example of a private practice in therapeutic recreation. One goal was to provide a fresh approach to therapeutic recreation, one that embraces a strengths-based paradigm in a holistic environment nurturing the six domains of well-being and the aspirations of individuals served. To operationalize this goal, a thorough review of literature was undertaken and reported on; theoretical foundations and practice models were explored and selected; guiding principles, goals, and objectives were identified; a comprehensive program plan as well as specific intervention plans were created; target populations were identified based on a needs assessment; and best business practices were determined. The outcome is a private practice model that serves as a blueprint for other practitioners to expand upon or reformulate to implement a therapeutic recreation practice. InnerVision Therapeutic Leisure Services and Wellness Coaching, LLC is the end-product of this project. The Operations Manual highlights three specific intervention protocols: Body Luv!, Optimize!, and RetireEase! Also included are protocols for referrals, intake, assessment, planning, implementation, completion, documentation, evaluation, staffing,budgeting, financing, risk management, marketing, and business structure

Sib Kinnect: supporting siblings of children with disabilities using a telehealth approach

Current evidence-based literature regarding the experiences of siblings of children with disabilities acknowledges that siblings have diverse experiences and that it is unclear to what extent siblings are negatively impacted. (Emerson & Giallo, 2014; Giallo, Roberts, Emerson, Wood, & Gavidia-Payne, 2014; Goudie, Havercamp, Jamieson, & Sahr, 2013; Neely-Barnes & Graff, 2011). Yet the literature also emphasizes that a substantial portion of siblings experience emotional and social difficulties and are in need of clinical services that better address their challenges. The aim of this doctoral project is to create an evidence-based and theoretically grounded program that supports siblings through the use of telehealth. Telehealth has previously been used with youth, mostly to address chronic conditions, and demonstrated comparable, and sometimes superior, outcomes when using telehealth as opposed to face-to-face treatment (Dougherty, Lipman, Hyams, & Montgomery, 2014; Gettings, Franco, & Santosh, 2015; Letourneau et al., 2012). The objectives of Sib Kinnect, the proposed program, are to use telehealth to increase knowledge about disability, promote development of meaningful interests, improve coping and problem solving skills, and provide an enjoyable experience in which siblings can connect and learn from each other. The eight-week manual-guided program is designed for siblings, ages 10-12, of children with developmental disabilities and will include fun, age-appropriate activities and discussions that address the desired outcomes in a format that is enjoyable and engaging. In order for this program to be implemented, this project will also discuss important operational components such as the evaluation plan, information dissemination, staffing, and fundin