Forefront Cares is one of services provided by Forefront Suicide Prevention, a center at the University of Washington School of Social Work. Suicide loss survivors receive care packages and have the opportunity to be connected to mentors, who are also suicide loss survivors and are specially trained to provide support to new loss survivors. The goals of Forefront Cares are to offer support to suicide loss survivors and to help them find resources that are appropriate for their individual needs. The purpose of this study was to examine participants’ perceptions of Forefront Cares, including what is helpful and what could be improved, through an online satisfaction survey which I created. I then sent e-mails to individuals who received a Forefront Cares package between January 2013 and December 2017, inviting them to participate in the study. Those who participated completed a brief anonymous online survey, which involved rating experiences with Forefront Cares. Questions addressed how helpful they found the package they received and what they found most or least helpful. Participants who had a Forefront Cares mentor were asked to rate how helpful that experience was. The data collection ended in mid-April, and I analyzed data with assistance from my mentor. Results will help determine what participants found more and less useful, as well as the acceptability of the Forefront Cares package and mentor process. It is expected that findings will indicate the importance of community support in the grief journey of newly bereaved suicide loss survivors. The creation of the satisfaction survey was intended to be a starting point in establishing ongoing analysis of Forefront Cares, as Forefront currently lacks permanent evaluation tool to assess their services. Information obtained will help improve the Forefront Cares process for future participants.

Nationwide older adults experiencing homelessness is on the rise. In Seattle, over 11,000 individuals are homeless and over 20% are over the age of 50. People experiencing homelessness face a variety of barriers in attaining and maintaining physical and mental health. These barriers are often insurmountable for older adults. The purpose of this investigation was to explore the facilitators and barriers to wellbeing in a sample of male adults over age 50 who are homeless and utilizing a night shelter in Seattle. We used an interpretive phenomenological approach with a photovoice methodology. Participants were asked to take photos that captured their response to the questions, "What supports your wellbeing and what are barriers to your wellbeing?" Additionally, we collected demographic variables such as age, gender, duration of homelessness, and age first homeless. Following the collection of photographs, we held two semi-structured focus groups approximately three weeks apart. At the first meeting, we discussed the meanings captured by their photos. The meeting was audio recorded, transcribed verbatim, and themes were extracted utilizing Dedoose software. We anticipate that older adults have unique unmet needs. A lack of established services tailored to this population, coupled with recent cuts to services has impacted access to programs that foster good mental and physical health. These findings have important implications for nursing practice, gerontology, and public health. Information gained from this project can serve as a tool to inform policy change towards efficacious person-centered solutions for older adults experiencing homelessness.

The population of refugee and immigrant families in Seattle's Lake City neighborhood has grown significantly in the last decade.  Despite the health challenges these families often face, no one has performed a systematic assessment of the health needs specific to this population.  Our project aims to provide preliminary data about the health needs of refugee and immigrant children and families in the Lake City neighborhood, as well as resources available to assist them.  This analysis is timely and relevant for community stakeholders, such as the non-profit Refugee Women's Alliance (ReWA), who are currently expanding services for refugee and immigrant children in Lake City.  We used mixed methods to assess the health and health-related resources relevant to preschool age children of refugee and immigrant groups in the Lake City neighborhood.  These methods included key informant interviews with individuals knowledgeable about the health of refugee and immigrant families in Lake City, as well as analysis of publicly available secondary data.  Interpreting the interviews using relevant secondary data provides a holistic initial picture of the physical, socio-economic, educational, cultural, and community factors contributing to the health and wellbeing of refugee and immigrant children and their families in Lake City.  We anticipate our research findings will reveal a culturally diverse community with distinct needs, as well as many existing community resources—assertions confirmed by preliminary results.  The results of this study will both inform ReWA's early childhood education programming, and give healthcare providers and community organizations in the area a more comprehensive understanding of refugee and immigrant needs.  Because this project has stimulated community interest in further research relating to these populations, this study can also serve as a platform for future work in the area. 

The use of Potentially Inappropriate Medications (PIM) in elderly is common and can lead to increasing risks for adverse drug events, morbidity, and increased utilization of health care resources. Early identification of PIM can improve the quality of care in elders and reduce hospitalizations. This study aims to identify PIM in a sample of N=60 people living with dementia who recently experienced a hospitalization and to evaluate what PIM are most common. We also aim to evaluate correlations between PIM and the number of patient’s chronic conditions and the total number of medications. Our hypothesis is that patients with higher burden of illness (more conditions and medications) can have higher number of PIM. We identified PIMs by evaluating medical records using the STOPP/START criteria. The STOPP/START criteria classify inappropriate medications that should be stopped as well as the appropriate medications that should be started instead.Descriptive statistics was used to describe the sample and the prevalence of PMI, chronic conditions and medications. Correlation analyses was used to explore relationships between the variables. Study findings will inform healthcare providers about the prevalence of PIM and help identify patients who are at higher risk of PIM.

Homeless service providers often provide care and support to homeless individuals and families with experiences of trauma. Through hearing their client’s trauma stories and witnessing the pain, fear, and suffering that their clients endure, homeless service providers may be at risk for developing secondary trauma. Secondary trauma occurs when a helping professional develops symptoms of post-traumatic stress disorder through empathetic engagement with someone who has firsthand trauma experiences. A recent study revealed that 25% of homeless service providers reported high levels of vicarious traumatization. Amid a growing homelessness crisis and the challenges of ongoing budget cuts that homeless service agencies face, the percentage of homeless service providers with secondary trauma is likely to increase. The purpose of this investigation is to gain a better understanding about homeless service providers’ exposure and experiences of secondary trauma in their work environment. Participants of this study are homeless service providers that were recruited through convenience sampling from a large homeless service organization in King County. Participants completed demographic questions, a highly validated scale measuring Professional Quality of Life (ProQOL), and open-ended focus questions that explored occupational health challenges as well as personal level protective health factors. All measures were collected using an online survey application. We anticipate to find associations between secondary trauma among homeless service providers and high cumulative exposure to working with survivors of trauma, low engagement with self-care practices, a perceived lack of social and organizational support, and high work-related stress. Information gained through this research may be used to identifying ways to protect, sustain, and empower homeless service providers so that they can provide safe and quality care for their clients. The results of this investigation will be used to support occupational health policies and guidelines that promote the health and wellbeing of frontline workers in the homeless sector.

Sleep is crucial for producing higher levels of concentration, performance, and overall health and safety. Yet, teens, a vulnerable population, get far less sleep than the recommended 8-10 hours and continuously incur a sleep debt that negatively impacts their health. This troubling issue led to a national public health initiative to delay high school start times to benefit teens’ health. Though the Seattle school district recently accepted and implemented this initiative, it remains to be seen if the time change had the expected impact on the teens’ sleep quantity and therefore overall performance and health. The purpose of our research was to explore any correlation between the later school start time and positive outcomes of improved sleep, health and performance. In order to address this question, we created a 22-item survey which asks questions regarding quantity of sleep, self-reported measurements of mood and mental health, academic and extracurricular activity performance. We used convenience sampling and recruited from the community, specifically high schoolers within the Seattle school district who experienced the time change, to complete this survey. We expect to find that the later school start time increased the quantity of sleep high schoolers obtained, contributing to improved overall health and performance. If we obtain our expected results, we hope the data can be used to encourage other school districts to also adopt the time change and promote the health of the teen population.

Fetal ultrasounds are frequently associated with joy and happiness for expecting mothers, however, women seeking termination can be subjected to emotional and financial distress due to mandatory ultrasound screenings. My literature review examined how different ultrasound laws and healthcare coverage impacted women in Washington and Texas. These states have very different regulations and coverage for ultrasounds during pregnancy or termination. To do this, I examined laws in each state regarding fetal ultrasounds to see if there were benefits or disadvantages for women choosing to carry their pregnancies to term versus choosing to terminate. My findings showed women seeking termination in Texas undergo a mandatory viewing of their fetal ultrasound before they can access termination, whereas, women in Washington are not required to do so. Payment coverage for ultrasounds also varied between states. Differences in required payment for private insurance and Medicaid disadvantaged women in Texas, but not Washington. My findings showed Texas Medicaid did not cover the mandatory ultrasound before termination, whereas Washington Medicaid covered all termination services. Texas Medicaid was also shown to offer less coverage for women intending to carry their pregnancies to full term than private insurance. Depending upon geographical residence and health insurance status, the ultrasound experience will vary significantly, especially for women seeking termination. With this research, I hope to increase awareness of the effects of mandatory ultrasound laws and gaps in payment coverage for women covered by Medicaid. Drawing attention to this issue and starting a conversation is the first step in moving towards an equitable health care system.

Increased specialization within the forestry industry has led to the rise of a distinct industry known as forestry services. Whereas logging historically encompassed this work, a separate population increasingly participates in the remote grooming and tree planting of forest lands. Physically demanding, dangerously hazardous, and low paying, forestry services work in the Pacific Northwest predominantly employs Mexican and Central American immigrants. As an extension of my honors project at the UW School of Nursing, I examined how occupational injury among this group of workers with correlates with attitudes that workers and employers hold about their work environments. Performing a secondary analysis using survey interview data collected by the UW Pacific Northwest Agricultural Safety & Health Center, and the Northwest Forest Worker Center, I identified top risk perceptions and barriers to workplace safety as reported by workers, as well as by a set of employers and supervisors. Not only was there variation in the prevalence of worker injury between different employers, there was also variation in the perceived attitudes about workplace safety. In future research, it will be possible to link the experiences of workers with the attitudes and policies of those who employ them.