This thesis explores how a completely online treatment service can help lower the treatment gap through a financial lens. The thesis then analyzes how an online only model differs from traditional treatment programs with an emphasis on financial data. It includes market models and financial forecasts. The thesis also outlines a business model for an online only treatment center and addresses the financial and operational difficulties in starting such a venture.

Development of effective therapeutic interventions for the treatment of mental health disorders has been a significant driving force in the search to understand the human brain. Current treatments for mental health disorders rely on modulating neurotransmitter systems such as norepinephrine (NE), serotonin (5-HT), dopamine (DA) and γ-aminobutyric acid (GABA) to achieve clinically relevant relief of symptoms. While many medications are available to the clinician that individually target these neural systems, treatment often results in patients reporting unwanted side effects or experiencing incomplete relief. To counter this lack of treatment efficacy, further investigation of other avenues for achieving similar or better outcomes and potentially reach patients refractory to common therapies must be undertaken. One of these potential new target systems is the endogenous cannabinoid system (ECS), which is currently composed of cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2). These metabotropic seven transmembrane (7-TM) loop G-protein coupled receptors (GPCR) are responsible for mediating the effects of acute Cannabis ingestion as well as modulating several core functions of the nervous system including emotion, memory, and learning behavior. Due ubiquitous expression of ECS proteins, there is broad overlap between brain regions that show high levels of receptor expression and those thought to be involved in the etiology of a range of mental health disorders including depression, anxiety and schizophrenia. Consequently, modulation of cannabinoid receptor function is a novel and potentially clinically relevant mechanism for influencing the levels of other neuromodulators and neurotransmitters, such as dopamine, that are known to play crucial roles in the progression of mental illness. In addition, characterization of endogenous cannabinoids and cannabinoid receptors with respect to their normal physiological function and possible roles in pathophysiology may provide insight for the development of future ECS-based therapies.

Substance abuse has become a major problem in the USA in the past decade, with immense public health and societal consequences. Methamphetamine (meth) use has grown due to an increased number of meth production and distribution markets. Border states such as Arizona and California are especially concerned with Mexico’s production and distribution of meth to their residents. A mathematical model for meth use and markets was developed and then analyzed to track multiple types of drug markets and drug-related arrests for possession or distribution. The importance of social influences as a major causal factor in the onset of illicit drug use is explicitly incorporated. The model parameters are then estimated using meth-related data from California and Arizona. A parameter sensitivity analysis on the model output was carried out. The results suggest that law enforcement policy aimed at marketers will be significantly more effective than targeting current users. Moreover, local unorganized markets have a greater role in maintaining the endemic level of meth users. Whereas, global organized markets play a role in initiating meth use outbreaks. Some implications for interventions and health promotion for the two states are also discussed.

The purpose of this research study was to examine the intersection of the relationship between homelessness and mental illness, including other factors such as substance abuse. A secondary purpose of this study was to gain an awareness of service delivery models and associated funding streams for providing services to homeless persons with mental illness. A thorough literature review was conducted by the author in order to aid in answering these questions. The author also conducted interviews with 27 homeless and formerly homeless clients living in Denver who were receiving services through the Colorado Coalition for the Homeless. Finally, the author conducted 4 qualitative interviews with policy experts who worked extensively in homeless services and advocacy in the Metro-Denver area. All data was entered into an Excel workbook, and a series of graphs and tables were made to present the research results. The themes of mental illness and substance abuse were common amongst the sample population, but the most common theme was that of the lack of affordable housing available. The majority of respondents also cited involvement in the criminal justice system such as incarceration, as well as family issues as major factors in them becoming homeless. The policy experts all cited the Housing First as well as the Permanent Supportive Housing model as the most effective service delivery model for those who are both homeless and mentally-ill, and Denver is utilizing some very innovative funding streams for these service delivery models. In conclusion, the author found through both the literature review and quantitative research, that homelessness is not truly a mental illness or substance abuse issue alone, though this relationship does hold clinical importance. Homelessness is instead the result of an excessive shortage of permanent and affordable housing units across the United States.

The goal is to develop a long term collaborative partnership that benefits the four main stakeholders: Arizona State University, The City of Phoenix, Westward Ho residents, and Westward Ho ownership. Arizona State University gains unique access to a research and learning environment for faculty and students of a variety of health disciplines. The City of Phoenix receives stability and safety to the neighborhood and protects the city's investment in the Westward Ho. The residents gain needed services through participation in ASU programs and initiatives. They acquire new life skills that contribute to their independence, thereby reducing the demand for costly emergency services and adding to their quality of life. The owners gain a more stable resident population and ASU's investment allows them to continue to upgrade the property, benefitting the city, the residents, and ASU.

This study examined poverty, material hardship, financial capability, and quality of life among residents of a subsidized housing complex for seniors and adults with disabilities in Phoenix, Arizona. Respondents (N-25) completed a 42-item questionnaire in March of 2017. Data analysis revealed reports of incomes as low as 200% of the poverty level, difficulty paying for food, medications, recreation, and transportation. The study found a positive correlation between the presence of a disability and obtaining sufficient food. In addition, the results indicated lowered financial literacy, reduced ability to keep up with monthly expenses, and a positive correlation between lower income and inability to come up with $2000 in the event of an unexpected expense. Respondents reported minimal use of non-mainstream financial services; most had checking accounts, while fewer reported savings accounts. Scores on financial literacy questions were low and respondents indicated interest in a financial literacy course. The study also revealed low perceived quality of life among the majority of respondents and a positive relationship with material hardship and lower quality of life scores. Implications include the need for further research within the population.

The purpose of Supported Education Student Survey study was to calculate the prevalence of psychiatric disabilities and assess the current need among Arizona State University undergraduates who identified as having a psychiatric disability. Three research questions were used to guide the study: what is the prevalence of psychiatric disabilities, student’s active involvement in treatment, and the current service utilization and unmet needs for this specific population of students. An online survey was distributed to 2158 undergraduate students who were enrolled in one of the courses; PSY 101, SOC 101, SWU 171, and COM 100. A total of 76 students participated in the online survey. The prevalence of psychiatric disabilities within the total student sample, consisted of 25 (33%) students who self-reported as having been formally diagnosed by a medical professional with a psychiatric disability and an additional 41 (54%) students indicated that they had informally diagnosed themselves with a psychiatric disability. Results for active involvement in treatment showed that just over 13 % of the total student sample is currently in treatment, although twice as many had received treatment in the past. Close to 90% of the respondents report that they have never disclosed their disability to ASU faculty or staff members – presumably including staff in the Disability Resource Center, the Counseling Training Center, or the Student Health Center. Three out of the four primary areas offered in a Supported Education Programs Career Planning, Academic Survival Skills, and Direct Assistance were identified by the student sample as a potential resource to help supplement students with psychiatric disabilities current unmet needs.

Traumatic events have deleterious effects biologically, emotionally, socially, and cognitively. Events may include violence, neglect, and abuse and are best understood through a lifecourse perspective. Preventable and treatable, traumatic exposure promotes the development of trauma symptoms including avoidance, hyperarousal, increased fear, intrusive experiences, and aggression/violence. Trauma symptomology is thought to be an underlying cause of child maltreatment and intergenerational cycles of abuse
eglect. Traumatic symptoms may interfere with the ability to work, function, and care for young children and may accompany a Post-Traumatic Stress Disorder (PTSD) diagnosis.

Although these experiences are known to be harmful, little research has focused on experiences of mothers involved in the child welfare system with young children (< 5 years). Subsequently, this study explored maternal experiences of trauma whilst calculating one of the first PTSD estimates. Types of trauma exposure, age of exposure, and event details were explored alongside history of substance use, domestic violence, and mental illness. Trauma symptom type, severity, and frequency were assessed. Utilizing adult attachment as a partial mediator, relationships between trauma exposure, trauma symptoms, and parenting were examined.

Supported by a university-community collaboration within the Safe Babies Court Teams Program in Maricopa County, Arizona, this study is exploratory and cross-sectional. A convenience sample of child welfare involved mothers (N = 141) with young children were recruited who were new clinical intakes with open court dependencies. Data on child/adult traumatic events, trauma symptoms, adult attachment, and parenting were collected. Results indicated high rates of complex/chronic trauma, specifically domestic violence and physical/sexual abuse. Mothers experienced higher than average childhood adversity/emotional abuse with significant overlap between trauma exposure and reduced mental health. PTSD rates ranged from 35-39%. Adult attachment did not to mediate trauma on parenting behaviors however strong and significant direct effects were found. Insecure-disorganized and insecure-resistant were the most dominant attachment styles.



Overall, these findings indicate the complex lifecourse nature of trauma exposure and the need to pay special attention to mental health and domestic violence histories in child welfare involved mothers of young children. Implications for social work practice, policy, and research are presented and provide impetus for continued future work.

The dissertation examines treatment services received by youth on probation in the Maricopa County, Arizona. The project focuses on three primary issues: 1) the factors associated with receiving treatment services while on probation, 2) the factors associated with receiving treatment services through different funding streams, and 3) whether treatment services and specific characteristics of treatment services, particularly the funding source, influence recidivism outcomes of youth. To answer these questions the research used data obtained from the Maricopa County Juvenile Probation Department from July 2012 thru August 2014. Multivariate regression, along with statistical techniques to control for selection bias, were used to identify the factors associated with receiving treatment services, the factors associated with the funding source of treatment services, and the effect of treatment services on recidivism. The findings from the current dissertation suggest that the receipt of treatment services is not equal across groups, and particularly that minorities are less likely to receive treatment services compared to their White counterparts. Additionally, the findings reveal that certain characteristics of youth and the type of treatment service received influence the funding source, but the source of funding does not influence the effectiveness of the treatment services. Finally, using propensity score matching, the current dissertation found that treatment services were effective in reducing recidivism while under probation supervision and 6 months after probation supervision has ended. Implications for policy and research are discussed in light of these findings.