Browsing by Author "Yeager, Valerie"

Now showing 1 - 6 of 6
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    Availability of Behavioral Health Crisis Care and Associated Changes in Emergency Department Utilization
    (2024-06) Burns, Ashlyn Brooke; Yeager, Valerie; Menachemi, Nir; Vest, Joshua R.; Mazurenko, Olena; Salyers, Michelle
    One in eight emergency department visits involves a behavioral health crisis. Yet, emergency departments are rarely equipped to meet the needs of patients experiencing a behavioral health crisis. Innovative care delivery models, such as behavioral health crisis care services delivered by mental health treatment facilities, offer a promising alternative to the emergency department. As decisions are being made around reimbursement and expansion of behavioral health crisis care models, empirical evidence on the relationship between these services and emergency department utilization is needed. The purpose of this dissertation is to 1) assess availability of behavioral health crisis care services across the United States; 2) identify community-level characteristics associated with availability of behavioral health crisis care services; and 3) quantify changes in emergency department utilization associated with availability of behavioral health crisis care services. In doing so, this dissertation identifies gaps in the nation’s existing behavioral health crisis care system and highlights the value of ensuring access to these life-saving services. As national implementation of the new 988 Suicide and Crisis Lifeline is underway, findings from this dissertation may help inform efforts to transform the crisis continuum and ensure access to care for all individuals experiencing a crisis.
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    Dance of Dollars: State Funding Effects on Local Health Department Expenditures
    (Wolters Kluwer, 2022) Viall, Abigail H.; Bekemeier, Betty; Yeager, Valerie; Carton, Thomas; Health Policy and Management, Richard M. Fairbanks School of Public Health
    Objective: We examined changes in total local health department (LHD) expenditures in the state of Washington following introduction of a new state funding program to support core public health services and infrastructure. Methods: We used a pre/posttest design regression model to evaluate changes in LHD expenditures 1, 2, and 6 years into the new state program. To address potential endogeneity in the model, we repeated all 3 analyses using 2-stage least squares regression. Results: In the base case, overall spending among LHDs significantly increased with receipt of the new state funds in the first years of the program (2008 and 2009). However, those increases were not sustained over the longer term (2013). In subpopulation analyses, total LHD spending increased more among larger LHDs. Conclusions: Between 2006 and 2013, new state investments in core public health functions increased Washington State LHD expenditures in the short term, but those increases did not persist over time. For public health financial modernization efforts to translate into public health infrastructure modernization successes, the way new investments are structured may be as important as the amount of funding added.
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    Indiana Public Health System Review
    (Richard M. Fairbanks School of Public Health, 2020-12) Halverson, Paul; Yeager, Valerie
    This study examines the current state of Indiana’s public health system. In particular, this report focuses on the centerpiece of the public health system - the network of local and state governmental public health agencies - their structure, human and financial resources, authorities, and activities.
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    On Becoming a Chief Health Strategist
    (2025-01) Brandenburg, Terry L.; Yeager, Valerie; Stone, Cynthia; Nelson, David
    The vision for Public Health 3.0 includes a call to embrace the concept of health departments becoming chief health strategists. This term refers to public health organizations that possess the capacity and competency to take a leadership role in improving the health of communities. Although the practices of a chief health strategist have been defined, research is silent on “how” health departments can become proficient chief health strategists. The purpose of this study is to determine how local health departments can assimilate the role of chief health strategists within their communities. A qualitative multiple case study was designed to research this question. Eighteen local health directors from Wisconsin were selected and functioned as key informants. Semi-structured interviews were conducted, and participants completed a chief health strategist competency self-assessment survey and provided organizational documents. The key informant interview guide created for this study was developed using the five domains of the Consolidated Framework for Implementation Research (CFIR). Key findings of the study found four major themes that impact an organization’s ability to provide population health services and function as a proficient chief health strategist. The identification of facilitators and barriers to change and recommendations for change from the key informants served as the basis for the development of a plan for change. The plan for change was guided by John Kotter’s eight-step process of creating change model.
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    Perceptions of Nurses Delivering Nursing Home Virtual Care Support: A Qualitative Pilot Study
    (Oxford University Press, 2022-12-20) Blackburn, Justin; Mills, Carol; Tran, Yvette; Yeager, Valerie; Unroe, Kathleen; Holmes, Ann; Health Policy and Management, School of Public Health
    Avoidable hospitalizations among nursing home residents result in poorer health outcomes and excess costs. Consequently, efforts to reduce avoidable hospitalizations have been a priority over the recent decade. However, many potential interventions are time-intensive, require dedicated clinical staff, and nursing homes are chronically understaffed. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project was one of seven sites selected by CMS as "enhanced care & coordination providers" and was implemented from 2012 to 2020. A virtual program based on the principles of OPTIMISTIC was developed in the spring of 2020 with the goal of expanding the reach of the program’s services. This qualitative study explores the perceptions and experiences of the nurses that piloted a virtual care support project in 11 nursing homes in a midwestern state, and identified the nurses’ perceived facilitators of, and barriers to, the effectiveness of delivering a novel virtual care support program. A key finding from this analysis is that relationships, communication, and access to information were identified as common themes facilitating or impeding the perceived effectiveness of implementation of virtual care support programs within nursing homes, from the perspective of the nurses delivering the services. The experiences and recommendations of the program nurses provide insights into crucial elements important to the implementation of similar virtual care support models, and the role of telehealth in bridging healthcare workforce gaps.
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    Understanding Factors Related to Decision Making by State Health Officials in a Public Health Emergency
    (2022-10) Barishansky, Raphael M.; Halverson, Paul; Menachemi, Nir; Yeager, Valerie
    Background and Purpose - State Health Officials (SHOs), as the leaders of state governmental public health agencies, play a critical role in their respective states. Their decisions guide the overall actions of their organizations in executing programs, policies and activities that ultimately affect the health of the state’s population. This study will add to the research and serve as a potential guide to future SHO training, specific to decision making, in a public health emergency Methods – Twenty-one individuals, who are either currently working as SHOs or who were former SHOs, were interviewed to understand their perspectives on issues that may impact their response to a public health emergency: decision-making, interaction with the public and the media and the role of politics in public health, and other areas of consequence. Results – While the study was focused more broadly, all of the respondents specifically mentioned the COVID19 pandemic as the most complicated public health emergency they have responded to as a SHO. All respondents also mentioned that they did not have a specific decision-making tool to utilize during this emergency and primarily relied on a consensus-driven decision-making process. Additionally, issues such as the challenges of managing the media and the politicization of public health during this pandemic, were mentioned by many of the respondents. Conclusion - These findings pointed to the need for a step-by-step decision-making tool to be utilized by SHOs in a public health emergency. This has the potential to lead to a more methodical approach to SHOs decision-making during a public health emergency, including a focus on various operational aspects such as understanding the role of the media in a public health emergency, managing elected officials in a public health emergency, and lessons learned from past public health emergencies.