This study examined the effectiveness of a family counseling intervention program called the Parent Monitoring Program (PMP) on reducing the rate of recidivism with first-time juvenile offenders in New Orleans, Louisiana. The PMP is a multimodal treatment intervention that combines individual, family, and group, counseling services to juvenile offenders and their families. Pugh, Force, Rault, and Triche (2000) reported that with effective and innovative family and community based intervention programs, juvenile offenders can be deterred from further delinquent behaviors. There is a great need for research studies to examine effective interventions that address reducing the rate of recidivism with juvenile crime (Cullen & Grandeau, 2000). This study looked at the differences in recidivism rates for the treatment group, juvenile offenders who completed the PMP, versus the control groups those juvenile offenders who either did not complete the PMP, or who refused the PMP services. The participants (N=1144) were mainly African Americans of low SES who committed minor offenses from the years 2001-2003. A logistic regression analysis was conducted to find out the differences in recidivism rates between the treatment and control groups, as well as levels of offenses in terms of recidivism rates and gender differences. Results of the analyses indicated that those participants who completed the PMP had lower recidivism rates than those who did not complete or refused the PMP service. In addition, level of offenses was positively associated in terms of recidivism (p <.001). However, in terms of recidivism, there were no differences between males and females xiii ( p =.108). Faculty members in counselor education can use the findings from this study to pay attention to the problems that this special population faces. Counselors can become more aware of the importance of a multimodal approach with emphasis on family involvement and early intervention. The multi cultural issues and risk factors that surround this population are of relevance to the curriculum in counselor education programs. Future research should look at the impact that religious organizations have on juvenile delinquency in terms of recidivism rates and the important role that the community plays.

Prescription opioid pain reliever utilization has been increasing since the 1990s, due in part to changes in recommendations for the treatment of chronic pain, but also to abuse and diversion. One innovative policy solution to the abuse and diversion of prescription opioids is state prescription drug monitoring programs (PDMPs), which provide prescribers and other selected parties with patient controlled substance dispensation history; thereby, correcting an information asymmetry problem between prescribers and patients. The widespread implementation of state PDMPs, which vary in program design and requirements, has resulted in a variety of intended and unintended consequences. Previous PDMP evaluations have suggested such outcomes as the reduction of consumer access to opioids, the influencing of healthcare provider prescribing behaviors for opioids, and the re-shaping of the United States market for prescription opioids. PDMPs may also be associated with unintended outcomes: namely, the restriction of pharmaceutical opioids could be associated with an increase in heroin use, as evidenced by increases in heroin substance abuse treatment facility discharges. The analyses in this project examine the influence of PDMPs on healthcare providers and the market for prescription drugs by comparing trends in opioid utilization in states with varying PDMP features using Medicaid prescription utilization data and commercial insurance claims. The effect of PDMPs on consumers is explored with an analysis comparing substance abuse treatment facility discharge data for heroin abuse with pharmaceutical opioid prescriptions before and after PDMP regulatory change. Finally, the impact of other related opioid policy interventions, opioid overdose medication access laws, are analyzed by comparing opioid overdose mortality across states with differing overdose medication access policies over time. Contributions to the understanding about the impacts of these state-level opioid abuse and diversion policies can be used to improve or amplify intended outcomes and ameliorate unintended consequences.

OBJECTIVE: To review existing PDMP statutes, and to provide recommendations for good legislative drafting that will create effective statutory components that will enhance the function and increase the use of PDMPs. METHODS: This policy review was conducted from July 2014 to December 2014, using articles dated January 01, 2004 to July 01, 2014. All PubMed searches were artificially limited to peer reviewed articles that were available as “free full text.” To ensure a comprehensive review of the policies, statutes from all fifty states were surveyed using the legal database, Westlaw Next. The search used terms associated with PDMPs. Each statute was reviewed by title and content to determine applicability to the study. The list of statutes compiled from Westlaw Next was compared with existing publications that survey PDMP statutes. The recommendations are based on the investigator’s experience and training in law and public health in consultation with a legislative expert, and supported by peer reviewed articles and legislative drafting guides. RESULTS: There are twelve main topical components that are addressed in existing state PDMP statutes. The policy brief’s primary three recommendations are to implement an advisory committee with an outlined membership, impose a duty for the committee to routinely review database information and to report on the findings, mandate practitioners to consult the database prior to administering controlled substances, and enact a PDMP educational component for practitioners. Appendix A of this policy review (attached) provides a full list of the recommendations for effective legislation on all twelve topical components.

Im Anschluss an die von der Fugro Consult GmbH durchgeführte geotechnische Baugrunderkundung für die geplante Erweiterung eines Öl- und Gasterminals im Sangachal Distrikt südlich von Baku, Aserbaidschan, wurde durch die Fugro Consult GmbH in Zusammenarbeit mit Fugro Loadtest ein geotechnisches Monitoring-Programm in Form von Pfahlprobebelastungen durchgeführt und in diesem Zusammenhang verschiedene statische Zustände simuliert. Neben Vertikallasten, den Hauptlasten aus den zukünftigen Bauwerken, wurden auch horizontale Lasten am Pfahlkopf aufgetragen und mit verschiedenen Monitoring-Methoden während der Versuchsdurchführung überwacht. Das Monitoring-Programm wurde in zwei Feldkampagnen durchgeführt. In der ersten Kampagne wurden Probepfähle an ausgewählten Lokationen bis zum Versagen belastet, um Grenzzustände zu ermitteln, das Pfahldesign zu optimieren und die in der Baugrunderkundung ermittelten geotechnischen Parameter zu überprüfen. In einer zweiten Kampagne wurden dann Bauwerkspfähle getestet, um die Qualität der Pfahlherstellung zu prüfen und die vom Statiker vorgegebenen zulässigen Setzungen der Pfähle unter der geplanten Bauwerkslast zu kontrollieren. / Following the geotechnical site investigation for the extension of the Oil- and Gas terminal in the Sangachal district, south of Baku, Azerbaijan performed by Fugro Consult GmbH a comprehensive pile monitoring program was performed subsequently by Fugro Consult GmbH in collaboration with Fugro Loadtest. The monitoring program comprised full scale static axial, lateral and bi-directional pile load tests using the O-cell® method. Beside vertical loads induced by the future building, also lateral loads were applied and monitored by means of different monitoring methods. The monitoring Program was performed in two field campaigns. During the first campaign only preliminary piles were loaded until failure in order to determine the ultimate limit state, to optimize the pile design and to verify the geotechnical parameter acquired during the preceding site investigation. During the second field campaign only working piles were tested to assure constant quality during pile installation and to confirm that allowable settlements stipulated by the designer are not exceeded.

Im Anschluss an die von der Fugro Consult GmbH durchgeführte geotechnische Baugrunderkundung für die geplante Erweiterung eines Öl- und Gasterminals im Sangachal Distrikt südlich von Baku, Aserbaidschan, wurde durch die Fugro Consult GmbH in Zusammenarbeit mit Fugro Loadtest ein geotechnisches Monitoring-Programm in Form von Pfahlprobebelastungen durchgeführt und in diesem Zusammenhang verschiedene statische Zustände simuliert. Neben Vertikallasten, den Hauptlasten aus den zukünftigen Bauwerken, wurden auch horizontale Lasten am Pfahlkopf aufgetragen und mit verschiedenen Monitoring-Methoden während der Versuchsdurchführung überwacht. Das Monitoring-Programm wurde in zwei Feldkampagnen durchgeführt. In der ersten Kampagne wurden Probepfähle an ausgewählten Lokationen bis zum Versagen belastet, um Grenzzustände zu ermitteln, das Pfahldesign zu optimieren und die in der Baugrunderkundung ermittelten geotechnischen Parameter zu überprüfen. In einer zweiten Kampagne wurden dann Bauwerkspfähle getestet, um die Qualität der Pfahlherstellung zu prüfen und die vom Statiker vorgegebenen zulässigen Setzungen der Pfähle unter der geplanten Bauwerkslast zu kontrollieren. / Following the geotechnical site investigation for the extension of the Oil- and Gas terminal in the Sangachal district, south of Baku, Azerbaijan performed by Fugro Consult GmbH a comprehensive pile monitoring program was performed subsequently by Fugro Consult GmbH in collaboration with Fugro Loadtest. The monitoring program comprised full scale static axial, lateral and bi-directional pile load tests using the O-cell® method. Beside vertical loads induced by the future building, also lateral loads were applied and monitored by means of different monitoring methods. The monitoring Program was performed in two field campaigns. During the first campaign only preliminary piles were loaded until failure in order to determine the ultimate limit state, to optimize the pile design and to verify the geotechnical parameter acquired during the preceding site investigation. During the second field campaign only working piles were tested to assure constant quality during pile installation and to confirm that allowable settlements stipulated by the designer are not exceeded.

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The purpose of this phenomenological study is to describe participants' experiences in a monitoring program for impaired nurses in Virginia, determine what beliefs and attitudes underscore the participants' abilities to cope with the program, and uncover what meaning is made of the experiences. In Virginia, health care providers are supported through the Virginia Health Practitioners' Monitoring Program (HPMP). Limited research exists concerning the lived experiences of substance use nurses who are participating in a state monitoring agency. Research focuses on how a nurse copes with personal and job-related stress and the use of peer support as an important aspect of recovery. This study helps to uncover what policies are effective and ineffective and serves as valuable feedback to ensure the success of monitoring programs, the recovery of substance use nurses, and the safety of the public. In this phenomenological study, five participants were solicited, four females and one male. Three out of the five participants were near completion of the HPMP experience. Two participants were relatively new (over one year) to HPMP. The study focused on three primary research questions: (1) What has been the lived experience of the participant in HPMP?; (2) What beliefs/attitudes are used by the participants to cope with the monitoring experience?; (3) What meaning do the participants give to their experiences in the HPMP? Initially, a pre-interview was held on the phone. Then, two interviews were conducted in the participants' hometowns spaced one week to ten days apart. The first interview centered around gathering a focused life history and on the details of the experience. The second interview afforded the opportunity for reflection on the meaning of the experience in HPMP. Data analysis began with an immersion into the descriptive words of the lived experience of each participant. Through the compilation of textural and structural descriptions, three themes emerged from the rich data. The findings indicated that the participants felt overwhelmed with the program's requirements. Participants found the use of coping skills helped them work through the overwhelming rules and regulations. Finally, participants discovered that with acceptance of the program came accountability. / Ph. D. / A message on a t-shirt read, “I’m a nurse…what’s your superpower? Our society admires and respects the nursing profession. Nurses provide a service that is vital to patient comfort and recovery. Because of this responsibility, nurses are often under a tremendous amount of pressure. For relief, some nurses may turn to substance abuse. The discovery that a nurse has a substance abuse problem may lead to a sense of shame and dishonor and negatively impact the nurse’s career. This study focused on the experiences of nurses who were seeking treatment for substance abuse through the Virginia Health Practitioner’s Monitoring Program. The purpose of this study was to describe the experiences of impaired nurses who had been part of the Virginia Health Practitioner’s Monitoring Program and to find which policies were successful and which were not. Five participants were selected for this study. Two participants were new to the program and three had almost completed it. Three primary research questions were used in the study that focused on what participants had experienced in the program, their attitudes toward the program, and what meaning they gave their experiences. A phone interview was followed by two face-to-face interviews in which participants answered the research questions. The researcher analyzed the data by becoming immersed in the interview transcripts while looking for commonalities. The researcher discovered three themes that emerged. First, participants felt overwhelmed by the program’s requirements. Secondly, they all used coping skills to help them work through the rules and regulations of the program. Finally, they learned accountability and acceptance.

The United States is in the midst of an opioid epidemic. In addition to other system level interventions, almost all states have responded to the crisis by implementing prescription drug monitoring programs (PDMPs). PDMPs are state-level interventions that track the dispensing of Controlled Substances. Data generated at the time of medication dispensing is uploaded to a central data server that may be used to assist in identifying drug diversion, medication misuse, or potentially aberrant prescribing practices. Prior studies assessing the impact of PDMPs on trends in opioid-related morbidity have often failed to take into account the wide heterogeneity of program features and how the effectiveness of these features may be mitigated by insurance status. Previous research has also failed to differentiate the effects of these programs on prescription vs. illicit opioid-related morbidity. The studies in this dissertation attempt to address these gaps using epidemiological techniques to examine the associations between specific PDMP features and trends in prescription and illicit opioid-related poisonings in populations of different insurance beneficiaries. Results of these studies demonstrate that implementation of specific PDMP features is significantly associated with differential trends in prescription and illicit-opioid related poisonings and that the effectiveness of these features vary depending on the insurance status of the population studied. These results suggest that PDMPs offer a valuable tool in addressing the United States’ opioid epidemic, and may be used as empirical evidence to support PDMP best practices in the future.

Increased opioid analgesic (OA) prescribing has been associated with increased risk of prescription opioid diversion, misuse, and abuse. States established prescription drug monitoring programs (PDMPs) to collect and analyze electronic records for dispensed controlled substances to reduce prescription drug abuse and diversion. PDMP data can be used by prescribers for tracking patient’s history of controlled substance prescribing to inform clinical decisions. The studies in this dissertation are focused on the less utilized potential of the PDMP data to enhance public health surveillance to monitor OA prescribing and co-prescribing and association with opioid overdose mortality and morbidity. Longitudinal analysis of OA prescribing and evaluation of the effect of recent policies and opioid prescribing guidelines require consensus measures for OA utilization and computational tools for uniform operationalization by researchers and agencies. Statistical macros and computational tools for OA utilization measures were developed and tested with Kentucky PDMP data. A set of covariate measures using mortality and morbidity surveillance data were also developed as proxy measures for prevalence of painful conditions justifying OA utilization, and availability of heroin and medication treatment for opioid use disorder. A series of epidemiological studies used the developed OA measures as outcomes, and adjusted for time-varying socio-demographic and health care utilization covariates in population-averaged statistical models to assess longitudinal trend and pattern changes in OA utilization in Kentucky in recent years. The first study, “Trends and Patterns of OA Prescribing: Regional and Rural-Urban Variations in Kentucky from 2012 to 2015,” shows significant downward trends in rates of residents with OA prescriptions. Despite the significant decline over time, and after accounting for prevalence of injuries and cancer, the rate of dispensed OA prescriptions among residents in Kentucky Appalachian counties remained significantly higher than the rest of the state. The second study, “Population-Level Measures for High-Risk OA Prescribing: Longitudinal Trends and Relationships with Pain-Associated Conditions,” shows significant reduction in high-risk OA prescribing (e.g., high daily dosage, long-term use, concurrent prescriptions for OA and benzodiazepines) from 2012 to 2016, significantly positive associations between high-risk OA prescribing and cancer mortality rates with no substantial change in the association magnitude over time, and declining strengths of positive associations between high-risk OA prescribing and acute traumatic injuries or chronic non-cancer pain over the study period. The third study, “A Reciprocal Association between Longitudinal Trends of Buprenorphine/Naloxone Prescribing and High-Dose OA Prescribing,” indicates a significant reciprocal relationship between high-dose OA prescribing and buprenorphine/ naloxone prescribing, and a clinically meaningful effect of buprenorphine/naloxone prescribing on reducing OA utilization. The results from the studies advanced the understanding of the epidemiology of opioid use and misuse in Kentucky, and identified actionable risk and protective factors that can inform policy, education, and drug overdose prevention interventions. The developed operational definition inventory and computational tools could stimulate further research in Kentucky and comparative studies in other states.