<p> <b>Problem:</b> Medical and nursing literature poorly identify primary care providers' (PCP) relationship to care coordination (CC). Primary care providers' education, experience, and perspective, contribute to: (a) assessments of patient's care coordination needs, and (b) variability in behavior to address needs. Dissimilar approaches to CC by PCPs affect work relationships and office flow. </p><p> <b>Purpose:</b> To pre-pilot a new tool describing PCPs' knowledge, perception, and behavior regarding CC. Methods: Primary care physicians, nurse practitioners, and physician assistants were surveyed. </p><p> <b>Analysis:</b> Frequencies and percentages provided sample characteristics. Descriptive statistics analyzed provider responses within and between groups. Narratives were analyzed for themes. Tool refinement is suggested however, the tool does describe PCPs and CC activities. </p><p> <b>Significance:</b> A tool was developed to evaluate areas of CC activity performed by PCPs. Information from surveys of PCPs can illuminate behaviors that lead to improved work flow, efficiency, and patient outcomes. Doctors of Nursing Practice who are PCPs contribute to primary care CC through leadership, experience, and descriptive evidence.</p>

<p> A resource guide for mental health practitioners working with Latino victims of collective trauma was developed based on a review of the literature. The development of the resource was also informed by two structured interviews with experts in the field of collective trauma within the Latino population. Review of the literature and structured interviews were used to develop culturally sensitive treatment approaches for victims of collective trauma from Latin America. The resource guide offers clinicians culturally adapted interventions, including PTSD measures, a table to identify culture bound syndromes, PTSD psychoeducation handouts (provided in Spanish and English), relaxation skills (e.g. breathing techniques, progressive muscle relaxation, the use of music, meditation), interoceptive exposure protocols, and tools to help clients live a life of meaning as well as restore their roles in the community and within their family. An additional two experts in the field evaluated the resource guide for validity, content, and applicability to the Latino population. Feedback from the evaluators will be used for future versions of the resource guide. Results indicated that the resource guide may be advantageous for Latino victims of collective trauma and may therefore serve as an adjunct to current treatment protocols. The resource guide may assist mental health practitioners in modifying their approach to treatment as well as offer culturally appropriate interventions in order to enhance cultural sensitivity, thus leading to a stronger therapeutic alliance.</p>

Bakgrund: En pågående trend inom hälso- och sjukvården är införandet av marknadsreformer. Den lag som ska tillämpas när ett vårdvalssystem införs är lagen om valfrihetssystem (LOV). På grund av att landstingen är självstyrande kan formerna för organisation och styrning variera. Syfte: Att undersöka och beskriva hur landsting praktiskt arbetar med att följa upp privata vårdgivare inom primärvården, med avseende på kvalitet i vården. Metod: Deskriptiv fallstudie med triangulering. Resultat: I alla de tre fallen framhålls att uppföljningen av de offentliga och privata vårdcentralerna är likadan. Det görs uppföljning av samtliga vårdcentraler en gång per år. Till denna samlas data in från olika källor. Stockholm och Sörmland gör även månadsvis mätningar av några indikatorer. Vilka indikatorer som används till uppföljningarna skiljer sig något mellan de olika landstingen. Om avvikelser upptäcks vidtas olika former av åtgärder, exempelvis utskick av skriftliga frågor eller möten där avvikelsen, eventuella orsaker samt vad som ska göras diskuteras. Andra åtgärder kan vara besök hos vårdgivaren, fördjupad granskning eller medicinsk revision. I landstingens förfrågningsunderlag finns beskrivet vad som följs upp. Vissa indikatorer kopplas till målrelaterad ersättning, viten eller bonus. Det framgår även under vilka förutsättningar ett avtal skulle kunna sägas upp i förtid. Förtida uppsägning baserat på kvalitetsskäl har endast skett i Stockholm. Exempel på ett område där samtliga landsting har pågående utvecklingsarbete är utformning av kvalitetsindikatorerna. Samarbeten sker med andra landsting i olika nätverk för utveckling av uppföljningsarbetet. Exempel på svårigheter som ses är att kvaliteten på data som rapporteras in kan brista, tillgång till olika datasystem samt att mäta och fråga rätt saker. Slutsats: Det finns likheter i hur landstingen har utformat sina uppföljningsverksamheter men också skillnader, exempelvis att Stockholm rutinmässigt gör uppföljningsbesök hos nystartade enheter och att Uppsala gör en generell fördjupad uppföljning. / Background: An ongoing trend in health care is the implementation of market reforms. The applicable law when implementing a system of choice is lagen om valfrihetssystem (LOV). Because of the fact that the county councils have home rule the forms of organization and governance can vary. Aim: To study and describe how county councils work with following up private actors in primary care, with regard to quality. Method: Descriptive case study with triangulation. Results: In all three cases it is stressed that the follow up is the same for private and public district health care centres. A follow up of each centre is carried out annualy. For this data is collected from different sources. Stockholm and Sörmland also measure some indicators monthly. Which indicators that are used in the follow ups differ somewhat between the county councils. If deviations are detected different steps are taken, for instance written questions or meetings where the deviation, possible causes and interventions are discussed. Other steps could be to visit the actor, have an intensed review or medical revision. The county councils’ rule books describe what is included in the follow ups. Some indicators are connected to a goal related payment, fine or bonus. It is also stated under what circumstances a contract could be terminaded prematurely. Premature termination based on quality reasons has only occurred in Stockholm. An example of an area where all county councils have an ongoing developement is formation of the quality indicators. There are cooperations with other county councils in different networks regarding development of the follow ups. Difficulties that have been noted are for example that the quality of data that is reported in might be lacking, access to different computer systems and measuring the correct things. Conclusion: There are similarities between the county councils with regard to how they have chosen to design their follow up work, but there are also differences, for instance that Stockholm routinely makes follow up visits to newly started units and that Uppsala does a general intensed review.

<p> Objective: Although externalizing behavior problems are the most common problems in childhood, most remain untreated. Identifying factors related to treatment use can help close the gap between need and utilization. This study examined how the severity of a child's behavioral symptoms moderates the relationship between parents' perceptions of treatment effectiveness and the likelihood of using offered treatments. </p><p> Method: Participants were 182 parents of three to eight year old children attending primary care pediatric visits in five Midwestern community-based practices. Parents completed questionnaires rating the perceived effectiveness of the treatment, likelihood of utilizing the treatment, and the Pediatric Symptom Checklist. </p><p> Results: Separate linear regressions were conducted for four treatment types. Child behavior moderated the relationship between parental perceived effectiveness and likelihood to use prescription medication, <i>p </i> &lt; .05. Parents of children with more severe behavior problems were more likely to use prescription medication than parents of children without severe behavior problems, and likelihood to use prescription medication had a weaker relationship with believing it will work than for other parents. For parents of children with less severe behavior problems, belief in the effectiveness of prescription medication was positively associated with likelihood to use. All other regressions were not significant. </p><p> Discussion: The impact of perceived effectiveness of prescription medication on likelihood to use it varies depending on the severity of a child's behavioral symptoms. Parents of children without a clinically-significant behavior problem need to believe in prescription medication's effectiveness in order to increase their likelihood to use it.</p>

<p> The purpose of this research was to explore how CACREP accredited Clinical Mental Health Counseling programs conceptualize self-care and integrate self-care education into counseling curriculum. Counselor educators in CACREP accredited Clinical Mental Health Counseling programs served as representatives to their programs and were invited to share how their counseling programs conceptualize self-care and integrate self-care education into the curriculum. In addition, the counselor educators identified a faculty member teaching a course in which the CACREP standard is met. This faculty member completed a questionnaire regarding their experiences teaching the course. The questions guiding the research were:</p><p> 1. How do Clinical Mental Health Counseling programs accredited by CACREP conceptualize self-care? </p><p> 2. How is self-care education integrated into counseling curriculum? </p><p> Participants included three counselor educators teaching in a Clinical Mental Health Counseling program accredited under the 2009 CACREP standards and two faculty members teaching a course in which the CACREP standard was met. </p><p> In response to the first question of how self-care is conceptualized in the program, two common themes emerged between the three individual cases: ambiguity of self-care conceptualization and an emphasis on prevention and early intervention. In response to question two which explored how the programs are integrating self-care education into the curriculum, two common themes emerged between the three cases: specific course integration and infusion throughout the program, and faculty involvement and demonstration of importance. The results and interpretations are explained; contributions to the current literature, implications, and limitations are discussed; and recommendations for future research are provided.</p>

<p> Asthma is the most prevalent chronic illness in the United States. Disparities in asthma treatment in the emergency department prognosticate asthma outcomes in children and adult asthma patients. The purpose of this study was to investigate the relationship between socio-economic/demographic factors (i.e., ethnicity, income level, insurance type, and location) of asthma patients and receipt of asthma treatment, evaluation, and management in emergency departments in Maryland. Methods: This study was a non-experimental research design. The representative population consisted of 146 adults and children with asthma in Maryland. One-hundred-forty-six cases with codes for management, evaluation, and treatment of mild, moderate, and severe persistent asthma symptoms were extracted from the 2009 State Emergency Department Databases (SEDD). Frequency distribution of the population by marital status, length of stay, gender, ethnicity, admission source, and admission type was displayed. The significance of ethnicity, income level, location, insurance type and management, evaluation, and treatment of mild, moderate, and severe persistent asthma was tested. Results: The number of African Americans presenting themselves to the emergency department for evaluation and management for mild persistent asthma was significantly higher than expected, X&sup2; (6, n = 107) = 17.213, p = .009. This was inconsistent with the literature which stated that African Americans and Hispanics used the emergency department more than any other ethnicity. No significance was found between location and asthma treatment, management, and evaluation; health insurance status and asthma treatment, management, and evaluation; income and asthma treatment, management, and evaluation. Gender was independent from age at admission, length of stay, number of procedures, and total charges. Conclusion: Inconsistent with the literature review the results of this study did not show significance the study variables except for relationship for ethnicity and asthma treatment, evaluation, and management.</p>

<p> Meta-cognitive reactions to emotions involve the manner in which individuals cognitively appraise and emotionally respond to the provocation of their feelings (e.g., viewing sadness as weakness, becoming embarrassed that one is sad). The manner in which an individual meta-cognitively responds to his or her emotions may be an important consideration in disorders characterized by emotional pathology, such as mood and anxiety disorders. Previous research has linked negative beliefs regarding emotions and discomfort with one's feelings to anxiety and depressive pathology. The current study examined meta-cognitive reactions to sadness, anger, and anxiety, as assessed by self-report and structured interview, in relation to self-reported symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in college students. Study findings indicated that individuals with higher levels of symptoms of psychopathology (i.e., individuals in the MDD and GAD analogue groups) were less comfortable with their negative emotions, viewed their negative emotions as more problematic, were more fearful of the provocation of their negative emotions, and viewed themselves as less able to effectively cope with their negative emotions, as compared to relatively healthy individuals. Additionally, an exploratory analysis found a trend for individuals in the GAD analogue group to be more fearful of anxiety than individuals in the MDD analogue group. Finally, fear of negative emotions was found to moderate the relationship between worry and GAD symptoms, as well as the relationship between brooding and MDD symptoms, such that higher levels of fear of negative emotions strengthened these relationships. The manner in which individuals cognitively appraise and emotionally respond to their feelings is a relatively understudied area of research that has meaningful implications for the understanding and treatment of MDD and GAD. Further research is needed to elucidate distinctive emotional processes in MDD and GAD, including meta-cognitive reactions to emotions, in order to refine our understanding of the nature of these two disorders and inform cognitive-behavioral interventions that can specifically target important areas of emotional dysfunction and distress.</p>

<p> People living with HIV (PLWH) display disproportionally high levels of psychopathology (i.e., posttraumatic stress disorder symptoms [PTSS] and depressive symptoms) that may interfere with optimal medication adherence and health-related quality of life (HR-QOL). The adverse consequences of non-adherence and diminished HR-QOL, including reduced length of survival, highlight the need for intervention in PLWH. Though recent research suggests that the removal of psychological barriers (i.e., PTSS and depressive symptoms) may result in improvements in adherence and HR-QOL, this has never been directly tested in PLWH. We previously demonstrated the success of prolonged exposure (PE) therapy at improving PTSS and depressive symptoms in PLWH. The proposed study extends these findings by determining whether PE also impacted self-reported and electronically monitored medication adherence, and self-reported adherence self-efficacy, physical health symptoms, and HR-QOL in 65 PLWH. Participants were randomly assigned to either the PE (n = 40) or weekly monitoring/wait-list control group (n = 25), and completed assessments at baseline, post-treatment, and 3-months post-treatment. Following the 3-month assessment, control group participants were offered the intervention, and all PE recipients completed the 6-month assessment. Multilevel growth curve models were conducted on the completer and intent-to-treat samples using the HLM software, and exploratory mediation analyses were conducted in SPSS. Compared to the controls, PE recipients did not experience direct benefits in self-reported or electronically monitored medication adherence or HR-QOL throughout 3-months post-intervention; however, physical health symptoms improved for participants in both groups, and PE recipients reported increased adherence self-efficacy throughout 3 months. Mediation analyses further demonstrated that the removal of psychological barriers led to better short-term adherence and health.</p>

<p> The purpose of this project was to identify and create a program that would meet the needs of a target population, identify potential funding sources, and write a grant to fund a program at St. Mary's Hospital in Long Beach, California. An examination of the literature expanded knowledge about the challenges homeless individuals face. Homeless individuals commonly receive inadequate medical care and often access more costly acute care services due to limited resources, discrimination, and cost. Housing and case management services after discharge from a hospital setting can help improve health care outcomes and reduce costly services.</p><p> The program was designed to provide specialized discharge planning services to homeless individuals being discharged from St. Mary's Hospital. The California Wellness Foundation was chosen for this grant based on the program areas of the funder. The actual submission and/or funding of this proposal was not a requirement for completion of this project.</p>

<p> The goal of this project was to create a grant proposal and identify a potential funding source to develop a holistic mentoring program for foster youth in one non-profit organization in Long Beach, California. A thorough literature review identified risk factors for foster youth and identified evidence-based mentoring programs that the grant writer used to design a holistic mentoring program for foster youth. The Foundation Directory's on-line database at the Long Beach Non-Profit Partnership identified the Dwight Stuart Youth Foundation as the best funding source for this project. A grant was then written to support a holistic mentoring program at Power 4 Youth in Long Beach, California. The actual submission of this grant was not a requirement for the successful completion of the project.</p>