Doctor of Social Work Capstone Reports

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Addressing the "Digital Divide" and Impact to Educational Equity and Access: A Qualitative Inquiry of Students in Higher Education
(2023) Thorn, Lauren; Jackson, Sebrena; Tuchmayer, Jeremy
In March 2020, much of higher education transitioned to emergency online education as a response to the COVID-19 pandemic and the subsequent shutdown of colleges and universities, with many students being sent home to communities that were not able to support reliable broadband internet service or to environments that lacked the necessary devices and software for their educational studies (Ibacache et al., 2021). Universities were provided with funding to address student emergency needs, including providing additional devices to students and families, utilizing technology to make courses mobile-friendly and to connect students to the internet through hot spots or supplementing the costs of increased internet usage in their homes (Ratledge et al., 2020). This study explores the research question, “As online education and digital access remain an integral part of the higher education experience, what programs can colleges and universities implement to ensure equitable student access to technology and highspeed internet needed for academic success?” Through a review of current literature, relevant questions were identified, and a qualitative research study protocol was established to host focus groups with students who were impacted by the COVID-19 pandemic to assess their experiences and identify potential services and resources for additional support. Following review and coding of the focus group transcripts, key themes emerged around access to digital course codes and texts, technological efficacy and skills needed to engage in online classes, addressing financial barriers associated with external software and platforms, and integrating training and educationinto existing programs for faculty, students, and staff. The project explores systemic practice implications, legislative and policy impacts, and related theoretical framework that will guide future research in this area.
Assessing the Impact of COVID-19 and Race-Based Trauma on the Mental Health of Black Social Work Providers
Foster, Carmen Reese; Davis, Curtis; Held, Mary; University of Alabama Tuscaloosa
The aim of this study was to assess the impact of COVID-19 and race-based trauma on the mental health of Black social workers and to identify support systems. An explanatory sequential design was used to measure mental health, COVID-19, quality of life, race-based trauma, and support systems. A multiple regression analysis was conducted to determine which dependent variables would significantly correlate with COVID-19 and race-based trauma. Depression, anxiety, and stress were significant. Several themes emerged from the qualitative interviews, with 85% reporting a lack of support from their White colleagues. Identified sources of support were therapy and positive relationships.
Assessment of Integration of Religion and Spirituality in Social Work Field Education Among Students and Field Instructors
Creech, Sean C.; Ruggiano, Nicole; Curington, Allison; University of Alabama Tuscaloosa
In recent years, there has been an increase in the interest to integrate spiritual and religious perspectives into social work practice. Understanding religion and spirituality in practice is developed through and supported by exposure in social work education programs and field education. As more social work programs integrate religion and spirituality into practice, a reliable instrument to measure student perceptions and attitudes about its integration into practice is needed. The purpose of this study was to determine if the Religious and Spirituality Integrated Practice Assessment Scale (RSIPAS) was a reliable instrument for use with social work field students. This study also explored the extent to which educational courses and training have been provided to those affiliated with social work programs. Furthermore, the study compared the views of self-efficacy, attitudes, perceived feasibility, and behaviors with integration into practice between social work field instructors and field students and again between MSW and BSW field students. The research was collected utilizing a correlational research design using a quantitative cross-sectional survey. Participants included students in their field placements at accredited social work programs and field instructors affiliated with those programs. The study found that the RSIPAS was a reliable instrument to assess student familiarity with and views about integrating religious and spiritual needs into practice. The study also revealed significant correlations between education and the impact on the agreement to items in the instrument. Lastly, there were statistically significant differences between the responses of social work field students and social work field instructors regarding their views around self-efficacy and between MSW and BSW students regarding the frequency of engaging in practice behaviors. The results of this study support opportunities to increase course content around religion and spirituality and that those who receive education around the content can better integrate religion and spirituality into social work practice.
Assessment of Integration of Religion and Spirituality in Social Work Field Education among Students and Field Instructors
Creech, Sean C.; Ruggiano, Nicole; Curington, Allison; University of Alabama Tuscaloosa
In recent years, there has been an increase in the interest to integrate spiritual and religious perspectives into social work practice. Understanding religion and spirituality in practice is developed through and supported by exposure in social work education programs and field education. As more social work programs integrate religion and spirituality into practice, a reliable instrument to measure student perceptions and attitudes about its integration into practice is needed. The purpose of this study was to determine if the Religious and Spirituality Integrated Practice Assessment Scale (RSIPAS) was a reliable instrument for use with social work field students. This study also explored the extent to which educational courses and training have been provided to those affiliated with social work programs. Furthermore, the study compared the views of self-efficacy, attitudes, perceived feasibility, and behaviors with integration into practice between social work field instructors and field students and again between MSW and BSW field students. The research was collected utilizing a correlational research design using a quantitative cross-sectional survey. Participants included students in their field placements at accredited social work programs and field instructors affiliated with those programs. The study found that the RSIPAS was a reliable instrument to assess student familiarity with and views about integrating religious and spiritual needs into practice. The study also revealed significant correlations between education and the impact on the agreement to items in the instrument. Lastly, there were statistically significant differences between the responses of social work field students and social work field instructors regarding their views around self-efficacy and between MSW and BSW students regarding the frequency of engaging in practice behaviors. The results of this study support opportunities to increase course content around religion and spirituality and that those who receive education around the content can better integrate religion and spirituality into social work practice.
Behavioral Health Needs and Barriers to Care Among Soldiers Who Report Past Year Sexual Harassment and/or Sexual Assault
(2023) Kunhavijit, Michael; Shah, Avani; Ruggiano, Nicole
Background: Sexual harassment and sexual assault (SH/SA) continue to be a problem in the military despite extensive efforts to mitigate incidents. The mental health needs of military SH/SA survivors are often unmet due to stigma, military cultural values related to self-reliance, and logistical barriers. This secondary analysis assessed data related to the prevalence of past-year SH/SA across demographics, identified the mental health needs among those who experienced it, and ascertained the perceived barriers to treatment among members of an Army brigade combat team (BCT).Methods: For this analysis, any affirmative response to either 1) past-year sexual harassment, and/or 2) past-year sexual assault was combined to create a past-year SH/SA indicator variable. Mental health outcomes included major depression, generalized anxiety, post-traumatic stress disorder, suicidal ideation, alcohol use, and insomnia. Perceived barriers to treatment outcomes included stigma, self-reliance, and logistical barriers. Descriptive statistics, chi-square, and logistical regression were used to report findings.Results: SH/SA incidents were concentrated among young (17-24) junior enlisted (E1-E4) female soldiers; SH/SA survivors reported psychological problems at a higher rate compared to non-victims (73% vs. 31%); and SH/SA survivors reported higher occurrences of stigma and barriers to care compared to non-victims.Conclusion:The results of this study were mixed. The SH/SA survivors that indicated psychological concerns reported higher rates of stigma and barriers to care but sought mental health care at higher rates than non-victims that indicated psychological concerns. The gap between SH/SA victimization and BH utilization needs improving as unmet BH needs can lead to a myriad of issues. Changing perspectives on self-reliance as it relates to coping with mental health problems is a way to address this gap. Leaders must emphasize that mental health care is a form of self-reliance, while military mental health professionals must implement effective self-care initiatives and promote available resources to aid soldiers in overcoming their mental health problems.
Can a Schoolwide Advisory Program Reduce Discipline Referrals and Boost Feelings of School Connectedness?
(2022) Manning, Conor; McKinney, Robert; Ruggiano, Nicole; University of Alabama Tuscaloosa
Introduction/Background: School discipline procedures are harmful to students and programs that reduce the likelihood of suspension are important for students’ wellbeing. School connectedness is a known protective factor for students. This study explores the implementation of a schoolwide advisory program’s impact on discipline referrals and students’ feelings of school connectedness. Methods: Data were collected over the course of an entire school year and results were compared pre- and post-intervention. The intervention took place during the 2nd semester of the school year. School discipline data and survey data (Student Subjective Wellbeing Questionnaire [SSWQ]) were compared pre- and post-intervention. Results: Mean out-of-school suspension rates were reduced at statistically significant levels. Mean ISS rates increased. There was not a statistically significant change in mean SSWQ scores. Discussion: This might serve as foundational work that a schoolwide advisory program could use to help reduce rates of out-of-school suspension.
A Case for Social Workers as Investigators in Public Defender Offices
Hurd, Amy L.; Cheatham, Leah P.; Davis, Curtis; University of Alabama Tuscaloosa
Social workers play a critical role in modern public defender offices, whether performing mitigation work for pre-trial negotiations and sentencing hearings or helping clients to secure access to basic human needs. Although social workers have held in-house positions in public defender offices since at least the 1970s, their service is largely limited to mitigation practice and traditional social work. This article raises an opportunity for social workers to broaden their capacity within public defense by pursuing investigator positions. A case is made for interested social workers to draw upon their education, training, and experience to showcase the alignment between their talents and the requisite skills and performance required of investigative work. Evidence is offered to support the notion that social workers bring skills and a social justice orientation to investigative work that can provide for fresh insight and innovation in investigation and defense strategy. The value brought to investigation by social workers throughout a legal defense is specified, as are considerations for applying and interviewing for investigator positions as social workers.
Conceptualizing the Use of Critical Race Theory as a Teaching Tool and Intervention Approach
Williams, Erika J.; Davis, Curtis; Agee, Jarralynne; University of Alabama Tuscaloosa
Critical Race Theory can be a useful framework in helping to address the racial disparities and social injustices occurring in the United States. Embedding the framework in the social work curriculum is needed as it provides a method to broaden students’ knowledge of the racial and social injustice that remains pervasive in the country. It is imperative that social work educators help students to understand that although the country has made considerable strides in the quest for equality, racial injustices still exist. In this paper I postulate that social work education programs should give considerable attention to weaving the use of Critical Race Theory tools into the classroom to increase students’ knowledge of racial justice and anti-oppression.
Connecting Workplace Bullying to Domestic and Sexual Victim Advocate Burnout
(2024) Fleming-Trice, Trace; Davis, Curtis; Scott, Hannah
This study sought to identify the prevalence of workplace bullying within domestic and sexual violence organizations and how this work hazard impacts anti-violence advocates. Three questions were investigated: (1) Do domestic and sexual violence victim advocates experience workplace bullying within domestic and sexual violence organizations? (2) Does workplace bullying contribute to domestic and sexual violence victim advocate burnout? (3) If advocates do experience workplace bullying, in what ways do advocates experience the phenomena in their organizations? Data was collected from 55 advocates throughout the United States and Canada. 55.6% of the respondents reported workplace bullying experiences occurring within the last 10 years of their careers. Most often, supervisors were found to be bullies. Instances of racism and homophobia contributed to advocate bullying experiences as did a lack of support from Boards of Directors. Advocates also indicated instances of bullying occurring from organizational community partners. The study found that over 70% of respondents indicated that exposure to bullying did contribute to their career burnout. Several advocates shared that they had left the field of domestic and sexual violence victim advocacy altogether due to their bullying experiences. Various forms of workplace bullying tactics found on the modified Duluth Power and Control Wheel for workplace bullying were identified by the respondents. This research suggests the urgent need for increased awareness of workplace bullying within the domestic and sexual violence victim service industry, leadership training, and organizational policy change to address protecting advocates.
Considering Empathic Leadership’s Impact on the Retention of Social Work Employees
(2022) Davis, Cynthia J.; Davis, Curtis; Hall, Kotina L.; University of Alabama Tuscaloosa
Retention of social workers is a common issue that affects various organizations. Retention of social workers in child welfare, social service, and other human service agencies is a serious concern. The high turnover rate of professional workers poses a major challenge to child welfare agencies and to the social work field in general. Turnover rates range from 30 to 60 percent in a typical year. According to Srinika Jayaratne and Wayne Chess (1984), “39 percent of social workers in family services and 43 percent in community mental health are likely to leave their jobs within a year of starting.” This article utilizes information derived from a comprehensive literature review to present a conceptual training model of empathic leadership to remedy the overwhelming dilemma of retaining social work employees.
A Different Medicine: Challenging Racial Health Disparities through a Social Work Lens within a Healthcare Setting
Arnold, Daphne D. E.; Davis, Curtis; Weems-Bryant, Denise; University of Alabama Tuscaloosa
The United States has an extensive and horrendous history as it relates to social injustices frequently experienced by People of Color (POC). One form of social injustice experienced by POC is what society commonly refers to as health disparities. When seeking healthcare services, POC reported that they frequently face problems such as inadequate time with providers during their appointments, discrimination, and insensitivity to their cultural beliefs and systems. Cultural Competence training put forth by social work practitioners has been shown to be an effective strategy for increasing knowledge and skills for providers in healthcare settings as well as decreasing negative thoughts, attitudes, beliefs, and behaviors. This project seeks to provide empirical data to existing literature regarding the efficacy of cultural diversity education training amongst key stakeholders in a healthcare setting. This work also seeks to ascertain whether training programs in healthcare settings should offer a more systematic approach when providing cultural competence training. This work involved evaluating a proposed 6-hour multi-session cultural diversity education training program. The knowledge and skills amongst the participants slightly improved while negative thoughts, attitudes, beliefs, and behaviors slightly decreased. Study participants’ responses in the focus group affirmed the need for training programs to offer a more systematic approach that includes more interactive activities as well as a debriefing focus group to aid in effective and efficient learning for trainees. Implications for training programs regarding utilizing cultural diversity education training to help reduce racial health disparities and future research opportunities are discussed.
Eating Disorder Rates and Body Image Dissatisfaction Among College Females
(2023) Blair, Abigail Hogan; McKinney, Robert; Cheatham, Leah
The purpose of this study was to obtain further information on the rates of eating disorders among college-aged females and the possible sociocultural protective factors at play, especially those concerned with race and ethnicity. Participants included female undergraduate students at colleges and universities in the Southeast and Midwest portions of the United States who completed online surveys. The study remains ongoing, but implications to date are discussed.
Educational Awareness of Homeless Students in the Public-School Community
Smith-Johnson, Sowitza; Hopson, Laura; Carter, Candace; University of Alabama Tuscaloosa
The number of homeless children and youth enrolled in public-schools has doubled over the past 20+ years (Sparks, 2019). This attributed to lack of affordable housing, unemployment, domestic violence, economic instability, medical/mental health issues and natural disasters (Sparks, 2019). Therefore, generating many educational barriers due to the disruption and trauma of not having a fixed, regular, and adequate place to reside (U.S. Department of Education, 2020). Research and literature on interventions for homeless students are limited and/or outdated. There does not appear to be a universal model or framework that could be implemented across all public-school districts and/or all grade levels in the U.S. The project focuses on the significance of public-schools offering a place of stability, safety, and supportive services for students experiencing homelessness. The project looks beyond the social and physical barriers that potentially suppress motivation to achieve educational-related change of those students experiencing homeless. The project was guided by the McKinney Vento Homeless Model and the ecological system framework, using a pre and post-test survey design. The project was conducted virtually over 3-consecutive days, utilizing the same participants that serve as homeless liaisons in the Greenwood Leflore Consolidated School District. Participants consisted of 24 district employees, female/male, of various ethnicity/race who self-identified as school administrators, school social workers, or district registration staff members. The content during the educational workshops raised awareness of homelessness, the McKinney Vento Homeless Assistance Act, and effective supportive services/resources for students experiencing homeless. The findings indicated that participants were cognizant on the definition of homeless, had limited understanding of the McKinney Vento Homeless Assistance Act and lacked knowledge of supportive services and resources for students experiencing homelessness. Participants acknowledged limited training as a factor on their perception of homeless students, well as the lack of knowledge pertaining to services/resources. Contributing recommendations at the district level included revising GLCSD Student Handbook to include policies relating to homeless students/families, incorporating a District Homeless Resource Team, designing a District Resource Manual/Website Accessibility, providing ongoing educational workshops for all district employees, and creating “Safe Space” sites customized for homeless students in all 12 school locations in the Greenwood Leflore Consolidated District. Implications for practitioners and educators include incorporating district policies and program interventions using a holistic approach to call attention to homelessness and promote student wellness in the public-school community (academically, emotionally, and socially).
Evaluating Engagement in the University of Alabama’s Distance Learning BSW Program
Jaime, Stephanie; Ruggiano, Nicole; Traylor, Amy; University of Alabama Tuscaloosa
Distance learning can often feel like an isolating experience. Because of this, engagement is an essential component. This study involves an evaluation of The University of Alabama’s Distance Learning BSW program to evaluate the program’s strengths and areas of needed improvement, specifically looking at engagement within the program. The data will be used for overall program development and to promote engagement between students and instructors. The evaluation included focus groups, individual instructors' surveys, individual student interviews, and a student questionnaire. The data collection tools used included focus group/individual interview questions and survey questions. Student and instructor focus groups and interviews were conducted over Zoom. Student surveys were conducted utilizing Qualitrics Operating System. Questions focused on student and instructor engagement, student readiness for the field, and program strengths and areas for improvement. Six instructors participated in two different focus groups, two in the first group and four in the second group. Two professors participated in individual interviews. Three students participated in individual interviews, and 21 students participated in a survey. Data outcomes will help guide the program with areas of opportunity for improvement. Most students felt The University of Alabama’s Distance Learning BSW Program met their expectations and would recommend the program to family and peers. Field placement appears to be the major source of programmatic issues the students are experiencing. Students reported that, while they have been able to make connections and engage with their peers and instructors, it takes additional time and effort to connect through avenues not offered by the program, such as GroupMe. On the other hand, instructors felt that distance learning education is a self-guided experience, and the addition of synchronous class time would assist them and students in building rapport and feeling engaged. Instructors unanimously feel the learning management system is harder to use than other schools they are affiliated with. While instructors understand the desire for students to participate in a distance learning program, they do not hold their distance learning students to the same standard as traditional students. Overall, instructors feel supported by the program and director, and have a positive outlook on the program. Students and instructors acknowledge the extra effort taken to promote engagement in a distance learning program. Research on distance learning is prevalent in today’s education as higher education continues to grow and offer more hybrid models as well as fully distance learning programs. Data outcomes will help guide the program with areas of opportunity for improvement. It is important for schools of social work that offer distance learning programs to ensure that their programs are graduating competent and field-ready students.
Exploring the Feasibility of Adapting and Implementing an Effective Postpartum Depression Evidence-based Intervention for Black Mothers
Lee-Okonya, Kim; Johnson, Karen; University of Alabama Tuscaloosa
maternal health. African American women are 5.2 times more likely to die from pregnancy related causes and 1 out of 3 are impacted by postpartum depression, as compared to 1 out of 7 White women. Scholarly research supports the lived experiences and prolonged exposure to chronic stress due to racism, sexism, discrimination, and oppression impact African American women’s overall health and maternal health. Despite these risks, there are no evidence-based treatment interventions specific to Black women with postpartum depression. This project addresses this gap. Guided by the first 4 phases of the ADAPT-ITT intervention adaptation framework, community based participatory research approach, intersection theory, Black feminist thought and ecological systems theory, this project describes the formative work done in collaboration with Black mothers with recent histories of postpartum depression (n=6) to culturally tailor an existing evidence based perinatal treatment intervention for use with Black mothers specifically. The Mothers and Babies course, the intervention in question, is an 8-week, facilitator led, group course grounded in cognitive behavioral therapy, attachment theory and the Reality Management approach. In the current study, two focus groups were conducted virtually with the same participants (n=6). Participants were college educated, middle-class African American women ranging in age from 30-44 years old who self-identified as having postpartum depression within the last 3 years. Topics that pertained to Black women, motherhood, and postpartum depression such as the Superwoman schema, systemic discrimination and the influence of maternal figures were introduced and discussed during the focus groups. Focus groups were recorded, transcribed, thematically coded, and the emergent used to guide and introduce cultural congruent themes to the intervention. The findings from this project suggest most interventions of this sort pilot studies with populations of low-income women, leaving middle class women unaccounted for while they are also greatly impacted by postpartum depression. Policy change recommendations include expanding funding for group focused research efforts, organizations, and programs to implement culturally tailored interventions for all women experiencing postpartum depression to make services more accessible. Implications for social workers and researchers include conducting more group focused research, addressing implicit bias, and culturally tailoring current interventions and theoretical frameworks to speak to Black women’s experiences using an ecological systems theory lens.
Exploring the Impact of Telehealth on Black Women Controlling Hypertension
(2024) Reese, Patrice J.
Black women are struggling to properly control their hypertension. Black women continue to be disproportionately affected by hypertension due to historically systemic and structural barriers. The Social Determinants of Health related to race, gender, and access are major contributing factors. The Black woman’s plight is explained through the concepts of Intersectionality Theory and the Superwoman Schema. With interventions varying on controlling hypertension, research agrees that adherence to preventative and follow-up care is essential to improving blood pressure results. During COVID-19, there was a resurgence in the use of telehealth to improve health outcomes without the need of in-person visits. Through the evaluation of literature and content analysis, this author utilized this information to encourage the use of telehealth as a workable intervention to provide Black women with additional resources to improve efforts to properly control their hypertension.
Exploring the Provisions in Medical Social Work Settings for Those Living with Diabetes: A Systematic Review
(2022) Brunson, Amie D.; Davis, Curtis; McKinney, Robert; University of Alabama Tuscaloosa
Diabetes is a public health issue that constantly prompts social work practitioners to examine how to best serve those diagnosed. Social workers and other practitioners unfamiliar with the disease may think of a disease that is easily managed by checking one’s blood sugar and taking medications. Not many people imagine a disease that has the power to inflict extreme damage internally before manifesting in external signs and symptoms. Anyone is susceptible to this disease. Without the knowledge of proper treatment and access to resources on the part of practitioners, devastating consequences can arise for those with diabetes. Nowhere is this issue more prevalent than in communities of color and the underprivileged. Medicaid-eligible patients are particularly at-risk for higher rates of chronic diseases, while communities of color disproportionately suffer from higher rates of poorly controlled diabetes and remain at heightened risk for negative health outcomes. The following systematic review will include a detailed explanation of the disease process along with the devastating effects of untreated diabetes. Care coordination services will be evaluated to determine whether the implementation of those services decrease adverse health outcomes in diabetic patients. By systematically reviewing the literature, this study highlights the crucial need for interventions targeting social determinants of health factors that often affect communities of color and the underprivileged. Without those interventions to address those barriers, the benefits of care coordination services are minimal. are cancelled out. By considering the ways in which the disease has primarily been managed by medical professionals in the past, this will allow for an alternative view of managing the disease in the future.
Exploring Virtual Calming Rooms as an Intervention to Address the Mental Health Needs of Students
(2022) Gainey, Brittny; Davis, Curtis; Ruggiano, Nicole; University of Alabama Tuscaloosa
A Qualitative Content Analysis was conducted to determine prevalent themes in Virtual Calming Rooms in Virginia K-12 Schools. Given the inclusionary criteria, located in Virginia and connected to a K-12 school, eleven Virtual Calming Rooms were analyzed. Through this analysis six common themes were identified, and 18 content areas were coded. The results of this study suggest that Virtual Calming Rooms are a viable intervention to address the mental health needs of students. A thematic review of the literature exploring educational disparities stemming from the COVID-19 pandemic lockdown created foundational knowledge of the mental health crisis that children and adolescents experience(d) particularly those of school-age. This review was through the lens of the opportunity gap as it conceptualizes educational outcomes within students resources accessibility and attainability and exposure.
“Failure Is Not An Option”: A Scoping Review to Identify Contributing Factors of Nonprofit Organizational Failure
(2023) Thomas, Courtney Chapman; Davis, Curtis; Gold, Shaunna Payne
Failure in the context of nonprofit organizations is a concept that has intrigued many scholars. Unfortunately, the research of the root cause and indicators of failure is still fragmented. A great deal of the current research focuses on the success of nonprofits. This study is founded in systems theory and seeks to derive a list of common indicators of factors that attribute to failure among nonprofit organizations. It also seeks to determine if leadership is an overarching correlating factor among all failures. Through the evaluation of literature and a content analysis, this paper produces a list of indicators of failure within nonprofit organizations. The author utilizes this information to propose intervention and prevention models that could correct or deter failure with intentional focus on the role of Social Work Education.
Finding a Final Home: A Needs and Gaps Analysis of the Referral Process into Long-Term Care for Aging Veterans with a Mental Health Diagnosis
(2022) Lawlor, Kristen; Davis, Curtis; Ruggiano, Nicole; University of Alabama Tuscaloosa
Introduction/Background: This study aimed to improve the referral process for Veterans with mental health who are seeking long-term care support through the VA with a needs and gaps analysis. Hackman and Oldham’s theoretical framework served as a lens to gain insight into stakeholders of the process and explore the need for stakeholders to know the whole process to yield the most effective outcome. Methods: Survey, 9 structured interviews, Mental Health admission data collection Results: More than 45% of all clinical staff at Manchester Veterans Affairs Medical Center reported not feeling confident or only slightly confident on their knowledge of the Long-Term Care Referral Process while 71% reported not feeling confident or slightly confident on their knowledge of the PASRR as part of the referral process. Data Collection from Geriatric programs found all four programs had 35% or more Veterans e nrolled with a Mental Health diagnosis. There were five central themes found from interviews in data analysis; a lack of knowledge of the referral process, an increase in aging mental health Veterans, needed resources, COVID Impact and a need for more training. Discussion: A discovered lack of knowledge of the whole referral process amongst stakeholders is negatively impacting nursing home placements with an inconsistency in completing the PASRR which supports existing literature on a need for a standardization of the PASRR and an Interdisciplinary approach. This study introduced an approach to standardize the PASRR implementation and improve the effectiveness of the LTC referral process through Oldham & Hackman’s theoretical framework. While this was applied to the LTC referral process this approach can be generalized to other areas working to breakdown the compartmentalization of workflows. Manchester is one VA of 171 facilities. This study was limited to VA stakeholders and future research would benefit from community stakeholder insight.

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