DSpace Repository :: Browsing by Author "Pollio, David E."

Browsing by Author "Pollio, David E."

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Comparing Homeless Persons' Care Experiences in Tailored Versus Nontailored Primary Care Programs
(American Public Health Association, 2013) Kertesz, Stefan G.; Holt, Cheryl L.; Steward, Jocelyn L.; Jones, Richard N.; Roth, David L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa W.; Austin, Erika L.; Henry, Stephen Randal; Johnson, N. Kay; Granstaff, U. Shanette; O'Connell, James J.; Golden, Joya F.; Young, Alexander S.; Davis, Lori L.; Pollio, David E.; US Department of Veterans Affairs; Veterans Health Administration (VHA); Veterans Affairs Medical Center - Birmingham; University of Maryland Baltimore; University of Alabama Birmingham; Brown University; Johns Hopkins University; Washington University (WUSTL); VA Pittsburgh Healthcare System; University of Alabama Tuscaloosa
Objectives. We compared homeless patients' experiences of care in health care organizations that differed in their degree of primary care design service tailoring. Methods. We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the "Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients. Results. Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P < .001). Adjusting for patient characteristics, these differences remained significant for subscales assessing the patient-clinician relationship (P < .001) and perceptions of cooperation among providers (P = .004). There were 1.5- to 3-fold increased odds of an unfavorable experience in the domains of the patient-clinician relationship, cooperation, and access or coordination for the mainstream VA sites compared with the tailored non-VA site; the tailored VA site attained intermediate results. Conclusions. Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness.
Configurations of risk factors for poor parental treatment engagement
(University of Alabama Libraries, 2011) Minney, Jessica Ann; Lochman, John E.; University of Alabama Tuscaloosa
Behavioral parent training is an effective treatment for many child behavior problems; however, low parent attendance and engagement has been a chronic barrier to its successful implementation. Previous research identified a number of risk factors that were predictive of low engagement in parent training. The present study tested whether these risk factors were valid predictors in a targeted prevention sample using latent class analysis and a binary segmentation procedure to identify meaningful sub-groups within the sample. Although the latent class analysis did not identify meaningful classes which predicted attendance, the binary segmentation procedure resulted in six mutually exclusive groups. These groups were classified based on social support and stressful life events, and group membership significantly predicted attendance at parent training. The validity of these predictors was further supported by a backward stepwise regression. Other frequently studied predictors, such as income, did not discriminate within the sample. These findings suggest that the risk factors for low engagement and participation in targeted prevention parenting interventions may be different from the risk factors for treatment seeking samples.
Deriving costs of service use among an urban homeless population
(Pergamon, 2014) Fuehrlein, Brian S.; Cowell, Alexander J.; Pollio, David E.; Cupps, Lori Y.; Balfour, Margaret E.; North, Carol S.; University of Florida; Research Triangle Institute; University of Alabama Tuscaloosa; Washington University (WUSTL); University of Texas Southwestern Medical Center Dallas; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA North Texas Health Care System
The purpose of this study was to describe a novel approach to calculating service use costs across multiple domains of service for homeless populations. A randomly-selected sample of homeless persons was interviewed in St. Louis, MO and followed for 2 years. Service- and cost-related data were collected from homeless individuals and from the agencies serving them. Detailed interviews of study participants and of agency personnel in specific domains of service (medical, psychiatric, substance abuse, homeless maintenance, and homeless amelioration services) were conducted using a standardized approach. Service utilization data were obtained from agency records. Standardized service-related costs were derived and aggregated across multiple domains from agency-reported data. Housing status was not found to be significantly associated with costs. Although labor intensive, this approach to cost estimation allows costs to be accurately compared across domains. These methods could potentially be applied to other populations. Published by Elsevier Inc.
Experience of Primary Care among Homeless Individuals with Mental Health Conditions
(PLOS, 2015) Chrystal, Joya G.; Glover, Dawn L.; Young, Alexander S.; Whelan, Fiona; Austin, Erika L.; Johnson, Nancy K.; Pollio, David E.; Holt, Cheryl L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa A.; Daigle, Shanette G.; Steward, Jocelyn L.; Kertesz, Stefan G.; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA Greater Los Angeles Healthcare System; University of California Los Angeles; Veterans Affairs Medical Center - Birmingham; University of Alabama Tuscaloosa; University of Maryland College Park; VA Pittsburgh Healthcare System; University of Pittsburgh; Boston University; University of Alabama Birmingham
The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons' needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers.
Exploring individual- and community-level predictors and mediators of suboptimal HIV primary care appointment adherence: the importance of place
(University of Alabama Libraries, 2013) Batey, David Scott; Pollio, David E.; University of Alabama Tuscaloosa
The advent of highly active antiretroviral therapy (HAART) for the treatment of human immunodeficiency virus (HIV) has provided prolonged viral suppression and an extended quality of life for HIV-infected persons. Research focusing on factors associated with suboptimal HIV medication adherence has been the principal antecedent to more contemporary research suggesting that absolute adherence to HIV primary care appointments is vitally important to achieve successful clinical management of the disease, as well, and missed visits have been independently associated with HIV virologic failure when other factors are controlled. Generally speaking, research examining the role of community correlates in shaping behaviors is somewhat scant in the HIV treatment literature. Existing research suggests that HIV-infected persons may experience unique patterns of negative health outcomes, such as quality of life, access to and retention in treatment, and morbidity. It stands to reason that these patterns may be the result of certain characteristics of many communities that are conducive to poor health, in general, such as low high school graduation rates, high rates of un- and underemployment, substandard housing, and extensive poverty. This study, conducted in two distinct phases, involves secondary data analysis of individual-level factors collected through a prospective cohort study (the 1917 Clinic Cohort) that includes HIV positive individuals who receive primary and sub-specialty medical care at the University of Alabama at Birmingham (UAB) 1917 Clinic. The second phase involves investigation of community-level data (census tract- or county-level) for each participant's residence address at the time of initial presentation to HIV primary medical care. The mediation effect of community-level variables on the association between individual-level predictors and linkage to and retention in care outcomes was then investigated. A non-probability, convenience sample of HIV-infected adults initially presenting for HIV primary medical care at the UAB 1917 Clinic was selected from larger cohort studies, including the CFAR Network of Integrated Clinical Systems (CNICS) and Project CONNECT, a local UAB 1917 Clinic new patient orientation protocol which provides systematic linkage to HIV medical care. Study eligibility included age 19 or over, an HIV diagnosis with a Project CONNECT interview during the study period (7/01/09-6/30/11), normal cognitive functioning, ability to speak and communicate in English, and self-reported residence within the State of Alabama. The principal exposures for this study included three measures of linkage to care (a general linkage to care measure, effective linkage to care, and efficient linkage to care) and five measures of retention in care (appointment no show, visit adherence, visit constancy, gaps in care, and the HRSA-HAB). All measures are widely used in the literature. Bivariate logistic regression was used to determine relationships between individual- and community-level independent variables and the study outcomes. To determine mediation, bivariate logistic regression and Ordinary Least Squares (OLS) regression was used to identify associations between individual- and community-level independent variables and measures of strain. The study replicated existing findings in the literature that have established relationships between individual- and community-level independent variables and linkage to and retention in HIV primary medical care. Additionally, findings suggest that some concepts of community-level strain--specifically, aggregate community measures of age structure, crime, and family structure--may also predict principal outcomes. While a measure of composite strain was not found to mediate the relationship between independent variables and the study outcomes, two aggregate strain measures (age structure and family structure) were found to mediate the relationship between self-reported trouble remembering and HIV transmission risk, respectively, and HIV primary medical care visit adherence. The findings are highly relevant to social work practice, research, and policy in the HIV/AIDS linkage to and retention in care field, and they suggest a number of future directions to further investigate the role of the community--and community strain specifically--in facilitating and/or preventing optimal HIV treatment.
Geographical Access and the Substitution of Traditional Healing for Biomedical Services in 2 American Indian Tribes
(Lippincott Williams & Wilkins, 2012) AI-SUPERPFP Team; Fortney, John C.; Kaufman, Carol E.; Pollio, David E.; Beals, Janette; Edlund, Carrie; Novins, Douglas K.; University of Arkansas Medical Sciences; US Department of Veterans Affairs; Veterans Health Administration (VHA); Central Arkansas Veterans Healthcare System; University of Colorado Anschutz Medical Campus; University of Alabama Tuscaloosa
Objectives: American Indians who live in rural reservation communities face substantial geographic barriers to care that may limit their use of health services and contribute to their well-documented health disparities. The purpose of this study was to examine the impact of geographical access to care on the use of services for physical and mental health problems and to explore American Indians' use of traditional healing services in relation to use of biomedical services. Methods: We analyzed survey data collected from 2 tribes (Southwest and Northern Plains). Geographical access to the closest biomedical service was measured using a Geographic Information System, including road travel distance, elevation gain, and reservation boundary crossing. Results: Use of biomedical services was unaffected by geographical access for Northern Plains tribal members with mental health problems and for Southwest tribal members with physical or mental health problems. For members of the Northern Plains tribe with physical health problems, travel distance (P = 0.007) and elevation gain (P = 0.029) significantly predicted a lower likelihood of service use. The use of traditional healing was unrelated to biomedical service use for members of the Northern Plains tribe with physical or mental health problems and for members of the Southwest tribe with physical health problems. For members of the Southwest tribe with mental health problems, the use of biomedical services increased the likelihood of using traditional healing services. Conclusions: Findings suggest that biomedical services are geographically accessible to most tribal members and that tribal members are not substituting traditional healing for biomedical treatments because of poor geographical access.
A grounded theory study of the context of gay-straight alliance formation and maintenance in the deep south
(University of Alabama Libraries, 2016) Young, Sarah Reta; Hopson, Laura M.; University of Alabama Tuscaloosa
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth are a population at risk of many negative health and mental health outcomes due to the stigma and oppression they may face at home, in school, and in the community. There is some evidence to suggest that LGBTQ youths’ experiences may vary by region in the United States (U.S.), in part impacted by differing experiences in their social contexts. This variance is evident in the Deep South, where schools are less likely to adopt needed policy protections for this population, and have a lower density of LGBTQ-affirming Gay-Straight Alliance (GSA) clubs compared to other regions of the country. In research studies, GSAs have been demonstrated to provide positive impacts for LGBTQ youth (as well as ally youth) in schools, but little is known about their formation and maintenance. This study investigates the perceived contexts surrounding the formation and/or maintenance of GSAs in the Deep South region of the U.S. A grounded theory approach led to the recruitment of 17 participants who were either students, advisors, advocates, or some combination of roles within a GSA. These 17 participants represented the following states, defined as the “Deep South”: Alabama, Georgia, Louisiana, Mississippi, South Carolina, and Tennessee. The findings and resulting theory indicate that GSAs experience three distinct stages: pre-formation, formation, and maintenance. The findings also indicate that students, advocates, and advisors work to build strength, minimize threats, and negotiate failure and barriers. These findings have implications for social workers and advocates by suggesting ways to enhance GSA functioning in service of protecting LGBTQ youth.
The influence of cultural adaptation on depressive symptoms among young Hispanic immigrants
(University of Alabama Libraries, 2012) Jaggers, Jeremiah W.; MacNeil, Gordon; University of Alabama Tuscaloosa
This study examines how cultural adaptation and family cohesion impact depressive symptoms in Hispanic immigrants that migrated to the U.S. by the age of 17. Using the National Latino and Asian American Study, a recursive regression was conducted on a hypothesized model demonstrating the relationship among the study variables: acculturation, acculturative stress, subjective social status, discrimination, ethnic social identity, dissonant acculturation, family cohesion and depressive symptoms. Psychosocial contextual variables are also included in the analysis and include gender, age, years in the U.S., education, income, and ethnicity. Results revealed two important themes in the data. The first is the importance of family in the adaptation process. As hypothesized, dissonant acculturation leads to the development of depressive symptoms. Additional findings concluded that family cohesion moderated the effect of dissonant acculturation. The second theme revealed in the data was the risk posed by acculturative stress in the adaptation process. Acculturative stress contributes directly to dissonant acculturation and to depressive symptoms.
Medication state at the time of the offense: medication noncompliance and criminal responsibility
(University of Alabama Libraries, 2014) Titcomb, Caroline Richards; Brodsky, Stanley L.; University of Alabama Tuscaloosa
Ethical and due process concerns arise when insanity standards lack a nuanced picture of how society views mental illness and its effects on the volitional nature of a defendant's actions. This project examined whether mock jurors consider meta-responsibility (MR) of mentally ill defendants, how they think about MR in relation to criminal responsibility, and if various degrees of MR differentially influence defendant responsibility and guilt. The MR benchmark manipulation was medication compliance (or noncompliance; MNC) for a NGRI defendant at three levels: medication compliant (MC/control), purposive MNC, and inadvertent MNC. The type of MNC was manipulated by establishing the defendant's insight into his illness as either High or Low. A second variable - the extent to which a forensic mental health expert explains issues relevant to the defendant's MR (i.e., MNC and insight into one's mental illness) - was also manipulated. Using a between-subjects jury deliberation paradigm and a mixed quantitative-qualitative methodology, results did not yield the hypothesized interactions between a NGRI defendant's MNC, insight, and testimony elaboration on MR and verdict. Results suggest that as ecological validity of the study parameters increased, effects found in prior research with more experimental control were unsupported. Findings were consistent with research suggesting jurors are unlikely to recognize the complexity of the relationship between a defendant's MNC and volitional, informed decision-making; thus, readily attributing MR to NGRI defendants at the cost of overlooking individual differences in case facts related to some of the key determinants of their verdicts such as MNC and insight into one's illness. Implications for future research, NGRI proceedings, and forensic mental health expert testimony are discussed.
The Neighborhood Context of Homelessness
(American Public Health Association, 2013) Alexander-Eitzman, Ben; Pollio, David E.; North, Carol S.; University of North Carolina; Appalachian State University; University of Alabama Tuscaloosa; University of Texas Southwestern Medical Center Dallas; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA North Texas Health Care System
Objectives. We examined and compared the changing neighborhood characteristics of a group of homeless adults over time. Methods. We collected the addresses of previous housing and sleep locations from a longitudinal study of 400 homeless adults in the St. Louis, Missouri, region and compared census measures of housing and economic opportunities at different points along individual pathways from housing to homelessness and at 1- and 2-year follow-up interviews. Results. Sleep locations of homeless adults were much more concentrated in the urban core at baseline than were their previous housed and follow-up locations. These core areas had higher poverty, unemployment, and rent-to-income ratios and lower median incomes. Conclusions. The spatial concentration of homeless adults in areas with fewer opportunities and more economic and housing distress may present additional barriers to regaining stable housing and employment. A big-picture spatial and time-course viewpoint is critical for both policymakers and future homelessness researchers.
State legislator perceptions of the political advocacy involvement of nonprofit human service organizations
(University of Alabama Libraries, 2017) Knierim, Matthew Thomas; Smith, Brenda D.; University of Alabama Tuscaloosa
Advocacy has long been a central tenant of the social work profession. From its inception, the profession of social work has considered itself a vehicle for social change by providing a voice for those who have been traditionally oppressed, marginalized and underrepresented in the decision making processes that impact their lives. As a result, social workers, the majority of which are employed within the nonprofit sector, have a unique opportunity and a professional obligation to leverage their knowledge and skills with the resources and reach of their organizations to advance the interests and increase the well-being of those they serve though political advocacy. Yet, despite their importance in the delivery of social services, the current body of literature suggests that there is not a corresponding level of political engagement among social workers, and consequently by nonprofit human service organizations (NHSOs). In order to better understand the political advocacy involvement of NHSOs, a pragmatic qualitative approach was employed. Semi-structured interviews were conducted with 13 state legislators, in order to answer the research question, “How do state legislators perceive the political advocacy involvement of nonprofit human service organizations in the policymaking process?” Thematic analysis of the data yielded five themes: that perceived advocacy involvement by NHSOs was mixed, that legislators saw a clear opportunity for NHSOs to influence policy decisions, that NHSOs often lack an understanding of the political process, that legislators recognized capacity issues create challenges for some NHSOs interested in advocacy, and that legislators perceived relationships to be the most valuable political currency for NHSOs. These findings not only provide something of a snapshot of the current state of nonprofit political advocacy, but also provide novel and important insights into the perceived participation and the impact of NHSOs in the policymaking process at the state level. Furthermore, these findings also have important implications for social work practice and social work education. These implications, as well as some preliminary strategies to increase the advocacy participation and effectiveness of advocacy efforts of NHSOs, are presented.

Browsing by Author "Pollio, David E."

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