Matching Items (20)
130982-Thumbnail Image.png
Description
Individual control of sensitive health information is a matter of great concern to patients, practitioners, insurers and policymakers. Federal and state law generally supports consent approaches that allow patients to share all or none of their health data. However, research demonstrates that patients prefer more detailed control of their personal

Individual control of sensitive health information is a matter of great concern to patients, practitioners, insurers and policymakers. Federal and state law generally supports consent approaches that allow patients to share all or none of their health data. However, research demonstrates that patients prefer more detailed control of their personal data sharing. In particular, little is known about data sharing preferences of patients with behavioral health conditions (BHCs). This study will explore the technical feasibility of supporting patient-driven, consent-based data access through a preliminary analysis of data collected from the My Data Choices e-consent tool. Through these findings, this research seeks to inform stakeholders about the clinical, ethical, policy, and regulatory implications of broader consent choices.
ContributorsKaing, Tina C. (Author) / Grando, Maria Adela (Thesis director) / Murcko, Anita (Committee member) / College of Health Solutions (Contributor, Contributor) / Barrett, The Honors College (Contributor)
Created2020-12
168816-Thumbnail Image.png
Description
The traditional model of assessing and treating behavioral health (BH) and physical health (PH) in silos is inadequate for supporting whole-person health and wellness. The integration of BH and PH may result in better care quality, patient-provider experiences, outcomes, and reduced costs. Cross-organizational health data sharing between BH and PH

The traditional model of assessing and treating behavioral health (BH) and physical health (PH) in silos is inadequate for supporting whole-person health and wellness. The integration of BH and PH may result in better care quality, patient-provider experiences, outcomes, and reduced costs. Cross-organizational health data sharing between BH and PH providers is critical to patients with BH conditions (BHCs). In the last few decades, many initiatives -including health information exchange organizations- have facilitated cross-organizational health data sharing. The current challenge is affording meaningful consent and ensuring patient privacy, two of the core requirements for advancing the adoption and use of health information technology (HIT) in the US. The Office of the National Coordinator for HIT (ONC) recommends that patients should be given granular control beyond the “share all” or “share none” approach widely used currently in consent practices. But there is no consensus on the variables relevant to promote granularity in data sharing to honor privacy satisfaction for patients. As a result, existing granular data sharing (GDS) studies use ad-hoc and non-standardized approaches to implement or investigate patient data sharing preferences. Novel informatics methods were proposed and piloted to support patient-driven GDS and to validate the suitability and applicability of such methods in clinical environments. The hypotheses were: H1) the variables recommended by the ONC are relevant to support GDS; H2) there is diversity in medical record sharing preferences of individuals with BHCs; and H3) the most frequently used sensitive data taxonomy captures sensitive data sharing preferences of patients with BHCs. Findings validated the study hypotheses by proposing an innovative standards-based GDS framework, validating the framework with the design and pilot testing of a clinical decision support system with 209 patients with BHCs, validating with patients the adequacy of the most frequently used sensitive data taxonomy, and systematically exploring data privacy views and data sharing perceptions of patients with BHCs. This research built the foundations for a new generation of future data segmentation methods and tools that advances the vision of the ONC of creating standards-based, interoperable models to share sensitive health information in compliance with patients’ data privacy preferences.
ContributorsKarway, George K (Author) / Grando, Adela Maria (Thesis advisor) / Murcko, Anita C (Committee member) / Franczak, Michael (Committee member) / Arizona State University (Publisher)
Created2022
158317-Thumbnail Image.png
Description
Sensitive data sharing presents many challenges in case of unauthorized disclosures, including stigma and discrimination for patients with behavioral health conditions (BHCs). Sensitive information (e.g. mental health) warrants consent-based sharing to achieve integrated care. As many patients with BHCs receive cross-organizational behavioral and physical health care, data sharing can improve

Sensitive data sharing presents many challenges in case of unauthorized disclosures, including stigma and discrimination for patients with behavioral health conditions (BHCs). Sensitive information (e.g. mental health) warrants consent-based sharing to achieve integrated care. As many patients with BHCs receive cross-organizational behavioral and physical health care, data sharing can improve care quality, patient-provider experiences, outcomes, and reduce costs. Granularity in data sharing further allows for privacy satisfaction. Though the subjectivity in information patients consider sensitive and related sharing preferences are rarely investigated. Research, federal policies, and recommendations demand a better understanding of patient perspectives of data sensitivity and sharing.

The goal of this research is to enhance the understanding of data sensitivity and related sharing preferences of patients with BHCs. The hypotheses are that 1) there is a diversity in medical record sensitivity and sharing preferences of patients with BHCs concerning the type of information, information recipients, and purpose of sharing; and 2) there is a mismatch between the existing sensitive data categories and the desires of patients with BHCs.

A systematic literature review on methods assessing sensitivity perspectives showed a lack of methodologies for characterizing patient perceptions of sensitivity and assessing the variations in perceptions from clinical interpretations. Novel informatics approaches were proposed and applied using patients’ medical records to assess data sensitivity, sharing perspectives and comparing those with healthcare providers’ views. Findings showed variations in perceived sensitivity and sharing preferences. Patients’ sensitivity perspectives often varied from standard clinical interpretations. Comparison of patients’ and providers’ views on data sensitivity found differences in sensitivity perceptions of patients. Patients’ experiences (family history as genetic data), stigma towards category definitions or labels (drug “abuse”), and self-perceptions of information applicability (alcohol dependency) were influential factors in patients’ sensitivity determination.

This clinical informatics research innovation introduces new methods using medical records to study data sensitivity and sharing. The outcomes of this research can guide the development of effective data sharing consent processes, education materials to inform patients and providers, granular technologies segmenting electronic health data, and policies and recommendations on sensitive data sharing.
ContributorsSoni, Hiral (Author) / Grando, Maria A (Thesis advisor) / Murcko, Anita C (Committee member) / Patel, Vimla L. (Committee member) / Chern, Darwyn (Committee member) / Arizona State University (Publisher)
Created2020
Description

Purpose: Assess provider perceptions on care coordination, collaboration, teamwork, and shared decision-making practices pre and post a brief educational intervention on interprofessional collaboration (IPC).

Background and significance: A lack of care coordination and active follow up in the outpatient setting of individuals living with mental illness places this population at high

Purpose: Assess provider perceptions on care coordination, collaboration, teamwork, and shared decision-making practices pre and post a brief educational intervention on interprofessional collaboration (IPC).

Background and significance: A lack of care coordination and active follow up in the outpatient setting of individuals living with mental illness places this population at high risk for developing various comorbidities. Care coordination across care providers and patients in a IPC, patient-centered treatment model of care is an intervention that can reduce this barrier to care.

Methods: At a behavioral health clinic in the southwestern United States (U.S.) twenty-two participants were assessed via the Collaborative Practice Assessment Tool (CPAT), before and after an educational presentation on IPC care. The CPAT is a tool that was developed to assess collaborative practice within teams and help identify needs for professional development.

Results: Statistical significance was found from pretest to posttest scores (t(21) = -1.936, p = .066). Statistical significance was found in two of the eight domains; mission, meaningful purpose, and goals (p = .009) and decision-making and conflict management (p = .058). Increases in posttest scores were seen in all eight domains.

Conclusions: Training behavioral health professionals in IPC practice and teambuilding may facilitate improved clinical team experiences and communication. Behavioral health professionals treating individuals living with serious mental illness (SMI), IPC training could prepare providers to work more effectively and efficiently in the delivery of patient-centered care in this population with complex health care needs.

ContributorsVioletta, Tina (Author) / Harrell, Liz (Thesis advisor)
Created2016-05-04
522-Thumbnail Image.png
Description

Introduction: Despite depression affecting one of every ten adolescents, primary care providers struggle to detect depression in affected individuals. Unmanaged early onset adolescent mood disorders have an increased potential to result in suicide, the second leading cause of death in adolescents. Referring all patients with a positive depression screen to

Introduction: Despite depression affecting one of every ten adolescents, primary care providers struggle to detect depression in affected individuals. Unmanaged early onset adolescent mood disorders have an increased potential to result in suicide, the second leading cause of death in adolescents. Referring all patients with a positive depression screen to a mental health specialist creates treatment delay and burdens already limited community resources.

Objective: The objective of this primary care practice transformation was to improve pediatric primary care provider confidence and behavior to support and deliver evidence-based behavioral healthcare for adolescents with mild to moderate depression.

Methods: An evidence-based adolescent depression education program was delivered to pediatric primary care providers in a small community setting. The program’s components included measures to identify and manage mild to moderate depression. Outcome measures included: 1. Provider knowledge, beliefs, and confidence measured pre- and post-intervention; and 2. Electronic health record documentation of provider adherence to guideline recommendations one, two, and three months post-intervention.

Results: Four providers participated in the intervention. The mean total score for the provider beliefs and knowledge from a 5-point Likert scale demonstrated a positive increase after the intervention (14.75 vs. 23.25, p = .068). The mean total provider confidence score achieved near significance as well (12.25 vs. 21.75, p = .066). Resultant behavior change in the providers did not reach statistical significance when the electronic health records of all adolescent well visits over a three-month period were assessed. Screening for depression at adolescent well visits
Adolescent Depression 3 increased from 0% to 84-90% post-intervention. Setting treatment goals upon detection of depression increased from 0% to 41% (p = .089). Providers appropriately administered active support 67% of the time when a patient was identified with mild depressive symptomology post-intervention. Providers complied with guideline recommendations with identified cases of moderate and severe depression (n = 2).

Conclusions: Pediatric primary care providers demonstrated some positive behavioral changes towards integrating behavioral healthcare into their practice after an educational session on the guidelines for adolescent depression.

ContributorsHuftalin, Tori (Author) / Jacobson, Diana (Thesis advisor)
Created2017-04-04
638-Thumbnail Image.png
Description

Aim: To determine the change in provider’s compassion fatigue after implementing an education-based intervention in behavioral health.

Materials and Methods: A four-part education-based intervention for compassion fatigue was implemented over the course of 16 weeks. The Professional Quality of Life instrument was used to measure compassion fatigue and compassion satisfaction.

Results: Although

Aim: To determine the change in provider’s compassion fatigue after implementing an education-based intervention in behavioral health.

Materials and Methods: A four-part education-based intervention for compassion fatigue was implemented over the course of 16 weeks. The Professional Quality of Life instrument was used to measure compassion fatigue and compassion satisfaction.

Results: Although not statistically significant, mean compassion fatigue scores decreased in the sample.

Conclusion: Based on these results, further exploration into the causative factors of compassion fatigue in behavioral health are recommended.

ContributorsPeeples, Elizabeth (Author)
Created2017-04-29
609-Thumbnail Image.png
Description

Background: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of those who use substances, their friends, family members, communities and nations. Screening, Brief Intervention (BI) and Referral to Treatment (SBIRT)

Background: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of those who use substances, their friends, family members, communities and nations. Screening, Brief Intervention (BI) and Referral to Treatment (SBIRT) provides an evidence-based (EB) framework to detect and treat SU. Evidence shows that mental health (MH) providers are not providing EB SU management. Federally grant-funded SBIRT demonstrated evidence of decreased SU and prevention of full disorders. Implementation outcomes in smaller-scale projects have included increased clinician knowledge, documentation and interdisciplinary teamwork.

Objective: To improve quality of care (QOC) for adolescents who use substances in the inpatient psychiatric setting by implementing EB SBIRT practices.

Methods: Research questions focused on whether the number of SBIRT notes documented (N=170 charts) increased and whether training of the interdisciplinary team (N=26 clinicians) increased SBIRT knowledge. Individualized interventions used existing processes, training and a new SBIRT Note template. An SBIRT knowledge survey was adapted from a similar study. A pre-and post-chart audit was conducted to show increase in SBIRT documentation. The rationale for the latter was not only for compliance, but also so that all team members can know the status of SBIRT services. Thus, increased interdisciplinary teamwork was an intentional, though indirect, outcome.

Results: A paired-samples t-test indicated clinician SBIRT knowledge significantly increased, with a large effect size. The results suggest that a short, 45-60-minute tailored education module can significantly increase clinician SBIRT knowledge. Auditing screening & BI notes both before and after the study period yielded important patient SU information and which types of SBIRT documentation increased post-implementation. The CRAFFT scores of the patients were quite high from a SU perspective, averaging over 3/6 both pre- and post-implementation, revealing over an 80% chance that the adolescent patient had a SU disorder. Most patients were positive for at least one substance (pre- = 47.1%; post- = 65.2%), with cannabis and alcohol being the most commonly used substances. Completed CRAFFT screenings increased from 62.5% to 72.7% of audited patients. Post-implementation, there were two types of BI notes: the preexisting Progress Note BI (PN BI) and the new Auto-Text BI (AT BI), part of the new SBIRT Note template introduced during implementation. The PN BIs not completed despite a positive screen increased from 79.6% to 83.7%. PN BIs increased 1%. The option for AT BI notes ameliorated this effect. Total BI notes completed for a patient positive for a substance increased from 20.4% to 32.6%, with 67.4% not receiving a documented BI. Total BIs completed for all patients was 21.2% post-implementation.

Conclusion: This project is scalable throughout the U.S. in MH settings and will provide crucial knowledge about positive and negative drivers in small-scale SBIRT implementations. The role of registered nurses (RNs), social workers and psychiatrists in providing SBIRT services as an interdisciplinary team will be enhanced. Likely conclusions are that short trainings can significantly increase clinician knowledge about SBIRT and compliance with standards. Consistent with prior evidence, significant management involvement, SBIRT champions, thought leaders and other consistent emphasis is necessary to continue improving SBIRT practice in the target setting.

Keywords: adolescents, teenagers, youth, alcohol, behavioral health, cannabis, crisis, documentation, drug use, epidemic, high-risk use, illicit drugs, implementation, mental health, opiates, opioid, pilot study, psychiatric inpatient hospital, quality improvement, SBIRT, Screening, Brief Intervention and Referral to Treatment, substance use, unhealthy alcohol use, use disorders

ContributorsMaixner, Roberta (Author) / Guthery, Ann (Thesis advisor) / Mensik, Jennifer (Thesis advisor) / Uriri-Glover, Johannah (Thesis advisor)
Created2019-05-02
Description
The Bedside Box of Play is a kit of play activities designed specifically for children experiencing hospitalization. 30 kits were delivered to the Child Life unit at a local hospital with materials provided in English and Spanish. It is a free resource informed by research to maximize the potential for

The Bedside Box of Play is a kit of play activities designed specifically for children experiencing hospitalization. 30 kits were delivered to the Child Life unit at a local hospital with materials provided in English and Spanish. It is a free resource informed by research to maximize the potential for healthy coping during a time that may be stressful or overwhelming. Activities were created intentionally to allow for creativity, direction of the activity by the child, and family engagement. My hope for the Bedside Box of play is that it provides children and families with an easy way to incorporate play into the hospital environment, while also promoting healthy child development and building coping skills to be used post-discharge. This creative project also outlines a potential framework for helping professionals to make play effective and accessible in a variety of settings.
ContributorsCywinski, Morgan (Author) / Krysik, Judy (Thesis director) / Kelly, Cara (Committee member) / Barrett, The Honors College (Contributor) / School of Social Work (Contributor)
Created2023-12
158838-Thumbnail Image.png
Description
There are federal mandates attached to funding for behavioral health programs that require the use of evidence-based treatments (EBTs) to treat mental health disorders in order to improve clinical outcomes. However, these EBTs have not been constructed with American Indian/Alaskan Native (AI/AN) populations. There are over 340 EBTs, and only

There are federal mandates attached to funding for behavioral health programs that require the use of evidence-based treatments (EBTs) to treat mental health disorders in order to improve clinical outcomes. However, these EBTs have not been constructed with American Indian/Alaskan Native (AI/AN) populations. There are over 340 EBTs, and only two outcome controlled studies have demonstrated effectiveness with AI/AN populations to treat mental health disorders. AI/AN communities often have to select an EBT that is not reflective of their culture, language, and traditions. Although EBTs are frequently used in AI/AN communities, little is known about the adaptation process of these interventions with the AI/AN population. For this study, a qualitative design was used to explore how American Indian behavioral health (AIBH) organizations in the Southwest adapted EBTs for cultural relevancy and cultural appropriateness. One urban and two tribal AIBH programs were recruited for the study. Over a six-week period, 24 respondents (practitioners and cultural experts) participated in a semi-structured interview. Transcripts were analyzed using the constant comparative analysis approach. As a result, four themes emerged: 1) attitudes towards EBTs, 2) how to build culturally competent clinical skills, 3) steps to adapt EBTs, and 4) internal and external organizational factors required to adopt EBTs. The four themes identify how to build a culturally responsive behavioral health program in Indian country and are the purview of this dissertation.
ContributorsPoola, Charlene (Author) / Segal, Elizabeth A. (Thesis advisor) / Mitchell, Felicia M. (Thesis advisor) / Oh, Hyunsung (Committee member) / Arizona State University (Publisher)
Created2020
126912-Thumbnail Image.png
Description

Seclusion and restraint (SR) continue to be used in psychiatric settings when a patient is a harm to self or others despite growing concern and calls to eliminate the practice due to its harmful, potentially life-threatening effects on patients. The purpose of this evidence-based project was to assist a hospital

Seclusion and restraint (SR) continue to be used in psychiatric settings when a patient is a harm to self or others despite growing concern and calls to eliminate the practice due to its harmful, potentially life-threatening effects on patients. The purpose of this evidence-based project was to assist a hospital in the southwestern United States decrease their seclusion and restraint rates among their adolescent patients. Trauma-informed care approaches have been shown to significantly reduce the incidence of SR in inpatient settings.

The nurses and behavioral health technicians (BHTs) received a two-hour trauma-informed care training in November of 2019. SR rates three months pre-training and post-training were compared. In the three months prior to the training, SR rates averaged 23.4 events per 1000 patient days. Comparatively, the three months after the training SR rates averaged 19.5 events per 1000 patient days. This shows a clinically significant decrease in SR rates after the TIC training. This evidence-based project (EBP) highlights the need to address this problem and gives an intervention option that can reduce harm for patients and address the needs of healthcare organizations seeking to improve patient care.

ContributorsNava, Lidice L. (Author) / Bucci, Aimee (Thesis advisor)
Created2020-05-03