Loneliness and depression in older adults are under-recognized public health concerns that increase risks for all-cause mortality, medical morbidity, and rising healthcare costs. This quality improvement project assessed whether smartphone Mindfulness software mitigated self-reported feelings of loneliness and depression among community-dwelling older adults. Nine participants aged 65 and older, living at home, experiencing loneliness or depression, and owning a smartphone were recruited using newsletters and fliers. A short demographics questionnaire and two valid and reliable instruments, namely the University of California Los Angeles Loneliness Scale (UCLA V3) and Geriatric Depression Scale (GDS), were used in pre-intervention and four weeks post-intervention. Participants downloaded the UCLA Mindful app on their smartphones after attending a 20-minute Mindfulness education at a local church banquet room. Participants used the UCLA Mindful software twice weekly for ten minutes for four weeks. Of the nine participants, three completed the study. A two-tailed paired sample t-test and descriptive analysis were used to evaluate the efficacy of the UCLA Mindful smartphone software. The results of the two-tailed paired sample t-test were not statistically significant for the UCLA V3 Loneliness scale (p=.220) and GDS (p=.208) due to the small sample size. Although the results were negligible, participants nevertheless reported favorable impacts. Future research with a larger sample size is encouraged.

Nonadherence to psychiatric medications was identified as an issue worldwide and in a non-profit organization for women recovering from substance use disorders (SUD) in the southwestern United States. Non-adherence is associated with increased hospitalizations and relapse. A literature review indicated that motivational interviewing (MI) was an evidence-based intervention for increasing psychiatric medication adherence in women recovering from SUD. This project aimed to assess if training the organization staff on MI, would impact their beliefs, knowledge, and comfort of using MI on their clients with non-adherence. The Theory of Planned Behavior is the underlying principle of the project. A recruitment flyer was sent to the organization via email, and interested staff attended the training on the basics of MI via a PowerPoint presentation through video conferencing. Pre-, post-, and one-month follow-up questionnaires were provided to assess participants' knowledge, familiarity, and comfort with MI. The questionnaires consisted of the reliable/validated Beliefs About Medication questionnaire (BMQ) and questions about MI. Participants were deidentified for data collection. A Friedman's test and descriptive statistics were used for analysis. 17 staff participated; five one-month follow-ups were completed. Participants believed medication was more beneficial than harmful and necessary for improvement-nonsignificant: Friedman test p = .179. Upon follow-up, 40% reported being comfortable using MI while 60% reported they had not used MI yet. MI training may improve staff comfort and ability to address medication nonadherence. A larger sample may lead to significant and generalizable results.

According to The Joint Commission, most sentinel events in healthcare can be attributed to errors in communication. Thousands of medical students in the United States lack adequate communication training. Current literature illustrated that communication skills training programs increase confidence and communication skills of medical students and residents. These programs vary in techniques, with many including lectures and role play exercises. This project aimed to improve outcomes at a forensic facility in Arizona by utilizing a student role play intervention and lecture. Outcomes were measured utilizing developed pre- and post-intervention surveys. The surveys included a validated tool which measured four communication skill categories. A convenience sample consisted of pre-medical interns who participated in the project. The small sample size (four) led to descriptive statistics utilization to provide preliminary data. Prior to the intervention, communication skill average scores were as follows: listening (15), giving and getting feedback (12), sending clear messages (13.75), and handling emotional interactions (11.5). Post-intervention, the average scores for the communication skills were as follows: listening (18.25), giving and getting feedback (13), sending clear messages (16), and handling emotional interactions (12.75). Average scores for each category showed an increase after the implementation of the intervention. The survey was completed for four (100%) of participants, and 75 percent of participants stated they felt more confident with utilizing communication skills in their internship. A communication skills training program can enhance communication skills of medical trainees by providing structured support. Further research is needed on effective techniques to train medical trainees.

Background: There is growing evidence that persistent exposure to the adverse effects of stressful work conditions, abuse, and re-traumatization without proper intervention leads to compassion fatigue (CF) and reduced compassion satisfaction (CS). Without appropriate intervention, the outcome of CF affects the patient, staff, and the organization. Despite proposed self-care measures, mental health (MH) workers continue to struggle with CF and lack the resources to combat the issue. Objectives: Ongoing awareness on the implications of trauma and its impact on one's behavior, supports the use of Trauma-informed care (TIC) skills in creating a conducive work environment. This quality improvement project examines the efficacy of TIC education as an intervention for CF pre/post-one-hour education session among MH workers. Methods: MH nurses (n=8) from diverse backgrounds in a Phoenix inpatient psychiatric hospital gave consent for the study. Participation was sought via flyers and entailed attending the one-hour education session, filling out a demographic, and pre/post-professional quality of life (ProQol) surveys. The ProQol standardized tool measures CF, CS, and burnout with reliability >0.70. Expected outcomes include a reduction in CF and an improvement in CS. Data analysis using intellectus software involved descriptive analysis and paired t-tests to compare outcomes. Results: Pre/post data analysis was statistically significant, P = 0.003, which shows a reduction in CF and an improvement in CS. Conclusion: TIC as an intervention for CF looks promising. MH nurses can manage their stress symptoms and that of their patients using TIC skills.

Objective: Attention Deficit Hyperactivity Disorder is a pervasive neurodevelopmental disorder among children. Research has shown that young girls are underserved in diagnosing and treating ADHD or never diagnosed compared males. Utilizing the Health Promotion Model, this project aims to determine if primary care providers are aware of sex differences in ADHD and if a brief education on sex differences in ADHD affects the primary care setting's screening rate. Design/Methods: With the Arizona institutional review Boards' approval, primary care providers (PCP) in a Southwest family practice in Arizona (n=35) are provided with virtual education on sex differences in ADHD. Pre- post-intervention surveys were electronically administered to five PCPS. Data were deidentified. A two-tailed paired t-test was conducted to examine the mean difference of responses. Results: Analysis of responses demonstrate that primary care providers are well aware of sex differences in ADHD but screened less for ADHD before the education intervention. Major themes emerged from provider comments on ADHD symptom recognition, time constraints, and increased screening to identify girls in the primary setting. A significant increase in ADHD screening is seen four weeks post-intervention t(4) = -6.32, p = .003. Conclusion: Future research is needed to identify other factors that could strengthen ADHD screening during well-child visits overall. Also, the use of a pediatric screener which can highlight inattentive symptoms would assist in the process of identifying girls with ADHD.

Purpose: To assess the burnout levels of mental health workers and to evaluate the effectiveness of promoting self-care practices in improving their well-being and resiliency. Background and Significance: Burnout is highly prevalent among mental health workers due to the nature of their work and the population of patients they serve. Turnover has been a significant problem within this specialty for decades. Before the COVID-19 pandemic, the mental health workforce was projected to experience shortage by 2025. The pandemic will likely worsen this. Evidence from literature supports the effectiveness of promoting self-care towards the development of resiliency and well-being in addressing burnout among healthcare workers. Methods: The Maslach Burnout Inventory – Human Services Survey (MBI-HSS) was used to assess the burnout levels of mental health workers in a psychiatric hospital in Arizona pre- and post-intervention. Educational modules were provided for each participant to review. They were asked to perform at least one self-care activity and to utilize the tools in the Provider Resilience application every week for four weeks. Results: Pre-intervention surveys indicated moderate levels of emotional exhaustion (m=20.71) and depersonalization (m=9.29) and high levels of personal accomplishment (m=28.71). Improvements were seen on emotional exhaustion (m=18.86), depersonalization (m=6.43), and personal accomplishment (m=33.86) were seen post-intervention. Conclusion: Although the results were not statistically significant due to small sample size, the improvements seen on two out of three components of burnout (emotional exhaustion and depersonalization) indicated that awareness of burnout levels and self-care practices contribute to improving the well-being of mental health workers.

Childhood traumatic experiences are a prevalent public health issue. Children exposed to trauma often exhibit behaviors that make educating them challenging. Preschool teachers at a southwestern United States preschool receive no training related to childhood trauma and resilience. The purpose of this project was to educate preschool teachers on trauma and resilience to improve attitude related to educating children with trauma. Following Arizona State University Internal Review Board approval, preschool teachers were recruited from a non-profit metropolitan preschool. Project included two pre-training questionnaires (Adult Resilience Measure-Revised [ARM-R] and Attitudes Related to Trauma Informed Care scale [ARTIC]), one two-hour training via Zoom on childhood trauma and resilience, and post-training ARTIC questionnaire at two and six weeks. Seven teachers (n=7) participated in pre-training questionnaires, and three of these teachers (n=3) participated in both post-training questionnaires. All participating teachers were female and Caucasian. Average age of participants was 49.43 years (SD=8.40, range 36-60), and experience average was 17.17 years (SD=10.15, range 3-30). AMR-R average score was 72.29 (SD=8.28, range 61-83). Pre-training ARTIC score average was 3.87 (SD=0.16). Post-training ARTIC scores at two weeks and six weeks post-training were 3.65 (SD=0.22) and 3.86 (SD=0.25). Clinical significance included improved teacher awareness of childhood trauma and improved ability to interact with children exposed to trauma. Teachers exhibited high resilience scores. Additional research needed related to further address educating preschool teachers related to trauma informed care, related to building resilience in children, and related to the impact of teacher resilience on trauma informed care.

Objective: To assess the attitudes and knowledge of behavioral health technicians (BHTs) towards opioid overdose management and to assess the effect of online training on opioid overdose response on BHTs’ attitudes and knowledge, and the confidence to identify and respond to opioid overdose situations. Design/Methods: Pre-intervention Opioid Overdose Knowledge Scale (OOKS) and Opioid Overdose Attitude Scale (OOAS) surveys were administered electronically to five BHTs in 2020. Data obtained were de-identified. Comparisons between responses to pre-and post-surveys questions were carried out using the standardized Wilcoxon signed-rank statistical test(z). This study was conducted in a residential treatment center (RTC) with the institutional review board's approval from Arizona State University. BHTs aged 18 years and above, working at this RTC were included in the study. Interventions: An online training was provided on opioid overdose response (OOR) and naloxone administration and on when to refer patients with opioid use disorder (OUD) for medication-assisted treatment. Results: Compared to the pre-intervention surveys, the BHTs showed significant improvements in attitudes on the overall score on the OOAS (mean= 26.4 ± 13.1; 95% CI = 10.1 - 42.7; z = 2.02; p = 0.043) and significant improvement in knowledge on the OOKS (mean= 10.6 ± 6.5; 95% CI = 2.5 – 18.7; z =2.02, p = 0.043). Conclusions and Relevance: Training BHTs working in an RTC on opioid overdose response is effective in increasing attitudes and knowledge related to opioid overdose management. opioid overdose reversal in RTCs.

Childhood traumatic experiences are a prevalent public health issue. Children exposed to trauma often exhibit behaviors that make educating them challenging. Preschool teachers at a southwestern United States preschool receive no training related to childhood trauma and resilience. The purpose of this project was to educate preschool teachers on trauma and resilience to improve attitude related to educating children with trauma.

Following Arizona State University Internal Review Board approval, preschool teachers were recruited from a non-profit metropolitan preschool. Project included two pre-training questionnaires (Adult Resilience Measure-Revised [ARM-R] and Attitudes Related to Trauma Informed Care scale [ARTIC]), one two-hour training via Zoom on childhood trauma and resilience, and post-training ARTIC questionnaire at two and six weeks.

Seven teachers (n=7) participated in pre-training questionnaires, and three of these teachers (n=3) participated in both post-training questionnaires. All participating teachers were female and Caucasian. Average age of participants was 49.43 years (SD=8.40, range 36-60), and experience average was 17.17 years (SD=10.15, range 3-30). AMR-R average score was 72.29 (SD=8.28, range 61-83). Pre-training ARTIC score average was 3.87 (SD=0.16). Post-training ARTIC scores at two weeks and six weeks post-training were 3.65 (SD=0.22) and 3.86 (SD=0.25).

Clinical significance included improved teacher awareness of childhood trauma and improved ability to interact with children exposed to trauma. Teachers exhibited high resilience scores. Additional research needed related to further address educating preschool teachers related to trauma informed care, related to building resilience in children, and related to the impact of teacher resilience on trauma informed care.

Keywords: teacher training, adverse childhood experiences, ACEs, childhood trauma, resilience