Theses and Dissertations at Montana State University (MSU)

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Implementation of a mental health pre-visit process in a rural primary care clinic: a quality improvement project
(Montana State University - Bozeman, College of Nursing, 2024) Kaufman, Tori Rae; Chairperson, Graduate Committee: Jamie M. Besel; This is a manuscript style paper that includes co-authored chapters.
Background: United States rural residents have limited access to mental healthcare. Nearly half of Montana's population is designated rural. Maximizing resources in resource-deficient regions requires creative strategies and process implementation to streamline workflow to achieve sufficient care. Local Problem: A rural Eastern Montana primary clinic has attempted to address its rural community's limited mental health resources by employing a psychologist. There is no new mental health patient pre-visit process at the project site. The purpose of the project was to implement a pre-visit process to improve the psychologist's ability to effectively care for the patient population. Methods: The Iowa Model Revised guided this quality improvement (QI) project. Process changes evaluations occurred at week three, week six, and postintervention. Interventions: A new mental health patient pre-visit process and packet were created, including a standardized Mental Health History Questionnaire (MHHQ). Educational in-services and staff completion checklists were performed to promote adherence to the process change. Results: The project goals were achieved: 95% of the new mental health patient pre-visit packets were mailed within two days of referral acceptance, 75% of new mental health patients returned their MHHQs, and 100% of staff reviewed and signed the new mental health patient pre-visit process. Conclusion: The project improved the psychologist and staff's new mental health patient workflow process. The psychologist noted an increase in patient preparedness and satisfaction, a decrease in time to diagnosis/treatment, and a slight decrease in the initial mental health evaluation duration.
The mental wellness conversation curriculum: better understanding the gap between facilitator training and community conversations
(Montana State University - Bozeman, College of Education, Health & Human Development, 2024) Sutphen, Katharine Nora; Chairperson, Graduate Committee: Michelle U. Grocke-Dewey
This thesis whether the MSU Extension Mental Wellness Conversation Curriculum (MWCC) is effective in terms of adequately preparing newly trained facilitators to lead their own community based MWCC conversations. The MWCC is a mental health and wellness conversation pedagogy designed to be delivered in rural communities by community volunteer facilitators. The Social Ecological Model (SEM) explains the nuance of this program and incorporates supporting studies that leverage community-based and volunteer-led techniques. The results from the volunteer training evaluation data, a pre-and post- survey, indicate a positive change in awareness, knowledge, and beliefs among the 24 facilitators regarding specific mental health and wellness content presented in the training. The results indicate high favorability from volunteers regarding their experience at the MWCC training and optimism about the future of MWCC as a mental health and wellness program. However, despite favorable and statistically significant improvements from pre and post training data, there has been stagnation among community volunteers leading their own MWCC conversations. In response to this finding, a follow up exploration into possible explanations was conducted. Results indicated the importance of volunteer training as a predictor of volunteer engagement success. Additionally, the following themes were explored to understand the impact they had on MWCC volunteer engagement: 1) the duality of agency and autonomy in volunteering, 2) the explanatory power of the Self-determination Theory as it relates to volunteer motivation, 3) the importance of volunteer recruitment strategies and clear objectives, 4) the value of skills-based volunteering, and 5) the importance of content delivery within a training to maximize future engagement. Minor adaptations to the MWCC training and evaluation efforts would be beneficial for improved volunteer engagement going forward. Future research suggestions include further exploring how social context and environmental factors may impact the success of community based MWCC conversations.
Implementation of a school nurse-led anxiety screening protocol within an elementary school: a quality improvement project
(Montana State University - Bozeman, College of Nursing, 2024) Sanders, Donna Ruth; Chairperson, Graduate Committee: Margaret Hammersla; This is a manuscript style paper that includes co-authored chapters.
Childhood anxiety disorders are becoming increasingly prevalent in the US, with reported cases rising from 7.1% in 2016 to over 9.2% by 2020. This increase is often manifested through somatic symptoms in children, highlighting the urgent need for early detection and intervention, particularly in school settings where these symptoms frequently result in visits to school nurses. In a rural elementary school in Montana, there was a lack of systematic screening for anxiety among students aged 8-12. These students often present with somatic complaints that lack a clear medical diagnosis, leading to under-identification and inconsistent referral practices. The Plan-Do-Study-Act (PDSA) framework guided the implementation of a school nurse-led anxiety screening initiative using the SCARED tool. This project focused on systematic screening of English-speaking students who exhibited recurrent, unexplained somatic symptoms. Key interventions included training the school nurse on the SCARED tool, the establishment of structured screening protocols, and improved communication with parents to meet legislative consent requirements. The initiative was highly successful, achieving a 100% identification rate for students meeting the anxiety criteria, with all positively screened students referred for further support. These results demonstrate a significant enhancement in schools' capacity to manage childhood anxiety. This quality improvement project effectively addressed the rising prevalence of anxiety disorders in elementary students, emphasizing the value of structured, nurse-led screening processes. It successfully met and exceeded the set SMART goals, offering a replicable model for early detection and management of anxiety in schools. This model also highlights the importance of considering somatic complaints as potential indicators of anxiety disorders.
Sleep and savoring: the influence of sleep restriction on positive emotion regulation
(Montana State University - Bozeman, College of Letters & Science, 2022) Powell, Suzanna Lee; Chairperson, Graduate Committee: Cara A. Palmer
Although previous research broadly demonstrates that sleep loss leads to reductions in positive affect, relatively few studies examine the impact of sleep loss on low and high arousal positive affective processes, the regulation of positive emotions, or the influence of different sleep stages. The current study sought to build on previous findings that suggest slow wave and rapid eye movement stages of sleep may have distinct influences on affect by examining the effects of sleep restriction on positive affect, reactivity, and regulation (i.e., savoring and dampening). Thirty-four participants (50% female, ages 18-25 years) were included in final analyses. Participants completed a healthy night of sleep (9h time in bed) and a night of sleep restriction (4h time in bed). Sleep was restricted between participants in two ways, early in the night to primarily restrict slow wave sleep and later in the night to primarily restrict rapid eye movement sleep. Following both a night of normal sleep and the night of sleep restriction, participants completed questionnaires to measure positive affect, and a video task which instructed them react normally or to savor while watching positive affect-inducing videos. After each video, participants reported on their feelings of valence, arousal, and high and low arousal positive affect. Savoring and dampening strategies utilized during the task were also reported. Following sleep restriction participants reported diminished high and low arousal positive affect compared to when they were well-rested. Participants also reported less positive reactivity to the videos when they were sleep restricted compared to when they were well-rested after both reacting normally and after savoring. However, participants experienced greater increases in positive affect when savoring compared to when they were instructed to react after sleep restriction. Slow wave sleep loss was related to marginally reduced positive affect compared to loss of rapid eye movement sleep, but no other effects of type of sleep restriction emerged. This study indicates that sleep loss results in diminished high and low arousal positive affect and blunted reactivity to positive stimuli, but that engaging in intentional up-regulation strategies may help buffer the negative effects of sleep loss.
The positive emotion regulation questionnaire and the assessment of strategy use profiles as predictors of mental health outcomes
(Montana State University - Bozeman, College of Letters & Science, 2022) McCullen, Jennifer Renee; Chairperson, Graduate Committee: Brandon Scott
Past research has shown that experiencing and upregulating positive emotions may be beneficial for youths' well-being (Martin-Krumm, 2018; Young et al., 2019). Further, research with negative ER suggests having a wider range of strategies enhances ER success (Lougheed & Hollenstein, 2012). However, most studies on positive emotion regulation (ER) have focused on savoring strategies and lack youth involvement. I propose that it is not only how many strategies youth use but the pattern of strategies youth use to regulate positive emotions that relate to internalizing problems. The purpose of our study was to examine the factor structure of a novel self-report measure of positive ER strategies in adolescents and their relations to mental health as well as to investigate the number and type of profiles that emerge from youths' use of 13 positive ER strategies and differences in mental health. I recruited a sample of 349 English-speaking 13- 17-year-old youth (50% females; 32% non-binary/other gender; Mage = 15.7) who reported on positive ER strategies, anxiety, depression, difficulties regulating positive emotions, resilience, and trauma. Exploratory factor analysis of the measure indicated 10 factors. Correlations showed greater use of Self-Improvement, Physical Activity, and Positive Thinking were related to more resilience; greater use of Fantasizing and Sensation Seeking were related to more anxiety; and greater use of Sensation Seeking and Relaxation were related to more depression. Conversely, greater use of Sensation Seeking was related to less resilience; greater use of Positive Thinking was related to less anxiety; and greater use of Positive Thinking and Physical activity were related to less depression. Profile analysis revealed a 6-profile model with two unique profiles characterized by either mainly using personal growth strategies more frequently than other strategies (profile 3) or using more frequently sensation seeking and fantasizing as opposed to other strategies available to them (profile 4). ANOVA results revealed significant differences in depression among profiles. These findings demonstrate adolescents utilize a wide range of emotion regulation strategies to maintain and upregulate positive emotions. Further, certain positive ER profiles may indicate protective (high personal growth only) or risk (high sensation seeking and fantasizing) for experiencing depressive symptoms.
Implementing peer conducted mental health and wellness checks in rural law enforcement: a quality improvement project
(Montana State University - Bozeman, College of Nursing, 2023) Feltz, Cheyenne Jae; Chairperson, Graduate Committee: Molly Secor
Background and purpose: Law enforcement officers in the United States are at a significantly increased risk of suicide and mental health challenges, accompanied with increased perceptions of stigma that limits mental health resource utilization. These trends are even more prominent among rural law enforcement officers compared to their urban counterparts. The purpose of this quality improvement project was to assist a rural law enforcement detachment in decreasing mental health stigma through implementation of peer conducted mental health and wellness check-ins. Methods: Baseline and progressive trends of stigma were assessed through the Attitudes About Mental Illness and its Treatment Scale (AMIS) following implementation of peer conducted proactive mental health support check-ins in the detachment. Intervention: This project utilized peer support law enforcement members to facilitate scheduled check-in's and discuss predetermined mental health topics while facilitating access of additional resources and education that could improve health outcomes. Results: A small rural law enforcement detachment conducted peer facilitated mental health and wellness checks with its full team of six team members. Evaluation of the AMIS assessments and personal feedback indicated that these meetings decreased reports of stigma and increased open discussion of mental health issues. Conclusion: Conclusive support for this intervention cannot be ascertained due to the small sample size and short duration of evaluation. However, this initiative indicates a framework for initiating similar processes in other areas and reveals a promising acceptance and trend of utilization and support by involved law enforcement members.
Effective leadership in school-community partnerships
(Montana State University - Bozeman, College of Education, Health & Human Development, 2022) Keenan, Matthew James; Chairperson, Graduate Committee: William Ruff
The broad approach of Multi-Tiered Support Systems (MTSS) is a well-established educational practice that has found acceptance on the national level, as it has been demonstrated to help students improve more effectively than the 'wait-to-fail' approaches of the past. There are many studies examining the implementation of MTSS systems and the factors associated with their successful integration into the school culture, including pre-service preparation, ongoing professional development, educational leadership, cultivating staff buy-in, the use of appropriate supports and interventions, etc. While traditional MTSS systems focus primarily on curriculum or student behavior there is also increasing recognition of the impact that a student's social and emotional growth has on their academic success, and schools are seeking more holistic ways to support struggling students with the cooperation of school staff, community organizations, and the families of students. The process of developing and implementing these new, collaborative MTSS programs that rely on partnerships between schools and community organizations have not been well documented, especially at the secondary level. This phenomenological case study examined the implementation of a new partnership between a large, public high school and a community organization designed to support these non-academic barriers to learning through the use of increasing interventions. Semi-structured interviews were conducted and artifacts associated with the program were collected and analyzed to examine the role of school leaders in this process of building partnerships. These data led the conclusion that school leaders play critical roles in cultivating the conditions within the school to allow for and welcome innovative programs to meet student needs, and they also serve as the conduits between their schools and potential community partners to implement collaborative programs. While school leaders are not directly responsible for conceptualization and implementation of every innovative school program, they are responsible for the school culture, climate, and policies that can either enhance or inhibit the implementation of innovative partnerships.
Implementation of measurement based care for bipolar disorder: systematic symptom assessment to improve patient care
(Montana State University - Bozeman, College of Nursing, 2021) Linster, Rachel Corey; Chairperson, Graduate Committee: Margaret Hammersla
Measurement-based care (MBC) in psychiatry facilitates greater recognition and communication of problematic symptoms. MBC is not commonly utilized in the routine care of individuals with bipolar disorder, resulting in failure to recognize treatment failure or subsyndromal symptoms. The purpose of this project was to improve patient outcomes through implementation of the Altman Self-Rating Mania Scale and Quick Inventory of Depression-Self Report as way to incorporate MBC at a community mental health center. Paper and pencil copies of assessment tools were utilized by clinicians with individuals aged 18 and over with a diagnosis of bipolar 1 or 2 disorder at the beginning of their appointments. Information about assessment tool use was collected via a tracking sheet and reviewed weekly. Of the 11 patients with bipolar disorder seen during the project timeframe, seven completed one or more assessment tool, one patient presentation was not clinically appropriate for assessment tool use, one patient preferred not to respond, and in two instances the provider forgot to use the tools. Utilization of both tools is indicated in order to assess both manic and depressive symptoms. Results support the integration of MBC into the EMR in order to reinforce the process of care. The relatively high use of one tool (5 of 11 times) supports the switch to a single tool to assess both manic and depressive symptoms. The Internal States Scale was identified as the tool that best fits the identified clinical and patient needs.
The effects of red flag laws on firearm suicides and homicides
(Montana State University - Bozeman, College of Agriculture, 2021) Harris, Mitchell John; Chairperson, Graduate Committee: Mark Anderson
Risk-based firearm removal laws, commonly known as Red Flag laws have become increasingly popular among lawmakers attempting to reduce gun violence in America. Despite widespread public support, these laws have yet to be studied in economics. Using mortality data from the National Vital Statistics System, I find that Red Flag laws have a significant negative effect on firearm suicides and firearm homicides. Upon further analysis, I find that there is evidence of a pre-existing downward trend in both firearm suicides and firearm homicides. Red Flag laws do not cause changes in these mortality outcomes, rather there is an unobserved shock that decreases firearm suicides and homicides, while simultaneously affecting a state's propensity to adopt a Red Flag law. These results contradict existing non-economic literature, which suggests that Red Flag laws cause a large decrease in firearm suicides.
Improving treatment of metabolic side effects from atypical antipsychotics
(Montana State University - Bozeman, College of Nursing, 2021) Galahan, Alicia Marie; Chairperson, Graduate Committee: Margaret Hammersla
Atypical antipsychotics are commonly used to treat a variety of mental health disorders in children and adolescents. Prescribing atypical antipsychotics is not without risk as the development of metabolic side effects can lead to reduced life expectancy from chronic metabolic diseases. The metabolic side effects from atypical antipsychotics are considered treatable medical conditions requiring appropriate screening and intervention. Despite recommendations, psychiatric providers do not consistently screen and treat metabolic abnormalities, creating a gap in care for these individuals. This quality improvement project took place on an adolescent inpatient residential unit. This project focused on incorporating recommendations from clinical practice guidelines by focusing on improving rates of metabolic screening and utilization of treatment interventions when metabolic abnormalities are identified to reduce the burden of metabolic side effects for patients. The Plan-Do-Study-Act framework was used to guide this quality improvement project over six weeks with four separate cycles varying in duration from one to two weeks each. A metabolic screening bundle for psychiatric provider notes was created within the electronic health record to improve ease of interpreting metabolic screening values and identifying need for further intervention. At the end of the quality improvement project, rates of metabolic screening remained unchanged. The rate of patients receiving treatment interventions increased and multiple patients received more than one treatment intervention. Treatment modalities studied included metformin, individual physical activity, and nutritionist consult. This quality improvement project sought to decrease patients experiencing metabolic abnormalities after treatment with atypical antipsychotic medication, but effectiveness was unable to be measured due to the short time frame. Metabolic screening is a necessary part of atypical antipsychotic treatment that needs to be completed upon initiation of medication and at future appointments. Once metabolic screening is completed, further education on potential treatment interventions for metabolic abnormalities needs to be discussed with the patient and other professionals involved in their care to improve patient outcomes.

Theses and Dissertations at Montana State University (MSU)

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