Instructions
Part 8: Stakeholder Engagement Monitor and Control Plan
For the project selected in Unit I, create a simple stakeholder engagement monitor and control plan. Your plan should follow the process for managing and monitoring stakeholder engagement, as referred to in Figures 9.1 and 9.2 in the textbook. Your plan should include an introduction, and should answer the following questions:
· What specific soft skills will you employ in managing project stakeholders?
· What ground rules will you establish for managing project stakeholders?
· What types of meetings do you plan to have with project stakeholders? How often do you plan to hold them?
· How will you manage change requests from stakeholders?
· How will you monitor stakeholders and levels of stakeholder engagement?
· How will you manage changes to stakeholder requirements?
· What historical documents will you update in the process of managing and monitoring stakeholders?
Create the stakeholder management and control plan that addresses the questions above. Feel free to use tables, graphics, or document template examples to summarize your policy and approach. As a guide to depth, your stakeholder management and control plan should be a minimum of two pages in length. If you use tables, you may either create your table in Word and include it at the end of the document, or submit it as a separate Excel file.
Adhere to APA Style when constructing this assignment, including in-text citations and references for all sources that are used. Please note that no abstract is needed.
Instructions
Course Project, Executive Summary
For the project selected in Unit I, prepare a PowerPoint presentation of a minimum of 10 slides to provide an executive summary briefing. The minimum number of slides does not count the title slide or the references slide. The presentation should summarize each part of the course project that you developed throughout this course. The goal of the briefing PowerPoint presentation is to offer a succinct yet comprehensive view of your project stakeholder and communication plan. This includes the following elements:
· Part 1: Project Selection, Stakeholder Identification, And Stakeholder Analysis
· Part 2: Resource Management Plan and RACI (responsible, accountable, consulted, and informed) Chart
· Part 3: Communication Plan
· Part 4: Stakeholder Plan
· Part 5: Resource Acquisition Plan
· Part 6: Team Development Plan
· Part 7: Team Performance Reporting
· Part 8: Stakeholder Engagement Monitor and Control Plan (from the assignment also in this unit)
Adhere to APA Style when constructing this assignment, including in-text citations and references for all sources that are used.
Establishing an Integrated Care Practice in a Community Health Center
Andrea Auxier and Tillman Farley
Salud Family Health Centers, Fort Lupton, Colorado and
University of Colorado, Denver
Katrin Seifert
Salud Family Health Centers, Fort Lupton, Colorado
In a progressiv ...
Key Stakeholders in Public Health Issue.docx4934bk
Key stakeholders in a public health issue include those affected by the issue as well as those who can influence or make decisions related to the issue. It is important to identify stakeholders to understand their interests and perspectives which informs policy analysis. Primary care physicians, specialists, and other healthcare providers have an interest in public health issues that impact patient care. Government agencies also have an interest as they are responsible for funding programs and creating regulations and policies. Identifying stakeholders is crucial for conducting a thorough policy analysis.
32
Dissertation Prospectus
Factors Influencing Individuals' Decision to Utilize Mental Health in South Texas
Submitted by:
James Dada
April 5, 2020
The Prospectus Overview and Instructions
Prospectus Instructions:
1. Read the entire Prospectus Template to understand the requirements for writing your prospectus. Each section contains a narrative overview of what should be included in the section and a table with required criteria for each section. WRITE TO THE CRITERIA, as they will be used to assess the prospectus for overall quality and feasibility of your proposed research study.
2. As you draft each section, delete the narrative instructions and insert your work related to that section. Use the criterion table for each section to ensure that you address the requirements for that particular section. Do not delete/remove the criterion table as this is used by you and your committee to evaluate your prospectus.
3. Prior to submitting your prospectus for review by your chair or methodologist, use the criteria table for each section to complete a realistic self-evaluation, inserting what you believe is your score for each listed criterion into the Learner Self-Evaluation column. This is an exercise in self-evaluation and critical reflection, and to ensure that you completed all sections, addressing all required criteria for that section.
4. The scoring for the criteria ranges from a 0-3 as defined below. Complete a realistic and thoughtful evaluation of your work. Your chair and methodologist will also use the criterion tables to evaluate your work.
5. Your Prospectus should be no longer than 6-10 pages when the tables are deleted.
Score
Assessment
0
Item Not Present
1
Item is Present. Does Not Meet Expectations. Revisions are Required: Not all components are present. Large gaps are present in the components that leave the reader with significant questions. All items scored at 1 must be addressed by learner per reviewer comments.
2
Item is Acceptable. Meets Expectations.Some Revisions May Be Required Now or in the Future. Component is present and adequate. Small gaps are present that leave the reader with questions. Any item scored at 2 must be addressed by the learner per the reviewer comments.
3
Item Exceeds Expectations. No Revisions Required. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. No changes required.
Dissertation Prospectus
Introduction
This research study will examine the factors according to mental health providers that influence an individuals' decision to utilize mental health services in South Texas. This research will help us understand why individuals choose to utilize or reject mental health services in the state. Researchers (AUTH YEAR) have expressed a need for further research on the reasons why people decide to utilize or reject mental health services. In South Texas this research is needed because XXXXXXX. There is a ...
32
Dissertation Prospectus
Factors Influencing Individuals' Decision to Utilize Mental Health in South Texas
Submitted by:
James Dada
April 5, 2020
The Prospectus Overview and Instructions
Prospectus Instructions:
1. Read the entire Prospectus Template to understand the requirements for writing your prospectus. Each section contains a narrative overview of what should be included in the section and a table with required criteria for each section. WRITE TO THE CRITERIA, as they will be used to assess the prospectus for overall quality and feasibility of your proposed research study.
2. As you draft each section, delete the narrative instructions and insert your work related to that section. Use the criterion table for each section to ensure that you address the requirements for that particular section. Do not delete/remove the criterion table as this is used by you and your committee to evaluate your prospectus.
3. Prior to submitting your prospectus for review by your chair or methodologist, use the criteria table for each section to complete a realistic self-evaluation, inserting what you believe is your score for each listed criterion into the Learner Self-Evaluation column. This is an exercise in self-evaluation and critical reflection, and to ensure that you completed all sections, addressing all required criteria for that section.
4. The scoring for the criteria ranges from a 0-3 as defined below. Complete a realistic and thoughtful evaluation of your work. Your chair and methodologist will also use the criterion tables to evaluate your work.
5. Your Prospectus should be no longer than 6-10 pages when the tables are deleted.
Score
Assessment
0
Item Not Present
1
Item is Present. Does Not Meet Expectations. Revisions are Required: Not all components are present. Large gaps are present in the components that leave the reader with significant questions. All items scored at 1 must be addressed by learner per reviewer comments.
2
Item is Acceptable. Meets Expectations.Some Revisions May Be Required Now or in the Future. Component is present and adequate. Small gaps are present that leave the reader with questions. Any item scored at 2 must be addressed by the learner per the reviewer comments.
3
Item Exceeds Expectations. No Revisions Required. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. No changes required.
Dissertation Prospectus
Introduction
This research study will examine the factors according to mental health providers that influence an individuals' decision to utilize mental health services in South Texas. This research will help us understand why individuals choose to utilize or reject mental health services in the state. Researchers (AUTH YEAR) have expressed a need for further research on the reasons why people decide to utilize or reject mental health services. In South Texas this research is needed because XXXXXXX. There is a ...
The document outlines the topics and assessments for a course on case management and mental health. It discusses the history and definition of case management. The key stages of case management are intake, assessment, planning, implementation, monitoring, review and exit. Family involvement is an important part of a client's recovery plan. Assessment tasks for the course include an essay on topics related to mental health in older adults and a group presentation on the impact of mental illness on different types of family members and caregivers.
NURS FPX 4050 Assessment 3 Care Coordination Presentation to Colleagues.docxstirlingvwriters
This document provides instructions for a nursing student to develop a 20-minute presentation for colleagues on care coordination fundamentals. It includes an introduction defining care coordination and its importance. It also outlines key factors to address, such as community resources, ethics, policy issues, and change management. The student is instructed to create a 4-5 page script and record a video presentation. A reference list is also required.
Three Mountains Regional Hospital· Medical and surgical facility.docxjuliennehar
Three Mountains Regional Hospital
· Medical and surgical facility.
· Offer outpatient and inpatient surgeries.
· Committed to providing high-quality health services.
Electronic Medical Record
Defined as medical records kept on a computer.
Records are kept by doctors, health care providers, hospital or medical office staff.
Contents of EMR
The records contain general patient information, such as:
· Health condition
· Diagnostic tests
· Prescriptions and
· Treatment
· Personal details like name, contacts, and date of birth
EMRs are safe and confidential.
Records can be shared securely through a network.
HIPPA/
Confidentiality
It is a U.S legislation that safeguards medical information.
The law provides privacy and security to health data.
It requires health care information to be handled with confidentiality.
Level of Confidentiality
High-levels of confidentiality assured when transferring, receiving, sharing, or handling protected health information.
Release of Information
To maintain patient confidentiality and comply with set laws, health information will only be released upon written authorization by the patient.
The process of requesting your health records at Three Mountains Regional hospital is as follows:
· Obtain, fill and submit Authorization for Release of Health Information Form
·
· Form must be completed and signed.
· Specify information to be released.
· Health practitioner to review request and clinical appropriateness for release.
· After approval, information is released.
NB:
The following Protected health information cannot be shared without patient permission:
· Test and laboratory results
· Demographic information
· Mental health condition
· Medical histories and
· Insurance information
Privacy Pledge
At Three Mountains Regional Hospital, we pledge to keep all your information private and confidentiality in compliance with the law and through our
You did a nice job with the brochure layout, as it looks very good and you made a nice use of graphics and language. Nice work on the EMR. You need to discuss the joint committee requirement and add a citation to show that you used the material. In the HIPPA section, good job defining how HIPPA provides privacy and security protection. You need to expand and tell the patient how HIPPA is used by the facility to ensure their privacy. Your release of information good and explains the process as nice use of steps a patient needs to do besides just contacting the facility to get a form . You need to draft a more developed privacy pledge that adds a goal to comply with all federal and state laws regarding privacy to your pledge.
specific privacy policies.
Title
ABC/123 Version X
1
Grading Guide for Issues of Substance Abuse and Addiction
CPSS 420
1
University of Phoenix Material
Week 5: Substance Abuse Treatment
Content (80%)
Points Earned:
· All key elements of the assignment are covered in a substantive way. Major points are stated clearly; are supporte ...
ACT implementation may include a variety of
community stakeholders as well as both local and state
health authorities. If an organization is providing
effective ACT services, many systems which interface
with ACT clients (e.g., behavioral healthcare, primary
healthcare, criminal justice) have an investment in the
outcomes generated by ACT, because clients will not
be showing up in those systems as frequently. Courts,
hospitals, managed-care companies, and the local
mental health authority all interact with the
individuals you are serving. Therefore, it is important
to engage these key stakeholders in the
implementation process.
Navigate 2 Scenario for Health PolicyEpisode 1Policy An.docxmayank272369
Navigate 2 Scenario for Health Policy
Episode 1:
Policy Analysis and Development
Overview
In this episode, you will be in a health care policy internship program in a Senator’s office in Washington, D.C. The Senator wants to develop policy that requires all health care organizations that receive federal funds to implement the recommendations presented in the Institute of Medicine reports on quality care. You will develop a policy, so that it can become proposed legislation. You must collect data, describe the problem, solutions and related ethical issues, examine the cost-benefit analysis, identify stakeholders (such as lobbyists from American Hospital Association, health care providers, health care corporations, pharmaceuticals, insurers, etc.), and impact. Based on this information, you will create a policy description that will be the foundation for a bill. You will describe critical issues that would be in the bill such as requirements of hospitals to:
Monitor and report medical errors to the Department of Health and Human Services
Use root cause analysis on a certain percentage of errors
Track and report patient outcomes focused on the clinical problems identified in the
National Health Care
Quality Report
Integrate the 5 health care profession core competencies into staff education and track outcomes
Establish a no-blame culture
*I suggest for you to do some research on your own, and if you use outside sources to help your compile your policy description, be sure to reference them (following an APA format) at the end of your post.
Assignment
You will post a policy description to this discussion board forum. Make sure to identify a plan that addresses legal and ethical issues in a health care policy. You must also respond to 2 of your peers' posts and make sure to reference any outside sources you may have used in your recommendation.
Below are the characters from this LearnScapes scenario (LearnScapes for
Health Policy
1):
The Student (which is you), Health Care Policy Intern for Congress
The student used to work within the Bright Road Health Care System, and had a special interest in policy. The student is thinking about moving into politics, hoping to make a difference at that level. The student has just been accepted into the internship; this is the student’s first big project.
Peter Shackley, Senior Policy Staff Member
The student’s mentor, Peter, is a young and feisty staff member. In his late 20s, Pete has been interested in politics since he was President of his high school student body. He’s especially passionate about policy-making and how the process works. Pete will help guide the student through the policy-making process.
Gretchen Wilde, Senator Chief of Staff
Gretchen is in her 30s and has been the Senator’s Chief of Staff for about 2 years now. She’s very professional, and holds high expectations for everyone in the Senator’s office, including interns. Gretchen is responsible for reviewing polic.
Key Stakeholders in Public Health Issue.docx4934bk
Key stakeholders in a public health issue include those affected by the issue as well as those who can influence or make decisions related to the issue. It is important to identify stakeholders to understand their interests and perspectives which informs policy analysis. Primary care physicians, specialists, and other healthcare providers have an interest in public health issues that impact patient care. Government agencies also have an interest as they are responsible for funding programs and creating regulations and policies. Identifying stakeholders is crucial for conducting a thorough policy analysis.
32
Dissertation Prospectus
Factors Influencing Individuals' Decision to Utilize Mental Health in South Texas
Submitted by:
James Dada
April 5, 2020
The Prospectus Overview and Instructions
Prospectus Instructions:
1. Read the entire Prospectus Template to understand the requirements for writing your prospectus. Each section contains a narrative overview of what should be included in the section and a table with required criteria for each section. WRITE TO THE CRITERIA, as they will be used to assess the prospectus for overall quality and feasibility of your proposed research study.
2. As you draft each section, delete the narrative instructions and insert your work related to that section. Use the criterion table for each section to ensure that you address the requirements for that particular section. Do not delete/remove the criterion table as this is used by you and your committee to evaluate your prospectus.
3. Prior to submitting your prospectus for review by your chair or methodologist, use the criteria table for each section to complete a realistic self-evaluation, inserting what you believe is your score for each listed criterion into the Learner Self-Evaluation column. This is an exercise in self-evaluation and critical reflection, and to ensure that you completed all sections, addressing all required criteria for that section.
4. The scoring for the criteria ranges from a 0-3 as defined below. Complete a realistic and thoughtful evaluation of your work. Your chair and methodologist will also use the criterion tables to evaluate your work.
5. Your Prospectus should be no longer than 6-10 pages when the tables are deleted.
Score
Assessment
0
Item Not Present
1
Item is Present. Does Not Meet Expectations. Revisions are Required: Not all components are present. Large gaps are present in the components that leave the reader with significant questions. All items scored at 1 must be addressed by learner per reviewer comments.
2
Item is Acceptable. Meets Expectations.Some Revisions May Be Required Now or in the Future. Component is present and adequate. Small gaps are present that leave the reader with questions. Any item scored at 2 must be addressed by the learner per the reviewer comments.
3
Item Exceeds Expectations. No Revisions Required. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. No changes required.
Dissertation Prospectus
Introduction
This research study will examine the factors according to mental health providers that influence an individuals' decision to utilize mental health services in South Texas. This research will help us understand why individuals choose to utilize or reject mental health services in the state. Researchers (AUTH YEAR) have expressed a need for further research on the reasons why people decide to utilize or reject mental health services. In South Texas this research is needed because XXXXXXX. There is a ...
32
Dissertation Prospectus
Factors Influencing Individuals' Decision to Utilize Mental Health in South Texas
Submitted by:
James Dada
April 5, 2020
The Prospectus Overview and Instructions
Prospectus Instructions:
1. Read the entire Prospectus Template to understand the requirements for writing your prospectus. Each section contains a narrative overview of what should be included in the section and a table with required criteria for each section. WRITE TO THE CRITERIA, as they will be used to assess the prospectus for overall quality and feasibility of your proposed research study.
2. As you draft each section, delete the narrative instructions and insert your work related to that section. Use the criterion table for each section to ensure that you address the requirements for that particular section. Do not delete/remove the criterion table as this is used by you and your committee to evaluate your prospectus.
3. Prior to submitting your prospectus for review by your chair or methodologist, use the criteria table for each section to complete a realistic self-evaluation, inserting what you believe is your score for each listed criterion into the Learner Self-Evaluation column. This is an exercise in self-evaluation and critical reflection, and to ensure that you completed all sections, addressing all required criteria for that section.
4. The scoring for the criteria ranges from a 0-3 as defined below. Complete a realistic and thoughtful evaluation of your work. Your chair and methodologist will also use the criterion tables to evaluate your work.
5. Your Prospectus should be no longer than 6-10 pages when the tables are deleted.
Score
Assessment
0
Item Not Present
1
Item is Present. Does Not Meet Expectations. Revisions are Required: Not all components are present. Large gaps are present in the components that leave the reader with significant questions. All items scored at 1 must be addressed by learner per reviewer comments.
2
Item is Acceptable. Meets Expectations.Some Revisions May Be Required Now or in the Future. Component is present and adequate. Small gaps are present that leave the reader with questions. Any item scored at 2 must be addressed by the learner per the reviewer comments.
3
Item Exceeds Expectations. No Revisions Required. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. No changes required.
Dissertation Prospectus
Introduction
This research study will examine the factors according to mental health providers that influence an individuals' decision to utilize mental health services in South Texas. This research will help us understand why individuals choose to utilize or reject mental health services in the state. Researchers (AUTH YEAR) have expressed a need for further research on the reasons why people decide to utilize or reject mental health services. In South Texas this research is needed because XXXXXXX. There is a ...
The document outlines the topics and assessments for a course on case management and mental health. It discusses the history and definition of case management. The key stages of case management are intake, assessment, planning, implementation, monitoring, review and exit. Family involvement is an important part of a client's recovery plan. Assessment tasks for the course include an essay on topics related to mental health in older adults and a group presentation on the impact of mental illness on different types of family members and caregivers.
NURS FPX 4050 Assessment 3 Care Coordination Presentation to Colleagues.docxstirlingvwriters
This document provides instructions for a nursing student to develop a 20-minute presentation for colleagues on care coordination fundamentals. It includes an introduction defining care coordination and its importance. It also outlines key factors to address, such as community resources, ethics, policy issues, and change management. The student is instructed to create a 4-5 page script and record a video presentation. A reference list is also required.
Three Mountains Regional Hospital· Medical and surgical facility.docxjuliennehar
Three Mountains Regional Hospital
· Medical and surgical facility.
· Offer outpatient and inpatient surgeries.
· Committed to providing high-quality health services.
Electronic Medical Record
Defined as medical records kept on a computer.
Records are kept by doctors, health care providers, hospital or medical office staff.
Contents of EMR
The records contain general patient information, such as:
· Health condition
· Diagnostic tests
· Prescriptions and
· Treatment
· Personal details like name, contacts, and date of birth
EMRs are safe and confidential.
Records can be shared securely through a network.
HIPPA/
Confidentiality
It is a U.S legislation that safeguards medical information.
The law provides privacy and security to health data.
It requires health care information to be handled with confidentiality.
Level of Confidentiality
High-levels of confidentiality assured when transferring, receiving, sharing, or handling protected health information.
Release of Information
To maintain patient confidentiality and comply with set laws, health information will only be released upon written authorization by the patient.
The process of requesting your health records at Three Mountains Regional hospital is as follows:
· Obtain, fill and submit Authorization for Release of Health Information Form
·
· Form must be completed and signed.
· Specify information to be released.
· Health practitioner to review request and clinical appropriateness for release.
· After approval, information is released.
NB:
The following Protected health information cannot be shared without patient permission:
· Test and laboratory results
· Demographic information
· Mental health condition
· Medical histories and
· Insurance information
Privacy Pledge
At Three Mountains Regional Hospital, we pledge to keep all your information private and confidentiality in compliance with the law and through our
You did a nice job with the brochure layout, as it looks very good and you made a nice use of graphics and language. Nice work on the EMR. You need to discuss the joint committee requirement and add a citation to show that you used the material. In the HIPPA section, good job defining how HIPPA provides privacy and security protection. You need to expand and tell the patient how HIPPA is used by the facility to ensure their privacy. Your release of information good and explains the process as nice use of steps a patient needs to do besides just contacting the facility to get a form . You need to draft a more developed privacy pledge that adds a goal to comply with all federal and state laws regarding privacy to your pledge.
specific privacy policies.
Title
ABC/123 Version X
1
Grading Guide for Issues of Substance Abuse and Addiction
CPSS 420
1
University of Phoenix Material
Week 5: Substance Abuse Treatment
Content (80%)
Points Earned:
· All key elements of the assignment are covered in a substantive way. Major points are stated clearly; are supporte ...
ACT implementation may include a variety of
community stakeholders as well as both local and state
health authorities. If an organization is providing
effective ACT services, many systems which interface
with ACT clients (e.g., behavioral healthcare, primary
healthcare, criminal justice) have an investment in the
outcomes generated by ACT, because clients will not
be showing up in those systems as frequently. Courts,
hospitals, managed-care companies, and the local
mental health authority all interact with the
individuals you are serving. Therefore, it is important
to engage these key stakeholders in the
implementation process.
Navigate 2 Scenario for Health PolicyEpisode 1Policy An.docxmayank272369
Navigate 2 Scenario for Health Policy
Episode 1:
Policy Analysis and Development
Overview
In this episode, you will be in a health care policy internship program in a Senator’s office in Washington, D.C. The Senator wants to develop policy that requires all health care organizations that receive federal funds to implement the recommendations presented in the Institute of Medicine reports on quality care. You will develop a policy, so that it can become proposed legislation. You must collect data, describe the problem, solutions and related ethical issues, examine the cost-benefit analysis, identify stakeholders (such as lobbyists from American Hospital Association, health care providers, health care corporations, pharmaceuticals, insurers, etc.), and impact. Based on this information, you will create a policy description that will be the foundation for a bill. You will describe critical issues that would be in the bill such as requirements of hospitals to:
Monitor and report medical errors to the Department of Health and Human Services
Use root cause analysis on a certain percentage of errors
Track and report patient outcomes focused on the clinical problems identified in the
National Health Care
Quality Report
Integrate the 5 health care profession core competencies into staff education and track outcomes
Establish a no-blame culture
*I suggest for you to do some research on your own, and if you use outside sources to help your compile your policy description, be sure to reference them (following an APA format) at the end of your post.
Assignment
You will post a policy description to this discussion board forum. Make sure to identify a plan that addresses legal and ethical issues in a health care policy. You must also respond to 2 of your peers' posts and make sure to reference any outside sources you may have used in your recommendation.
Below are the characters from this LearnScapes scenario (LearnScapes for
Health Policy
1):
The Student (which is you), Health Care Policy Intern for Congress
The student used to work within the Bright Road Health Care System, and had a special interest in policy. The student is thinking about moving into politics, hoping to make a difference at that level. The student has just been accepted into the internship; this is the student’s first big project.
Peter Shackley, Senior Policy Staff Member
The student’s mentor, Peter, is a young and feisty staff member. In his late 20s, Pete has been interested in politics since he was President of his high school student body. He’s especially passionate about policy-making and how the process works. Pete will help guide the student through the policy-making process.
Gretchen Wilde, Senator Chief of Staff
Gretchen is in her 30s and has been the Senator’s Chief of Staff for about 2 years now. She’s very professional, and holds high expectations for everyone in the Senator’s office, including interns. Gretchen is responsible for reviewing polic.
1
2
Women Veterans Mental Healthcare during Pregnancy
Student Name
Student Affiliation (For Example, Department + Institute Name)
Course Name and Number
Instructor Name
Date
Women Veterans Mental Healthcare during Pregnancy
Pregnancy in women veterans is often associated with anxiety, depression, and other stress disorders. The incidence of these diseases is high in women veterans due to significant endeavors during military services (Creech et al., 2019). The implementation plan for pregnant veterans includes providing financial aids and sufficient resources to improve their mental health during pregnancy. The proposed change plan comprises certain strategic interventions to reduce the ongoing incidence of mental health problems during pregnancy in women veterans.
Distinguish organizational strategies needed to implement and maintain the change plan.
The proposed change plan comprises certain modifications in the management of pregnant veterans by providing them with adequate funds, quick medical access, and paid pregnancy leaves. Similarly, the organization should pay attention to the fault lines of the already implemented plan. To maintain the change, there should be active leadership that prioritizes the success and sustenance of the change plan. The other strategy that can make the implementation plan easy and productive is empowering women veterans through effective communication and negotiation. This strategy will ultimately help to reduce the mental stress and grievances of pregnant veterans. Hence, the change plan can categorically operate.
Identify the stakeholders needed to support the implementation of the proposed plan.
The major stakeholders are healthcare professionals such as doctors, nurses, allied health professionals, paramedical staff, and pregnant veterans as a patient of prime focus for this change plan. Additionally, hospital management and leadership also play a significant role in implementing the proposed change plan (Nillni et al., 2021). Similarly, there are certain private investors and NGOs that work for the mandate of the organization and patient care. Insurance companies are also one of the key stakeholders of the implementation plan. Similarly, pharmaceutical firms and government subsidies are also supportive elements for the implementation plan. All these stakeholders will provide affordable health care costs and quality medical care for pregnant veterans.
Explain how these stakeholders are vital to implementing the change plan.
Doctors and nurses are the first-line workers to assist the patient and provide the baseline for effective implementation. Efficient staff will introduce interventions that will improve the mental health of the veterans. Similarly, the insurance companies and other private investors directly fund the patient and hospital management to increase the plan's efficacy. This strategy will ensure the safe delivery and life of the child and mother (Nillni et al., 2021 ...
1
2
Women Veterans Mental Healthcare during Pregnancy
Student Name
Student Affiliation (For Example, Department + Institute Name)
Course Name and Number
Instructor Name
Date
Women Veterans Mental Healthcare during Pregnancy
Pregnancy in women veterans is often associated with anxiety, depression, and other stress disorders. The incidence of these diseases is high in women veterans due to significant endeavors during military services (Creech et al., 2019). The implementation plan for pregnant veterans includes providing financial aids and sufficient resources to improve their mental health during pregnancy. The proposed change plan comprises certain strategic interventions to reduce the ongoing incidence of mental health problems during pregnancy in women veterans.
Distinguish organizational strategies needed to implement and maintain the change plan.
The proposed change plan comprises certain modifications in the management of pregnant veterans by providing them with adequate funds, quick medical access, and paid pregnancy leaves. Similarly, the organization should pay attention to the fault lines of the already implemented plan. To maintain the change, there should be active leadership that prioritizes the success and sustenance of the change plan. The other strategy that can make the implementation plan easy and productive is empowering women veterans through effective communication and negotiation. This strategy will ultimately help to reduce the mental stress and grievances of pregnant veterans. Hence, the change plan can categorically operate.
Identify the stakeholders needed to support the implementation of the proposed plan.
The major stakeholders are healthcare professionals such as doctors, nurses, allied health professionals, paramedical staff, and pregnant veterans as a patient of prime focus for this change plan. Additionally, hospital management and leadership also play a significant role in implementing the proposed change plan (Nillni et al., 2021). Similarly, there are certain private investors and NGOs that work for the mandate of the organization and patient care. Insurance companies are also one of the key stakeholders of the implementation plan. Similarly, pharmaceutical firms and government subsidies are also supportive elements for the implementation plan. All these stakeholders will provide affordable health care costs and quality medical care for pregnant veterans.
Explain how these stakeholders are vital to implementing the change plan.
Doctors and nurses are the first-line workers to assist the patient and provide the baseline for effective implementation. Efficient staff will introduce interventions that will improve the mental health of the veterans. Similarly, the insurance companies and other private investors directly fund the patient and hospital management to increase the plan's efficacy. This strategy will ensure the safe delivery and life of the child and mother (Nillni et al., 2021 ...
This document provides guidance for nurses on developing a policy brief to advocate for one of the recommendations from the Institute of Medicine's 2010 report "The Future of Nursing: Leading Change, Advancing Health." It outlines the components that should be included in a 2-3 page single-spaced policy brief, such as a short introduction stating the problem, the selected recommendation, background on the issue, current solutions and status, and a conclusion. Nurses are encouraged to write policy briefs to communicate health policy issues clearly to decision makers and advocate for changes that can improve health outcomes.
QUESTION 1What are the main streams of influence, according to.docxmakdul
QUESTION 1
What are the main streams of influence, according to the Theory of Triadic Influence? Please provide examples factors/attributes that belong to each of those streams. What is the relationship/correlation between each of those streams?
Your response should be at least 200 words in length.
QUESTION 2
The PRECEDE-PROCEED approach has several key assessment/diagnosis phases. Please describe the epidemiological assessment. What are some key sources of data used in this assessment? Which main questions is this assessment is trying to address/answer?
Your response should be at least 200 words in length.
QUESTION 3
What specific questions the evaluators are bringing forward as they are trying to collect the necessary evaluation data? What are the three main types of evaluation discussed in the PRECEDE-PROCEED approach? What is each of them trying to identify, measure, evaluate?
Your response should be at least 200 words in length.
QUESTION 4
What are some of the key assumptions behind the PRECEDE-PROCEED approach? What are some of the key benefits of using this approach? What are some of the “real-life” examples of using this approach?
Your response should be at least 200 words in length.
Unit Lesson Study Guide
In Unit 4, we will continue to discuss health behavior and its association with factors that could influence such behaviors. These types of influences are referred to as multilevel factors of behaviors, and they typically fall into five main categories:
1. individual factors,
2. inter-personal factors,
3. organizational factors,
4. community factors, and
5. policy factors
Consider the following scenario:
A 50-year-old man may purposely postpone getting a prostate cancer test because he is scared of finding out that he may have prostate cancer. This is an example of an individual- level factor. However, we need to look into this further and consider the following: his inaction might also be influenced by his primary physician’s failure to actually recommend and insist that he would need to take the prostate test. Another factor might be the difficulty of scheduling an appointment due to either unavailable equipment or the unavailability of staff at his local clinic. Another limiting factor could be that the fee for the exam is so high he cannot afford it, and his insurance does not cover this type of procedure. Thus, all these interpersonal, organizational, and policy factors are influencing this man’s behavior to not complete the prostate test. Therefore, for health promotion practitioners, it is very important to be aware of all these factors so effective change strategies or interventions can be prescribed.
One of the multilevel theories that will be discussed is the Theory of Triadic Influence (TTI). TTI behaviors arise due to one’s current social situation, general cultural environment, and their personal characteristics. Any health-related behaviors are influenced by an individual’s decisions.
What wo ...
HCM 3305, Community Health 1 Course Learning Outcom.docxaryan532920
This document discusses systems thinking and community health programming. It provides an overview of the steps to plan, implement, and evaluate community health programs. The key steps include assessing needs, setting goals and objectives, developing interventions, implementation, and evaluation. Evaluation is important to determine a program's effectiveness and identify areas for improvement. Systems thinking is also discussed as an alternative evaluation approach.
Name olubunmi salako date 1262021identification of scenariojack60216
This document provides an annotated bibliography by Olubunmi Salako for a leadership and management in nursing course. It summarizes four sources that discuss various aspects of patient education, nursing standards, and healthcare policy. The sources examine how competency-based nursing curriculum and educational interventions can improve compliance with nursing standards. They also discuss how health policies and addressing social determinants can help reduce public health problems and disparities. The annotations provide details on the authors and relevance of each source to topics like patient education, nursing practice standards, and using policy to influence health outcomes.
This document discusses eHealth strategies and the benefits they provide to patients, healthcare providers, and health systems. It analyzes the key stakeholders in large-scale eHealth projects, including primary/secondary healthcare centers, health insurances, hospitals, pharmacies, and nursing homes. Large eHealth projects involve many institutions that each have their own goals and agendas. Successful projects require identifying these stakeholders, describing the system benefits for each, and finding solutions that balance their various requirements through transparency and discussion.
PAGE
20
Dissertation Prospectus
Factors Influencing Individuals' Decision to Utilize Mental Health in South Texas
Submitted by:
The Prospectus Overview and Instructions
Prospectus Instructions:
1. Read the entire Prospectus Template to understand the requirements for writing your prospectus. Each section contains a narrative overview of what should be included in the section and a table with required criteria for each section. WRITE TO THE CRITERIA, as they will be used to assess the prospectus for overall quality and feasibility of your proposed research study.
2. As you draft each section, delete the narrative instructions and insert your work related to that section. Use the criterion table for each section to ensure that you address the requirements for that particular section. Do not delete/remove the criterion table as this is used by you and your committee to evaluate your prospectus.
3. Prior to submitting your prospectus for review by your chair or methodologist, use the criteria table for each section to complete a realistic self-evaluation, inserting what you believe is your score for each listed criterion into the Learner Self-Evaluation column. This is an exercise in self-evaluation and critical reflection, and to ensure that you completed all sections, addressing all required criteria for that section.
4. The scoring for the criteria ranges from a 0-3 as defined below. Complete a realistic and thoughtful evaluation of your work. Your chair and methodologist will also use the criterion tables to evaluate your work.
5. Your Prospectus should be no longer than 6-10 pages when the tables are deleted.
0
Item Not Present
1
Item is Present. Does Not Meet Expectations. Revisions are Required: Not all components are present. Large gaps are present in the components that leave the reader with significant questions. All items scored at 1 must be addressed by learner per reviewer comments.
2
Item is Acceptable. Meets Expectations.Some Revisions May Be Required Now or in the Future. Component is present and adequate. Small gaps are present that leave the reader with questions. Any item scored at 2 must be addressed by the learner per the reviewer comments.
3
Item Exceeds Expectations. No Revisions Required. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. No changes required.
Dissertation Prospectus
Introduction
Southern Texas encompasses different groups of people whose behavior, gender identity, and gender expression varies depending on cultural identity and norms. About a quarter of individuals in United States have a history or are experiencing a mental disorder with approximately 6% of the population having critical mental illness. These mental problems typically affect the general well-being of an individual. For instance, patients living with severe mental disorders are more likely to die in average of twenty-six years earlier than the average life expectanc ...
This document provides instructions for an assignment analyzing a pertinent healthcare issue. Students are asked to select a national healthcare issue/stressor, review research addressing change strategies by healthcare organizations, and write a 3-4 page white paper to organizational leadership about the issue. The paper should describe the issue's impact, summarize strategies from research, and explain how strategies could impact the organization positively and negatively.
H. E. R. O - Helping through Encouragement and ReachJeanmarieColbert3
H. E. R. O - Helping through Encouragement and Reaching Out
Selena Lama
Doriyan Darden
Kabita Budhathoki
Kusim Syangbo
Radhika Chhetri
Yesenia Binkley
Texas A&M University - Commerce
2. Table of Contents (1 page)
3. Executive Summary (1 page)
4. Program Rationale (4-6 pages)
5. Program Planning Documentation (2-4 Pages)
Program Planning Documentation
Suicide prevention in middle-aged male veterans teams uses PROCEDE-PROCEED for program H.E.R.O. There are several reasons we choose to use this planning model. (1) It is hypothetically base and combines a series of phases in the planning, implementation, and evaluation to acquire the quality of life to the target population; (2) “It is the most widely known model in program planning” (Green & Kreuter, 2005); (3) This planning model starts with consequences and determines its cause; once the cause is known, an intervention will design to reach the desired outcomes; (4) “PRECEDE is helping to predisposing, reinforcing, and enabling constructs in education; PROCEED helps in policymaking, controlling and structural constructs in educational development” (Green & Kreuter, 2005, p. 9).
"In phase 1 is called the social assessment, the model seeks to state the quality of life of the target population to know problems and priorities of those population so that team can identify the desired outcomes" (Green & Kreuter, 2005). It analyzes the situation and allows the employee and employer the assessing the needs for achieving the quality of life. In phase 2, epidemiological assessment, we use data to determine the risk factors or causes of health in the population's genetics, behavioral patterns, and environment and rank the health goals and problems identified in phase 1. we use this phase to plan the health program. Phase 3, educational and ecological assessment, helps identify and classify the many factors into three categories: predisposing, reinforcing, and enabling. These three categories help provide social benefits such as appreciation, relief of discomfort or pain, or tangible rewards like avoidance of cost to get quality of life in the target population in the H.E.R.O program. In phase 4, the intervention alignment, we aim to compare the strategies and interventions from the previous phase and bring needed changes to the policies. Administrative and policy assessment helps determine what resources are available to carry out the health promotion intervention, what time the invention can conduct, there are financial resources to buy needed stuff for an employee or not, what organization and administration will support the H.E.R.O program. After identifying the intervention, we determine the availability of program resources; in phase 5, we begin the implementation, and in Phase 6,7 and 8, we evaluate the program's composition based on the objectives that we create during the assessment phase (Green & Kreuter, 2005). We focus on the availability of educational components for the employe ...
This document provides instructions for writing a dissertation prospectus. It outlines 5 requirements for the prospectus, including reading the entire template, writing each section to address criteria in a table, using the criteria table for self-evaluation, and keeping the prospectus between 6-10 pages. It then provides a sample prospectus section on the theoretical foundations/conceptual framework and review of literature/themes. This section reviews literature identifying themes around lack of mental health education/infrastructure, lack of medical insurance, and poor community perceptions as factors affecting utilization of mental health services in South Texas. It proposes using Albert Bandura's social cognitive theory as the theoretical model.
Chapter 12 IT Alignment and Strategic Planning Learning ObjectivesEstelaJeffery653
The document discusses software architectural design and detailed design. It covers architectural styles like pipes and filters, event-driven, client-server, model-view-controller, layered, database-centric, and three-tier. It also discusses architectural tactics, reference architectures, functional decomposition, relational database design, object-oriented design, user interface design, and other topics like the model-view-controller pattern. The goal is to understand different approaches to structuring software solutions at both the architectural and detailed levels of design.
Agenda SettingA key aspect of the policy process is agendacheryllwashburn
This document outlines an assignment for students to analyze agenda setting in the policy process. It instructs students to identify a clinical practice issue for their organization's agenda, consider relevant stakeholders, and write a 550-word post discussing strategies to inform and persuade stakeholders of the issue's importance. The post must reference at least 3 required readings that discuss stakeholder analysis, policy briefs, examples of nursing advocacy, and the role of research in policymaking.
You will summarize the possible impact of the DHHS’ policy in a di.docxrosemarybdodson23141
You will summarize the possible impact of the DHHS’ policy in a discussion board post. Make sure to list the data required to monitor outcomes of policies within the Health Care. You must also respond to 2 of your peers' posts and make sure to reference any outside sources you may have used in your assignment post
Navigate 2 Scenario for Health Policy
Episode 4: Evaluating a Health Care Policy
Overview
In this Navigate 2 Scenario, you are responsible for examining the DHHS’ evaluation of the policy and how it may impact the Health Care System. You will then work with a team to determine the best way to monitor the implementation of policy within the
Health Care
System and report it to the DHHS. Specifically, how they:
Monitor and report medical errors to the Department of Health and Human
Use root cause analysis on a certain percentage of
Track and report patient outcomes focused on the clinical problems identified in the
National Health Care
Quality Report (
http://www.ahrq.gov/qual/qrdr10.htm (Links to an external site.)
).
Integrate the 5 health care profession core competencies into staff education and track
Establish a no-blame
Assignment
You will summarize the possible impact of the DHHS’ policy in a discussion board post. Make sure to list the data required to monitor outcomes of policies within the Health Care. You must also respond to 2 of your peers' posts and make sure to reference any outside sources you may have used in your assignment post.
Learning Objectives for this LearnScapes scenario
Analyze how such various applications of the law affect decisions in the development and operation of a health care
Use technology and information resources to research issues in health care policy, law, and ethics.
LearnScape 4 Characters
Timothy Kohl, Staff member at DHHS
Timothy is in his mid-50s, and has been with DHHS for more than 20 years. His main focus is health policy. Timothy consults with staff in various departments and agencies to work out how health care law should be written and then implemented. He will work extensively with the student to determine what data is needed to stay in compliance.
Tiffany Halpert, Chief of Medical Staff of Bright Road Health Care System
Tiffany is a physician in her early 40’s. She is bright, funny, and very direct. Her current responsibilities include care management and organizational performance for the Health Care System including medical management, care coordination, case management and management engineering. She is an internist, just beginning her term as Chief of Medical staff.
Ken Bloom, Chief Nursing Officer of Bright Road Health Care System
Ken is in his mid-40s, and has held various positions of nursing departments in both small and large medical facilities. At Bright Road, he began his career in an urgent care facility, where he saw a lot of elderly patients. He had a natural inclination for assisting elderly patients, so he shifted his focus to geriatri.
National Institute of Health: Theory at a Glance, A Guide for Health Promotio...Zach Lukasiewicz
Introduction viii
Audience and Purpose 1
Contents 1
Part 1: Foundations of Theory in Health Promotion and Health Behavior 3
Why Is Theory Important to Health Promotion and Health Behavior Practice? 4
What Is Theory? 4
How Can Theory Help Plan Effective Programs? 4
Explanatory Theory and Change Theory 5
Fitting Theory to the Field of Practice 5
Using Theory to Address Health Issues in Diverse Populations 7
Part 2: Theories and Applications 9
The Ecological Perspective: A Multilevel, Interactive Approach 10
Theoretical Explanations of Three Levels of Influence 12
Individual or Intrapersonal Level 12
Health Belief Model 13
Stages of Change Model 15
Theory of Planned Behavior 16
Precaution Adoption Process Model 18
Interpersonal Level 19
Social Cognitive Theory 19
Community Level 22
Community Organization and Other Participatory Models 23
Diffusion of Innovations 27
Communication Theory 29
Media Effects 30
Agenda Setting 30
New Communication Technologies 31
The Quadruple Aim provides broad categories of goals to pursue to ma.docxhelen23456789
The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.
Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time.
In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected.
To Prepare:
Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.
Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected.
Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.
The Assignment (3-4 Pages):
Analysis of a Pertinent Healthcare Issue
Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:
Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.
Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain ho.
11Week Two Assignment Identification of Healthcare Policy Conc.docxdrennanmicah
11
Week Two Assignment: Identification of Healthcare Policy Concern Guidelines and Grading Rubric
Purpose
In this course, the students will have the opportunity to identify a healthcare policy concern and community
healthcare concern which can be improved with a change in policy, ordinance or the language in existing
law. The outcome would be the potential for improved health for a population group. Students will present
a proposed solution or change to an elected official, and provide an analysis of the project. While students
are not responsible for ensuring the implementation of their identified solution to the healthcare policy
concern, the student is required to meet with an elected official to present the concern and
proposed resolution. The purpose of this current assignment is to identify the community-based healthcare
policy concern and provide an extensive evidenced-based foundation for proposing a policy change to an
elected official.
Course Outcomes
This assignment enables the student to meet the following course outcomes:
CO 1. Employ strategies to impact the development, implementation, and consequences of holistic focused healthcare policies at the institutional, local, national, and international levels using evidence-based practice principles. (PO 1)
CO 3. Demonstrate professional and personal growth regarding the advocacy role of the advance practice nurse in healthcare policy for diverse healthcare settings. (PO 3)
CO 5. Advocate for institutional, local, national, and international policies that influence person-centered healthcare, consumers, and nursing practice. (PO 5)
Due Date Sunday 11:59 p.m. MT at the end of Week 2
Total Points: 250 points
Requirements
Description of the Assignment
For this assignment, the student must first select a healthcare policy concern. The concern must be a community-based, public health policy concern. Student may not use healthcare entities or organizational concerns occurring within a private or public healthcare facility. Scholarly evidence supporting the concern must be presented that provides a comprehensive picture of the selected healthcare concern as well as the student-identified solution. The elected official whom the student will interview is also identified in this paper.
Criteria for Content
1. Overview of healthcare policy: This section introduces healthcare policy. It should contain the following elements:
· Define healthcare policy in general and its implications for the nursing profession
· Define the role of advocacy and how it can impact healthcare policy
· Explain how the role of advocacy is consistent with the responsibilities of an advance practice nurse
2. Identification of selected healthcare policy concern: This section provides foundational information regarding the student-selected healthcare policy concern. It should contain the following elements:
· Specifically identify the selected healthcare policy concern
· Description of .
This document summarizes a presentation on case management. It discusses that while there is no universal definition of case management, core components generally involve locating resources, coordinating services, and monitoring care to meet assessed needs. The key requisites of a case manager are experience, strong communication and problem-solving skills, and the ability to coordinate complex care packages. Effective case management provides an organized long-term care framework that aims to improve patient outcomes by streamlining services and reducing emergency admissions.
1) The document discusses agenda setting in the policy process and how clinical practice issues can be moved onto organizational agendas.
2) It provides required readings on stakeholder engagement, policy briefs, nursing advocacy, and research usefulness for policymaking.
3) Readers are asked to identify a clinical practice issue for their organization's agenda, stakeholders interested in the issue, and strategies to inform and persuade stakeholders of the issue's importance.
Please readRobert Geraci, Russia Minorities and Empire,” in .docxTatianaMajor22
Please read:
Robert Geraci, “Russia: Minorities and Empire,” in Abbott Gleason, ed., A Companion to Russian History (Oxford: Wiley-Blackwell, 2009), 243-260.
And discuss:
How does Geraci portray the legacy of the early Russian history for the make-up of 18-19th century Russia?
Please read: Leonard Victor Rutgers, “Roman Policy Towards the Jews: Expulsions from the City of Rome during the First Century C.E.,” in Classical Antiquity, Vol. 13, No. 1 (Apr., 1994), pp. 56-74.
And discuss: Rutgers surveys the different reasons historians have given for the expulsion of the Jews from Rome in the first century C.E. Who place did Jews have in Roman society at this time? Were they expelled because of their religious practices, or because they were ‘unruly’ as Rutgers argues? If so, what caused them to act in this way? What kind of historical evidence does the author use?
There are 2 essay, each one should write at least 300-350 words and plus one reference page.
MLA format. Must use quote( “ ”) for every source you use from website. And put (author, page number) behind quote.
Roman Policy towards the Jews: Expulsions from the City of Rome during the First Century
C.E.
Author(s): Leonard Victor Rutgers
Source: Classical Antiquity, Vol. 13, No. 1 (Apr., 1994), pp. 56-74
Published by: University of California Press
Stable URL: http://www.jstor.org/stable/25011005 .
Accessed: 26/08/2011 13:35
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .
http://www.jstor.org/page/info/about/policies/terms.jsp
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of scholarship. For more information about JSTOR, please contact [email protected]
University of California Press is collaborating with JSTOR to digitize, preserve and extend access to Classical
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LEONARD VICTOR RUTGERS
Roman Policy towards the Jews:
Expulsions from the City of Rome
during the First Century c. E.
Tant de causes secretes se melent souvent a la cause apparente, tant de ressorts
inconnus servent a persecuter un homme, qu'il est impossible de demeler dans les
siecles posterieures la source cachee des malheurs des hommes les plus consider
ables, a plus forte raison celle du supplice d'un particulier qui ne pouvait etre
connu que par ceux de son parti.
-Voltaire, Traite sur la tolerance (1763)
IN THIS ARTICLE I want to discuss the evidence for expulsions of Jews from
the city of Rome in the first century C.E. Scholars have long been interested in the
reasons underlying these expulsions. Because the anci.
Ford VS ChevroletThere are many reasons that make the Chevy.docxTatianaMajor22
Ford VS Chevrolet
There are many reasons that make the Chevy’s and Ford’s motors two most common trucks. Studies reveal that that they are the most popular vehicles on sales today. It is because they are powerful, versatile and reasonably priced. They also come in a wide variety of configurations and styles. However, many buyers and sellers have questioned themselves on the better vehicle compared to the other in terms of quality, Wi-Fi, price ranges, value, and costs. To compare and contrast on this subject, let us take an example of two vehicles each from each company to facilitate comparison.
Ford offers the full-size track with automatic high-beam control, automatic parallel parking and power-retractable running boards. Fords are elegant, and they are mostly aluminum making them save weight and bolster gas mileage. None of these features are offered Chevy’s. Chevrolets have outstanding quality. They are mostly comprised of steel, for instance, the Chevrolet Silverado. This makes them good for rough roads and difficult terrains.
Fords have employed the use of up to date Wi-Fi technology. Ford intends to provide the Ford Sync, which will provide robust connections for occupants. Latest Chevrolet brands Malibu utilize the 4G LTE Wi-Fi Technology that provides rich in-vehicle experiences. This technology is powerful compared to Ford Sync, and is used for connecting devices and executing few remote operations within the car.
From the value and cost standpoint, Ford can consume a little more, and its payload capacity is a little higher. Additionally, its mileage is too better. The prices vary from nation to nation. Chevrolet seems to be a little cheaper, and reasonably priced going for $33,044, which is slightly less than Ford, but the differences are not serious to propel buyers towards one truck leaving the other
Technophiles are likely to put their preferences on Ford to Chevrolet. On overall, Fords have many features as compared Chevy’s. However, they may be hard to maintain. Compared to Fords, Chevrolets are reliable and cheaper. However, the two brands are equally good performers. It is, therefore, prudent to pick what one thinks would fit his or her usage and preference and personal style
Ethical Systems, Research Paper, Spring 2015, Douglas Green, Page 1 of 1
Ethical
Systems/Final
Research
Paper
2,000
words
minimum,
double-‐spaced
Final
Draft
Due:
Tuesday,
April
28,
12:00
pm
(afternoon)
Please
email
your
final
research
paper
to
me
via
MS
Word
attachment
AND
by
cutting/pasting
the
entire
document
into
the
body
of
your
email.
IF
YOU
DO
NOT
RECEIVE
A
CONFIRMATION
EMAIL
BACK,
I
DID
NOT
RECEIVE
YOUR
ESSAY
AND
YOU
WILL
LOSE
ALL
CREDIT
FOR
THIS
REQUIREMENT.
NO
LATE
WORK
WILL
BE
ACCEPTED…
PERIOD!
.
More Related Content
Similar to InstructionsPart 8 Stakeholder Engagement Monitor and Control P
1
2
Women Veterans Mental Healthcare during Pregnancy
Student Name
Student Affiliation (For Example, Department + Institute Name)
Course Name and Number
Instructor Name
Date
Women Veterans Mental Healthcare during Pregnancy
Pregnancy in women veterans is often associated with anxiety, depression, and other stress disorders. The incidence of these diseases is high in women veterans due to significant endeavors during military services (Creech et al., 2019). The implementation plan for pregnant veterans includes providing financial aids and sufficient resources to improve their mental health during pregnancy. The proposed change plan comprises certain strategic interventions to reduce the ongoing incidence of mental health problems during pregnancy in women veterans.
Distinguish organizational strategies needed to implement and maintain the change plan.
The proposed change plan comprises certain modifications in the management of pregnant veterans by providing them with adequate funds, quick medical access, and paid pregnancy leaves. Similarly, the organization should pay attention to the fault lines of the already implemented plan. To maintain the change, there should be active leadership that prioritizes the success and sustenance of the change plan. The other strategy that can make the implementation plan easy and productive is empowering women veterans through effective communication and negotiation. This strategy will ultimately help to reduce the mental stress and grievances of pregnant veterans. Hence, the change plan can categorically operate.
Identify the stakeholders needed to support the implementation of the proposed plan.
The major stakeholders are healthcare professionals such as doctors, nurses, allied health professionals, paramedical staff, and pregnant veterans as a patient of prime focus for this change plan. Additionally, hospital management and leadership also play a significant role in implementing the proposed change plan (Nillni et al., 2021). Similarly, there are certain private investors and NGOs that work for the mandate of the organization and patient care. Insurance companies are also one of the key stakeholders of the implementation plan. Similarly, pharmaceutical firms and government subsidies are also supportive elements for the implementation plan. All these stakeholders will provide affordable health care costs and quality medical care for pregnant veterans.
Explain how these stakeholders are vital to implementing the change plan.
Doctors and nurses are the first-line workers to assist the patient and provide the baseline for effective implementation. Efficient staff will introduce interventions that will improve the mental health of the veterans. Similarly, the insurance companies and other private investors directly fund the patient and hospital management to increase the plan's efficacy. This strategy will ensure the safe delivery and life of the child and mother (Nillni et al., 2021 ...
1
2
Women Veterans Mental Healthcare during Pregnancy
Student Name
Student Affiliation (For Example, Department + Institute Name)
Course Name and Number
Instructor Name
Date
Women Veterans Mental Healthcare during Pregnancy
Pregnancy in women veterans is often associated with anxiety, depression, and other stress disorders. The incidence of these diseases is high in women veterans due to significant endeavors during military services (Creech et al., 2019). The implementation plan for pregnant veterans includes providing financial aids and sufficient resources to improve their mental health during pregnancy. The proposed change plan comprises certain strategic interventions to reduce the ongoing incidence of mental health problems during pregnancy in women veterans.
Distinguish organizational strategies needed to implement and maintain the change plan.
The proposed change plan comprises certain modifications in the management of pregnant veterans by providing them with adequate funds, quick medical access, and paid pregnancy leaves. Similarly, the organization should pay attention to the fault lines of the already implemented plan. To maintain the change, there should be active leadership that prioritizes the success and sustenance of the change plan. The other strategy that can make the implementation plan easy and productive is empowering women veterans through effective communication and negotiation. This strategy will ultimately help to reduce the mental stress and grievances of pregnant veterans. Hence, the change plan can categorically operate.
Identify the stakeholders needed to support the implementation of the proposed plan.
The major stakeholders are healthcare professionals such as doctors, nurses, allied health professionals, paramedical staff, and pregnant veterans as a patient of prime focus for this change plan. Additionally, hospital management and leadership also play a significant role in implementing the proposed change plan (Nillni et al., 2021). Similarly, there are certain private investors and NGOs that work for the mandate of the organization and patient care. Insurance companies are also one of the key stakeholders of the implementation plan. Similarly, pharmaceutical firms and government subsidies are also supportive elements for the implementation plan. All these stakeholders will provide affordable health care costs and quality medical care for pregnant veterans.
Explain how these stakeholders are vital to implementing the change plan.
Doctors and nurses are the first-line workers to assist the patient and provide the baseline for effective implementation. Efficient staff will introduce interventions that will improve the mental health of the veterans. Similarly, the insurance companies and other private investors directly fund the patient and hospital management to increase the plan's efficacy. This strategy will ensure the safe delivery and life of the child and mother (Nillni et al., 2021 ...
This document provides guidance for nurses on developing a policy brief to advocate for one of the recommendations from the Institute of Medicine's 2010 report "The Future of Nursing: Leading Change, Advancing Health." It outlines the components that should be included in a 2-3 page single-spaced policy brief, such as a short introduction stating the problem, the selected recommendation, background on the issue, current solutions and status, and a conclusion. Nurses are encouraged to write policy briefs to communicate health policy issues clearly to decision makers and advocate for changes that can improve health outcomes.
QUESTION 1What are the main streams of influence, according to.docxmakdul
QUESTION 1
What are the main streams of influence, according to the Theory of Triadic Influence? Please provide examples factors/attributes that belong to each of those streams. What is the relationship/correlation between each of those streams?
Your response should be at least 200 words in length.
QUESTION 2
The PRECEDE-PROCEED approach has several key assessment/diagnosis phases. Please describe the epidemiological assessment. What are some key sources of data used in this assessment? Which main questions is this assessment is trying to address/answer?
Your response should be at least 200 words in length.
QUESTION 3
What specific questions the evaluators are bringing forward as they are trying to collect the necessary evaluation data? What are the three main types of evaluation discussed in the PRECEDE-PROCEED approach? What is each of them trying to identify, measure, evaluate?
Your response should be at least 200 words in length.
QUESTION 4
What are some of the key assumptions behind the PRECEDE-PROCEED approach? What are some of the key benefits of using this approach? What are some of the “real-life” examples of using this approach?
Your response should be at least 200 words in length.
Unit Lesson Study Guide
In Unit 4, we will continue to discuss health behavior and its association with factors that could influence such behaviors. These types of influences are referred to as multilevel factors of behaviors, and they typically fall into five main categories:
1. individual factors,
2. inter-personal factors,
3. organizational factors,
4. community factors, and
5. policy factors
Consider the following scenario:
A 50-year-old man may purposely postpone getting a prostate cancer test because he is scared of finding out that he may have prostate cancer. This is an example of an individual- level factor. However, we need to look into this further and consider the following: his inaction might also be influenced by his primary physician’s failure to actually recommend and insist that he would need to take the prostate test. Another factor might be the difficulty of scheduling an appointment due to either unavailable equipment or the unavailability of staff at his local clinic. Another limiting factor could be that the fee for the exam is so high he cannot afford it, and his insurance does not cover this type of procedure. Thus, all these interpersonal, organizational, and policy factors are influencing this man’s behavior to not complete the prostate test. Therefore, for health promotion practitioners, it is very important to be aware of all these factors so effective change strategies or interventions can be prescribed.
One of the multilevel theories that will be discussed is the Theory of Triadic Influence (TTI). TTI behaviors arise due to one’s current social situation, general cultural environment, and their personal characteristics. Any health-related behaviors are influenced by an individual’s decisions.
What wo ...
HCM 3305, Community Health 1 Course Learning Outcom.docxaryan532920
This document discusses systems thinking and community health programming. It provides an overview of the steps to plan, implement, and evaluate community health programs. The key steps include assessing needs, setting goals and objectives, developing interventions, implementation, and evaluation. Evaluation is important to determine a program's effectiveness and identify areas for improvement. Systems thinking is also discussed as an alternative evaluation approach.
Name olubunmi salako date 1262021identification of scenariojack60216
This document provides an annotated bibliography by Olubunmi Salako for a leadership and management in nursing course. It summarizes four sources that discuss various aspects of patient education, nursing standards, and healthcare policy. The sources examine how competency-based nursing curriculum and educational interventions can improve compliance with nursing standards. They also discuss how health policies and addressing social determinants can help reduce public health problems and disparities. The annotations provide details on the authors and relevance of each source to topics like patient education, nursing practice standards, and using policy to influence health outcomes.
This document discusses eHealth strategies and the benefits they provide to patients, healthcare providers, and health systems. It analyzes the key stakeholders in large-scale eHealth projects, including primary/secondary healthcare centers, health insurances, hospitals, pharmacies, and nursing homes. Large eHealth projects involve many institutions that each have their own goals and agendas. Successful projects require identifying these stakeholders, describing the system benefits for each, and finding solutions that balance their various requirements through transparency and discussion.
PAGE
20
Dissertation Prospectus
Factors Influencing Individuals' Decision to Utilize Mental Health in South Texas
Submitted by:
The Prospectus Overview and Instructions
Prospectus Instructions:
1. Read the entire Prospectus Template to understand the requirements for writing your prospectus. Each section contains a narrative overview of what should be included in the section and a table with required criteria for each section. WRITE TO THE CRITERIA, as they will be used to assess the prospectus for overall quality and feasibility of your proposed research study.
2. As you draft each section, delete the narrative instructions and insert your work related to that section. Use the criterion table for each section to ensure that you address the requirements for that particular section. Do not delete/remove the criterion table as this is used by you and your committee to evaluate your prospectus.
3. Prior to submitting your prospectus for review by your chair or methodologist, use the criteria table for each section to complete a realistic self-evaluation, inserting what you believe is your score for each listed criterion into the Learner Self-Evaluation column. This is an exercise in self-evaluation and critical reflection, and to ensure that you completed all sections, addressing all required criteria for that section.
4. The scoring for the criteria ranges from a 0-3 as defined below. Complete a realistic and thoughtful evaluation of your work. Your chair and methodologist will also use the criterion tables to evaluate your work.
5. Your Prospectus should be no longer than 6-10 pages when the tables are deleted.
0
Item Not Present
1
Item is Present. Does Not Meet Expectations. Revisions are Required: Not all components are present. Large gaps are present in the components that leave the reader with significant questions. All items scored at 1 must be addressed by learner per reviewer comments.
2
Item is Acceptable. Meets Expectations.Some Revisions May Be Required Now or in the Future. Component is present and adequate. Small gaps are present that leave the reader with questions. Any item scored at 2 must be addressed by the learner per the reviewer comments.
3
Item Exceeds Expectations. No Revisions Required. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. No changes required.
Dissertation Prospectus
Introduction
Southern Texas encompasses different groups of people whose behavior, gender identity, and gender expression varies depending on cultural identity and norms. About a quarter of individuals in United States have a history or are experiencing a mental disorder with approximately 6% of the population having critical mental illness. These mental problems typically affect the general well-being of an individual. For instance, patients living with severe mental disorders are more likely to die in average of twenty-six years earlier than the average life expectanc ...
This document provides instructions for an assignment analyzing a pertinent healthcare issue. Students are asked to select a national healthcare issue/stressor, review research addressing change strategies by healthcare organizations, and write a 3-4 page white paper to organizational leadership about the issue. The paper should describe the issue's impact, summarize strategies from research, and explain how strategies could impact the organization positively and negatively.
H. E. R. O - Helping through Encouragement and ReachJeanmarieColbert3
H. E. R. O - Helping through Encouragement and Reaching Out
Selena Lama
Doriyan Darden
Kabita Budhathoki
Kusim Syangbo
Radhika Chhetri
Yesenia Binkley
Texas A&M University - Commerce
2. Table of Contents (1 page)
3. Executive Summary (1 page)
4. Program Rationale (4-6 pages)
5. Program Planning Documentation (2-4 Pages)
Program Planning Documentation
Suicide prevention in middle-aged male veterans teams uses PROCEDE-PROCEED for program H.E.R.O. There are several reasons we choose to use this planning model. (1) It is hypothetically base and combines a series of phases in the planning, implementation, and evaluation to acquire the quality of life to the target population; (2) “It is the most widely known model in program planning” (Green & Kreuter, 2005); (3) This planning model starts with consequences and determines its cause; once the cause is known, an intervention will design to reach the desired outcomes; (4) “PRECEDE is helping to predisposing, reinforcing, and enabling constructs in education; PROCEED helps in policymaking, controlling and structural constructs in educational development” (Green & Kreuter, 2005, p. 9).
"In phase 1 is called the social assessment, the model seeks to state the quality of life of the target population to know problems and priorities of those population so that team can identify the desired outcomes" (Green & Kreuter, 2005). It analyzes the situation and allows the employee and employer the assessing the needs for achieving the quality of life. In phase 2, epidemiological assessment, we use data to determine the risk factors or causes of health in the population's genetics, behavioral patterns, and environment and rank the health goals and problems identified in phase 1. we use this phase to plan the health program. Phase 3, educational and ecological assessment, helps identify and classify the many factors into three categories: predisposing, reinforcing, and enabling. These three categories help provide social benefits such as appreciation, relief of discomfort or pain, or tangible rewards like avoidance of cost to get quality of life in the target population in the H.E.R.O program. In phase 4, the intervention alignment, we aim to compare the strategies and interventions from the previous phase and bring needed changes to the policies. Administrative and policy assessment helps determine what resources are available to carry out the health promotion intervention, what time the invention can conduct, there are financial resources to buy needed stuff for an employee or not, what organization and administration will support the H.E.R.O program. After identifying the intervention, we determine the availability of program resources; in phase 5, we begin the implementation, and in Phase 6,7 and 8, we evaluate the program's composition based on the objectives that we create during the assessment phase (Green & Kreuter, 2005). We focus on the availability of educational components for the employe ...
This document provides instructions for writing a dissertation prospectus. It outlines 5 requirements for the prospectus, including reading the entire template, writing each section to address criteria in a table, using the criteria table for self-evaluation, and keeping the prospectus between 6-10 pages. It then provides a sample prospectus section on the theoretical foundations/conceptual framework and review of literature/themes. This section reviews literature identifying themes around lack of mental health education/infrastructure, lack of medical insurance, and poor community perceptions as factors affecting utilization of mental health services in South Texas. It proposes using Albert Bandura's social cognitive theory as the theoretical model.
Chapter 12 IT Alignment and Strategic Planning Learning ObjectivesEstelaJeffery653
The document discusses software architectural design and detailed design. It covers architectural styles like pipes and filters, event-driven, client-server, model-view-controller, layered, database-centric, and three-tier. It also discusses architectural tactics, reference architectures, functional decomposition, relational database design, object-oriented design, user interface design, and other topics like the model-view-controller pattern. The goal is to understand different approaches to structuring software solutions at both the architectural and detailed levels of design.
Agenda SettingA key aspect of the policy process is agendacheryllwashburn
This document outlines an assignment for students to analyze agenda setting in the policy process. It instructs students to identify a clinical practice issue for their organization's agenda, consider relevant stakeholders, and write a 550-word post discussing strategies to inform and persuade stakeholders of the issue's importance. The post must reference at least 3 required readings that discuss stakeholder analysis, policy briefs, examples of nursing advocacy, and the role of research in policymaking.
You will summarize the possible impact of the DHHS’ policy in a di.docxrosemarybdodson23141
You will summarize the possible impact of the DHHS’ policy in a discussion board post. Make sure to list the data required to monitor outcomes of policies within the Health Care. You must also respond to 2 of your peers' posts and make sure to reference any outside sources you may have used in your assignment post
Navigate 2 Scenario for Health Policy
Episode 4: Evaluating a Health Care Policy
Overview
In this Navigate 2 Scenario, you are responsible for examining the DHHS’ evaluation of the policy and how it may impact the Health Care System. You will then work with a team to determine the best way to monitor the implementation of policy within the
Health Care
System and report it to the DHHS. Specifically, how they:
Monitor and report medical errors to the Department of Health and Human
Use root cause analysis on a certain percentage of
Track and report patient outcomes focused on the clinical problems identified in the
National Health Care
Quality Report (
http://www.ahrq.gov/qual/qrdr10.htm (Links to an external site.)
).
Integrate the 5 health care profession core competencies into staff education and track
Establish a no-blame
Assignment
You will summarize the possible impact of the DHHS’ policy in a discussion board post. Make sure to list the data required to monitor outcomes of policies within the Health Care. You must also respond to 2 of your peers' posts and make sure to reference any outside sources you may have used in your assignment post.
Learning Objectives for this LearnScapes scenario
Analyze how such various applications of the law affect decisions in the development and operation of a health care
Use technology and information resources to research issues in health care policy, law, and ethics.
LearnScape 4 Characters
Timothy Kohl, Staff member at DHHS
Timothy is in his mid-50s, and has been with DHHS for more than 20 years. His main focus is health policy. Timothy consults with staff in various departments and agencies to work out how health care law should be written and then implemented. He will work extensively with the student to determine what data is needed to stay in compliance.
Tiffany Halpert, Chief of Medical Staff of Bright Road Health Care System
Tiffany is a physician in her early 40’s. She is bright, funny, and very direct. Her current responsibilities include care management and organizational performance for the Health Care System including medical management, care coordination, case management and management engineering. She is an internist, just beginning her term as Chief of Medical staff.
Ken Bloom, Chief Nursing Officer of Bright Road Health Care System
Ken is in his mid-40s, and has held various positions of nursing departments in both small and large medical facilities. At Bright Road, he began his career in an urgent care facility, where he saw a lot of elderly patients. He had a natural inclination for assisting elderly patients, so he shifted his focus to geriatri.
National Institute of Health: Theory at a Glance, A Guide for Health Promotio...Zach Lukasiewicz
Introduction viii
Audience and Purpose 1
Contents 1
Part 1: Foundations of Theory in Health Promotion and Health Behavior 3
Why Is Theory Important to Health Promotion and Health Behavior Practice? 4
What Is Theory? 4
How Can Theory Help Plan Effective Programs? 4
Explanatory Theory and Change Theory 5
Fitting Theory to the Field of Practice 5
Using Theory to Address Health Issues in Diverse Populations 7
Part 2: Theories and Applications 9
The Ecological Perspective: A Multilevel, Interactive Approach 10
Theoretical Explanations of Three Levels of Influence 12
Individual or Intrapersonal Level 12
Health Belief Model 13
Stages of Change Model 15
Theory of Planned Behavior 16
Precaution Adoption Process Model 18
Interpersonal Level 19
Social Cognitive Theory 19
Community Level 22
Community Organization and Other Participatory Models 23
Diffusion of Innovations 27
Communication Theory 29
Media Effects 30
Agenda Setting 30
New Communication Technologies 31
The Quadruple Aim provides broad categories of goals to pursue to ma.docxhelen23456789
The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.
Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time.
In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected.
To Prepare:
Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.
Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected.
Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.
The Assignment (3-4 Pages):
Analysis of a Pertinent Healthcare Issue
Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:
Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.
Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain ho.
11Week Two Assignment Identification of Healthcare Policy Conc.docxdrennanmicah
11
Week Two Assignment: Identification of Healthcare Policy Concern Guidelines and Grading Rubric
Purpose
In this course, the students will have the opportunity to identify a healthcare policy concern and community
healthcare concern which can be improved with a change in policy, ordinance or the language in existing
law. The outcome would be the potential for improved health for a population group. Students will present
a proposed solution or change to an elected official, and provide an analysis of the project. While students
are not responsible for ensuring the implementation of their identified solution to the healthcare policy
concern, the student is required to meet with an elected official to present the concern and
proposed resolution. The purpose of this current assignment is to identify the community-based healthcare
policy concern and provide an extensive evidenced-based foundation for proposing a policy change to an
elected official.
Course Outcomes
This assignment enables the student to meet the following course outcomes:
CO 1. Employ strategies to impact the development, implementation, and consequences of holistic focused healthcare policies at the institutional, local, national, and international levels using evidence-based practice principles. (PO 1)
CO 3. Demonstrate professional and personal growth regarding the advocacy role of the advance practice nurse in healthcare policy for diverse healthcare settings. (PO 3)
CO 5. Advocate for institutional, local, national, and international policies that influence person-centered healthcare, consumers, and nursing practice. (PO 5)
Due Date Sunday 11:59 p.m. MT at the end of Week 2
Total Points: 250 points
Requirements
Description of the Assignment
For this assignment, the student must first select a healthcare policy concern. The concern must be a community-based, public health policy concern. Student may not use healthcare entities or organizational concerns occurring within a private or public healthcare facility. Scholarly evidence supporting the concern must be presented that provides a comprehensive picture of the selected healthcare concern as well as the student-identified solution. The elected official whom the student will interview is also identified in this paper.
Criteria for Content
1. Overview of healthcare policy: This section introduces healthcare policy. It should contain the following elements:
· Define healthcare policy in general and its implications for the nursing profession
· Define the role of advocacy and how it can impact healthcare policy
· Explain how the role of advocacy is consistent with the responsibilities of an advance practice nurse
2. Identification of selected healthcare policy concern: This section provides foundational information regarding the student-selected healthcare policy concern. It should contain the following elements:
· Specifically identify the selected healthcare policy concern
· Description of .
This document summarizes a presentation on case management. It discusses that while there is no universal definition of case management, core components generally involve locating resources, coordinating services, and monitoring care to meet assessed needs. The key requisites of a case manager are experience, strong communication and problem-solving skills, and the ability to coordinate complex care packages. Effective case management provides an organized long-term care framework that aims to improve patient outcomes by streamlining services and reducing emergency admissions.
1) The document discusses agenda setting in the policy process and how clinical practice issues can be moved onto organizational agendas.
2) It provides required readings on stakeholder engagement, policy briefs, nursing advocacy, and research usefulness for policymaking.
3) Readers are asked to identify a clinical practice issue for their organization's agenda, stakeholders interested in the issue, and strategies to inform and persuade stakeholders of the issue's importance.
Similar to InstructionsPart 8 Stakeholder Engagement Monitor and Control P (20)
Please readRobert Geraci, Russia Minorities and Empire,” in .docxTatianaMajor22
Please read:
Robert Geraci, “Russia: Minorities and Empire,” in Abbott Gleason, ed., A Companion to Russian History (Oxford: Wiley-Blackwell, 2009), 243-260.
And discuss:
How does Geraci portray the legacy of the early Russian history for the make-up of 18-19th century Russia?
Please read: Leonard Victor Rutgers, “Roman Policy Towards the Jews: Expulsions from the City of Rome during the First Century C.E.,” in Classical Antiquity, Vol. 13, No. 1 (Apr., 1994), pp. 56-74.
And discuss: Rutgers surveys the different reasons historians have given for the expulsion of the Jews from Rome in the first century C.E. Who place did Jews have in Roman society at this time? Were they expelled because of their religious practices, or because they were ‘unruly’ as Rutgers argues? If so, what caused them to act in this way? What kind of historical evidence does the author use?
There are 2 essay, each one should write at least 300-350 words and plus one reference page.
MLA format. Must use quote( “ ”) for every source you use from website. And put (author, page number) behind quote.
Roman Policy towards the Jews: Expulsions from the City of Rome during the First Century
C.E.
Author(s): Leonard Victor Rutgers
Source: Classical Antiquity, Vol. 13, No. 1 (Apr., 1994), pp. 56-74
Published by: University of California Press
Stable URL: http://www.jstor.org/stable/25011005 .
Accessed: 26/08/2011 13:35
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .
http://www.jstor.org/page/info/about/policies/terms.jsp
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content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms
of scholarship. For more information about JSTOR, please contact [email protected]
University of California Press is collaborating with JSTOR to digitize, preserve and extend access to Classical
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LEONARD VICTOR RUTGERS
Roman Policy towards the Jews:
Expulsions from the City of Rome
during the First Century c. E.
Tant de causes secretes se melent souvent a la cause apparente, tant de ressorts
inconnus servent a persecuter un homme, qu'il est impossible de demeler dans les
siecles posterieures la source cachee des malheurs des hommes les plus consider
ables, a plus forte raison celle du supplice d'un particulier qui ne pouvait etre
connu que par ceux de son parti.
-Voltaire, Traite sur la tolerance (1763)
IN THIS ARTICLE I want to discuss the evidence for expulsions of Jews from
the city of Rome in the first century C.E. Scholars have long been interested in the
reasons underlying these expulsions. Because the anci.
Ford VS ChevroletThere are many reasons that make the Chevy.docxTatianaMajor22
Ford VS Chevrolet
There are many reasons that make the Chevy’s and Ford’s motors two most common trucks. Studies reveal that that they are the most popular vehicles on sales today. It is because they are powerful, versatile and reasonably priced. They also come in a wide variety of configurations and styles. However, many buyers and sellers have questioned themselves on the better vehicle compared to the other in terms of quality, Wi-Fi, price ranges, value, and costs. To compare and contrast on this subject, let us take an example of two vehicles each from each company to facilitate comparison.
Ford offers the full-size track with automatic high-beam control, automatic parallel parking and power-retractable running boards. Fords are elegant, and they are mostly aluminum making them save weight and bolster gas mileage. None of these features are offered Chevy’s. Chevrolets have outstanding quality. They are mostly comprised of steel, for instance, the Chevrolet Silverado. This makes them good for rough roads and difficult terrains.
Fords have employed the use of up to date Wi-Fi technology. Ford intends to provide the Ford Sync, which will provide robust connections for occupants. Latest Chevrolet brands Malibu utilize the 4G LTE Wi-Fi Technology that provides rich in-vehicle experiences. This technology is powerful compared to Ford Sync, and is used for connecting devices and executing few remote operations within the car.
From the value and cost standpoint, Ford can consume a little more, and its payload capacity is a little higher. Additionally, its mileage is too better. The prices vary from nation to nation. Chevrolet seems to be a little cheaper, and reasonably priced going for $33,044, which is slightly less than Ford, but the differences are not serious to propel buyers towards one truck leaving the other
Technophiles are likely to put their preferences on Ford to Chevrolet. On overall, Fords have many features as compared Chevy’s. However, they may be hard to maintain. Compared to Fords, Chevrolets are reliable and cheaper. However, the two brands are equally good performers. It is, therefore, prudent to pick what one thinks would fit his or her usage and preference and personal style
Ethical Systems, Research Paper, Spring 2015, Douglas Green, Page 1 of 1
Ethical
Systems/Final
Research
Paper
2,000
words
minimum,
double-‐spaced
Final
Draft
Due:
Tuesday,
April
28,
12:00
pm
(afternoon)
Please
email
your
final
research
paper
to
me
via
MS
Word
attachment
AND
by
cutting/pasting
the
entire
document
into
the
body
of
your
email.
IF
YOU
DO
NOT
RECEIVE
A
CONFIRMATION
EMAIL
BACK,
I
DID
NOT
RECEIVE
YOUR
ESSAY
AND
YOU
WILL
LOSE
ALL
CREDIT
FOR
THIS
REQUIREMENT.
NO
LATE
WORK
WILL
BE
ACCEPTED…
PERIOD!
.
Fairness and Discipline Weve all been disciplined at one.docxTatianaMajor22
Fairness and Discipline
We've all been disciplined at one time or another by a parent or a teacher. What disciplinary experiences have you had as a child that took a non-punitive approach?
I need paragraph or half page with reference
.
Appendix 12A Statement of Cash Flows—Direct MethodLEARNING .docxTatianaMajor22
Appendix 12A
Statement of Cash Flows—Direct Method
LEARNING OBJECTIVE
6
Prepare a statement of cash flows using the direct method.
To explain and illustrate the direct method, we will use the transactions of Computer Services Company for 2014, to prepare a statement of cash flows. Illustration 12A-1 presents information related to 2014 for Computer Services Company.
To prepare a statement of cash flows under the direct approach, we will apply the three steps outlined in Illustration 12-4.
Illustration 12A-1
Comparative balance sheets, income statement, and additional information for Computer Services Company
STEP 1: OPERATING ACTIVITIES
DETERMINE NET CASH PROVIDED/USED BY OPERATING ACTIVITIES BY CONVERTING NET INCOME FROM AN ACCRUAL BASIS TO A CASH BASIS
Under the direct method, companies compute net cash provided by operating activities by adjusting each item in the income statement from the accrual basis to the cash basis. To simplify and condense the operating activities section, companies report only major classes of operating cash receipts and cash payments. For these major classes, the difference between cash receipts and cash payments is the net cash provided by operating activities. These relationships are as shown in Illustration 12A-2.
Illustration 12A-2
Major classes of cash receipts and payments
An efficient way to apply the direct method is to analyze the items reported in the income statement in the order in which they are listed. We then determine cash receipts and cash payments related to these revenues and expenses. The following pages present the adjustments required to prepare a statement of cash flows for Computer Services Company using the direct approach.
CASH RECEIPTS FROM CUSTOMERS.
The income statement for Computer Services Company reported sales revenue from customers of $507,000. How much of that was cash receipts? To answer that, companies need to consider the change in accounts receivable during the year. When accounts receivable increase during the year, revenues on an accrual basis are higher than cash receipts from customers. Operations led to revenues, but not all of these revenues resulted in cash receipts.
To determine the amount of cash receipts, the company deducts from sales revenue the increase in accounts receivable. On the other hand, there may be a decrease in accounts receivable. That would occur if cash receipts from customers exceeded sales revenue. In that case, the company adds to sales revenue the decrease in accounts receivable. For Computer Services Company, accounts receivable decreased $10,000. Thus, cash receipts from customers were $517,000, computed as shown in Illustration 12A-3.
Illustration 12A-3
Computation of cash receipts from customers
Computer Services can also determine cash receipts from customers from an analysis of the Accounts Receivable account, as shown in Illustration 12A-4.
Illustration 12A-4
Analysis of Accounts Receivable
Illustration.
Effects of StressProvide a 1-page description of a stressful .docxTatianaMajor22
Effects of Stress
Provide a 1-page description of a stressful event currently occurring in your life.
Discuss I am married work a full time job as an occupational therapy assistant am taking two courses
Have to take care of a home feed the animals attend to laundry
Think of my pateitns worry about their well being and what I can do for them ( I bring home my patients issues)
Constantly doing paper work for work such as documentation for billing
I feel like I have no free time for me some days I don’t even eat dinner or lunch because I don’t have time to make anything or am just too tired to cook
On top of this I am married and married ppl do argue and my husband am I have been bunting heads on finances.
Then, referring to information you learned throughout this course, address the following:
· What physiological changes occur in the brain due to the stress response?
· What emotional and cognitive effects might occur due to this stressful situation?
· Would the above changes (physiological, cognitive, or emotional) be any different if the same stress were being experienced by a person of the opposite sex or someone much older or younger than you?
· If the situation continues, how might your physical health be affected?
· What three behavioral strategies would you implement to reduce the effects of this stressor? Describe each strategy. Explain how each behavior could cause changes in brain physiology (e.g., exercise can raise serotonin levels).
· If you were encouraging an adult client to make the above changes, what ethical considerations would you have to keep in mind? How would you address those ethical considerations?
In addition to citing the online course and the text, you are also required to cite a minimum of four scholarly sources. For reputable web sources, look for .gov or .edu sites as opposed to .com sites. Please do not use Wikipedia.
Your paper should be double-spaced, in 12-point Times New Roman font, and with normal 1-inch margins; written in APA style; and free of typographical and grammatical errors. It should include a title page with a running head, an abstract, and a reference page.
The body of the paper should be at least 6 pages in length total
not including the reference or title page
Assignment 1 Grading Criteria
Maximum Points
Described a stressful event.
20
Explained the physiological changes that occur in the brain due to the stress response.
36
Explained the emotional and cognitive effects that may occur due to this stressful situation.
32
Analyzed potential differences in physiological, cognitive, and emotional responses in someone of a different age or sex.
32
Discussed the physical health risks.
28
Provided three behavioral strategies to reduce the effects of the stressor and explained how each could cause changes in brain physiology.
40
Analyzed ethical considerations in implementing behavioral strategies and offered suggestions for addressing these.
40
Integrated at least two scholarly references .
Design Factors NotesCIO’s Office 5 People IT Chief’s Offi.docxTatianaMajor22
Design Factors
Notes
CIO’s Office
5 People
IT Chief’s Office
5 People
LAN/WAN Maint.
20 People
Reception
4 People
Telecommunications
20 People
LAN Management
50 People
Server Room A
2 Person
Server Room B
4 Person
Equipment:
Patch Cable
Computer to Wall
Patch Cable
LAN Room
Cable Trays/Runs
Horizontal Runs
Cisco Border Router
Research: Attached to 5 Floor Switches
Server Room A
10 Servers
Server Room B
10 Servers
Computers
One Per Person
Standard floor (first floor) Lesson 2 Project Plan info
Design Factors
Notes
CIO’s Office
5 People
IT Chief’s Office
5 People
LAN/WAN Maint.
20 People
Reception
4 People
Telecommunications
20 People
LAN Management
50 People
Server Room A
2 Person
Server Room B
4 Person
Equipment:
Patch Cable
Computer to Wall
Patch Cable
LAN Room
Cable Trays/Runs
Horizontal Runs
Cisco Border Router
Research: Attached to 5 Floor Switches
Server Room A
10 Servers
Server Room B
10 Servers
Computers
One Per Person
Basement floor
Design Factors
Notes
Vertical Riser Run
On Outside Wall of LAN Room on Each Floor.
Fiber-Optic Multimode
Riser Runs: Backbone
SC Connectors
Fiber-Optic Cable
Cisco Catalyst: Switch: WS-C3750G-24PS-S: 24 Ports
Leave a Minimum of four ports free on each switch
Color Laser Printer
Minimum of One per Room or One per 20 people
Vertical Riser Run
On Outside Wall of LAN Room on Each Floor and Server RM B on this floor.
Fiber-Optic Multimode
Riser Runs: Backbone
SC Connectors
Fiber-Optic Cable
Cable Trays/Runs
Horizontal Runs
Horizontal Runs
Leave a Minimum of four ports free on each switch
Applicataion
U.S. Minimum Requirement Ranges
Space per Employee - 1997
Two people, such as a supervisor and an employee, can meet in an office with a table or desk between them
60" to 72" x 90" to 126:/5.78m2 to 11.7m2
280Sq. Ft./26.0m2
Worker has a primary desk plus a return
60" to 72"x60"to 84"/5.78 to 7.8m2
193Sq. Ft./17.9m2
Executive office - three to four people can meet around a desk
105 to 130"x96 to 123"/9.75 to 11.4 m2
142Sq. Ft./13.2m2
Basic workstation such as a call center
42" to 52" x 60" to 72"/3.9 to 6.7 m2
114Sq. Ft./10.6 m2
NT1310: Project
Page 1
PRO JECT D ESC RIPT ION
As the project manager for the Cable Planning team, you will manage the creation of the cable plan for
the new building that will be built, with construction set to begin in six weeks.
The deliverables for the entire Cable Plan will consist of an Executive Summary, a PowerPoint
Presentation and an Excel Spreadsheet. You will develop different parts of each of these in three parts.
The final organization should contain these elements:
The Executive Summary:
o Project Introduction
o Standards and Codes
Cable Standards and Codes
Building Standards and Codes
o Project Materials
o Copper Cable, Tools, and Test Equipment
o Fiber-Optic Cable, Tools, and Test Equipment
o Fiber-Optic Design Considerations
o Basement Server Comp.
Question 12.5 pointsSaveThe OSU studies concluded that le.docxTatianaMajor22
The document contains questions about leadership, motivation, communication, groups/teams, and decision making. The questions assess knowledge of topics like situational leadership theory, Maslow's hierarchy of needs, organizational communication barriers, stages of team development, and group decision making techniques like brainstorming.
Case Study 1 Questions1. What is the allocated budget .docxTatianaMajor22
Case Study 1 Questions:
1. What is the allocated budget ? $250,000
2. Where does the server room located? Currently, there is no server room
3. What is the number of users with PCs inside each existing site?
Currently there are
4. What is the current cabling used in each location? (cat5e or cat6) Current cabling does not meet the company’s current and future needs
5. Do want us to upgrade token Ring or use a completely new Ethernet network What is your recommendation and why?
6. regarding the ordering system , it is not clear what the we should do , do you want to talk about how to connect the system to the network or how to built the ordering online system because it is more software engineering than networking . Talk about the kind of network (hardware) you recommend based on the business requirements
7. all the sites should have access to our servers in the main branch? yes
8. Regarding the order software, do you need more details about the way it works or just about its connection with the network? Your solution should be from a network point of view
9. Distances are given in Meters or feet? feet
10. Shipment is done by truck, or ships? Currently, only trucking
11. In Dimebox branch, where are administration offices located? See Business goals # 4
12. What is the current network connectivity status? How many devices are currently on the network? How they are physically laid out? Is cabling running all over the floor, hidden in walls or threaded through the ceiling? What are the switches used and its speed? Currently, only the office is networked (token ring) NOVELL
13. What is the minimum Internet speed wanted? See Business Goals on page 2 – I only can tell you what we need the network for, you must tell me what we need to meet the business needs
14. Will the corporation provide wireless access? If yes will it be in all department and buildings? Wireless access would be helpful if we can justify the cost
15. Are there phones in offices? yes
16. What is the internet speed available now? What speed do you want for future? Internet access is through time warner cable company which is not very reliable
17. Do employees access their emails outside the company? yes
18. Do you have plans for future expansion? We like to increase our customer base by 20% over the next year
REMEMBER, you are the IT expert, I’m only a business person who must rely on your expertise.
Network Design and Performance
Case Study
Dooma-Flochies, Inc. with headquarters located on Podunk Road in Trumansburg, NY, is the sole manufacturer of Dooma-Flochies (big surprise). They currently have a manufacturing facility in, Lake Ridge, NY (across Cayuga Lake) on Cayuga Dr. and have recently diversified by purchasing a company, This-N-That, on Industry Ave. in, Dime Box Texas. This-N-That is the sole competitor of Domma-Flochies with their product Thinga-Ma-Jigs. This acquisition gives Dooma-Flochies, Inc a monopoly in this mark.
Behavior in OrganizationsIntercultural Communications Exercise .docxTatianaMajor22
Behavior in Organizations
Intercultural Communications Exercise Response Paper –
Week 5
The most overt cultural differences, such as greeting rituals and name format, can be overcome most easily. The underlying, intangible differences are very difficult to overcome. In this case, the underlying cultural differences are
· Assumptions about the purpose of the event (is the party strictly for fun and for relationship building, or are their business matters to take care of?).
· Assumptions about the purpose and the nature of business relationship.
· Assumptions about power and leadership relationships (who makes the decisions and how?).
· Response styles (verbal and nonverbal signals of agreement, disagreement, politeness, etc.).
Many (though not all) cultural differences can be overcome if you carefully observe other people, think creatively, remain flexible, and remember that your own culture is not inherently superior to others.
The Scenario
Three corporations are planning a joint venture to sponsor an international concert tour. The corporations are Decibel, an agency representing the musicians (from the US, Britain, and Japan); Images, a marketing firm which will handle sales of tickets, snacks and beverages, clothing, and CDs; and Event, a special events company which will hire the ushers, concessionaires, and security officers; print the programs; and clean up the arenas after the shows. The companies come from three different cultures: Blue, Green, and Red. Each has specific cultural traits, customs, and practices.
You are a manager in one of these companies. You will attend the opening cocktail party in Perth, Australia the evening before a 3-day meeting during which the three companies will negotiate the details of the partnership. Your management team includes a Vice President and a number of other managers.
During the 3-day meeting, the companies have the following goals:
Decibel
· As high a royalty rate as possible on sales of T-shirts, videos, and CDs
· Aggressive marketing and advertising to increase attendance and sales
· Good security, both before and during the show Image
Image
· Well known bands that will be easy to market
· As much income as possible from the concerts
· Smoothly functioning event so that publicity from early concerts is positive
Event
· Bands that are not likely to provoke stampedes, riots, or other antisocial behavior
· Bands that are reliable and will show up on time, ready to play
· As much income as possible from the concerts
The cultures that are assigned to the various companies are:
BLUE CULTURE
Image (Marketing Company)
Beliefs, Values, and Attitudes that Underlie This Culture’s Communication
Believe that fate and luck control most things.
Believe in feelings more than reasoning.
An authoritarian leader makes the ultimate decisions.
Nonverbal Traits of This Culture
Treat time as something that is unimportant. It is not a commodity that can be lost.
Conversation distance is close (about 15 inches, face-.
Discussion Question Comparison of Theories on Anxiety Disord.docxTatianaMajor22
Discussion Question:
Comparison of Theories on Anxiety Disorders
There are numerous theories that attempt to explain the development and manifestation of psychological disorders. Some researchers hold that certain disorders result from learned behaviors (behavioral theory), while other researchers believe that there is a genetic or biological basis to psychological disorders (medical model), while still others hold that psychological disorders stem from unresolved unconscious conflict (psychoanalytic theory). How would each of these theoretical viewpoints explain anxiety disorders? Does one explain the development and manifestation of anxiety disorders better than the others?
200- 400 words please
Three min resources with
in text citations and examples
you can use the following as a module reference
cite as university 2014
Anxiety Disorders
Anxiety disorders such as panic disorder, specific phobias, and social anxiety disorder feature a heightened autonomic nervous system response that is above and beyond what would be considered normal when faced with the object or situation that the person reacts to. For example, a person with a specific phobia of spiders (called arachnophobia) experiences a heightened autonomic response when confronted with a spider (or even an image of a spider). This anxiety response must result in significant distress or impairment. In general, anxiety disorders have been linked to underactive gamma-aminobutyric acid (GABA) in the brain, resulting in overexcitability of the amygdala and the anterior cingulate cortex. Additionally, genetic research shows that anxiety disorders demonstrate a clear pattern of genetic predisposition
Charles Darwin's Perspective
We talked about Charles Darwin when discussing evolution and natural selection. Darwin was also very interested in emotions. One of his books published in 1872,The Expression of Emotions in Man and Animals, was devoted to this topic.
Darwin believed that emotions play an important role in the survival of the species and result from evolutionary processes in the same way as other behaviors and psychological functions. Darwin's writing on this topic also prompted psychologists to study animal behavior as a way to better understand human behavior.
James–Lange Theory of Emotions
Modern theories of emotion can be traced to William James and Carl Lange (Pinel, 2011). William James was a renowned Harvard psychologist who is sometimes called the father of American psychology. Carl Lange was a Danish physician. James and Lange formulated the same theory of emotions independently at about the same time (1884). As a result, it is called the James–Lange theory of emotions. This theory reversed the commonsensical notion that emotions are automatic responses to events around us. Instead, it proposes that emotions are the brain's interpretation of physiological responses to emotionally provocative stimuli.
Cannon–Bard Theory of Emotions
In 1915, Harvard physiologist Walt.
I have always liked Dustin Hoffmans style of acting, in this mov.docxTatianaMajor22
I have always liked Dustin Hoffman's style of acting, in this movie he takes on a sexually deprived young male just out of college, and has never been with a female, and is duped by horny older woman that feels neglected. Dustin Hoffman takes the characters form of a young male, goofy, respectful virgin and intelligent male, missing something but not really sure at the beginning till Ann Bancroft coaxes him with seduction to fulfill her own needs. In an other movie called "The life of Little Big Man" he plays almost the same character but as a white child raised by the Native Americans and a wise old chief that deeply care and loves him as his own, and Fay Dunaway plays a Holy rollers wife that is older and sexually deprived and feeling neglected by her husband and also she goes through major changes in her life from devoted wife, to a honey bell/ house hooker, whats funny Dustin Hoffman is a awesome actor but has to have his surrounding characters bring his character to life. The Graduate was Dustin Hoffman's first big movie of his career.
I actually liked movie "Little Big man" way better due to he went through major changes in his life, from being a Native boy warrior, captured by Yankees, meets Fay Dunaway who loves to give baths, to finding his sister who teaches him to be a gunslinger and then returns to his Grand Father to be a native again and tells his blind Grand Father the world of the white man is a crazy one, then his see the Psyho Col. Custer and gets his revenge by telling Custer the truth. The movie Little Big Man makes you laugh, teaches you things about people and survial and cry at times... its a must see...
Although a stray away from the Benjamin Braddock written about in the novel The Graduate, Dustin Hoffman does an awesome job with this character on film. When you first meet Ben he is at a party that his parents are throwing in his academic honor upon his graduation from school and return home. The whole night, Hoffman stumbles though various conversations and tries to coyly escape from the festivities. Small things such as this Hoffman did a great job at, conveying the hesitance and crisis that Ben was going through as a graduate. There are multiple times in the movie he hardly expresses anything at all, yet it clearly shows you that Ben is having a very hard time internally with everything going on. Even through his relationships with Mrs. Robinson and her daughter Elaine you see the young man struggling with himself through either failed attempts at affection or lack thereof.
.
Is obedience to the law sufficient to ensure ethical behavior Wh.docxTatianaMajor22
Is obedience to the law sufficient to ensure ethical behavior? Why, or why not? Support your answer with at least three reasons that justify your position.
100 words
Discuss the differences between an attitude and a behavior. Provide 4 substantive reasons why it is important for organizations to monitor and mitigate employee behavior that is either beneficial or detrimental to the organization's goals and existence.
150 words
.
If you are using the Blackboard Mobile Learn IOS App, please clic.docxTatianaMajor22
If you are using the Blackboard Mobile Learn IOS App, please click "View in Browser." V BUS 520Week 9 Assignment 4 Paper
I need the paper as soon as possible
Students, please view the "Submit a Clickable Rubric Assignment" in the Student Center.
Instructors, training on how to grade is within the Instructor Center.
Assignment 4: Leadership Style: What Do People Do When They Are Leading?
Due Week 9 and worth 100 points
Choose one (1) of the following CEOs for this assignment: Larry Page (Google), Tony Hsieh (Zappos), Gary Kelly (Southwest Airlines), Meg Whitman (Hewlett Packard), Ursula Burns (Xerox), Terri Kelly (W.L. Gore), Ellen Kullman (DuPont), or Bob McDonald (Procter & Gamble). Use the Internet to investigate the leadership style and effectiveness of the selected CEO. (Note: Just choose one that is easier for you to right about.) It does not matter to me which CEO you pick
Write a five to six (5-6) page paper in which you:
1. Provide a brief (one [1] paragraph) background of the CEO.
2. Analyze the CEO’s leadership style and philosophy, and how the CEO’s leadership style aligns with the culture.
3. Examine the CEO’s personal and organizational values.
4. Evaluate how the values of the CEO are likely to influence ethical behavior within the organization.
5. Determine the CEO’s three (3) greatest strengths and three (3) greatest weaknesses.
6. Select the quality that you believe contributes most to this leader’s success. Support your reasoning.
7. Assess how communication and collaboration, and power and politics influence group (i.e., the organization’s) dynamics.
8. Use at least five (5) quality academic resources in this assignment. Note: Wikipedia and other Websites do not qualify as academic resources.
Your assignment must follow these formatting requirements:
· Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
· Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.
The specific course learning outcomes associated with this assignment are:
· Analyze the formation and dynamics of group behavior and work teams, including the application of power in groups.
· Outline various individual and group decision-making processes and key factors affecting these processes.
· Examine the primary conflict levels within organization and the process for negotiating resolutions.
· Examine how power and influence empower and affect office politics, political interpretations, and political behavior.
· Use technology and information resources to research issues in organizational behavior.
· Write clearly and concisely about organizational behavior using proper writing mechanics.
Click here.
Is the proliferation of social media and communication devices a .docxTatianaMajor22
Social media and communication devices have both benefits and drawbacks for society. While they allow easy connection with others and access to information, overuse can negatively impact relationships and mental health. Overall, moderation is key to reap the upsides of technology while avoiding the downsides.
MATH 107 FINAL EXAMINATIONMULTIPLE CHOICE1. Deter.docxTatianaMajor22
The document contains a 30-question math exam covering topics like functions, graphs, equations, inequalities, logarithms, and other math concepts. It includes multiple choice, short answer, and show work questions assessing skills like domain and range, solving equations, graphing, composites, inverses, lines, maximizing profit, and more. Students must demonstrate mathematical reasoning and problem-solving abilities.
If the CIO is to be valued as a strategic actor, how can he bring.docxTatianaMajor22
If the CIO is to be valued as a strategic actor, how can he bring to the table the ethos of alignment, bound to the demands of process strategic planning to move IT to the forefront of the organization's future? Is there a lack of information on strategic planning? Nope. I think the process of planning is poorly understood, and rarely endorsed. The reasons are simple enough. Planning requires a commitment of resources (time, talent, money); it requires insight; it requires a total immersion in the corporate culture. While organizations do plan, planning is invariably attached to the budget process. It is typically here that the CIO lays out his/her vision for the coming year Now a few years ago authors began writing on the value of aligning IT purpose to organizational purpose. They wrote at a time when enterprise architectural planning was fairly new, and enterprise resource management was on the lips of every executive. My view is that alignment is a natural process driven by the availability of the tools to accomplish it. Twenty years ago making sense of IT was more about processing power, and database management. We are in a new age of IT, and it is the computer that is the network, not the network as an independent self-contained exchange of information. If you will spend some time reviewing the basic materials I provided on strategic planning and alignment, we can begin our discussions for the course. Again, here is the problem I would like for us to tackle: If the CIO is to be valued as a strategic actor, how can he bring to the table the ethos of alignment, bound to the demands of process strategic planning to move IT to the forefront of the organization's future? Most of the articles I bundled together for this week are replete with tables and charts. These can be a heavy read. Your approach should be to review these articles for the "big ideas" or lessons that are take away. I think these studies are significant enough that we will conclude our first week with an understanding of the roles between executive leaders, and how they see Information Technology playing a role in shaping a business strategy.
Read the articles to answer the question. Please No Plagerism or verbatim but you are allowed to quote from the article.
Achieving and Sustaining
Business-IT Alignment
Jerry Luftman
Tom Brier
I
n recent decades, billions of dollars have been invested in intormation tech-
nology (IT). A key concern of business executives is alignment—applying IT
in an appropriate and timely way and in harmony with business strategies,
goals, and needs. This issue addresses both how IT is aligned with the busi-
ness and how the business should be aligned with IT Frustratingly, organizations
seem to find it difficult or impossible to harness the power of information tech-
nology for their own long-term benefit, even though there is worldwide evi-
dence that IT has the power to transform whole industries and markets.' How
can companies.
I am showing below the proof of breakeven, which is fixed costs .docxTatianaMajor22
I am showing below the proof of breakeven, which is fixed costs/ contribution margin.
We start with the definition of breakeven and proceed using elementary algebra to derive the formula. Breakeven is a number and is created by knowing fixed and variable costs, and the retail sales price. It is thus not a point of discussion but is based on the assumptions of these variables.
Proof of Breakeven
Definition of BreakevenVolume: Total Revenue = Total Expenses
Definition
1.Total Revenue = Total Expenses
Breakdown of Definition
2. Retail Price * Volume = Fixed Expenses + Variable Expenses
Further Analysis
3. Retail Price * Volume = Fixed Expenses + (Volume * Unit Variable Expenses)
Subtract (Volume * Unit Variable Expenses) from both sides
4. Fixed Expenses = (Retail Price * Volume) — (Volume * Unit Variable Expenses)
Factor
5. Fixed Expenses = Volume * (Retail Price – Unit Variable Expenses)
Divide both sides by (Retail Price – Unit Variable Expenses)
6. Volume = Fixed Expenses
(Retail Price – Unit Variable Expenses)
Substitution based on Definition
7. Since (Retail Price — Unit Variable Expenses) is called Contribution Margin,
Therefore:
Breakeven Volume = Fixed Expenses / Contribution Margin
NAME_________________________________________________ DATE ____________
1. Explain some of the economic, social, and political considerations involved in changing the tax law.
2. Explain the difference between a Partnership, a Limited Liability Partnership (LLP) and a Limited Liability Company (LLC). In each structure who has liability?
3. How is “control” defined for purposes of Section 351 of the IRS Code?
4. What are the advantages and disadvantages of using debt in a firm’s capital structure?
5. Under what circumstances is a corporation’s assumption of liabilities considered boot in a Section 351exchange?
6. What are the tax consequences for the transferor and transferee when property is transferred to a newly created corporation in an exchange qualifying as nontaxable under Section 351?
7. Why are corporations allowed a dividend-received deduction? What dividends qualify for this special deduction?
8. Provide 3 examples of a Constructive Dividend. Are these Constructive Dividends taxable?
9. Discuss the tax consequences of a new Partnership Formation and give details to gain and losses and basis?
10. Provide 2 similarities and 2 differences when comparing Sections 351 and 721 of the IRS Code.
11. What is the difference between inside and outside basis with a partnership?
12. ABC Partnership distributes $12,000 of taxable income to partner Bob and $24,000 of tax-exempt income to Partner Bob. As a result of these two distributions, how does Bob’s basis change?
13. On January 1, Katie pays $2,000 for a 10% capital, profits, and loss interest in a partnership.
Examine the way in which death and dying are viewed at different .docxTatianaMajor22
Examine the way in which death and dying are viewed at different points in human development.
Using only my text as a reference:
Berger, K.S. (2011). The developing person through the life span (8th ed.).
I need 3 detailed PowerPoint slide with very detailed speaker notes. There must be detailed speaker notes on each slide. The 4th slide will be the reference.
.
Karimi 1 Big Picture Blog Post First Draft College .docxTatianaMajor22
Karimi 1
Big Picture Blog Post First Draft
College Girls in Media
Sogand Karimi
Media and Hollywood movies have affected and influenced society’s perception on
female college students. Due to Hollywood movies and media, society mostly recognizes the
negative stereotypes of a college women. Saran Donahoo, an associate professor and education
administration of Southern Illinois University, once said, “The messages in these films
consistently emphasized college as a place where young women come to have fun, engage in
romances with young men, experiment with sex and alcohol, face dilemmas regarding body
image, and encounter difficulties in associating with other college women.” In this essay I will
be talking about the recurring stereotypes and themes portrayed in three hollywood movies,
Spring Breakers, The house bunny and Legally Blond and how these stereotypes affect our
society.
The movie Spring Breakers is about four college girls who are bored with their daily
routines and want to escape on a spring break vacation to Florida. After realizing they don’t have
enough money, they rub a local diner with fake guns and ski masks. They break the laws in order
to get down to Florida, just to break more rules and laws once they’re there. During the film, you
will notice a lot of partying, drugs and sexual activity. The four girls wear bikinis for majority of
the film and are overly sexual. These are some common themes and stereotypes seen in all three
movies. Media and movies like spring breakers have made it a norm to constantly want to party,
get drunk and have sex as a college woman. In an article by Heather Long, she mentions how the
movie can even be seen as supporting rape culture. She believes because of these stereotypes
always being shown in media, it is contributing to the “girls asking for it” excuse when it comes
to rape cases with young girls. Long also said “...never mind the fact that thousands of college
students are spending their spring break not on a beach, but volunteering with groups like Habitat
for Humanity and the United Way, especially after Hurricanes Katrina and Sandy.” THIS shows
how media only displays one side of a certain group or story. Even though not all college girls
like to party and lay on a beach naked for spring break, that’s what media likes to portray. Not
only does this give the wrong message to our society but it influences bigger issues like rape, as
the author mentioned.
http://www.huffingtonpost.com/2010/03/10/alternative-spring-break_n_494028.html
http://www.huffingtonpost.com/2010/03/10/alternative-spring-break_n_494028.html
Karimi 2
The movie House bunny. The House bunny is a movie about an ex playmate or girlfriend
if Hugh Hefner that gets kicked out of the Playboy Mansion due to her aging. She then becomes
a mother of an unpopular sorority with girls that are bit geeky, and unusual compared to other
girls on campus. The story.
Please try not to use hard words Thank youWeek 3Individual.docxTatianaMajor22
Please try not to use hard words Thank you
Week 3
Individual
Problems and Goals Case Study
Select one of the following three case studies in Ch. 6 of The Helping Process:
· Case Susanna
· Case James and Samantha
· Case Alicia and Montford
Identify three to five problems in the case study you have selected.
Write a 500- to 700-word paperthatincludes the following:
· A problem-solving strategy and a goal for each problem
· The services, resources, and supports the client may need and why
· A description of how goals are measurable and realistically attainable for the client
Here is the case studies
Exercise 3: Careful Assessment
The following case studies are about Susanna, James, Samantha, Alicia, and Montford, all
homeless children attending school. The principal of the school has asked you to conduct
an assessment of these children and provide initial recommendations.
Before you begin this exercise, go to the website that accompanies this book: www.
wadsworth.com/counseling/mcclam, Chapter Three, Link 1, to read more about homeless
families and children.
Susanna
Susanna is 15 years old. Th e city where she lives has four schools: two elementary, one
middle, and one high school. Th ere are about 1,500 students enrolled in the city/county
school district and about 450 in the local high school that Susanna is attending. For the
past six months, Susanna has been living with her boyfriend and his parents. Prior to this,
she left her mother’s home and lived on the streets. She is pregnant and her boyfriend’s
parents want her to move out of their home. Her father lives in a town with his girlfriend,
about 50 miles from the city. Her mother lives outside the city with Susanna’s baby brother.
Right now Susanna’s mother is receiving child support for the two children. Susanna wants
to have a portion of the child support so that she can find a place of her own to live. Her
mother says that the only way that Susanna can have access to that money is to move back
home. Susanna refuses to move back in with her mother.
You receive a call from the behavior specialist at Susanna’s high school. Susanna’s
mother is at the school demanding that Susanna be withdrawn from school. Susanna’s
mother indicates that Susanna will be moving in with her and will be enrolling in another
school district.
Currently Susanna is not doing very well in school. She misses school and she tells the
helper it is because she is tired and that she does not have good food to eat. She has not told
the helper that she is looking for a place to live. Right now she is failing two of her classes
and she has one B and two Ds. Her boyfriend has missed a lot of school, too.
James and Samantha
James is 10 years old and he has a sister, Samantha, who is 8. At the beginning of the
school year, both of the children were attending Boone Elementary School. Both children
live with their aunt and uncle; their parents are in prison. In the middle of the scho.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
InstructionsPart 8 Stakeholder Engagement Monitor and Control P
1. Instructions
Part 8: Stakeholder Engagement Monitor and Control Plan
For the project selected in Unit I, create a simple stakeholder
engagement monitor and control plan. Your plan should follow
the process for managing and monitoring stakeholder
engagement, as referred to in Figures 9.1 and 9.2 in the
textbook. Your plan should include an introduction, and should
answer the following questions:
· What specific soft skills will you employ in managing project
stakeholders?
· What ground rules will you establish for managing project
stakeholders?
· What types of meetings do you plan to have with project
stakeholders? How often do you plan to hold them?
· How will you manage change requests from stakeholders?
· How will you monitor stakeholders and levels of stakeholder
engagement?
· How will you manage changes to stakeholder requirements?
· What historical documents will you update in the process of
managing and monitoring stakeholders?
Create the stakeholder management and control plan that
addresses the questions above. Feel free to use tables, graphics,
or document template examples to summarize your policy and
approach. As a guide to depth, your stakeholder management
and control plan should be a minimum of two pages in length. If
you use tables, you may either create your table in Word and
include it at the end of the document, or submit it as a separate
Excel file.
Adhere to APA Style when constructing this assignment,
including in-text citations and references for all sources that are
used. Please note that no abstract is needed.
2. Instructions
Course Project, Executive Summary
For the project selected in Unit I, prepare a PowerPoint
presentation of a minimum of 10 slides to provide an executive
summary briefing. The minimum number of slides does not
count the title slide or the references slide. The presentation
should summarize each part of the course project that you
developed throughout this course. The goal of the briefing
PowerPoint presentation is to offer a succinct yet
comprehensive view of your project stakeholder and
communication plan. This includes the following elements:
· Part 1: Project Selection, Stakeholder Identification, And
Stakeholder Analysis
· Part 2: Resource Management Plan and RACI (responsible,
accountable, consulted, and informed) Chart
· Part 3: Communication Plan
· Part 4: Stakeholder Plan
· Part 5: Resource Acquisition Plan
· Part 6: Team Development Plan
· Part 7: Team Performance Reporting
· Part 8: Stakeholder Engagement Monitor and Control Plan
(from the assignment also in this unit)
Adhere to APA Style when constructing this assignment,
including in-text citations and references for all sources that are
used.
3. Establishing an Integrated Care Practice in a Community Health
Center
Andrea Auxier and Tillman Farley
Salud Family Health Centers, Fort Lupton, Colorado and
University of Colorado, Denver
Katrin Seifert
Salud Family Health Centers, Fort Lupton, Colorado
In a progressively complex and fragmented health care system
and in response to the need to provide
whole-person, quality care to greater numbers of patients than
ever before, primary care practices
throughout the United States have turned their attention and
efforts to integrating behavioral health
into their standard service-delivery models. With few resources
and little guidance, systems struggle
to gather the support required to establish effective integrated
programs. Based on first-hand
experience, we describe a working integrated primary care
model, currently utilized in a large
community health center system in Colorado, that encompasses
4. universal screening, consultation,
psychotherapy, and psychological testing. With appreciation for
the way an organization’s unique
circumstances inform the best approach for that particular
organization, we highlight the clinical-
level and system-level variables that we consider necessary for
successful practice development and
address how our behavioral health program operates despite
funding limitations. We conclude that
organizations that aim for integrated primary care must
mobilize leadership to implement systemic
changes while making difficult decisions about program
development, financing, staffing, and
interagency relationships.
Keywords: integrated care, primary care, integrative medici ne,
health psychology, collaborative care
The health care system in the United States is facing a paradox
of declining outcomes and rapidly increasing costs (Rabin et al.,
2009). In 2008, mental health conditions accounted for $72
billion
in expenditures, making them the third most costly group of
conditions (along with cancer), exceeded only by heart
conditions
and trauma-related disorders or conditions (Agency for
Healthcare
Research & Quality, 2008). In an effort to improve the
provision
of health care, many experts and key organizations are lending
support to the movement for integration of behavioral health
into
primary care settings (Blount, 2003; Institute of Medicine,
2001,
2006; Pincus, 2003; U.S. Department of Health and Human Ser-
5. vices, 2006; World Health Organization & World Organization
of
Family Doctors, 2008). Numerous studies have demonstrated
that
integrated services can improve access to mental health care,
enhance quality of care, decrease health care costs, improve
over-
all health, decrease the burden on primary care providers
(PCPs),
and improve PCPs’ ability to address patients’ mental health
needs
(Butler et al., 2008; Chiles, Lambert, & Hatch, 1999;
O’Donohue,
Cummings, & Ferguson, 2003; World Health Organization &
World Organization of Family Doctors, 2008).
The decision to organize integration efforts at our community
health center was, in part, based on well-known data regarding
primary care patients. For example, psychiatric conditions are
common in patients who are seen in primary care practices
(Cwikel, Zilber, Feinson, & Lerner, 2008) and many patients
who
have mental health needs seek treatment for these concerns
through their PCP (Goldman, Rye, & Sirovatka, 2000; Petterson
et
al., 2008; Wang et al., 2006). Additionally, the majority of
medical
problems seen in primary care practices are undeniably linked
with
behaviors, and it has been estimated that 40% of premature
deaths
in the United States are attributable to health behavior factors
(McGinnis & Foege, 1993; Mokdad, Marks, Stoup, &
Gerberding,
2004). Behavioral health integration is an integral part of a
solution
6. to the complex health care needs of these patients.
Although the terms mental health and behavioral health are
sometimes used interchangeably, we conceptualize them as
differ-
ent constructs. The term behavioral health applies to patients
whose primary diagnosis is somatic and whose psychological
symptoms, if present, are subclinical and related to the primary
diagnosis. The term mental health applies when the focus of
treatment is psychiatric; there may or may not be an
accompanying
This article was published Online First August 29, 2011.
ANDREA AUXIER received her PhD in clinical psychology
from the Uni-
versity of Massachusetts, Boston. She is Director of Integrated
Services
and Clinical Training at Salud Family Health Centers and a
senior clinical
instructor at the University of Colorado, Denver, Department of
Family
Medicine. Her areas of professional interest include integrated
primary care
research and practice, especially as they apply to immigrant
populations
with trauma histories.
TILLMAN FARLEY received his MD from the University of
Colorado, School
of Medicine, and completed his residency at the University of
Rochester.
He is board certified in Family Medicine. He is the Medical
Services
Director at Salud Family Health Centers and an associate
professor at the
University of Colorado, Denver, Department of Family
Medicine. His
12. medical condition. In this article, however, the term behavioral
health will subsume both categories.
Integrated Primary Care at Salud Family
Health Centers
Founded in 1970, Salud Family Health Centers (Salud) is a
federally qualified community health center consisting of nine
health care clinics covering eight counties in North Central
Colo-
rado. Salud is an important part of the health care safety net,
providing population-based, fully integrated medical, dental,
and
behavioral health services regardless of finances, insurance cov -
erage, or ability to pay–Salud focuses on the needs of the medi-
cally indigent, uninsured, and underinsured populations. The
na-
tional distribution of payer sources for federally qualified
health
centers is 35% Medicaid and 25% Medicare or private
insurance,
with 40% of patients falling into the uninsured category
(Adashi,
Geiger, & Fine, 2010). By comparison, 30% of Salud’s patients
have Medicaid, 14% have Medicare or private insurance, and
56%
are uninsured, leaving Salud to support the health care of a
greater
proportion of patients with no funding source.
Salud employs 540 individuals, including 60 medical providers,
14 dentists, 9 dental hygienists, and 15 behavioral health
providers
(BHPs). In 2010, Salud served more than 80,000 patients with
13. approximately 300,000 visits, making it the second largest
health
care provider in a six-state region. The most common visit types
include well-child checks, prenatal visits, diabetes, and
hyperten-
sion. About 3,000 of Salud’s patients are migrant and seasonal
farmworkers, and 65% of patients are Latino, many of whom
speak Spanish as their primary or only language.
In response to the extraordinary number of patients with behav-
ioral health needs, immigration-related stressors, and limited fi-
nancial means, Salud’s move toward integration began in 1997
under the leadership of its medical director, who had received
training in an integrated model. The need for integration was
apparent, but it soon became clear that incorporating a team of
behavioral health providers into an established medical setting
was
a more complex proposition than it initially seemed. The
program
started with one BHP in one clinic. PCPs who found value in
the
service vocalized their desire for an expanded behavioral health
presence. As Salud hired more BHPs, it became necessary to
build
an infrastructure designed to support integration at an organiza-
tional level. We set out to create a service-delivery model and
develop job descriptions, billing and coding practices, policies,
protocols, standard operating procedures, and data tracking
mech-
anisms. In order to accomplish these tasks, the focus shifted
toward securing administrative support from key members of
the
organization. Over time, with the collective mission to provide
quality health care—and with the implicit acceptance that
behav-
ioral health needs must be addressed as part of its delivery—
14. efforts materialized into an integrated care program. In an effort
to
measure the effectiveness of our program, we recently have
begun
to work toward an information-technology-driven, outcome-
based
approach, whereby we collaborate with university partners to
measure and benchmark our data through regional and national
comparative effectiveness research networks.
In 2010, we developed a mission statement that reads: “To
deliver stratified, integrated, patient-centered, population-based
services utilizing a diversified team of behavioral health profes -
sionals who function as PCPs, not ancillary staff, and who work
shoulder-to-shoulder with the rest of the medical team in the
same
place, at the same time, with the same patients.” The
implications
of this mission include that BHPs have the ability to see a
patient
at any time, for any reason, without requiring a consult request
from a PCP. This approach requires a paradigm shift from a
superior/subordinate mentality to one of implicit understanding
of
the unique skills that all persons involved in the patient’s care
contribute to the patient’s overall well-being. It gives BHPs the
latitude to determine which patients they need to assess on a
given
day, and providers see each patient as “our patient” not “my
patient.”
Components of Integrated Care
Over time, we have become familiar with many factors that
influence the development, success, and sustainability of an
15. inte-
grated primary care practice. Below is a summary of what we
have
found to be essential components of integration, broken down
into
those variables related to clinical decisions and interventions
and
those related to system-level considerations.
Clinical Variables
One prospect of integration is the provision of real time inter -
ventions. As soon as a need is identified, a BHP is present to
provide services. PCPs who might otherwise shy away from un-
covering mental health issues are less likely to do so if they
know
they can call upon a BHP to address identified concerns. Just as
some primary care visits are considered urgent, so are some
behavioral health visits. Having a BHP available when these
situations arise can mean that a patient actually receives care as
opposed to falling through the cracks in a health care system in
which timely access is often a problem (Pincus, 2003; Strosahl,
1998).
In any large primary care system, behavioral health services
must be population-based and not disease specific. A
population-
based approach focuses on the needs of a defined community
with
an emphasis on evidence-based practice and effective outcomes
as
well as primary prevention (Ibrahim, Savitz, Carey, & Wagner,
2001). In order to meet the needs of an entire community, BHPs
must be capable of assessing and addressing multiple presenting
concerns of varying levels of severity. BHPs in primary care
cannot be limited to utilizing interventions that target only a
16. specific disease category, primarily because comorbidity is the
rule
rather than the exception (Klinkman, 2009). In response to this
reality, treatment approaches must be geared toward the whole
person, not the illness.
BHPs who work in a primary care setting need to have strong
generalist training, with sufficient understanding of normal and
abnormal developmental processes across the life span, and to
be
flexible. The nature of the setting requires BHPs to make instant
connections with patients, to formulate quick assessments, and
to
communicate the relevant findings to the PCP immediately.
From
a logistical standpoint, BHPs must be willing to swap the
comfort
and controllability of a therapy room for the unpredictable and
unsettling reality of seeing patients in the medical rooms, often
with interruptions.
392 AUXIER, FARLEY, AND SEIFERT
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21. System Variables
Colocation is crucial for successful integrated primary care
(Blount, 2003). For integration to be truly seamless, the BHP
must
be in the flow of the action occurring in the clinic and must be
visible to patients and PCPs alike. Although 80% of patients
with
unexplained symptoms and psychosocial distress accept
manage-
ment by PCPs, only 10% will attend a psychosocial referral
(Smith
et al., 2003). Not having to travel to another facility or even a
different area of the clinic to access behavioral health may help
reduce the stigma associated with mental illness and thus
increase
the number of patients receiving services (Pincus, 2003;
Strosahl,
1998).
Although the concept of a multidisciplinary team is not a new
one, redefining the team approach to include PCPs and BHPs
requires a willingness to accept a paradigm shift of shared
respon-
sibility for a patient. A reevaluation of the systems that
maintain
power differentials among providers at the expense of quality,
comprehensive care is necessary, along with efforts to dismantle
and rebuild those systems.
Using a shared medical record, in which PCPs and BHPs have
access to each other’s notes, can help support the paradigm
shift.
The Health Insurance Portability and Accountability Act
(HIPAA)
22. regulations clearly delineate the differences between
psychother-
apy notes and progress notes (Gillman, 2004) and it is the latter
kind of note that we suggest BHPs use in integrated settings.
Psychotherapy notes are granted special protection under
HIPAA
due to the likelihood that they contain particularly sensitive
infor-
mation, are considered the personal notes of the treating
therapist,
and must be kept separate from the medical record. Progress
notes
are limited to medication information, modality and frequency
of
treatment, and a summary of diagnosis, functional status, symp-
toms, prognosis, and progress to date. Unlike psychotherapy
notes,
these notes are part of the medical record.
An ideal integrated care system does not operate within a
vacuum, but rather allows for coordination of care within and
across health care settings. In order to achieve this goal, a
service-
delivery model must be defined. What patients will be referred
out,
to whom, and for what reasons? Similarly, what kinds of
patients
will be accepted from other agencies and for what reasons? In
theory, patients with higher mental health needs are better-
suited to
receive treatment in specialized agencies such as community
men-
tal health centers (CMHCs). In practice, however, there are sig-
nificant barriers to implementing this transition. These
obstacles
include patients’ reluctance to go to a CMHC because of the
23. stigma associated with mental illness, a previous negative
experi-
ence, long waiting lists, limited transportation options, or
failure to
meet diagnostic or funding requirements. Moreover, some
patients
prefer having all health care needs met in one place even when
the
aforementioned barriers do not apply. Therefore, we argue that
an
integrated practice that emphasizes primary-care-level
behavioral
interventions must remain flexible enough to accommodate all
patients, regardless of problem severity.
Putting It All Together: Salud’s Integrated
Care Model
There is tremendous variability in the kinds of behavioral health
issues seen in our setting, and symptom severity in each patient
is
fluid rather than static. We argue that behavioral health is not a
bimodal phenomenon determined by the presence or absence of
health; rather, it exists along a continuum. We conceptualize
this
continuum as having four levels of severity; at any given time
fewer patients fall into the more severe levels and more patients
fall into the less severe levels. Conceptualizing our population
in
this fashion allows us to better allocate resources based on the
distribution of patients.
Patients presenting at Level 1 are in a state of acute need,
requiring immediate referral to emergency departments and/or
inpatient care. Examples include imminent suicidal depression,
24. acute psychosis, and manic crisis. Because of the seriousness
and
visible nature of their symptoms, these patients are more likely
to
present to an emergency room or to be detained by police than
they
are to present to PCP offices. Level 2 consists of patients who
have
severe and persistent mental illness. Although these patients can
benefit from psychiatric follow-up in a specialized mental
health
setting, the need is not immediate. Many can be monitored in
primary care settings when stable, especially when psychiatry
consultation is available. Patients at Level 3 present with
problems
that are chronic and of lower severity. They are common in
primary care practice and include somatization disorders,
nonpsy-
chotic depression, acute stress disorder, and anxiety disorders
where functional impairment is present but the symptoms are
not
completely debilitating. Level 3 patients frequently seek care in
primary care settings, but PCPs are not always equipped with
the
expertise and knowledge to address their needs (Goldman et al.,
2000). Level 4 includes patients with temporary mental health
and
psychosocial problems, including concerns such as marital diffi -
culties, parenting problems, bereavement, employment
problems,
financial stress, and so forth. Left untreated, Level 4 problems
can
progress, potentially leading to risky behaviors, unhealthy life
choices, and worsening of chronic diseases. Last, at any given
time, there are patients who do not qualify for assignment to a
particular level but who nevertheless might benefit from educa-
25. tional and preventive interventions.
In an attempt to provide adequate services to the 80,000 patients
in the Salud system in alignment with our mission, we grappled
with how BHPs were going to spend their time. We wanted to
maximize their ability to see a high number of patients while
still
maintaining a high standard of care. Based on the four-level
model
of severity just described, BHPs spend 30% of their time
providing
more traditional therapy services to Levels 1 and 2, the highest-
needs patients, who make up a significant portion, though not
the
majority of our population. BHPs spend 70% of their time
provid-
ing various integrated services to Levels 3 and 4 and the unas -
signed, whose symptoms are less severe or temporarily
nonexistent
but who make up a much larger portion of our patient
population.
After careful consideration, we decided that the best service-
delivery model for patients in our geographical area is a
stepped-
care approach. The initial point of contact with a BHP typically
occurs during a medical visit. Of patients requiring follow-up
care,
some are referred out but many continue with onsite therapy
services. Therapy appointments are scheduled separately from
medical appointments and consist of a limited number of visits,
which can be extended if necessary by department approval.
His-
torically, referrals to CMHCs more commonly were driven by
payer source (i.e., Medicaid) than by patient need, creating a
dual
26. standard of care whereby some but not all patients received
inte-
393ESTABLISHING AN INTEGRATED CARE PRACTICE
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.
grated care. Recently, we have determined that this standard is
unacceptable and have made modifications to our care model to
allow primarily clinical determinants to inform referral
decisions.
These clinical determinants include when a patient a) needs ser -
vices for a longer period than we can provide; b) requires
specialty
services such as vocational rehabilitation, day treatment, wrap-
around services, and so forth; and c) qualifies as severely and
persistently mentally ill or severely emotionally disturbed.
Services Offered
BHPs at Salud offer a variety of evidence-based services, in-
cluding screenings, consultations, psychotherapy, and
psycholog-
ical assessment. A report by the Institute of Medicine (2001)
31. defined evidence-based practice in psychology as the
“integration
of the best available research with clinical expertise in the
context
of patient characteristics, culture, and preferences” (p. 147).
Re-
search suggests that sensitivity and flexibility in administering
therapeutic interventions produces better outcomes than rigid
ap-
plication of manuals or principles (Castonguay, Boswell,
Constan-
tino, Goldfried, & Hill, 2010; Henry, Schacht, Strupp, Butler, &
Binder, 1993; Huppert et al., 2001). Because clinicians with
sound
clinical judgment will be more effective when operating from
treatment perspectives that are most consistent with their views
(Benish, Imel, & Wampold, 2008; Luborsky et al., 1999;
Wampold, Minami, Baskin, & Tierney, 2002), we encourage
BHPs to utilize all of their clinical knowledge from an
evidenced-
based perspective, rather than limiting themselves to a narrow
range of interventions.
As opposed to evidence-based practice, empirically validated
treatments (EVTs) are specific treatments for defined groups of
individuals who have particular disorders. We argue that,
although
there is certainly a place for EVTs in any setting, applying such
interventions in a primary care setting is particularly
challenging
for several reasons. First, much of the work being done in
primary
care is brief, which can limit the ability of the BHP to provide
the
intervention in full-form. Second, the population in primary
care is
32. extremely heterogeneous. Primary care patients cover the entire
life span, present with multiple comorbidities, and do not
usually
request treatment for a well-defined condition, thus making it
extremely difficult to choose the appropriate EVT. Supporting
evidence-based practice over EVT makes sense in an integrated
primary care setting because it is research-based without being
prescriptive. BHPs therefore have latitude to make difficult
treat-
ment decisions and to derive interventions from the research
even
when the available research does not fully address the
population’s
clinical needs (American Psychological Association, 2005). The
following section describes Salud’s service-delivery model in
greater detail.
Screening. The purpose of screening is to identify patients
who may be at risk for behavioral health difficulties by
detecting
previously unrecognized symptoms. Establishing a smooth
screen-
ing process that does not interrupt the workflow can be
challeng-
ing. We found that there needs to be clear communication to all
employees, including PCPs and support staff, of the expectation
that the practice is integrated. Additionally, BHPs and PCPs
must
have open dialogues about workflow. Last, priority groups need
to
be established so that BHPs can decide which patients to screen
first when it is not possible to screen every patient.
Screenings are intended to be structured and brief (5–10 min-
utes) and targeted at specific priority groups—for Salud, this
includes pregnant patients, postpartum patients, new patients,
33. and
children. We designed our screenings to encompass conditions
specified by the United States Preventive Task Force as well as
those concerns commonly seen in our setting. For patients older
than 16, we developed an eight-item prescreen the Screen for
Life
Stressors, containing Yes/No responses about symptoms of de-
pression; anxiety; posttraumatic stress disorder (PTSD);
tobacco,
alcohol, and substance use; and safety in the current living envi -
ronment. The questionnaire is a combination of items from the
Primary Care Evaluation of Mental Disorders (PRIME-MD), a
questionnaire designed to assist general practitioners in the
diag-
nosis of minor psychiatric disorders (Spitzer et al., 1994); the
Primary Care PTSD Screen, a 4-question screen for symptoms
of
PTSD (Prins et al., 2003); questions based on Screening Brief
Intervention Referral to Treatment guidelines for substance use
and abuse (Colorado Clinical Guidelines Collaborative, 2008);
and
questions we developed specifically for this purpose.
We typically administer the prescreen face-to-face to help es-
tablish a relationship with the patient and to provide the
opportu-
nity for immediate brief interventions. Positive prescreens
trigger
a more intensive screening with standardized instruments
assess-
ing depression, anxiety, alcohol abuse, substance abuse, and
PTSD. Depending on the patient’s literacy level, these question-
naires can be filled out by the patient or administered interview -
style by the BHP. We currently use the following instruments:
Patient Health Questionnaire - 9 from the PRIME-MD or Edin-
burgh Postnatal Depression Scale (Cox, Holden, & Sagovsky,
34. 1987); Generalized Anxiety Disorder (7-item) Scale from the
PRIME-MD; PTSD Checklist (Blanchard, Jones-Alexander,
Buckley, & Forneris, 1996); Drug Abuse Screening Test
(Skinner,
1982); and Alcohol Use Disorders Identification Test (Saunders,
Aasland, Babor, de la Fuente, & Grant, 1993). Children are
screened using the Parents’ Evaluation of Developmental Status
(for ages 0 – 8; Glascoe, 2010) and the Pediatric Symptom
Check-
list (for ages 9 –16; Jellinek, Murphy, & Burns, 1986).
Because false positives are inherent in any screening procedure,
formal diagnoses are not based solely on the results of a
screening.
Screenings that turn into diagnostic assessments are documented
separately. When patients screen positive, the BHP or PCP
offers
follow-up services, either onsite, if possible, or through an
outside
agency (Pignone et al., 2002).
Consultation. Although BHPs can see any patient at any time
for any reason, PCPs will often ask a BHP to evaluate and/or
treat
a patient during a medical visit. Reasons for requesting
consulta-
tion include but are not limited to psychoeducation or
therapeutic
interventions for a specific behavioral health concern, health
be-
havior change interventions, and assessment for diagnostic
impres-
sions, suicide risk, and capacity to make health care decisions.
PCPs also frequently request crisis management services and/or
referral for onsite or offsite services.
35. Psychotherapy. Full time BHPs have the ability to schedule
up to three patients per day for individual psychotherapy
appoint-
ments. Patients seen in this capacity complete disclosure and
informed-consent forms and work with their BHP to develop a
treatment plan. The typical session length is 50 minutes,
although
some clinicians prefer shorter intervals. Scheduling is done
either
by the BHP directly or through a centralized call center. Given
the
394 AUXIER, FARLEY, AND SEIFERT
T
hi
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m
en
t i
s
co
py
ri
gh
te
d
39. is
n
ot
to
b
e
di
ss
em
in
at
ed
b
ro
ad
ly
.
nature of a primary care setting, termination for no-shows/
cancellations is determined on a case-by-case basis. BHPs need
to
be flexible when scheduling patients as many will not fall into
the
traditional once per week model.
Psychological testing. Psychological testing for adults is
40. provided through Salud’s psychology training program, which
includes six postdoctoral fellows and several graduate-level
practi-
cum trainees. A licensed psychologist on staff provides supervi -
sion to any trainee completing testing. Reasons for testing
include
diagnostic clarification to inform medication management and
psychotherapy, to rule out a learning disorder, to evaluate
memory
(e.g., normal aging vs. abnormal memory functioning; specify
type
of memory impairment), to determine need for intensive neuro-
psychological testing, and to assess intellectual functioning.
Patient Contacts
Using the reporting functions from our electronic health record
and billing system, we were able to capture the number of
patients
seen in 2010. Table 1 shows the results of the prescreenings
described above. Table 2 reflects the other behavioral health
ser-
vices rendered in 2010. The behavioral health team provided
approximately 3000 screenings, 5500 consults, and 1800
individ-
ual therapy visits in 2010.
Financing
In a health care system characterized by barriers to integrated
practice, especially financial ones, it is surprising that so many
practices are making the move toward integration. We think
inte-
gration is essential for comprehensive patient care consistent
with
a patient-centered philosophy, but cost-effectiveness is hard to
41. measure. Higher levels of integration are more costly due to the
staffing and administrative demands associated with more com-
plex service delivery. Integration reduces costs for the entire
health
care system to a point (Chiles et al., 1999; Katon et al., 2006;
Mumford, Schlesinger, Glass, Patrick, & Cuerdon, 1984), but
primary care practices may not share directly in the cost savings
from effectiveness. From a strict revenue-producing standpoint,
Salud’s integrated care team does not generate enough revenue
to
support its staffing. Nevertheless, the cost of funding
integration
must be compared to the cost of not funding integration.
As a federally qualified health center, Salud receives 20% of its
$50 million/year operating budget from the federal government,
20% from state grants, and 60% from direct patient fees.
Enhanced
Medicaid reimbursements for medical visits help offset the
costs of
providing services to such a large percentage of uninsured indi -
viduals. Federally qualified health centers cannot receive any
additional reimbursement from Medicaid for behavioral health
services during medical visits because the Medicaid rate is a
flat
per-patient rate regardless of the number or type of services
rendered during a particular visit. It is possible to bill Medicaid
for
services outside a regular medical visit by contracting with the
behavioral health organizations that administer Medicaid. How -
ever, for the time being, we have chosen not to pursue this
funding
stream because the current regulations are not favorable to i nte-
grated systems. Salud generates a small amount of revenue
through
42. direct patient fees for therapy and assessment services rendered
to
non-Medicaid patients. Third-party payers are not billed
because
of paneling and credentialing requirements for provi ders, same-
day billing restrictions, administrative burden, and internal
costs
associated with electronic claims. We thus decided to pursue
other
funding for our integrated program.
The behavioral health program remains viable through two
ongoing Health Resources Services Administration (HRSA)
grants, included in Salud’s annual HRSA funding for operating
as
a federally qualified health center. The psychology training pro-
gram is sustained through a combination of grants, including a
large one dedicated specifically to postdoctoral training.
Finally,
many of our BHPs are employed through collaborative arrange-
ments with our CMHC partners or similar agencies. In these
cases,
Salud does not pay the BHP’s salary; the outside agencies
benefit
by increasing their Medicaid penetration rate and/or by demon-
strating that they are reaching more patients.
Conclusion
Primary care patients who have behavioral health problems are
very expensive to the system (Petterson et al., 2008), and
behav-
ioral health affects overall health whether we address it or not.
This
Table 1
43. Prescreening Results 2010
Dimension Positive screen Negative screen Total % Positive
Depression 1066 1924 2990 35.7
Anxiety 979 1865 2844 34.4
Trauma 338 2549 2887 11.7
Alcohol 302 2689 2991 10.1
Tobacco Use 879 1551 2430 36.2
Other Substance Abuse 105 2319 2424 4.3
Unsafe Living Environment 59 2845 2904 2
Table 2
Other Behavioral Health Contacts, 2010
Service Number of contacts
Consultation 5507
Diagnostic Evaluations 310
Individual therapy 1844
Family therapy 82
Group therapy 37
Smoking cessation 237
Alcohol/Substance Treatment 73
Child Screen 299
395ESTABLISHING AN INTEGRATED CARE PRACTICE
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48. ly
.
article has been an attempt to describe how these basic
consider-
ations have driven the evolution of an integrated care practice
in a
large community health center system that serves vulnerable
pop-
ulations across North Central Colorado. With the caveat that
there
is no one correct way to achieve integrated care, we have
presented
the various considerations and decisions made along the way in
hopes that others who are considering or are in the process of
establishing an integrated care practice might learn from our
experiences. We have detailed our thoughts about the necessary
and sufficient components of successful integration, with
special
attention to the role of evidence-based practice. We have also
argued that paradigm shifts from a medically focused mentality
to a patient-centered mentality must be made at the
organizational
level.
For practices considering integrating behavioral health into pri -
mary care, is value measured by dollars brought into the organi -
zation, provider satisfaction, patient satisfaction, decreased
utili-
zation, fewer emergency room visits, or improvement in
physical
markers? If the only way to generate revenue through
behavioral
49. health services is by moving from an integrated to a colocated
model, is this approach consistent with the organizational
mission?
Do the administrative burdens and costs of billing fee-for-
service
outweigh the benefits? Do they impact the organization’s ability
to
offer high-volume quality services? These are merely a few of
the
questions that will arise when setting up an integrated care
prac-
tice.
References
Adashi, E. Y., Geiger, H. J., & Fine, M. D. (2010). Health care
reform and
primary care–the growing importance of the community health
center.
The New England Journal of Medicine, 362, 2047–2050.
doi:10.1056/
NEJMp1003729
Agency for Healthcare Research and Quality. (2008). Total
expenses and
percent distribution for selected conditions by type of service:
United
States, 2008. Medical Expenditure Panel Survey Household
Component
Data. Retrieved from
http://www.meps.ahrq.gov/mepsweb/data_stats/
tables_compendia_hh_interactive.jsp?_SERVICE�MEPSSocket
0&_
PROGRAM � MEPSPGM. TC. SAS & File � HCFY2008 &
Table �
HCFY2008%5FCNDXP%5FC&_Debug�
50. American Psychological Association. (2005). Report of the
2005 presiden-
tial task force on evidence-based practice. Retrieved from
http://
www.apa.org/practice/resources/evidence/evidence-based-
report.pdf
Benish, S. G., Imel, Z. E., & Wampold, B. E. (2008). The
relative efficacy
of bona fide psychotherapies for treating post-traumatic stress
disorder:
A meta-analysis of direct comparisons. Clinical Psychology
Review, 28,
746 –758. doi:10.1016/j.cpr.2007.10.005
Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., &
Forneris, C. A.
(1996). Psychometric properties of the PTSD Checklist (PCL).
Behav-
iour Research and Therapy, 34, 669 – 673. doi:10.1016/0005-
7967(96)00033-2
Blount, A. (2003). Integrated primary care: Organizing the
evidence.
Families, Systems, & Health, 21, 121–133. doi:10.1037/1091-
7527.21.2.121
Butler, M., Kane, R. L., McAlpin, D., Kathol, R. G., Fu, S. S.,
Hagedorn,
H., & Wilt, T. J. (2008). Integration of mental health/substance
abuse
and primary care No. 173 (AHRQ Publication No. 09-E003).
Rockville,
MD: Agency for Healthcare Research and Quality.
51. Castonguay, L. G., Boswell, J. F., Constantino, M. J.,
Goldfried, M. R., &
Hill, C. E. (2010). Training implications of harmful effects of
psycho-
logical treatments. The American Psychologist, 65, 34 – 49.
doi:10.1037/
a0017330
Chiles, J. A., Lambert, M. J., & Hatch, A. L. (1999). The impact
of
psychological interventions on medical cost offset: A meta-
analytic
review. Clinical Psychology: Science and practice, 6, 204 –220.
doi:
10.1093/clipsy.6.2.204
Colorado Clinical Guidelines Collaborative. (2008). Guideline
for alcohol
and substance use screening, brief intervention, referral to
treatment.
Retrieved from
http://www.healthteamworks.org/guidelines/sbirt.html
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of
postnatal
depression: Development of the 10-item Edinburgh Postnatal
Depres-
sion Scale. British Journal of Psychiatry, 150, 782–786.
doi:10.1192/
bjp.150.6.782
Cwikel, J. Zilber, N. Feinson. M., & Lerner, Y. (2008).
Prevalence and risk
factors of threshold and sub-threshold psychiatric disorders in
primary
care. Social Psychiatry and Psychiatric Epidemiology, 43, 184 –
52. 191.
doi:10.1007/s00127-007-0286-9
Gillman, P. B. (2004). A new era of documentation in
psychiatry: Advice
on psychotherapy, progress notes. Behavioral Healthcare
Tomorrow,
13, 48 –50.
Glascoe, F. P. (2010). Parents’ Evaluation of Developmental
Status
(PEDS). Nolensville, TN: PEDSTest.com, LLC.
Goldman, H. H., Rye, P., & Sirovatka, P. (2000). A report of
the surgeon
general. Washington, DC: Department of Health and Human
Services.
Henry, W. P., Schacht, T. E., Strupp, H. H., Butler, S. F., &
Binder, J. L.
(1993). Effects of training in time-limited dynamic
psychotherapy:
Changes in therapist behavior. Journal of Consulting and
Clinical Psy-
chology, 61, 434 – 440. doi:10.1037/0022-006X.61.3.434
Huppert, J. D., Bufka, L. F., Barlow, D. H., Gorman, J. M.,
Shear, M. K.,
& Woods, S. W. (2001). Therapist, therapist variables, and
cognitive-
behavioral therapy outcomes in a multicenter trial for pani c
disorder.
Journal of Consulting and Clinical Psychology, 69, 747–755.
doi:
10.1037/0022-006X.69.5.747
53. Ibrahim, M., Savitz, L., Carey, T., & Wagner, E. (2001).
Population-based
health principles in medical and public health practice. Journal
of Public
Health Management, 7, 75– 81.
Institute of Medicine. (2001). Crossing the quality chasm: A
new health
system for the 21st Century. Washington, DC: National
Academies
Press. Retrieved from http://www.nap.edu/catalog.php?recor -
d_id�10027
Institute of Medicine. (2006). Improving the quality of
healthcare for
mental and substance-use conditions: Quality chasm series.
Washing-
ton, DC: National Academies Press. Retrieved from http://www
.nap.edu/catalog.php?record_id�11470#toc
Jellinek, M. S., Murphy, J. M., & Burns, B. J. (1986). Brief
psychosocial
screening in outpatient pediatric practice. Journal of Pediatrics,
109,
371–378. doi:10.1016/S0022-3476(86)80408-5
Katon, W. J., Unutzer, J., Fan, M., Williams, J. W.,
Schoenbaum, M., Lin,
E. H., & Hunkeler, E. M. (2006). Cost-effectiveness and net
benefit of
enhanced treatment of depression for older adults with diabetes
and
depression. Diabetes Care, 29, 265–270. doi:10.2337/diacare
.29.02.06.dc05–1572
Klinkman, M. S. (2009). Assessing functional outcomes in
54. clinical prac-
tice. The American Journal of Managed Care, 15, S335–S342.
Luborsky, L., Diguer, L., Seligman, D. A., Rosenthal, R.,
Krause, E. D.,
Johnson, S., . . . Schweizer, E. (1999). The researcher’s own
therapeutic
allegiances: A “wild card” in comparisons of treatment efficacy.
Clinical
Psychology: Science and Practice, 6, 95–106.
doi:10.1093/clipsy/6.1.95
McGinnis, J. M., & Foege, W. H. (1993). Actual causes of death
in the
United States. Journal of the American Medical Association,
270, 2207–
2212. doi:10.1001/jama.270.18.2207
Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L.
(2004).
Actual causes of death in the United States, 2000. Journal of the
American Medical Association, 291, 1230 –1245. doi:10.1001/
jama.291.10.1238
Mumford, E., Schlesinger, H. J., Glass, G. V., Patrick, C., &
Cuerdon, T.
396 AUXIER, FARLEY, AND SEIFERT
T
hi
s
do
cu
59. ad
ly
.
(1984). A new look at evidence about reduced cost of medical
utilization
following mental health treatment. American Journal of
Psychiatry, 141,
1145–1158.
O’Donohue, W. T., Cummings, N. A., & Ferguson, K. E.
(2003). Clinical
integration: The promise and the path. In N. A. Cummings, W.
T.
O’Donohue, & K. E. Ferguson (Eds.), Behavioral health as
primary
care: Beyond efficacy to effectiveness (pp. 15–30). Reno, NV:
Context.
Petterson, S. M., Phillips, R. L., Bazemore, A. W., Dodoo, M.
S., Zhang,
X., & Green, L. A. (2008). Why there must be room for mental
health
in the medical home. American Family Physicians, 77, 757.
Pignone, M. P., Gaynes, B. N., Rushton, J. L., Burchell, C. M.,
Orleans,
C. T., Mulrow, C. D., & Lohr, K. N. (2002). Screening for
depression in
adults: A summary of the evidence for the U.S. Preventive
Services Task
Force. Annals of Internal Medicine, 136, 765–776.
60. Pincus, H. A. (2003). The future of behavioral health and
primary care:
Drowning in the mainstream or left on the bank?
Psychosomatics, 44,
1–11. doi:10.1176/appi.psy.44.1.1
Prins, A., Ouimette, P., Kimerling, R., Cameron, R. P.,
Hugelshofer, D. S.,
Shaw-Hegwer, J., . . . Sheikh, J. I. (2003). The primary care
PTSD
screen (PC-PTSD): Development and operating characteristics.
Primary
Care Psychiatry, 9, 9 –14. doi:10.1185/135525703125002360
Rabin, D., Petterson, S. M., Bazemore, A. W., Teevan, B.,
Phillips, R. L.,
Dodoo, M. S., & Xierali, I. (2009). Decreasing self-perceived
health
status despite rising health expenditures. American Family
Physician,
80, 427.
Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J.
R., & Grant,
M. (1993). Development of the Alcohol Use Disorders
Identification
Test (AUDIT): WHO collaborative project on early detection of
persons
with harmful alcohol consumption. II. Addiction, 88, 791– 804.
doi:
10.1111/j.1360-0443.1993.tb02093.x
Skinner, H. A. (1982). The Drug Abuse Screening Test.
Addictive Behav-
ior, 7, 363–371. doi:10.1016/0306-4603(82)90005-3
61. Smith, R. C., Lein, C., Collins, C., Lyles, J. S., Given, B.,
Dwamena, F. C.,
. . . Given, C. W. (2003). Treating patients with medically
unexplained
symptoms in primary care. Journal of General Internal
Medicine, 18,
478 – 489. doi:10.1046/j.1525-1497.2003.20815.x
Spitzer, R. L., Williams, J. B., Kroenke, K., Linzer, M., deGruy,
F. V.,
Hahn, S. R., . . . Johnson, J. G. (1994). Utility of a new
procedure for
diagnosing mental disorders in primary care: The PRIME-MD
1000
Study. Journal of the American Medical Association, 272, 1749
–1756.
doi:10.1001/jama.272.22.1749
Strosahl, K. (1998). Integrated primary care behavioral health
services: The
primary mental healthcare paradigm. In A. Blount (Ed.),
Integrative
primary care: The future of medical and mental health
collaboration
(pp. 139 –166). New York: Norton.
U.S. Department of Health and Human Services, Substance
Abuse and
Mental Health Services Administration. (2006). Transforming
mental
healthcare in America: The federal action agenda: First steps.
Retrieved
from
http://www.samhsa.gov/Federalactionagenda/NFC_execsum.asp
x
62. Wampold, B. E., Minami, T., Baskin, T., & Tierney, S. (2002).
A meta-
(re)analysis of the effects of cognitive therapy versus “other
therapies”
for depression. Journal of Affective Disorders, 68, 159 –165.
doi:
10.1016/S0165-0327(00)00287-1
Wang, P. S., Demler, O., Olfson, M., Pincus, H. A., Wells, K.
B., &
Kessler, R. C. (2006). Changing profiles of service sectors used
for
mental healthcare in the United States. American Journal of
Psychiatry,
163, 1187–1198. doi:10.1176/appi.ajp.163.7.1187
World Health Organization & World Organization of Family
Doctors.
(2008). Integrating mental health into primary care: A global
perspec-
tive. Geneva: World Health Organization. Retrieved from http://
whqlibdoc.who.int/publications/2008/9789241563680_eng.pdf
Received March 21, 2011
Revision received June 9, 2011
Accepted June 15, 2011 �
397ESTABLISHING AN INTEGRATED CARE PRACTICE
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.
Integrating Behavioral Health Services Into a University
Health Center: Patient and Provider Satisfaction
Jennifer S. Funderburk, PhD
VA Center for Integrated Healthcare, Syracuse,
New York, Syracuse University, and University of
Rochester
Robyn L. Fielder, MS
Syracuse University
Kelly S. DeMartini, PhD
Syracuse University and Yale University School of
Medicine
Cheryl A. Flynn, MD
University of Vermont
The goals of this study were to (a) describe an Integrated
Behavioral Health Care
(IBHC) program within a university health center and (b) assess
provider and patient
acceptability and satisfaction with the IBHC program, including
68. behavioral health
screening and clinical services of integrated behavioral health
providers (BHPs).
Fifteen providers (nine primary care providers and six nurses)
and 79 patients (75%
female, 65% Caucasian) completed program ratings in 2010.
Providers completed an
anonymous web-based questionnaire that assessed satisfaction
with and acceptability of
behavioral health screening and the IBHC program featuring
integrated BHPs. Patients
completed an anonymous web-based questionnaire that assessed
program satisfaction
and comfort with BHPs. Providers reported that behavioral
health screening stimulated
new conversations about behavioral health concerns, the BHPs
provided clinically
useful services, and patients benefited from the IBHC program.
Patients reported
satisfaction with behavioral health services and reported a
willingness to meet again
with BHPs. Providers and patients found the IBHC program
beneficial to clinical care.
Use of integrated BHPs can help university health centers
support regular screening for
mental and behavioral health issues. Care integration increases
access to needed mental
health treatment.
Keywords: integrated behavioral health care, integrated primary
care, mental health care
Integrated behavioral health care (IBHC), in
which primary care providers (PCPs) and be-
havioral health providers (BHPs) collaborate to
provide coordinated care, is an emerging model
69. of patient care. Over the past decade, research
has identified IBHC as a clinically effective and
cost-effective method for improving clinical
outcomes within primary care settings (Blount
et al., 2007; Bryan, Morrow, & Appolonio,
2009; Cigrang, Dobmeyer, Becknell, Roa-
Navarrete, & Yerian, 2006; Goodie, Isler, Hun-
ger, & Peterson, 2009). Typically, this research
has focused on integrating mental and behav-
ioral health care within adult primary care set-
This article was published Online First May 21, 2012.
Jennifer S. Funderburk, PhD, VA Center for Integrated
Healthcare, Syracuse, New York, Department of Psychol-
ogy, Syracuse University, and Department of Psychiatry,
University of Rochester; Robyn L. Fielder, MS, Depart-
ment of Psychology, Syracuse University; Kelly S. DeMar-
tini, PhD, Department of Psychology, Syracuse University
and Department of Psychiatry, Yale University School of
Medicine; Cheryl A. Flynn, MD, Center for Health and
Wellbeing, University of Vermont.
The views expressed in this article are those of the authors and
do not reflect the official policy of the Veterans’ Affairs’
depart-
ment or other departments of the U.S. government. This
material
is based upon work supported by the American College Health
Association United Healthcare Student Recourse Initiatives in
College Mental and Behavioral Health grant.
Correspondence concerning this article should be ad-
dressed to Jennifer S. Funderburk, Center for Integrated
Healthcare, 800 Irving Avenue, Room 116C, Syracuse,
74. b
e
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ro
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ly
.
tings, such as private family medicine practices,
academic medical center primary care clinics,
and primary care services offered within the
Veterans Health Administration or Federal
Qualified Centers. However, there is little re-
search examining IBHC in university health
clinics.
University health centers share many features
with standard primary care settings. For exam-
ple, university health centers tend to offer am-
bulatory care and other basic medical services
to a wide range of patients (Christmas, 1995).
These clinics tend to be students’ first option
75. when seeking medical care in nonemergency
situations. University health centers may coor-
dinate referrals to off-campus specialists as nec-
essary. Thus, in terms of services offered and
general approach to care, university health cen-
ters and primary care clinics are quite similar.
Nevertheless, compared with typical primary
care practices, university health clinics are
somewhat unique in that they generally serve a
restricted age range (i.e., 18 –24 years of age)
for a limited period of time (i.e., academic se-
mesters) that has predictable elevations in
stress/illness as a result of the increased work-
load that occurs toward the end of the semester.
In addition, a majority of students are develop-
mentally just beginning to take care of them-
selves while continuing to maintain significant
ties to their parents, sometimes limiting their
financial resources and ability to travel off cam-
pus for additional specialty services. Another
caveat is that most university health clinics pro-
vide services to students using a general health
fee that is wrapped into their tuition, eliminating
difficulties with insurance claims (Mills, Gold,
& Curran, 1996).
The lack of research examining the integra-
tion of mental health services into university
health clinics is surprising because of the alarm-
ing rates of mental health issues on college
campuses (American College Health Associa-
tion [ACHA], 2010a; Mowbray et al., 2006) and
the fact that most college students with clini-
cally significant psychological distress do not
receive mental health treatment (Rosenthal &
Wilson, 2008). For instance, only 15% of stu-
76. dents with moderately severe to severe depres-
sion or past-month suicidal ideation received
any mental health care (Garlow et al., 2008). A
recent ACHA white paper (2010b) argued for
the integration of campus medical and counsel-
ing clinics, given the great potential for inte-
grated care to increase treatment access, en-
hance clinical outcomes, and improve patient
satisfaction.
Similar to other primary care settings, IBHC
in university health centers can provide an av-
enue to address many of the obstacles to treat-
ment access for college students. For instance, a
higher proportion of students use campus health
clinics than campus mental health clinics (79%
vs. 10% in one recent study; Eisenberg, Golber-
stein & Gollust, 2007), and many students feel
more comfortable seeing PCPs than therapists
(ACHA, 2010b). Moreover, because many
mental health issues cause physical symptoms,
many students seek evaluation at health clinics
first (ACHA, 2010b). The few studies examin-
ing IBHC within university health settings have
reported numerous benefits, including increased
accessibility of mental/behavioral health care,
increased referral follow-through, and higher
quality patient care (Masters, Stillman, Brown-
ing & Davis, 2005; Tucker, Sloan, Vance, &
Brownson, 2008; Westheimer & Steinley-
Bumgarner, 2008).
Besides clinical outcomes, another vital com-
ponent in the process of evaluating a new
program of service, and whether others should
77. consider implementing such a program within
college health, is obtaining feedback from the
“consumers” involved in the program (Gallo et
al., 2004; Reiss-Brennan, Briot, Daumit, &
Ford, 2006; Runyan, Fonseca, & Hunter, 2003).
For IBHC, primary consumers include PCPs
and patients. A lack of acceptability and/or sat-
isfaction among the PCPs with the various com-
ponents of the IBHC program would ultimately
sabotage the program because of (a) the pivotal
role PCPs have within IBHC (i.e., referring
patients to BHPs) and (b) the focus all IBHC
programs have on increasing collaboration be-
tween PCPs and BHPs. Similarly, it is ex-
tremely important that the patients are satisfied
with clinical services provided by a new
program, otherwise patients may not remain
engaged or comply with treatment recommen-
dations, which could compromise treatment
success. Patient satisfaction is an important out-
come measure that identifies problems with
health care (Sitzia & Wood, 1997) and is asso-
ciated with treatment adherence and provider/
program selection (Fitzpatrick, 1991).
131INTEGRATING BEHAVIORAL HEALTH SERVICES
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Preliminary studies have begun to examine
patient and provider opinions about IBHC
within the college health setting. Tucker et al.
(2008) examined an international student’s ex-
perience of the Integrated Health Program at the
University of Texas at Austin using a case study
design and found his overall experience to be
positive. Westheimer and Steinley-Bumgarner
(2008) examined provider behaviors, opinions,
and experiences during the integration process
of IBHC within the same university and found
PCPs ascribed a high level of value to the col-
laborative effort integrated BHPs could provide
in helping with a diverse number of conditions.
However, neither of these studies provided a
sound understanding of patient or provider sat-
isfaction with the IBHC program and its various
components.
Two studies have examined the use of screen-
ing questionnaires designed to increase discus-
sion of mental and behavioral health issues dur-
ing university health center visits. In a pilot
study, Cowan and Morewitz (1995) found that
use of a screening questionnaire prompted dis-
cussion of psychosocial concerns that may not
have otherwise come up. However, this study
did not use a validated screening measure or
examine provider or patient satisfaction with
use of the screening measure. Alschuler,
Hoodin, and Byrd (2008) examined provider
83. and patient satisfaction with the integration of a
screening questionnaire for behavioral health
issues in a college health center. They found
that patients who were randomly assigned to fill
out the screening questionnaire reported it
helped them discuss concerns with their provid-
ers and they would like its use to continue in the
future. The providers reported that they also
found the screening questionnaire helpful and
would be happy to collaborate with integrated
BHPs on-site. Although this study provided pre-
liminary evidence toward patient and provider
satisfaction with IBHC, it focused on integrat-
ing the screening measure and it did not involve
the actual integration of BHPs, which is a fun-
damental component of IBHC programs.
In sum, IBHC is an emerging approach to
health care that can increase access to mental
and behavioral health care while reducing the
burden on PCPs and specialty mental health
centers. University health centers are an oppor-
tune setting in which to implement the IBHC
model. However, despite the importance of en-
suring provider and patient acceptability and
satisfaction when implementing new clinical
programs, little research has examined these
factors with respect to IBHC in university
health centers. Therefore, the purpose of this
study was to collect feedback from PCPs and
patients to assess the acceptability and satisfac-
tion with all aspects of integrating an IBHC
program at Syracuse University, which included
the implementation of a behavioral health
screening questionnaire as well as the integra-
84. tion of several BHPs. It was expected that PCPs
and patients would indicate a high level of sat-
isfaction and acceptability with all aspects of
the program.
Method
Our Integrated Behavioral Health Primary
Care Program
We developed our IBHC program by adapt-
ing a common model of integrated health care
called the Primary Mental Health Care model
described by Strosahl (1998). Syracuse Univer-
sity Health Services (SUHS), which serves ap-
proximately 9,038 patients per year, collabo-
rated with the Syracuse University doctoral
program in clinical psychology to integrate
three to five advanced doctoral students as
BHPs per academic year (for additional infor-
mation regarding this type of collaborative ef-
fort, see Masters et al., 2005). The BHPs pro-
vided clinical services 20 –35 hours per week as
part of an Advanced Practicum course. Working
under the supervision of a licensed psychologist
and an onsite medical provider, the BHPs saw
approximately 152 students per semester for
various presenting problems (e.g., insomnia, de-
pressive symptoms). BHPs acted as consultants
to the PCPs, seeing patients for brief sessions
(i.e., one to three sessions lasting approximately
15–30 minutes each; Strosahl, 1998). The aver-
age number of sessions per patient was 1.43
(SD � 0.83, range 1–5) for the Spring, 2010
semester and 1.61 (SD � 0.97, range 1– 6) for
the Fall, 2010 semester.
85. In this IBHC model, the PCP ultimately
maintains responsibility for patient manage-
ment throughout the course of treatment. None-
theless, the PCPs can utilize the BHPs in several
ways: (a) to conduct further assessment of be-
havioral health issues; (b) to provide brief in-
132 FUNDERBURK, FIELDER, DEMARTINI, AND FLYNN
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terventions for patients reporting mild-moderate
mental health symptomatology, behavioral
health issues (e.g., sleep problems), or symp-
toms associated with chronic disease; (c) to
triage patients reporting more severe mental
health symptoms to more specialized services;
and (d) to provide crisis assessment. BHPs
maintain an open access schedule, keeping at
least 15 minutes free between half-hour ap-
pointments to allow PCPs to walk patients
down for same-day visits. Assessments and pa-
tient progress notes are shared among the team
90. via verbal and/or written communications
within the electronic medical record. Therefore,
this IBHC model is strikingly different from the
colocation of specialty mental health services
within a university health clinic, which often
continues to maintain separate medical records,
provide more intensive treatment (i.e., a higher
number of sessions, longer sessions), see pa-
tients for more severe symptomatology, and is
often unable to accommodate same-day noncri-
sis appointments.
To help facilitate referrals and to follow na-
tional recommendations regarding screening for
depression and at-risk alcohol use among young
adults (American Academy of Pediatrics, 2001;
Nimalasuriya, Compton, Guillory & Prevention
Practice Committee of the American College of
Preventive Medicine, 2009; U.S. Preventive
Services Task Force, 2009), we implemented a
screening tool as part of our IBHC program.
Specifically, all students seen by PCPs for any
reason were screened for the following symp-
toms: (a) depression and suicidal ideation with
the Patient Health Questionnaire-9 (PHQ-9;
Spitzer, Kroenke & Williams, 1999); (b) at-risk
alcohol use with the Alcohol Use Disorders
Identification Test-Consumption (AUDIT-C;
Saunders, Aasland, Babor, de la Fuente &
Grant, 1993); (c) sleep problems with two items
from the Insomnia Severity Index (ISI; Bastien,
Valliéres & Morin, 2002); and (d) tobacco use
with three items to assess smoking habits. Stu-
dents were given the screening tool by nurses
as they waited for the medical providers follow -
ing the nurse obtaining vital signs. The screen-
91. ing tool clearly describes the purpose of the
questionnaire, the confidentiality of the infor-
mation, and that the items ask about symptoms
unrelated to any current acute illness (e.g., cold,
flu).
Procedure
This study was approved by the Syracuse
University Institutional Review Board. To ob-
tain the provider satisfaction data, we sent three
recruitment emails, one week apart, to all PCPs
and nurses working at the university health
clinic over a 4-week period during the Spring
semester of 2010. The email provided a brief
description of the study and linked the provider
to an anonymous web-based questionnaire. Af-
ter providing informed consent, participants
provided information on whether they were a
PCP (MD, NP) or nurse and filled out a provider
satisfaction survey. Providers were not given
any compensation for participation.
To obtain the patient satisfaction data, we
obtained a list of all students who had at least
one session with an integrated BHP during the
Spring (i.e., January 15 to May 15, 2010) or Fall
semester in 2010 (i.e., August 15 to Decem-
ber 15, 2010) by pulling a list of all patients
who were included in the electronic medical
record as having the specific encounter code
used only by the BHPs to identify behavioral
health visits. Then, email addresses were lo-
cated using the publicly available student email
address directory. In addition, basic demo-
graphics of all IBHC patients were obtained
92. from a tracking database maintained by the
BHPs. We sent three recruitment emails, ap-
proximately 3– 4 weeks apart, to each identified
patient at the end of each semester to their
university-provided email address to ask them
to participate in an anonymous web-based pa-
tient satisfaction survey. After completing in-
formed consent, participants completed the
questionnaire. As an incentive, participants
were offered a chance to win one of 12 $25 gift
cards to an online retailer.
Participants
All PCPs (n � 9, two physician and seven
nurse practitioners) and nurses (n � 10) work-
ing in the university health clinic were eligible
to complete the provider satisfaction question-
naire. Fifteen participants (nine PCPs and six
nurses) did so, yielding a 79% (100% for PCPs
and 60% for nurses) response rate. Because of
the small number of providers at the clinic and
the need to maintain their anonymity to encour-
age higher response rates and candid respond-
133INTEGRATING BEHAVIORAL HEALTH SERVICES
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ing, we did not collect demographics from the
participants.
A total of 303 (175 Spring semester, 128 Fall
semester) unique IBHC patients were identified
using the electronic medical record. A total
of 27 (23 from Spring semester and four from
Fall semester) had recruitment emails returned
because of a nonexistent address error likely
resulting from the fact that the student left the
university for some reason (e.g., graduation). Of
the remaining participants who were eligible
(n � 276), 79 participants (32 Spring semes-
ter, 47 Fall semester) completed the patient sat-
isfaction survey, resulting in an overall 29%
response rate (n � 152, 21% for Spring semes-
ter and n � 124, 38% for Fall semester). The
majority of the participants were female
(n � 59, 75%), white (n � 51, 65%), and not
Hispanic or Latino (n � 72, 91%). To under-
stand the representativeness of our sample, Table
1 presents the demographics for those who partic-
ipated in the study and for the total sample of
patients (n � 303) who saw a BHP during the
Spring and Fall semesters of 2010. Because the
patient satisfaction survey was anonymous, we
were unable to test for demographic differences
between responders and nonresponders.
Measures
98. Provider satisfaction questionnaire. Par-
ticipants rated their level of agreement with 18
statements about the acceptability and useful-
ness of each component of the IBHC program
on a Likert scale that ranged from strongly
disagree (1) to neutral (3) to strongly agree (5).
The 18 items (see Table 2) were generated by
the first and fourth author and focused on each
element of the IBHC program implemented. For
several items, the participant could choose “not
applicable” because of the lack of relevance of
the statement to nurses versus PCPs and vice
versa. Cronbach’s alpha for the scale was .80.
Patient satisfaction questionnaire. Par-
ticipants answered five demographic questions
(i.e., age, sex, race, ethnicity, and class in
school), and three yes/no questions (i.e.,
whether they remembered filling out the screen-
ing measure, whether their PCP discussed one
of the topics on the screening measure with
them, and whether they met with an integrated
BHP). Those who remembered filling out the
screening measure and meeting with the inte-
grated BHP completed an additional six state-
ments (see Table 3) which asked participants to
rate their level of satisfaction, comfort, or will-
ingness on a Likert scale that ranged from (1)
extremely unsatisfied/uncomfortable/unwilling
to (3) neutral to (5) extremely satisfied/
comfortable/willing on a variety of elements
associated with the IBHC program. These items
were generated by the first and fourth author.
For those participants who completed the Likert
portion of the questionnaire, Cronbach’s alpha
99. for those six items was .75.
Table 1
Demographics of Survey Participants and All IBHC Patients
Participant Demographics All IBHC Patients
M SD n % M SD n %
Age 30.0 3.8 79 21.7 4.1 303
Males 20 25.3 121 40.0
Hispanic or Latino 7 8.9 22 7.3
Racea
White 51 64.6 201 66.3
Black 7 8.9 34 11.2
Asian 10 12.7 24 7.9
Other 10 12.7 44 14.5
Classb
Freshman 4 5.1 55 18.2
Sophomore 22 27.8 55 18.2
Junior 17 21.5 47 15.5
Senior 9 11.4 67 22.1
Graduate Student 27 34.2 75 24.8
a One participant left race unknown. b Four patients’ class was
unknown.
134 FUNDERBURK, FIELDER, DEMARTINI, AND FLYNN
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Data Analytic Plan
Because of the descriptive nature of the ob-
jectives of this study, our data analytic plan
focused primarily on examining distributions
and calculating the frequencies, modes, means,
and standard deviations of individual survey
items.
Results
Provider Satisfaction
As shown in Table 2, both PCPs and nurses
reported a high level of support for regular
implementation of the screening measure across
all four screening domains and reported that
patients were comfortable answering the ques-
tions on the screening measure. Providers
strongly agreed that the screening measure
helped stimulate discussion on topics that
would not have come up during the visit other-
wise. There was a greater level of variability
yielding average (i.e., means ranging from 2.5–
3.0) and modal responses within the neutral
105. range for the two items assessing whether the
screening measure took too much time away
from other clinical duties and was difficult to
score and interpret.
PCPs and nurses considered the integrated
BHPs a part of the primary care team and felt
the IBHC program helped patients receive treat-
ment more quickly. PCPs perceived that pa-
Table 2
Provider Ratings of IBHC Acceptability and Satisfaction
Item
PCPs Nurses
n M (SD) Range n M (SD) Range
Rate your level of agreement with the
implementation of regular screening at
SUHS for
a) Depression 9 4.7 (0.5) 4–5 6 4.7 (0.5) 4–5
b) Sleep problems 9 4.3 (1.0) 2–5 6 4.7 (0.5) 4–5
c) Tobacco use 9 4.2 (0.7) 3–5 6 4.6 (0.5) 4–5
d) Alcohol misuse 9 4.7 (0.5) 4–5 6 4.7 (0.5) 4–5
The items that assessed the problem below
were useful in my clinical practice
a) Depressed mood 9 4.4 (0.5) 4–5 2 4.0 (1.4) 3–5
b) Sleep problems 9 3.9 (0.9) 2–5 1 5.0 (0.0) 5
c) Tobacco use 9 3.4 (0.7) 3–5 1 5.0 (0.0) 5
d) Alcohol consumption 9 3.8 (1.0) 2–5 2 4.5 (0.7) 4–5
106. The screening measure
Took too much time away from clinical
duties 9 2.9 (0.8) 2–4 6 2.5 (0.8) 1–3
Was difficult to score and interpret 9 2.6 (1.2) 1–4 5 3.0 (0.7)
2–4
Helped stimulate discussion of topics that
would not have come up during patient
visits 9 4.3 (0.7) 3–5 1 5.0 (0.0) 5
A majority of my patients felt comfortable
answering the questions on the
screening measure 9 4.3 (1.0) 2–5 6 3.8 (0.8) 3–5
The BHPs
Were useful within my clinical practice 9 4.7 (0.5) 4–5 3 4.7
(0.6) 4–5
Became part of our primary care team 9 4.1 (0.6) 3–5 6 3.8 (1.0)
3–5
Benefited my patients 9 4.8 (0.4) 4–5 2 5.0 (0.0) 5
Helped my patients receive treatment
more quickly 9 4.8 (0.4) 4–5 6 5.0 (0.0) 5
I would recommend this service to other
colleagues 9 4.4 (0.7) 3–5 6 4.1 (1.0) 3–5
I would like the integrated behavioral health
service to continue 9 4.7 (0.5) 4–5 6 4.7 (0.5) 4–5
Note. The ns vary because some providers chose “Not
Applicable” for a response.
135INTEGRATING BEHAVIORAL HEALTH SERVICES
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tients benefited from seeing the BHPs. Both
PCPs and nurses would recommend this service
to other colleagues within college health and
would like IBHC to continue in the future.
Patient Satisfaction
Results of the satisfaction assessment indi-
cate that a majority of the sample of patients
were satisfied with their overall care at SUHS
(see Table 3). A number of students did not
remember filling out the screening question-
naire (n � 13, 17%) or meeting with a BHP
(n � 26, 33%), so they did not rate their satis-
faction or report on those elements of the IBHC
program in Table 3. Of those who remembered
completing the questionnaire, the majority re-
ported that they talked to the medical provider
about a topic on the screening measure (n � 57,
86%). Of those who remembered meeting with
a BHP, the majority reported that they felt that
the BHP helped them with the topic that they
112. discussed (n � 38, 73%).
As shown in Table 3, overall participants
reported a general level of comfort filling out
the screening measure, were satisfied with the
service provided by the integrated BHP, and
would be willing to seek help from the BHP
again if necessary. Although the average re-
sponse was within a level of agreement
(M � 3.6), there was a greater level of variabil-
ity when it came to having the service within the
university health setting as compared with a
specialty mental health clinic on campus, with a
mode of 3.0 indicating a neutral response.
Discussion
As expected, this study found that PCPs,
nurses, and patients reported positive experi-
ences with the two major components of the
IBHC program: the implementation of a behav-
ioral health screening assessment and the inte-
gration of BHPs into the university health cen-
ter. The results provide further evidence that
this model of care can be used on college cam-
puses with success in terms of provider and
patient satisfaction.
Similar to past research (Alschuler et al.,
2008; Cowan & Morewitz, 1995), this study
found that providers indicated that having brief
screening items to assess sleep problems, de-
pression, alcohol use, and tobacco use was help-
ful to their clinical practice. In addition, the
assessment items reportedly helped stimulate
113. discussions with patients about topics that
would not have otherwise been discussed.
Alschuler and colleagues (2008) found a similar
result such that those providers whose patients
Table 3
Patient Ratings of IBHC Satisfaction and Acceptability
Item n Mode M SD Range
Rate your overall level of satisfaction with
the visit(s) you had at University Health
Service 79 4.0 3.4 1.1 1–5
Rate your level of comfort filling out the
screening questionnaire during your visit 66 4.0 3.5 1.1 1–5
Rate your level of satisfaction with the
service you were provided during the visits
with the integrated behavioral health
provider 52 4.0 3.4 1.2 1–5
Rate your level of willingness meet with one
of those providers again if something else
or that issue continued 52 4.0 3.4 1.4 1–5
Rate your level of comfort meeting with them
at University Health Service rather than
some other location on campus (e.g., SU
Counseling Center) 52 3.0 3.6 1.0 2–5
Rate your level of comfort with the length of
the meetings (i.e., typically less than 40
minutes) with the integrated behavioral
health provider 52 4.0 3.7 0.9 2–5
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were randomly assigned to fill out a mental
health questionnaire discussed those issues with
their patients more than those providers whose
patients were not assigned to fill out the ques-
tionnaire. Not only did providers perceive the
screening questionnaire as having a high level
of utility within their clinical practice, but the
patients also reportedly were comfortable with
filling out the questionnaire during their ap-
pointments.
Our findings highlight the importance of se-
lecting an appropriate screening questionnaire
that can be completed and scored quickly. A
common concern among providers when dis-
cussing the implementation of regular screening
for mental health issues is the time involved in
integrating the screen within the clinical ap-
pointment (Thomas, Waxmonsky, McGinnis, &
Barry, 2006). Within this study, a majority of
119. the providers and nurses reported responses
within the neutral range when asked about
whether the screening measure took time away
from other clinical duties. This is not surprising
as the questionnaire obviously does add time to
the patient visit, as noted in prior research
(Alschuler et al., 2008). The typical patient ap-
pointment at this clinic is only 15 minutes, so
allocating 1–2 minutes to review the screen with
the patient would reduce the time left to focus
on the patient’s presenting complaint. The fact
that providers endorsed a modal response
within the neutral range suggests that the
screening can be incorporated without a signif-
icant negative impact. One study on behavioral
health screening found that using a measure that
includes areas specific to college students (e.g.,
academic stress, risky sexual behavior) im-
proved detection of students struggling with
adjustment issues compared to a more general
screening measure (Alschuler, Hoodin, & Byrd,
2009). However, the benefit of added sensitivity
from a college-specific screening measure may
not offset the cost of greater administration and
scoring time. As completion time increases, the
rate of compliance with screening may de-
crease.
Another element that was identified within
this study was the importance of not only de-
signing the screening questionnaire to be easily
comprehended by patients but to make sure it is
easily scored and interpreted by providers. Most
providers did not indicate difficulty scoring or
interpreting the screen. However, anecdotally
120. there were some problems with patients incor-
rectly self-scoring the PHQ-9; this may have led
to some confusion or the need for providers to
double-check or recalculate scores. The screen-
ing tool was later modified to discourage pa-
tients from totaling their own scores. To maxi-
mize screening coverage and efficiency, it is
important to select brief, user-friendly, vali-
dated measures that are easy to score and inter-
pret (Kirkcaldy & Tynes, 2006).
As university health centers work toward im-
proving the identification and treatment of men-
tal health issues as well as implementing rec-
ommended screening guidelines for depression,
suicidal ideation, tobacco use, and alcohol mis-
use, this study suggests that an IBHC program
may be one way to effectively accomplish this
while maintaining provider and patient satisfac-
tion. A previous study of behavioral health
screening in university health centers found that
screening increased discussion of behavioral
health issues among patients and PCPs
(Alschuler et al., 2008). However, PCPs re-
ported that they did not have the time or the
expertise to adequately address behavioral
health issues with patients, but they were open
to collaborating with BHPs. Likewise, our re-
sults suggest high willingness to refer patients
to BHPs to improve attention to behavioral
health issues. Thus, the IBHC program can help
PCPs deal with positive screens by providing
the integrated BHPs, who are trained to assess
mental health issues and provide brief treatment
on-site or facilitate a referral to a specialty men-
tal health clinic.
121. Regarding the integrated BHPs component of
the IBHC program, PCPs also strongly indi-
cated that their patients benefited from the ser-
vices provided by the BHPs. The providers felt
that having the integrated BHPs helped patients
receive treatment faster (compared to referring
them to specialty mental health) and that the
BHPs functioned as part of the overall care
team. All of the providers reported that they
would strongly recommend the IBHC to other
colleagues working in college health. Taken
together, these results indicate satisfaction
among the medical providers, which is essential
for the success of IBHC. Strong buy-in on the
part of PCPs is needed to sustain the implemen-
tation of a new clinical program like IBHC,
which requires procedural changes and addi-
tional effort (i.e., reviewing screens, referring
137INTEGRATING BEHAVIORAL HEALTH SERVICES
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126. patients to BHPs). Acceptability among the
nurses is also important, as they were the ones
responsible for offering patients the behavioral
health screens in our IBHC program.
Similarly, satisfaction and acceptability were
high among patients. Patients who were seen by
BHPs reported feeling comfortable with the ser-
vices received and were willing to be seen again
should the service be needed in the future.
These results corroborate Westheimer and
Steinley-Bumgarner’s (2008) finding that pa-
tients were accepting of referrals to BHPs. Pa-
tients may like the convenience of being seen
quickly by BHPs in health centers. In the case
of BHPs having open access schedules, patients
can be seen immediately after their PCP visit,
which eliminates the need for scheduling an-
other appointment or returning to the health
center; in contrast, specialty mental health cen-
ters may have long (e.g., up to 2–3 weeks) wait
times (Mowbray et al., 2006). Also, health cen-
ters carry less stigma compared with specialty
mental health settings. On average, the patients
were comfortable seeking services at the uni-
versity health center, but there was a greater
level of variability suggesting some individual
differences as to the comfort of seeking those
services at a specialty mental health clinic.
Limitations
Interpretation of the findings should take into
account the limitations of the study. First, al-
though slightly higher than that found in other
research using similar methodology (Shih &
127. Fan, 2009), our response rate for the patient
satisfaction survey was 29%. The response rate
may be improved by contacting patients soon
after their final IBHC visit instead of at the end
of each semester, which is generally a busy time
for students. Second, a significant proportion of
the patients did not remember completing the
screening questionnaire or meeting with a BHP.
Patients may not have remembered completing
the screening questionnaire because it was a
brief (i.e., 2–3 minutes) activity and/or because
their health center visit was up to four months
before completing the satisfaction survey. It is
possible that the students who did not remember
meeting with a BHP had a more neutral expe-
rience than the students who remembered the
program. Thus, the satisfaction ratings could be
artificially elevated because of this lack of data.
It is also possible, however, that these students
did not remember the meeting with the BHP
because they simply considered the components
of the IBHC part of standard medical care.
Authors have noted that primary care has be-
come the “de facto mental health care system”
(Kessler & Stafford, 2008, p. 9), so these stu-
dents may have expected to discuss behavioral
health problems during their visit and may not
have perceived the BHP as different from a
regular medical provider.
Third, patient data were obtained via anony-
mous self-report. Though this method of data
collection was necessary because of the scope
of this study, it prohibited collection of identi-
fying information, including diagnostic infor-
128. mation. The ability to compare satisfaction
across diagnostic categories would have pro-
vided beneficial information, including whether
patients with more severe diagnoses (e.g., major
depressive disorder vs. adjustment disorder with
depressed mood) had equally positive experi-
ences with the program. In addition, the satis-
faction ratings are limited to only those patients
who were seen by an integrated BHP. Future
research should compare satisfaction between
patients seen within IBHC and patients seen
within standard care (i.e., the PCP provides any
treatment for behavioral health concerns or
makes a referral to specialty mental health).
Fourth, the provider and patient satisfaction
measures were created specifically for this
study. The limited range of response options
(1–5) may contribute to restricted range/
variability and ceiling effects. These limitations
should not be ignored when considering the
generalizability of the study.
Finally, the scope of this study did not allow
us to obtain information on the clinical out-
comes associated with the IBHC program. Al-
though providers reported that patients benefit-
ted from meeting with BHPs, their perceptions
were based solely on behavioral observations of
and/or self-report from patients, not on clinical
outcome data. Future research should evaluate
the clinical effectiveness of interventions deliv-
ered by integrated BHPs. From an IBHC per-
spective, other markers of success that are wor-
thy of future study include increased access to
mental/behavioral health services, improved
identification of mental/behavioral health issues
129. through screening, increased referral uptake
(i.e., BHPs referral attendance compared to spe-
138 FUNDERBURK, FIELDER, DEMARTINI, AND FLYNN
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cialty mental health referral attendance) attrib-
utable to colocation and “warm hand-offs,” im-
proved provider communication (e.g., between
BHPs and PCPs), reduced burden on specialty
mental health centers from patients with sub-
threshold or mild symptoms, and reduced bur-
den on PCPs from repeat visits because of psy-
chosocial issues.
Conclusions
In summary, providers and patients indicated
a high level of satisfaction with this IBHC pro-
gram. Accordingly, providers are likely to refer
patients to BHPs, and patients are likely to
engage in brief treatment within the IBHC pro-
gram. Given the increasing demand on univer-
134. sity primary care clinics to address the mental
health needs of students, IBHC offers a prom-
ising method whereby to address this need. Par-
ticularly in light of data that indicate that most
college students do not seek needed mental
health treatment (Rosenthal & Wilson, 2008),
the finding that IBHC patients would feel com-
fortable seeing a BHP again in the future is a
positive step toward making mental health care
more accessible to patients who need treatment.
References
Alschuler, K., Hoodin, F., & Byrd, M. (2008). The
need for integrating behavioral care in a college
health center. Health Psychology, 27, 388 –393.
doi:10.1037/0278-6133.27.3.388
Alschuler, K. N., Hoodin, F., & Byrd, M. R.
(2009). Rapid assessment for psychopathology
in a college health clinic: Utility of college
student specific questions. Journal of American
College Health, 58, 177–179. doi:10.1080/
07448480903221210
American Academy of Pediatrics. (2001). Alcohol
use and abuse: A pediatric concern. Pediatrics,
108, 185–189. doi:10.1542/peds.108.1.185
American College Health Association. (2010a).
American College Health Association National
College Health Assessment II: Reference Group
Executive Summary Spring 2010. Linthicum, MD:
Author.
American College Health Association. (2010b). Con-
135. siderations for integration of counseling and
health services on college and university cam-
puses. Journal of American College Health, 58,
583–596. doi:10.1080/07448481.2010.482436
Bastien, C. H., Valliéres, A., & Morin, C. M. (2002).
Validation of the Insomnia Severity Index as an
outcome measure for insomnia research. Sleep
Medicine, 2, 297–307. doi:10.1016/S1389-
9457(00)00065-4
Blount, A., Schoenbaum, M., Kathol, R., Rollman,
B. L., Thomas, M., O’Donohue, W., & Peek, C. J.
(2007). The economics of behavioral health ser-
vices in medical settings: A summary of the evi-
dence. Professional Psychology: Research and
Practice, 38, 290 –297. doi:10.1037/0735-
7028.38.3.290
Bryan, C. J., Morrow, C., & Appolonio, K. K. (2009).
Impact of behavioral health consultant interven-
tions on patient symptoms and functioning in an
integrated family medicine clinic. Journal of
Clinical Psychology, 65, 281–293. doi:10.1002/
jclp.20539
Christmas, W. A. (1995). The evolution of medical
services for students at colleges and universities
in the United States. Journal of American College
Health, 43, 241–246. doi:10.1080/07448481
.1995.9940897
Cigrang, J. A., Dobmeyer, A. C., Becknell, M. E.,
Roa-Navarrete, R. A., & Yerian, S. R. (2006).
Evaluation of a collaborative mental health pro-
136. gram in primary care: Effects on patient distress
and health care utilization. Primary Care & Com-
munity Psychiatry, 11, 121–127. doi:10.1185/
135525706X121192
Cowan, P. F., & Morewitz, S. J. (1995). Encouraging
discussion of psychosocial issues at student health
visits. Journal of American College Health, 43,
197–200. doi:10.1080/07448481.1995.9940476
Eisenberg, D., Golberstein, E., & Gollust, S. E.
(2007). Help-seeking and access to mental
health care in a university student population.
Medical Care, 45, 594 – 601. doi:10.1097/
MLR.0b013e31803bb4c1
Fitzpatrick, R. (1991). Surveys of patient satisfac-
tion: I—Important general considerations. British
Medical Journal, 302, 887– 889. doi:10.1136/
bmj.302.6781.887
Gallo, J. J., Zubritsky, C., Maxwell, J., Nazar, M.,
Bogner, H. R., Quijano, L. M., . . . Levkoff, S. E.,
& the PRISM-E investigators (2004). Primary
care clinicians evaluate integrated and referral
models of behavioral health care for older adults:
Results from a multisite effectiveness trial
(PRISM-E). Annals of Family Medicine, 2, 305–
309. doi:10.1370/afm.116
Garlow, S. J., Rosenberg, J., Moore, J. D., Haas,
A. P., Koestner, B., Hendin, H., & Nemeroff,
C. B. (2008). Depression, desperation, and sui-
cidal ideation in college students: Results from
the American Foundation for Suicide Prevention
College Screening Project at Emory University.
137. Depression and Anxiety, 25, 482– 488. doi:
10.1002/da.20321
Goodie, J. L., Isler, W. C., Hunter, C., & Peterson,
139INTEGRATING BEHAVIORAL HEALTH SERVICES
T
hi
s
do
cu
m
en
t i
s
co
py
ri
gh
te
d
by
th
e
A
m
141. e
di
ss
em
in
at
ed
b
ro
ad
ly
.
A. L. (2009). Using behavioral health consultants
to treat insomnia in primary care: A clinical case
series. Journal of Clinical Psychology, 65, 294 –
304. doi:10.1002/jclp.20548
Kessler, R., & Stafford, D. (2008). Primary care is
the de facto mental health system. In R. Kessler &
D. Stafford (Eds.), Collaborative medicine case
studies: Evidence in practice (pp. 9 –21). New
York: Springer. doi:10.1007/978-0-387-76894-
6_2
Kirkcaldy, R. D., & Tynes, L. L. (2006). Depression
screening in a VA primary care clinic. Psychiatric
Services, 57, 1694 –1696. doi:10.1176/appi.ps
142. .57.12.1694
Masters, K. M., Stillman, A. M., Browning, A. D., &
Davis, J. W. (2005). Primary care psychology
training on campus: Collaboration within a stu-
dent health center. Professional Psychology: Re-
search and Practice, 36, 144 –150. doi:10.1037/
0735-7028.36.2.144
Mills, D., Gold, R., & Curran, M. (1996). Healthcare
reform: A survey of college health services. Jour-
nal of American College Health, 45, 106 –117.
doi:10.1080/07448481.1996.9936870
Mowbray, C. T., Megivern, D., Mandiberg, J. M.,
Strauss, S., Stein, C. H., Collins, K., . . . Lett, R.
(2006). Campus mental health services: Recom-
mendations for change. American Journal of Or-
thopsychiatry, 76, 226 –237. doi:10.1037/0002-
9432.76.2.226
Nimalasuriya, K., Compton, M. T., Guillory, V. J., &
Prevention Practice Committee of the American
College of Preventive Medicine. (2009). Screen-
ing adults for depression in primary care: A po-
sition statement of the American College of Pre-
ventive Medicine. Journal of Family Practice, 58,
535–538.
Reiss-Brennan, B., Briot, P., Daumit, G., & Ford, D.
(2006). Evaluation of “depression in primary
care” innovations. Administration and Policy in
Mental Health and Mental Health Services Re-
search, 33, 86 –91. doi:10.1007/s10488-005-
4239-x
143. Rosenthal, B., & Wilson, W. C. (2008). Mental
health services: Use and disparity among diverse
college students. Journal of American College
Health, 57, 61– 68. doi:10.3200/JACH.57.1.61-68
Runyan, C. N., Fonseca, V. P., & Hunter, C. (2003).
Integrating consultive behavioral healthcare into
the Air Force Medical System. In W. T.
O’Donohue, K. E. Ferguson, & N. A. Cummings
(Eds.), Behavioral health as primary care: Be-
yond efficacy to effectiveness (pp. 145–163).
Reno, NV: Context Press.
Saunders, J. B., Aasland, O. G., Babor, T. F., de la
Fuente, J. R., & Grant, M. (1993). Development
of the Alcohol Use Disorders Identification Test
(AUDIT): WHO collaborative project on early
detection of persons with harmful alcohol con-
sumption, II. Addiction, 88, 791– 804. doi:
10.1111/j.1360-0443.1993.tb02093.x
Shih, T., & Fan, X. (2009). Comparing response rates
in e-mail and paper surveys: A meta-analysis.
Educational Research Review, 4, 26 – 40. doi:
10.1016/j.edurev.2008.01.003
Sitzia, J., & Wood, N. (1997). Patient satisfaction: A
review of issues and concepts. Social Science &
Medicine, 45, 1829 –1843. doi:10.1016/S0277-
9536(97)00128-7
Spitzer, R. L., Kroenke, K., & Williams, J. B. W.
(1999). Validation and utility of a self-report ver-
sion of PRIME-MD: The PHQ primary care
study. JAMA: Journal of the American Medical