Persons with aphasia (PWAs) often demonstrate challenges in the areas of expressive language, comprehension, reading, and writing. Due to these deficits, PWAs have limited opportunity to express their opinions and contribute to treatment planning. This project focused on the development of a self-report needs assessment tool for PWAs that facilitates PWAs participation in treatment planning. The needs assessment tool was designed using aphasia-friendly features including pictographic/visual analog scale, key words in bold, simple wording, large font, consistent question formatting, flexible administration, and the use of a communication partner/interview. The needs assessment tool was administered to seven PWAs in the Bowling Green, Kentucky area. Participants were recruited from short-term rehabilitation facilities, long-term care facilities, and personal homes. The needs assessment tool is comprised of 12 items targeting interest in therapeutic offerings for inclusion in a new intensive comprehensive aphasia program (ICAP). Results revealed the importance of flexible administration in response to participants’ communication abilities and limitations. With use of communicative support, the needs assessment tool provided an opportunity for PWAs to effectively express treatment preferences. Participants indicated moderate interest in an ICAP at Western Kentucky University and treatment options including individual speech and language therapy, physical therapy, and community outings.

Objective: The purpose of this study was to evaluate the effectiveness of a public behavioral health (PBH) agency that had implemented continuous outcome feedback as a quality improvement strategy. Method: I investigated the pre-post treatment outcomes of 4,389 ethnically diverse youths (6 to 17 years old) at or under the poverty line participating in treatment (from January 2008 to March 2014) for a broad range of primary diagnoses including depression and anxiety disorders (23%); adjustment disorders (27%); Attention Deficit/Hyperactivity Disorder (13%), various V-codes (18%); bipolar disorders (3%); and substance use disorders (2%). I also investigated the treatment outcomes for a subset of youth (N = 469) presenting with depression-related psychological distress. Treatment outcome was measured with the Outcome Rating Scale (ORS; Duncan, 2011; Miller & Duncan, 2004) and the child version: Child Outcome Rating Scale (Duncan Sparks, Miller, Bohanske, & Claud, 2006). Benchmark methodology allowed effect size comparisons to randomized clinical trials. Results: The average treatment effect size estimate of psychotherapy (d = 0.74) for all youth at the PBH agency was comparable to the average effect size estimate for treatment from nine clinical trials using client feedback, yet not equivalent to an average effect size estimate from feedback trials using the ORS. Compared to treatment-as-usual (TAU) groups, treatment at PBH was clinically superior to the TAU group outcomes in both the benchmark from all nine feedback trials and the TAU benchmark from the three ORS trials. The average treatment effect size estimate of psychotherapy (d = 1.51) for the PBH depression sample was clinically superior to a waitlist/no treatment benchmark drawn from 17 clinical trials of youth depression, and clinically equivalent to a treatment benchmark drawn from 13 youth depression clinical trials using intent-to-treat analyses. Conclusions: Despite the existing socioeconomic disparities in mental healthcare for youth, these findings demonstrate that mental health services to youth in poverty across an entire agency can be effective. Continuous outcome feedback can bridge the gap between research and practice and may be a feasible strategy to ensure quality of services for PBH agencies.

The purpose of this dissertation was to examine whether a breast cancer survivor’s view of God influences her religious coping strategies, depression, anxiety, stress, fear of recurrence, and psychological well-being. These variables were selected based on literature that demonstrates relationships among them for breast cancer survivors. The specific aims of this dissertation were to: 1) identify religious coping strategies common to each of the four views of God; 2) examine the relationship of psychological well-being (Ryff) and religious coping strategies; and 3) examine differences in depression, anxiety, stress, fear of recurrence, and psychological well-being among women holding various views of God. Three manuscripts comprise this dissertation. The first manuscript is a systematic review of the literature describing what is known about the relationships between psychological adjustment and religion/spirituality (R/S) in women with breast cancer. The second manuscript examines the psychometric properties of the Image of God Scale in a population responding to a crisis event, women with breast cancer. The original scale was developed from a general population survey. Finally, the third manuscript investigates the relationships between view of God, religious coping strategies, and psychological adjustment in women with breast cancer. The systematic review identified three primary themes: 1) R/S domains and psychological adjustment; 2) dynamics of R/S conservation and struggle; and 3) reframing the cancer experience. The psychometric analysis confirmed the original 2-factor model with factor loadings ranging from .56 to .83. Cronbach’s alphas for the two subscales – belief in God’s anger (.80) and belief in God’s engagement (.89) – were consistent with those established at development. Differences were found between views of God and use of religious/spiritual coping strategies focused on Spiritual Conservation and Spiritual Struggle. Psychological Well-Being (SPWB) was inversely correlated with Spiritual Struggle. Differences were noted for psychological well-being, Fear of Recurrence, and the Stress subscale in women who viewed God as highly engaged or not. No differences were noted for the same variables in women who view God as more or less angry. Direct comparisons between groups and variations in outcomes based on common views of God could lead to effective screening for persons at risk for particular outcomes and to effective individualized interventions.

Caregiving can be stressful, and older adults’ health and well-being may be impacted by the roles and responsibilities they assume as caregivers for persons with serious mental illness (SMI). This study is the first to apply the Stress Process Model of Caregiving (SPM) in an attempt to understand how mental illness stigma influences caregiver outcomes, specifically their desire to relinquish care. The intent of this study was to call attention to care relinquishment as an under-studied stress process outcome and to explore stress factors, with a focus on mental illness stigma, that contribute to SMI caregivers’ desire to relinquish care. Using convenience sampling, members of the National Alliance on Mental Illness in the eastern U.S. were invited to participate in an online survey, resulting in a sample of n = 285. Regression analysis findings suggest that caregivers’ partnership status, exposure to problematic behaviors, and perceptions of courtesy stigma predicted desire to relinquish care. Neither age nor caregiver sense of mastery moderated the relationship between perceived courtesy stigma and relinquishment desire. Perceptions of stigma were negatively associated with caregiver health, sense of mastery, and social support levels, indicating stigma’s role in the erosion of caregiver resources. This study provides information that can inform the development of educational and supportive services that may help caregivers better cope with the stressors associated with SMI caregiving. With caregiving stressors diminished, older caregivers will be able to better apply their resources toward self-care and maintaining their quality of life.

While the media frenzy focuses on the physical risks of concussion, there is also growing concern about the academic repercussions for students who sustain the injury. We do not currently have a uniform evidence-based approach for optimally returning a student back to learning activities after a concussion. We also do not understand how the diverse consequences of a concussion may affect academic self-efficacy and performance. The purpose of this study is to explore the effects a concussion may have on college students who are navigating the return to learn (RTL) process. This research aims to inform whether there are measureable deficits in academic self-efficacy using the previously validated and abridged survey measure, the Self-Efficacy of Learning Form (SELF-A). Time of injury during the academic semester is also considered, as we hypothesize greater healing should negate the concussion's effects on the measure of self-efficacy. In addition, the research explores students' experiences with RTL using a semi-structured interview approach. The results suggest that college students who suffer a concussion during an academic semester have lower measures of academic self-efficacy compared to a control group of their peers. In addition, results show that students are returning to learn while still suffering from the effects of their concussion. This study found no significant correlation between the healing time of a concussion and the scores on the SELF-A. The interviews served to underscore the diverse myriad physical and psychological challenges a student faces, as well as the precarious variance in RTL strategies. This study highlights the challenges that students face while they RTL following a concussion, and begs the investigation of whether better RTL practices can help mitigate the negative effects. It underscores the necessity for further research, evidence-based medical care, instructor accommodations, and institutional policies to support students' safe RTL and ability to perform at their maximal academic potential.

Background: Dementia is a degenerative neurological disorder that afflicts a growing proportion of the global population. Complementary alternative medicine (CAM) modalities are under investigation for their therapeutic value in the management of dementia. Purpose: Nursing care of dementia sufferers can include managing agitation and negative behaviors; this study investigates staff appraisal of the Multi-Sensory Stimulation Environment (MSSE) as an intervention for these nursing challenges. Methods: A purposive sample of nursing staff employed in residential care for dementia patients were recruited 10 weeks after the initiation of an open-access MSSE at the facility to complete a confidential self-administered questionnaire. Results: 79% of potential participants returned completed surveys for a total sample of n = 23. 70% of survey respondents felt that residents were utilizing the MSSE "Somewhat Frequently" or "Very Frequently." 77% of the staff felt the MSSE should continue in use at the facility or continue with some alterations. The sample suggested that the MSSE is helpful for mood, specifically anger, sadness, anxiety, and restlessness, but not for boredom. Higher-scoring items in favor of the MSSE intervention included confusion, perseverating, wandering, and interpersonal conflict. Conclusion: Several components of agitation and negative behavior in the dementia population appear to be improved with the use of an MSSE according to this sample. Further research is needed to support the results of this sample and to explore more detailed recommendations regarding the use of MSSE in dementia care.

Research has revealed a variety of negative health consequences for older adults who stop driving, and with the "graying of America," this will be a frequently encountered issue for healthcare providers. The purpose of this study was to determine if there are differences in quality of life and depressive symptoms between former drivers who made the decision to stop driving voluntarily and former drivers who made the decision involuntarily (either in a resistant or in a reluctant manner). In this cross-sectional cohort comparison study, community dwelling older adults were asked to complete questionnaires of depression (using the Geriatric Depression Scale), and quality of life (QOL) (using the Short Form Health Survey-36 questionnaire). Descriptive statistics include data for each individual group separately; separate analysis of variance (ANOVA) was used to analyze the data to determine if differences in QOL and depression exist between the groups. Results: the small sample (n=18) was predominantly comprised of women (15/18), most were widowed, and the age of participants was 81 years. No differences were detected between the three group means for the GDS, F(2, 15) = .782 (p = .47). Results for the SF-36 revealed differences between the group means in the mental health component summary was F(2,13) = 4.209, (p = .039). Conclusions: There are few differences between involuntary and voluntary former drivers demographics, but differences may exist between involuntary and voluntary former drivers' quality of life.

Background & Purpose: Opioid maintenance therapy (OMT) is an effective method of treating opioid addiction. Of incarcerated individuals in the U.S., 50-85% have a history of substance abuse, and >80% of inmates with opioid addiction history do not receive treatment. The purpose of this study was to explore individuals' experiences after being tapered from OMT upon incarceration. Methods: Interpretative phenomenological analysis (IPA) was employed using in-depth interviewing of 10 participants. Results: Analysis identified six themes that captured the essence of the participants' experiences. Implications & Conclusion: Losing OMT upon incarceration was described as an extremely stressful experience for many individuals, and may create issues for both inmates and facility staff. Further research is needed to discover ways in which to improve addiction treatment in prison.

Written in the Scholarly Personal Narrative (SPN) style of writing, this thesis explores my personal experience as a college admissions counselor. It offers a reflection of my own college search and application experience, my perspective on the experience of today's high school students, and my professional experience working within an admissions office. The juxtaposition of these three perspectives alongside scholarly references on higher education, philosophy, and anxiety, provides a full-spectrum view of the college admissions process. The core topic of this reflection is anxiety, and showing how each party experiences anxiety in the college search, application, and selection process. Other topics such as social media use, technological advances, parental involvement, and self-care are explored as factors that can induce, or reduce, anxiety. The intertwining of my own college story with the stories of current students shows how quickly the admissions process can change, but how the feelings experienced remain similar. This SPN writing was an opportunity to reflect on my work as an admissions counselor and provide a view into an often-shrouded industry. My hope is that my experiences, first as a high school student and then as an admissions professional, and the experiences of today's current students will help to show the commonalities between each party. The understanding of these commonalities, especially shared anxieties, could create the support and understanding that the admissions industry desperately needs. This work provides suggestions and guidance on how to work through anxiety in hopes of lessening the impact that anxiety has on the complicated college admissions process.

Modern psychiatry in the United States emerged at the same time as debate about slavery intensified and dominated public discourse, contributing to dramatic denominational schisms and to the greater visibility of women in the public sphere. as the only institution to accept slaves and free blacks as patients, and to employ slaves as attendants, The Eastern Lunatic Asylum of Williamsburg, Virginia, offers unique insights into the ways in which gender, race and religion transformed psychiatry from an obscure enterprise in the early nineteenth century to a medical specialty with wide-reaching cultural authority by the twentieth century.;Utilizing a variety of sources, including a collection of un-catalogued and largely unexamined papers, this dissertation employs interdisciplinary methods to explore the meaning of interracial medical encounters, and the role of the asylum in promoting rational religion and normalizing domestic violence.;The dissertation begins by examining the life and writings of asylum Superintendent John M. Galt, whose experience at the head of an interracial institution led him to reject proposals for separate institutions for whites and blacks and to promote the cottage system of outpatient care. The following chapter addresses the labor of enslaved attendants, without whom the asylum could not have functioned and for whom moral rectitude and spiritual equality appear to have been the ethical foundation of care-giving. Discussion of ethics and spirituality, in turn, prompts consideration of the role of religion in asylum care. The association of enthusiastic religion with slaves and with abolitionism contributed to the regulation of religious expression as a common feature of asylum medicine. Religious evangelism was viewed by hospital administrators as a symptom of insanity, while religious rationalism was enshrined as normative and, paradoxically, as secular.;Asylum medicine also normalized domestic violence by treating the social problem of violence, from wife beating to the rape of slave women, as the medical pathology of individuals. In so doing, the asylum undermined the religious authority from which many women derived comfort, meaning and purpose; and overemphasized the role of female sexual and reproductive organs as an alleged cause of insanity. Ultimately, the struggle over efforts to contain interracial alliances, women's autonomy and enthusiastic religious expression coalesced in the state's promotion of eugenics in the early twentieth century.