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- Creators: Arizona State University
- Creators: Johnson, William G.
- Creators: Bautista, Hija Mae
- Resource Type: Text
Using the behavior analytic model, this dissertation explores the challenging and supportive situations former foster youth experience with mental health services while transitioning to adulthood. Qualitative interviews and focus groups inform the development of a quantitative instrument in a mixed methods, sequential exploratory research design. The resulting instrument identifies the most intense and frequently encountered situations former foster youth experience, related to their mental health and transitions to adulthood.
Results indicate the most challenging situations foster youth experience during the transition are related to overwhelming expectations, receiving mixed messages from professionals, feelings of isolation, and a lack of voice and choice with regard to mental health services. Young adults in this study also emphasized the importance of responsive engagement, self-efficacy, and consistency in relationships both formally and informally.
This research provides important implications for social work practice, policy, and education. Acknowledging the voice of foster youth gives them a choice in services and allows for realistic transition planning. Developing problem-solving skills and a support network beyond foster care are necessary strategies of preparation to age out. Finally, practitioners should recognize the impact of trauma and other contextual factors when conducting assessment and treatment, to promote positive outcomes.
Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care setting. The Medicare Incentive Program is the platform for this initiative. This quantitative project used a valid and reliable pre and posttest design that consisted of 27 items on a Likert-scale. A 3.5-month chart audit (n=91) was conducted to assess the completion rate. Descriptive statistics was used to describe the demographic data.
The results of the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -2.37, p = .018. There was a significant increase in the post-readiness to change average scores. A Mann Whitney test was used to analyze the statistically significant difference between the averages in two ACP types and electronic health record documentation (EHR). Staff did not always code (Mdn = 0.00) but they documented in the EHR (Mdn =1.00; 512.00, p = 0.003). ACP discussion was performed 63% of the time during Annual Wellness Visits (AWV), and there was a 49% increase in the EHR documentation. Trained staff are key stakeholders in guiding ACP conversations. They understand the barriers, impact, and consequences related to the lack of advance directives.