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Treatment of Borderline Personality Disorder
Get PDFCase StudyThe following is a de-identified case study that presents the assessment, diagnosis, and
treatment of Borderline Personality Disorder (BPD) utilizing Dialectical Behavior Therapy
(DBT). Names and other identifying information have been changed to protect the client’s
privacy. The name “Erin” is used in place of the client’s real name. At the time of treatment, this
64-year-old Caucasian woman was struggling to manage anger and interpersonal relationships.
In addition, Erin reported suicidal ideation and has a history of three suicide attempts. Erin was
administered a diagnostic interview and various screening measures to aid in diagnosis. A
combination of a primary diagnosis of BPD with secondary diagnoses of Major Depressive
Disorder (MDD) and Generalized Anxiety Disorder (GAD) were determined to capture Erin’s
presenting symptoms most accurately. The client attended 40 treatment sessions working with a
student intern therapist. Treatment sessions targeted life-threatening behaviors, therapyinterfering behaviors, quality-of-life interfering behaviors, and skills acquisition and
generalization. Pre-to-post and ongoing assessment and mood tracking indicate Erin would
benefit from continuing treatment to manage patterns of interpersonal conflict, impulsive
behaviors, and suicide risk.Department of Psycholog
Implementation of a Vaccines for Children Project for Underserved Children in Shawnee County, Kansas
Get PDFIntroduction and Purpose: The project was conducted to improve access to immunizations and increase the number of recommended vaccines received by children residing in a rural Shawnee County, Kansas, community.
Framework: The Health Belief Model (Becker, 1974) and PDSA (IHI, 2021) QI method guided the project.
Critical Appraisal and Synthesis of Literature: One Level I study and 18 Level II-V studies identified education and access as barriers to immunization in pediatric populations. Solutions included mobile health clinics, pharmacy-based clinics, and school-based clinics.
Methods: (Plan) A first PDSA cycle involved formation of a focus group, and development of a parent survey to understand community barriers to pediatric immunization. (Do) A focus group of stakeholders was conducted that included Washburn University School of Nursing, county health department representatives, school officials, community librarian, and pharmacist. Surveys were distributed to two local schools and the local library. (Study) Focus group output was thematically analyzed, and survey data analyzed using SPSS to determine descriptive statistics. Results were shared with a second focus group and interventions were developed. (Act) Selected interventions to reduce vaccination barriers were implemented. Results: Sixty-four surveys were returned, representing 134 children, with a return rate of approximately 22%. A synthesis of focus group and survey findings identified barriers to be education and access. Completion of the first PDSA cycle resulted in distribution of an educational flyer and provision of a cost-effective school-based influenza clinic. Thirty influenza vaccines were administered to community members.
Process Improvements: The infrastructure for subsequent PDSA cycles was established, and plans were made for expanding the impact of the project through continued stakeholder engagement and DNP leadership.
Conclusions and Recommendations: One team member will continue future cycles to include provision of both required and recommended childhood vaccines, and potential expansion into surrounding communities.School of Nursin
Use of the Depression Medication Choice Decision Aid for Antidepressant Prescribing in Primary Care
Get PDFPurpose: Primary care providers (PCPs) are well placed to diagnose and treat patients who have symptoms of depression; however, they may not have comprehensive knowledge of the subtle variations in antidepressant medications (ADMs) used in first-line treatment of depression. The purpose of this quality improvement project was to implement the Depression Medication Choice Decision Aid (DMCDA), an evidence-based decision-making tool created by Mayo Clinic. This tool is designed to aid PCPs in collaborating with patients for initial ADM selection in the adult population.
Methods: Six PCPs from two sites, one student health clinic and one rural health clinic, were recruited to implement the DMCDA tool. A survey was given pre- and post-intervention to assess provider attitudes, skills, and behaviors related to prescribing ADM in the primary care setting. Charts were reviewed to determine whether PCPs were documenting the use of the tool and to compare pre- and post-intervention patient adherence to therapy and follow-up appointments. Results Survey results showed an overall increase in attitude and skill mean scores, with mixed results for behaviors. Providers documented use of the DMCDA in fifteen out of sixteen post-implementation patient encounters. Twelve out of 13 follow-up appointments were kept, and 10 out of 14 patients remained on therapy through follow-up. Implications Use of the DMCDA in the selection of ADM may improve patient-provider collaboration, improve provider perceptions regarding the treatment of depression in the primary care setting, and improve patient adherence to scheduled followup appointments and prescribed ADM.School of Nursin
Identifying & Overcoming Prescriber Barriers to Improve the Use of Prescriptive Drug Monitoring Program
Get PDFBackground/Problem: The misuse, abuse, and diversion of controlled substances is a problematic health concern in the United States. Healthcare practitioners who prescribe controlled substances play an important role in prescribing and monitoring how these drugs are used. Purpose: The purpose of this quality improvement (QI) project was to identify perceived barriers prescribers face that hinder their ability to access and use the PDMP prior to prescribing controlled substances. Once barriers were identified, site-specific initiatives aimed at addressing barriers were developed and delivered. Methods: A pre- and post-intervention survey to assess prescriber knowledge and barriers related to PDMP use was developed, approved by IRB, and administered to a sample of prescribers in California, Florida, and Kansas. A mixed-method approach was used to collect qualitative and quantitative data. Pre-intervention survey analysis and appraisal of the literature guided site-specific initiatives developed to address prescriber barriers to using the PDMP. The interventions included an asynchronous video and PowerPoint presentation in California and Florida, and an in-person luncheon with discussion and PowerPoint presentation in Kansas. The QI team members provided the participants with a toolkit and resources specific to each site's needs to improve the utilization of the PDMP. The post-survey was conducted six weeks after the initial pre-survey review. Results: 22 participants responded to the preliminary survey. Out of the 22 participants, 18 respondents completed the post-survey questionnaire. The participants reported increased knowledge of accessing and using the PDMP, increased understanding of how to prescribe naloxone, and agreed that PDMP is an excellent tool for mitigating the controlled substance crisis. Conclusion: Targeted educational awareness can increase compliance with the PDMP and improve overall patient safety through safe controlledSchool of Nursin
Improving Depression Screening for Adults in Rural Louisiana
Get PDFProblem Statement: The adult and senior population of a primary care clinic in rural Louisiana lack depression
screening.
Purpose: This project aimed to improve screening for depression in a privately owned primary care clinic in adults 50 years of age and older residing in a rural parish in southern Louisiana. By Family Nurse Practitioners (FNPs) appropriately screening patients and improving diagnosis of depression, mental health barriers, and access to mental health services for rural patients will improve.
Methods: A quality improvement approach of Plan Do Study Act (PDSA) cycles, each approximately one month in length, was utilized to assess if depression screening rates for adults ages 50 and older in a rural primary care clinic improved after a 3-month implementation of screening process using the PHQ-2 (2-item Patient Health Questionnaire) and PHQ-9. The project team, nurse practitioner, and clinic staff developed a process to improve screening rates for all patients ages 50 years and older who received care at the clinic between October 6, 2021, and January 6, 2022. Retrospective chart audits at months one, two, and three were completed to identify if the patients had been screened for depression. Descriptive statistics were used to evaluate if the screening rate had improved between cycles and within the overall time frame.
Conclusion: Depression screening rates incrementally increased from 0% to 98% by the project's conclusion. After the first PDSA cycle, depression screening rose to 48.7%. After the second cycle, they increased to 91.1% and concluded at 98% with the end of the third and final PDSA cycle. New diagnoses of depression were made based on screening results during the second and third cycles.
Implications: These findings have provided primary care clinics and their staff with solid support regarding depression screening of older adults in a primary care setting. Primary care providers, especially those in a rural practice environment, are better equipped to identify mental health disorders, such as depression when fully understanding the impact of utilizing a developed screening tool on all eligible patients. This study's results solidify the need to incorporate depression screening tools into routine patient care provided by NPs to identify mental health disorders in rural populations and adequately diagnose and treat these disorders to improve patient outcomes.School of nursin
Adolescent Well Child Examinations in the Midwest
Get PDFWell child examinations (WCEs) are annual comprehensive preventive care visits conducted to address age-appropriate physical,
psychosocial, and developmental milestones set forth by the American Academy of Pediatrics and Bright Futures. As adolescents
assume responsibility for their own health habits, they are at a critical juncture where preventative screenings and education serve
an important role in future development, yet only 29% of adolescents are seeing their healthcare providers to address these vital
issues. Behaviors learned in adolescence have a strong influence on adult lifestyle choices, illustrating further necessity for WCEs
guided by health care providers during these developmental years.
This mixed-methods project integrates qualitative and quantitative tools to evaluate health care providers’ beliefs, general clinic
processes, and the overall quality of WCEs among adolescents aged 11 to 17 years in two midwestern primary care clinics.
Qualitative data was obtained through focus group interviews. Quantitative data was obtained through automatically generated
reports and manual electronic health record (EHR) chart audits. Qualitative results indicated that prompts for age-appropriate highrisk
behaviors are not triggered within the EHR until 17 to 18 years at the Kansas clinic whereas triggers were present for all ages at
the Iowa clinic. Though Iowa had substantially higher screening rates, both clinics were found to be deficient in high-risk behavior
and mental health screenings along with addressing immunization status during WCEs when compared to national averages. Clinic
recommendations to improve the quality and completion rate of adolescent WCEs included encouraging the use of standardized
assessments, age appropriate EHR triggers, and the use of marketing materials and EHR appointment reminders.School of Nursin
Treatment of Posttraumatic Stress Disorder: A Case Study of a 19-Year-Old
Get PDFAn Empirically Supported Treatment Case StudyThe following is a de-identified case study that presents the assessment, diagnosis, and treatment of Posttraumatic Stress Disorder (PTSD) utilizing Cognitive Processing Therapy (CPT). Names and other identifying information have been changed to protect the client’s privacy, with the name “Ruby” used in lieu of the client’s real name. At the time of treatment, this 19-year-old Caucasian female, was struggling to manage PTSD symptoms. Ruby was administered the Clinician Administered PTSD Scale (CAPS-5) and various self-report measures to aid in diagnoses and track treatment progress. Ruby’s primary diagnosis was PTSD with a secondary diagnosis of Major Depressive Disorder. She attended 14 treatment sessions over the course of five months utilizing the treatment protocol outlined in Cognitive Processing Therapy for PTSD: A Comprehensive Manual (Resick et al., 2017). The treatment included
psychoeducation, self-monitoring, cognitive restructuring, and behavioral activation strategies. Treatment was still in progress during the writing of this report. Comparisons of pre-to-post test scores on diagnostic and other measures suggest Ruby had made some treatment gains in the areas of a decrease in symptom severity, specifically arousal symptoms of PTSD, and decrease in functional impairment, regarding home and social related tasks.Psychology Departmen
Nonprofits and C Corporations: Performance Comparison
Get PDFWe extend the performance comparison study of nonprofits (NPs) and pass-throughs by examining large NPs and large C corporations (CCs). Unlike that study, we also examine performance outcomes under two different tax shield policies. We use the Capital Structure Model as our main methodology. Our purpose is to compare large NPs with large CCs in terms of debt choice, valuation, leverage gain, and growth-related outcomes. All tests considered, NPs (compared to CCs) have a 34.90% valuation advantage; achieve a 78.12% greater increase in value when going from nongrowth to growth (using a 12.34% lower plowback ratio and 10.97% less in retained earnings); attain a 2.56% greater optimal leverage ratio; and, realize 10.97% less in dollars added from debt. We show that switching from an interest tax shield to a retained earnings tax shield increases CC value between 1.35% and 3.28%. The NP value limit is only 0.42% since NPs pay little taxes. Our findings are value-additive for the comparative ownership form research.Kaw Valley Ban
Treatment of OCD: A Case Study of a Man with Checking Associated with Not Just Right Experiences
Get PDFAn Empirically Supported Treatment Case StudyThe following is a de-identified case study that presents the assessment, diagnosis, and
treatment of Obsessive Compulsive Disorder (OCD) utilizing Cognitive Behavioral Therapy
(CBT) and Exposure and Response Prevention (ERP). To protect the client’s anonymity, names
and other identifying details have been changed. When Simon presented to treatment, this 23-
year-old White male was struggling to manage OCD checking and rearranging behaviors related
to maintaining a “just right” sensation. He was assessed with a general history interview, the
Mini-International Neuropsychiatric Interview (MINI 7.0), the Yale Brown Obsessive
Compulsive Scale (Y-BOCS), and a battery of self-report assessments. Simon solely met criteria
for OCD and over the course of five months, attended 15 ERP treatment sessions.
Psychoeducation, self-monitoring, in-vivo and imaginal exposures, response prevention, and
behavioral strategies were utilized throughout the course of treatment. While treatment was not
concluded at the submission of this report, this client demonstrated significant improvement in
the management of his symptoms and his Y-BOCS scores decreased substantially.Psychology Departmen
Impact of G8 Stock Markets on Chinese Stock Market
Get PDFWe extend the stock market integration research by exploring the linkages among nine large stock markets that include former GS nations (current G7 and Russia) and China. We use a crisis-free period of 2009-2019 to avoid detecting linkages caused by interdependencies created by a major crisis. Our major purpose is to examine the impact of GS stock markets on China's market. We use standard time series methods: stationarity tests (ADF and PP unit root); long-run correlation tests (Johansen integration involving trace and maximum eigenvalue); impact of GS markets on China's market (VECM test); influence of GS markets on volatility in China's market (variance decomposition analysis); and, effect from shocks in GS markets on China's market (impulse response function). Major findings include the following. First, except for Germany and Russia, all markets have a significant causal influence on China with UK's market having the greatest influence. Second, GS markets are not the major source of short-run fluctuation in China's market but over time can exercise a noteworthy impact with the UK market manifesting the largest impact. Third, there are occasions for international portfolio diversification with China's market providing the greatest potential. Fourth, all markets provide a short-run window of profit opportunity.Kaw Valley Ban