Implementing an APRN-Led Integrated Behavioral Health Clinic in a Rural Community.

OBJECTIVE: A rural primary care clinic implemented an advance practice providers, including nurse practitioner (APRN)-led integrated behavioral health program to facilitate holistic health care delivery. METHODS: Implementation was facilitated by Health Resources and Services Administration Grant funding to a state University College of Nursing. The College formed an academic-practice partnership with a Federally Qualified Health Center (FQHC) to implement integrated care in a rural satellite clinic administered by the FQHC. An interdisciplinary team (two family APRNs, a psychiatric APRN, a licensed behavioral health provider, and the Grant Project Director who is a Psychiatric APRN and a licensed Psychologist) provided the integrated care based on the University of Washington's Collaborative Care Model. RESULTS: This brief report describes the implementation of integrated care during the clinic's first year, services provided, lessons learned, community response, and improvement in anxiety and depressive symptoms for patients who were treated for behavioral health problems. An exemplar illustrates how collaborative care addressed one patient's behavioral health and primary care needs. CONCLUSIONS: APRN-led collaborative care can expand access to holistic, affordable care in rural areas to improve mental health. Adaptation and flexibility in traditional roles may be necessary and determining post-grant access to funding for services will be necessary for sustainability.

Afraid to Seek Care? A Fixed Effects Analysis of State Fetal Protection Legislation and Prenatal Healthcare Utilization from 2002 to 2015.

•Fixed-effects analysis of fetal protection policies on prenatal healthcare utilization.•Original panel data examines changes across the United States between 2002 and 2015.•Certain policies are associated with fewer women utilizing prenatal healthcare when recommended.•State policies may have unintended consequences on maternal decision-making.

Childhood adversity, mental health, and the perpetration of physical violence in the adult intimate relationships of women prisoners: A life course approach.

BACKGROUND: Adverse childhood experiences (ACEs) are common, with nearly two-thirds of adult samples reporting exposure to at least one and one-quarter reporting exposure to three or more distinct types of ACEs. ACEs have been linked to various negative outcomes across the life course, including mental health problems, and the perpetration of physical violence in intimate relationships. However, little is known about the relationships between ACEs, PTSD symptomology, and use of physical violence against an adult intimate partner among incarcerated women. OBJECTIVE: The purpose of this paper is to examine the relationships between ACEs, PTSD symptoms, and the perpetration of the physical violence in the adult intimate relationships of women prisoners. METHODS: Using data from the 2014 Oklahoma Study of Incarcerated Mothers and Their Children (N = 349) and structural equation modeling (SEM) techniques, we investigate the potential mediating effect of PTSD symptoms in the relationship between ACEs and perpetrating violence against an intimate partner. RESULTS: Our findings indicate that PTSD symptomology fully mediates the relationship between ACEs and the perpetration of physical violence against an adult intimate partner, indicating that PTSD experiences may be central to understanding women's pathways toward violence. CONCLUSIONS: Women prisoners who were exposed to ACEs during childhood were at a particularly elevated risk of developing PTSD symptomology and perpetrating physical violence against an adult intimate partner. Based on the current study's findings, treatment programs that address these complex relationships between ACEs, particularly focusing on the central role of mental health in these processes, are needed for incarcerated women.

Advantage and choice: social relationships and staff assistance in assisted living.

UNLABELLED: OBJECTIVES. To understand how "cumulative inequality" (CI), expressed as individual advantage and choice, and "external social supports" contribute to the quality of social relationships and perceptions of staff assistance for older individuals in different assisted living (AL) settings. METHODS: Data are from 429 cognitively intact AL residents aged 60 years and older interviewed for the Florida Study of Assisted Living. Bivariate and multivariate statistical analyses show how individual advantage and choice and external social networks influence respondents' social relationships and staff assistance in AL. RESULTS: Controlling for resident and facility characteristics, being able to pay privately enhances resident satisfaction with staff assistance and having control over the move to AL is positively associated with perceptions of staff relationships and assistance. Maintaining contact with pre-AL friends predicts quality of coresident relationships, as does family contact. Regular contact with family buffers some of the disadvantages associated with CI for perceptions of staff relationships but not perceptions of staff assistance. Discussion. Individual advantage and choice influence the quality of staff relationships and assistance for AL residents but matter little for coresident relationships. External social relationships buffer some of the risks associated with CI for perceptions of staff relationships but not perceived quality of staff assistance. Findings highlight outcomes associated with CI, including predictable risks that disadvantaged elders face in particular types of AL settings, differential advantages others enjoy that influence positive perceptions of staff relationships and staff assistance, and the enduring importance of supportive social relationships.

The effect of licensure type on the policies, practices, and resident composition of Florida assisted living facilities.

PURPOSE: Most assisted living facility (ALF) residents are White widows in their mid- to late 80s who need assistance with activities of daily living (ADLs) because of frailty or cognitive decline. Yet, ALFs also serve younger individuals with physical disabilities, traumatic brain injury, or serious mental illness. We compare Florida ALFs with different licensure profiles by admission-discharge policies and resident population characteristics. DESIGN AND METHODS: We use state administrative data and facility survey data from the Florida Study of Assisted Living (FSAL) to classify ALFs by licensure type and to determine how licensure influences ALF policies, practices, and resident population profiles. RESULTS: Standard-licensed traditional ALFs primarily serve elderly White women with physical care needs and typically retain residents when their physical health deteriorates. Some ALFs that hold specialty licenses (extended congregate care and limited nursing services) offer extra physical care services and serve an older, more physically frail population with greater physical and cognitive challenges. ALFs with limited mental health (LMH) licenses serve clientele who are more racially and ethnically diverse, younger, and more likely to be men and single. LMH facilities also have a significant proportion of frail elder residents who live alongside these younger residents, including some who exhibit behavioral problems. LMH facilities also employ discharge policies that make it more difficult for frail elderly residents to age in place. IMPLICATIONS: These differences by facility type raise important quality of life issues for both the frail elderly individuals and assisted living residents who do not fit the conventional demographic profile.

Educational expectations and the rise in women's post-secondary attainments.

This study examines the gender difference in educational expectations among black, white, and Hispanic high school seniors in 1972 and 1992. We link gender-related changes in expectations to students' perceived parental encouragement for higher education and access to college-preparatory coursework, and then examine the influence of expectations on subsequent educational attainments. In contrast to 1972, girls in 1992 perceived their parents to be equally or more encouraging of their pursuit of higher education than did boys, and girls were more likely to be enrolled in college preparatory coursework. The changes were most dramatic among white students, and the rise in expectations among high school girls independently contributes to their recent advances in higher education.

The salience of social relationships for resident well-being in assisted living.

OBJECTIVES: We examined how organizational characteristics, transition experiences, and social relationships impact three subjective measures of well-being among assisted living residents: life satisfaction, quality of life, and perception that assisted living feels like home. METHODS: Data were from 384 assisted living residents interviewed for the Florida Study of Assisted Living. Using ordinary least squares and logistic regression we estimated associations between resident well-being and organizational characteristics, transition experiences, and social relationships, controlling for gender, age, education, and physical functioning. RESULTS: To varying degrees depending on the measure used, higher resident well-being was associated with facility size, facility acceptance of payment from Florida's low income program, and resident perceptions of adequate privacy. Non-kin room sharing reduced life satisfaction, whereas food quality positively affected all measures of well-being. The most consistent findings concerned internal social relationships. Residents with high scores on internal social relationship measures reported more positive well-being across all measures than residents with low scores on the same measures. DISCUSSION: Individuals have the capacity to form new support networks following a move to assisted living, and relationships formed become more salient to their well-being than the continuation of past relationships or the physical characteristics of the immediate surroundings.

Identifying clinical scholarship guidelines for faculty practice.

Clear descriptors of faculty practice and scholarly activities are essential to precisely demonstrate that the faculty practice role meets the standards of academic advancement and to influence academic policy. A description of scholarly clinical activities (1) justifies the benefits of faculty practice by means other than fiscal, (2) provides data for research regarding faculty practice, and (3) provides data to support the nursing profession's political, social, and health care agendas. Guidelines for clinical scholarship are described in this article. A review of relevant literature demonstrates that these guidelines go beyond current models by describing 24 scholarly activities organized into 4 areas: quality, governance, leadership, and knowledge development. Three years of data describing the scholarly activities of a college of nursing faculty engaged in practice are presented to demonstrate the effectiveness of the indicators in achieving these goals. These data can provide valuable information for trend analysis and, through heightened awareness of opportunities, increase faculty clinical scholarship activities.

Integral Nursing: an emerging framework for engaging the evolution of the profession.

These are turbulent times for health care as well as nursing. Nursing needs to consciously evolve to survive and thrive in the 21st century. The authors suggest that nursing has many of the theoretical and conceptual models needed to facilitate this evolution. However, the profession would benefit from the addition of a comprehensive framework that can integrate various aspects of nursing and serve as a device to effectively interface nursing with the rest of the health care system. We believe that the Integral Nursing approach described here is such a framework. In this article, we describe the model and explore benefits of its application for nursing within health care.