There is significant documentation showing that health disparities experienced by underserved persons can be mitigated through the provision of quality integrated healthcare. This research project was grounded in social support theory and how support influences improvements in physical, psychological, and overall health. Social workers in integrated healthcare are in a unique position to be the source of social support for individuals experiencing health disparities, yet there is little research concerning how these social workers are providing services and how they affect health outcomes. This research addressed gaps in the literature concerning social worker roles in order to improve integrated healthcare for underserved populations. Data was gathered from social workers employed by Federally Qualified Health Care integrated facilities in Colorado that treated underserved populations. An action research methodology was used to investigate social worker roles through the utilization of a focus group (N = 4); there were 4 emergent themes. These themes were: social workers supporting patients and staff, influencing quality healthcare integration, possessing certain characteristics and competencies, and performing role responsibilities. Support through the use of personal characteristics, competencies, and role responsibilities was identified by stakeholders as the foundation of quality integrated healthcare. The potential impact of understanding social worker roles may include improved health outcomes for individuals served, improved social work practice, improved integrated healthcare provision, gaps in the literature filled, positive social change, and contribution to a wider body of knowledge.

The purpose of this study was to document the perspectives and experiences of five Indigenous Elders on the potential for Indigenous and Western healing paradigms and practices to be integrated in mental health service delivery for Indigenous peoples. Semi-structured qualitative interviews were held with each participant, and a narrative analysis was used to generate research themes and findings. Results indicated that all five Elders perceived a potential for Indigenous and Western approaches and practitioners to work collaboratively together in the future, and Elders reported varying levels of experience with integrated healthcare delivery. However, all five Elders identified numerous issues requiring attention and steps to be taken prior to integrated practice taking place. These included the need to reclaim Indigenous knowledge, an acceptance and respect for Indigenous knowledge and practices by the Western healthcare system, and the need for increased and formalized education related to Indigenous knowledge and healing approaches.

The purpose of this study was to document the perspectives and experiences of five Indigenous Elders on the potential for Indigenous and Western healing paradigms and practices to be integrated in mental health service delivery for Indigenous peoples. Semi-structured qualitative interviews were held with each participant, and a narrative analysis was used to generate research themes and findings. Results indicated that all five Elders perceived a potential for Indigenous and Western approaches and practitioners to work collaboratively together in the future, and Elders reported varying levels of experience with integrated healthcare delivery. However, all five Elders identified numerous issues requiring attention and steps to be taken prior to integrated practice taking place. These included the need to reclaim Indigenous knowledge, an acceptance and respect for Indigenous knowledge and practices by the Western healthcare system, and the need for increased and formalized education related to Indigenous knowledge and healing approaches.

No description available.

Background: Comparing Full-Time (FT) and Part-Time (PT) staffing models for a mobile integrated health (MIH) program established by a local Fire Department. Objective: Determine if the program is sustainable and which staffing model is more effective at obtaining sustainability. Design: Quality Improvement project with retrospective data review. Setting: Green Valley Fire District in Green Valley, Arizona. A predominant retirement community. Target: The residents of the Green Valley Fire District. Interventions: Utilizing the RE-AIM framework, a retrospective review of the data collected by the previously implemented MIH Program in Green Valley was completed. The framework was utilized to review relevant data and determine if the program has achieved the expected outcomes, and maintained a sustainable and transferable MIH program. Measurement: Decrease in emergency medical (EM) calls for service with the implementation of the MIH program. Comparing staffing models for consistency in services. Results: The results showed a decline in EM calls for service with the MIH program, and more consistency in availability and patient services with the FT staffing model. Limitations: The demographics of the community limit the generalizability and transferability of the data obtained from the project. Additional data should be collected and analyzed both retrospectively and for successive years to substantiate the benefits and continue to improve the effectiveness of the MIH program. Conclusions: The program could be used as a model for other MIH programs, with adjustments made for the respective community. The value or sustainability of any MIH program cannot be limited to revenue solely. Other perspectives of value added service and cost savings must also be considered. Significance: This study highlights the effectiveness of an MIH program in a small retirement community and shows the benefit of a FT staffing model versus a PT staffing model for consistency of patient care and daily program operations. There are also multiple aspects of value to an MIH program, some of which are difficult to conceptualize and measure based on historical models of healthcare delivery and Fire Department Services. Further review of these types of programs is needed to establish the overall benefits of MIH.

Societal stigma surrounding mental health has adversely affected individuals with mental health concerns. Stigma often keeps persons with mental illness from seeking treatment from mental health professionals, bringing such issues to their primary care providers instead. This is problematic, as primary care providers have been shown to endorse mental health stigma toward patients with mental illness. Integrated healthcare, a system in which behavioral health services are integrated into primary care settings, has been hypothesized as a method for reducing mental health stigma among primary care providers and the general public. However, there has been little research examining the impact of integrated healthcare on primary care provider’s endorsement of mental health stigma. The present study was an effort to address this gap in the literature by examining the impact of working in integrated health care settings, personal and professional experience with mental health, and training in mental health and diversity on the endorsement of mental health stigma among primary care providers. The present study contributes to the understanding of the impact of factors in endorsement of mental health stigma among primary care providers in the United States. Contrary to my hypothesis that integrated healthcare reduces mental health stigma, the present study revealed that healthcare integration alone was not a significant predictor of lower endorsement of mental health stigma among primary care providers in the present sample. In contrast, training in mental health and diversity was found to be the most significant predictor of mental health stigma, with participants reporting more in-depth training in these areas endorsing lower levels of mental health stigma. Further research is needed to confirm this association and establish a clearer understanding of the role of integrated healthcare in reduction of mental health stigma. These results can be used to assist in improving training in research regarding mental health stigma and integrated healthcare.

Background: Community paramedicine (CP) is an emerging form of health services delivery with the potential to reduce emergency department (ED) visits and to improve access to care. Rationale: There is growing global interest towards CP. Studies have focused on health outcomes and cost-effectiveness, but there is no comprehensive understanding about the types of CP programs and training; this knowledge may support the development of CP programs, training, and policy. Objectives: To describe CP programs and the skills for each program type, and to inform recommendations for CP programming and growth. Methods: A systematic review of MEDLINE and Embase was completed in duplicate by two independent reviewers. The Mixed Methods Appraisal Tool (MMAT) was used to assess studies’ methodological quality. A full methodology is available on PROSPERO (CRD42017051774). Results: The yield of 47 studies captured 44 unique CP programs. CP programs most often served emergency callers and individuals at risk for ED admission or readmission or hospitalization. The most common services provided were physical assessment; and assessment, referral and/or transport to community services. Training was not described by 43% of CP programs, and the mean MMAT score was three out of four criteria met. Study heterogeneity prevented meta-analysis of health outcomes. Discussion: CP programs have adapted to various populations by providing different services and training. CP training is centred on technical skills and knowledge. Since CP often involves more client interactions and inter-professional collaboration than traditional paramedicine, CP training should also include communication and teamwork skills. Challenges to CP growth include unclear role definition, introducing new healthcare roles, and competing services. Conclusion: Of the 44 unique CP programs, common services provided included physical assessments and assessing clients for community services. CP training was centred on technical skills and knowledge, but there should be more training on communication and teamwork skills. / Thesis / Master of Public Health (MPH) / Community paramedicine (CP) is an emerging form of health services delivery with programs established internationally. Community paramedics take on expanded paramedicine roles, including community-based health promotion and prevention activities. Studies on CP have focused on health outcomes and cost-effectiveness, but there is no comprehensive understanding about the types of CP programs and training. Through a systematic review of the literature, the goals of this thesis are to describe CP programs and the skills required for each program type, and to use findings to inform recommendations for CP program development and growth. No other literature review provides information on the components of CP programs and their training. Communities interested in CP can use the findings of this thesis to inform the development of their CP programs and training. By discussing challenges facing continued CP growth, this thesis also identifies areas for change at the program and policy levels.

The Doctor Interactive Group Medical Appointment (DIGMA) is a group health intervention that combines the services of behavioral health and primary care. The DIGMA was first invented by Edward Noffsinger in 1996, in response to his own difficulties with the overtaxed primary care system at Kaiser Permanente in California (Noffsinger, 1999). Integrating healthcare services in this way has practical implications such as efficient use of resources, treating multiple complaints at once, and beginning to view the mind and body as one (Noffsinger, 1999; Engel, 1977). The DIGMA at the Austin Veterans Outpatient Clinic was designed to address the specific needs of veterans with hypertension. It consists of 4 sessions of 1.5 hours each and addresses such varied topics as exercise, stress-management, nutrition, and medication adherence. These topics are discussed in a group format with the tenets of group psychotherapy (Yalom & Leszcz, 2005) as a backdrop. An exploratory study was warranted to determine whether programs of this sort would be effective on a broad scale. A pretest/posttest design was utilized to determine if the DIGMA was effective at reducing symptoms of hypertension; improving health promoting behavior; increasing self-efficacy to manage hypertension; and increasing internal health locus of control while decreasing chance and powerful others health locus of control. Groups were conducted over a period of seven months with a total of 73 male veterans enrolled in the study. The final n was 58. Findings indicated that both systolic and diastolic blood pressure readings were reduced significantly from pretest to posttest. Health promoting behavior increased significantly; hypertension self efficacy increased significantly; and locus of control did not change significantly from pretest to posttest. The exploratory study concluded that the DIGMA may be efficacious for a variety of aspects of the management of hypertension. It is suggested that further research be conducted but that integrating services in this way can lead to improved patient outcomes and can also be cost-effective. / text

The implementation of the Affordable Care Act (ACA, 2010) has resulted in efforts to make healthcare more affordable and effective. One strategy for making healthcare more affordable and effective is the integration of behavioral health and primary care. In today’s healthcare system, it is estimated that approximately one in three patients seen in a primary care setting meet the criteria for a mental health disorder and another third – while not meeting those criteria – are experiencing psychological symptoms that impair their functioning (Kessler, 2005). Despite the evidence supporting behavioral health services in a primary care setting, treatments tend to be diagnosis specific (Archer et al., 2012; Lemmens, Molema, Versnel, Baan, & deBruin, 2015) and as such do not capture patients’ varied presentations. Patient feedback offers a potential strategy to improve the quality of services provided. Patient feedback is the use of measures administered at each session to assess distress and track progress. There is a robust psychotherapy literature demonstrating the effectiveness of using routine progress monitoring in clinical practice but it has not been evaluated in an integrated care setting. Therefore, the purpose of this study was to evaluate the efficacy of patient feedback in this setting. Preliminary results of this ongoing study revealed there was a moderate feedback effect using both the ORS (d = 0.38) and PHQ-9 (d = 0.12) as the outcome measures. Using the ORS as the outcome measure, patients in the feedback condition demonstrated faster treatment gains, which suggests that they improved faster compared to those patients in the TAU condition. Additionally, patients in the feedback condition incurred significantly more reliable change compared to TAU. However, this result was not replicated when the PHQ-9 was used to measure outcome. Overall, the results suggest that PCOMS may be a potentially useful quality improvement strategy.

Despite the development of an Aboriginal Healing and Wellness Strategy (AHWS), which implemented Aboriginal Health Access Centres (AHACs) to provide integrated healthcare including both mainstream and traditional services, health inequalities persist among the urban Aboriginal population in Ontario. There are multiple social determinants of health (SDOH) besides access to healthcare that affect Aboriginal health. The objectives of this study were to describe the past and current policy strategies to address Aboriginal health in Ontario, and to investigate the ways that service providers perceive health inequalities, demonstrating whether the SDOH are considered in service provision to urban Aboriginal clients. In addition to a document review, interviews were held with representatives from three provincial ministries involved with the AHWS. Through a community engagement research strategy, nine semi-structured interviews were conducted with service providers from various departments within an urban AHAC. Interviews were analyzed using a modified grounded theory, which was guided by the SDOH framework. In understanding policy development, themes included: collaboration with Aboriginal communities and improving access to holistic care. In approaching service provision, themes included: perceived health inequalities and their determinants, what is being done and what must be done to address health inequalities and the use of the SDOH framework in practice. Findings suggest that service providers accurately identify the health needs of their clients, and utilize the SDOH to understand the causes of inequalities, however the SDOH cannot be fully addressed at the service provision level. The SDOH framework must be utilized at the policy level, in order to effectively address the wider determinants of health through intersectoral collaboration between provincial ministries and Aboriginal communities. / Thesis / Master of Arts (MA)