Large numbers of individuals utilize the ER each year for mental health reasons. The health home agency in this study was designed under the Affordable Care Act with the intention of increasing patient self-management thus decreasing high-cost service utilization. The effectiveness of health homes in reducing mental health-related ER visits has remained unexplored. In this study, the relationship between participation in this program and ER utilization was examined, using the theoretical framework of the Health Belief Model. The sample of 128 health home participants with documented mental health conditions was selected using systematic random sampling. A one-way, repeated-measures t-test and a one-way, repeated-measures ANCOVA were used to analyze hospital records for ER visits with a primary or secondary mental health diagnosis. The results indicated that health home participation did not have a statistically significant impact on ER utilization when comparing overall 12-month means or at quarterly anniversary dates when controlling for age, race, and gender. These findings suggested opportunities for improvement in professional practice, identified areas that require further research, and will be used to initiate discussion into the existing and potential value that health homes offer to the mental health clientele being served. Those discussions have the potential to create social change through infrastructure changes that lead to improved service coordination, increased resources for improving access and quality of care, and overall enhancement of outcomes for individuals with mental health conditions.

While obesity is a nationwide phenomenon, African Americans - especially women - continue to be more severely affected than any other ethnic group. According to the Centers for Disease Control and Prevention, over 20% of African American women are obese compared to 15.6% of Caucasian women. The church is an important community center for many African Americans, and is often a site for health promotion programs, though little is known of the effectiveness of these programs. The purpose of this qualitative study was to study the experiences and attitudes of African American women who have gone through a church-based weight-loss program. Questions were asked about the cultural, environmental and social barriers to weight loss, and the components of effective church-based weight loss programs. Using a phenomenological approach, this study was designed to capture new data for the development of sustainable church-based weight-loss programs. The theory of social support was used as a theoretical framework. The major themes arising from the data concerned the importance of: (a) social support on all levels; (b) the involvement of the pastor, his spouse, or other church leadership; (c) the inclusion of weight-loss participants in program design; (d) a holistic program design to meet the needs of the entire family; and (e) a culturally sensitive program. The inclusion of all these elements is recommended for future programs. The social change implication is that these recommendations could be helpful in the design, development, and implementation of sustainable church-based weight-loss programs for African American women.

Police officers experience stress from operational and organizational demands which are extrinsic in nature. Officers may also experience stress from not being able to attain their personal goals for becoming a police officer, which is referred to as goal negation. The purpose of this mixed model, exploratory study was to examine if stress from goal negation is an intrinsic moderating factor of police officers' overall experience of career-related stress that may be adding to the health risks of the profession. The framework for the study included the concept of goal negation and the theory of operational and organizational or intrinsic and extrinsic stressors. The study was conducted in a Southern state with a sample of 52 acting police officers with 1 to 6 years of field experience. Two online survey questionnaires were modified from McCreary and Thompson's PSQ-Org and PSQ-Op and used to measure organizational and operational stressors. In-depth interviews added to the exploration of the lived experiences of officers in assessing their personal goal attainment. Results from the exploratory multivariate factor analysis of variance (MANOVA) of operational and organizational survey scores indicated that goal negation played a significant role in moderating stress for police officers in their duties. In addition, the content analysis of the interviews revealed a theme of conflict between police officers' personal goals and the operational role of police in the public context today. The results of this study will contribute to social change by informing police agencies, police training centers, and mental health treatment facilities of possible job sources of stress for new hires and career-oriented police personnel.

In the 2006 census, Statistics Canada recorded that 23% of immigrant women aged 15 and over had a university degree at the bachelor's level or above. These women could help sustain an organization's competitive advantage and respond to labor shortages posed by an aging population. This phenomenological study highlighted self-initiated migration journey and career advancement experiences of migrant women. Through LinkedIn and referrals from non-profit organizations, a sample of 20 women was recruited. All women had migrated to Canada between the ages 32 to 50, all had 5 to 10 years of residence in Canada and all had college degrees from their home countries. Data were collected through in-depth qualitative interviews and analyzed utilizing Moustakas's framework. The themes were driven predominantly by the data from the study. In order to manage structural barriers to their career development, the participants highlighted the importance of career preparation such as postgraduate education, qualification accreditations and international experience to advancing their careers in Canada. The findings of this study showed that, the principles of meritocracy was influenced by ethic discrimination and educational barriers experienced by participants. The participants challenged inequalities by navigating within organizational structures using these modes of engagement; maintenance, transformation, and entrepreneurship as they developed their careers. The results provide a framework to the Canadian government, businesses, and settlement agencies to understand the implications of ethnicity and international experience to the current debate and proposition for reforms to immigration and hiring policies.

The prevalence of hypertension in African Americans is the highest of any population in the United States, and this population also demonstrates lower rates of adherence to mediation. Social support and patient-provider communication have been considered as reinforcing factors to help hypertensive patients achieve optimal blood pressure control. The purpose of this study was to examine the association of social support and patient-provider communication and medication adherence for hypertensive African American men and women. The study was guided by the theory of reasoned action. This study was conducted to determine whether social support and patient-provider communication was associated with medication adherence by self-report, age, and gender. A quantitative cross-sectional design with secondary data analyses was used. The sample included 566 hypertensive African American men and women between the ages of 21and 65 years who participated in a survey administered in the Counseling African Americans to Control Hypertension clinical trial collected between 2004 and 2011. The independent variables were social support and patient-provider communication; the dependent variable was medication adherence. Descriptive, 2-way analysis of variance and hierarchical logistic regression model analyses indicated a significant association between patient-provider communication and medication adherence. There was no significant difference in the relationship between social support, patient-provider communication, and age and gender and medication adherence. The implications of this study for social change include improvement in policies and development programs to support the critical role of providers in ensuring medication adherence in hypertensive African American patients.

Devalued homes and weakened economic conditions of 2008 led to lost property tax revenues, more vacant and abandoned properties, and destabilized neighborhoods. The first Neighborhood Stabilization Program (NSP1) was a federal intervention designed to mitigate the damage of the recession, but there is scant evidence of program effectiveness. A phenomenological study, using a method outlined by Moustakas, answered questions on the benefits and barriers of NSP1 as perceived by stakeholders in a Mid-Atlantic city. Stakeholders included nonprofit housing advocates, residents, business partners, and government officials. Theories of collaborative governance and community stakeholders were used to guide the investigation of NSP1 processes and stakeholders' perceptions. Ten stakeholders responded to 9 compound interview questions derived from the research question and 4 subquestions in semi-structured interviews. Responses were transcribed, verified for accuracy, and then coded and analyzed for recurring themes. Five prominent themes emerged: (1) challenges with NSP1 guidelines, (2) importance of partner capacity, (3) positive results in targeted neighborhoods, (4) city's approach to community development, and (5) sustaining positive results. Findings were that NSP1's benefits for residents outweighed procedural barriers and NSP1's short duration still yielded positive results in neighborhoods. This study has policy and social change implications for all stakeholders involved. Recommendations include continuous city involvement to stabilize neighborhoods during future recessions and better entrepreneurial strategies to integrate private and non-profit stakeholders in all phases of collaborative governance.

Between 2001 and 2017, the Civilian Complaint Review Board (CCRB) received 295,616 allegations of police misconduct involving New York Police Department (NYPD) officers' use of force, abuse of authority, discourtesy, and offensive language (FADO). The purpose of this study was to explore the influence of administrative disciplinary actions on officers' emotional intelligence and performance in relation to citizen complaints of police misconduct. The central research question addressed how administrative practices influence law enforcement officers' behavior in relation to emotional intelligence-based performance. The theoretical construct for this study is based on the emotional intelligence theories of Bar-On, Goleman, and Mayer, DiPaolo and Salovey which suggest that individuals, including police officers, are responsible for their emotional intelligence and conduct. A qualitative analysis of citizen allegations of police misconduct of the NYPD was conducted using documents from the CCRB and Office of the Inspector General for the NYPD. Each complaint was evaluated using a thematic-based analysis. The findings suggested that the NYPD's low disciplinary rate might have influenced FADO behavior, revealing patterns and practices of racial, ethnic, and social stereotyping, and a lack of compliance with department policies. Recommendations include officer and administrator training on emotional intelligence practices and restructuring department policy processes which can lead to positive social change by helping law enforcement agencies engender trust with their communities and eliminate patterns and practices related to social bias, profiling, and racial stereotyping.

Seasonal influenza outbreaks are associated with morbidity and mortality in the United States. Though children are the most susceptible to influenza infection and are most likely to transmit the illness to others, many children are not vaccinated. The purpose of this study was to examine the relationship between seasonal influenza vaccination Advisory Committee on Immunization Practices (ACIP) recommendations, demographic characteristics, socioeconomic factors, and vaccine type among children over 3 consecutive flu seasons. This quantitative cross-sectional study was guided by the social ecology of health model. Secondary data from 3 consecutive flu seasons (2014-2015, 2015-2016, and 2016-2017) provided by the National Health Interview Survey was used for this study. Binary logistic regression and chi-square were used to analyze the data. A relationship between socioeconomic status, demographics (age, race, and family income) and vaccine type (live-attenuated influenza vaccine [LAIV]/inactivated influenza vaccine) was established among U.S. children; those who received LAIV were most likely to be White elementary school age children with a higher family income. Demographic and socioeconomic status was not considered influential in LAIV uptake for race, health insurance status, or family income. ACIP recommendations by age and year had the greatest impact on flu vaccine choice for this sample population. The results of this study can lead to social change by providing information for policy that can increase vaccine uptake, which can result in lower health cost and reduced illness and death rates associated with the flu, especially for those most at risk.

Previous research has indicated the importance of providing marriage education to ethnic minority couples who are struggling with their marital relationships. Despite this known importance, significantly fewer resources are available for Latino couples, who have a high rate of divorce. The purpose of this quantitative, randomized, wait-list control group trial design was to determine whether Couples in Contact, a culturally-based, psychoeducational intervention group program for Latino couples, increases marital satisfaction, as measured by the Marital Satisfaction Inventory, Revised (MSI-R). This study drew on cognitive behavioral therapy applied to couples, and the supportive theories underlying family systems theory and Gottman's theory. This study included 50 Latino married couples who were primarily Spanish speaking and either first- or second-generation immigrants. They were randomly assigned to the experimental or wait list control condition. Marital satisfaction was assessed before and after the experimental group participated in the intervention. A 2-way ANOVA was used to analyze the data. Results indicated that Couples in Contact yielded significant results for 3 out of the 4 of the research questions assessed. The findings suggest positive changes in the individual couple level, and an effective tool for mental health providers to use when working with Latino couples. This evidence-based program can be used to help reduce the divorce rate, foster the quality of married life, promote a healthier family life, and build a stronger community.

Leaders in some narcotics treatment programs struggle with change development and implementation. The objective of this single-case study was to explore strategies used by leaders in a narcotics treatment program to develop and implement organizational change initiatives successfully. Participants included 4 leaders who had developed and implemented successful change initiatives repeatedly for more than 10 years in a narcotics treatment program in the southeastern United States. Bertalanffy's general systems theory was the basis for the conceptual framework. Data collection included semistructured interviews of leaders of a narcotics treatment program and collection of archival data, such as reports relating to strategic planning, core value analysis, and risk assessments. Data analysis, using qualitative analysis software revealed 3 themes: communication, education through research, and resistance. The identified themes aligned with the conceptual framework, as the themes work together as a unit. Recommendations for action include further research for the application of social media in the treatment of patients. Leaders of narcotics treatment programs may use the findings to improve the success of social change development and implementation. Successful social change within these programs could result in the betterment of community relations and an increase in productive members of society who contribute to the economic health of the community.