RESIDENCY PRESENTATION

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Prior to attending Residency, you submitted a paper outlining your topic, gap, foundational theory, problem, and methodology. Those components have likely undergone some degree of revision. In this assignment, you will defend your choices of topic, gap, foundational theory, problem, and methodology as revised during Residency.

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Use the following information to ensure successful completion of the assignment:

· Locate the RSD-851 Defense Template on the DC Network: https://dc.gcu.edu/documents/refereancestandards/2013-residency-2/2013-rsd-851/01_required_pre_residency_assignments_and_activities (ATTACHED)

· Doctoral learners are required to use APA style for their writing assignments.

· Refer to Chapters 2-4 of the Publication Manual of the American Psychological Association (6th ed.) for specific guidelines related to doctoral level writing. These chapters contain essential information on manuscript structure and content, clear and concise writing, and academic grammar and usage.

· This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.

· You are required to submit this assignment to LopesWrite.

 

 

 

 

Prospectus presentation

Factors Influencing Individuals’ Decision to not Utilize Mental Health in South Texas

 

 

RSD-881 Residency: Presentation of Progress

James Dada

Grand Canyon University

January 27, 2020

 

Purpose Statement

 

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The purpose of this qualitative descriptive study is to examine how mental health providers describe the factors influencing individuals’ decision to not utilize mental health services in South Texas

 

 

 

Background of the Problem

History

U.S. Mental Health Care & Policy: Mental Health America (MHA), was developed in 1909

First studies on the effects of not using mental health services was identified in the mid-1950s

It found that institutional inpatient and outpatient care models are required

It also facilitated the development of a variety of antipsychotic drugs

 

(Mental Health America, 2020)

 

Literature review

Background/GAP

 

Factors Influencing Individuals’ Decision Not Using Mental Health

Stigmatization of mental illness

Concern over confidentiality

Concerns about cost

Causes of Problem

Uninsured

Fear of other people finding out

 

Negative attitudes towards seeking help generally due to the unhygienic and confinement of mentally ill individuals.

 

Lower income earnings makes it had to get mental health services

Solution

Reducing stigma

Improving mental health literacy

Creating Awareness

 

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Literature review

Background/GAP (Cont’d.)

 

Objective: To examine the factors influencing individuals’ decision to not utilize mental health in South Texas

 

Augsberger, A., Yeung, A., Dougher, M., & Hahm, H. C. (2015). Measured the history of suicidal ideation and suicide attempts over the last 12 months among Asian Americans

Result:

Asian parents dismissive of mental health concerns

Mental health & cultural stigma was identified as the central theme on the family and community levels.

Among 701 participants identified , more than 60% of women of the high-risk group did not access any mental health care

Recommendations:

Reduce stigma and educate about mental illness

Create awareness and acknowledgment of mental health issues in the Asian community

Encourage culturally sensitive screening and treatment services that incorporate cultural aspects

 

 

 

 

 

 

5

Literature review

Theoretical Foundations

 

De Luca et.al. (2016). Contends that conflicting results surround the impact of race/ethnicity on utilization of Mental Health treatment. The author has confirmed in some of his empirical studies by comparing the variances in the rates of utilization of Mental Health among the African Americans, Caucasians and Hispanics in Southern Texas. https://link.springer.com/article/10.1007/s10597-015-9964-3

 

 

 

 

 

 

 

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Problem Statement

 

It is not known how do mental health providers describe the factors influencing individuals’ decision to not utilize mental health services?

Review of the Literature

 

Physical Activity: Substance abuse such as drugs, including nicotine and alcohol, tend to change how individuals feel, because they want to feel better or different. However, experts say physical activity allows children to have a better outlook on life by building confidence, managing anxiety and depression, and increasing self-esteem and cognitive skills (Tala, 2017).

Cognition: Research suggests that drug abuse alters cognitive activities such as decision-making and inhibition, likely setting the stage for addiction and relapse. However, treatment for mental illness, alcohol abuse or drug abuse helps in reducing subsequent medical care utilization (Boardwalk Recovery Center. 2019).

Lifestyle Choices and Mental Health: Better mental health was linked to higher frequency of physical and mental activity, moderate alcohol consumption (i.e. not increased or no alcohol consumption), non-smoking, a body mass index within the range of normal to overweight (i.e. not underweight or obese) and a regular life rhythm (Velten, J., Lavallee, K. L., Scholten, S., Andrea Hans Meyer, A. H., Xiao-Chi Zhang, X. Schneider, S., & Margraf, J. 2015).)

 

 

Population, Target population & Sample

Population:

Individuals who do not utilize Mental Health but needs it

Target Population:

Mental Health providers with membership of Mental Health Association

Sample:

The sample will be in South Texas of the United States

Out of a population of 20 within the Mental Health Providers

10% of the total population

Questionnaire: Minimum of 40

Interviews: Minimum of 12 Mental Health providers

Research Questions

 

 

 

 

 

 

 

 

RQ2

What do mental health professionals consider appropriate mental health interventions for the Southern Texas population

 

 

 

 

 

 

 

 

 

RQ1

What do Mental Health providers perceive as barriers to accessing mental health care in Southern Texas?

 

 

Phenomena

To understand why the people living in Southern Texas are not effectively utilizing mental health services

 

There is a high rate of mental health conditions in Southern Texas

 

Individuals living in South Texas utilizes very low budget allocation on funding of mental health care

 

Cost is a factor impacting the population’s utilization of mental health services

 

Methodology

 

A qualitative descriptive study will be used.

 

This methodology was adopted because it will help to provide real life evidences from the interview with participants. The literature has determined the causes of the low utilization of mental health in South Texas and shows the limitations to accessing health care by examining barriers to specialty mental health care utilization (Augsberger, Yeung, Dougher, & Hahm, 2015).

Interviews and Questionnaires will be used to gather accurate information

Data will be obtained to determine the health seeking behavior and mental health patients/services in the State

Design

Qualitative Descriptive Study

 

This is the most appropriate methodology because it involves mental health providers and mental health professionals who actively work with clients and people with mental health issues. It gives credibility.

Literature supports the facts that issues of underutilized mental health resources and non-institutionalized adults is a behavioral risk factor in Southern Texas (Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley, 2016).

Data Collection

Site visits to mental & Behavioral Health providers with the membership of mental health association

 

Consent from participants

 

Interview with Mental Health Providers: Physicians & Therapist recorded on tape

 

Sampling Method: Purposeful Sampling

 

Sources: Surveys, Interviews & Questionnaires

 

 

Data analysis

Data will be collected for the study using surveys, interviews and questionnaires. Notes will be taken; interviews will be tape recorded and documented properly

 

Descriptive statistics will be used in summarizing acquired data.

 

Coding will be used to address questions posed.

 

A narrative summary will be developed.

 

 

 

References

 

 

American Psychological Association (2020) Cognition is central to drug addiction. Retrieved from https://www.apa.org/monitor/jun01/cogcentral

Augsberger, A., Yeung, A., Dougher, M., & Hahm, H. C. (2015). Factors influencing the underutilization of mental health services among Asian American women with a history of depression and suicide. BMC health services research, 15(1), 542. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1191-7

Basu, S., Rehkopf, D. H., Siddiqi, A., Glymour, M. M., & Kawachi, I. (2016). Health behaviors, mental health, and health care utilization among single mothers after welfare reforms in the 1990s. American journal of epidemiology, 183(6), 531-538. https://academic.oup.com/aje/article/183/6/531/2195922

Blosnich, J. R., Marsiglio, M. C., Gao, S., Gordon, A. J., Shipherd, J. C., Kauth, M., … & Fine, M. J. (2016). Mental health of transgender veterans in US states with and without discrimination and hate crime legal protection. American journal of public health, 106(3), 534-540. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302981

Boardwalk Recovery (2019). Cognitive Behavioral Therapy for Substance Abuse. Retrieved from https://boardwalkrecoverycenter.com/cognitive-behavioral-therapy-for-substance-abuse/

De Luca, S. M., Blosnich, J. R., Hentschel, E. A., King, E., & Amen, S. (2016). Mental health care utilization: how race, ethnicity and veteran status are associated with seeking help. Community mental health journal, 52(2), 174-179. https://link.springer.com/article/10.1007/s10597-015-9964-3

 

 

 

 

 

References

 

 

 

 

Hamilton, J. E., Desai, P. V., Hoot, N. R., Gearing, R. E., Jeong, S., Meyer, T. D., … & Begley, C. E. (2016). Factors associated with the likelihood of hospitalization following emergency department visits for behavioral health conditions. Academic Emergency Medicine, 23(11), 1257-1266. https://onlinelibrary.wiley.com/doi/full/10.1111/acem.13044

HomIan, M. A., Stanley, I. H., & Joiner Jr. T. E. (2015). Evaluating Factors and Interventions that Influence Help-Seeking and Mental Health Service Utilization among Suicidal Individuals: A review of the Literature. Retrieved from https://www.sciencedirect.com/science/article/pii/S0272735815000768

 

LARSON, Z. (2018). America’s Long-Suffering Mental Health System. Retrieved from http://origins.osu.edu/article/americas-long-suffering-mental-health-system

Tala, A. (2017). Healthline: Exercise Benefits Children Physically and Mentally. Retrieved from https://www.healthline.com/health-news/exercise-benefits-children-physically-and-mentally#1

 

Velten, J., Lavallee, K. L., Scholten, S., Andrea Hans Meyer, A. H., Xiao-Chi Zhang, X. Schneider, S., & Margraf, J. (2015). Lifestyle choices and mental health: a representative population survey. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304169/

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10 STRATEGIC POINTS 2

10 STRATEGIC POINTS 2

Factor Responsible for Poor Utilization of Mental Health Services in Texas

RES-825: Theories of Inquiry

Kehinde Alli

Grand Canyon University

August 15, 2020

10 Strategic Points

  My Degree: Ph.D.

Program Emphasis: Industrial Organizational Psychology

  Ten Strategic Points Comments or Feedback
Broad Topic Area Factor Responsible for Poor Utilization of Mental Health Services in Texas  
Lit Review

(Theoretical Framework (Theory)

Gaps

Themes

All Citations

Gaps

A. Basu, Rehkopf, Siddiqi, Glymour, & Kawachi (2016). According to the authors, the changes being experienced in social policies in recent years has created a gap among women with low income in the South Texas. Accordingly, the authors used the determination of the differences in income to understand the relationships between health outcomes and welfare reforms as it impacts the less privileged women in comparison to the most affected women.

B. Ly, A. (2019). This study focused on the factors that influence the utilization of mental health among Vietnamese Americans and the barriers to seeking help in Texas. The study had 12 participants including providers and community leaders who were familiar with the target population. The findings of the study indicated the need to culturally specify mental health intervention to improve mental health utilization. However, the study was limited by the small sample size hence the findings cannot be generalized. Further studies should include more cultural groups to validate the findings of this research.

C. Kwan, P. P., Soniega-Sherwood, J., Esmundo, S., Watts, J., Pike, J., Sabado-Liwag, M., & Palmer, P. H. (2020). The authors of this study aimed to evaluate the facilitators and barriers to mental health utilization among Pacific Islanders. Semi structure interviews were used to collect information from 12 pacific islanders. Trained community leaders recruited eligible candidates for the study. The study was limited by the small sample size. Five themes arose from the study. Cost of healthcare, mental health stigma and language and culture barriers were themes that emerged concerning barriers affecting the utilization of mental health services. The researchers indicated the need for future studies to include a larger sample size to enable generalization of the findings.

D. Volkert, J., Andreas, S., Härter, M., Dehoust, M. C., Sehner, S., Suling, A., . . . Schulz, H. (2018). The aim of this study was to evaluate various aspects of the utilization of mental health services among the elderly. The study had 3,142 participants aged between 65-84 years. Logic regression approach was used to analyze predisposing, enabling, and need factors among the participants. Similarly, the study found that most elderly people failed to utilize mental health services because they felt they could deal with their situations. The study indicated that more research is needed to validate the results of this study.

Theoretical Foundation

Albert Bandura’s Social Cognitive Theory will be used as the theoretical model for this research gap (Morin & Cherry, 2019). The authors, Morin & Cherry, (2019), describe the Social Cognitive Theory as an applicable theory that is appropriate in the context of mental health promotion and prevention. The theory helps in describing how motivations in health and human behavior is influenced by the interaction of people’s beliefs, environment, and behaviors (Morin & Cherry, 2019).

Components of the theory is concerned with individual behavior change such as:

•Self-efficacy: which is the belief and self-confidence, which states a person can control and execute a behavior successfully. This is uniquely influenced by a person’s capabilities and environmental factors. (Bandura, 1994).

•Behavioral capability: which entails the understanding and acquisition of behavioral skills and ability to execute the behavior.

Literature Review

A. Empathic Approach: The problems of underutilization of mental health services and non-institutionalization of adults has been emphasized as behavioral risk factors. According to Kohn et al. (2018) there is a gap in utilization of mental health services in the United States among the individuals that require treatment and those that actually receive the treatment. Therefore, there is the need to establish and understand what the social determinants of mental disorders are, and align them with the sustainable development goals, and to establish the potential mechanisms and targets for interventions (Kohn et al., 2018). Lund et al., (2018) also expressed the same gap in mental health utilization in Southern Texas, stating that there is need to conduct further research on why individuals utilize or chose to reject mental health services. The authors assert that the number of mental health patients seeking treatment and medication are fewer than those that are actually suffering from the illness (Lund et al., 2018).

Professional Development:

Job Satisfaction:

With some recent issues in the country that have been linked to mental health issues, there is an emergence focus on mental health as a critical area of interest. Problems of mental health has been sidelined for many years, but now, there is the realization to understand the reasons why people utilize or reject treatment. While this is being extensively studied, more attention should be focused been to the patients. According to De Luca et.al. (2016), most chronic health conditions and terminal illnesses tend to result in mental disorders in patients. For various reasons, mental health is now among the priorities of medical practice (De Luca et al., 2016).

Kohn, et al. (2018), examined recent prevalence of mental health disorders including lack of utilization of its services. The outcome was that about 43% of children and adolescents in the country suffer from mental illness, the treatment gap in the group was 64%. Utilizing or rejecting the services is dependent on collaboration of participating in treatment, while both patients and providers work together to make the therapy valuable.

(Kohn, et al., 2016).

 

 
Problem Statement It is not known how mental health providers describe the factors responsible for utilization or reject mental health services in Texas.  
Research Questions · RQ1: What do mental health providers identify as factors contributing to patient’s utilization of mental health services?

· RQ 2: What strategies do mental health providers use to encourage patients to use mental health services?

· RQ3: What do mental health providers identify as factors contributing to patient’s rejection of mental health services?

· RQ 4: What strategies do mental health providers use to address patient’s rejection of mental health services?

 

 
Population

Target Population

Sample

· Location – Harris County, Texas. USA

· Participants will include people who are members of Mental Health Organizations including:

· Mental Health America (MHA)

· National Institute of Mental Health (NIMH)

· National Alliance on Mental Health (NAMI)

· Target Population:

· Mental Health Providers

· Caregivers

· Psychiatrists

· Therapists

Sample: 20 samples that will comprise of interviews with 10 Mental Health Providers and 10 Caregivers.

 
Describe Phenomena (qualitative) or Define Variables/Hypotheses (quantitative) To understand factors responsible for poor utilization of mental health services by individuals living in Harris County, Texas.

· Lack of mental health utilization in Harris County, Texas.

· High rate of mental health conditions is reported in Southern Texas

· Harris County, Texas is reported as poorly utilizing its allocated budget funding of mental health care

 
Methodology & Design Qualitative Descriptive Study

Rationale for Methodology

Qualitative methodology is justified for my research because it is effective at providing rich data and is neither restrained nor bound by limitations. In addition, it is most appropriate because it is going to provide real life evidences based on interviews with participants who will be healthcare providers and caregivers that have difference experiences at giving primary data (Colorafi & Evans, 2016).

Furthermore, Ondersma, et al., (2017)’s comments on kim et al. (2017)’s topic “Staying Focused on Non‐Treatment Seekers,” described qualitative methodology as appropriate because data can be obtained in order to determine the health seeking behaviors (Ondersma, et al., 2017). This is applicable to my study as I try to determine individuals’ behavioral patterns and why they choose to either utilize or reject mental health treatment.

Qualitative methodology appropriately addressed the problem statement that tries to understand how mental health providers and caregivers describe the contributing factors to individual’s decision to utilize or reject mental health treatment because the methodology will be flexible and effective when collecting data and gathering information from the participants (healthcare providers and caregivers) based on their experiences.

 
Purpose Statement The purpose of this qualitative descriptive case study is to understand what mental health providers describe as the factors responsible for the utilization of mental health services in Harris County, Texas  
Data Collection Approach · Informed & signed consent by participants

· Visits to mental health providers and mental health facilities

· Interview with mental health providers & caregivers recorded on tape

· Interviews will involve 20 respondents from within Texas.

· Focus group with subset of 6.

· Sampling Method: Purposeful Sampling

· Sources: Interviews, Questionnaires & Focus Group Discussion

 
Data Analysis Approach · Data to be collected

· Data will be analyzed for the study.

· Data will be entered into MaxQDA for analysis.

· Peer Debriefer meetings after analysis complete

· Descriptive statistics will be used to summarize collected data.

· Coding will be adopted to answer all questions.

· Will develop a narrative summary.

· Summaries of each participants codes will be emailed to participants for members’ checking. (Code, Definition, Quote for each code)

 

Summary

The South Texas health care costs is growing at a faster rate than in any other market in the country as it exceeds over $7,000 per person. However, despite the massive government’s healthcare investment and the expenditure in the region, there are still some surprising facts about healthcare in the region. Health care utility in the State is one-third higher than those at the Mayo Clinic in Rochester (Blosnich et.al. 2016). Yet, the Southern region of the State is underutilizing its available mental health resources. Report shows that there are discrepancies in the population’s utilization of mental health based on the marked differences in the amount of care ordered for patients. In comparisons with similar medical/health care patients Nationwide; generally, the patients in South Texas got much more of everything including more diagnostic testing, more hospital treatment, more surgery, and more home care, however, mental health services and its resources remained underutilized by its population. For this reason, there is need for more research at several levels including an understanding of the reasons why people choose to utilize or reject treatment.

Kohn, et al. (2018), states that generally, there is a gap in mental health treatment in the US based on its examination as a result of the prevalence of mental health disorders and the lack of utilization of mental health services. My research study is intended to examine what factors have been identified by mental health providers as influencing individuals’ decision to either utilize or reject mental health services, as well ask them for the strategies they are using to encourage patients to accept treatment and not reject it especially at the start of treatment and when continuing treatment. The research will be targeting the Southern Texas population for the study where it will systematically help in reviewing evidences that shows the potential mechanisms causing people to either utilize or reject mental health treatment in South Texas.

The research will use Albert Bandura’s Social Cognitive Theory as the its theoretical model to identify the gap, which Morin & Cherry (2019) described the as the most appropriate theory applicable to my research based on the context of mental health promotion and prevention. The theory will help to describe how motivations in health and human behavior can be influenced by individuals’ interaction based on beliefs, environment, and behaviors (Lake, 2017).

References

Basu, S., Rehkopf, D. H., Siddiqi, A., Glymour, M. M., & Kawachi, I. (2016). Health behaviors, mental health, and health care utilization among single mothers after welfare reforms in the 1990s. American Journal of Epidemiology, 183(6), 531-538. doi:10.1093/aje/kwv249

Bradshaw, C., Atkinson, S., & Doody, O. (2017). Employing a Qualitative Description Approach in Health Care Research. Global Qualitative Nursing Research, 4, 233339361774228. https://doi.org/10.1177/2333393617742282

Colorafi, K. J., & Evans, B. (2016). Qualitative descriptive methods in health science research. HERD: Health Environments Research & Design Journal, 9(4), 16-25.

De Luca, S. M., Blosnich, J. R., Hentschel, E. A., King, E., & Amen, S. (2016). Mental health care utilization: How race, ethnicity and veteran status are associated with seeking help. Community mental health journal, 52(2), 174-179. https://link.springer.com/article/10.1007/s10597-015-9964-3

Eslami, A. A., Norozi, E., Hajihosseini, M., Ramazani, A. A., & Miri, M. R. (2018). Social cognitive theory as a theoretical framework to predict sustained abstinence 6 months after substance use treatment. Philadelphia, Pennsylvania: Taylor & Francis Ltd. doi:10.1080/14659891.2017.1394382

Kwan, P. P., Soniega-Sherwood, J., Esmundo, S., Watts, J., Pike, J., Sabado-Liwag, M., & Palmer, P. H. (2020). Access and utilization of mental health services among pacific islanders. Asian American Journal of Psychology, 11(2), 69-78. doi:10.1037/aap0000172

Kohn, R., Ali, A. A., Puac-Polanco, V., Figueroa, C., López-Soto, V., Morgan, K., . . . Vicente, B. (2018). Mental health in the Americas: An overview of the treatment gap. Revista Panamericana De Salud Pública, 42 doi:10.26633/RPSP.2018.165

Lund, C., Brooke-Sumner, C., Baingana, F., Baron, E. C., Breuer, E., Chandra, P., . . . Saxena, S. (2018). Social determinants of mental disorders and the sustainable development goals: A systematic review of reviews. The Lancet. Psychiatry, 5(4), 357-369. doi:10.1016/s2215-0366(18)30060-9

Ly, A. (2019). Mental Illnesses and Barriers to Seeking Mental Health Care in the Vietnamese Community in Austin, Texas from The Perspectives of Community Leaders and Providers (Doctoral dissertation). Retrieved from https://repositories.lib.utexas.edu/handle/2152/81247

Morin, A. & Cherry, K. (2019). How Social Learning Theory Works. Retrieved from https://www.verywellmind.com/social-learning-theory-2795074

Ondersma, S. J., Martino, S., Svikis, D. S., & Yonkers, K. A. (2017). Commentary on kim et al. (2017): Staying focused on non‐treatment seekers. Addiction, 112(5), 828-829. doi:10.1111/add.13736

Seixas, B., Smith, N., & Mitton, C. (2017). The Qualitative Descriptive Approach in International Comparative Studies: Using Online Qualitative Surveys. International Journal of Health Policy and Management, 7(9), 778-781. https://doi.org/10.15171/ijhpm.2017.142

Volkert, J., Andreas, S., Härter, M., Dehoust, M. C., Sehner, S., Suling, A., . . . Schulz, H. (2018). Predisposing, enabling, and need factors of service utilization in the elderly with mental health problems. International Psychogeriatrics, 30(7), 1027-1037. doi:10.1017/S1041610217002526

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