Integrative Learning Experience (ILE) Theses

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  Staff and Provider Perspectives on a Low-Barrier Buprenorphine Program in Portland, Maine

  Emily Follo

  Background: Homelessness and opioid use disorder are at the forefront of public health issues in Maine. Substance use accounts for a higher proportion of deaths among those experiencing homelessness than it does in the overall population. In 2022, Maine ranked third in the U.S. for fatal overdoses involving opioids. The clinic at the center of this evaluation is a low-barrier buprenorphine bridge program serving people experiencing homelessness that provides same-day prescriptions and other supports, while connecting patients to ongoing care for substance use disorder. Methods: This was a qualitative program evaluation that used semi-structured key informant interviews. The evaluation focused on assessing internal processes, attitudes and beliefs of employees, and relationships with partner organizations. Participants were included if they are curren employees at the clinic or a partner organization. Interviews were conducted via Zoom and recorded. Interviews were coded in Excel using in-vivo coding. Codes were categorized using a color-coding system. Themes were assessed based on codes and categories. Results: Six interviews were conducted. A total of six participants were interviewed. Four of these participants currently work at the clinic, and two work at partner organizations. After analysis and coding, a total of 26 distinct categories of codes were identified. Among the codes and categories, five unifying themes emerged. The five themes include: Providers/Staff at the clinic build trusting, respectful relationships with patients & partners which is key to success; the clinic is the lowest barrier in the community, which promotes harm-reduction; Many systemic challenges impact the clinic and its patients; Respondents are excited to expand the clinic to include more outreach 3 via van; Respondents overwhelmingly support low-barrier buprenorphine and acknowledge limitations/drawbacks. Discussion: The findings support low-barrier, harm-reduction approaches to treating substance use disorder, especially in a population that is experiencing homelessness. The findings highlight human connection, harm reduction approaches, and trusting, respectful relationships as strengths of the clinic. The findings also highlight the need to include patient voices in future study. At the community level, the findings could spark further discussion about harm reduction and promote its adoption in more medical settings. Conclusions: The clinic is a local leader in harm reduction, and would benefit from more social work support. Further evaluation is needed that includes patient voices. These findings can help garner support for the clinic and for low-barrier buprenorphine in the community.

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  Staff and Provider Perspectives on a Low-Barrier Buprenorphine Program in Portland, Maine

  Emily Follo MD, MPH

  Homelessness and opioid use disorder are at the forefront of public health issues in Maine. Substance use accounts for a higher proportion of deaths among those experiencing homelessness than it does in the overall population. In 2022, Maine ranked third in the U.S. for fatal overdoses involving opioids. The clinic at the center of this evaluation is a low-barrier buprenorphine bridge program serving people experiencing homelessness that provides same-day prescriptions and other supports, while connecting patients to ongoing care for substance use disorder.

  This was a qualitative program evaluation that used semi-structured key informant interviews. The evaluation focused on assessing internal processes, attitudes and beliefs of employees, and relationships with partner organizations. Participants were included if they are current employees at the clinic or a partner organization. Interviews were conducted via Zoom and recorded. Interviews were coded in Excel using in-vivo coding. Codes were categorized using a color-coding system. Themes were assessed based on codes and categories.

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  O U T of Stigma: An Evaluation of a Harm Reduction Program in Connecticut

  Rossy Fuentes MD, MPH

  The alarming rise in opioid use and misuse despite several efforts to control it, has resulted in a significant public health crisis around the world. Besides increasing the number of opioid-related deaths, it increases homelessness, joblessness, scholar absenteeism, and family disruption.

  This study evaluated the Harm Reduction program's reach, implementation, and development. The main goal of this evaluation was to identify strengths, barriers, and areas where the program could improve and provide recommendations for allocating resources under new grant funding.

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  A Policy Analysis of the Effectiveness of Tobacco and Vaping Legislation in Adolescents and Adults in New York State

  Samina Mian

  This policy analysis ascertained the effectiveness of tobacco and vaping legislation in adolescents and adults in New York State (NYS). The analysis discussed the Adolescent Tobacco Use Prevention Act (ATUPA), which is a tobacco policy aimed at tobacco prevention among adolescents and young adults. A detailed approach was conducted with collected data on tobacco and vaping statistics, including NYS smoking rates, morbidity and mortality rates, and prevalence in both adults and adolescents. Data were collected from the NYS Department of Health, the Centers for Disease Control and Prevention (CDC), and others. The socioecological and CDC Policy Analysis Frameworks were used to guide this analysis. In addition, a literature review and an environmental scan were conducted. Although several successful tobacco policies exist in NYS, increased legislation and funding are needed to continue current tobacco control efforts. The analysis provided insights into the strengths and weaknesses of the current policies. It explored potential areas of policy enhancement to address challenges. Efforts to continue increasing the price of tobacco and vaping products are needed. Revenues from these increases would be used to support additional tobacco control programs. There is also a need to extend regulations limiting tobacco and vaping product availability and accessibility, especially near schools. The analysis aims to inform stakeholders regarding strategies to improve public health outcomes. These recommendations could have a lasting impact on tobacco and vaping product usage rates and overall community health.

  Keywords

  Policy analysis, public health, effectiveness, tobacco, vaping, legislation, adolescents, adults, New York State, ATUPA

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  Predicting Community COVID-19 Public Health Needs Through Wastewater Based Epidemiology, Maine USA

  Tyler J. Zanon

  This research examines the applicability of various wastewater based epidemiological (WBE) approaches to predicting Coronavirus disease 2019 (COVID-19) incidence in four different Maine communities.

  The study analyzes the predictive fit of COVID-19 cases based on a simple predictive model, a linear regression model, and a Susceptible, Exposed, Infected, and Recovered (SEIR) differential equation model.

  The findings further bolster existing evidence supporting that WBE can play a vital supplementary role in COVID-19 disease surveillance and prediction. predictive models through WBE is becoming an important public health surveillance tool and leveraging it in the future could provide numerous benefits to community level understanding and response related to population health.

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  California’s Stabilizing of Reproductive Autonomy Amid Major Policy Shifts: Punctuated Equilibrium Theory in Action

  Ramanpreet Decker

  This paper analyzes CA's Prop 1 within the theoretical framework of the Punctuated Equilibrium Theory (PET). The analysis offered a deeper understanding of the developmental dynamics surrounding Prop 1 and CA's efforts to maintain policy stability. Additionally, the analysis sheds light on the central role played by CA in protecting abortion rights in response to the ever-changing and disruptive terrain of abortion policy within the US.

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  Where have all the OBGYNs gone? An investigation into the effect of abortion restrictions on availability of women's health providers

  Carlie Famiglietti

  In 2022, the Supreme Court overturned its previous ruling in Roe v. Wade, effectively ending federal protections for abortion. Quickly after, many states enacted abortion restrictions or outright bans. Abortion bans are harmful public policies that are impacting the availability of OB-GYNs for many reasons, including the threat of criminal prosecution. This has led to a dearth of healthcare access for millions of women in 21 abortion-restricted states, as OB-GYNs move out of state and new medical residents choose to practice elsewhere. A literature review and interviews with three key informants were conducted to explore this issue. Key informant interviews focused on the post-Dobbs landscape for women’s healthcare, the impact of reproductive care restrictions on healthcare providers and patients, and future prospects. Findings show that both practicing and resident OB-GYNs are choosing not to work or train in abortion- restricted states. Qualitative results revealed the psychological toll of abortion bans on all healthcare providers and widening socioeconomic disparities. Barriers to keeping OB-GYNs in state also include restrictions on their autonomy and threat of criminal liability. No agency or governmental organization has proposed a policy solution to this problem. Primary solutions have come from physician-led organizations. These groups are building coalitions to lobby state policymakers against abortion bans and campaign for ballot measures in favor of abortion rights. These findings have implications for the future of women’s healthcare. If policymakers are unwilling to propose solutions and physician-led organizations are unsuccessful in their efforts, millions of women will lose access to routine gynecological care, not only access to abortion.

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  Policy for a Singular Neurodevelopmental Disorder: A Multiple Streams Analysis of the Combating Autism Act of 2006 Using Kingdon’s Framework

  Michelle C. Fong

  The Combating Autism Act of 2006 (CAA) is a single-disorder law for the population with autism spectrum disorder (ASD), one of six neurodevelopmental disorders (NDDs). All NDDs have common origins, overlapping symptoms, and lifelong adverse individual and societal impacts. Yet, no analogous policy exists for the other NDDs. The inequity between related disorders is a curiosity, and moreover, it results in health and economic inequities with devastating consequences. This analysis examines the conditions that led to the CAA, which has been reauthorized three times since 2006 and is now known as the Autism Collaboration, Accountability, Research, Education, and Support (CARES) Act. Understanding how we arrived at this landmark legislation serves to inform future reauthorizations and elicit consideration of CARES equity for people experiencing all NDDs.

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  Implementing a Health Leadership Program - Clinical Perspectives

  Usamah Tabani

  A Health Leadership Program (HLP) was developed in Maine to equip healthcare students with essential knowledge and skills in reproductive health. This evaluation presents findings from a qualitative analysis that assessed the impact of HLP on healthcare students' attitudes, beliefs, and clinical preparedness.