Master of Science / Department of Journalism and Mass Communications / William Adams / Mental illness and suicide present vexing challenges for journalists who seek to elevate public understanding of public health issues and remedies. Using the theoretical frameworks of media agenda setting and issue framing, content analysis was used to examine a nationwide sample of newspapers stories for evidence of media familiarity with prevailing norms for community mental health care and suicide prevention. Stories examined showed little evidence of such expertise, leaving questions about the ability of journalists — and their readers — to differentiate between standard and substandard mental health care systems. Long-term change in public policy about mental illness and suicide prevention will likely depend on the ability of special interests to capture and keep media attention as well as media management decisions to assign mental health coverage to general assignment reporters or place it in the hands of journalists with specialized training.

Doctor of Philosophy / Department of Family Studies and Human Services / Joyce A. Baptist / Sickle cell disease (SCD) is a prevalent, pervasive chronic illness. It is a hereditary condition that affects those of African, Mediterranean, Indian, Middle Eastern, and Hispanic/Latino descent. It causes extreme pain for patients and a myriad of other symptoms and complications. The medical issues associated with and the very nature of SCD has the potential to cause psychological distress and related problems for patients. Parents, caregivers, significant others, and family members are similarly affected by a family member with SCD. Applying the Vulnerability-Stress-Adaptation Model, this qualitative study used heterogeneous sampling and explored the experience of three families with SCD. Three main themes emerged from the data, analyzed using thematic analysis: Stress and Challenges, Adapting to and Coping with the Demands of SCD, and Individual and Family Strengths. The pervasiveness and unpredictability of SCD as well as the strengthening effects of having experienced SCD were shared across families, despite their heterogeneity. Clinical implications for families with SCD are discussed.

Master of Public Health / Department of Human Nutrition / Sandra B. Procter / Family meals and meals with caregivers can be sources of social support. Current literature indicates that social support is important for physical and psychological health and well-being. There has been no published research looking at the role of communal meals in collegiate dining centers as sources of social support. This study investigated the possibility that communal meals in a collegiate dining center and eating with other people in these settings may be related to perceived social support, academic success, frequency of family meals, and/or degree of involvement in college extracurricular activities. To investigate these relationships, first-year Kansas State University students living in the residence halls of the Derby Complex (Ford, Haymaker, Moore, and West Halls) were administered a survey about dining center usage habits. The survey included the previously tested Interpersonal Relationship Inventory Short Form by V.P. Tilden (n.d.) as a measure of perceived social support. Participants granted access to their first semester Kansas State University grade point average and semester dining center usage data. Surveys were completed online (n=216) and in paper format (n=89) for a total of 303 participants. There was no significant difference between the demographics of those that completed the online versus paper formats of the survey. Therefore, the online and paper formats of the survey were analyzed together. The data were analyzed for all participants and for males (n=94) and females (n=209) separately. Results revealed multiple significant relationships (p<0.05). Results related to grade point average and perceived social support revealed a significant positive relationship between frequency of eating in the dining center and grade point average for all participants combined. This relationship was also noted for males and females analyzed separately. Frequency of eating with others was found to be significantly positively correlated to perceived social support score for all participants combined, and for males and females analyzed separately. Frequency of eating with others was significantly positively correlated with grade point average for males alone and females alone, but not all participants combined. Further research is needed to determine if the relationships are causal and if so, the direction of causality in the relationships.

Master of Science / School of Family Studies and Human Services / Farrell J. Webb / The Food Sufficiency Status Model is a conceptual model that was devised to help explain why some individuals are at an increased risk of becoming food insufficient. This model proposes that there are four factors that can influence an individual’s food status they are—demographics, family status/household size, food risk factors, and depression. This study uses data from the National Health and Nutrition Examination Survey (NHANES, 2007-2008)—Flexible Consumer Behavior Survey Module (n = 3,413), collected by the Centers for Disease Control and Prevention (CDC). The overall results generally supported the Food Sufficiency model and explained 22% (R[superscript]2adj = 0.215) of the variance in food sufficiency in the study’s population.

Doctor of Philosophy / Department of Family Studies and Human Services / Anthony Jurich / Ann Murray / Despite the intensified research efforts into the field of Infant Mental Health and Marriage and Family Therapy, a truly systemically designed program has not been developed. This formative evaluation study illuminates the design phase, its developmental process, and the professional staff member’s experience of this newly implemented “Options” program. I focused specifically on Crawford County Community Mental Health Center’s innovative systemic approach to issues related to infant mental health. In this body of work, I describe the process of creating this innovative approach, identified how the program originators made decisions about their approach and how the approach is being operationalized on a daily basis by interviewing the clinicians, who are providing the services and the administrators who created and oversee the program. I utilized a qualitative approach in the design, transcription categorization, and data analysis. This formative evaluation used the “flashback approach” to tell the story of the evaluation findings, this included an Executive Summary. This study’s exploration yielded a clearer understanding of the developmental process of the infant mental health program and its initial implementation. The results of this evaluation revealed that there are a number of core program components (three levels of focus: child and family, program, and community and catchment area) that were organized and clearly disseminated throughout the staff. The interviews revealed that the program has encountered problematic issues including; policy and procedural agreements and mandates, staff turnover, program ownership and funding limitations. It grew increasingly clear that the value of the program’s positive impact on families outweighed the perceived hassle of establishing and implementing the program. This evaluation produced a number of program recommendations for program perpetuation and potential improvements. The program recommendations addressed the challenges facing the “Options Program” are explained. The future research implications of this formative evaluation are enumerated.

Policies are shaped by social values and assumptions, and can significantly impact the delivery of health and social services. Marginalized groups are often disadvantaged in the political realm and reliant on publicly funded services and supports. The purpose of this research is to consider how public policies are constructed and implemented for marginalized groups and to increase understanding of the consequences of policy reform. It draws on a case study of the Ontario Disability Support Program, Employment Supports (ODSP-ES) and considers the impact of the policy revision that occurred in 2006 on employment support services for people living with mental illness. A constructivist grounded theory approach guided data collection and analysis. Key policy documents were analyzed and 25 key informant interviews were conducted with individuals who were involved in: the construction and/or implementation of the policy; developing and/or delivering employment services under the policy; or advocacy work related to the policy. The findings highlight the impact of outcome-based funding on employment services and practices, and provide lessons for the construction and implementation of public policy for marginalized groups. The new funding system has promoted a shift from a traditional social service model of employment supports towards a marketing model, wherein services focus on increasing job placement and short-term job retention rates. However, the introduction of market principles into employment services has had significant implications for people living with mental illness. Employment programs are required to absorb increased financial risk, thereby altering the way service providers work with clients to help them find and keep jobs; there is a heightened focus on the rapid placement of clients into available jobs and less attention to the quality of employment being achieved and to complex barriers that prevent individuals from succeeding with employment. Although ODSP-ES has been somewhat successful at connecting people with disabilities to competitive employment, it has led to secondary consequences that compromise its overall utility. The findings highlight the complexity of constructing and implementing public policy for marginalized groups and suggest that evaluating public policy is an interpretative exercise that should be explored from multiple perspectives beyond the stated objectives.

Policies are shaped by social values and assumptions, and can significantly impact the delivery of health and social services. Marginalized groups are often disadvantaged in the political realm and reliant on publicly funded services and supports. The purpose of this research is to consider how public policies are constructed and implemented for marginalized groups and to increase understanding of the consequences of policy reform. It draws on a case study of the Ontario Disability Support Program, Employment Supports (ODSP-ES) and considers the impact of the policy revision that occurred in 2006 on employment support services for people living with mental illness. A constructivist grounded theory approach guided data collection and analysis. Key policy documents were analyzed and 25 key informant interviews were conducted with individuals who were involved in: the construction and/or implementation of the policy; developing and/or delivering employment services under the policy; or advocacy work related to the policy. The findings highlight the impact of outcome-based funding on employment services and practices, and provide lessons for the construction and implementation of public policy for marginalized groups. The new funding system has promoted a shift from a traditional social service model of employment supports towards a marketing model, wherein services focus on increasing job placement and short-term job retention rates. However, the introduction of market principles into employment services has had significant implications for people living with mental illness. Employment programs are required to absorb increased financial risk, thereby altering the way service providers work with clients to help them find and keep jobs; there is a heightened focus on the rapid placement of clients into available jobs and less attention to the quality of employment being achieved and to complex barriers that prevent individuals from succeeding with employment. Although ODSP-ES has been somewhat successful at connecting people with disabilities to competitive employment, it has led to secondary consequences that compromise its overall utility. The findings highlight the complexity of constructing and implementing public policy for marginalized groups and suggest that evaluating public policy is an interpretative exercise that should be explored from multiple perspectives beyond the stated objectives.

Neuropsychological deficits may perpetuate the risk and chronicity of psychiatric disorder. Borderline Personality Disorder, characterized by significant suicide risk, intense affect and behavioural dysregulation, is frequently associated with the executive function (EF) deficits of decision making and inhibitory control. However, the role of inhibitory control on decision making remains poorly understood. This study examined the relationships among working memory, cognitive and motor inhibitory control, and IGT decision-making performance in 41 women with BPD and 41 healthy controls. Associations among EF and suicide risk were also explored. Experimental tasks included the Iowa Gambling Task, Digit Span, Stroop and Stop Tasks, and Raven’s Matrices. Only IGT decision-making deficits distinguished BPD subjects from healthy controls. Weaker yet normal range IQ and EFs in BPD women did not explain their disadvantageous IGT performance. Contrary to expectations, IGT deficits in BPD women did not predict any suicidal risk; however, intact interference control was as sensitive to suicidal risk as was depression. Normal interference control was associated with a reduction in suicide risk. While IGT decision making may be a marker for BPD, Stroop interference control is more sensitive to suicide risk and may represent a vulnerability for suicide that exists beyond psychiatric diagnosis.

Neuropsychological deficits may perpetuate the risk and chronicity of psychiatric disorder. Borderline Personality Disorder, characterized by significant suicide risk, intense affect and behavioural dysregulation, is frequently associated with the executive function (EF) deficits of decision making and inhibitory control. However, the role of inhibitory control on decision making remains poorly understood. This study examined the relationships among working memory, cognitive and motor inhibitory control, and IGT decision-making performance in 41 women with BPD and 41 healthy controls. Associations among EF and suicide risk were also explored. Experimental tasks included the Iowa Gambling Task, Digit Span, Stroop and Stop Tasks, and Raven’s Matrices. Only IGT decision-making deficits distinguished BPD subjects from healthy controls. Weaker yet normal range IQ and EFs in BPD women did not explain their disadvantageous IGT performance. Contrary to expectations, IGT deficits in BPD women did not predict any suicidal risk; however, intact interference control was as sensitive to suicidal risk as was depression. Normal interference control was associated with a reduction in suicide risk. While IGT decision making may be a marker for BPD, Stroop interference control is more sensitive to suicide risk and may represent a vulnerability for suicide that exists beyond psychiatric diagnosis.

This thesis is an analysis and evaluation of a case study in deinstitutionalisation of people with intellectual disabilities. The process has been viewed as an example of organisational change and the focus is on the relationship between formal and informal caregivers and the notion of care. Three key groups were included in the study, families of residents, the residents and staff. A qualitative approach was taken. The theoretical perspective that was developed attempted to account for links between social movements, organisations and individual experience in the arena of intellectual disability. This was based on the approach of New Institutionalism in organisational theory. The focus was primarily on the process--of change, and in caregiving. Three models of intellectual disability, which have informed policy and the recent changes to a preference for community care, have been identified and the links between these and the elements of organisations developed for providing care explored. The experience of families and residents within the hospital setting and then the community care setting has been examined in relation to the nature of the organisation. Outcomes for the three groups have been examined in terms of their needs and the extent to which these needs were met by the arrangements over a given time. It is concluded that community care has the potential to better meet the needs of those involved, than has hospital based care. A number of factors in the process of change and in the delivery of care have been identified as impacting on outcomes for those involved. Consideration is given to the practical implications of these findings. / Subscription resource available via Digital Dissertations only.