Theses and Dissertations at Montana State University (MSU)
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Item 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 ScottPast 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.Item An improved approach to screening of eating disorder risk in a pediatric psychiatric care facility(Montana State University - Bozeman, College of Nursing, 2022) Smith, Christopher Scott; Chairperson, Graduate Committee: Molly SecorEating disorders (EDs) have emerged as a prominent but underrecognized problem in the pediatric population from lack of screening. Reviewed were multiple screening tool options for risk of EDs to utilize in the admission assessment at a pediatric psychiatric care facility, resulting in the use of the Sick-Control-One-Fat-Food (SCOFF) questionnaire. Additionally, screening on admission was moved from nursing staff to that of the project's population--the medical group of nurse practitioners (NPs) who facilitated referrals based on results. The goals of this quality improvement project included a 100% screening rate for all patients aged 6 to 18 years admitted to the facility and a subsequent 100% referral rate for all positive screenings to psychiatry and the registered dietitian. These changes were implemented at the facility over eight weeks with weekly data collection and analysis comparing weekly census reports to SCOFF screened admissions and positive screenings to the number of referrals made. Every two weeks in the implementation, Plan-Do-Study-Act (PDSA) cycles were used in meetings with the medical group NPs to address and overcome barriers in implementation. The results showed overall improved screening rates, but the goals of 100% screening and 100% referral rates were not met. An average of 88% screening rate and 85% referral rate for positive screenings were achieved. Findings of this study inform future practice to utilize a risk for EDs screening tool that is valid, reliable, brief, and easy to score implemented in similar populations. Additionally, more time should be allowed in implementation--at least 12-weeks to allow for more data collection and PDSA cycle completions.Item Improved suicide risk assessment screening in a youth treatment facility: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Sell, Carly Ruth; Chairperson, Graduate Committee: Tracy HellemResearch suggests that youth receiving mental health treatment are at increased risk for suicidal ideation or suicide attempts. Thus, youth admitted to a psychiatric treatment facility must receive appropriate suicide risk assessments. The Columbia-Suicide Severity Rating Scale (C-SSRS) is a well-researched, evidence-based, tool which has been endorsed by multiple agencies, including The Joint Commission, as an effective instrument to screen for suicide risk in youth populations. This quality improvement project aimed to improve the overall safety of patients admitted to the designated clinical site by implementing a standardized suicide assessment screening process using the C-SSRS as the identified screening tool. The Model for Improvement was the framework chosen for this quality improvement project. The clinical site selected was a licensed therapeutic group home and school specializing in relational-based trauma-informed care, treating children and adolescents aged 5 to 15 years. Five licensed therapists and one registered nurse received formal training to administer the two identified versions of the C-SSRS. Data pertaining to completion rates for assessments and interventions implemented per protocol were collected over three PDSA cycles. 100% (n=19) of baseline and admission assessments were completed and documented in the EHR within 24 hours of assessment completion. Additionally, 100% (n=19) of the patients assessed completed a safety plan as part of the organization's identified suicide risk-reduction interventions. During the data collection period, no patients presented with possible suicidal ideation, and no patients screened in the "high-risk" category. Therefore, no data were collected related to these objectives. This quality improvement project aimed to improve the overall safety of patients admitted to the designated clinical site. Despite several limitations, all patients received baseline suicide assessments and completed a safety plan. The long-term hopes for this process change include improving the ability of clinicians to accurately assess suicide risk and intervene appropriately, leading to fewer patients presenting with suicidal behaviors and overall improvements to patient safety.Item Estimating the impact of high-speed internet on teen and young adult labor force participation(Montana State University - Bozeman, College of Agriculture, 2021) Bridgewater, Samuel Edward; Chairperson, Graduate Committee: Gregory GilpinHigh-speed residential internet access was rolled out in the United States in the early 2000's. While the advent of high-speed internet brought with it a lot of positive changes, like greater access to information (Dettling 2017) or flexibility in working arrangements for working parents (Dettling 2018), it also ushered in a new era of inexpensive and high-quality leisure activities. During this same period of time, teens and young adults are observed leaving the labor force. This thesis uses a Bartik or shift share instrument and variation in rollout of high-speed residential internet access to estimate the impact on teen and young adult labor force participation decisions. The results find that both students and non-students younger than 25 are less likely to participate in the labor force, and males were more profoundly impacted than females.Item Improving access to peer-to-peer support for caregivers of children and youth with special health care needs: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Patera, Caitlyn Ashley; Chairperson, Graduate Committee: Margaret HammerslaCaregivers of children and youth with special health care needs (CYSHCN) experience stress, burden, and social isolation, which are powerful predictors of poor health outcomes for both the caregivers and their children. Supporting caregivers of CYSHCN in a clinical setting is critical in holistically supporting a CYSHCN medical home. The Montana Parent Partner Program (MTPPP) is an evidence-informed peer-to-peer support opportunity aimed at improving health and social outcomes for caregivers. This program is funded by the Department of Public Health and Human Services (DPHHS) and is available to Montana health care clinics that serve the CYSHCN at no cost to the clinic. At the selected practice site location (PSL), the referral rate and enrollment rate to the program were low; in November and December 2021, only two enrollments were completed into the program out of the 66 patients evaluated aged 0-21 years--a total enrollment rate of 3%. The referral rate was not historically tracked. DPHHS, the PSL, and the MTPPP partnered together in a quality improvement (QI) effort to achieve a referral rate into the MTPPP between January and February 2022 of 50%. The QI team identified barriers to referring and enrolling caregivers into the MTPPP and subsequently proposed opportunities for improvement to reach their goal. First, the team aimed to educate providers at the PSL on the evidence, benefits, and services of the MTPPP. Once the team expressed increased confidence in referring patients to the program, the team re-developed the workflow, referral, consent, and enrollment process and integrated information technology to streamline the processes. Regular PDSA cycles were used in meetings to elicit feedback and address barriers. The results established a referral rate of 40% and an increased enrollment rate of 14% from the previous two months. The findings of this effort can inform current MTPPP hosts and future practices to utilize the PDSA cycle to improve processes. Although the results are affirmative, more time should be dedicated to the quality improvement effort, allowing for more data collection and PDSA cycle completions.Item Improving screening of eating disorders in rural community adolescents(Montana State University - Bozeman, College of Nursing, 2021) Smelser, Ryann Lyn; Chairperson, Graduate Committee: Susan LuparellEating disorders are the least likely to be screened for in adolescents aged 12 to 21 years. In many rural communities the only screening done is during a school physical questionnaire in which the child is asked if they are happy with their weight. Many clinicians are not comfortable investigating these concerns and are unsure what resources are available. A rural clinic was observed to have no formal screening tool in place for eating disorders among adolescents aged 12 to 21 years. This project sought to improve screening in the stated age group within the clinic setting. The SCOFF screening tool, consisting of five questions, was administered to adolescents during any clinic visit to any of three providers in the facility. Nursing staff offered the SCOFF tool during intake of the patients and prior to seeing the clinician. Out of 67 patients who were seen in an 8-week period, 19 were offered the SCOFF screening, equating to an overall 28.4% increase in screening. Plan-Do-Study-Act (PDSA) evaluations were done at 4-week intervals with the intention to further improve the number of screenings. This did improve screenings periodically throughout the project showing improvement in some weeks as high as 100%.Item Implementation of standardized trauma and resiliency screening in a youth therapeutic residential setting: a quality-improvement project(Montana State University - Bozeman, College of Nursing, 2021) Bugni, Katherine Tabije; Chairperson, Graduate Committee: Sandra Benavides-VaelloThe purpose of this DNP project was to establish standardized trauma and resiliency screening for patients within the youth therapeutic residential setting. A lack of standardized screening and documentation of trauma exposure and resiliency factors was identified internally by the organization. The establishment of routine screening for traumatic experiences provides valuable data, which will inform and be incorporated into the patient's treatment plan. Additionally, routine screening of the patient's resiliency measures complements the trauma information that was collected. This information is important as resiliency plays a critical role in countering the downward trajectory that is set by a child's experience of trauma. Resilience can act as a safeguard from the negative outcomes that are linked with experiencing early trauma. The major objectives for this project were (1) for staff to implement trauma screening and (2) resiliency screening with youth in a therapeutic setting. Not only does the trauma score provide key information about the patient, but it can also guide treatment and serves to establish a baseline for the continued tracking of trauma and resiliency experiences. Additionally, continued data tracking beyond discharge is a requirement of the recent Family First Prevention Services Act of 2018. This project's aim was for participants to utilize the organization's electronic health record to collect and house the screening data. At a later date, the information can be utilized for advocacy of funding, vitals tracking, and for future quality-improvement processes. The results include that staff obtained screenings for 100% of the organization's residential population, with screenings for trauma (ACEs) and resiliency (CYRM-R), incorporating the new process into routine practice within the short PDSA cycle. The results of staff success in incorporating the new screening process for trauma and resiliency with youth residents during weekly routine visits indicate that this practice change is not only achievable, but can be applied during already established weekly visit time between existing trained staff and the patients within the two communities' residential therapeutic group homes.Item Perceptions of 4-H record books as part of the experiential learning cycle(Montana State University - Bozeman, College of Letters & Science, 2019) Tangedal, Kara Bates; Chairperson, Graduate Committee: Greg FrancisThis study investigated how perceptions of record books by 4-H adult and youth members changed before and after treatment, and if their perceived value of club meetings and project workshops, as well as growth in a project area improved after treatment. The subject of this treatment was enrolled Lewis and Clark County 4-H program members in Montana. Surveys were administered prior to record books being actively used in 4-H clubs and project workshops as a tool for goal-setting and reflection. Following volunteer training on how to effectively use record books in the Experiential Learning Cycle, club and project meetings were assessed on how effectively record books were incorporated, and subsequent remediation was made if necessary. If clubs and projects were evaluated to be using record books effectively, adult and youth members were asked to complete a post-treatment Record Book Survey. Pre- and post-treatment results were statistically analyzed and compared to qualitative interview findings, resulting in a significant increase in frequency of record book use, and modest increase of positive perceptions toward record book use and their relation to goal-setting and reflection, especially in youth members.Item Solo signator: analysis of the minor alone statutes(Montana State University - Bozeman, College of Agriculture, 2019) Parker, Lev Ariel; Chairperson, Graduate Committee: Carly UrbanLack of banking access affects approximately a quarter of the population. It is often the most vulnerable populations that are most likely to be unbanked. Without access to the formal banking system, people turn to alternative financial services (AFS) which are significantly more expensive than the formal alternatives. Granting minors independent access to the formal banking system may be a policy tool which can reduce the number of unbanked adults and adults who frequent AFS. I exploit variation in a set a laws known as the Minor Alone Statutes (MAS) which grant minors independent access to state-chartered banks and credit unions. Results on how the MAS affect account ownership are inconclusive, but the MAS do decrease the probability of young adults with bank accounts frequenting AFS by approximately 10%.Item Presentation of a comprehensive community suicide prevention program: improvements for young adult males ages 18-34 years old(Montana State University - Bozeman, College of Nursing, 2019) Bagley, Jamie Lynn; Chairperson, Graduate Committee: Maria WinesSuicide continues to be a worldwide phenomenon causing more than 44,000 deaths nationally (American Foundation for Suicide Prevention [AFSP], 2015) and 800,000 deaths globally (World Health Organization [WHO], 2017). Although any population can be affected by suicide, certain populations are at a higher risk of being impacted. Completed suicides by the male population have been rapidly accelerating both nationally and within the state of Montana. Over the last 40 years Montana has been in the top five states for the highest suicide rates in the nation (Montana Department of Public Health and Human Services [MTDPHHS], 2016b), and as of January 2018, Montana ranked first in the nation for highest suicide death rate (Centers for Disease Control and Prevention [CDC], 2018). Male youth suicide is rising and is now the second leading cause of death between males ages 15-34 years old (CDC, 2015). Butte-Silver Bow County, located in Montana, is no exception, and is one of four counties in Montana with the highest suicide rates of 20.6/100,000 compared to Montana's suicide rate of 16.4/100,000 (MTDPHHS, 2016a). Twelve percent of males in Butte-Silver Bow County report 'fair' or 'poor' mental health (Sisters of Charity of Leavenworth [SLC], 2015). There is significant need for mental health support services for this age group. The lack of evidenced-based suicide prevention interventions/programs for males, particularly male youth, is alarming. The goal of this proposed community implementation program is to provide Butte-Silver Bow County and future communities with evidence-based interventions to decrease male youth suicides. An exhaustive literature search was conducted, and evidence-based suicide prevention programs were evaluated. As a result, evidenced-based components from Problem Solving Therapy (PST), and The Collaborative Assessment and Management of Suicidality (CAMS) were combined to form one comprehensive suicide prevention intervention program.