Browsing by Subject "problems"
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Item Early Adversity on Post-Adoption Functioning(2016-04) Tang, Jennifer; Kroupina, MariaAdopted children are known to being prone to a variety of mental health and behavioral problems. Less is known about the effects of early adversity on adopted children's later attachment and behavioral problems with their caregiver. It is imperative for clinicians and caregivers to fully understand how these children's history can impact their overall functioning. This study aims to better understand how factors in pre-adoption history can predict later attachment and behavior problems with the caregiver post-adoption. The variables used for pre-adoption were: age at adoption, number of transitions in care, number/severity of adversity experiences reported (physical abuse, sexual abuse, emotional abuse, neglect, and pre-birth exposure to drugs/alcohol), and the timing between adoption and initial visit in the U.S. The study analyzed these variables with attachment and behavior functioning with the caregiver by looking at: overall attachment from the Disturbance of Attachment Interview (DAI) administered at the mental health visit, problems in Disinhibited Social Engagement Disorder (DSED) and Reactive Attachment Disorder (RAD) domains taken from the DAI, and parent concerns reported at the initial visit. The results found that the majority of adopted children (90%) had a emotional regulation issue in their attachment with their caregiver, and 75% displayed problems in the RAD domain of seeking comfort from their parent. It was also found that children who went through more transitions in care pre-adoption were reported to having more attention problems post-adoption by their caregiver. Additionally, there were no significant differences in any of the pre-adoption history measures with the overall attachment with the caregiver. This suggests for more focus to be placed on clinical observations, questionnaires, and coming in for services as early as possible after adoption. Pre-adoption history may not be the best indicator for later functioning, and individual resilience should be taken into account to further understand how adopted children function and attach to their caregiver.Item Leveraging Electronic Health Record Data For Whole-Person Knowledge Discovery(2018-04) Gao, GraceThis dissertation presents strengths data capture in electronic health record (EHR) documentation, risk assessment and management using a strengths-based data capture model, and a strengths-based research study within a wellbeing context using de-identified EHR data and a data-driven model. It starts with the description of the current state of documentation of problems and strengths in the EHRs. There exists a gap of strengths data in EHRs that predominantly follow problem-based infrastructure in the healthcare information system, and there are also emerging new data sources that include strengths data in EHRs. Following this trend, this dissertation examines the potential of leveraging the use of a proposed Strengths-based Data Capture Model in health risk assessment and management. This model adds a whole-person perspective including the purposeful use of strengths data as health assets in data capture, aggregation, and person-driven application throughout the process of risk assessment and management. It concludes by a strengths-based research in older adults using a data-driven model to aid data-mining discovery of associations among older adults’ strengths, problems, planned nursing interventions, and baseline Knowledge, Behavior, and Status scores using EHR data captured by the Omaha System. By integrating strengths-based documentation, data capture model, and research, this dissertation introduces a cutting-edge data capture model, and creates a platform for continued research and application of a strength-based ontology in clinical practice and electronic system of documentation.