Direct Practice Improvement (DPI) Project Proposal Chapter 1 - Introduction to the Project Chapter 1 of the Direct Practice Improvement (DPI) Project is titled "Introduction to the Project" and includ

Dissertation Prospectus

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Prospectus Instructions: Read the entire Prospectus Template to understand the requirements for writing your prospectus. Each section contains a narrative overview of what should be included in the section and a table with required criteria for each section. WRITE TO THE CRITERIA, as they will be used to assess the prospectus for overall quality and feasibility of your proposed research study. As you draft each section, delete the narrative instructions and insert your work related to that section. Use the criterion table for each section to ensure that you address the requirements for that particular section. Do not delete/remove the criterion table as this is used by you and your committee to evaluate your prospectus. Prior to submitting your prospectus for review by your chair or methodologist, use the criteria table for each section to complete a realistic self-evaluation, inserting what you believe is your score for each listed criterion into the Learner Self-Evaluation column. This is an exercise in self-evaluation and critical reflection, and to ensure that you completed all sections, addressing all required criteria for that section. The scoring for the criteria ranges from a 0-3 as defined below. Complete a realistic and thoughtful evaluation of your work. Your chair and methodologist will also use the criterion tables to evaluate your work. Your Prospectus should be no longer than 6-10 pages when the tables are deleted.
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0	Item Not Present
1	Item is Present. Does Not Meet Expectations. Revisions are Required: Not all components are present. Large gaps are present in the components that leave the reader with significant questions. All items scored at 1 must be addressed by learner per reviewer comments.
2	Item is Acceptable. Meets Expectations. Some Revisions May Be Required Now or in the Future. Component is present and adequate. Small gaps are present that leave the reader with questions. Any item scored at 2 must be addressed by the learner per the reviewer comments.
3	Item Exceeds Expectations. No Revisions Required. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. No changes required.

Dissertation Prospectus

Introduction

The Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Justice, every year in the United States, millions of people suffer from mental illness. The high numbers necessitate raising public awareness and start campaigning for a much better health care system (Hamilton.et.al, 2016). In 2018, 47.6 million people in the U.S. experienced mental illness which means 1 in every 5 adults. 11.4 million Adults between ages 25 and 35 had an episode of serious mental illness. In 2016, 7.7 million youths aged 6-17 experienced some sort of mental health disorder, while 9.2 million people were reported to have experienced substance use disorder (National Alliance on Mental Illness, 2019).

The health sector in this Southern State has been applauded for the good work in health allocations and expenditures. However, despite all the expenditures and better services offered to the people living in the county, mental health sector still faces challenges, especially among many Asian and African American people living in the county who have little to no access and utilization of the services within the region (Texas, 2017). This has been attributed to a number of factors which hinder most people from accessing mental health services. In addition, the results of the studies conducted on the mental health care in the country have shown that the issuance of mental health services has a big gap among the different cultures, but mostly affecting the minority groups in the nation. The most difficult challenge that was established was the improvement of mental health especially among the minority groups such as the Asian Americans and the African Americans. In most reported cases, many people are dying and committing suicide as a result of not properly utilizing mental illness health services and lack of insurance coverage.

One Southern State County has been recognized as one of the counties where the utilization of mental health facilities is below the expected standards. Although the county is one of the areas with the highest and the best health facilities, yet, the county still faces a lot of challenges on the number of children with mental health challenges.

The study will be conducted on the people, who are basically African Americans, Asian Americans and the Caucasian citizens of the county, that were affected by lack of mental health services. The high mental health cases in this Southern State County are blamed on various factors. One of the factors is the lack of enough and well-trained mental health professionals within the county. Such has resulted to lack of utilization of the mental health facilities hence the rising number of mentally challenged children. Poverty levels in the county have also been blamed for the increased number of mentally challenged children. Most of the people in the county have low income and cannot afford insurance hence lacking the access to mental healthcare.

Caregivers in the mental healthcare clinics in this county, agreed that many people in the county laced knowledge about the mental healthcare because of their low social status within the county. Also, they acknowledged that they lacked enough knowledge about the importance of mental healthcare.

This is a research study aimed at discussing the factors influencing individuals' decision not to utilize mental health services in a Southern State County. The study is important in understanding the major reasons which limit utilization of mental health services in the county and recommending ways through which the issues can be resolved.

Criteria	Learner Self-Evaluation Score (0-3)	Chair Evaluation Score (0-3)	Reviewer Score (0-3)
Introduction This section briefly overviews the research focus or problem, why this study is worth conducting, and how this study will be completed. The recommended length for this section is two to three paragraphs.
Dissertation topic is introduced along with why the study is needed.
Provides a summary of results from the prior empirical research on the topic.
Using results, societal needs, recommendations for further study, or needs identified in three to five research studies (primarily from the last three years), the learner identifies the stated need, called a gap
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.
NOTE: This Introduction section elaborates on the Topic from the 10 Strategic Points. This Introduction section provides the foundation for the Introduction section in Chapter 1 of the Proposal.
Reviewer Comments:

Background of the Problem

The objectives of this prospectus are to examine the factors influencing individuals' decision to not utilize mental health in one Southern State County. Previous research works have explored the field of health accessibility not only in Texas but throughout the country. When narrowing down to this county, research has shown a gap alignment of medical services and needs of the people living in the county. Children at Risk (2017) deliberate on various increasing children with mental disorders’ needs in the society. Most of them develop mental illness from birth. Though the county has been applauded for having the best health services, the area still faces a number of challenges which are a threat to the child-health. Access to mental health is a gap yet to be filled in Fort bend (Beatty, Wilson, Ciecior, & Stringer, 2015). This has been fueled by few mental health professionals in Texas which has led to poor infrastructure in the mental health sector. The sectors greatly affected are the juvenile systems and emergency facilities. Many people in the region are uninsured and also have lower income which makes it had for them to get mental health services. In addition, poor parenting was a great contributor of health illness. This calls for further research into the field to understand more factors which affects the utilization of mental-health services in the areas not only in children but all people of this Southern State County.

According to the Centers for Disease Control and Prevention, mental health has become a significant public health issue in the United States that requires immediate attention and must be diagnosed at its early stages. Without an early diagnosis and treatment, children and adolescents may experience problems in the home, at school and among friends including issues with forming friendships. Accordingly, researchers have explored some barriers relating to the utilization of mental health service, notwithstanding, there were other factors that may also influence individuals' decision to not utilize mental health.

Caregivers are primarily the means by which most people including children and adolescents as well as adults enter treatment. They are responsible for taking care of their patients/clients physical and emotional well-being. The objective here is to specifically explore any relationship existing in utilizing mental health services and the influences of caregivers, including burden, caregiver mental health status and caregiver type. The study is a cross-sectional and utilizes secondary analysis of the 2003 National Survey of Children’s Health of 3,986 children and adolescents ages 6-17 with mental health needs. To understand caregiver influences and their characteristics as it relates to the relationship between need and utilization of mental health services, a bivariate and multivariate analyses were conducted (Grayson, 2016).

Results indicates that experienced caregivers who encounter some level of burden may likely utilize mental services than others who do not experience any burden. Caregivers that experience high level of burden will likely 15 times or more utilize mental health services (OR =13.70; 95% CI 10.58-17.74, p<0.001). Similarly, the caregivers that experience serious signs of depression or anxiety in their child or adolescent (OR=1.55; 95% CI 1.21-1.98; p<0.05) will tend to use the services more than the caregivers who experience mild or no sign of depression or anxiety. The mental health status of the caregiver is of no significance and has no influence on need and utilization (Grayson, 2016).

Teenagers in the age range of 14 to 17 are significant and are found to utilize mental health services more than the younger ones (OR=1.48; 95% CI1.16-1.89; p<0.05). African American children use mental health services more than the Caucasian Hispanic or other children (OR=0.59; 95% CI 0.38-0.91; p<0.05). The income and the caregivers have no influence on utilization. Furthermore, individuals with insurance coverage tend to use mental health services more than those without coverage (OR=1.88; 95% CI 1.22-2.64; p<0.05). The findings of this research indicate that caregivers are important for people to get mental health treatment for their loved ones; in addition, to how caregivers may be barriers to people with need. Furthermore, this study is promoting the need for more studies to include qualitative research to fully understand extra issues and challenges that caregivers and people face while trying to get mental health treatment (Grayson, 2016).

Similarly, in their 2015 research analysis, Augsberger, Yeung, Dougher, & Hahm (2015), analyzed the hidden barriers to accessing care and utilization of mental health for Asian American Women in the county. It showed that 299 women representing 43% of the participants have suffered from symptoms of depression or have had suicidal attempts. It examined the mismatch between available services and cultural needs, contribution of Asian society to mental health and contribution of Asian family to the stigma of mental health.

Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley (2016), did research on the factors that affect mental healthcare access among African Americans. They identified one of the reasons to be low income and lack of awareness about the existing institutions that offer mental healthcare. Augsberger, Yeung, Dougher, & Hahm (2015), identified further issues that affect the accessibility of mental healthcare among Asian American women in the county. Accordingly, the authors concluded in their research that the Asian American women are suffering from depression and often were faced with the thoughts of suicide. According to the authors, Asian American women were stigmatized because of the mental health issues, and most of them do not want to come out and seek treatment.

Misra, S. M., Guffey, D., Roth, I., & Giardino, A. P. (2017) in their article “Complementary and Alternative Medicine use in Uninsured Children in Texas”, the authors describe the concept relating to the use of complementary and alternative medicine (CAM) for mental health treatment among children in this Southern State County. According to the authors, CAM use among US children stands at 12%. According to the 2012 National Health Interview Study. The research suggests that there are a number of uninsured population due to their limited access to care, which resulted in higher CAM use. A survey of 250 uninsured patients at various pediatric facilities in a free mobile clinic program showed a very high use by Hispanic population, their rate of CAM use in the last 12 months was close to 50% among children and 60% among parents. One Southern State has placed a lot of effort into improving the health care treatment of children; according to that 2012 research report conducted a study National Health Interview Study. Research study suggests that facilities that the services offered are inversely proportional to the allocation provided. Misra and the rest have concluded that this issue has raised a lot of concern since the mental health of the people remain to be very low despite the efforts implanted. Research showed that some institutions have released a lot of funds to run this sector. This research also showed that this Sothern State receive the second largest allocation for mental health.

Based on the data collected, a gap was identified regarding the factors that affect the utilization of Mental health facilities within the county. Various people within the mental healthcare profession have done research on some factors that may deter people from receiving mental healthcare. The literature on the mental health gap in the county has revealed major reasons as to why the gap exists. Stigmatization and low income are some reasons as to why the gap exists in the county.

Criteria	Learner Self-Evaluation Score (0-3)	Chair or Score (0-3)	Reviewer Score (0-3)
Background of the Problem This section uses the literature to provide the reader with a definition and statement of the research gap and problem the study will address. This section further presents a brief historical perspective of when the problem started and how it has evolved over time. The recommended length for this section is two-three paragraphs.
Includes a brief discussion demonstrating how literature has established the gap and a clear statement informing the reader of the gap.	1
Discusses how the “need” or “defined gap” has evolved historically into the current problem or opportunity to be addressed by the proposed study (citing seminal and/or current research).	1
ALIGNMENT: The problem statement for the dissertation will be developed from and justified by the “need” or “defined gap” that is described in this section and supported by the empirical research literature published within the past 3-5 years.	2
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.	2
NOTE: This Background of the Problem section uses information from the Literature Review in the 10 Strategic Points. This Background of the Problem section becomes the Background of the Study in Note, this section develops the foundation for Chapter 1 in the Proposal. It is then expanded to develop the comprehensive Background to the Problem section and Identification of the GAP sections in Chapter 2 (Literature Review) in the Proposal.
Reviewer Comments:

Theoretical Foundations/Conceptual Framework and Review of the Literature/Themes

Theoretical literature

There is the need to understand the consequences of not utilizing mental health as it evolved historically. Mental health services in this Southern State has faced several challenges. Texas (2017) asserts that people suffering from mental illness still faces problems despite the huge costs that are directed towards the healthcare. Schwartz, (2017) in support of this Southern State argue that the increased growth-rate of populations in one specific county located in a Southern State has impacted the health sector at large. The high population together with economic constrains has led to few medical insurances which limits access to health. The access to, and utilization of mental health care for the populations living in this county has created a gap within the county (Children at Risk, 2013).

Review of the Literature

Empirical Approach: Emphasized the issues of underutilized mental health resources and non-institutionalized adults as behavioral risk factors in Southern Texas.

(Augsberger, Yeung, Dougher, & Hahm, 2015; Basu, Rehkopf, Siddiqi, Glymour, & Kawachi, 2016; De Luca, Blosnich, Hentschel, King, & Amen, 2016; Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley, (2016).

Augsberger, Yeung, Dougher, & Hahm (2015) identified various issues such as the history of suicide thoughts and depression among the Asian American women, different cultural needs in this specific Southern State county.

There are identifying facts suggesting that certain factors are influencing the under-utilization of mental health services among Asian American women with a history of depression and suicide in this county of research. There is also a mismatch between available services and cultural needs, contribution of Asian society to mental health and contribution of families to the stigma of mental health. It concluded and recommended that mental health utilization should not be low among all the cultures, but rather extremely encouraged especially among women in the county (Augsberger, Yeung, Dougher, & Hahm, 2015).

Boyer, C., Greenberg, L., Chutuape, K., Walker, B., Monte, D., Kirk, J., & Ellen, J. (2017). Exchange of sex for drugs or money in adolescents and young adults: An examination of sociodemographic factors, HIV-related risk, and community context. Journal of Community Health, 42(1), 90-100. doi:10.1007/s10900-016-0234-2

The purpose of this article is to carry out an assessment on maternal health and the well-being of the child and how it contributes to long term mental health. This mainly focuses on the anal stage especially when the child is born. It lays an emphasis on ensuring an understanding of basic but critical pediatric care. The result was that the hospital was able to ensure that it provides the pediatric care to the critical patients for 24 hours before and after birth. This is to make sure that young and divorced mothers know how to navigate and ensure the provision of proper mental care. Recommendations includes providing classes and courses that to the main practitioners on how to handle new parents and how to guide them into providing the required help to the children who are ill.

Goldman D., Robin R. W. & Chester B. (2018), Factors Influencing Utilization of Mental Health and Substance Abuse Services by American Health Institutions

The purpose of this article is to study the impact that gender, the number of childhood victimization and psychiatric diagnoses has on the utilization of mental health patients in the Southwestern American Indian community. In its outcome and recommendations, the article declares these factors as the main contributors in the utilization of the substance abuse and mental health when one is coming up with proper treatment interventions.

Schwartz, A. (2017). A report on the demographic changes and changing needs of fort bend county University of Texas at Austin. doi:10.15781/T2MC8RZ1M

Ariel and Peter gave an analysis of how population growth has affected the health status of people living in this Southern State County. There have been different studies conducted to indicate the mental status of individuals living within the country. In the outcome of the research, this article laid emphasis on the fact that many people in the population are uninsured, and that the economic challenges that the large population is experiencing is responsible in part for what is influencing individuals' decisions to not utilize Mental Health and the extent to which the community healthcare extends its services to every member. Recommendations include training and mentioning healthcare providers and caregivers on improvements that need to be done continually to ensure that the different needs of the growing population are met.

Literature Themes

Review of the literature review identified the following themes:

Lack of proper mental health education and infrastructure has been the major factor affecting the utilization of mental health. Goldman Robin & Chester (2018) in his research found out that women who had been exposed to sexual abuse and drug abuse formed the high numbers of people who utilize mental health services among the Hispanic and non-white people in the county. Augsberger, Yeung, Dougher, & Hahm, (2015) in support of this research argued that mental health services had been underutilized by Asian women living in this county, as a result of both cultural needs and mismatch of the services offered in the health facilities in this Southern State.
Lack of medical insurance. Research has shown that many people due to poor economic status has left many people without health insurance as they cannot afford. This limits many average and lower-class families from accessing mental illness services (Children at Risk, 2013).
Poor perception among the community members. Researchers reveals that many people who live in this county perceive child mental illness as a mere sign of hunger besides poor diets. This has left many people neglecting utilization of mental healthcare in the community (Children at Risk, 2013).

The theoretical model for the research gap is the Vygotsky Social Development Theory. The Social Development theory is a theory done by De Luca et al. Within the theory, the authors propose that unfavorable social conditions and chronic health issues have a role that they play in promoting mental health issues within a certain category of people. Similarly, the authors made a comparison between the utilization of mental health conditions among African Americans, Asian-Americans and the Caucasians in this Southern State County.

Criteria	Learner Self-Evaluation Score (0-3)	Chair or Score (0-3)	Reviewer Score (0-3)
Theoretical Foundations and/or Conceptual Framework This section identifies the theory(s) or model(s) that provide the foundation for the research. This section should present the theory(s) or models(s) and explain how the problem under investigation relates to the theory or model. The theory(s) or models(s) guide the research questions and justify what is being measured (variables) as well as how those variables are related (quantitative) or the phenomena being investigated (qualitative). Review of the Literature/Themes This section provides a broad, balanced overview of the existing literature related to the proposed research topic. It describes the literature in related topic areas and its relevance to the proposed research topic findings, providing a short 3-4 sentence description of each theme and identifies its relevance to the research problem supporting it with at least two citations from the empirical literature from the past 3-5 years. The recommended length for this section is 1 paragraph for Theoretical Foundations and a bulleted list for Literature Themes section.
Theoretical Foundations section identifies the theory(s), model(s) relevant to the variables (quantitative study) or phenomenon (qualitative study). This section should explain how the study topic or problem coming out of the “need” or “defined gap” in the as described in the Background to the Problem section relates to the theory(s) or model(s) presented in this section. (One paragraph)	1
Review of the Literature Themes section: This section is a bulleted list of the major themes or topics related to the research topic. Each theme or topic should have a one-two sentence summary.	1.5
ALIGNMENT: The Theoretical Foundations models and theories need to be related to and support the problem statement or study topic. The sections in the Review of the Literature are topical areas needed to understand the various aspects of the phenomenon (qualitative) or variables/groups (quantitative) being studied; to select the design needed to address the Problem Statement; to select surveys or instruments to collect information on variables/groups; to define the population and sample for the study; to describe components or factors that comprise the phenomenon; to describe key topics related to the study topic, etc.	1.5
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.	1
NOTE: The two parts of this section use information about the Literature Review and Theoretical Foundations/Conceptual Framework from the 10 Strategic Points. This Theoretical Foundations section is expanded upon to become the Theoretical Foundations section in Chapter 2 (Literature Review). The Theoretical Foundations and the Literature Review sections are also used to help create the Advancing Scientific Knowledge/Review of the Literature section in Chapter 2 (Literature Review).
Reviewer Comments:

Problem Statement

It is not known what is influencing individuals' decision to not utilize mental health in the United States. It is not known how mental health providers describe the factors influencing individuals’ decision to not utilize mental health in one county located in a Southern State. While there are increasing mental health cases among the children in the county, the research topics seek to identify the key issues that prevent the people of this county from utilizing the mental health services and facilities.

Population of interest are the individuals living in this Southern State region. The study plans to use qualitative-descriptive-research design in carrying out the study with target on service providers, caregivers and other mental health professionals in the county. The importance of the study is to ensure that individuals do not miss the opportunity of utilizing mental health services in the county including screening and evaluating patients and how to begin treatment if needed and the roles of primary caregivers in addressing behavioral health issues as part of the scopes of their work and those of social workers in addressing any or all issues relating to depression, anxiety and substance abuse.

Criteria	Learner Self-Evaluation Score (0-3)	Chair or Score (0-3)	Reviewer Score (0-3)
Problem Statement This section includes the problem statement, the population affected, and how the study will contribute to solving the problem. The recommended length for this section is one paragraph.
States the specific problem proposed for research with a clear declarative statement.
Describes the population of interest affected by the problem. The general population refers to all individuals that could be affected by the study problem.
Describes the unit of analysis. For qualitative studies this describes how the phenomenon will be studied. This can be individuals, group, or organization under study. For quantitative studies, the unit of analysis needs to be defined in terms of the variable structure (conceptual, operational, and measurement).
Discusses the importance, scope, or opportunity for the problem and the importance of addressing the problem.
The problem statement is developed based on the need or gap defined in the Background to the Study section.
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.
NOTE: This section elaborates on the Problem Statement from the 10 Strategic Points. This section becomes the foundation for the Problem Statement section in Chapter 1 and other Chapters where appropriate in the Proposal.
Reviewer Comments:

Purpose of the Study

The purpose of this qualitative, descriptive study is to explore how mental health providers, including caregivers and other professionals such as psychiatrists, therapists and counselors describe the factors influencing individuals’ decision to not utilize mental health in one county located in a Southern State. The purpose of the study is to come with the factors that deter the people of this county from accessing the much-needed mental healthcare. The study will employ a qualitative study that will target the specific people within the county who are service providers, caregivers and other mental health professionals as well as some people who have mental challenges and yet cannot utilize the mental facilities available in the county. This qualitative descriptive study aims at finding out the factors that affect mental health utilization in this Southern State County. The study will go ahead to come up with recommendation on how to improve the mental health accessibility in the county. The study identified multiple factors that are associated with the under-utilization of specialty mental health services among the people living in the county such as delays in observing and recognizing the symptoms and how to seek help, the absence of appropriate mental health providers, and lack of health insurance.

Criteria	Learner Self-Evaluation Score (0-3)	Chair or Score (0-3)	Reviewer Score (0-3)
PURPOSE OF THE STUDY This section reflects what the study is about, connecting the problem statement, methodology & research design, target population, variables/phenomena, and geographic location. The recommended length for this section is one paragraph.
Begins with one sentence that identifies the research methodology and design, target population, variables (quantitative) or phenomena (qualitative) to be studied and geographic location.
Quantitative Studies: Defines the variables and relationship of variables. Qualitative Studies: Describes the nature of the phenomena to be explored.
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.
NOTE: This section elaborates on information in the Purpose Statement from the 10 Strategic Points. This section becomes the foundation for the Purpose of the Study section in Chapter 1 and other Chapters where appropriate in the Proposal.
Reviewer Comments:

Research Questions

The study is going to be a qualitative descriptive study that will involve psychiatrists, therapists, caregivers and service providers' descriptions of what and why they feel people are not accessing mental health services and what must be done to change their behavior towards accessing the services. It entails utilizing interviews to collect data and to understand how successful it will be if professionals are learning more about the Fort Bend communities, and how they can contribute to improved learning outcomes.

Research questions

The following research questions will help to guide this qualitative study:

RQ1: How do mental health professionals describe their collaborative efforts with other professionals supports community delivery of mental health education?
RQ2: How do mental health professionals describe delivery of mental health education contributes to the public's utilization of mental health services?

Criteria	Learner Self-Evaluation Score (0-3)	Chair Score (0-3)	Reviewer Score (0-3)
Research Question(s) and/or Hypotheses The recommendation is a minimum of two research questions along with related hypotheses and variables is required for a quantitative study. Also recommended is a minimum of two research questions along with the phenomenon description is required for a qualitative study. Put the Research Questions in the appropriate Table in Appendix B based on whether the study is qualitative or quantitative. The recommended length for this section is a list of research questions and associated hypotheses (quantitative)
Qualitative Studies: States the research question(s) the study will answer and describes the phenomenon to be studied. Quantitative Studies: States the research questions the study will answer, identifies and describes the variables, and states the hypotheses (predictive statements) using the format appropriate for the specific design and statistical analysis.
Alignment: The research questions are based on both the Problem Statement and Theoretical Foundation model(s) or theory(s). There should be no research questions that are not clearly aligned to the Problem Statement.
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.
NOTE: This section elaborates on the information about Research Questions) & Hypothesis/variables or Phenomena from the 10 Strategic Points. This section becomes the foundation for the Research Question(s) and/or Hypotheses section in Chapter 1 in the Proposal.
Reviewer Comments:

Advancing Scientific Knowledge and Significance of the Study

The major objective of any health sector is to improve healthcare for the citizens regardless of the sickness. This Southern State County has devoted a large share of its finances towards healthcare which has seen it shine on the national map. Despite this effort, statistics show that mental health accessibility in the county is still very low. This has been evidenced by numerous research findings. Lack of Insurance, professionals, infrastructure and education has been theorized as a major source problem. This project through qualitative descriptive research aims at finding the factors that affect utilization of mental healthcare and recommend better ways through which mental health utilization can be improved in the county.

The results of this research will add considerably to the results of other studies as it provides means by which prevention and intervention efforts will help to raise mental health awareness and the importance of utilizing mental health services among Americans as well as offer culturally sensitive services. The result should also direct efforts and focus at reducing stigma that is associated with mental health problems in the minds of most people (Morin & Cherry, 2019). In addition, the results will help, and be of value to practitioners in determining the necessary strategies to be used to allow more individuals to receive the necessary health care services that they require. It will also help in eliminating the individualized beliefs that ties people from getting the public services they ought to and thus help them be more responsive to the services which are available to them.

Similarly, the result will enhance knowledge of social learning theory through observation and modeling as they both play significant and primary roles in this process, which moves far and beyond Albert Bandura’s behavioral theory, which suggests that all behaviors can or are learned through conditioning, and cognitive theories. Bandura's social learning theory also proposed that learning also exist or develop simply by observing the actions of others (Morin & Cherry, 2019). Therefore, a learning condition like this may be used in explaining different behaviors, including those factors influencing individuals' decision to not utilize mental health in that Southern State County.

Criteria	Learner Self-Evaluation Score (0-3)	Chair Score (0-3)	Reviewer Score (0-3)
ADVANCING SCIENTIFIC KNOWLEDGE and SIGNIFICANCE OF THE STUDY This section reiterates the gap or need in the literature and states how the study will address the gap or need and how the research will contribute to the literature, practical implications to the community of interest, and alignment with the program of study. The recommended length for this section is one to two paragraphs, providing a brief synopsis of each criteria listed below which will be expanded in the proposal.
Clearly identifies the “gap” or “need” in the literature that was used to define the problem statement and develop the research questions. (citations required)
Describes how the study will address the “gap” or “identified need” defined in the literature and contribute to /advance the body of literature. (citations required)
Describes the potential practical applications from the research. (citations required)
Identifies and connects the theory(ies) or model(s) that provide the theoretical foundations or conceptual frameworks for the study. (citations required)
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.
NOTE: This section builds on information about the Literature review and Theoretical Foundations sections in the 10 Strategic Points. This section becomes the foundation for the Theoretical Foundations section in Chapter 2
Reviewer Comments:

Rationale for Methodology

The most appropriate methodology that will be used in answering the research questions, and which will also address the problem statement is a qualitative methodology (Colorafi, & Evans, 2016). The qualitative approach is very effective when a phenomenon that is being queried properly and effectively defined, and this study has distinctly defined the phenomena of factors influencing the behavior and choices of people in a natural environment to not utilize Mental Health in one Southern State County. The methodology is preferred as it is flexible when researching on health science topic to support various medical theories. This will support the research in finding and filling the gap in the study.

Study behavior in a natural environment.

Criteria	Learner Self-Evaluation Score (0-3)	Chair or Score (0-3)	Reviewer Score (0-3)
Rationale for Methodology The Rationale for Methodology section clearly justifies the methodology the researcher plans to use for conducting the study. It argues how the methodological choice (quantitative or qualitative) is the best approach to answer the research questions and address the problem statement. Finally, it contains citations from textbooks and articles on research methodology and/or articles on related studies to provide evidence to support the argument for the selected methodology. The recommended length for this section is one paragraph.
Identifies the specific research methodology for the study.
Justifies the methodology to be used for the study by discussing why it is an appropriate approach for answering the research question(s) and addressing the problem statement. Quantitative Studies: Justify in terms of problem statement and the variables for which data will be collected. Qualitative Studies: Justify in terms of problem statement and phenomenon.
Uses citations from seminal (authoritative) sources (textbooks and/or empirical research literature) to justify the selected methodology. Note: Introductory or survey research textbooks (such as Creswell) are not considered seminal sources.
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.
NOTE: This section elaborates on the Methodology and Design in the 10 Strategic Points. This section becomes the foundation for the Research Methodology in Chapter 1 of the Proposal and the basis for developing Chapter 3, Research Methodology.
Reviewer Comments:

Nature of the Research Design for the Study

The design for this piece of research work will be a qualitative descriptive study that will collect information from caregivers, service providers, psychiatrists, therapists, school counselors and members of the community, which is aimed at identifying the specific issues that are deterring the utilization of mental healthcare facilities in this Southern State County. This method is justified as it applies the description of the factors in play and how they affect the outcome. According to Kim, Sefcik, & Bradway (2017), a qualitative-descriptive research is descriptive in nature and helps in describing a natural phenomenon. This method is suitable in research as it will provide a description of factors limiting utilization of mental healthcare in the county.

After analysis of the population group, 70 respondents were determined to suffice as a sample group. The respondents will be chosen from the county, which will include focus groups such as caregivers, psychiatrists, therapists, and service providers' that will form the sample population. Study area for the research will be schools, hospitals, doctors’ offices and counseling facilities within the county. A Semi structured system of interviews will be used as the primary source of data. The data will be collected in a period of three weeks with each respondent given 30 minutes for the interview and filing the questionnaire. After the exercise, the questionnaires and all research materials will be coded. The phenomenon under testing is factors influencing individuals' decision to not utilize Mental Health in one Southern State County.

Criterion Score	Learner Self-Evaluation Score (0-3)	Chair or Score (0-3)	Reviewer Score (0-3)
Nature of the Research Design for the Study This section describes the specific research design to answer the research questions and why this approach was selected. Here, the learner discusses why the selected design is the best design to address the problem statement and research questions as compared to other designs. This section contains a description of the research sample being studied, as well as, the process that will be used to collect the data on the sample. The recommended length for this section is two to three paragraphs and must address each criterion.
Identifies and describes the selected design for the study.
Justifies why the selected design addresses the problem statement and research questions. Quantitative Studies: Justifies the selected design based on the appropriateness of the design to address the research questions and data for each variable. Qualitative Studies: Justifies the selected design based on appropriateness of design to address research questions and study the phenomenon.
Briefly describes the target population and sample for the study.
Identifies the sources and instruments that will be used to collect data needed to answer the research questions.
Briefly describes data collection procedures to collect data on the sample.
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.
NOTE: This section also elaborates on the Design portion of the Methodology and Design section in the 10 Strategic Points. This section provides the foundation for Nature of the Research Design for the Study in Chapter 1.
Reviewer Comments:

Sources of Data

The interview will utilize both unstructured and structured questionnaires developed by the researcher to uncover the phenomena at hand in addition to face-face interviews for the research that will be structured with questions that require answers on the reasons that causes the hesitation in receiving treatment among the individuals who require mental health treatment. Tools will be used in collecting primary data, while the selected group will be composed of service providers, caregivers, healthcare professionals, schools and hospitals. A tape-recorded analysis will also be used within the focus groups. Furthermore, the research will take note of the factors that interviewees think can improve the mental health accessibility in the country.

Criterion Score	Learner Self-Evaluation Score (0-3)	Chair or Score (0-3)	Reviewer Score (0-3)
RESEARCH MATERIALS, INSTRUMENTATION, OR SOURCES OF DATA This section identifies and describes the types of data that will be collected, as well as the specific research materials, instruments, and sources used to collect those data (tests, surveys, validated instruments, questionnaires, interview protocols, databases, media, etc.). The recommended length for this section is one to two paragraphs. Note: this section can be set up as a bulleted list.
Quantitative- Instruments/Research Materials: Provides a bulleted list of the instrumentation and/or materials for data collection. Describes the survey instruments or equipment/materials used (experimental research) and specifies the type and level of data collected with each instrument. Includes citations from original publications by instrument developers (and subsequent users as appropriate) or related studies.
Qualitative - Sources of Data: Describes the structure of each data collection instrument and data sources (tests, questionnaires, interview protocols, observations databases, media, etc.).
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.
NOTE: This section elaborates on the Data Collection from the 10 Strategic Points. This information is summarized high level in Chapter 1 in the Proposal in the Nature of the Research Design for the Study section. This section provides the foundation for Research Materials, Instrumentation (quantitative) or Sources of Data (qualitative) section in Chapter 3.
Reviewer Comments:

Data Collection

Approval from the dean of student’s affairs at Grand Canyon University’s IRB committee will be sought and obtained before starting the process of data collection. The process will begin by writing a letter to the dean to get permission. After the IRB committee gives its approval for the project to begin, participants will be selected. The study sample is set to include caregivers, service providers, psychiatrists, therapists, school counselors and members of the community. Data collection will only start after candidates must have acknowledged and signed the consent form. The informed consent form will be written in simple language that is easily understood by the participants, it will not contain anything that will signal coercion or undue influence, and the participants will be given enough time to consider their participation. Furthermore, the dissertation will collect information from a selected group of patients to provide primary data.

We will communicate with the sample group and allocate everyone specified time that they are free and then the interviewers will follow up to ensure that all the sample members are included. Moreover, we will ensure that the people who are to receive questionnaires are directly contacted to make sure that they receive and fill out the questionnaire then send them back to us. It will be collected systematically in a way that begins with schools, interview with caregivers and service providers' interview with psychiatrists and therapists and hospitals. The process will be as follows:

Five respondents from 10 schools, hospitals, hospitals will be given questionnaires to fill be three researchers.
Interviews will involve two respondents from caregivers, service providers, psychiatrists, therapists, and hospitals and schools within the county.
Respondents will respond to both interviews and both types of questionnaires.
Manual coding will be done to all collected data.
Data will be checked for any errors by both parties before further processing.
Data will be entered into SciLab for analysis.

Criteria	Learner Self-Evaluation Score (0-3)	Chair or Score (0-3)	Reviewer Score (0-3)
DATA COLLECTION AND MANAGEMENT This section details the data collection process and procedures so that another researcher could conduct or replicate the study. It includes authorizations and detailed steps. The recommended length for this section is a bullet or numbered list of data collection steps that should not exceed one page.
Quantitative Studies: Lists steps for the actual data collection that would allow replication of the study by another researcher, including how each instrument or data source was used, how and where data were collected, and recorded. Includes a linear sequence of actions or step-by-step of procedures used to carry out all the major steps for data collection. Includes a workflow and corresponding timeline, presenting a logical, sequential, and transparent protocol for data collection that would allow another researcher to replicate the study. Data from different sources may have to be collected in parallel (e.g., paper-and-pen surveys for teachers, corresponding students, and their parents AND retrieval of archival data from the school district). A flow chart is ok—"linear" may not apply to all situations Qualitative Studies: Provides detailed description of data collection process, including all sources of data and methods used, such as interviews, member checking, observations, surveys, field tests, and expert panel review. Note: The collected data must be sufficient in breadth and depth to answer the research question(s) and interpreted and presented correctly, by theme, research question, and/or source of data.	2
Describes the procedures for obtaining participant informed consent and for protecting the rights and well-being of the study sample participants.	2
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.	2
NOTE: This section elaborates on the Sample and Location and Data Collection in the 10 Strategic Points. This section provides the foundation for the Data Collection Procedures section in Chapter 3 in the Proposal. And it is summarized high level in Chapter 1 in Nature of the Research Design for the Study in the Proposal.
Reviewer Comments:

Data Analysis Procedures

Data analysis will be conducted using descriptive statistics, followed by its transcription from the tape recorder, then analysis will be performed based on interviews and focus groups. Data collected will first be manually coded in relation to the themes of the study. The coded themes will then be analyzed, and explanations given. The overall aim of the analysis will be to find factors influencing individuals' decision to not utilize Mental Health in one Southern State County. At the initial starting stage, individual interviews will be conducted, recorded and transcribed verbatim. This will be followed by the researcher repeatedly reading and listening to the content in order to get familiarized with it. As such, the researcher will be able to gain deeper and better familiarization with the contents; he or she will also identify the answers to those questions asked as well as identify the themes. The researcher will use the two theories selected to see if the themes from the interviews align with the theoretical framework.

Data will be collected and analyzed for the study.
Descriptive statistics will be used in summarizing acquired data.
Coding will be used to address the questions posed.
A narrative summary will be developed.

The researcher may adopt the process notes and MAXDQA in organizing and visualizing data. Similarly, he or she can also adopt the Braun and Clarke’s (2006) six-step thematic analysis process in identifying the relevant patterns in the data.

Stage 1: Get familiarized with the data. At this stage, the researcher is expected to already get familiarized with the contents of the research and have a better understanding of it. This is because the researcher is the individual that will collect the data.
Stage 2: At the second stage, the researcher is going to generate first codes regarding the significant ideas discovered in the data.
Stage 3: This stage allows the researcher to start the search for themes through analysis and a review of the codes and to understand those that can be developed into acceptable themes.
Stage 4: This provides the researcher the opportunity of reviewing and refining the themes and then determine whether there is any of them that needs to be removed, combined, or if they can be broken down into additional themes.
Stage 5: The researcher is expected to define and name the themes after refining them.
Phase 6: At this stage, the final report should be generated by the researcher.

Criteria	Learner Self-Evaluation Score (0-3)	Chair or Score (0-3)	Reviewer Score (0-3)
DATA ANALYSIS PROCEDURES This section provides detailed steps for the analytic procedures to be used to conduct data analysis. The recommended length for this section is one to two paragraphs, can also be presented in bulleted format.
Describes in detail the relevant data collected for each stated research question and/or each variable within each hypothesis (if applicable). Quantitative Studies: "In detail" means scales (and subscales) of specified instruments AND type of data for each variable of interest. IMPORTANT: For (quasi) experimental studies, provide detailed description of all treatment materials per treatment condition, as part of the description of the independent variable corresponding to the experimental manipulation.	2
What: Describes, in detail, statistical and non-statistical analysis to be used and procedures used to conduct the data analysis. Quantitative Studies: (1) describe data file preparation (descriptive statistics used to check completeness and accuracy; for files from different sources, possibly aggregating data to obtain a common unit of analysis in all files, necessarily merging files (using the key variable defining the unit of analysis); (2) computation of statistics for the sample profile; (3) computation of (subscales and) scales; (4) reliability analysis for all scales and subscales; (5) computation of descriptive statistics for all variables of interest in the study (except those already presented in the sample profile); (6) state and justify all statistical procedures ("tests") needed to generate the information to answer all research questions; and (7) state assumptions checks for all those statistical procedures (including the tests and / or charts to be computed). Qualitative Studies: This section begins by identifying and discussing the specific analysis approach or strategy, followed by a discussion of coding procedures to be used. Note: coding procedures may be different for Thematic Analysis, Narrative Analysis, Phenomenological Analysis, or Grounded Theory Analysis.	2
Why: Provides the justification for each of the (statistical and non-statistical) data analysis procedures used in the study.	2
Show Steps that Support Evidence Quantitative Analysis - states the level of statistical significance for each test as appropriate and describes tests of assumptions for each statistical test. Qualitative Analysis - evidence of qualitative analysis approach, such as coding and theming process, must be completely described and included the analysis /interpretation process. Clear evidence from how codes moved to themes must be presented.	2
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.	2
NOTE: This section elaborates on the Data Analysis from the 10 Strategic Points. This section provides the foundation for Data Analysis Procedures section in Chapter 3 in the Proposal.
Reviewer Comments:

Ethical Considerations

Before the commencement of the study, I will seek authorization form all the relevant bodies including the IRB for approval. The research will also seek authority from the University board for conducting the research. All the data collected will be purely used for research purposes and remain confidential. The data will remain free to withdrawal by respondents from the study. No personal name or organizational names which may bring conflict of interest in the research will be included. The research will remain in the custody of the University will all rights reserved. Additionally, only relevant data will be collected by the researcher, solely for the study. He or she must stay clear of any subjectivity in analyzing the data and must also be proactive at preventing anything that will be harmful to the participants.

Criteria	Learner Self-Evaluation Score (0-3)	Chair or Score (0-3)	Reviewer Score (0-3)
Ethical Considerations This section discusses the potential ethical issues surrounding the research, as well as how human subjects and data will be protected. It identifies how any potential ethical issues will be addressed. The recommended length for this section is one paragraph.
Describes site authorization process, subject recruiting, and informed consent processes.
Describes how the identities of the participants in the study and data will be protected.
Discusses potential ethical concerns that might occur during the data collection process.
ALIGNMENT: Ethical considerations are clearly aligned with and relate directly to the specific Data Collection Procedures. This section also identifies ethical considerations related to the target population being researched and organization or location as described in the Purpose Statement section.
Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.
NOTE: This section does not include information from any of the 10 Strategic Points. This section provides the foundation for Ethical Considerations section in Chapter 3 in the Proposal.
Reviewer Comments:

References

Augsberger, A., Yeung, A., Dougher, M., & Hahm, H. C. (2015). Factors influencing the underutilization of mental health services among Asian American women with a history of depression and suicide. BMC health services research, 15(1), 542. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1191-7

Basu, S., Rehkopf, D. H., Siddiqi, A., Glymour, M. M., & Kawachi, I. (2016). Health behaviors, mental health, and health care utilization among single mothers after welfare reforms in the 1990s. American journal of epidemiology, 183(6), 531-538. https://academic.oup.com/aje/article/183/6/531/2195922

Beatty, K. E., Wilson, K. D., Ciecior, A., & Stringer, L. (2015). Collaboration among Missouri nonprofit hospitals and local health departments: Content analysis of community health needs assessments. American Journal of Public Health, 105 Suppl 2(S2), S337-S344. doi:10.2105/AJPH.2014.3024

Blosnich, J. R., Marsiglio, M. C., Gao, S., Gordon, A. J., Shipherd, J. C., Kauth, M., ... & Fine, M. J. (2016). Mental health of transgender veterans in US states with and without discrimination and hate crime legal protection. American journal of public health, 106(3), 534-540. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302981

Children at Risk (2013), Fort Bend County Assessment, A Report on the Needs of the Community’s Children, The George Foundation and The Fort Bend Chamber of Commerce, pp. 23.

Children at Risk: The Future of Fort-Bend’s Children 2012-2014. Retrieved from http://www.thegeorgefoundation.org/media/resources/future-of-fort-bends-children-report-2014.pdf

Colorafi, K. J., & Evans, B. (2016). Qualitative descriptive methods in health science research. HERD: Health Environments Research & Design Journal, 9(4), 16-25.

De Luca, S. M., Blosnich, J. R., Hentschel, E. A., King, E., & Amen, S. (2016). Mental health care utilization: how race, ethnicity and veteran status are associated with seeking help. Community mental health journal, 52(2), 174-179. https://link.springer.com/article/10.1007/s10597-015-9964-3

Grayson, H. C. (2016). Caregiver impact on the relationship between need and utilization for child and adolescent mental health: An examination of factors influencing utilization of mental health services Available from ProQuest Central Student. Retrieved from https://search.proquest.com/docview/1840134079

Hamilton, J. E., Desai, P. V., Hoot, N. R., Gearing, R. E., Jeong, S., Meyer, T. D., ... & Begley, C. E. (2016). Factors associated with the likelihood of hospitalization following emergency department visits for behavioral health conditions. Academic Emergency Medicine, 23(11), 1257-1266. https://onlinelibrary.wiley.com/doi/full/10.1111/acem.13044

Morin, A. & Cherry, K. (2019). How Social Learning Theory Works. Retrieved from https://www.verywellmind.com/social-learning-theory-2795074

Schwartz, A. (2017). A report on the demographic changes and changing needs of fort bend county University

Texas 2017 mental health national outcome measures (NOMS): SAMHSA uniform reporting system: Center for mental health services uniform reporting system output tables;2018 ASI 4096-13.50. (2018)

Appendix A

10 Strategic Points

	My Degree: Ph.D. Program Emphasis: Industrial & Organizational Psychology
	Ten Strategic Points	Comments or Feedback
Final Topic	Factors Influencing Individuals' Decision to not Utilize Mental Health in one County Located in a Southern State
Lit Review (Theoretical Framework (Theory) Gaps Themes All Citations	Gaps Augsberger, Yeung, Dougher, & Hahm (2015) identified various issues such as the history of suicide thoughts and depression among the Asian American women, different cultural needs in one Southern State County. There are identifying facts suggesting that certain factors are influencing the under-utilization of mental health services among Asian American women with a history of depression and suicide in this County located in a Southern State . There is also a mismatch between available services and cultural needs, contribution of Asian society to mental health and contribution of families to the stigma of mental health. It concluded and recommended that mental health utilization should not be low among all the cultures, but rather extremely encouraged especially among women in the county (Augsberger, Yeung, Dougher, & Hahm, 2015). Boyer, C., Greenberg, L., Chutuape, K., Walker, B., Monte, D., Kirk, J., & Ellen, J. (2017). Exchange of sex for drugs or money in adolescents and young adults: An examination of sociodemographic factors, HIV-related risk, and community context. Journal of Community Health, 42(1), 90-100. doi:10.1007/s10900-016-0234-2 The purpose of this article is to carry out an assessment on maternal health and the well-being of the child and how it contributes to long term mental health. This mainly focuses on the anal stage especially when the child is born. It lays an emphasis on ensuring an understanding of basic but critical pediatric care. The result was that the hospital was able to ensure that it provides the pediatric care to the critical patients for 24 hours before and after birth. This is to make sure that young and divorced mothers know how to navigate and ensure the provision of proper mental care. Recommendations includes providing classes and courses that to the main practitioners on how to handle new parents and how to guide them into providing the required help to the children who are ill. Goldman D., Robin R. W. & Chester B. (2018), Factors Influencing Utilization of Mental Health and Substance Abuse Services by American Health Institutions The purpose of this article is to study the impact that gender, the number of childhood victimization and psychiatric diagnoses has on the utilization of mental health patients in the Southwestern American Indian community. In its outcome and recommendations, the article declares these factors as the main contributors in the utilization of the substance abuse and mental health when one is coming up with proper treatment interventions. Schwartz, A. (2017). A report on the demographic changes and changing needs of fort bend county University of Texas at Austin. doi:10.15781/T2MC8RZ1M Ariel and Peter gave an analysis of how population growth has affected the health status of people living in one County located in a Southern State. There have been different studies conducted to indicate the mental status of individuals living within the country. In the outcome of the research, this article laid emphasis on the fact that many people in the population are uninsured, and that the economic challenges that the large population is experiencing is responsible in part for what is influencing individuals' decisions to not utilize Mental Health and the extent to which the community healthcare extends its services to every member. Recommendations include training and mentioning healthcare providers and caregivers on improvements that need to be done continually to ensure that the different needs of the growing population are met. Theoretical Foundation The theoretical model for the research gap is the Vygotsky Social Development Theory. The Social Development theory is a theory done by De Luca et al. Within the theory, the authors propose that unfavorable social conditions and chronic health issues have a role that they play in promoting mental health issues within a certain category of people. Similarly, the authors made a comparison between the utilization of the mental health conditions between the African Americans, Asian-Americans and the Caucasians in this county located in a Southern State. Literature Review Empathic Approach: Emphasized the issues of underutilized mental health resources and non-institutionalized adults as behavioral risk factors in Southern Texas. (Augsberger, Yeung, Dougher, & Hahm, 2015; Basu, Rehkopf, Siddiqi, Glymour, & Kawachi, 2016; De Luca, Blosnich, Hentschel, King, & Amen, 2016; Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley, 2016). There are certain factors that influence the underutilization of mental health services among Asian American women with a history of depression and suicide in this Southern State county. There is also a mismatch between available services and cultural needs, contribution of Asian society to mental health and contribution of families to the stigma of mental health. It concluded that mental health utilization is extremely low among all the cultures, especially among women in the county. Augsberger, Yeung, Dougher, & Hahm (2015). Professional Development: Job Satisfaction: Mental health has recently emerged as a critical area of interest as it had been sidelined for years. Due to this realization, the illness is now been studied extensively, and more attention has been given to patients. It has been suggested that most of the chronic conditions and terminal illnesses lead to mental disorders in patients. For many reasons, mental health is now among the priorities of medical practice (De Luca et.al. 2016).
Problem Statement	It is not known factors influencing individuals' decision to not utilize mental health in one county located in a Southern State.
Research Questions	RQ1: How do mental health professionals describe their collaborative efforts with other professionals supports community delivery of mental health education? RQ2: How do mental health professionals describe delivery of mental health education contributes to the public's utilization of mental health services?
Population Target Population Sample	Location – A county located in one Southern State, USA. Target Population: Behavioral Hospitals Caregivers Psychiatrists Service Providers Therapists School Counselors Sample: Will comprise of interviews with 2 mental health hospital professionals, 2 caregivers, 2 service providers, 2 schools, 2 counselors, 2 Psychiatrists, and 2 Therapists in the county.
Describe Phenomena (qualitative) or Define Variables/Hypotheses (quantitative)	To understand why the people living in this county located in one of the Southern States are not effectively utilizing the mental health resources available to them There is a high rate of mental health conditions in a county located in one of the Southern States The county utilizes very low budget allocation on funding of mental health care The utilization of mental health services in one Southern State is poor compared to cost.
Methodology & Design	Qualitative Descriptive Study
Purpose Statement	The purpose of this qualitative descriptive study is to understand the factors influencing individuals' decision to not utilize mental health in one county located in a Southern State.
Data Collection Approach	Informed & signed consent from participants Visits to hospital sites, schools and other mental health facilities Interview with Caregivers, Service Providers, Physicians & Therapist recorded on tape Sampling Method: Purposeful Sampling Sources: Interviews, Surveys & Questionnaires
Data Analysis Approach	Data will be collected and analyzed for the study. Descriptive statistics will be used in summarizing acquired data. Coding will be used to address questions posed. A narrative summary will be developed.

Appendix C

Demographics of the participants

Age	Male	Female
20 to 30
30 to 40		12
40 to 50	12	13
50 and above