Matching Items (30)

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Implementation of Adolescent Depression Care Guidelines into the Electronic Health Record at a Rural Pediatric Primary Care Clinic

Description

Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice,

Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice, primary care providers (PCPs) must document effectively to ensure a complete treatment plan is in place in the patient’s electronic health record (EHR).

Intervention: Elements from a flowsheet were implemented into the EHR to promote thorough assessment and documentation of care delivered to adolescents with depression.

Methods: An initial chart review was completed on patients diagnosed with depression. An updated depression template was implemented within the EHR for six weeks. A follow-up chart review was completed post-intervention to determine if documentation of elements from the adolescent depression guidelines improved after the EHR update. Pre-intervention and post- intervention surveys were delivered to PCP’s to understand their perspective on adolescent depression management.

Outcomes: The chart review revealed that baseline PHQ-9 screenings were documented in 91% (n=43) of the charts reviewed in the pre-intervention timeframe. Only 78% (n=7) of the charts reviewed during post-intervention included PHQ-9 screenings. Early intervention treatment options documented in the pre-intervention timeframe included education 100% (n=47), medication prescriptions 53% (n=25), and psychotherapy referrals 18% (n=18). During post- intervention, education 100% (n=9), medication prescriptions 78% (7), and psychotherapy referrals 22% (n=7) were documented by the PCPs.

Recommendation: The quality improvement project focused heavily on documentation completed over a one year pre-intervention timeframe compared to a six-week post-intervention timeframe. Further evaluation and chart review over the next year will provide a more adequate comparison of documentation within primary care practice.

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2020-05-01

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Mental Health Training: Pathway to Early Mental Health Intervention

Description

There is an increase in the prevalence of mental health problems in the United States. Healthy People 2020’s leading mental health indicator is to increase the delivery of care to those with mental health issues and lower the number of

There is an increase in the prevalence of mental health problems in the United States. Healthy People 2020’s leading mental health indicator is to increase the delivery of care to those with mental health issues and lower the number of youth who experience a major depressive disorder. Teachers and non-teaching staff are well placed in the community to identify youth undergoing emotional distress and facilitate early interventions, yet do not receive adequate training in mental health.

A project was undertaken to determine if a mental health training intervention affected the community youth mentors knowledge, attitude and self-efficacy towards helping youth with mental health issues. Three instruments with good validity and reliability namely Mental Health Literacy Scale (MHLS), Attitudes to Severe Mental Illness (ASMI) scale, and Gatekeeper Behavior Scale were used in pre intervention, immediately post intervention and two weeks post intervention questionnaires. The Wilcoxon Signed Ranks test indicated changes in the pre and post intervention scores as significant in knowledge, and attitude between pre intervention and immediately post intervention time periods. Cohen’s effect size value suggested large, medium, small, and minimum clinical significance in the variables over period of time.

Mental health literacy narrows the gap between symptom onset and intervention. Numerous mental health trainings are currently available worldwide. Schools and after school clubs in collaboration with hospital mental health and other community agencies are better equipped to bridge the gap. School staff report better confidence in addressing mental health and behavioral health issues among youth when equipped with additional resources within the school in the form of psychologists, social workers, and counselors.

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2020-05-03

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Reducing Seclusion and Restraints in Adolescent Patients

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

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.

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2020-05-03

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Improving Adolescent Human Papillomavirus Vaccination Rates Through Provider Education

Description

Human papillomavirus (HPV) is a prevalent sexually transmitted infection that affects many adolescents and adults worldwide. The consequences of contracting HPV have proven to be devastating, potentially leading to a variety of life-threatening genitourinary and oral cancers. As such, prevention

Human papillomavirus (HPV) is a prevalent sexually transmitted infection that affects many adolescents and adults worldwide. The consequences of contracting HPV have proven to be devastating, potentially leading to a variety of life-threatening genitourinary and oral cancers. As such, prevention via vaccination is critical. HPV vaccination is recommended for all adolescents beginning at 11 years of age. Although the immunization has proven to be safe and effective, HPV vaccination rates are substantially below target goals worldwide.

A literature review of evidence from the last five years was conducted to examine barriers and facilitators to HPV vaccine uptake. The most commonly cited barriers to vaccination included lack of knowledge about the vaccine and inadequate provider recommendation. Current evidence regarding interventions to increase HPV vaccine uptake reveal that best practices are multi-factorial and should include a combination of provider education and recommendation training. These findings led to the proposal of an evidence-based intervention aimed to increase adolescent HPV vaccination rates.

A one-hour educational program was conducted at a local pediatric primary care facility. Five healthcare providers participated in the program, which consisted of a PowerPoint presentation outlining the benefits of HPV vaccination and use of an interactive application from the CDC. The app taught participants how to offer a strong recommendation for the vaccine through active participation. Pre and posttests were administered to determine the providers’ intent to vaccinate and vaccination rates were monitored. Analysis of the data collected revealed a statistically significant rise in vaccination rates. These results reveal that provider education can improve recommendation techniques and therefore increase vaccine coverage. Further research is needed to see if one-time education is sustainable.

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2020-04-28

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Feasibility of Cognitive Behavioral Therapy in the Treatment of Suicidality of Children

Description

Background: Suicidal ideation and attempts are increasing in the adolescent population and suicide is now the second leading cause of death for youth 10-24 years of age (Center for Disease Control and Prevention [CDC], 2016). Children that continue to struggle

Background: Suicidal ideation and attempts are increasing in the adolescent population and suicide is now the second leading cause of death for youth 10-24 years of age (Center for Disease Control and Prevention [CDC], 2016). Children that continue to struggle with suicidality and depression after treatment as usual have an increased length of stay, from an average of five days to nine days per admission. Recidivism rates are also increasing, with some patients
requiring readmission the same day as discharge.

Method: The purpose of project was to check the feasibility of the use of cognitive behavioral therapy-based group called Creating Opportunities for Personal Empowerment (COPE) in the treatment of children with depression and suicidality. The study patients participated in up to 7 groups of a 60-minute lesson of COPE each day, combined with interactive activities that helped
them practice problem solving and coping skills. The feasibility of the COPE groups were measured by the consistent decrease of Columbia Suicide Severity Rating Scale at the beginning and conclusion of lessons as well as consistency of engaged participation in the COPE groups on the unit based of staff observation obtained from Staff Survey.

Results: The results analyzed using the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -3.64, p < .001. This indicated that the differences between Pre-CSSR and Post-CSSR were not likely due to random post variation. The median of Pre-CSSR (Mdn = 1.00) was significantly lower than the median of Post-CSSR (Mdn = 2.00).

Discussion: The results proved feasibility of a cognitive behavioral therapy-based group in the treatment of depression and suicidality of children in an inpatient unit.

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2020-05-02

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The ",field_main_title:"hangout was serious business: exploring literacies and learning in an online Sims fan fiction community

Description

The purpose of this study is to explore the literacy practices members of an online fan community engage in to participate in the space and to question what learning happens through that participation. This dissertation is the product of a

The purpose of this study is to explore the literacy practices members of an online fan community engage in to participate in the space and to question what learning happens through that participation. This dissertation is the product of a two-year virtual ethnographic study of The Sims Writers' Hangout (SWH), a discussion forum website established by fans of The Sims to support members' interests in creating and sharing Sims fan fiction. Affinity space theory informs an understanding of SWH's organization, and a definition of literacies as situated, social practices also frames the study. Data were collected following a discourse-centered online ethnographic approach, which guided systematic observation and interactions with eight key informants. The data corpus includes hundreds of pages of discussion forum posts, member profiles, moderator-created norming texts, numerous digital, multimodal Sims fan fiction texts, virtual interview responses from informants, field notes, and additional virtual artifacts, such as informants' websites and Flickr® photostreams. Study results are presented within three separate manuscripts prepared for publication and presentation, each exploring different lines of inquiry related to SWH. Chapter 3 focuses on tensions visible in the forum discussions to argue for an expansion of affinity space theory that accounts for the “hanging out” members do in the space. Chapter 4 analyzes one informant's literacy practices using a Design perspective. This analysis reveals the collaborative nature of Sims fan fiction literacies. The final manuscript (Chapter 5) offers an analysis of SWH pedagogy using Bernstein's pedagogic device concept. Data illustrate how pedagogic discourse in this online, informal learning space aligns with and challenges Bernstein's theory. Finally, Chapter 6 offers conclusions about how these three analyses expand our understanding of adolescent literacies and 21st century learning. This chapter also contains implications for theory and practice, recommendations for future research, and reflections on lessons learned.

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Date Created
2011

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An examination of Mexican American adolescent and adult romantic relationships

Description

This dissertation examined Mexican American individuals' romantic relationships within two distinct developmental periods, adolescence and adulthood. Study 1 used latent class analysis to explore whether 12th grade Mexican Americans' (N = 218) romantic relationship characteristics, cultural values, and gender created

This dissertation examined Mexican American individuals' romantic relationships within two distinct developmental periods, adolescence and adulthood. Study 1 used latent class analysis to explore whether 12th grade Mexican Americans' (N = 218) romantic relationship characteristics, cultural values, and gender created unique romantic relationship profiles. Results suggested a three-class solution: higher quality, satisfactory quality, and lower quality romantic relationships. Subsequently, associations between profiles and adolescents' adjustment variables were examined via regression analyses. Adolescents with higher and satisfactory quality romantic relationships reported greater future family expectations, higher self-esteem, and fewer externalizing symptoms than adolescents with lower quality romantic relationships. Similarly, adolescents with higher quality romantic relationships reported greater academic self-efficacy and fewer sexual partners than adolescents with lower quality romantic relationships. Finally, adolescents with higher quality romantic relationships also reported greater future family expectations and higher academic self-efficacy than adolescents with satisfactory quality romantic relationships. To summarize, results suggested that adolescents engaged in three unique types of romantic relationships with higher quality being most optimal for their adjustment. Study 2 used latent growth modeling to examine marital partners' (N = 466) intra- and inter-individual changes of acculturative stress, depressive symptoms, and marital quality. On average across the seven years, husbands' acculturative stress remained steady, but wives' significantly decreased; partners' depressive symptoms remained relatively steady, but their marital quality significantly decreased. Although partners' experiences of acculturative stress were less similar than their experiences of depressive symptoms and marital quality, overall their experiences were interconnected. Significant spillover and crossover effects emerged between partners' initial levels of acculturative stress and depressive symptoms and between depressive symptoms and marital quality. Moreover, changes in husbands' depressive symptoms were negatively associated with changes in their marital quality. Overall, results suggested that partners' experiences were interconnected across time.

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Date Created
2014

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Adolescent motivation for healthy behaviors: a theory-based enhanced health curriculum for adolescents

Description

ABSTRACT

Adolescence is a period marked by significant physical, developmental, cognitive, and social changes, all of which contribute to health concerns for teens. A steady rise in life expectancy over the past two centuries is potentially diminishing due to the

ABSTRACT

Adolescence is a period marked by significant physical, developmental, cognitive, and social changes, all of which contribute to health concerns for teens. A steady rise in life expectancy over the past two centuries is potentially diminishing due to the increase in prevalence, severity, and consequences of obesity in children and adolescents related to unhealthy lifestyle behaviors. Health behaviors are often established during childhood and adolescence that continue into adulthood. The development and integration of healthy lifestyle behaviors are vital through adolescence. Self-determination theory (SDT) offers a theoretical framework for attempting to understand individual differences in motivation and behavior. Recent studies have primarily focused on how adolescents make choices related to eating behaviors, physical activity, and self-care habits, and how the resultant behaviors are measured. Participants in this study were 63 healthy adolescents enrolled in 9th grade health class. All participants provided baseline data at Time 1 and again following the five-week pretest posttest intervention study at Time 2. This study examined the utility of SDT in the development of the Adolescent Intrinsic Motivation, a healthy lifestyle behavior intervention, using the tenets of SDT to explain healthy lifestyle motivational beliefs in adolescents, along with healthy lifestyle behaviors and knowledge. The AIM intervention study introduced basic health recommendations to adolescents in an autonomy-supportive environment, which has been shown to encourage the adolescent to make healthy behavior choices based on their own interest and enjoyment. Preliminary effects of the study indicated that participants receiving the AIM intervention demonstrated significant differences in motivational beliefs, healthy lifestyle knowledge, as well as healthy lifestyle behaviors from Time 1 (baseline) to Time 2 (post-intervention). Results of this study provide support for the use of SDT to address the competence, relatedness, and autonomy of adolescents in the development of health education material. Testing this intervention in a larger, random sampling of schools within the state, or even in more than one state, with a three- or six-month follow-up would be useful in determining the longer-term effects of the intervention.

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Date Created
2015

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The influence of parent cultural values on Mexican heritage adolescent intentions to use drugs

Description

This study examined the influence of the traditional values held by Mexican heritage parents on the intention of their adolescent children to use drugs. Specifically, the study tested a mediation model in which the traditional cultural values of parents were

This study examined the influence of the traditional values held by Mexican heritage parents on the intention of their adolescent children to use drugs. Specifically, the study tested a mediation model in which the traditional cultural values of parents were hypothesized to influence adolescent drug use intentions indirectly by influencing ethnic identify and adolescent perceptions of parental injunctive norms against drug use. Parents reported on traditional cultural values and expectations for their child. Adolescents reported perceived reaction from parents if they used drugs (parental injunctive norms), ethnic identity, and their intention to use drugs in the future. Two direct effects were observed: parental values on expectations and parental injunctive norms on adolescent drug use intentions. Two paths were also moderated by the sex of the adolescent. The path from parent values to parent expectations was significantly stronger for adolescent girls than boys; the path from ethnic identity affirmation to drug intentions was protective for boys but not for girls. The negative relationship between perceived parental reaction and adolescent drug use intentions suggests that anti-drug norms communicated by parents had a protective influence and can deter youth from using drugs. The results of the current study did not support the hypothesized mediational model, but did provide additional support for the importance of parental influence on adolescents' plans and ideas about using alcohol, cigarettes, and marijuana. More research is necessary to examine the influence of culture and the mechanisms by which cultural values impact Mexican heritage adolescents' intentions to use drugs and subsequent use.

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Date Created
2012

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I have to go on: the effect of a mother's death on her daughter's education

Description

Parents die during the lives of their children. If the child is an adolescent, that death will impact the student's education immediately or in subsequent years. Findings show the death of a mother does impact the daughter's education. It is

Parents die during the lives of their children. If the child is an adolescent, that death will impact the student's education immediately or in subsequent years. Findings show the death of a mother does impact the daughter's education. It is imperative educators are willing to work with the student at the time the death occurs as well as in the ensuing months. Seidman's (2006) three-interview format was used as a template for the interviews of 11 women, ranging in age from 19 to 78 and whose mothers died when the women were adolescents. The interviews were primarily conducted in one sitting, transcribed, and then analyzed for common themes that connected to the research on the topic. Those themes include grieving, the role of caring in education, the role of teacher as the second mother, mother-daughter relationships, and the impact of parent death on schooling. These themes from the data cross cut with thematic strands within the study's theoretical framework: the nurturing and empathetic role of the mother, a desire of the daughter not to be different, and the ethics of caring. Findings in this study reveal that the negative impacts of mother loss are felt in diffuse ways, such as a lack of academic or emotional encouragement. Many women discussed the need and availability of support groups including groups at colleges. One practical implication of these findings is schools need to become caring communities in which caring is the norm for all students and teachers, thereby providing all students with needed support in times of crisis. The implications for further research include the impact of the mother death on the education of daughters, how volunteering with an organization related to the cause of the mother's death assists the daughter and types of programs most important to a student's success in post-secondary education. Adolescents are in a time of great change in their lives, and for a daughter, the loss of a mother has an everlasting, life-changing impact.

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2011