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Transforming Disability Services: A Study on Large Language Model Acceptance and Utilization Among Support Staff
Neelia Abadi, Naomi Burhans, Margret Joos, Edward Harrington, Eryney Marrogi, Aiden Masters, Jai Narain, and Curtis Plante
Background: Champlain Community Services (CCS) is a Vermont-based non-profit which helps adults with intellectual disabilities and autism find meaningful employment and community engagement opportunities. We sought to investigate large language models (LLMs), a form of artificial intelligence (AI), as a tool to enhance the work of Direct Support Professionals. Specifically, we aimed to assess knowledge of LLMs and routes for their implementation at CCS. Methods: Staff members (n=66) were administered a pre-training survey (responses = 39) prior to a 30-minute training session. Attendees (n=40) were given a post-training survey (responses = 25). Responses were analyzed in Python. Results: After the training, 3.3% and 14.4% more participants described themselves as “somewhat familiar” or “familiar” with AI, respectively. No participants rated themselves as “not familiar at all” with AI, compared to 15.4% of participants pre-training. Smaller percentages of participants were concerned about job displacement (percent change (PC) = -3.1%), lack of training (PC = -3.3%), and effectiveness (PC = -4.7%). An increased percentage were concerned about privacy and data security (PC = 11.9%). 19% more respondents thought AI could improve CCS’s services while 12.7% fewer people thought AI would not improve their services. Conclusion: Employees’ enhanced familiarity with AI and belief in its benefits support the utility of LLMs in services for adults with intellectual and developmental disabilities and autism after training is provided. Participants’ remaining concerns following training suggest future sessions should focus on addressing privacy-related concerns. Further inquiry should investigate applications of AI within larger organizations within and beyond Vermont.
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PCP Attitudes: Understanding of Cancer Risk from CT Imaging
Kenneth Allen, Caitie Beattie, Noah Manz, Max Pendleton, Chloe Ruscilli, Chloe Ruscilli, Zaymee Syeda, and Eli Zettler
Background: The use of ionizing radiation in medical imaging has revolutionized the ability to diagnose and treat illness. While it is difficult to measure the risk associated with low-level radiation exposures, estimates can be made by extrapolating data from atomic-bomb survivors. Based on these estimates, the American College of Radiology has recommended steps that clinicians can take to minimize risk for patients. Studies evaluating knowledge of radiation risk have so far focused on physicians in emergency and surgical settings, finding potential gaps of significance. This study seeks to establish radiation-safety knowledge possessed by primary-care providers in the state of Vermont. Methods: A structured survey was created to assess primary-care providers' (PCPs) attitudes, practices, and knowledge about ordering CT scans and sent to PCPs within the UVMMC Health Network. Results: Survey results demonstrated a widespread lack of knowledge of CT risk. Out of a maximum score of 5 on the knowledge assessment portion, the average test performance was 2.2. Average test scores were tabulated against graduation year from medical school, self-rated familiarity and knowledge with CT imaging, and levels of training in this specific area. No comparisons reached statistical significance (p<0.05). Conclusion: Despite differences in training, familiarity with CT, and professional titles, there remains a lack of knowledge regarding CT radiation safety. Further research and advancements in CT knowledge, along with increased education for medical professionals, are necessary.
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Understanding barriers to equitable care for people with intellectual and developmental disability
Alexia Amaio, Dalton David, Michael Greenberg, Thomas Khodadad, Harsimran Multani, Sarah Pfreundschuh, Selin Tukel, Leena Ziane, and Thomas Griffin PhD
Background: Approximately 14% of the U.S. population live with an intellectual and/or developmental disability (IDD). Individuals with IDD face barriers to accessing equitable healthcare, contributing to health disparities. In collaboration with Special Olympics Vermont (SOVT), this study aims to identify and understand the barriers individuals with IDD encounter when seeking healthcare. The findings will help inform strategies to improve access and promote equity. Methods: A Redcap survey including 16 multiple-choice and 2 open-ended questions was designed to understand the barriers to equitable care for individuals with IDD. Surveys were distributed via the SOVT email list and at an SOVT athletic event. Survey participants, including athletes and their parents/guardians, were offered the opportunity to share thoughts via Zoom interview or in-person interview at the athletic event. Qualitative themes were identified following review of interview notes. Descriptive statistics and Chi square analysis were conducted in R Studio Version 4.4.2. Results: Analysis of qualitative interviews yielded 5 major themes revolving around communication difficulties based on quotes from athletes/caregivers. Survey results for multiple-choice questions demonstrated room for improvement in several areas. Most notably, respondents reported overwhelming negative experiences with communication and positive experiences with access to care and provider availability. Conclusion: Despite positive responses regarding healthcare logistics, additional work is needed on provider training and ensuring patients with IDD are communicated with effectively and appropriately. Interviewees frequently remarked on feeling overlooked during appointments. Future directions include developing such training and implementing it for all medical providers.
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Addressing Social Isolation and Loneliness Amongst Older Vermonters
Anastasia Arvin-DiBlasio, Jonathan Chen, Oona Davies, Jonathan Palmer, Benjamin Rubin, Matthew Saunders, Zachary Wheeler, and Garrett Wu
Background: This study sought to identify ways to address loneliness and social isolation among older Vermonters. Social isolation in the elderly is linked to increased anxiety, depression, and loneliness. Methods: We investigated the prevalence and nature of loneliness and social isolation among older Vermonters (65+). Using a mixed-methods approach, 40 participants completed a survey incorporating the Steptoe Social Isolation Index, self-identification of loneliness and social isolation (based on Merriam-Webster definitions), and open-ended questions exploring potential solutions to loneliness, effective interventions to address the loneliness epidemic, and factors promoting social connectedness. Results: Quantitatively, 10% met Steptoe criteria for social isolation, while 32.5% self-identified as socially isolated and 42.5% as lonely, highlighting a discrepancy between standardized measures and lived experience. Notably, 25% reported experiencing both loneliness and social isolation. Qualitative data were analyzed using a group coding system, identifying recurring themes within responses. Regarding loneliness mitigation, “Connection & Communication” (40%) was most frequently cited, followed by “Community Engagement & Volunteering” (30%) and “Physical Activities & Hobbies” (27.5%). Addressing the loneliness epidemic prioritized “Social Programming & Community Culture” (70%), “Infrastructure & Services” (40%), and “Public Meeting Spaces” (30%). Maintaining social connectedness emphasized “Social & Community Engagement” (40%), “Friends & Family” (37.5%), and “Mindset” (37.5%). Conclusion: These findings suggest that while standardized measures provide a baseline, self-perception of loneliness and social isolation is more prevalent. A multi-faceted approach addressing both individual needs (connection, activity) and societal structures (programming, infrastructure) is crucial for combating loneliness among older Vermonters.
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Health Professionals' Awareness of Accommodations for Deaf/Hard of Hearing Patients at UVMMC
Lajla Badnjević, Marina Cannon, Joselvin Galeas, Hamza Mirza, Elizabeth Pendlebury, Lauren Schiff MS, Genevieve C. Wakeman, and Oliver Young
Background: The Vermont Deaf, Hard of Hearing, and DeafBlind (DHHDB) Advisory Council estimates that 400 to 600 Vermonters are culturally deaf, with 12 to 20 identifying as deafblind. DHH individuals are nearly seven times more likely to have inadequate health literacy, contributing to higher rates of chronic conditions and lower healthcare satisfaction due to communication barriers. This project assessed University of Vermont Medical Center (UVMMC) employees' perceptions of healthcare barriers for DHHDB patients and knowledge of accommodation services. Methods: Survey questions were developed based on literature on health access accommodations for DHHDB individuals. The survey was distributed via a poster QR code to UVMMC departments. Results: The survey received 81 responses from physicians, nurses, American Sign Language (ASL) interpreters, and front desk staff. Sixty percent reported interacting with DHHDB patients weekly, and 74% felt comfortable doing so. Over 80% were aware of clear masks, video remote interpreting (VRI), and in-person ASL interpreters. However, only 64% were aware of how to access in-person interpreters, 73% how to access VRI, and 14% how to access telehealth VRI connections. Awareness of tactile interpreters and patient portal alternatives was 5%. Additionally, 70% reported not receiving onboarding training for DHHDB services, though 86% expressed willingness to complete such training. Conclusion: The survey highlights gaps in awareness and use of DHHDB accommodations. While most respondents felt comfortable interacting with DHHDB patients, knowledge of resources was limited. Addressing these gaps through enhanced education and procedural improvements could improve healthcare delivery for this population.
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Prevent Child Abuse Vermont Demonstrates the Long-Term Benefits of the Nurturing Parenting Programs in Improving Parents' Attitudes Toward Their Children
Tanner Baroni, Grace Kim, Elizabeth Medve, Sung Bin Roh, Benjamin Sebuufu, Eunice Suberu, and Shannon Wasley
Background: Over 600,000 children in the United States experienced abuse or neglect in 2021. Programs for child abuse prevention have shown reductions in child abuse; long-term follow-up research has not been performed. This project collaborated with Prevent Child Abuse Vermont (PCAVT) to examine long-term outcomes of the Nurturing Parent Program® (NPP) on patterns associated with child abuse and neglect. Methods: The NPP assesses risk using the validated Adolescent Parenting Inventory (AAPI) before and immediately after the program. The current study distributed an optional survey containing five subjective open-ended questions and AAPI to 321 former participants via two emails and a text reminder. Quantitative data was analyzed using methods from the NPP; qualitative data were coded and analyzed to identify themes and insights regarding the program's impact. Results: Thirteen responses were received; 10 completed the AAPI. Data from PCAVT showed improvement in all constructs immediately after the NPP. Post-post testing demonstrated sustained improvements above pre-test values for four constructs, while scoring on the use of corporal punishment was worse than baseline. Free response questions demonstrated themes of realistic expectations of children and learning both coping and self-regulation skills. Nine of eleven respondents wished they completed the NPP sooner. Conclusion: Our study is one of the first to evaluate long-term impact of programs like the NPP. PCAVT has highlighted the importance of long-term evaluation to support maintaining no-cost offerings to future participants. Future investigation into changed attitudes toward corporal punishment could elucidate how to sustain improvements in this area as well.
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Understanding the Challenges and Motivations for Dentists to Practice in Rural Vermont: A Study on Recruitment and Retention in Windham County
Kartheek Batch, Alison Chivers, Aaron Dees, Kiersten Donovan, Matthew Mullen, Estefania Obando, Harjas Sabharwal, Marty Hammond, and Carolyn Taylor-Olsen M.D.
Background: Rural populations often experience limited access to healthcare due to a shortage of providers, financial constraints, and logistical barriers. Windham County in Southeast Vermont exemplifies these challenges, with only 50 dentists per 100,000 people compared to the national average of 60 per 100,000. The objective of this project is to identify the barriers to recruiting and retaining dentists in rural Vermont, focusing on understanding what factors motivate dentists to practice in underserved areas and what obstacles discourage them. Methods: This study incorporated a literature review, interviews with rural dentists in Windham County, and surveys of dental residents at the University of Vermont. Interviews identified challenges such as geographic isolation, financial pressures, staffing shortages, and integration difficulties within rural communities. Survey responses provided additional insights into perceptions of rural practice, highlighting both barriers and motivators for recruiting and retaining dentists in underserved areas. Results: Key barriers to rural dental practice included the high cost of dental education, low Medicaid reimbursement rates, and limited professional support networks. However, several dentists cited a strong sense of community and personal fulfillment from serving a close-knit population as positive factors that improve retention. Conclusion: Analysis of the survey responses suggests that targeted financial incentives, community integration efforts, and support networks may help attract more dental professionals to Windham County and similar rural areas.
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Examining the Adolescent Mental Health Crisis in Vermont Through the Experiences of Healthcare Providers
Cliff Bauman, Jeff Heithmar, Ryan Marawala, Jill Rogers, Evelyn Thomas, Alex Vitali, and Kyra Weaver
Background: Vermont is experiencing an adolescent mental health (MH) crisis, with 34% of Vermont high schoolers reporting poor MH and 20% of middle schoolers reporting thoughts of suicide. Our aim is to assess Vermont MH providers’ perceptions and utilization of adolescent MH resources towards the goal of improved understanding of barriers and facilitators for accessing quality adolescent MH services. Methods: We developed and implemented a survey of Vermont MH providers consisting of eighteen multiple choice and five free response questions. Topics included assessing respondents’ educational background and practice setting, awareness of current resources, assessments of those resources, and priority issues for improving adolescent MH. Data analysis used a thematic content approach and descriptive statistics. Results: We received 77 responses from physicians, nurse practitioners, physician assistants, registered nurses, LICSWs, LMSWs, and MH professionals. Review of multiple choices questions points to: 1) Comfort screening adolescents for MH problems but less with treatment, 2) Similar levels of comfort in recommending and referring adolescents to MH resources, and 3) More comfort in working with families of adolescents than schools. Thematic analysis of free responses yielded themes regarding current care inadequacies: 1) lack of access to appropriate care, 2) insufficient resources for patients, 3) providers unable to navigate the current system, and 4) lack of providers. Respondents also reported gratefulness for their colleagues and statewide resources. Conclusion: Preliminary results support the need for additional MH provider capacity and training in Vermont and for addressing systemic issues impairing optimal treatment of our adolescent population.
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Vermont Public School Preparedness for Sudden Cardiac Arrest
Brian Canova, Isaac Sellinger, Jake Ayisi, Kelly Tran, Anthony Jeong, Mohamed Ahmed, Michael Hermanto, and Syed Jafri
Background: Sudden cardiac arrest (SCA) survival decreases 7–10% per minute without treatment, with EMS response averaging 9 minutes. Early AED use doubles survival. Only 55% of Vermont high schools have cardiac Emergency Action Plans, prompting this study to assess and improve emergency preparedness. Methods: A confidential web-based survey assessed sudden cardiac arrest preparedness in Vermont public schools (Oct–Dec 2024) via REDCap. It examined school demographics, Emergency Action Plans, AED availability, CPR/AED training, EMS coordination, and cardiac events. IRB-exempt data collection aimed to identify barriers and evaluate cardiac emergency preparedness. Results: A survey of 159 respondents found that AED availability in schools is universal among respondents (100%). with most units publicly accessible at all hours (97.5%) and having modest maintenance costs (<$500: 70.5%). Despite this, only 52.5% of Vermont schools have plans for sudden cardiac arrest (SCA). Barriers include time constraints, insufficient support, and lack of guidance. Funding primarily comes from school budgets (60.4%) and grants (24.5%). Compliance with proposed bill provisions varied, with 35.7% meeting all four criteria for preparedness. Conclusions: Our survey reveals progress and challenges in school emergency preparedness in Vermont. The financial burden of acquiring an AED would not be an issue for the majority of public schools in Vermont. Most would need to invest time and human resources into adopting a plan and coordinating with local EMS. Pre-made materials from the American Heart Association could help schools requiring guidance to meet these requirements, addressing key gaps and improving compliance with proposed legislation.
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Assessing Palliative Care Reimbursement Models through Vermont Medicaid
Elliot Cullen, Petergaye Murray, Abigail Mercier, Anna Gorbacheva, Jake Reigle, and Kevin Peters
Background: Palliative care (PC) provides a mix of comfort care and curative treatment to increase longevity while maintaining quality of life (QOL). In contrast to hospice services, few Medicaid programs reimburse for PC. The Department of Vermont Health Access (DVHA) reimburses institutional and home-based PC (HBPC) for pediatric beneficiaries, but only institutional PC for adults. The project goal is to identify provider reimbursement perspectives and models. Methods: We conducted literature reviews, and reviewed reimbursement models for palliative care coverage for California, Hawaii, and Washington. We drafted Interview scripts specific to Vermont. Thirty-minute interviews were conducted with three expert medical providers and representatives from two home healthcare providers via video conference calls. Analysis was performed through NVivo software (version 14), and common themes were identified. Results: Model, Care, Home, Reimbursement, Visit, Nurse, Palliative, Patients, and Providers were themes. Consensus was that HBPC is viewed favorably, and patients would benefit from expanded utilization. A per-member-per-unit-time, or capitated reimbursement plan was preferred due to incentivization of appropriate levels of care as well as preventative care. Challenges regarding care access were universal concerns, with lack of home-based staff and insurance coverage as the greatest concerns, along with obstacles inherent in a fee-for-service model when patients have varied needs. Conclusion: A capitated reimbursement model was noted as an option for effective and accessible HBPC services for Vermonters. A per-member-per-month (PMPM) model was proposed as the preferred reimbursement time scale to ensure that home health agencies administering HBPC are reimbursed fairly while meeting Vermonters’ healthcare needs.
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Community-Sponsored Cannabis Education for Older Vermonters: An Investigation of Community Needs and Available Resources
Ivan Davis, Raihan Kabir, Benjamin Koren, Maxime Lapointe-Gagner, Isabel Thomas, Merisah Trisciuzzi, Serena Verma, Andrew Warfied, Abigail Hielscher PhD, Mahat Abdullahi, Camille Bakoulis, and Amy Carmol
Background: Cannabis use among older adults is increasing, driven in part by recreational-use legalization and evolving norms. Considering the public health impact of substance-related resources, this study investigated how community service providers are informing older adults in Vermont about cannabis. Methods: Non-medical service organizations in Chittenden County were identified in partnership with United Way of Northwest Vermont. Representatives from 58 eligible organizations were contacted. Descriptive categorical data from a seven-question, multiple-selection survey were summarized. Results: Thirteen organizations completed the survey. Forty-six percent predominantly served older adults (>50%); none offered information on cannabis. Substance-related resources were largely distributed by organizations that provided basic needs (50%) and/or community services (60%). There was overlap between organizations currently sharing substance-related materials and those interested in providing information on cannabis if made available: most sites with nicotine materials (75%) and all sites with opioid and alcohol resources indicated interest. Overall, most organizations (62%) indicated a readiness to distribute materials on cannabis education. Conclusion: Organizations serving older Vermonters lack educational resources on cannabis. However, most organizations engaged in substance education express an interest in incorporating information on cannabis. Targeted distribution of cannabis-related materials is a feasible public health solution.
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Understanding Veterans’ Preferences for Firearm Safety Conversations: Developing Culturally Conscious Approaches to Suicide Prevention
Joseph Du, Shannon Bennet, Taylor Krause, Jaime Rodriguez, Carlos Montejo, Amir Zafaranian, Nick Jowkar, and Sean Britton
Background: United States military veterans suffer a disproportionately high suicide rate compared to the general population. Firearms represented the majority of lethal means involved in successful suicide attempts in veterans from 2001 to 2022. Communication with firearm owning patients is often difficult with a prevalent distrust of providers during interviews. For the provider, lack of training can lead to hesitancy approaching the topic. Once provided training, providers self-report more confidence speaking to the topic. Methods: A survey and interview guideline were designed using data from a literature search focusing on veteran suicide and firearm owning cultural competency. Data collection was performed with community partners and a convenience sample of veterans, active military, and reservists. Raw data was coded for thematic similarities and trends in themes were analyzed for formal results. Results: 11 total valid responses were obtained. Physician questioning is preferred when there are concerns on safety at home. Veterans are generally in favor of lethal means safety discussions, emphasizing the need for safe and secure storage, especially when children are present in the household. Participants preferred nonconfrontational language that emphasizes firearms being discussed in the same tone as other lethal means like medications. Participants also prefer conversations with trusted providers who have knowledge of veteran culture and of firearms safety. Conclusion: Themes are supported by existing literature on the general population. Further studies should include a larger sample and focus on elucidating cultural touchpoints that firearm owning veterans would find relatable to create and disseminate lethal means safety resources.
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Antibiotic Stewardship in Vermont: Prescribers’ Attitudes and Perceptions
Andries Feder; Arya Kale; Saim Ali; Francisco Cordero; Erin Manogaran; Martin Briche; Ranya Moshashaian; Sarah Chiavacci; Patsy Kelso PhD; Allison Lafferty MD; and Jan K. Carney MD, MPH
Background: Antibiotic stewardship is essential for minimizing the adverse effects of inappropriate prescribing, including the emergence of drug-resistant pathogens and iatrogenic C. Difficile infection. In collaboration with the Vermont Department of Health, we surveyed Vermont prescribers' perceptions and attitudes towards antibiotic resistance and stewardship initiatives. Methods: We conducted a statewide survey of 82 practicing prescribers in Vermont, distributed via messaging from the Vermont Department of Health. Regression models were used to analyze statistically significant trends. Results: Respondents included physicians, nurse practitioners, dentists, and physician assistants. Most respondents (85%) agreed that antibiotic resistance was a concern for their practice. However, fewer (52.5%) agreed that inappropriate prescribing was an issue in their practice. Physicians had the highest proportion of respondents who disagreed that inappropriate antibiotic prescribing was a concern in their practice, but had the highest share agree that antibiotic resistance was a concern. Conclusion: Healthcare providers’ perception that inappropriate prescribing is not an issue in their workplace presents a challenge for implementing effective antibiotic stewardship measures. Out of all proposed interventions, most respondents (86%) indicated that instruction on how and when to de-label a penicillin allergy in the medical record would be a useful stewardship strategy. Targeted educational interventions, specialty-specific guidelines, and regional collaborations within the medical community can better improve antibiotic stewardship.
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Evaluating Best Practices in LGBTQIA+ Healthcare: A Vermont Diversity Health Project Initiative
Anne Lindholm, Cassandra Chin, Lindsey Gleason, Camila Salcedo, Julia Geaghan-Breiner, Marie Kim, and Sasha Bonesteel
Background: The Vermont Diversity Health Project (VDHP) seeks to improve care for 2STLGBTQIA+ individuals by maintaining a database of affirming healthcare providers. However, the database lacks standardized criteria for provider inclusion. In partnership with the Pride Center of Vermont, we explored best practices in 2STLGBTQIA+ healthcare and assessed whether self-identified providers on the VDHP database meet these standards. Our research question asks: Do these providers deliver care aligned with established best practices for 2STLGBTQIA+ patients? Methods: We consulted experts and reviewed literature to identify best practices for 2STLGBTQIA+ healthcare. Using the World Professional Association for Transgender Health Standards of Care 8 (SOC 8) as a framework, we developed a 31-question REDCap survey to evaluate provider adherence to these standards. The survey was distributed to 240 providers listed in the VDHP database. Results: The survey received 77 responses (32% response rate). Of respondents, 64.9% identified as part of the 2STLGBTQIA+ community, 62.3% worked in mental health, and 71% practiced in private settings. Most providers (88%) reported offering gender-affirming care, while 66% used electronic health records (EHRs) that included patient pronouns. Pronoun disclosure practices varied: 36% always mentioned their pronouns to patients, while 22% rarely did. Gender-inclusive restrooms were available in 81% of clinical spaces. Conclusions: Some SOC 8 metrics are not consistently met by self-identified providers, potentially impacting patient care. Future work should include a broader range of providers and incorporate patient input. This research could inform the development of a standardized survey to guide provider selection for the VDHP database.
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Healthcare Workforce Implications of State Reproductive Health Policies
Varsha Pudi, Jeremiah Bates, Jonathon Woo, Kristin Reed, Ian Kent, Oliver Koch, Nicholas Khoo, and Claudia Tarrant
Background: Since the 2022 Dobbs decision there has been an increase in self-managed medication abortions, out of state travel to obtain abortions, and heightened burden in states where abortion remains legal. Concurrently, applications to OBGYN residency programs in abortion-restricted states declined. There is a need to understand medical provider preparedness and willingness to manage complications of self-managed abortions, and to examine the potential impacts to healthcare workforce development. Methods: Surveys were developed for practicing health professionals and trainees, with input from representatives of the target audiences. Surveys were distributed to Vermont Primary Care Providers (PCPs), including MDs, APRNs, and PAs, as well as medical trainees (UVM medical students and residents). Data were analyzed using Stata analytical software and Excel. Results: We explored generational differences in attitudes regarding reproductive healthcare. Younger generations reported greater familiarity with potential complications following a medication abortion, stronger interest in learning more about these complications, and a greater willingness to expand their scope of practice to ensure safe access to care while PCPs born between 1945-1964 (Baby Boomers) reported less familiarity and interest. Respondents reported that state-based reproductive policies influence their decisions regarding where they would practice. Conclusion: These data highlight the influence of reproductive healthcare policy on the career decisions of current and future healthcare providers, and underscore the impacts on provider scope of practice, training priorities, and career decisions across generations. Adapting PCP training and continuing education to respond to emerging legislation will be required to ensure access to safe reproductive healthcare.
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Barriers and Facilitators to Improving Free Menstrual Product Distribution in Vermont Schools Post-Legislation
Rhea Puthumana, Claire Baptiste, Nicki Nikkhoy, Julia Hurley, Mikayla Howie, Kimberly Bau, Sulekha Kilas, and Nancy Kaplan MS
Background: Lack of menstrual product access forces female students, particularly trans and non-binary students, to face social and emotional distress, possibly resulting in educational gaps. Vermont’s recent legislature (Title 16: Education Chapter 031) designated menstrual products to be accessible in both women's and gender-neutral bathrooms at no cost; schools are responsible for cost, and school nurses primarily handle implementation. Methods: We conducted a literature review and interviewed two Vermont school staff members involved in implementation. We then surveyed Vermont school nurses to assess their experiences with implementing period product access in compliance with the legislation. Frequencies and chi-squared tests were used to analyze the data. Results: Among 89 school nurses (93% female, 64% aged 40-59), 66% were aware of the original Vermont legislation, primarily through the Vermont State School Nurses Association (58%). Awareness of the initial Vermont legislation is significantly associated with the presence of products in any bathrooms (p<0.01). Of those aware, 66% also knew of the legislative update mandating products in gender-neutral bathrooms, with a strong association between awareness and availability in these spaces (p<0.001). Facilitators for providing products include school budget (62%), staff support (56%), classroom discussions (49%), and working with facilities (45%). Barriers include lack of funding (41%) with some nurses relying on community donations (23%) or purchases out of pocket (17%) to sustain access. Product misuse (21%) and improper disposal (7%) were also noted as areas of concern. Conclusion: Legislation implementation has been hindered by awareness and funding. Additional efforts to raise awareness are recommended.
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