dissertation and work samples

Running head: PROFESSIONAL PORTFOLIO

MELISSA STANTON737 Brandon Lane SW, Rochester, MN 55902 | 507-990-8210 | [email protected]

EDUCATIONWalden University, Minneapolis, MNIn Progress: Ph.D. in Public Health – Epidemiology 2015-PresentDissertation: Spontaneous Coronary Artery Dissection (SCAD) and Body ImageHonors:

Winona State University, Winona, MNB.A. Honors in Psychology 2010Areas of Concentration: PsychologyMinor: SociologyPhi Theta Kappa, Psi Chi, Golden Key

TEACHING EXPERIENCEWinona State University, Winona, MNTeaching Assistant – “Statistics” 2010Provided tutoring, graded exams, provided content for exams

RELATED EXPERIENCEGraduate Student AssistantData Analysis Assistance 2015-2016Assisted a graduate student with creating her thesis project. Helped her develop hypotheses, implement methodology, create surveys based on the literature, and analyze her results.

Recovery is Happening, Rochester, MNVolunteer 2015Created a Recovery Service Score (RSS) for providers of Rochester, MN. Utilized Lee’s (n.d.) dimensions of recovery and rules for successful recovery and SAMHSA’s (2012) working definition of recovery as theoretical framework to guide methodology, results, and implications.

Bear Creek Services, Rochester, MNProgram Manager 2013 – 2015Developed and implemented independent living skills for people with intellectual disabilities and mental health issues. Performed program evaluation to inform improvements on the program. Utilized surveys, observation techniques, Likert-type scales, repeated measures t-tests, and analysis of variance.

Diversity Council, Rochester, MNIntern 2010 – 2010Assisted education program director with the development and distribution of surveys, targeting adolescents ages 12-18 in the public school system. The surveys were meant to gather feedback from the students as to whether they thought the Diversity Council’s education programming was meaningful. Conducted data analysis when surveys were completed; created graphs and tables to present to the Diversity Council’s executive director.

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PROFESSIONAL PORTFOLIO

LANGUAGES

[English – native language]

MEMBERSHIPSAmerican Psychological AssociationMN Psych AssociationAssociation of Counselors National Education and Research AssociationAmerican Public Health Association

PLEASE SEE BELOW FOR EXAMPLES OF WORK:

Example 1: Excerpts from Stanton, M. (2016). Quantitative Research Plan: Spontaneous Coronary Artery Dissection

(SCAD) and Body Image, pp. 3-12.

Example 2: Excerpts from Data Analysis for a Graduate Student, pp. 13-25.

Example 3: Excerpts from Assessment Proposal for Recovery is Happening, 25 July 2015, pp. 26-45.

Example 4: Excerpts from Work at Bear Creek Services Independent Living Skills Program, pp. 45-52

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Example 1

Excerpts from Stanton, M. (2016). Quantitative Research Plan: Spontaneous Coronary Artery Dissection (SCAD) and Body

Image

IntroductionOpening Statement

Spontaneous Coronary Artery Dissection (SCAD) is a rare cardiovascular condition that causes myocardial

infarction (MI) and mostly occurs in younger (< 50 years of age) women (Tweet et al., 2012; Alfonso et al., 2012; Vanzetto

et al., 2009), although the true occurrence rate is still relatively unknown (Tweet et al., 2012). The re-occurrence of SCAD

is also unknown, but several studies indicate that this rate is relatively high (Puck et al., 2012; Nakashima et al., 2016).

Scientists have proposed several physiological risk factors of SCAD for women in particular; however, little (if no) studies

exist on the psychosocial risk factors. This study will attempt to determine if one particular psychosocial concept is a risk

factor of SCAD.

Problem Statement

We do not know the relationship between women who have had a SCAD-related MI, men who have had a SCAD

event, and women who have had a non-SCAD related MI on four measures of body image.

Purpose/intent of the study.

The purpose of this study is to uncover relationships (Newman, Ridenour, Newman, & DeMarco, 2003).

Specifically, the purpose of this experimental/quasi-experimental between-groups posttest-only control group and

contrasted groups factorial study is to examine the relationship between MI types, gender, and body image, controlling for

age and race of cardiac patients at various locations. Furthermore, secondary purposes of this study are to add to the

existing knowledge base and generate future hypotheses (Newman et al., 2003).

Research Design

Variables.

There will be two independent variables with two levels each: type of MI (SCAD and non-SCAD) and biological

sex (female and male). The dependent variable will be defined as scores on four measures of body image. The control

variables will be defined as age and race.

Research Question(s)

What relationships exist between women who have had a SCAD-related MI, men who have had a SCAD-related

MI, and women who have had a non-SCAD related MI and body-image on four measures of body image?

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Null and alternative hypotheses.

Hypothesis 1:

H0: There is no significant difference between women who have had a SCAD-related MI, men who have

had a SCAD-related MI, and women who have had a non-SCAD related MI and body-image on four measures of body

image, controlling for age and race.

H1: There is a significant difference between women who have had a SCAD-related MI, men who have

had a SCAD-related MI, and women who have had a non-SCAD related MI and body-image on four measures of body

image, controlling for age and race.

Hypothesis 2:

H0: There is no significant difference between women who have had a SCAD-related MI and men who

have had a SCAD-related MI and body image on four measures of body image, controlling for age and race.

H1: There is a significant difference between women who have had a SCAD-related MI and men who

have had a SCAD-related MI and body image on four measures of body image, controlling for age and race.

Hypothesis 3:

H0: There is no significant difference between women who have had a SCAD-related MI and women who

have had a non-SCAD related MI and body image on four measures of body image, controlling for age and race.

H1: There is a significant difference between women who have had a SCAD-related MI and women who

have had a non-SCAD related MI and body image on four measures of body image, controlling for age and race.

Nature of the Study

Design & Rationale (Stanton, 2016b)

The classic experimental and Solomon four-group methods are inappropriate for my study for the following

reasons: I cannot manipulate the independent variable (e.g., induce cardiac events in participants); I do not plan on

randomly assigning participants to different groups because I want to evaluate the differences in body image perception

between SCAD and non-SCAD MI participants, as well as the differences between male and female SCAD and non-SCAD

participants; and I do not plan on administering a pre-test to the participants. The preexperimental designs are also

inappropriate for my research because I plan on having control and experimental groups and I plan on using control

procedures. The survey design would also be inappropriate for my study because again, I will not be randomly assigning

participants to the control and experimental groups.

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The planned variation, panel, time-series, and control-series designs are inappropriate for my study for the

following reasons: I cannot vary the magnitude of SCAD or non-SCAD cardiac event occurrence between the experimental

and control groups; I cannot compare before and after body image perception measurements because my participants will

have already experienced a SCAD or non-SCAD cardiac event; and at this time, I do not plan on taking multiple

measurements across time.

There are four remaining quantitative designs that I have considered for my research study. Since the purpose of

my study is primarily to test my hypotheses and uncover relationships (Newman et al, 2003), a cross-sectional design may

be appropriate. However, this type of design is one of the weaker quasi-experimental designs. The contrasted groups design

may be appropriate for my study because it will have categoric groups (Frankfurt-Nachmias et al, 2015a) with participants

having cardiac events (experimental groups) in common. I would be unable to utilize the more sophisticated contrasted

groups design (nonequivalent control group) because I will not be administering a pre-test. The design I will be using is a

combination of experimental and quasi-experimental approaches; a between-groups posttest-only control group and

contrasted groups factorial design. The posttest-only control group design fits under the true experiment category, while a

factorial design fits under both the true experiment and quasi-experimental categories. This type of design does not include

a pre-test, which boosts internal validity (Frankfurt-Nachmias et al, 2015a). Furthermore, I have two independent variables

(cardiac event type and gender) that each has two different dichotomous levels (SCAD vs. non-SCAD, male vs. female),

making a factorial design feasible (see Table 1 for hypothetical factorial design layout). I will not be administering a

treatment per se and complete random assignment is not possible with my study because participants’ pre-existing

characteristics determine which experimental group they belong to, so this design does not fit all of the criteria for a true

experiment. I plan on matching participants in the experimental and control groups based on similar characteristics such as

age and race. Furthermore, my control group will contain men and women who have not experienced any type of cardiac

event and who possess similar characteristics in regards to age and race with the experimental group participants.

Methodology

Sampling

Type of sampling.

My sampling unit (Frankfort-Nachmias et al., 2015b) is a Caucasian or African American woman or man between

the ages of 40 and 59 who lives in the United States and has experienced a non-SCAD related MI, a SCAD related MI, or

neither a MI nor a diagnosis of coronary heart disease. My sampling frame (Frankfort et al., 2015b) would ideally be a list

of all people living in the United States, separated by gender, age, and race. However, this will not be possible. Therefore, I

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plan on using a variety of online sources as my sampling frame. Online sources (to draw samples for women with SCAD-

related MI, non-SCAD related MI and men with SCAD-related MI) will include Facebook support groups (e.g., SCAD at

Mayo Clinic (2016), SCAD Survivor Support Together We Thrive (2016) , SCAD Alliance (2016), Heart Foundation

(2016), Society for Vascular Medicine (2016), and Beat SCAD UK (2016)), reputable internet support groups and pages

(The National Coalition for Women with Heart Disease (2016), Black Women’s Health Imperative (2016), Office of

Women’s Health, U.S. Department of Health and Human Services (n.d.), Heart Sisters (Thomas, 2016), Mended Hearts

(2016), and American Heart Association (2016b), and patient registries. I do not want to limit my sampling frame to people

only in my community or state because online sources do not include only people in one state, but from around the world.

This may pose a problem, however, because not everyone has access to the internet or has interest in joining online pages

or support communities, which introduces the problem of incomplete frames (Kish, 1965). Therefore, I will attempt to use

in-person support groups and supplemental lists to ensure I reach as many people as possible (Frankfort-Nachmias et al.,

2015a). In-person support groups that I have access to are Mayo Clinic’s Cardiovascular Rehab Clinic (2016) and

WomenHeart of Southeast Minnesota (The National Coalition for Women with Heart Disease, 2016). Supplemental lists

may include the Mayo Clinic’s SCAD Research Program Registry (Mayo Clinic, n.d.) or the U.S. Registry for

Fibromuscular Dysplasia (an underlying condition of SCAD) (Fibromuscular Dysplasia Society of America, 2013). I

anticipate that I may not gain access to these lists, due to HIPAA.

How the sample will be drawn (Stanton, 2016c).

The first step in identifying a sample design is determining whether one can use a probability or a nonprobability

sample. A probability sample is “distinguished by the ability to specify the probability at which each sampling unit of the

population will be included in the sample…all units of a population have the same probability of being included…”

(Frankfort-Nachmias et al., 2015b, p. 148). Because I will be using internet sites and Facebook groups, I know that every

person who has experienced a SCAD or non-SCAD relationship does not have an equal likelihood of being included in my

sample. Therefore, I will be using a nonprobability sample in which “there is no assurance that every unit has some chance

of being included” (Frankfort-Nachmias et al., 2015b, p. 148). Although nonprobability samples are less representative of

the population, researchers can use them when the exact parameters of the population of interest cannot be defined

(Frankfort-Nachmias et al., 2015b).

Nonprobability sampling designs include convenience, snowball, purposive, and quota samples (Frankfort-

Nachmias et al., 2015b). Researchers use convenience samples by recruiting participants from easily accessed or readily

available locations (Frankfort-Nachmias et al., 2015b). Although I live in the same town as the Mayo Clinic, I do not want

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all of my participants to be from Mayo, so I will not be using convenience sampling. Researchers use snowball samples

when they want to recruit participants in “hidden” populations (Frankfort-Nachmias et al., 2015b, p. 148). A specific

subtype of snowball sampling is respondent driven sampling (11), in which researchers assess recruitment networks to

further identify other participants. Although I could argue that people who experience SCAD related heart attacks are rare

or hidden because of the high occurrence of misdiagnosis, this isn’t necessarily grounds for using a snowball sampling

design, because they aren’t hiding for legal or safety reasons. Researchers use quota samples when they want their sample

to reflect the population (Frankfort-Nachmias et al., 2015b). I would like to have my sample be representative of the

African and Caucasian American population for the control group in terms of gender. I would also like my sample to be

representative of the African and Caucasian American population who experiences both SCAD and non-SCAD related MI

in terms of gender. However, I do not necessarily need to represent the SCAD and non-SCAD related MI population in

terms of age. This is because the majority of people who experience a SCAD related MI are between the ages of 20 and 50,

so I want to focus on that particular age group. Finally, a purposive sample involves a researcher using his/her judgment to

select a sample that appears to be representative of the intended population (Frankfort-Nachmias et al., 2015b). This is the

type of sampling design that I wish to use because I will be actively recruiting participants from websites, Facebook groups,

and registries. I aim to select a representative number of women and men, as well as a representative number of Caucasian

American and African American people.

Sample size and why chosen in relation to population size (Stanton, 2016c).

Researchers must carefully select the size of their samples if they wish to generalize their results to the larger

population (Burkholder, n.d.). To calculate a sample size, social scientists use statistical power, alpha, and effect size

(Burkholder, n.d.). To estimate the size of the sample I will need for my study, I will use the accepted power level of .80

and the standard alpha level of =.05 (Burkholder, n.d.). Finally, since I plan on using a factorial ANOVA to determine if

my results are statistically significant, I will anticipate a small effect size of R2 = .04 (Burkholder, n.d.). Using Burkholder’s

(n.d.) Analysis of Variance table recommendation, with k=4, my sample size should be n=67. If I anticipate a medium

effect size of R2 = .08, my sample size should be n=33. If I anticipate a large effect size of R2 = .20, my sample size should

be n=12. Furthermore, if I wanted to increase my statistical power, I could use an alpha level of = .01 (Gravetter &

Wallnau, 2007a), my sample sizes would need to be larger. Another issue I will need to be aware of is nonresponse error,

which occurs when participants do not return surveys or refuse to participate after committing to a study (Frankfort-

Nachmias et al., 2015b). The higher the nonresponse rate, the greater the bias and measurement error (Frankfort-Nachmias

et al., 2015b). I can determine my nonresponse rate after I my data collection is completed. Furthermore, I can set a

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response rate “goal” by utilizing Frankfort-Nachmias et al’s (2015b) response rate equation. If I want my nonresponse rate

to be 5% with a sample size of n=67, the number of responses I must obtain is r= ~64.

Instrumentation and Materials

Identify instrument (Stanton, 2016d).

Currently, I have selected four instruments to use in my research, all of which are criterion-referenced because

their developers compared them to other measures of body image disturbance and other negative body image or eating

disorder criteria, rather than comparing the test takers along some ranking system (Fairtest, The National Center for Fair

and Open Testing, 2007). Although each of these instruments demonstrates moderate to high reliability and validity

coefficients, they have been tested only on younger men and women who may or may not have cardiovascular problems.

To ensure reliability and validity in my research, I will need to demonstrate that these instruments are appropriate to use

with my population.

Data Analysis Plan

Analytical Tools

I will calculate the following descriptive statistics for the results of the BI-AAQ (Sandoz et al., 2013); BIDQ (Cash

et al., 2004a), BAS-2 (Tylka et al., 2015a), and BEECOM (Fitzsimmons et al., 2012a): Mean and standard deviation. The

mean and standard deviation are appropriate central tendency measures because the scores on each of the four assessments

are at the interval-level of measurement (Frankfort-Nachmias et al., 2015c). If outliers do not exist (Frankfort-Nachmias et

al., 2015e), I may also calculate the range, minimum, and maximum. The median and the mode will likely not reveal

important information, as these measures are more appropriate for nominal and ordinal data (Frankfort-Nachmias et al.,

2015e).

For my quantitative analysis, I plan on using factorial analysis of variance (ANOVA) procedures because I have

more than two independent variables and one dependent variable (Burkholder, n.d.). Furthermore, I want to examine the

individual and interaction effects of multiple factors within my two independent variables (Warner, 2013). The assumptions

of a factorial ANOVA are: 1) the outcome variable is continuous and normally distributed and 2) the populations from

which the samples are drawn have equal variances (Warner, 2013). Additionally, it is desirable if the number of groups

(factors within the independent variables) is not overly large and if the number of observations within each factor are equal

(Warner, 2013). However, if the number of observations within each factor cell is not equal, an orthogonal factorial

ANOVA can be calculated (Warner, 2013). My independent variables are MI type (IV 1) and gender (IV 2). SCAD MI is

factor A1 and non-SCAD MI is factor A2. Male gender is factor B1 and female gender is factor B2. Thus, I will be using a 2

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x 2 factorial ANOVA to predict body image from MI type (factor A), gender (factor B), and the interaction between factor

A and B. My null and alternative hypotheses are as follows:

H0A: A1 = A2 (no significant difference between populations on factor A; in other words, no main effect for factor

A; Warner, 2013)

H1A: A1 A2

H0B: B1 = B2 (no main effect for factor B)

H1B: B1 B2

H0: No A x B interaction (Warner, 2013)

H1: There is an interaction between factors (Gravetter & Wallnau, 2007b).

Ethical Concerns

According to the American Psychological Association’s (APA; 2010) code of conduct, researchers must follow the

five main principles of beneficence and nonmaleficence (benefit and do no harm), fidelity and responsibility (build and

maintain trusting relationships, avoid exploitation), integrity (avoid cheating, plagiarism, fraud), justice (awareness of

inequities and personal biases), and respect for people’s rights and dignity. Potential ethical concerns I may need to address

are ensuring anonymity to participants, maintaining data confidentially for a period of time (Creswell, 2009b), and avoiding

deception without giving away the hypotheses of the study (APA, 2010). I will be able to ensure confidentiality through the

use of a thorough informed consent form, detailed below. I will maintain data for a lengthy period of time, as suggested by

my committee members. Finally, I will be upfront with the participants about the purpose of the research, specifically

informing them that I am studying how weight, body image, and exercise affects people who have experienced a heart

attack.

Significance of the Study

Practical Contributions

The practical contributions to this study include: 1) establishing the reliability and validity of the BI-AAQ, BIDQ,

BAS-2, and BEECOM with patients who have experienced a SCAD or non SCAD-related MI; 2) identifying whether body

image intervention should be a part of the SCAD MI recovery process; and 3) initiating further research on body image and

other psychosocial factors within the SCAD MI population. If this study shows no relationship between body image and

SCAD MI, it will, at the very least, establish a starting point of the reliability and validity of the various measurement

instruments in a clinical population. If this study shows a relationship between body image and SCAD MI, perhaps

clinicians will consider integrating body image interventions or psychosocial education within the treatment model for

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SCAD-MI patients. Finally, regardless of whether this study shows a significant relationship between body image and

SCAD-MI, it will hopefully encourage other researchers to evaluate psychosocial factors in relation to health issues.

For Whom the Study is Important

This study is important to medical and psychological researchers. As stated above, researchers have found some

physiological associations with SCAD MI; however, research on the psychosocial links are few, even nonexistent.

Hopefully this study will enhance the existing knowledge base and encourage medical and psychological researchers to

continue collaborative research efforts. More importantly, this study will hopefully be important to SCAD MI patients and

their families. The ambiguous nature of SCAD, the uncertainties regarding recurrence, and the feelings of lack of control

over outcomes can have a negative impact on patients and their families. The more research that is devoted to this issue, the

more the scientific community can enhance patient outcomes and hope for the future.

Implications for Social Change

Orth-Gomer et al. (2009) implemented the Stockholm Women Intervention Trial for Coronary Heart Disease

(SWITCHD) in a sample of 250 female patients with CHD, which included stress reduction and behavioral modification

programs. Orth-Gomer et al. (2009) found that those in the intervention group, as opposed to those in the control group, had

significantly lower rates of acute MI, cardiovascular disease related death, and overall mortality. In another study, 2,481

post MI patients underwent cognitive behavioral therapy, which reduced their depressive symptoms, but only reduced

cardiovascular-related mortality in White men (The ENRICHD investigators, 2000). Schneiderman et al. (2004) then called

for researchers to develop and study interventions specifically tailored to women and other minorities. Thus, programs that

not only focus on the physiological risk factors of cardiovascular problems, such as SCAD-related MI’s, can be useful in

preventing recurrence and death, especially among women.

Another implication of this study is that it will continue the conversation surrounding societal norms and

expectations about women’s bodies. The Boston Women’s Health Collective (2011) described women’s body image as the

criticism continuum, with societal pressure to “look pretty” starting when we are very young and extending throughout the

lifetime with advertisements for Botox and the myriad of cosmetic products, exercise routines, and diets. Researchers have

been identifying interventions and strategies to promote positive body image, such as the acceptance model (Hahn,

Wiseman, Hendrickson, Phillips, & Hayden, 2012) and embodiment activities (Menzel & Levine, 2011). If this study

demonstrates a relationship between negative body image and SCAD MI, perhaps this will propel the direction of body

image research toward a societal paradigm shift in attitudes about women’s bodies.

Please inquire to obtain full reference list.

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Table 1

2x2 Factorial Design Layout

Independent Variable 2: Cardiac Event Type

Independent Variable 1: Biological Sex

Male Female

SCAD Experimental Group 1:

male SCAD patients

Experimental Group 2:

female SCAD patients

Non-SCAD Experimental Group 3:

male non-SCAD related

MI patients

Experimental Group 4:

female non-SCAD

related MI patients

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Table 2

Campbell & Fiske’s (1959) Multitrait-Multimethod Matrix with Hypothetical Validity Coefficients

Methods BI-

AAQ

BAS-2 BIDQ

Traits SW SM SC SW SM SC SW SM SC

BI-AAQ SW (1)

SM .5 (1)

SC .4 .4 (1)

BAS-2 SW .6 .2 .1 (1)

SM .2 .6 .1 .7 (1)

SC .1 .1 .5 .6 .6 (1)

BIDQ SW .6 .2 .1 .7 .4 .3 (1)

SM .3 .6 .1 .4 .7 .3 .7 (1)

SC .1 .1 .5 .3 .3 .6 .6 .6 (1)

Note. Values in parentheses are reliability values; values in red are validity values. Bolded values represent heterotraits

measured by the same method; italicized values represent heterotraits measured by different methods. SW = female patients

with SCAD, SM = male patients with SCAD, SC = all patients with non-SCAD cardiac events; BI-AAQ = Body Image

Acceptance and Action Questionnaire, BAS-2 = Body Appreciation Scale-2, BIDQ = Body Image Disturbance

Questionnaire.

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Example 2

Excerpts from Data Analysis for a Graduate Student

The baseline demographics were as follows: among the 11 participants that were probation officers, 36% were

male and 64% were female; the remaining characteristics of education, employment status, and wages were similar. Two of

the probation officer participants dropped out of the study before cycle two commenced. Among the eight participants that

were managers, 25% were male and 75% were female; the remaining characteristics of education, employment status, and

wages were similar. All eight of the managers were able to complete all four questionnaires administered during cycle one

and cycle two.

Main Analyses:

H0: There is no difference between collaboration scores before or after M4R implementation. Therefore, in the general

population, there is no tendency for the difference scores to be either systematically positive or systematically negative.

(e.g., Internal collaboration does not significantly change after M4R implementation).

H1: There is no difference between collaboration scores before or after M4R implementation. Therefore, in the general

population, there is no tendency for the difference scores to be either systematically positive or systematically negative.

(e.g., Internal collaboration does significantly change after M4R implementation).

Probation officers’ endorsements to each item on the collaboration questionnaire were summed to produce a total

collaboration score. The maximum total collaboration score was 40 (10 questions x largest Likert item selection of 4; see

Figure 1). 54% of the probation officers’ total collaboration scores increased after M4R implementation. Because Likert-

type items are considered ordinal, rather than interval measurements (Frankfort-Nachmias, Nachmias, & DeWaard, 2015),

quartiles and medians were reported. 25% of the probation officers’ total collaboration scores were 27 or below and 32 or

below, before and after M4R implementation, respectively. The median of all total collaboration scores was 33.00 both

before and after M4R implementation. 75% of the probation officers’ total collaboration scores both before and after M4R

implementation were 34 or below (see Table 1).

A Wilcoxon test was conducted to evaluate whether probation officers endorsed more collaboration, as measured

by their total collaboration scores, after four weeks of M4R implementation. Although the mean rank of the total

collaboration scores after M4R implementation (7.17) was greater than the mean rank of the total collaboration scores

before M4R implementation (4.60, see Table 2 and see Table 3 for an example of the ranking system for the Wilcoxon

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test), the results of the Wilcoxon test indicated no significant difference, z = -.892, p = .373 (see Table 4). Thus, my first

hypothesis that M4R would increase internal collaboration is not supported.

Table 1

Descriptive Statistics of Total Collaboration Scores Before and After M4R Implementation

N

Percentiles

25th 50th (Median) 75th

BeforeM4R 11 27.00 33.00 34.00

AfterM4R 11 32.00 33.00 34.00

Table 2

Mean Ranks of Total Collaboration Scores Before and After M4R Implementation

N Mean Rank Sum of Ranks

AfterM4R - BeforeM4R

Negative Ranks 5a 4.60 23.00

Positive Ranks 6b 7.17 43.00

Ties 0c

Total 11

Note. aAfter M4R < Before M4R. bAfter M4R > Before M4R. cAfter M4R = Before M4R

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Table 3

Example of Ranking Difference Scores for a Wilcoxon Test Using Total Collaboration Scores Before and After M4R

Implementation

Before M4R After M4R Difference Score Rank

33 34 1 2

33 32 -1 2

33 40 7 10

37 36 -1 2

27 33 6 9

31 34 3 6.5

34 32 -2 4.5

24 34 10 11

26 28 2 4.5

37 33 -5 8

33 30 -3 6.5

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Table 4

Results of Wilcoxon Test to Evaluate Differences in Total Collaboration Scores Before and After M4R Implementation

AfterM4R - BeforeM4R

Z -.892b

Asymp. Sig. (2-tailed) .373

Note. bBased on negative ranks.

Prob Office

r 1

Prob Office

r 2

Prob Office

r 3

Prob Office

r 4

Prob Office

r 5

Prob Office

r 6

Prob Office

r 7

Prob Office

r 8

Prob Office

r 9

Prob Office

r 10

Prob Office

r 11

0

5

10

15

20

25

30

35

40

Total Collaboration Scores Before and After M4R

Before M4R After M4R

Figure 1. Total collaboration scores for each probation officer was calculated by summing their endorsement selections on

each test item. The total possible score was 40.

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Another consideration was given to probation officers’ total collaboration scores before cycle one and before cycle

two because a four-week break occurred between the end of cycle one and the beginning of cycle two. The probation

officers may have needed time after the M4R intervention to accurately assess their level of internal collaboration. The

caveat of this analysis is that the sample sizes between cycles 1 and 2 were unequal. 25% of the probation officers had total

collaboration scores of 27 or below and 29.5 or below, after cycle one and before cycle two, respectively. The median of

the total collaboration scores after cycle one and before cycle two were 33 and 35, respectively. Finally, 75% of the

probation officers had total collaboration scores of 34 and 36.5 after cycle one and before cycle two, respectively (see Table

8).

A Wilcoxon test was conducted to evaluate whether probation officers endorsed more collaboration, as measured

by their total collaboration scores, before cycle two. Although mean rank of the total collaboration scores before cycle two

(4.83) was greater than the mean rank of the total collaboration scores before cycle one (3.50, see Table 9) and the

difference between the total collaboration scores (e.g., the difference between positive ranks and negative ranks) before

cycle one and cycle two were larger compared to the previous analyses, results of the Wilcoxon test indicated no significant

difference, z = -1.54, p = .123 (see Table 10). Figure 3 supports this finding as well.

Table 8

Descriptive Statistics of Total Collaboration Scores Before Cycle One and Before Cycle Two

N

Percentiles


PO Collaboration Score Before

Cycle 1

11 27.0000 33.0000 34.0000

PO Collaboration Score Before

Cycle 2

9 29.5000 35.0000 36.5000

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Table 9

Mean Ranks of Total Collaboration Scores Before Cycle One and Before Cycle Two

N Mean Rank Sum of Ranks

PO Collaboration Score

Before Cycle 2 - PO

Collaboration Score Before

Cycle 1



Ties 1c

Total 9

Note. aBefore Cycle 2 < Before Cycle 1. bBefore Cycle 2 > Before Cycle 1. cBefore Cycle 2 = Before Cycle 1.

Table 10

Results of Wilcoxon Test to Evaluate Differences in Total Collaboration Scores Before Cycle One and After Cycle Two

PO Collaboration Score Before Cycle 2 - PO Collaboration Score Before Cycle 1

Z -1.544b


Note. bBased on negative ranks.

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Prob Office

r 1

Prob Office

r 2

Prob Office

r 3

Prob Office

r 4

Prob Office

r 5

Prob Office

r 6

Prob Office

r 7

Prob Office

r 8

Prob Office

r 9

Prob Office

r 10

Prob Office

r 11

0

5

10

15

20

25

30

35

40

Total Collaboration Scores Before Cycle 1 and Before Cycle 2

PO Before C1 PO Before C2

Figure 3. Total collaboration scores for each probation officer was calculated by summing their endorsement selections on

each test item. The total possible score was 40. Probation officer 10 and probation officer 11 dropped out of the study

before cycle two.

Managers of the probation officers who participated in this study were given a separate questionnaire about their

expectations and observations of internal collaboration before and after M4R implementation. Managers’ endorsements to

each item on the expected collaboration questionnaire were summed to produce a total expected collaboration score. The

maximum total collaboration score was 40 (10 questions x largest Likert item selection of 4; see Figure 5). 25% of the

managers’ expected collaboration scores increased after M4R implementation, while 25% of the managers’ expected

collaboration scores remained the same. 25% of the managers’ expected collaboration scores before and after M4R

implementation were 30.25 or below. The median of all expected collaboration scores before and after M4R

implementation were 32 and 31.50, respectively. 75% of the managers’ expected collaboration scores both before and after

M4R implementation were 33 or below (see Table 14).

A Wilcoxon test was conducted to evaluate whether managers endorsed more collaboration, as measured by their

expected collaboration scores, after four weeks of M4R implementation. Although the mean of the ranks after M4R

implementation (4.50) was higher than the mean of the ranks before M4R implementation (3.00; see Table 15), the results

of the Wilcoxon test indicated no significant difference, z = -.333, p = .739 (see Table 16).

19


Table 14

Descriptive Statistics of Managers’ Expected Collaboration Scores Before and After M4R Implementation

N

Percentiles


Before M4R 8 30.25 32.00 33.00

After M4R 8 30.25 31.50 33.00

Table 15

Mean Ranks of Managers’ Expected Collaboration Scores Before and After M4R Implementation

After M4R - Before M4R



Ties 2c

Total 8

Note. aAfter M4R < Before M4R. bAfter M4R > Before M4R. cAfter M4R = Before M4R

20


Table 16

Results of Wilcoxon Test to Evaluate Differences in Managers’ Expected Collaboration Scores Before and After M4R

Implementation

After M4R - Before M4R

Z -.333b


Note. bBased on positive ranks.

Mngr 1 Mngr 2 Mngr 3 Mngr 4 Mngr 5 Mngr 6 Mngr 7 Mngr 80

5

10

15

20

25

30

35

40

Expected Collaboration Scores Before and After M4R

Before M4R After M4R

Figure 5. Total expected collaboration scores for each manager was calculated by summing their endorsement selections on

each test item. The total possible score was 40.

21


Spearman correlation coefficients were computed among probation officers’ total collaboration scores and

managers’ expected collaboration scores before and after M4R implementation. The results of the analysis presented in

Table 20 show that 1 out of 10 correlations was statistically significant, r = .804, p < 0.05. This significant finding only

demonstrated the relationship between managers’ expected collaboration scores before and after M4R implementation; the

absence of other significant correlations and the scatterplot in Figure 7 might suggest that probation officers’ perceptions of

collaboration are independent of their managers’ perceptions of collaboration, regardless of M4R implementation.

Table 20

Spearman Correlation Coefficients Between PO Total Collaboration Scores and Manager Expected Collaboration Scores

Before and After M4R Implementation

PO Before M4R Mngr Before M4R PO After M4R Mngr After M4R

Correlation

Coefficienta

1.00 .26 .09 .25

Correlation

Coefficientb

.26 1.00 .08 .80*

Correlation

Coefficientc

.09 .08 1.00 .34

Correlation

Coefficientd

.25 .80* .34 1.00

Note. *Correlation is significant at the 0.05 level (2-tailed). aPO Before M4R. bMngr Before M4R. cPO After M4R. dMngr

After M4R.

22


Figure 7. Correlation matrix showing no significant relationships between probation officers’ total collaboration scores and

managers’ expected collaboration scores, both before and after M4R implementation.

Finally, Spearman correlation coefficients were computed among probation officers’ total collaboration scores

before cycle one and after cycle two and managers’ expected collaboration scores before cycle one and after cycle two. The

results of the analysis presented in Table 22 one significant correlation between the probation officers’ total collaboration

scores after cycle two and the managers’ expected collaboration scores before cycle one, r = -.813, p < .05. This result is

interesting because as a manager’s expected collaboration score before intervention increased, a probation officer’s total

collaboration score after intervention decreased. This negative association is presented in Figure 9. Perhaps a manager with

high expectations that a collaboration intervention will increase internal collaboration amongst his/her employees explicitly

or implicitly “over-advertises” the intervention, which may negatively affect employees’ overall feelings of internal

collaboration within their organization.

23


Table 22

Spearman Correlation Coefficients Between PO Total Collaboration Scores and Manager Expected Collaboration Scores

Before Cycle 1 and After Cycle 2

PO Before C1 PO After C2 Mngr Before C1 Mngr After C2

Correlation

Coefficienta

1.00 -.04 .26 -.29

Correlation

Coefficientb

-.04 1.00 -.81* .17

Correlation

Coefficientc

.26 -.81* 1.00 -.05

Correlation

Coefficientd

-.29 .17 -.05 1.00

Note. aPO Before Cycle 1. bPO After Cycle 2. cMngr Before C1. dMngr After C2. *Correlation is significant at the 0.05

level (2-tailed).

24


Figure 9. Scatterplot of the significant negative relationships between managers’ expected collaboration scores before cycle

one and probation officers’ total collaboration scores after cycle two.

25


Example 3

Excerpts from Assessment Proposal for Recovery is Happening, 25 July 2015

Measurement 1:

1. Develop a measurement to compare providers with each other regarding how well they are providing services that align with SAMHSA’s eight dimensions of wellness and ideals for and access to recovery initiative

2. Goal: Making sure people have access to the most services3. Target: Service Providers, Other Professionals, and Individuals in Recovery in Rochester, MN4. Expectation: Gather usable data to present to treatment providers to represent recovery services for individuals

Creation of Recovery Service Scores to Evaluate Providers

Measurements:

1. How providers are doing in regards to providing services that align with SAMHSA’s eight dimensions of wellness and ideals of recovery

2. How providers compare with other providers3. How providers’ claims compare with individuals’ and other professionals’ experiences

The Recovery Service Score (RSS) is measured using SAMHSA’s (2015) eight dimensions of wellness, SAMHSA’s (n.d.) ideals of recovery, and SAMHSA’s (2003) recovery support services recommendations.

SAMHSA’s Eight Dimensions of Wellness:

1. Emotional: Coping effectively; creating and maintaining satisfying relationships2. Environmental: Pleasant, stimulating environments that support well-being3. Financial: Individual comfort with providing for self and family financially4. Intellectual: Using creative abilities; expanding knowledge and skills5. Physical: Engaging in physical activity, healthy eating, sufficient sleep6. Social: Having a sense of connection and belong, as well as a developed positive support system7. Spiritual: Having a sense of purpose and meaning in life

Recovery Service Score (RSS)

14 Ideals for Recovery and

Access to Recovery Initiative

8 Dimensions of Wellness

26


SAMHSA’s Ideals for and Access to Recovery Initiative:

1. Housing (HOUSE): Provide referrals to housing resources, provide housing resources (deposits, first month rent), provide housing while individual is looking for independent housing

2. Transportation (TRANSP): Provide free transportation to and from treatment groups; provide cab or bus vouchers; provide referrals to transportation resources; initiate volunteer drivers or ride shares

3. Basic Needs (BASIC): provide resources on how to attain basic needs; provide education on how to attain basic needs; provide vouchers for basic needs; provide basic needs while in treatment; provide referrals to agencies that can provide basic needs

a. Basic needs: food, clothing4. Parent Training (PARENT): provides parent training through the program; provides referrals to parent training

resources; provides parent training resources5. Child Care (CHILD): provides child care while individual attends outpatient services; provides vouchers for child

care; provides resources for childcare; provides referrals for child care assistance6. Vocational (VOC): provides job training; provides referrals to vocational resources; provides employment while in

treatment7. Life Skills (LIFE): provides education on independent living skills; provides referrals to ILS classes or other

resources; provides staff to assist with ILS in the individual’s homea. ILS: cooking, cleaning, money management, medication management, transportation, organization,

planning, making appointments for self and others8. Legal (LEGAL): provides support for individual dealing with legal matters; provides referrals to legal resources;

cooperates and collaborates with legal professionals if applicable9. Peer Support (PEER): the program has built in aspect of peer support; the program provides resources for peer

support; the program refers to other groups with peer support; the program encourages peer support10. Aftercare (AFTER): Program provides extended aftercare including individual and group therapy, medication

monitoring, drug or alcohol testing, medical care, home visits, psychoeducation11. Community Based (COMM): program encourages community living and reintegration; program assists individual with reintegration after inpatient treatment or during/after outpatient treatment; program provides referrals for reintegration assistance12. Assessment (ASSESS): psychological, drug testing services are done on site; provide referrals to testing services; provide resources for testing services13. Multiple Pathways (MULT): program encourages more than one pathway for recovery; program does not subscribe to one treatment method only (i.e. 12 step, religious, abstinence, harm reduction); program provides resources for alternative treatments14. Holistic (HOL): program addresses all individual’s needs – mind, body, spirit; program provides referrals to holistic programs

Within each dimension of wellness, the ideals and recovery support services are used to describe the dimensions further. As shown in Table 1, some categories are “weighted” less, depending on which dimension they are under because some categories are fundamental to the wellness dimension (heavier weight); others are “essential, but not necessary” (medium weight), and still others are “neither essential nor necessary, but nice to have” (low weight).

27


Table 1

Weighted Scores Along SAMHSA’s Eight Dimensions of Recovery

Emotional

Environmental

Financial

Intellectual

Occupational

Physical Social Spiritual

Heavier Wt

COMM

MULT

HOUSE

TRANSP

HOUSE

TRANSP

BASIC

VOC

PARENT

VOC

LIFE

COMM

TRANSP

BASIC

CHILD

VOC

COMM

HOL

BASIC

PARENT

MULT

HOL

PARENT

CHILD

VOC

LEGAL

PEER

COMM

VOC

LIFE

LEGAL

PEER

COMM

MULT

HOL

Medium Wt

LIFE

PEER

AFTER

PARENT

VOC

HOL

PARENT

CHILD

VOC

LIFE

LEGAL

COMM

BASIC

COMM

MULT

HOL

LIFE

LEGAL

TRANSP

HOL

BASIC

PEER

MULT

LIFE

LEGAL

MULT

AFTER

VOC

LIFE

PEER

AFTER

TRANSP

LIFE

AFTER

HOL

PARENT

AFTER

Low Wt HOUSE

TRANSP

BASIC

CHILD

LEGAL

ASSESS

PEER

AFTER

ASSESS

MULT

HOL

PEER

PARENT

CHILD

AFTER

ASSESS

LEGAL

AFTER

HOUSE

CHILD

ASSESS

PEER

PARENT

ASSESS

HOUSE

CHILD

COMM

HOUSE

TRANSP

LEGAL

ASSESS

HOUSE

MULT

ASSESS

BASIC

HOUSE

TRANSP

BASIC

CHILD

ASSESS

28


The RSS for SAMHSA Ideals:

1. Each of the above ideals is rated on a scale of 1 to 4a. 1: none (resource is not available, recommended, referred)b. 2: resource is inside the facility but requires additional referral; OR resource is outside the facility and

agency refersc. 3: resource is within the facility and accessible to individual (without referral)d. 4: resource is built into the program

2. Each ideal has a high score of 4 and a low score of 13. Each ideal is added to yield a total RSS4. Analyses:

a. Comparisons between facilities per total RSSb. Comparisons between facilities per each idealc. Comparisons between provider claims total RSS and individual experiences total RSSd. Comparisons between provider claims total RSS and other professionals’ experiences total RSS

The Weighted RSS for Dimensions

1. Each of the above ideals is rated on a scale of 1 to 4a. 1: none (resource is not available, recommended, referred)b. 2: resource is inside the facility but requires additional referral; OR resource is outside the facility and

agency refersc. 3: resource is within the facility and accessible to individual (without referral)d. 4: resource is built into the program

2. Each ideal has a high score of 4 and a low score of 1a. The mode of individual program scores per facility is usedb. Each mode for each ideal is weighted per dimension (see above table) to yield a weighted score c. Weighted scores are summed (eight weighted scores)d. Total score = Highest possible score (4) * (Weighted score for the particular ideal); summed

3. Weighted score summation/total score = Weighted RSS per dimensiona. Interaction of Dimension and Ideal

4. Analyses:a. Comparisons between facilities per total weighted RSS per dimensionb. Comparisons between facilities weighted RSS for each dimensionc. Comparisons between provider claims weighted RSS per dimension and individual experiences weighted

RSS per dimensiond. Comparisons between provider claims weighted RSS per dimension and OPs’ experiences weighted RSS

per dimension

Instrumentation/Method:

1. Instrumentation:a. Paper/pencil surveys (see Appendices A, B, C)b. Surveys for each facility, individuals, and OP’s will vary depending on which population they fall into.

Regardless, questions will remain the same, worded differently to appropriately reflect the individual taking the survey.

2. Pilot: One facility, ten individuals, ten OPs will pilot the surveysa. All participants of the pilot are expected to give critical feedback regarding wording, comfort, neutrality,

and ease of survey.b. Pilot surveys will be tested for construct validity and internal consistency (reliability).

3. Administrationa. Surveys will be distributed to the following facilities. Every employee from the facility will be

encouraged to take part in the surveys; employee surveys will be combined to yield scores for the facility:i. Zumbro Valley Health Center

ii. Mayo Cliniciii. Empower CTC

29


iv. Metro Treatment Centerv. Common Ground

vi. Fountain Centersvii. Nehemiah Family Services

viii. MN Adult & Teen Challenge b. Each facility will also be asked to fill out individual surveys for each of their programs, as shown in

Table 2:

Table 2Rochester, MN Treatment Facilities and Subsequent Programs

Facility Program

ZVHC Choices

Recovery Partners

Recovery Basics

PREP

Recovery Bound

Right to Recovery

Footsteps 4 Recovery

Women’s Way to Recovery

DWI Classes

Intensive Residential

CD Navigator

CRU

Psychiatry/Psychology

Monitored Antabuse

Opiate Recovery

Mayo Clinic Consultation

Intensive Addiction

Outpatient Addiction

Extended Outpatient

Early Recovery

Recovery Maintenance

Health Professionals

Empower CTC Primary CD

30


Relapse Prevention

DUI Program

Step Beyond

Metro Treatment Center Outpatient program

Common Ground Outpatient/Outpatient Extended

Jump Start

Relapse Program

DUI Classes

Counseling

Fountain Centers Outpatient Services

Adult Transition

Adult Relapse

Continuing Care

Nehemiah Family Services Outpatient

Relapse

Individual Counseling

MN Adult & Teen Challenge Long-Term Adult

Life Renewal

Restoration

c. Surveys will be distributed to individuals in the recovery community:i. Those in recovery (0-100 years)

ii. Those who have been through one of the facilities listed above for alcohol/drug treatment; they do not need to have graduated from the program in order to participate

iii. Recovery individuals who should not take surveys:1. Those currently in treatment in one of the facilities listed above – once they are out of

treatment, they can participated. Surveys will be distributed to other professionals who work with the recovery community:

i. Olmsted County employees: Social Workers, Child Protection Workers, Case Managers, Probation/Parole Officers, Law Enforcement Officers

ii. Mental health professionals who do not work for any of the above facilitiesiii. Medical professionals who do not work for any of the above programsiv. Professionals, volunteers who work for non-profit agencies that are involved in alcohol/drug

recovery4. Administration Period:

31


a. Surveys will be administered from xx/xx/xx to xx/xx/xx5. Administration Procedure

a. To be determined by Recovery is Happening6. Confounding Variables

a. Below, in Table 3, are the potential confounding variables of this survey’s administration and possible solutions to lessen their effects

Table 3Possible Confounding Variables and Possible Solutions

Confounding Variable Possible Solutions

Day survey is administered 1. If possible, administer surveys on the same day(s) of the week for all participants

Time of day survey is administered 1. If possible, administer surveys at the same time(s) for all participants

2. If possible, administer surveys during the same time frame(s) for all participants (i.e. 8a-12p OR 12p-4p OR 4p-8p)

Survey is completed individually or in a group setting 1. For facilities: Encourage one group of five to complete the facility-wide survey

2. Encourage all employees to individually fill out one survey for the facility-wide survey

3. Encourage individual employees to complete program-specific surveys

4. Encourage separate groups of five people to fill out program-specific surveys

5. Encourage individuals to complete surveys individually

6. Encourage other professionals to fill out surveys individually

Individual knowledge of facilities and/or programs 1. For facility employees, encourage them to fill out program-specific surveys only if they have worked for the program in the last two years for at least six months

2. For other professionals, encourage them to fill out program-specific and facility wide surveys only if they have worked directly with a facility/program in the last three years

Locations where survey is administered 1. Administer surveys at one location only2. Keep location consistent for each group (i.e. ZVHC

employees take surveys at ZVHC, Conference Rm 3)Survey proctor and instructions 1. The same survey proctor should administer all surveys

2. The same 2-3 survey proctors should administer all surveys

3. Survey instructions should be scripted and followed exactly; survey proctors should not insert their opinions while explaining the survey

4. Survey proctors should not be any person who has a stake in the survey; these individuals can be present to answer questions about the study only

32


Sample Descriptive Results:

Comparing Average RSS between facilities in Rochester, MN.

Highest possible score: 60

Median: 37

Average: 38.5

Highest: 43.4 (ZVHC)

Lowest: 33.7 (Mayo)

ZVHC MAYO EMPOWER MN ADULT METRO COMMON GROUND

FOUNTAIN NEHEMIAH0

10

20

30

40

50

60

AVERAGE RSS SCORE per Facility

Average RSS Score

33


Comparing RSS between Programs:

Highest possible score: 60

Choices

Recove

ry Part

ners

Recove

ry Basi

csPREP

Recove

ry Bound

Right to

Recover

y

Footst

eps 4

Recover

y

Women's W

ay to Reco

very

DWI Clas

ses

Intensiv

e Resi

dential

CD Naviga

torCRU

Psychiat

ry/Psyc

hology

Monitored

Antabuse

Opiate R

ecover

y0

10

20

30

40

50

60

RSS BY PROGRAM: ZVHC

Consulta

tion

Intensiv

e Addicti

on

Outpatien

t Addicti

on

Exten

ded Outpati

ent

Early

Recover

y

Recove

ry Main

tenan

ce

Health Profes

sionals

0

10

20

30

40

50

60

RSS BY PROGRAM: MAYO

In addition, averages for each SAMHSA recommendation can be calculated. This demonstrates how well all the providers combined are doing providing these services.

Narrative Example: “On average, the treatment providers in this community need to refer to other, outside agencies, to provide housing services to individuals in treatment.”

34


Housing

Transporta

tion

Basic N

eeds

Parenting T

raining

Childcar

e

Vocational

Life Sk

ills Legal

Peer S

upport

Aftercare

Provid

e reso

urces

Community base

d

Assessm

ents

on site

Multiple path

ways

Holistic

0

0.5

1

1.5

2

2.5

3

3.5

4

Average Individual RSS by SAMHSA Category

Scores can also yield a global look at the percentage of programs who have a recovery service built in, have a recovery service in house and accessible to the individual, have a recovery service in hour but needing an extra referral OR referral to an outside agency, and programs that do not refer.

Housing

Transporta

tion

Basic N

eeds

Parenting T

raining

Childcar

e

Vocational

Life Sk

ills Legal

Peer S

upport

Aftercare

Provid

e reso

urces

Community base

d

Assessm

ents o

n site

Multiple path

ways

Holistic

0102030405060708090

100

% Programs w/In House, In Program RS

35


Housing

Transporta

tion

Basic N

eeds

Parenting T

raining

Childcar

e

Vocational

Life Sk

ills Legal

Peer S

upport

Aftercare

Provid

e reso

urces

Community base

d

Assessm

ents o

n site

Multiple path

ways

Holistic

0

10

20

30

40

50

60

70

80

90

100

% Programs w/In House, Accessible RS

36


Housing

Transporta

tion

Basic N

eeds

Parenting T

raining

Childcar

e

Vocational

Life Sk

ills Legal

Peer S

upport

Aftercare

Provid

e reso

urces

Community base

d

Assessm

ents o

n site

Multiple path

ways

Holistic

0

20

40

60

80

100

% Programs Referring to In-House or Outside RS

37


Housing

Transporta

tion

Basic N

eeds

Parenting T

raining

Childcar

e

Vocational

Life Sk

ills Legal

Peer S

upport

Aftercare

Provid

e reso

urces

Community base

d

Assessm

ents o

n site

Multiple path

ways

Holistic

0

20

40

60

80

100

% Programs Not Referring

Comparing Weighted RSS by Dimension

Emotional

Envir

onmental

Finan

cial

Intellec

tual

Occupati

onal

Physical

Socia

l

Spirit

ual0

102030405060708090

100

Weighted RSS per Dimension

ZVHCMayoEmpower

Perc

enta

ge

38


Recovery Service Score (RSS) Survey (for Providers)

Please read the following before completing the survey.

A Recovery Service Score (RSS) has been developed using SAMHSA’s (2012) principles, guidelines, and recommendations on successful recovery. Below are 15 ideal resources that make up the RSS:

Housing: Provide referrals to housing resources, provide housing resources (deposits, first month rent), provide housing while individual is looking for independent housing

Transportation: Provide free transportation to and from treatment groups; provide cab or bus vouchers; provide referrals to transportation resources; initiate volunteer drivers or ride shares

Basic Needs: provide resources on how to attain basic needs; provide education on how to attain basic needs; provide vouchers for basic needs; provide basic needs while in treatment; provide referrals to agencies that can provide basic needs

o Basic needs: food, clothing

Parent Training: provides parent training through the program; provides referrals to parent training resources; provides parent training resources

Child Care: provides child care while individual attends outpatient services; provides vouchers for child care; provides resources for childcare; provides referrals for child care assistance

Vocational: provides job training; provides referrals to vocational resources; provides employment while in treatment

Life Skills: provides education on independent living skills; provides referrals to ILS classes or other resources; provides staff to assist with ILS in the individual’s home

o ILS: cooking, cleaning, money management, medication management, transportation, organization, planning, making appointments for self and others

Legal: provides support for individual dealing with legal matters; provides referrals to legal resources; cooperates and collaborates with legal professionals if applicable

Peer Support: the program has built in aspect of peer support; the program provides resources for peer support; the program refers to other groups with peer support; the program encourages peer support

Aftercare: Program provides extended aftercare including individual and group therapy, medication monitoring, drug or alcohol testing, medical care, home visits, psychoeducation

Community Based: program encourages community living and reintegration; program assists individual with reintegration after inpatient treatment or during/after outpatient treatment; program provides referrals for reintegration assistance

Assessment: psychological, drug testing services are done on site; provide referrals to testing services; provide resources for testing services

Multiple Pathways: program encourages more than one pathway for recovery; program does not subscribe to one treatment method only (i.e. 12 step, religious, abstinence, harm reduction); program provides resources for alternative treatments

39


Holistic: program addresses all individual’s needs – mind, body, spirit; program provides referrals to holistic programs

Culturally competent: All staff are trained in cultural competencies; program is sensitive to individual and cultural needs**

We are asking that you provide ratings of your facility and programs

1: none (resource is not available, recommended, referred)

2: resource is inside the facility but requires additional referral; OR resource is outside the facility and agency consistently refers clients to the resource

3: resource is within the facility and accessible to individual (without referral)

4: resource is built into the program

The below facilities and programs are invited to participate in this survey. Each program should complete one survey. Please collaborate with your coworkers who are knowledgeable about these programs to complete the surveys:

Zumbro Valley Health Center: CHOICES, Recovery Partners, PREP, Recovery Basics, Recovery Bound, Right to Recovery, Footsteps 4 Recovery, Women’s Way to Recovery, DWI Classes, Intensive Residential, CD Navigator, CRU, Psychiatry/Psychology Individual and Group Services, Monitored Antabuse, Opiate Recovery

Mayo Clinic: Consultation, Intensive Addiction Inpatient, Outpatient Addiction, Extended Outpatient, Early Recovery, Recovery Maintenance, Health Professionals

Fountain Centers: Outpatient Services, Adult Transition, Adult Relapse, Continuing Care

Empower CTC: Primary CD Treatment, Relapse Prevention, DUI Program, Step Beyond

MN Adult & Teen Challenge: Long-term adult inpatient, Life Renewal inpatient, Restoration

Common Ground: Outpatient, Outpatient Extended, Jump Start, Relapse Program, DUI Classes, Individual/Group Counseling

Nehemiah Family Services: Outpatient treatment, Relapse program, Individual counseling

Metro Treatment: Outpatient services, Methadone/Antabuse programs

40


Please Complete the Below Information:

Facility

Program

Your Job Title & Credentials, Certifications

Age Range (Circle) 18-28

29-38

39-48

49-58

59-68

69-78

Race

Ethnicity

Languages – Fluent (read, write, speak) English

Spanish

Chinese

Vietnamese

Arabic

Hindi

Korean

ASL (American Sign Language)

Numbers of years working with clients in recovery (Circle) Less than 1

1-3 years

3-5 years

41


5-8 years

8-12 years

12+ years

Housing:

1. Housing resources

2. Financial resources such as deposits and first month’s rent

3. Housing while an individual is treatment

4. Housing while an individual is looking for independent housing

5. Waiver programs that assist individuals with purchasing household essentials: furniture, kitchen supplies, bathroom supplies, towels

1 (None, resource is not available, or consistently not referred to by provider)

2 (Resource is inside the facility but requires individual referral OR resource is outside the facility and provider consistently refers client)

3 (Resource is inside the facility and accessible to client; no additional referrals are needed)

4 (Resource is built in an automatically provided to the client if needed)

1 2 3 4

Transportation:

1. Free or discounted transportation to and from treatment groups

2. Cab or bus vouchers

3. Transportation resources within community

4. Volunteer drivers or ride shares

1 (None, resource is not available, or consistently not referred to by provider)

2 (Resource is inside the facility but requires individual referral OR resource is outside the facility and provider consistently refers client)

3 (Resource is inside the facility and accessible to client; no additional referrals are needed)

4 (Resource is built in an automatically provided to the client if needed)

Recovery Service Score (RSS) Survey (for past or current individuals receiving treatment services)

42


Please read the following before completing the survey.

A Recovery Service Score (RSS) has been developed using SAMHSA’s (2012) principles, guidelines, and recommendations on successful recovery. Below are 15 ideal resources that make up the RSS and what qualifies programs as having the resource.

We are asking that you provide ratings of your treatment provider among the above categories. Below is the scale you will be using:

0: I didn’t know about this resource

1: I knew about the resource, but was not offered this resource

2: I knew about this resource, but was not referred to the resource

3: I knew about this resource and my provider referred me to the resource

4: The resource was automatically assigned to me in treatment

Please use your own insights about your experiences while in treatment. If a category does not apply or did not apply to you while in treatment, you can skip that category.

Parent Training:

1. Resources to parent training classes – for one or multiple age groups of children2. Education about custody, regaining custody, regaining partial custody3. Assistance for school enrollment, meetings, school supplies

0 (I did not know about this resource)

1 (I knew about this resource but my provider didn’t offer this to me)

2 (I knew about this resource but my provider didn’t refer me)

3 (I knew about this resource and my provider referred me)

4 (This resource was automatically built into my treatment program)

0 1 2 3 4

Life Skills:

1. Education and training on ILS2. Staff to assist with ILS outside of treatment**ILS: cooking, cleaning, money management, medication management, transportation, organization, planning, making appointments for self and family members






0 1 2 3 4

Multiple Pathways:

43


1. Alternative recovery such as Antabuse/Methadone clinics, spiritual/religion resources, exercise, meditation, hypnotherapy, acupuncture

2. Any other forms of recovery that do not ascribe to one method (i.e. 12 step, Christian-based, harm reduction, abstinence)






0 1 2 3 4

Holistic:

1. Addresses all of individual’s needs – mind, body, spirit2. Medical care and assistance3. Dental care and assistance4. Medical and dental care and assistance for children






0 1 2 3 4

Example 4

44


Excerpts from Work at Bear Creek Services Independent Living Skills Program

Agency: Human Services

Consumers: Individuals with ID/DD, MI, CD, TBI

Sample: Adults w/ ID/DD, MI, TBI wanting to live independently

Goals: Provide independent living skills under minimal supervision; client will then “graduate” to his/her own apartment

Design: Longitudinal (Short-Term)

Baseline Measurement

Multiple Post/Progress Measurements

Instruments:

ILS assessment

Repeated-measures T-test w/effect size analysis, Analysis of variance.

Independence Programming

1. Introduction

a. All clients, within days of moving in, are given an Independence Assessment. The Independence Assessment is an assessment of their activities of daily living.

b. The Independence Assessment should be used in conjunction with the initial skills assessment done by Olmsted County, as well as any intake forms/notes that have been drawn.

c. Following the Independence Assessment, the program manager will evaluate it, and then formulate the results. The results will determine each individual’s program during their stay at the apartment.

Assessment Items

a. The Independence Assessment consists of Specific Skills Checklists. Each list consists of a superordinate, basic, and subordinate level. The client is evaluated on the subordinate level of each skill. Below are the superordinate and basic levels for each skill set.

Superordinate Basic

Community Involvement Local Businesses, Community Resources, Giving Back

Emergency and Safety Resources, Weather, Evacuation

Home Maintenance Kitchen Maintenance, Home Safety, Home Maintenance

Interpersonal Conflict, Verbal, Non-Verbal, Communication, Relationships

Medication Management Prescription Medications, OTC Medications, Medication Information, Medication Safety

Money Management Budgeting, Banking

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Personal Safety and Health Medical, Dental, Eye/Ear, Hygiene, Clothing Maintenance, Physical Health, Personal Safety

Recreation and Leisure Structured Indoor, Structured Outdoor, Planning

Transportation Directions, Vehicle Travel, Walking Travel, Bus Travel, Biking/Blading Travel

b. Special Assessments can be given if needed. Need is identified by either the client or the staff. Each list consists of a superordinate, basic, and subordinate level. The client is evaluated on the subordinate level of each skill. Below are the superordinate and basic levels for each skill set.

Superordinate Basic

Cultural/Spiritual Acceptance, Disclosure, Integration

Educational Planning Decision-Making, Searching, Resources, Financial, Counseling, Applying, Getting Started

Job Maintenance Preparation, Professionalism, Communication, Conflict

Job Seeking Searching, Applying, Interviewing, Expressing Interest

Mental Health Management Mental Illness, Substance Use, Violence, Boundaries, Self-Esteem/Confidence/Worth

Substance Use Knowledge, Identification, Action, Assistance, Resources

Progress Report - Sample

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xx: Baseline vs. Progress 1 vs. Progress 2 vs. Progress 3

Category Baseline Score – 8.13.13 Progress 1 Score – 8.29.13 Progress 2 Score – 9.16.13

Progress 3 Score – 11.1.13

Community Involvement 2.5 2.7 3.1 3.5

Emergency & Safety 2.1 2.1 2.1 2.3

Interpersonal 3.6 3.6 3.6 3.8

Home 2.9 2.9 3.6 3.7

Job Maintenance 3.6 3.4 3.8 3.7

Med Mngmt 1.4 2.4 2.5 2.7

Mental Health 2.4 2.9 3.0 3.3

Money Management 2.7 3.5 3.3 3.4

Personal Safety & Health 3.6 3.4 3.3 3.6

Recreation & Leisure 3.3 3.5 3.3 3.5

Transportation 2.4 3.7 3.7 3.5

Spiritual/Cultural NA NA NA 3.6

Statistically Significant Differences Between Baseline and P3 Measurements

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(alpha=.05 for a two tailed test)

Category Critical Value T statistic (repeated measures)

Significance? (Y or N) Effect Size

Community Involvement 2.110 5.24 Y 1.22 (large)

Emergency & Safety 2.179 2.14 N NA

Home Maintenance 2.021 8.14 Y .59 (medium)

Interpersonal 2.042 2.84 Y .51 (medium)

Job Maintenance 2.160 2.21 Y .59 (medium)

Medication Management 2.131 3.91 Y .97 (large)

Mental Health Management

2.07 7.10 Y 1.48 (large)

Money Management 2.064 7.2 Y 1.42 (large)

Personal Safety & Health 2.021 4.86 Y .72 (medium)

Recreation & Leisure 2.179 1.92 N NA

Transportation 2.110 5.73 Y 1.35 (large)

*x has made statistically significant improvements in 9 out of 11 possible skill categories.

*One category (Cultural/Spiritual) was not included in the above tests as it did not have a baseline measurement.

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PROFESSIONAL PORTFOLIO 49


Program Growth - 8/2013-10/2014

Admissions vs. Graduations vs. SILS 8/2013-10/2014

**Graduations are also counted as SILS as all transition apartment graduates have requested for SILS hours.

Month Number of Participants Percentage Increase

August 2013 2 0

September 2013 2 0

October 2013 3 (3-2)/2=50%

November 2013 4 (4-3)/3=33%

December 2013 4 0

January 2014 5 (5-4)/4=25%

February 2014 6 (6-5)/5=20%

March 2014 6 0

April 2014 6 0

May 2014 8 (8-6)/6=33%

June 2014 9 (9-8)/8=12.5%

July 2014 9 0

August 2014 9 0

September 2014 10 (10-9)/9=11%

October 2014 15 (15-10)/10=50%

Total Increase 13 (13-2)/2=550%

Narrative Report Example

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With each new apartment participant, comes the following responsibilities (multiply the below duties by 7 admissions): 2 every 6 months1. Intake: 1-3 meetings (includes obtaining signatures, selling the program, creating meeting notes, sending notes); “pizza

party” or other “get to know you” events x 2-3 times including transportation to and from the apartment, other paperwork (service schedules, calendars, meal planning, bus plans, work schedules, medical emergency information, safety plans, hiring/training staff on ISP/CSSP and APP/IAPP, putting together admin file, requesting/organizing county paperwork and financial information)

2. Move-In: Coordinating move-in dates/times, assistance, move-in checklists, work schedules, bus plans for new routes, initial orientation paperwork with the participant (safety plans, “important items” checklist, financial information, releases, apartment paperwork (emergency notification form); assisting participant with getting/filling laundry card

3. Addition of the team: parents/guardians, other family members, case manager, work coordinator, psychiatrists, psychologists, medical doctors, significant others, friends - obtaining contact information

4. Frequent Updates: sending updates approximately every other day to the team to inform them of how the participant is doing. Update frequency decreases to once per week after the first month.

5. Frequent Meetings: coordinating and meeting every 2-3 weeks6. Assessment: Initiate the Independence Assessment; rank participants in each ILS category. Gather and organize data;

create charts and tables to present before every meeting.7. Transportation: driving participant to and from appointments, errands, activities

With each new SILS participant, comes the following responsibilities (multiply the below duties by 8 SILS admissions): as needed, typically 1 per month1. Intake: 1-3 meetings (includes obtaining signatures, selling the program, creating meeting notes, sending notes); other

paperwork (service schedules, calendars, meal planning, bus plans, work schedules, medical emergency information, safety plans, hiring/training staff on ISP/CSSP and APP/IAPP, putting together admin file, requesting/organizing county paperwork and financial information).

2. Addition of the team: parents/guardians, other family members, case manager, work coordinator, psychiatrists, psychologists, medical doctors, significant others, friends - obtaining contact information

3. Frequent Updates: sending updates approximately every other day to the team to inform them of how the participant is doing. Update frequency decreases to once per week after the first month.

4. Frequent Meetings: coordinating and meeting every 2-3 weeks5. Assessment (if requested): Initiate the Independence Assessment; rank participants in each ILS category. Gather and

organize data; create charts and tables to present before every meeting.

For all participants, the following responsibilities are continuous (multiply the below by 15 total participants):1. Direct support for participants - assisting, advising, coaching, mentoring, transportation, appointments, errands - daily2. Monthly paperwork: monthly report (petty cash report and green sheets); monthly expense report and budget

(participant does this with the help of staff); monthly and weekly calendars, monthly service schedules, meal plans, grocery templates, monthly ledgers, monthly med sheets (if needed), monthly PRN med sheets (for all participants), monthly tracking sheets (chores, medical issues, goals, “behaviors”) - monthly

3. Weekly paperwork: Weekend responsibilities with a breakdown of what the staff need to do with which participant and when; weekend activities sent to Olmsted County and given to staff; staff instructions with the weekend schedule, important notes about each participant (if they’re gone, previously planned activities, home visits, vacations) and specific instructions for weekend events including driving directions on how to get there - weekly

4. Tracking budgets: keeping/recording receipts in Excel budget sheet; assisting with activating EBT cards (includes informing support teams, send important numbers/PIN numbers for guardians, showing participants how to check their balances via phone and internet), assisting with filling out food support/MSA/energy assistance applications, training staff on how to use EBT cards, organizing bills and ensuring participants are paying their bills on time and in the right amount; reporting to parents/guardians about important bills; requesting money is put into participant’s account - daily

5. Medical Support/Appointments: arranging and assisting the arrangement of medical, psych, and other appointments as requested; maintaining appointment schedule on own calendar and participant’s calendar; providing transportation or training participant on bus route to attend appointment independently; attending important appointments, documenting appointments, informing teams about appointments, educating self and participants about medications, advocating for medication changes if needed, educating self about medication changes, updating medication books, updating and training staff on medications and medication changes, assisting with reordering medications, assisting with calling pharmacy and/or doctor when medications are not received; assisting with or refilling medication boxes; training participants and staff on their medications (what they are, what they look like, side effects, contraindications) - daily

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6. Transportation: provided for appointments, errands, activities, emergency/backup rides - daily7. Programming: providing staff with ILS sheets; starting with basic skills; changing programs at any moment, whenever

necessary; tailoring programs to work for the person - daily or weekly8. Therap: reading/correcting Therap documentation, writing T-Logs, updating all staff on participant changes - daily

Other Responsibilities:1. Staff schedules - master and individual: 9 permanent staff, 3 former staff, 4 on-call staff - monthly 2. Staff training - 9 permanent staff, 3 former staff, 4 on-call staff, 1 program manager - policies, house policies,

participants’ information (including person-centered training - likes, dislikes, services requested, how to help the person, what to do/not to do with the person) - as needed

3. Interviewing potential staff - as needed4. Filling open shifts; filling last minute open shifts - as needed5. On-call - 24x7 for the past 14 months with occasional weekend off - constant texts and calls from staff and participants6. Re-stocking the apartments - garbage bags, cleaning supplies, paper products, office supplies - 1 apartment from 8/2013-

10/2014, 2 apartments in 10/2014 - monthly7. Tracking SILS hours - per participant, per day, per week, per month - multiply by 9 SILS participants - daily8. Assisting with/cleaning SILS participants’ homes - during/after work hours - varies9. Restocking “prize box” for 1 SILS participant - monthly10. Calling participants and staff to give reminders for daily tasks, appointments, work, etc. - daily11. Tracking house accounts: house petty cash, Walmart card, Kwik Trip card, van mileage form - weekly12. Writing new staff training program - daily, if time permits

Daily, Weekly, Monthly Tasks: 8/2013 versus 10/2014:To quantify my responsibilities, each numbered item above is counted as 1 daily, weekly, or monthly task. As needed or

requested items are not counted in the below.8/2013 10/2014 Percentage Increase

Daily 32 (6 tasks x 2 participants + 1 task x 2 participants & 3 staff)

114 (6 tasks x 15 participants + 1 task x 15 participants & 9 staff)

(114-32)/32=256%

Weekly 6 (2 tasks x 2 participants + 2 tasks)

32 (2 tasks x 15 participants + 2 tasks)

(32-6)/6=433%

Monthly 5 (1 task x 2 participants + 1 task x 3 staff + 2 tasks)

26 (1 task x 15 participants + 1 task x 9 staff + 2 tasks)

(26-5)/5=420%

Percentage of apartment participants who have graduated: 43%Number of participants Graduates

7 3

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