Theses and Dissertations at Montana State University (MSU)
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Item Trauma screening in chronic disease management: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2021) Vaughan, David James; Chairperson, Graduate Committee: Sandra Benavides-Vaello and M. Jean Shreffler-Grant (co-chair)More than two decades of research has established the association of adverse childhood experiences (ACEs) and adverse health outcomes in adults as initially proposed in the original study by Felitti and colleagues across multiple, well-designed studies. Research indicates that this is a common problem affecting nearly two out of three in the general population. The positive, dose-related, cumulative association of ACEs and poor health outcomes in chronic diseases including diabetes, heart disease, lung disease, and others has been shown to shorten life expectancy by as much as twenty years compared to those with fewer ACEs. Despite the evidence, screening for ACEs in adult primary care is rare. This scholarly project utilized the Trauma-Informed Care framework to introduce an ACE screening tool in the electronic health record of a rural primary care setting. The target population for screening was adults with specific chronic medical conditions. The primary outcome measure was screening tool utilization, and the secondary measure was the referral to integrated behavioral health (IBH). In a six-week period, ACE screening tool utilization was low, being completed in only 9 of 494 included patient encounters. During the project period, the IBH referral rate increased from 1% to 12% in the same patient sample. Provider and organizational acceptance of the tool were modest. This scholarly project demonstrates several challenges that exist when translating research to practice. More time, education, and resources are needed to close this important research to practice gap.Item Breaking the cycle of adverse childhood experiences: a program evaluation(Montana State University - Bozeman, College of Nursing, 2019) McAnally, Jennifer Lyles; Chairperson, Graduate Committee: Dale MayerAdverse childhood experiences (ACEs) are specific types of childhood trauma, that, when experienced, have been found to have dose-response relationship to poor health outcomes later in life, namely, many of the leading causes of death in adults. ACEs include psychological, physical, or sexual abuse, witnessing violence against the mother, living with household members who were substance abusers, mentally ill or suicidal, or who are imprisoned. Recognizing a need for intervention to disrupt this ACE to illness trajectory, The American Academy of Pediatrics has called upon medical providers to address ACEs through screening and community-building. Since there is currently no guideline for how to address ACEs, the purpose of this scholarly project was to evaluate the Lewis and Clark County Health Department (L&CHD) ACE program for effectiveness and alignment with evidence-based practice. Using the Centers for Disease Control and Prevention manual titled Introduction to Program Evaluation for Public Health Programs (IPEPHP), an evaluation was completed. Steps included engaging stakeholders, describing the program, developing an evaluation plan, gathering credible evidence, and analyzing the evidence in order to develop conclusions and make recommendations. The L&CHD ACE program was found to be a largely progressive model that is consistent with most program goals and literature. Those who participated in the program tended to complete the program successfully, however, a majority of those who were referred to the ACE program either chose not to take advantage of the referral or declined to participate in the program. This finding was unexpected and warrants further inquiry. It appears that an integrated behavioral health model may be more effective for engaging potential participants, where they are able to initially meet with mental and behavioral health experts in the familiar primary care setting.Item A comparison of the way rural and urban populations handle stress in relation to mental health and illness(Montana State University - Bozeman, College of Nursing, 1980) Line, Ann Michelle Stock