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The Power of Research

Wilmington University faculty researchers are making real-world contributions to the real world.

Are you using a laptop, tablet, or cellphone to read this? What about that steady wi-fi connection and the heat and light in your house, making you comfortable as you read?

These, and many more good things, have come to us through research. Here’s a truth: Research helps people; research helps you. Wilmington University can boast several faculty members who, through research, are making vital contributions to bettering our communities. Their topics include helping form trauma-informed therapy for at-risk youth, looking closely at parental stress during the stay-at-home lockdowns in 2020 for COVID-19, exploring students’ use of Flipgrid instead of journals or discussion boards, testing a new academic clinical nurse educator skill acquisition tool for data validation, and determining if providing housing to the homeless before addressing other needs can help reduce costs and improve lives.

“Wilmington University is committed to academic excellence,” says Vice President for Academic Affairs Dr. Jim Wilson. “Our faculty bring real-world skills and practices into the classroom, and many are conducting research nationally and globally that focuses on real-world problems.” This is research that improves all our lives, and students benefit.

Dr. Robin Weinstein

Drs. Amy Danley and Robin Weinstein

College of Business Professor Dr. Amy Danley and Dr. Robin Weinstein, associate professor and chair of Human Resources Management program, have been mining data, specifically records from hospitals and jails that can tell them about the use of those facilities by the chronically homeless. They want to discover what changes in someone’s life when that person is permanently housed with wrap-around case management services. They found it did change, significantly.

“It costs about $40,000 a year for a homeless person to be on the streets,” says Dr. Weinstein, quoting statistics spoken in 2012 by former U.S. Department of Housing and Urban Development Secretary Shaun Donovan. Weinstein estimates that putting these people in housing first reduces costs to closer to $12,000.

Working with New Jersey’s Cumberland County Housing First Collaborative through the M25 Initiative, a consortium of social service organizations, faith-based institutions, and government agencies addressing the needs of the chronically homeless, Drs.Weinstein and Danley gathered data over the past year that compares an individual’s usage of jail and hospital services before and after housing placement.

Dr. Weinstein notes that in 2015, the local hospital system in the county served 107 homeless individuals through the emergency room department and behavioral health units in one year. These 107 individuals accounted for 662 visits in one year.

Since 2017, the Housing First Collaborative has placed 92 individuals in housing who had experienced chronic homelessness. He says initial findings indicate a reduction of hospital utilization by between 60 and 90 %. Based on the data compiled from the local jail, initial findings indicate a reduction of jail stays by between 86 to 95 %.

Putting these folks into housing before any other intervention works, hence the term “housing first.” To illustrate, Dr. Weinstein uses the story of one person in this study who was homeless for eight years. “He was one of the first people we housed,” he says. “He had 86 jail stays, 78 hospital visits. Once he got housed, two hospital visits, and zero days in jail.”

And, Dr. Danley adds, “There’s significant savings, not only from a cost savings perspective, but in recidivism rates. This initiative has had a tremendous impact.” Their data shows an approximate payor costs savings of over $6 million to related agencies.

The two have planned several presentations to note this cost savings and reduction in jail and hospital visits to encourage more partnerships throughout the community with health care providers, county and state agencies, police departments, and others. They want to encourage the integration of housing first throughout these organizations.

“This really needs to be embedded in the hospital system and in law enforcement,” says Dr. Weinstein. “As in, ‘OK, let’s have this housing first approach. How do we get these people stabilized?’ Ideally it would be going from a bed to a roof. The overall effect saves lives and saves money.”

He notes their work will continue, though COVID-19 restrictions put them behind. They had wanted to see 100 people housed by this point in their research.

“Housing first is a theoretical concept, and we’re taking snapshots at any given moment in time,” says Dr. Weinstein. “Our data is based on 2019 data. We need to further stretch that out and see what makes them successful or what doesn’t.”

While the research of Drs. Danley and Weinstein was delayed due to COVID-19 lockdowns over the last year, these same COVID-19 restrictions led to a different kind of research — on parental and child stress.

Alisha Fletcher

Alisha Fletcher

Alisha Fletcher, an adjunct in the College of Social and Behavioral Sciences and a licensed clinical social worker at Delaware Psychological Services, is studying the effects of those lockdowns on parents with children at home, and using that data to help people feeling overwhelming stress.

The 2020 COVID-19 pandemic abruptly upended family life, she says, with the adults in the family either having to work from home while also serving as full-time educators of young children, or as essential workers traveling away to work, and at the same time with those children suddenly expected to learn remotely.

She says she and a colleague at Delaware Psychological Services, Kathleen Honeywell, discussed what was happening with patients. “This is something so unique,” Fletcher notes. “You can’t replicate these sorts of situations. When you have something that presents itself, it just seemed like there wasn’t an option to not collect data in that moment as to how people are feeling.”

Fletcher says 70 parents of children 12 years and younger volunteered to participate in an online survey to measure parental mental health in the parent-child relationship, child adjustment problems, and to help identify dysfunctional parenting. The project was put into motion from the beginning of the lockdown, with data collection occurring from mid-May to mid-June 2020.

The survey asked many general questions related to COVID-19 and changes in the family.  For example, says Fletcher: “Are people needing to apply for unemployment and did they feel that this had a negative or a positive effect on them? Are they sitting down to more family dinners now that they’re home? How are parents sleeping?”

Even something most would consider a minor issue in times past became huge challenges for people. Fletcher says the survey included two established measures. “One of them asked parents questions that would promote further inquiry if parents were anxious, depressed, feeling anger, about sleep, about personality functioning.”

For the other part of the survey, the Parental Stress Index-4-Short Form was used. “This measures the parent-child system based on the parent’s perception of a child’s characteristics, the personal characteristics of the parent, and the interaction between the child and parent.”

Fletcher says the data analysis is still ongoing, but she reports some early findings. “The two biggest for parents overall, more than half reported feeling more irritated, grouchy, or angry than usual, so that’s anger. The other is anxiety, so feeling nervous, anxious, frightened, worried, or on edge.”

The percentages are telling, as well: 63% of respondents reported feeling anger and related feelings, with 60% reporting feeling more nervous, anxious, or worried. Also, respondents reported childcare responsibilities increased significantly (60%) with most parents (57%) converting to at-home work. More than 70% of children participated in school online, and half of the respondents reported that they did not feel their children work well independently at home on learning activities.

And, a little over 30% of parents reported parenting a child with difficult or challenging behaviors. A quarter of the sample shared feel-ings of Parent-Child Dysfunction, meaning that interaction with their child is not reinforcing to themselves as parents.

So how do you help these parents and children in the middle of a pandemic?

“In response to the pandemic crisis, most parents in this study converted treatment for or with their child or themselves using teletherapy,” Fletcher notes.

A therapy Fletcher uses is Parent-Child Interaction Therapy. In her office, “the PCIT trainers were able to come together and develop adaptions to what we needed to do to be able to continue to practice with fidelity online.”

The results of this survey will help inform what works best while continuing remotely, “and that’s evidenced-based practice,” she adds.

“We will be looking at a working blueprint that discusses those evidence-based models, as far as their effectiveness in teletherapy, so we can support potential subsequent interruptions in life,” she continues. “And these models will also be able to support parents in a way that they don’t need to commute, they can get this help and support right there in their living room.”

Dr. Debra Berke

Drs. Debra Berke and Shawn Stevens

community focus continues in research by Dr. Debra Berke, professor and director, Psychology/Organizational Dynamics Programs, and Dr. Shawn Stevens, assistant professor and chair of Doctor of Social Science — Prevention Science program, along with Dr. David Chen of ChristianaCare, Wilmington University Adjunct Tiffany Jester, and Shana Powell of Delaware Guidance.

Titled Overcoming Barriers to CBO-based Trauma Informed Therapy for At Risk Youth, the idea for this research is based on results from a study done by the Centers for Disease Control and Prevention on violence prevention, says Dr. Berke.

“They found that people most at risk actually were early adult males,” she notes. “But that’s not the population we are working with. Our intent was, if we can get children the services they need, such as mental health counseling, then perhaps we can prevent violence from occurring and help them be safer.” The children addressed in this research are ages 8 to 18.

Dr. Berke adds they have partnered with Hilltop Lutheran Center and Urban Promise in the City of Wilmington. But then COVID-19 entered the picture. This was to be a two-year project, and like other research in the past year, the direction and methods had to be adjusted to this new scenario.

If we can get children the services they need, such as mental health counseling, then perhaps we can prevent violence from occurring and help them be safer.” —Dr. Debra Berke

“We’re in the beginning stages, because initially we were going to roll this out face-to-face right about the time COVID-19 hit,” says Dr. Berke. “Then we had to regroup and figure out how can we do it online in a virtual environment. We’re probably a year behind schedule.” They have now added an additional year to the project. 

This fall, “we’ve trained their staff to screen the children, with consent by their caregiver, for mental health issues,” she says. “The screens are reviewed by licensed counselors at Delaware Guidance, who score it and determine whether the child needs to be interviewed, to determine if they need mental health services or just somebody to talk to once, and they’re really fine. They just might be having a bad day, an off day.” If the youth need mental health services, Delaware Guidance works with the youth and their caregivers to provide them. Wilmington University’s role in this is to oversee the data collection and analysis, she adds.

Dr. Shawn Stevens

Some screenings have already been done at Hilltop, and they are starting to screen children at Urban Promise. Because of COVID-19, Dr. Berke says, “we’re now testing telehealth and the ability to get children and youth access to mental health services through that, which can eliminate some barriers, like transportation, but brings other barriers, like technology. Part of the project is to figure out what those barriers are and then get them the access to whatever they need.” Dr. Berke adds that Social Contract oversees the administrative aspects.

Dr. Stevens is providing data analysis for the project. “Once the data starts rolling in, I will probably take a little bit more lead in some of the data collection results and interpretation, and be involved with some of the training of community-based staff to be able to implement the project,” he says.

He notes that Wilmington University has many close ties with the community, with faculty experts prepared to participate in all types of research, like this project. “Wilmington University is well positioned to do more and more of that,” Dr. Stevens says.

Dr. Aaron Sebach

Research that impacts the community of Wilmington University students is being led by Dr. Aaron Sebach, associate professor and chair of the Doctor in Nursing Practice program. His research is in two areas: The first, a program app called Flipgrid that Doctor of Nursing Practice students are using in the classroom, and, second, testing of a skill validation tool for clinical nurse educators.

Dr. Aaron Sebach

“In January of 2020, we were looking at different technologies that were available to enhance student engagement,” Dr. Sebach says. “We identified that, through looking at nursing education literature, Flipgrid is a great method to increase a sense of community. So we started replacing discussion boards and journal assignments in the DNP program with Flipgrid in the spring semester and it was very well received by students.”

Flipgrid is a free app that allows students and instructors to interact using a grid system, which acts as a message board. Students video their responses and post them in the grid. Microsoft owns Flipgrid and markets it as a K through Ph.D. level education technology tool.

“We give them a prompt and they respond to the prompts and the faculty provider,” says Dr. Sebach. “We can review it in real time, give feedback in real time. That works really well for our doctoral students who are implementing projects. We can provide feedback to them in a video format, and this is more interactive than a traditional discussion board.”

We started replacing discussion boards and journal assignments in the Doctor in Nursing Practice program with Flipgrid, and it was very well received by students.” —Dr. Aaron Sebach

Dr. Sebach says previous studies on doctoral students’ use of Flipgrid could not be found, so he decided to conduct one. “There’s a gap in the literature that we needed to fill, and the study was started in the fall 2020 semester.”

The qualitative survey asked the students about their experiences and sense of community over a two-week period. “Our response rate was overwhelming,” he says, with 35 of the DNP students replying, which is 37 percent of the doctoral students. Using the information he had gathered, he also presented on the use of Flipgrid at the National League for Nursing Conference, and is working on a manuscript for publication.

Using Flipgrid is like having a conversation instead of a discussion board. “They are able to articulate their thoughts clearly. And by the end of the program, the students said that participating as Flipgrid allowed them to be better prepared as a public speaker,” Dr. Sebach says.

“It’s a group tool, and the more I’ve learned about it, it’s really exciting. And it even has a Canvas integration. The maximum time a student can record is five minutes. So it’s not like hours of review time.”

Dr. Sebach sees value in this as an educational tool that others in the university might like to use. “I hope other colleges will be able to use the program. We’ve expanded it in our master’s degree in nursing program and I think some undergrad, so it’s picking up in popularity.”

Dr. Sebach and Indiana University’s Dr. Teresa Shellenbarger

Dr. Sebach’s other study is in collaboration with Dr. Teresa Shellenbarger of Indiana University in Pennsylvania. “She is a doctoral nursing program coordinator, where I got my Ph.D.,” he says. “I became interested in skill acquisition of nursing faculty, and that was my dissertation, looking at skill acquisition of the DNP-prepared nurse educator and Ph.D.-prepared nurse educator.”

Here again, Dr. Sebach says he found a gap in the literature regarding the nurse educator teaching in a clinical setting. “There, skills are very different than those facilitating lecture activities,” he notes. “There are validation tools that assess the competence of nurse educators, but no validation tool to assess the competence of clinical nurse educators. So we identified that as a gap in literature.”

Dr. Sebach and his research partner conducted a validity test and a reliability test with the tool with 168 participants, which included students from both Indiana University and Wilmington University.

“It was a pretty good completion rate, and it was a convenient sample of clinical nurse educators,” he says. “Now that we have the tool, which is called the academic clinical nurse educator skill acquisition assessment tool, and have done the validity and reliability testing on the tool, we’ll be able to do a randomized sample of clinical nurse educators throughout the United States.”

This tool is a first, says Dr. Sebach. “There is a credential offered by the National League for Nursing, certified clinical nurse educator. So the competencies are new for clinical nurse educator, just this year. And there’s not been a validated tool to look at the competency for that.”

Dr. Sebach notes that tool development is challenging and time-intensive. “This truly will be a tremendous asset to the body of nursing education and knowledge,” he adds. “Hopefully, this will be a benefit for my colleagues across the country.”

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