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<p> Depression affects over 16 million adults in the United States every year. Furthermore, depression is a chronic and reoccurring disorder for more than half of the individuals who experience it. There are various treatment options for depression; however, many people are unable to achieve long-term recovery from the disorder. Mindfulness-based cognitive therapy (MBCT) is an evidence-based intervention that significantly reduces the rates of depression relapse. The purpose of this project was to obtain funding to implement an on-going MBCT group at Hoag Memorial Hospital Presbyterian&rsquo;s Mental Health Center in Orange County, California. The goals of the group are to prevent depression relapse by helping participants develop and maintain positive coping skills, learn to be accepting of their thoughts and feelings, and become more compassionate towards their experiences. Included in this project is a literature review, suggested funder, staffing pattern, implementation timeline, evaluation strategy, and budget. Submission of the grant was not a requirement for this project.</p>

<p> The purpose of this project was to locate a potential funding source and write a grant to fund the implementation of the Youth Message Development (YMD) program for all sixth and eighth grade students in Santa Ana, California. </p><p> Marijuana is the most commonly used illicit substance in the United States. Research indicates that use of marijuana by adolescents can lead to negative neurological and cognitive consequences. The goals of the proposed program are to delay or deter marijuana use among youth in the Santa Ana Unified School District by increasing their media-literacy and criticalthinking skills when faced with pro-marijuana advertisements and messages. If funded, this program would help youth in Santa Ana increase their knowledge of advertisement techniques and develop essential skills that may protect them from the dangers that early initiation of marijuana can pose. Actual submission of and/or funding of this grant proposal was not required for successful completion of this project. </p><p>

<p> The purpose of this study was to conduct a community health risk assessment of the city of Long Beach, California specific to the 90813 ZIP code by utilizing an adaptation of the Catholic Health Association of the United States (2013) model for community health assessment to identify the most imperative risk factors for the chronic homeless population in the 90813 ZIP code of Long Beach. Data on three domains (physical health, mental health, and housing) measuring 16 risk factors were gathered from both archival data and major public sources. Data from Long Beach 90813 ZIP code were compared to data from Los Angeles County, California, and the United States. Risk factors that are the utmost concerning for the community appeared to be difficulties in obtaining health care, infectious diseases, both ER and hospitalization rates due to alcohol abuse and high poverty rate. Efforts to reduce the amount of both sheltered and unsheltered chronic homeless individuals should target all three domains. Recommendations for evidence-based programs and interventions to reduce the most salient risk factors are provided.</p><p>

Implicit in most observations about addictive drug use is the assumption that variance in addicts' use and drug related behavior are independent of social forces, that they are caused by the addictive condition. Drug related activities and attitudes include frequency of use, behaviors that increase risk of infection, and attitudes toward use and recovery. This dissertation explores the possibility that social influences account for differences in intravenous drug use and attitudes even after addiction has been established. To explore this possibility, two primary data sets were gathered from over 700 Ukrainian narcotic addicts. The first set was qualitative, made up of interviews with addicts at a national research hospital and provided the information used to design a structured instrument. The second set was made up of quantitative data collected with the structured instrument. Variables were organized into categories that represent corners of social influence , structural areas of social life such as immediate family, family of origin, conventional social institutions, peer networks, and economic circumstances. The study demonstrates that a variety of social factors arising from different corners of influence account for behaviors that previously would have been attributed to the addiction itself. Older narcotic addicts use more frequently than young addicts, and unemployed addicts use more frequently than the employed. Social networks and institutions with which the addicts engage are significantly related to the addicts' use frequencies, risk behaviors, and self-prognoses. Evidence suggests that the frequency of addicts' use is a function of family structure, economic conditions, local narcotic distribution means, and addicts' access to illicit markets. The findings, including the overarching statement that social factors influence addictive drug use and related behavior, have theoretical and practical implications. For sociology they raise questions about the experience of a chronic condition and the use of deviance theory to explain all drug related behavior. They also suggest shifts for intervention practice and policy that can reduce the harm caused by addiction.

Individuals with Post-Traumatic Stress Disorder (PTSD) faced one or more traumatic events in their lifetime that can lead to symptoms such as anxiety, flashbacks, and avoidance. As a result, these individuals can suffer from impairments such as a loss of functioning, inability to go work, and overall difficulties in coping with the difficulties of everyday life. Low-income individuals with PTSD face additional barriers due to the high costs of effective treatment. One evidence-based treatment for PTSD is Eye Movement Desensitization and Reprocessing (EMDR). Noting the equal need for people of low socioeconomic status to receive treatment, a grant proposal was drafted to develop a program that would offer subsidized, short-term EMDR treatment for low-income individuals who are adults (18 years and older) in Orange County. This program would reduce the symptoms of PTSD such that individuals can achieve a higher level of functioning. The grant was written in collaboration with the Norooz Foundation Clinic. Actual submission and funding of the grant are not required for the completion of the project.

<p>The purpose of this qualitative study was to explore the perceptions of Latino males with type 2 diabetes regarding aspects of living with this condition. The sample consisted of 11 adult males. Semi-structured interviews were performed, applying a grounded theory approach. The men reported how culture had impacted their perceptions of diabetes, including the concepts of azucar, nervios, and susto. The men also described their sources of support and whether they were comfortable speaking to family and friends about sensitive topics. They also discussed how being a Latino male had affected their attitudes towards the illness and the various coping skills they were practicing to facilitate their diabetes management and relieve their feelings of sadness and stress associated with diabetes. The results suggest that social workers should provide education and support to Latino men and should provide them with a safe place to facilitate conversations about sensitive topics.

<p> Advocacy for the counseling profession necessitates a thorough understanding of the factors influencing the hiring and reimbursement of licensed professional counselors. The Patient Protection and Affordable Care Act (ACA) enacted several health care reforms that may influence the utilization of mental health services and the employment of mental health professionals. These reforms included the option for states to expand their Medicaid population (effective January 1, 2014), mental health parity requirements for most insurance plans including Medicaid plans, and increased funding for Federally Qualified Health Centers (FQHCs or health centers). FQHCs, created by Congress in 1989, provide primary care services, including mental health services, to approximately 24 million Americans annually and function as a vital safety net for medically underserved communities and populations. </p><p> The largest source of revenue for FQHCs is Medicaid, and FQHCs receive enhanced reimbursement for services provided to Medicaid patients, known as the Medicaid Prospective Payment System (PPS) rate. Federal law, however, explicitly approves only certain health care professions as billable PPS providers. Licensed clinical social workers (LCSWs), along with psychologists and psychiatrists, are included as billable PPS providers under federal law, but not licensed professional counselors (LPCs). Some states have expanded the list of health care professions able to generate billable PPS encounters at FQHCs to include licensed professional counselors. It is vital for the counseling profession to understand the impact of these reforms and the interplay of federal and state policies related to reimbursement upon the mental health industry. </p><p> The optional Medicaid expansion provision of the ACA created an opportunity for a natural experiment to compare mental health service utilization and employment at FQHCs in Medicaid expansion states versus non-Medicaid expansion states. This quasi-experimental study first tested the causal impact of Medicaid expansion on the number of mental health visits and full-time equivalent (FTE) mental health staff at FQHCs, using state-level data gathered from FQHC reports submitted annually to the Uniform Data System. A count model difference-in-differences analysis strategy compared utilization and employment numbers in 2012-2013 (pre-Medicaid expansion) and 2014-2015 (post-Medicaid expansion) between Medicaid expansion states and non-Medicaid expansion states. Then, a two-sample test of proportions utilizing data from a research-developed employment survey examined the relationship between states approving counselors and states not approving counselors as billable FQHC mental health providers under the enhanced PPS reimbursement and the proportion of LPCs at FQHCs (of the total number of LPCs and LCSWs). </p><p> In both groups of states (Medicaid expansion states and non-Medicaid expansion states), it was evident that there was a substantial increase in the number of mental health visits and FTE mental health staff at FQHCs from 2012 to 2015. Contrary to prediction, the first count model difference-in-differences analysis indicated that non-Medicaid expansion states had a significantly <i> higher</i> rate of change in the number of mental health visits from pre-Medicaid expansion (2012-2013) to post-Medicaid expansion (2014-2015), as compared to Medicaid expansion states (&alpha; = .05, <i>p</i> = .01). Then, contrary to prediction, the second count model difference-in-differences analysis indicated that there was not a significant difference in the rate of change for the number of FTE mental health staff between Medicaid expansion states and non-Medicaid expansion states from pre-Medicaid expansion (2012-2013) to post-Medicaid expansion (2014-2015; &alpha; = .05, <i>p</i> = .13). As predicted, the two-sample test of proportions resulting from the survey responses of 138 FQHCs (60% response rate) indicated that there was a significantly higher proportion of LPCs employed at FQHCs in states approving LPCs as billable FQHC mental health providers under PPS as compared to states not approving LPCs (<i>Z</i> = 4.24, <i>p</i> &lt; .001, Cohen&rsquo;s <i>h</i> = .76). Thus, counselor employment at FQHCs was significantly improved in those states approving counselors as billable PPS providers. It is essential for counselors to understand the impact of federal and state health care policies, such as Medicaid expansion, increased funding of FQHCs, and various Medicaid reimbursement methodologies, to successfully advocate for the profession in the dynamic health care landscape. Counselor educators have a responsibility to convey information to students related to the potential repercussions of billable mental health provider status on their employment opportunities following graduation</p>

This thesis examined the development of advanced practice nursing in Thailand. The research focused on the perceptions of advanced practice nursing among Thai health care professionals and the factors affecting Thai nurses who are in the process of preparing to become advanced practice nurses (APNs). Although a large amount of literature about APN has been published, only one study has reported on the situation of the APN in Thailand. Other papers have been conducted with developing countries which employed different health services and nursing service systems. Various issues arose and were reported since the concept of APN was implemented in those countries, e.g. definition, qualifications, examination, registration, boundaries, incentive schemes and scope of practice. It was argued that nurses had encountered various obstacles during the preparation and transformation in becoming APN. Nevertheless, Thailand was only at the beginning of adopting this concept into the health service system. Therefore, this research aimed to investigate the development of APN in Thailand, which has never been explored. The study concentrated on the development of APN in nurses who are working in intensive care units (ICUs) because the model and the role of APN in this clinical area lack clarity in the published literature. Triangulation of two research methods was employed to address the research questions. The sample included staff nurses, head nurses, doctors and master degree students in an APN preparation programme. In the quantitative study, 226 questionnaires developed by the author were posted to 23 hospitals and 28 master degree students, yielding 156 usable responses. Qualitative data were collected from five focus group interviews with 28 master degree students using a semistructured interview schedule developed and piloted by the author. Factor analysis of quantitative data revealed five expected roles of the APN in ICU: extended roles, ensuring standards, patient management, nursing roles and academic roles. Regression analysis explained that there were significant relationships between being a head nurse and ensuring standards (P<O.5), age and nursing roles (P<O.5) and being a doctor and patient management (P<O.5). Being a head nurse, age and being a doctor appeared to be strong predictors of ensuring standards, nursing roles and patient management respectively. Qualitative data were analysed following Miles and Huberman and Strauss and Corbin's guidelines. Two central categories emerged: passage and process of the development of APN. Finally, a paradigm model was constructed, explaining the development of APN. Some concepts in the paradigm model were consistent with published literature, e.g. the readiness to change, transition and role theory. Other concepts were reflections of the unique Thai context, e.g. preparations for the development and anticipation of the role of APN. Thus, the development of APN in Thailand is a combed model. The thesis concludes with suggestions for the future research.

<p> The purpose of this study was to examine the utilization of emergency department services by homeless adults in Pomona, California achieved through quantitative cross-sectional research. The results revealed that many homeless adults frequent the emergency department for mental health reasons and those homeless adults with physical ailments required longer lengths of stay and extensive discharge planning. Most participants had insurance coverage, but many appeared to lack social or primary care resources in the community, leading to frequent emergency department usage. This study may be beneficial to individuals, communities, and professionals to better understand the healthcare experiences of homeless individuals. The tangible and nontangible barriers to healthcare, as well as outside social resources affect the general public health through risks of contagious diseases and the rise in emergency department overcrowding. </p><p>