Implementation of a Protocol to Improve Quality and Use of Existing Crisis Safety Plan Kaitlynn Earls, Dr. Jo-Ann Marrs, Dr. Judy Rice, Dr. Beth Schreiner. College of Nursing, East Tennessee State University. Crisis safety plans are an important tool for decreasing suicide attempts if a crisis situation arises. Pre-implementation data found that only approximately 20% of clients with schizophrenia/schizoaffective disorder in medication services only had a up to date crisis safety plan in place. The purpose of this quality improvement project is to implement and evaluate a protocol to increase the use of an already established crisis safety plan in the outpatient setting within the electronic medical record. Aim is to increase imitating and updating crisis safety plans for clients with schizophrenia/schizoaffective disorder. Participants include clerical and nursing and providers. Target population are patients diagnosed with schizophrenia/schizoaffective disorder with appointments in medication services clinic. Clerical staff will identify those in the target population who do not have updated safety plan. Those without an updated plan will meet with the LPN and/or nurse practitioner who will document it in the electronic medical record. Outcome goal of 75% or more would be completed by the end of the 12 week implementation period, with approximately 45 of 60 safety plans will be up to date by the end of the implementation period. Preliminary findings include an increase in recognition of absent safety plans, as well as more awareness about the importance of crisis safety plans among staff.

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Bibliography: pages 181-192. / Continued study towards understanding schizophrenia and the impairments it can cause, is regarded as essential in the meaningful fulfilment of the educative and diagnostic contributions which the social worker can make in a comprehensive treatment and rehabilitation programme (involving patients and their families). The first section of this descriptive dissertation focuses on aspects like terminology, definition, and the most recent diagnostic criteria, in an endeavour to contribute theoretically towards understanding the illness. The complexity of the diagnostic process is emphasized, and the recent revision of the criteria (1987) is seen as indicative of continuous efforts towards improved diagnosis, treatment and rehabilitation. Previous studies, improved pharmacology and more sophisticated neurophysiological examining led to a change in focus with regard to aetiology and the development of the vulnerability-stress-coping-competence model which brought new hope with regard to outcome of treatment. Section Two highlights several interventions which the clinical social worker can undertake as psychotherapist, group and family therapist, as well as educator on primary, secondary and tertiary levels, from this model and within the psycho-educative perspective. The Neuro B programme, Stikland Hospital, Bellville, is described in section Three, as an example of a presently operating, comprehensive programme where these interventions can be holistically implemented. Particulars about 56 patients who have been involved in the programme are highlighted in Section Four, while Section Five deals with the opinions of former patients and their families concerning involvement in the programme - elicited by two sets of questionnaires. The final chapter focuses on a summary of the dissertation, conclusions and implications for practice.

Background: Globally, studies have established that 40-50% of psychiatric patients with SMDs are readmitted within one year of discharge from the acute hospital admission. Lowand middle-income countries (LMICs) such as Malawi have also reported high rates of psychiatric readmissions. This poses challenges when providing psychiatric care to patients. Most of Malawi`s health institutions, including Saint John of God Psychiatric Hospital (SJOG), rely primarily on donor funding. In order to maximise the available donor funding, there is a need to reduce readmissions resulting from modifiable or controlled factors. There are no studies in Malawi which have investigated these risk factors. The study aimed to establish the frequency of readmissions and the associated factors among patients at SJOG Psychiatric Hospital in Mzuzu, Malawi. The specific areas examined were sociodemographic and clinical-related factors associated with readmission. Methods: This was a retrospective cohort case record review study. Two hundred and seventy five clinical files of patients admitted for the first time at SJOG Psychiatric Hospital Mzuzu, Malawi between 1 January, 2014 and 31 December, 2015 were extracted. Data on socio-demographics and clinical information were collected using an extraction sheet at 3, 6 and 12 months post-discharge from the acute (first) hospital admission. Logistic regression models were developed to investigate the associations between socio-demographics, clinicalrelated factors and readmissions. Ethical approval for this study was granted by the Faculty of Health Sciences Human Research Ethics Committee at the University of Cape Town. Approval to conduct this research in Malawi was obtained from the National Health Sciences Research Ethics Committee. Results: Readmission rates of 1.5%, 4.4%, and 11.3% were found within the 3, 6 and 12 months of discharge from the acute hospital admission respectively. None of the independent variables predicted readmission within the 3 month of discharge from the acute hospital admission. In the unadjusted logistic regression model, having children (OR=0.26, 95% C.I 0.07-0.96) protected against readmissions within the 6 month of follow-up period. In the unadjusted logistic regression model, having children (OR= 0.40, 95% C.I 0.18-0.88), staying outside the hospital catchment area (OR=0.44, 95% C.I 0.20-0.96), and having insight (OR=0.22, 95% C.I 0.10-0.49) into their illness were protective factors to readmission, while taking SGAs (OR=4.67, 95% C.I 1.33-16.39) predicted readmission within the 12 month follow-up period. After adjusting for age and gender in the multivariable analysis, staying outside catchment area (OR=0.33, 95% C.I 0.14-0.79) and having insight (OR=0.19, 95% C.I 0.08-0.46) to their illness were protective factors, while taking SGAs (OR=5.29, 95% C.I 1.43-19.51) remained a predictor of readmission within 12 months of discharge from the acute admission. Conclusion: The findings of this study demonstrated that readmissions are associated with socio-demographic and clinical factors such as catchment area, patient insight into their condition and type of antipsychotics. The study identifies the need to develop interventions targeting the groups at risk of being readmitted.

Suicide is a major health concern worldwide. Nurse practitioners must possess suicide assessment skills and treatment knowledge to ensure appropriate identification of persons with suicidal ideation. The purpose of this project was to assess psychiatric nurse practitioners' knowledge of suicide prevention in rural Kentucky. The conceptual framework was Orlando's nursing process theory, which emphasizes the importance of nurse-patient interaction. A 13-item survey of suicide-related knowledge and skills was administered to 10 psychiatric nurse practitioners in rural Kentucky. Only 3 participants responded correctly to a question related to suicidality in persons with borderline personality disorder. Regarding competency and support for assessing suicide, 100% of participants reported that they were comfortable asking direct and open-ended questions regarding suicide. Nine of the 10 respondents assessed their knowledge and skills as sufficient to engage effectively with patients contemplating suicide, which indicates that psychiatric nurse practitioners may overestimate their ability to identify and treat persons with suicidal ideation. Healthcare providers in all specialties can benefit from this project by improving competencies and guiding continuing education to bridge any gaps in knowledge for adequately assessing suicide. Further education is needed for psychiatric nurse practitioners to promote positive social change for suicidal persons, their families, and their communities.

Many individuals do not seek help for a mental health problem due to stigma and fear of rejection by peers and family. Researchers have highlighted that the age group least likely to seek help is youth. Stigma acts as an important barrier to help-seeking. Evidence indicating how mental health literacy can reduce stigma and encourage help-seeking remains inconclusive. In this study, the health belief model was used to understand how college students perceived an individual's susceptibility to mental illness and the barriers associated with seeking help. A posttest-only randomized controlled trial evaluated the impact of the Is It Just Me? mental health literacy program among college students and assessed whether the program was effective in generating changes in knowledge, lessening stigma, and encouraging help-seeking intentions should students experience a mental health problem. Gender and age data were collected for background information. The results of 2-tailed t tests showed less stigma p = .047, t = -2.02 in the experimental (M= 18.30, SD (2.21) compared to the control condition (M 17.02, SD (3.78)), with no effect on knowledge. With respect to help-seeking intentions, the control condition scored significantly higher than the experimental condition. In conclusion, college students who participated in this short-term mental health literacy program reported less stigma but also less help-seeking. Thus, the program contributed to a greater understanding and acceptance of people living with mental illness. Breaking down stigma and encouraging early intervention for students to seek help if they experience mental health problems can lead to better recovery outcomes and healthier trajectories.

Experiencing financial hardship is stressful and can lead to the development of psychological symptoms, including depression and anxiety. Although researchers have examined the broad categories of coping strategies that people employ when faced with financial hardship, little is known about the experiences of single men who were able to navigate stressful times without developing anxiety or anxiety-like symptoms. The purpose of this phenomenological study was to explore the successful coping experiences of single men with financial hardship (e.g., loss of job, home, finances). Bonanno's theory of resilience provided the framework for the study. Data were collected from interviews with 12 single men ages 18 to 65 who identified as middle or lower SES and had experienced financial hardship within the past 8 years. Data were analyzed using Van Kaam's method, producing 10 thematic categories: definitions of stressors, personal financial stressors, worries, challenges, how stressors were experienced, supports, coping strategies, definitions of resilience, experience of resilience, and added information. Sports and sharing with others were common coping skills; this contributed to an improved understanding of how single men may respond when faced with negative financial events. Findings may be helpful to those who provide counseling services for clients in this category and may be used in training programs to teach strategies for managing financial stress.

Abstract Low population density in rural areas makes it difficult to deliver services to people with mental health problems and nonmedical prescription opioid abuse remains a problem in the United States. The purpose of this cross-sectional study was to determine whether a parent's socioeconomic status affected care opportunities for children 12 to 17 years of age and whether bipolar disorder increased the likelihood of substance abuse in those children. The theory of reasoned action/planned behavior provided the framework for the study. Secondary data from the Interuniversity Consortium for Political and Social Research 36361 data system, specifically the National Survey on Drug Use and Health 2014, were collected that included information about the socioeconomic status of adolescents and their parents. Cross-sectional analysis was used to analyze data. The first research examined the extent to which bipolar disorder influenced opioid abuse in those between the ages of 12 and 17. There was a nonsignificant association between the variables: chi-square probability values (p > 0.05) for mental health difficulties and ever-used pain relievers non-medically. There was a significant association between mental health and emotional difficulties at p < 0.05. The second research question examined whether a parent's socioeconomic status impacted the level of care opportunities for those 12 to 17 years' old in relation to bipolar disorder in rural communities. Using multivariate logistic regression analysis, no significance was found between level-of-care opportunities and a parent's socioeconomic status. The findings of this study have potential to bring about social change by increasing clinician skills related to intervention planning related to opioid abuse in rural communities among adolescents with bipolar disorder.

Researchers have shown a relationship between mental health disorders and alcohol dependence. However, only 5-10% of individuals with substance use problems co-occurring with mental health problems are correctly identified. The purpose of this research was to identify predictors of relapse using three different instruments of varying complexity: the Patient Health Questionnaire-9 (PHQ-9), the Modified Mini Screen (MMS), and the Millon Clinical Multiaxial Inventory-III (MCMI-III). Researchers have found that using alcohol produces relief, similar to a pharmacological intervention, from troublesome mental health symptoms that individuals experience. Considering this association, the self-medication hypothesis was the conceptual lens used for the study as it provides a practical framework for analyzing the relationship between mental health disorders and relapse. At the request of this researcher, data were collected on 45 individuals who were provided detoxification services at a public treatment facility in central Wisconsin. Regression analyses were conducted and identified a statistically significant, although weak, predictive relationship between relapse and the variable of depression as measured by the PHQ-9 (R = .311a, R2 = .097, p = .037), and depression as measured by the MCMI-III (R = .364a, R2 = .133, p = .014). The implications for positive social change from this study include the potential to increase the effectiveness and efficiency in identifying co-occurring mental health disorders among individuals who are treated for alcohol detoxification, enhancing the accuracy of referrals for aftercare, and reducing readmissions for detoxification amongst the individuals served.