Thesis (Psy. D.)--Wheaton College Graduate School, Wheaton, IL, 2003. / Abstract. Includes bibliographical references (leaves 80-85).

Thesis (Ph. D.)--Mississippi State University. Department of Leadership and Foundations. / Title from title screen. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1977.

Thesis (Psy. D.)--Wheaton College Graduate School, Wheaton, IL, 2003. / Abstract. Includes bibliographical references (leaves 80-85).

Objective: To examine parents’ perceptions of stigma regarding mental health services for their child, consider stigma in the context of novel service delivery settings (e.g., telehealth, primary care, and schools), and evaluate stigma with other factors known to influence service access. Methods: 347 caregivers of children with psychosocial concerns completed surveys regarding their perceptions of stigma, service delivery settings, and barriers to care. Results:Parents endorsed low levels of stigma around services. Greater perceived stigma was related to less willingness to seek services in a mental/behavioral health center or schools but not in other settings, even when other barriers were considered. Having a younger child and a history of prior services was associated with greater willingness to seek services. Conclusions: Stigma does appear to present as a barrier, but only for some parents. Providing mental health services to young children and their parents in some nontraditional settings may increase access.

No description available.

Early detection and intervention are crucial for optimal outcomes in autism spectrum disorder (ASD), but access to services is often lacking in rural communities. In fact, the average age of ASD diagnosis in rural communities is later than elsewhere, increasing the risk of missed early intervention and subsequently poorer outcomes. Caregivers in Southwest Virginia report that major barriers to ASD services include few providers with expertise in ASD, unaffordability of services, and geographic isolation; limited parent training or education about ASD emerges as a particular paucity in this region. To address these barriers, the current pilot study assessed the feasibility of delivering ASD assessment through a mobile clinic (n = 15). During COVID-19, the study shifted to pilot an ASD teleassessment protocol (n = 15). Participants included 30 children between 1.7 and 14.9 years of age and one or both caregivers. Following a diagnostic feedback session, caregivers of children who received an ASD diagnosis (n = 28) were randomized to either attend psychoeducation sessions or receive comparable materials about ASD, with the goal of improving caregiver ASD knowledge and empowerment to seek and provide care for their child. Although flexibility in scheduling was necessary to accommodate families’ schedules, both delivery formats exhibited high feasibility and strong caregiver satisfaction. The primary reason for rescheduling mobile assessments was weather-related, whereas teleassessments were rescheduled due to family emergencies and work-related conflicts. Caregiver empowerment in the domains of family and the community improved after receiving assessment and psychoeducation services, as did total ASD knowledge (η2 = .114–.235, p < .05). / M.S. / Children with autism spectrum disorder (ASD) tend to achieve better outcomes with early intervention, which requires early assessment and diagnosis. However, families in rural areas typically have greater difficulty accessing such services, due to limited providers, high cost of services, and geographic distance from provider offices. This often results in children from rural regions being diagnosed with ASD at a later age than elsewhere, thereby missing opportunities for effective and timely treatment. To overcome these barriers, the current pilot study evaluated two novel service delivery formats: (1) mobile assessment through the Mobile Autism Clinic prior to the COVID-19 pandemic (n = 15); and (2) tele-assessment via a secure video platform during the pandemic (n = 15). Participants included 30 children between 1.7 and 14.9 years of age and one or both caregivers. After completing an assessment, caregivers attended a feedback session to review diagnoses and recommendations. If their child received an ASD diagnosis (n = 28), caregivers then either completed additional educational sessions about ASD or received similar informational materials, with the goal of improving caregiver knowledge and empowerment. Although flexibility in scheduling was necessary to accommodate families’ schedules, both delivery formats demonstrated high feasibility and strong caregiver satisfaction. The primary reason for rescheduling mobile assessments was weather-related, whereas teleassessments were rescheduled due to family emergencies and work-related conflicts. Caregiver empowerment within their family and community improved after receiving assessment and psychoeducation services, as did total ASD knowledge.

Alarming rates of suicide among production farmers have prompted researchers to investigate factors associated with depressive symptoms among this population. Aspects of farm life and farming can contribute to higher levels of depressive symptoms. Higher levels of depression can also increase an individual’s risk of injury and development of chronic disease, impacting overall quality of life. Despite the approximate 3.5 million farm women in the U.S., current research has focused on the male farmer. Men and women have different responses to stressors, and women in general have a higher prevalence of depressive symptoms. Farm women can be further subjected to stressors associated with farming as an occupation and their gendered role within the agrarian culture. The large number of farm women affected, the relationship of chronic depressive symptoms on health and quality of life, the lack of current research available, and the rising rates of suicide and depressive symptoms among farmers emphasize the need for further investigation of farm women and depressive symptoms. The overall purpose of this dissertation was to 1) explore the current state of the science of farm women and depressive symptoms and identify variables commonly associated with depressive symptoms among farm women, 2) identify variables influencing levels of depressive symptoms within farm women aged 50 and over and identify differences between those women with high depressive symptoms and those with low depressive symptoms, and 3) establish the reliability and validity of the 12-item John Henry Active Coping Scale (JHAC-12) within the sample. A systematic review of the literature revealed that there is a need for more research with strong study designs regarding farm women and depressive symptoms within the context of their environment, culture, and occupation. The review identified multidimensional factors from farm women’s lives that influence their level of depressive symptoms. Farm women’s ethnicity, the agrarian culture, family and social relations, as well as specific demographics were identified as key variables associated with an increased risk of higher depressive symptoms. Because of the identification of the multi-dimensional factors, the use of the Modified Biopsychosocial Model (MBPS) was selected as a framework for continued research as it depicts the interrelationship between the factors and their influence on farm women’s depressive symptoms. The MBPS was applied to data from 358 farm women aged 50 and older from a larger cohort study, and a secondary analysis was performed. Multivariable binary logistic regression was used to identify those variables associated with depressive symptoms among farm women. Depressive symptoms were predicted by race/ethnicity, years of education, adequacy of income for vacation, perceived health status, perceived stress score, and active coping score. Significant differences between those farm women with low CES-D score (< 16) and those with high CES-D score (≥ 16) were noted. Race/ethnicity, years of education, adequate income for vacation and retirement, reported health status of fair or better, perceived stress score, active coping score and satisfaction from farm work were all significant between groups. Women who were non-White, had less education, reported income not adequate for vacation or retirement, reported poor health, higher levels of perceived stress, lower levels of active coping and who were not satisfied with farm work were more likely to be in the high CES-D group. A principal component analysis with direct oblimin rotation in a sample population of older farm women (n=458) identified two dominant themes of the JHAC-12: “commitment to hard work” and “self-efficacy.” The instrument component structure reflects the culture of the agrarian society. In the two-component solution, 2 items were removed from the scale after revealing low values of communality (< .3). The item reduction resulted in more refined scale, increasing explained variance by 4.1% with less items. Cronbach’s of the JHAC-12 (α = .78) and JHAC-10 (α = .76) indicated high levels of reliability for both scales. Rotation of the items resulted in a simple structure with high loadings within items, no major-cross-loadings and little correlation between components (r = .29), supporting both convergent and discriminant validity in this population. The ability of the JHAC to encompass the socio-culture aspects of active coping among farm women and obtain a quantifiable result supports the JHAC as an important tool to utilize in future studies of depressive symptoms and farm women with use of the JHAC-10 in future studies of farm women decreasing the burden of the participants. Although there are limitations within each document, each section adds to the science of farm women and depression symptoms and provides directions for future research. The major gaps identified were: 1) the need for current research with stronger study designs, 2) studies of farm women across their life spans, 3) the need for focused studies among minority and migrant women, 4) an understanding of farm women and their leisure time, and 5) a broader application of the MBPS theory to include a large number of social variables shown to be associated with farm women and depressive symptoms that were not available in the dataset.

Unique barriers prevent parents in rural areas from seeking mental health services for their children. The implementation of innovative models of service delivery may reduce these barriers' impact on rural parents' treatment seeking. The purpose of this study was to determine: 1) parents' willingness to use innovative service delivery models; 2) barriers that parents perceive to seeking treatment in each of the 4 service delivery models, and; 3) the relationship between perceived barriers and willingness to seek help in the context of 4 service delivery models. Surveys were distributed to parents of children attending school in several counties in rural Appalachia. Results showed that parents perceived different barriers for different service models and that perceived barriers affected willingness differently depending on the model asked about. These results suggest that the use of innovative models (e.g., telehealth) may be acceptable in rural areas as alternatives to traditional mental health services.

No description available.