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Advancing the Implementation of Medication-Assisted Treatment in Residential Treatment

Description

Abstract
Objective: To assess the attitudes and knowledge of behavioral health technicians (BHTs)
towards opioid overdose management and to assess the effect of online training on opioid
overdose response on BHTs’ attitudes and knowledge, and the confidence to identify and
respond to opioid overdose situations.

Design/Methods: Pre-intervention Opioid Overdose Knowledge Scale (OOKS) and Opioid
Overdose Attitude…

Abstract
Objective: To assess the attitudes and knowledge of behavioral health technicians (BHTs)
towards opioid overdose management and to assess the effect of online training on opioid
overdose response on BHTs’ attitudes and knowledge, and the confidence to identify and
respond to opioid overdose situations.

Design/Methods: Pre-intervention Opioid Overdose Knowledge Scale (OOKS) and Opioid
Overdose Attitude Scale (OOAS) surveys were administered electronically to five BHTs in
2020. Data obtained were de-identified. Comparisons between responses to pre-and post-surveys questions were carried out using the standardized Wilcoxon signed-rank statistical test(z). This study was conducted in a residential treatment center (RTC) with the institutional review board's approval from Arizona State University. BHTs aged 18 years and above, working at this RTC were included in the study.

Interventions: An online training was provided on opioid overdose response (OOR) and
naloxone administration and on when to refer patients with opioid use disorder (OUD) for
medication-assisted treatment.

Results: Compared to the pre-intervention surveys, the BHTs showed significant improvements
in attitudes on the overall score on the OOAS (mean= 26.4 ± 13.1; 95% CI = 10.1 - 42.7; z =
2.02; p = 0.043) and significant improvement in knowledge on the OOKS (mean= 10.6 ± 6.5;
95% CI = 2.5 – 18.7; z =2.02, p = 0.043).

Conclusions and Relevance: Training BHTs working in an RTC on opioid overdose response is
effective in increasing attitudes and knowledge related to opioid overdose management. opioid
overdose reversal in RTCs.

Keywords: Naloxone, opioid overdose, overdose education, overdose response program
ContributorsQuie, Georgette (Author) / Guthery, Ann (Thesis advisor)
Created2021-04-12
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Preschool Teacher Training on Trauma and Resilience

Description

Childhood traumatic experiences are a prevalent public health issue. Children exposed to trauma often exhibit behaviors that make educating them challenging. Preschool teachers at a southwestern United States preschool receive no training related to childhood trauma and resilience. The purpose of this project was to educate preschool teachers on trauma…

Childhood traumatic experiences are a prevalent public health issue. Children exposed to trauma often exhibit behaviors that make educating them challenging. Preschool teachers at a southwestern United States preschool receive no training related to childhood trauma and resilience. The purpose of this project was to educate preschool teachers on trauma and resilience to improve attitude related to educating children with trauma.

Following Arizona State University Internal Review Board approval, preschool teachers were recruited from a non-profit metropolitan preschool. Project included two pre-training questionnaires (Adult Resilience Measure-Revised [ARM-R] and Attitudes Related to Trauma Informed Care scale [ARTIC]), one two-hour training via Zoom on childhood trauma and resilience, and post-training ARTIC questionnaire at two and six weeks.

Seven teachers (n=7) participated in pre-training questionnaires, and three of these teachers (n=3) participated in both post-training questionnaires. All participating teachers were female and Caucasian. Average age of participants was 49.43 years (SD=8.40, range 36-60), and experience average was 17.17 years (SD=10.15, range 3-30). AMR-R average score was 72.29 (SD=8.28, range 61-83). Pre-training ARTIC score average was 3.87 (SD=0.16). Post-training ARTIC scores at two weeks and six weeks post-training were 3.65 (SD=0.22) and 3.86 (SD=0.25).

Clinical significance included improved teacher awareness of childhood trauma and improved ability to interact with children exposed to trauma. Teachers exhibited high resilience scores. Additional research needed related to further address educating preschool teachers related to trauma informed care, related to building resilience in children, and related to the impact of teacher resilience on trauma informed care.

Keywords: teacher training, adverse childhood experiences, ACEs, childhood trauma, resilience
ContributorsGuthery, Ann (Thesis advisor) / Christmas, Melissa (Author)
Created2021-04-12
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Alternative Design Approaches for Advancing Infrastructure Resilience

Description
Traditional infrastructure design approaches were born with industrialization. During this time the relatively stable environments allowed infrastructure systems to reliably provide service with networks designed to precise parameters and organizations fixated on maximizing efficiency. Now, infrastructure systems face the challenge of operating in the Anthropocene, an era of complexity. The…

Traditional infrastructure design approaches were born with industrialization. During this time the relatively stable environments allowed infrastructure systems to reliably provide service with networks designed to precise parameters and organizations fixated on maximizing efficiency. Now, infrastructure systems face the challenge of operating in the Anthropocene, an era of complexity. The environments in which infrastructure systems operate are changing more rapidly than the technologies and governance systems of infrastructure. Infrastructure systems will need to be resilient to navigate stability and instability and avoid obsolescence. This dissertation addresses how infrastructure systems could be designed for the Anthropocene, assessing technologies able to operate with uncertainty, rethinking the principles of technology design, and restructuring infrastructure governance. Resilience, in engineering, has often been defined as resistance to known disturbances with a focus on infrastructure assets. Resilience, more broadly reviewed, includes resistance, adaptation, and transformation across physical and governance domains. This dissertation constructs a foundation for resilient infrastructure through an assessment of resilience paradigms in engineering, complexity and deep uncertainty (Chapter 2), ecology (Chapter 3), and organizational change and leadership (Chapter 4). The second chapter reconciles frameworks of complexity and deep uncertainty to help infrastructure managers navigate the instability infrastructure systems face, with a focus on climate change. The third chapter identifies competencies of resilience in infrastructure theory and practice and compares those competencies with ‘Life’s Principles’ in ecology, presenting opportunities for growth and innovation in infrastructure resilience and highlighting the need for satisficed (to satisfy and suffice) solutions. The fourth chapter navigates pressures of exploitation and exploration that infrastructure institutions face during periods of stability and instability, proposing leadership capabilities to enhance institutional resilience. Finally, the dissertation is concluded with a chapter synthesizing the previous chapters, providing guidance for alternative design approaches for advancing resilient infrastructure. Combined, the work challenges the basic mental models used by engineers when approaching infrastructure design and recommends new ways of doing and thinking for the accelerating and increasingly uncertain conditions of the future.
ContributorsHelmrich, Alysha Marie (Author) / Chester, Mikhail V (Thesis advisor) / Grimm, Nancy B (Committee member) / Garcia, Margaret (Committee member) / Meerow, Sara (Committee member) / Arizona State University (Publisher)
Created2021
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A Proposal for Infrastructure Adaptation and Cascading Failures for Black Swans

Description
Infrastructure managers are continually challenged to reorient their organizations to mitigate disturbances. Disturbances to infrastructure constantly intensify, and the world and its intricate systems are becoming more connected and complex. This complexity often leads to disturbances and cascading failures. Some of these events unfold in extreme ways previously unimagined (i.e.,…

Infrastructure managers are continually challenged to reorient their organizations to mitigate disturbances. Disturbances to infrastructure constantly intensify, and the world and its intricate systems are becoming more connected and complex. This complexity often leads to disturbances and cascading failures. Some of these events unfold in extreme ways previously unimagined (i.e., Black Swan events). Infrastructure managers currently seek pathways through this complexity. To this end, reimagined – multifaceted – definitions of resilience must inform future decisions. Moreover, the hazardous environment of the Anthropocene demands flexibility and dynamic reprioritization of infrastructure and resources during disturbances. In this dissertation, the introduction will briefly explain foundational concepts, frameworks, and models that will inform the rest of this work. Chapter 2 investigates the concept of dynamic criticality: the skill to reprioritize amidst disturbances, repeating this process with each new disturbance. There is a dearth of insight requisite skillsets for infrastructure organizations to attain dynamic criticality. Therefore, this dissertation searches other industries and finds goals, structures, sensemaking, and strategic best practices to propose a contextualized framework for infrastructure. Chapters 3 and 4 seek insight into modeling infrastructure interdependencies and cascading failure to elucidate extreme outcomes such as Black Swans. Chapter 3 explores this concept through a theoretical analysis considering the use of realistic but fictional (i.e., synthetic) models to simulate interdependent behavior and cascading failures. This chapter also discusses potential uses of synthetic networks for infrastructure resilience research and barriers to future success. Chapter 4 tests the preceding theoretical analysis with an empirical study. Chapter 4 builds realistic networks with dependency between power and water models and simulates cascading failure. The discussion considers the future application of similar modeling efforts and how these techniques can help infrastructure managers scan the horizon for Black Swans. Finally, Chapter 5 concludes the dissertation with a synthesis of the findings from the previous chapters, discusses the boundaries and limitations, and proposes inspirations for future work.
ContributorsHoff, Ryan Michael (Author) / Chester, Mikhail V (Thesis advisor) / Allenby, Braden (Committee member) / Johnson, Nathan (Committee member) / McPhearson, Timon (Committee member) / Arizona State University (Publisher)
Created2023
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Pluvial Flood Risk Modeling, Assessment, and Management under Evolving Urban Climates and Land Cover

Description
Pluvial flooding is a costly, injurious, and even deadly phenomenon with which cities will always contend. However, cities may reduce their risk of flood exposure by changing historically dominant patterns of development that have removed natural landscape features and reduce the damages that flooding causes by identifying and supporting vulnerable…

Pluvial flooding is a costly, injurious, and even deadly phenomenon with which cities will always contend. However, cities may reduce their risk of flood exposure by changing historically dominant patterns of development that have removed natural landscape features and reduce the damages that flooding causes by identifying and supporting vulnerable populations. Accomplishing either goal requires the development and application of appropriate frameworks for modeling or recording flood exposure. In this dissertation, I used modeling and surveying methods for assessing pluvial flood exposure in two cities, first in Valdivia, Chile, and then in Hermosillo, México. I open with a summary on pluvial flood risk in the present day and the threat it may pose under changing climates. In the second chapter, I explored how a form of urban ecological infrastructure (UEI), the wetland, is being wielded in Valdivia toward pluvial flood mitigation, and found that wetland daily, seasonal, and interannual changes in wetland surface and soil water storage alter pluvial flood risk in the city. In the third chapter, I used a mixed methodology, including projections of future land cover generated by cellular automata models with inputs from visioning workshops conducted by the Urban Resilience to Extremes Sustainability Research Network (UREx SRN), and found that wetland loss in future land configurations may lead to increased pluvial flood risk. In the fourth chapter, I combined these land cover models from the third chapter with downscaled climate data on precipitation, also generated by the UREx SRN, and found that wetland conservation can help to mitigate the pluvial flood risk posed by changing patterns of rainfall. In the fifth chapter, I applied the Arc-Malstrøm method for pluvial flood assessment in Hermosillo, México, and compared it with the more traditional rational method for flood assessment, and through accompanying surveys found that perception of flood risk is significantly affected by flood dimensions and impacts. This dissertation concludes with a synthesis of pluvial flood risk assessment, suggestions for improvements to modeling, as well as suggestions for future research on pluvial flood risk assessment in cities. This dissertation advances the understanding of the utility of inland wetland UEI in cities under present and future land cover and climate conditions. It also qualifies the utility of common and new pluvial flood risk assessments and offers research directions for future pluvial flood assessments.
ContributorsSauer, Jason R (Author) / Grimm, Nancy B (Thesis advisor) / Chester, Mikhail V (Committee member) / Cook, Elizabeth M (Committee member) / Childers, Daniel L (Committee member) / Eakin, Hallie (Committee member) / Arizona State University (Publisher)
Created2022
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Promoting Self-Care Towards Resiliency and Well-Being: Addressing Burnout Among Mental Health Workers

Description
Purpose: To assess the burnout levels of mental health workers and to evaluate the effectiveness of promoting self-care practices in improving their well-being and resiliency. Background and Significance: Burnout is highly prevalent among mental health workers due to the nature of their work and the population of patients they serve. Turnover has been…

Purpose: To assess the burnout levels of mental health workers and to evaluate the effectiveness of promoting self-care practices in improving their well-being and resiliency. Background and Significance: Burnout is highly prevalent among mental health workers due to the nature of their work and the population of patients they serve. Turnover has been a significant problem within this specialty for decades. Before the COVID-19 pandemic, the mental health workforce was projected to experience shortage by 2025. The pandemic will likely worsen this. Evidence from literature supports the effectiveness of promoting self-care towards the development of resiliency and well-being in addressing burnout among healthcare workers. Methods: The Maslach Burnout Inventory – Human Services Survey (MBI-HSS) was used to assess the burnout levels of mental health workers in a psychiatric hospital in Arizona pre- and post-intervention. Educational modules were provided for each participant to review. They were asked to perform at least one self-care activity and to utilize the tools in the Provider Resilience application every week for four weeks. Results: Pre-intervention surveys indicated moderate levels of emotional exhaustion (m=20.71) and depersonalization (m=9.29) and high levels of personal accomplishment (m=28.71). Improvements were seen on emotional exhaustion (m=18.86), depersonalization (m=6.43), and personal accomplishment (m=33.86) were seen post-intervention. Conclusion: Although the results were not statistically significant due to small sample size, the improvements seen on two out of three components of burnout (emotional exhaustion and depersonalization) indicated that awareness of burnout levels and self-care practices contribute to improving the well-being of mental health workers.
ContributorsLim, Jerica Elaine M. (Author) / Guthery, Ann (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-26
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Preschool Teacher Training on Trauma and Resilience

Description
Childhood traumatic experiences are a prevalent public health issue. Children exposed to trauma often exhibit behaviors that make educating them challenging. Preschool teachers at a southwestern United States preschool receive no training related to childhood trauma and resilience. The purpose of this project was to educate preschool teachers on trauma and resilience to improve…

Childhood traumatic experiences are a prevalent public health issue. Children exposed to trauma often exhibit behaviors that make educating them challenging. Preschool teachers at a southwestern United States preschool receive no training related to childhood trauma and resilience. The purpose of this project was to educate preschool teachers on trauma and resilience to improve attitude related to educating children with trauma. Following Arizona State University Internal Review Board approval, preschool teachers were recruited from a non-profit metropolitan preschool. Project included two pre-training questionnaires (Adult Resilience Measure-Revised [ARM-R] and Attitudes Related to Trauma Informed Care scale [ARTIC]), one two-hour training via Zoom on childhood trauma and resilience, and post-training ARTIC questionnaire at two and six weeks. Seven teachers (n=7) participated in pre-training questionnaires, and three of these teachers (n=3) participated in both post-training questionnaires. All participating teachers were female and Caucasian. Average age of participants was 49.43 years (SD=8.40, range 36-60), and experience average was 17.17 years (SD=10.15, range 3-30). AMR-R average score was 72.29 (SD=8.28, range 61-83). Pre-training ARTIC score average was 3.87 (SD=0.16). Post-training ARTIC scores at two weeks and six weeks post-training were 3.65 (SD=0.22) and 3.86 (SD=0.25). Clinical significance included improved teacher awareness of childhood trauma and improved ability to interact with children exposed to trauma. Teachers exhibited high resilience scores. Additional research needed related to further address educating preschool teachers related to trauma informed care, related to building resilience in children, and related to the impact of teacher resilience on trauma informed care.
ContributorsChristmas, Melissa (Author) / Guthery, Ann (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-12