Excerpt: MOTHERING A SON WITH SPECIAL NEEDS, or special-mothering, as I call it, is often solitary, crazy-making work. Several years ago, in part inspired by DeAnna Chester’s personal storied account of infertility, I started actively examining my own maternal story. Eventually, a desire surfaced in me to more openly witness (Frank), voicing my maternal experiences so that other special-parents know they are not alone. From the start, though, I wondered if I could witness in an ethical way. Granted, storytelling may be agency-generating, revealing previously unheard truths (Pitre, Kushner, and Hegadoren; Pitre, Kushner, Raine, and Hegadoren; Stevens). Still, as Kristin Langellier...

abstract: Climate change impacts are evident throughout the world, particularly in the low lying coastal areas. The multidimensional nature and cross-scale impacts of climate change require a concerted effort from different organizations operating at multiple levels of governance. The efficiency and effectiveness of the adaptation actions of these organizations rely on the problem framings, network structure, and power dynamics of the organizations and the challenges they encounter. Nevertheless, knowledge on how organizations within multi-level governance arrangements frame vulnerability, how the adaptation governance structure shapes their roles, how power dynamics affect the governance process, and how barriers emerge in adaptation governance as a result of multi-level interactions is limited. In this dissertation research, a multilevel governance perspective has been adopted to address these knowledge gaps through a case study of flood risk management in coastal Bangladesh. Key-informant interviews, systematic literature review, spatial multi-criteria decision analysis, social network analysis (SNA), and content analysis techniques have been used to collect and analyze data. This research finds that the organizations involved in adaptation governance generally have aligned framings of vulnerability, irrespective of the level at which they are operated, thus facilitating adaptation decision-making. However, this alignment raises concerns of a neglect of socio-economic aspects of vulnerability, potentially undermining adaptation initiatives. This study further finds that the adaptation governance process is elite-pluralistic in nature, but has a coexistence of top-down and bottom-up processes in different phases of adaptation actions. The analysis of power dynamics discloses the dominance of a few national level organizations in the adaptation governance process in Bangladesh. Lastly, four mechanisms have been found that can explain how organizational culture, practices, and preferences dictate the emergence of barriers in the adaptation governance process. This dissertation research overall advances our understanding on the significance of multilevel governance approach in climate change adaptation governance. / Dissertation/Thesis / Doctoral Dissertation Geography 2019

This dissertation investigates three topics related to movement and events associated with geospatial barriers. This research makes a unique contribution to geographic information science (GIScience), by examining how boundaries influence the interactions of other geographic features and to location-based services by bringing a GIScience perspective to geofence services. Chapters 2, 3, and 4 can be considered independently as journal articles. Each of these chapters builds on the previous. Chapter 2 serves as the base by examining geospatial barriers and impedance events associated with these barriers. The relationships between barriers, the features they protect and the features that they hinder are formalized in an ontology design pattern (ODP) that also includes events associated with these features. Algorithms are written to demonstrate the ODP can be used to answer queries about the presence or absence of barrier events. Chapter 3 transitions from physical boundaries to digital boundaries by examining geofences, a location-based notification service. Interaction between users and multiple geofences are investigated when the configuration of geofences differs (i.e. disconnected, partially overlapping, and completely overlapping) and when geofences are independent or dependent (a rule states that the activation of geofence Y depends on users having visited geofence X). A geofence system is prototyped in an iOS environment and used to further evaluate user-geofence interactions. Chapter 4 expands on the topic of location- based notification regions by investigating what is required for a geofence system to handle events. How changes in conditions (e.g. the spreading of a flood or movement of a fire) interact with geofences and users and what new categories of interactions are required to handle these changes are discussed. The proposed system is applied to a scenario of flooding on multiple rivers interrupting the transportation network.

This paper provides evidence on (1) refugees' subjective well-being, (2) their access and barriers to health care utilization and (3) their perception of health care provision in Austria, one of the countries most heavily affected by the European "refugee crisis". It is based on primary data from the Refugee Health and Integration Survey (ReHIS), a cross-sectional survey of roughly five hundred Syrian, Iraqi and Afghan refugees. Results indicate that refugees' self-rated health falls below the resident population's, in particular for female and Afghan refugees. Whereas respondents state overall high satisfaction with the Austrian health system, two in ten male and four in ten female refugees report unmet health needs. Most frequently cited barriers include scheduling conflicts, long waiting lists, lack of knowledge about doctors, and language. Although treatment costs were not frequently considered as barriers, consultation of specialist medical services frequently associated with co-payment by patients, in particular dental care, are significantly less often consulted by refugees than by Austrians. Refugees reported comparably high utilization of hospital services, with daycare treatment more common than inpatient stays. We recommend to improve refugees' access to health care in Austria by a) improving the information flow about available treatment, in particular specialists, b) fostering dental health care for refugees, and c) addressing language barriers by providing (web-based) interpretation services.

Aboriginal people in Canada are less likely to complete postsecondary education than are non-Aboriginal people. This lack of education leads to increased rates of unemployment and poverty and the need for additional government supports. The purpose of this project study was to identify and examine barriers faced by Canadian Aboriginal adult students as they return to school for postsecondary education. The conceptual framework for this qualitative study was based on the work of Ertmer, which suggests barriers can be placed into broad categories of extrinsic and intrinsic barriers. A case study design was used with a purposeful sample from a local academic institution. Eleven Canadian Aboriginal adult students were interviewed, 6 who successfully completed the college entrance program and 5 who did not complete the program. One counselor from the program was also interviewed to help provide a better understanding of the complexities of the identified barriers. Data analysis included substantive and theoretical coding. Thematic analysis led to 8 overall themes or barriers that affected these students' success: level of self-confidence, social environment, racism, spirituality, government policies, mental health and addictions, perceived value of education, and perceived need to demonstrate leadership. Recommendations include the development of a professional learning community made up of students, teachers, and the Aboriginal communities where the students lived. The project emanating from this study is a 3-part workshop intended to identify and mitigate barriers of Canadian Aboriginal adult students. Understanding and mitigating the barriers will promote positive social change by increasing the success rates of this population of students as they attempt to return to postsecondary education.

Despite the Centers for Disease Control and Prevention recommendations to test patients ages 13 to 64 years for HIV at health care settings, routine HIV testing is lacking. As a result, many people are unaware of their HIV seropositive status. The purpose of this quantitative cross-sectional study was to examine relationships between HIV testing and provider type, knowledge, attitudes, and behaviors regarding HIV testing in the acute care setting. The study was informed by social cognitive theory. Using a convenient sampling method, a questionnaire derived from previous surveys (Society of General Internal Medicine and University of Washington) was sent to 600 eligible acute care providers from a suburban Chicago hospital who treated HIV-negative patients ages 13 to 64 years. Completed surveys were received from 88 participants. Chi-square and multiple logistic regression testing showed no significant relationships between HIV testing and provider type (p = .09), age (p = .91), gender (p = .84), experience (p = 1), and race/ethnicity. However, knowledge of HIV testing regulations and positive attitudes about HIV testing were significantly associated with the likelihood of offering an HIV test (p = .026, p = .004 respectively). Results have some clinical importance, but also indicated a lack of routine opt-out HIV testing. Results may be used to promote HIV testing among acute care providers which could reduce HIV-status unawareness in the population.

Diabetes is a growing health concern among those in rural locations. Rural residents smoke more, exercise less, have less nutritious diets and are more likely to be obese than urban residents. Evidence-based diabetes prevention programs targeting behavior change are available to this population yet participation remains low. This study examined the self-reported barriers and health beliefs of those who declined participation in a diabetes prevention program (DPP). Of 269 clients identified to be at risk for developing Type II Diabetes (T2D), only 85 answered the phone and 33 were interviewed to discuss their health beliefs and reasons for not participating in a diabetes prevention program. Almost half of the participants who expressed their lack of desire to participate in the DPP cited a low level of interest and not seeing any personal benefit as their primary reasons. Participants were closed off when asked what it would take to get them to participate in the program with 63% citing “nothing” as the most common answer when questioned as to what would encourage their participation. In order to limit barriers to participation in prevention-based programs for rural populations special attention needs to address improving general interest and knowledge about the efficacy of a DPP.

Former United States military members have consistently faced mental health concerns post discharge from the military. Some researchers have argued that the use of mental health services by veterans does not parallel the prevalence and need of such services (Hoge, Castro, Messer, McGurk, Cotting, & Koffman, 2004; Milliken, Auchterlonie, & Hoge, 2007; Vogt, 2011). Reasons why veterans do not access mental health care are varied and broad, however, they tend to be consistent with explanations rooted in the stigma of mental health care, and in the barriers that prevent the use of mental health care. The degree of the impact of factors contributing to stigma and barriers to mental health care is not fully understood. Particularly lacking from previous research is an examination of how the education received while in the military about mental health symptoms and treatment impacts the likelihood that a service member will access care. In the current study, I used theories of stigma and barriers to care outlined by Overton and Medina (2008) to examine the relationships among demographic characteristics, self-reported diagnoses of common mental health disorders that veterans experience, and likelihood of accessing mental health care based on the education received while in the military with self-reported levels of stigma and barriers to care in a sample of 355 former military service members from several branches. Multiple regression analyses were used to examine the relationships among these variables. Results revealed statistically significant relationships among gender, age, self-reported diagnosis of depression, the impact of education, and stigma. Results also revealed statistically significant relationships among employment and barriers to care. In addition, stigma was found to have significant relationships with the positive impact of education, and the likelihood of accessing care. Lastly, results revealed that when in the presence of the mediation variable impact of education, stigma was no longer associated with the likelihood veterans would access care post discharge.

The purpose of this study is to identify the barriers to and facilitators of mental health services utilization among youth in the justice setting, and to explore ways to overcome these barriers and expand these facilitators. This qualitative study utilized focus groups as a means to extract themes among the perceptions of social workers on this topic. Results were transcribed to written form. Qualitative analysis procedures were followed to identify and label themes. A total of 473 statements are organized into 26 major themes with 18 sub‑themes. Suggestions for change under the agency/organizational category of domain three received the most overall discussion with 108 statements in all. The most discussed topics in the focus groups are quality of or improvements to services, which receives a total of 114 statements total, and punitive systems of care, which receives a total of 60 statements in all. Major suggestions for change made by participants include education and outreach for the public on mental health for juveniles, training on interventions and cultural competence for providers, and a shift from punitive to restorative for systems that justice youth interact with, to include schools, courts, probation, and law enforcement.

Gambling in the United States has been in existence since the 1800’s. For over two hundred years, gambling has brought in revenue and entertainment for consumers in the United States. As the population has diversified and the technology has advanced, the access to gambling has grown to be convenient and accessible for the consumer to enjoy. The purpose of this qualitative study was to explore the barriers and motivators from gamblers who sought recovery programs in Spanish. Fourteen current members of Spanish Gamblers Anonymous group were interviewed in small focus groups. The findings indicated that those who sought Spanish recovery programs underwent obstacles that where beyond finding and attending a program. Many barriers stood in their way including struggle with emotional feelings, language barriers, expectations of program, and inadequate support and resources. The majority of those interviewed did not seek the program entirely on their own behalf and the primary reason was not due to loss of money alone. This study reveals the emotional loss and personal gain from each participant. The lack of resources and poor public relations for problem gamblers who wish to attend meetings in Spanish continues to be a problem in the Inland Empire of Southern California, home of an ever growing population of Spanish speaking individuals and also home to some of the most visited casinos in Southern California.