Doctor of Healthcare Administration (D.H.A.), Franklin University, 2020, Health Programs

Mental illness is a growing concern among families in the United States, as one in five children between the ages of 13 and 18 suffer from a severe mental illness (National Alliance on Mental Illness, 2013). That means that 20% of children in the country are suffering from an illness whose treatment is difficult to access. Unfortunately, one-fourth of families report problems finding and initiating services for their children, with wait lists that typically start at three months (American Academy of Child and Adolescent Psychiatry, 2013). Even more troubling is the fact that 80% of children with mental illness do not receive any treatment at all (American Academy of Child and Adolescent Psychiatry, 2013). However, to improve access to treatment, organizations need to feel confident that they can open safe, financially sustainable mental health units. The Children's Hospital of Orange County (CHOC) in California recently opened an 18-bed inpatient psychiatric unit that services children ages 3-17 (Perkes, 2016). Many months of thoughtful consideration occurred to develop this elite and cutting-edge model of care. This researcher developed a specific model to approach pediatric mental healthcare through a different lens, called The Core Value Driven Care Model. The model of care is centered around three pillars of focus firmly built on the groundwork of core values. The pillars are representative of People, Place, and Practice, and are anchored in a foundation of empathy, compassion, trust, integrity, dignity, respect, sincerity, unity, honesty, and open-mindedness, as well as trauma-informed thinking. Implementing the Core Value Driven Care Model in a pediatric mental health unit directly impacts the perception of safety and quality of care being provided. The purpose of this study will be to assess the impact the 11 foundational core values have on employee perception of employee safety, patient safety, and quality of care.

Committee: David Meckstroth (Committee Chair); Alyncia Bowen (Committee Member); Jesse Florang (Committee Member) Subjects: Health Care; Health Care Management; Management; Mental Health; Occupational Health; Occupational Safety; Psychology; Systems Design

Psy. D., Antioch University, 2014, Antioch New England: Clinical Psychology

In 2009, Gawande published an article in The New Yorker that put the unknown mid-sized South Texas city of McAllen on the map. The article stated that McAllen was one of the most expensive health care markets in the country; it caused such media-frenzy that in a few days President Barack Obama (2009) began citing McAllen in his speeches for health care reform. Gawande concluded that overspending in the area was due to overutilization of medical services. The present study examined whether mental health services are overutilized based on archival data on McAllen's mental health services collected from Medicaid, Tropical Texas Behavioral Health (a McAllen area community mental health center [CMHC]), and The Behavioral Center at Doctors Hospital at Renaissance (a McAllen area private hospital). Findings yielded that diagnostic-related groups significantly impacted the average length of stay, as well as total costs for psychiatric inpatient treatment in McAllen, TX. Schizophrenia spectrum disorders required more days of treatment within the hospital than Bipolar disorders and further more days than Depressive disorders. Correspondingly, inpatient treatment of Schizophrenia spectrum disorders cost an additional $5,554.80 when compared to Bipolar disorders and $9,095.16 more than for Depressive disorders. Additionally, the readmission rate at Doctors Hospital was 26.72%, with nearly 1/4 of patients being readmitted at least once, and nearly 7% had 4 or more psychiatric hospitalizations within a one-year period. This readmission rate was higher than the national average perhaps because of inadequate after-care outpatient treatment in McAllen. Medicaid data showed that Texas consistently failed to contribute any state moneys to mental health spending; and that Massachusetts saw a considerably smaller increase in mental health expenditures over a 10-year period for both inpatient and outpatient services when compared to the United States as a whole (i.e., 26% vs. 260% for (open full item for complete abstract)

Committee: Gargi Roysircar Ph.D. (Committee Chair); David Hamolsky Psy.D. (Committee Member); Carlotta Willis Ph.D. (Committee Member) Subjects: Clinical Psychology

Psy. D., Antioch University, 2021, Antioch New England: Clinical Psychology

This dissertation explored interdisciplinary team functioning on a long-term adolescent inpatient psychiatric unit. It compared staff perceptions (MHCs, clinicians, and nurses) of interdisciplinary coherence and unit effectiveness. This study was particularly focused on understanding MHCs perceptions of team functioning and how satisfied team members are with their level of input and involvement in team decision-making. Additionally, this study explored possible barriers to effective team functioning in this setting. Eighty-four participants in this study completed the Interdisciplinary Team Process and Performance Survey (ITPPS) to assess perceptions of team functioning. Participants answered additional questions assessing barriers to communication and collaboration and levels of satisfaction with their input in the team's decision-making process. A one-way ANOVA was conducted to compare perceptions of team cohesion and team effectiveness across occupations. Results suggest that there is a significant difference among the three occupational groups regarding their perceptions of how their team functions, with MHCs having more negative perceptions of team processes than nurses and clinicians. This team ranked the three highest barriers to communication and collaboration: (a) Differences in accountability, payment, and rewards; (b) Hierarchy; and (c) Lack of training for MHCs. Regarding levels of satisfaction, results showed that MHCs reported the lowest levels of satisfaction, while clinicians rated the highest levels of satisfaction. With these findings, recommendations were made for ways in which long-term inpatient adolescent psychiatric hospitals can work to improve their interdisciplinary team functioning to increase job satisfaction and improve patient care.

Committee: Martha Straus Ph.D. (Committee Chair); Barbara Belcher-Timme Psy.D. (Committee Member); George Tremblay Ph.D. (Committee Member) Subjects: Clinical Psychology