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Item Building Essential Skills Together: Developing Employment and Skill Building Opportunities for Adults of All Abilities(2021-04) Lawson, Rebekah; Van Antwerp, Leah; Department of Occupational Therapy, School of Health and Human Sciences; Winkler, DanielleThe purpose of this doctoral capstone project was to address the gap in vocational and life skill services for Autistic young adults during their transition to adulthood. At the Building Essential Skills Together nonprofit organization, there is a goal to address this need and offer inclusive supported employment and life skill programs to adults of all abilities. Participants in these programs included two Autistic young adults on the Building Essential Skills Together team. Both young adults participated in food truck and cleaning/maintenance supported employment opportunities, completed weekly concession skill building experiences, and hosted a virtual trivia night using their interests. One young adult also participated in a 5-week life skills program led by the doctoral capstone student. This project utilized visual scripts, modeling, and prompting techniques during supported employment and skill building opportunities, and vocational and life skills assessments were established for future evaluation and tracking purposes. The Assessment of Functional Living Skills (AFLS)- Vocational Protocol was modified for the nonprofit’s food truck and cleaning/maintenance supported employment opportunities, and a non-standardized skills inventory was created for the life skills curriculum from the Occupational Therapy Practice Framework: Domain and Process (4th ed.). Development and implementation of supported employment and life skills materials during this project were guided by the Ecological Human Performance Model and Strengths-Based Frame of Reference for Autistic Individuals. Site feedback was obtained through electronic surveys at the conclusion of the project and indicated that project materials and implementation promoted inclusivity, independence, confidence, growth, and meaning for team members, as well as a foundation for the nonprofit programs.Item Expectations and Experiences of First-Time Mothers(2008-08-22T14:01:43Z) Freund, Andrea; Gardner, Carol BrooksThe aim of this qualitative study was to explore the expectations and experiences first-time mothers have before, during, and after pregnancy. Semi-structured interviews were conducted with fifteen first-time mothers, who gave birth within eighteen months before the date of the interview, and an additional interview was included with a first-time pregnant woman in her third trimester (N=16). The method of analysis was based on grounded theory, including line-by-line coding, focused coding and memo writing. Several themes emerged in the process. Approximately 70 percent of the women in this study became pregnant unintentionally. All of them described a certain amount of anxiety and fear about giving birth and becoming a mother. The measures taken in regard to activities and nutrition to improve pregnancy outcome were described. The most disconcerting findings were how the birth went for many of the women and the subject of postpartum emotional difficulties. Another theme was the different factors that negatively influenced the experience of giving birth. All of the women wanted to give birth vaginally and without medication, but seven of the women had to have medical interventions during birth - were administered Pitocin, mechanically induced, or had C-sections - which influenced their postpartum mental and emotional state severely. The disappointment after complications and diversions from a birth plan were significant. Fifty percent of the participating women reported to have suffered from postpartum emotional disorders, and three of them did not seek any help. Feelings of failure and low self-value due to emotional difficulties were described several times and also appeared in relation with body image issues. Physical changes, during and after pregnancy, were another major theme among the women. Transitions in their relationships were also mentioned in the interviews. Concluding, self-stigmatization was a main thread throughout the interviews. These findings are analyzed in relation to existing literature and the implications for future research are being discussed.Item Mental health challenges among adolescents living with HIV(Wiley, 2017-05-16) Vreeman, Rachel C.; McCoy, Brittany M.; Lee, Sonia; Pediatrics, School of MedicineIntroduction: Mental health is a critical and neglected global health challenge for adolescents infected with HIV. The prevalence of mental and behavioural health issues among HIV-infected adolescents may not be well understood or addressed as the world scales up HIV prevention and treatment for adolescents. The objective of this narrative review is to assess the current literature related to mental health challenges faced by adolescents living with HIV, including access to mental health services, the role of mental health challenges during transition from paediatric to adult care services and responsibilities, and the impact of mental health interventions., Methods: For each of the topics included in this review, individual searches were run using Medline and PubMed, accompanied by scans of bibliographies of relevant articles. The topics on which searches were conducted for HIV-infected adolescents include depression and anxiety, transition from paediatric to adult HIV care and its impact on adherence and mental health, HIV-related, mental health services and interventions, and the measurement of mental health problems. Articles were included if the focus was consistent with one of the identified topics, involved HIV-infected adolescents, and was published in English., Results and Discussion: Mental and behavioural health challenges are prevalent in HIV-infected adolescents, including in resource-limited settings where most of them live, and they impact all aspects of HIV prevention and treatment. Too little has been done to measure the impact of mental health challenges for adolescents living with HIV, to evaluate interventions to best sustain or improve the mental health of this population, or to create healthcare systems with personnel or resources to promote mental health., Conclusions: Mental health issues should be addressed proactively during adolescence for all HIV-infected youth. In addition, care systems need to pay greater attention to how mental health support is integrated into the care management for HIV, particularly throughout lifespan changes from childhood to adolescence to adulthood. The lack of research and support for mental health needs in resource-limited settings presents an enormous burden for which cost-effective solutions are urgently needed.Item Randomized Control Trial of COMPASS for Improving Transition Outcomes of Students with Autism Spectrum Disorder(Springer, 2018-10) Ruble, Lisa; McGrew, John H.; Toland, Michael; Dalrymple, Nancy; Adams, Medina; Snell-Rood, Claire; Psychology, School of ScienceThe postsecondary outcomes of individuals with autism spectrum disorder (ASD) are significantly worse than peers with other disabilities. One problem is the lack of empirically-supported transition planning interventions to guide services and help produce better outcomes. We applied an implementation science approach to adapt and modify an evidence-based consultation intervention originally tested with young children called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble et al., The collaborative model for promoting competence and success for students with ASD. Springer, New York, 2012a) and evaluate it for efficacy in a randomized controlled trial for transition-age youth. Results replicated findings with younger students with ASD that IEP outcomes were higher for COMPASS compared to the placebo control group (d = 2.1). Consultant fidelity was high and teacher adherence improved over time, replicating the importance of ongoing teacher coaching.Item TRANSITION TO ADULTHOOD: THE EXPERIENCE OF YOUTH WITH PHYSICAL DISABILITIES LIVING WITH A SERVICE DOG(2008-04-14T12:15:20Z) Modlin, Susan Jane; Swenson, Melinda M.; Austin, Joan K.; Sims, Sharon L.; McGrew, JohnThe focus of this qualitative descriptive study is the experience of physically disabled young people as they transition into adulthood while living with a service dog. The cornerstone of young adulthood is transition. For any young adult leaving home, the transition involves inter- and intra-personal changes that affect future well-being. Unfortunately, the majority of young adults with congenital disabilities are less likely to be fully employed and to live independently than their non-disabled peers. To date, very little research about living with a disability exists from the point of view of young adults. Even fewer qualitative research studies exist that focus on service dog teams. This research report will add to the body of nursing knowledge about people with disabilities and their experience of transition in the areas of health, work/school, relationships and identity. The findings result from descriptive analysis of interviews with four young adults and one parent. Using qualitative descriptive methods, the researcher identified three themes that defined the experience of transition. It’s different now contained stories regarding life before and after obtaining the service dog. This theme included elements of personality development similar to any young adult in transition, such as identifying “who I am now.” Going places was the most personal theme, describing the social implications of going or not going places and the environmental and personal barriers related to learning to drive. Calling the shots centered on the ability to make choices for themselves and the dog, as well as to participate in age appropriate milestones, such as attending college and living away from home. The findings of this study will be useful to professionals who place service dogs with persons with disabilities, rehabilitation specialists who desire appropriate interventions to facilitate transitions, and nurse researchers and clinicians who desire to understand the bond between animals and human beings.Item Trends of mutation accumulation across global SARS-CoV-2 genomes: Implications for the evolution of the novel coronavirus(Elsevier, 2020-11) Roy, Chayan; Mandal, Santi M.; Mondal, Suresh K.; Mukherjee, Shriparna; Mapder, Tarunendu; Ghosh, Wriddhiman; Chakraborty, Ranadhir; Medicine, School of MedicineTo understand SARS-CoV-2 microevolution, this study explored the genome-wide frequency, gene-wise distribution, and molecular nature of all point-mutations detected across its 71,703 RNA-genomes deposited in GISAID till 21 August 2020. Globally, nsp1/nsp2 and orf7a/orf3a were the most mutation-ridden non-structural and structural genes respectively. Phylogeny of 4618 spatiotemporally-representative genomes revealed that entities belonging to the early lineages are mostly spread over Asian countries, including India, whereas the recently-derived lineages are more globally distributed. Of the total 20,163 instances of polymorphism detected across global genomes, 12,594 and 7569 involved transitions and transversions, predominated by cytidine-to-uridine and guanosine-to-uridine conversions, respectively. Positive selection of nonsynonymous mutations (dN/dS >1) in most of the structural, but not the non-structural, genes indicated that SARS-CoV-2 has already harmonized its replication/transcription machineries with the host metabolism, while it is still redefining virulence/transmissibility strategies at the molecular level. Mechanistic bases and evolutionary/pathogenicity-related implications are discussed for the predominant mutation-types.Item Using a model of family adaptation to examine outcomes of caregivers of individuals with autism spectrum disorder transitioning into adulthood(Elsevier, 2018-10) Yu, Yue; McGrew, John H.; Rand, Kevin L.; Mosher, Catherine E.; Psychology, School of ScienceBackground The study examined the burden of caring for individuals with autism spectrum disorder (ASD) transitioning from high school and factors associated with burden derived from the Double ABCX model of family adaptation (i.e., autism symptom severity, problem behaviors, pile-up life demands, personality traits, social support, cognitive appraisals, and coping strategies). In particular, we were interested in the potential association between the “big 5” personality traits and burden. Method Participants (N = 105) were caregivers of individuals with ASD within two years pre- or post-graduation from high school. Results Primary caregivers reported moderate levels of burden. As hypothesized, burden was significantly associated with both child (i.e., increased autism symptom severity and problem behaviors) and caregiver characteristics (i.e., greater neuroticism, lower levels of extraversion, conscientiousness, agreeableness, and social support, and increased use of threat appraisals and passive-avoidance coping strategies). Using multiple regression, increased child behavior problems and increased caregiver use of passive-avoidance coping were identified as independent predictors of burden. Passive-avoidance coping mediated the relationship between caregiver burden and individual personality traits (i.e., neuroticism, extraversion, conscientiousness). Conclusions The results suggest that proximal variables, such as caregivers’ use of maladaptive coping strategies, explain the associations between burden and personality. Suggestions for interventions to relieve burden are discussed.