Showing papers in "Psychiatric Rehabilitation Journal in 2003"

Barriers to higher education for individuals with psychiatric disabilities.

Abstract: To study barriers to higher education, this qualitative study explored the college experiences of 35 people with psychiatric disabilities. Academic performance was related to psychiatric symptoms which subsequently led to college attrition. However, many research participants showed remarkable persistence in pursuit of academic goals. Campus-based support services were rarely utilized. Implications for psychiatric rehabilitation practice are discussed.

"It's like being in another world": Demonstrating the benefits of therapeutic horseback riding for individuals with psychiatric disability.

Abstract: Five adults with longstanding histories of psychiatric disabilities were recruited for a ten-week therapeutic horseback riding program. Individuals learned basic riding skills and had the opportunity to bond with a horse. In addition, the riders participated in a post-riding process group that used artistic and creative exercises to promote individual expression. By the end often weeks, the riders reported success in learning basic horsemanship and, in doing so, also reported additional psychosocial benefits, including an augmented sense of self-efficacy and self-esteem. In sum, this adjunctive therapy can facilitate the recovery process.

Social network correlates among people with psychiatric disabilities.

Abstract: This study explores three social network characteristics as they relate to demographic, clinical, and quality of life factors. The sample consists of 219 participants with serious mental illness. Results indicate that clients' social networks were small, and that network size is robustly related to symptoms and other measures of clinical and cognitive functioning, as well as with quality of life and self-esteem. The expected relation between network density and either the demographic variables or quality of life was not found. Moderate levels of network density, however, were associated with fewer psychiatric symptoms and higher IQ. Network multiplexity was most highly associated with demographic variables, such as ethnic minority status, less education, never being married, and living with family.

Transforming sheltered workshops into affirmative businesses: an outcome evaluation.

Abstract: This paper examines the outcomes associated with Voices, Opportunities and Choices Employment Club (VOCEC), which used the resources of a sheltered workshop to evolve affirmative businesses for people receiving mental health services. Quantitative and qualitative methodologies were used to understand the impact of VOCEC on employment and well-being outcomes compared to the former sheltered workshops and to competitive work. The results suggest that VOCEC has been successful in creating paid employment opportunities at levels approximating minimum wage and establishing a structure to incubate new businesses. The evaluation revealed the process by which Associates experience their participation as rewarding. It also indicated constraints on participation within the VOCEC model.

Practices differentiating high-performing from low-performing supported employment programs.

Abstract: This paper reports on a qualitative study designed to uncover the practices that differentiate programs producing high rates of competitive employment from those with low rates. The study found 13 differentiating practice factors in three areas: building consumer interest in working, getting a job, and maintaining a job. The congruence between these findings and current definitions of "best practice" is discussed.

Perspectives of people with psychiatric disabilities on employment disclosure.

Abstract: The Americans with Disabilities Act (ADA) of 1990 protects people with disabilities from employment discrimination. Under the ADA, employers must accommodate the known disabilities of a qualified employee or applicant. For persons with psychiatric disabilities, which are often invisible, the individual is required to make a conscious decision regarding disclosing their disability to an employer. The decision to disclose is very complex because the person needs to consider the possibility of confronting stigma and negative stereotypes. A qualitative study including a focus group and individual interviews was conducted to gather data from people with psychiatric disabilities/labels regarding employment disclosure. Major findings include the significant impact of disability identity (does the participant think they have a disability), and the importance of appropriate job matching as a disclosure strategy.

Community Membership and Social Networks in Mental Health Self-Help Agencies

Abstract: This article explores community membership among self-help agency (SHA) participants. It is suggested that SHAs foster the enhancement of peer-oriented social networks, leading to the experience of shared community. Social network analysis was used to examine the structure of support mechanisms, and to assess levels of community membership through peer inclusion. Results indicate that both individual and organizational characteristics play roles in predicting peer presence in social networks. Organizational empowerment is a key factor, with the SHA emerging as a promising locus for peer support development through enhanced social networks. Implications for the organization of consumer-based services are discussed.

Towards an integrated, structural model of psychiatric rehabilitation.

Abstract: In the past two decades, the number of principles and approaches that have been touted as psychiatric rehabilitation have overwhelmed the service provider. As a result, the field seems to be bombarded by contradictory ideas. In this paper, I seek to resolve this problem by providing an overview of psychiatric rehabilitation in terms of four key structures: goals (the reasons why people with psychiatric disabilities seek rehabilitation), strategies (the tools which service providers might use to help consumers reach their goals), settings (the places in which providers and consumers use these tools), and roles (the variety of professional and personal backgrounds which influence providers in carrying out their duties). In this paper, I review the research literature that has identified relevant examples of each of these structural dimensions. This description of psychiatric rehabilitation is based on a two-factor model of the life challenges that arise from mental illness: the disabilities produced by the disease and the loss of opportunity that result from stigma and discrimination. The paper also includes a brief discussion of the two-factor model.

Achieving the goal of evidence-based psychiatric rehabilitation practices for mothers with mental illnesses.

Abstract: There is a growing commitment to evidence-based practices in mental health. There is no well-articulated evidence base for interventions for mothers with mental illnesses. Parenthood is common among women with mental illnesses. Women themselves report motherhood is an important role. The risks of parental mental illness to children have been demonstrated; the challenges that motherhood brings to people with mental illnesses have been described. Because outcomes for both children and adults are multiply determined, there are many intervention opportunities. Recommendations for intervention are drawn from a focus group study and from the existing literature on parent training and support, exemplary programs for mothers with mental illnesses, and other evidence-based psychosocial interventions. The value of a psychiatric rehabilitation approach is highlighted. Challenges in documenting and testing interventions for mothers with mental illness include resource allocation and research innovation.

Effect of strengths model versus assertive community treatment model on participant outcomes and utilization: two-year follow-up.

Abstract: Community-based treatments for persons with serious mental illnesses have consistently proven to be effective. While most studies evaluate assertive community treatment (ACT) programs collectively, distinct models offer different approaches to improving participant outcomes. This study specifically examined the Strengths model versus more traditional ACT programs. Multivariate analyses tested changes in utilization, symptomatology, and clinical outcomes. Both ACT and Strengths reduced inpatient days while increasing outpatient care. Though all patients improved clinically, Strengths demonstrated a significantly greater advantage with symptomatology reduced by half. Findings support both treatment models, but additional clinical gains may be obtained from the Strengths approach.

Supported education programming for adults with psychiatric disabilities: results from a national survey.

Abstract: Over the last 10 years, supported education (SEd) programs have been the topic of many journal publications and conference presentations, but little is known about their numbers and types across the U.S. This article reports the results of a national survey of all known SEd programs, numbering over 100. The largest number was associated with clubhouses, where full and partial SEd models could be identified. On-site supported education programs were located in community colleges and universities. A dozen "free-standing" programs were also identified. Analyses documented differences across program types in services provided, budget amounts and sources, and coordination with mental health and higher educational institutions. If supported education is to move beyond a specialty program in mental health, providers need to do more to market these services and to work collaboratively with stakeholder groups to expand supported education programming.

Recovery: the heart and soul of treatment.

Abstract: Recovery is a process by which an individual recovers their self-esteem, dreams, self-worth, pride, choice, dignity and meaning. This paper discusses these issues, as well as offering suggestions on how clinicians and the system can help support the process. Recovery is about treating the whole person, identifying their strengths, instilling hope, and helping them to function at an optimal level by allowing them to take responsibility for their life. Also discussed is the importance of using setbacks as learning opportunities, the internal and external obstacles that people in recovery face, and the need to embrace the humanity of people in recovery.

Crime among homeless military veterans who abuse substances.

Abstract: This was a study of crime among 188 homeless persons who were in a Veterans' Affairs Medical Center program for substance abusers. The purpose of the study was to find out: (a) what proportion committed crimes, and (b) what other problems, relational factors, and personal attributes predict crime. Data indicate 27% of these homeless veterans committed nuisance offenses, and 41% have committed crimes in the past year. Logistic regression procedures indicated that alcohol and other drug abuse, less education, lack of employment, psychiatric problems, and living with a substance abuser increased the odds of committing crimes. This study also finds that physical and sexual abuse before 18 years of age increases the odds of committing crimes, whereas self-efficacy, ego integrity, and resilience decrease these odds. These latter factors have received scant attention in the literature on homeless substance abusers, and yet they are among the strongest predictors of crime. Implications for psychiatric rehabilitation are discussed.

The how and why of workplace adjustments: contextualizing the evidence.

Abstract: PURPOSE To identify the problems experienced in the workplace by service users returning to work and to explore how and why adjustments can help overcome them. METHOD Semi-structured interviews were carried out with 17 people in five employment projects and with their workplace managers. Interviews were tape recorded, fully transcribed and analyzed to identify and compare emerging themes. RESULTS Problems experienced by individuals included low energy and stamina levels, lack of confidence and psychological barriers to particular types of work. Adjustments to working hours, work schedules and job tasks proved crucial for some people in enabling them to overcome these problems.

Crisis and connection.

Abstract: Psychiatric interventions for crisis care lie at the center of the conflict between involuntary commitment and recovery/wellness systems in mental health services. Though crisis can mean completely different things to people who have the experience, the general public has been convinced by the media that people with psychiatric disabilities are to be feared. More and more this has led to social control but is erroneously still called treatment. This does nothing to help the person and in fact further confuses people already trying to make meaning of their experience. This paper offers a fundamental change in understanding and working with people in psychiatric crises. Rather than objectifying and naming the crisis experience in relation to illness, people can begin to explore the subjective experience of the person in crisis while offering their own subjective reality to the relationship. Out of this shared dynamic in which a greater sense of trust is built, the crisis can be an opportunity to create new meaning, and offer people mutually respectful relationships in which extreme emotional distress no longer has to be pathologized. The authors, who have had personal experience with psychiatric crises, have provided this kind of successful crisis counseling and planning and have designed and implemented peer support alternatives to psychiatric hospitalizations that support this model.

A new measure of coping with symptoms for use with persons diagnosed with severe mental illness.

Abstract: The purpose of the present investigation was to develop and field test a measure of coping with symptoms specifically designed for use with persons diagnosed with severe mental illness. Findings are reported on both the development of the Coping with Symptoms Checklist and the initial field trial (n = 91) conducted to examine reliability and validity. Reliability was assessed by computing coefficient alpha, and validity was assessed by examining convergent and discriminant correlations (n = 79 for many analyses). Findings suggest that the measure is a generally reliable and valid way of assessing how persons diagnosed with severe mental illness cope with their symptoms.

Gaining insight: who benefits from residential, integrated treatment for people with dual diagnoses?

Abstract: This retrospective study examines 18-month outcomes for 38 participants in an urban, residential integrated treatment (IT) program, and whether residents experienced different treatment benefits. Informed by an ACT team approach, the program emphasized harm reduction and motivational interventions. The design is naturalistic, and outcomes are self-comparisons over time reported in the aggregate. Repeated measurements with three standardized scales tracked stage of treatment and extent of alcohol and drug use. Outcomes analyses reveal advancements in stage of treatment and significant reductions in use of alcohol and drugs. Participants also worked more and were hospitalized less.

Interpreting narratives of motivation and schizophrenia: a biopsychosocial understanding.

Abstract: BACKGROUND The concept of motivation involves a complex interplay of biopsychosocial and environmental determinants. For individuals diagnosed with schizophrenia, motivation has traditionally been approached from a neuro-biological standpoint, obscuring this complexity. The findings from this study underscore the importance of broadening our understanding of motivation and schizophrenia through an exploration of individual perspectives and identification of the psychosocial factors that clarify the experience of diminished motivation.

Development of the Competency Assessment Tool-Mental Health, an instrument to assess core competencies for mental health care workers.

Abstract: As the focus on accountability in health care increases, there has been a corresponding emphasis on establishing core competencies for health care workers. This article discusses the development of an instrument to establish core competencies for workers in inpatient mental health settings. Twenty-six competencies were identified and rated by mental health care personnel on two subscales: the importance of the competency and how much behavioral health care workers could benefit from training on the competency. The reliability of the scale and its contributions to the training, retention and recruitment of direct care workers for behavioral health are discussed.

Knowledge and use of workplace accommodations and protections by young adults with schizophrenia: a mixed method study.

Abstract: Employment is an important outcome for individuals with schizophrenia and the Americans with Disabilities Act (ADA) is a key structural variable designed to favorably influence work. Little is known about how individuals understand and utilize ADA rights. The purpose of this mixed method study was to elicit understanding of the knowledge and use of ADA provisions from 20 persons with schizophrenia who returned to work. Three distinct groups emerged. Group differences suggest that use of ADA provisions may be dependent on individual need and comfort with ADA opportunity.

Connection and autonomy in the case management relationship.

Abstract: This study examines the effects of connection and autonomy in the client-case manager relationship on treatment participation, satisfaction with case management, and satisfaction with social life Three-month case manager ratings of connection were positively correlated with 9-month treatment participation Six-month client and case manager ratings of connection were positively correlated with improvements in all three outcomes at nine months Within this time frame, autonomy was positively correlated with treatment participation and satisfaction with case management and negatively correlated with satisfaction with social life These findings suggest that balancing connection and autonomy in different ways is important in the case management relationship

Aging women with schizophrenia.

Abstract: The purpose of this study was to describe the aging experiences of women with schizophrenia. The research focused on how participants viewed their own aging with schizophrenia, their perceived worries and concerns and how they were coping with aging with the disorder. Using a qualitative approach, data were collected using multiple in-depth interviews with six participants selected purposefully from the client list of a community mental health center. Interview transcriptions were coded and analyzed according to the study questions using QSR Nudist 4 software. Several categories and sub-categories emerged. These included the improvement in the illness over time; physical and daily living activity limitations; specific positive and negative changes that the women report have accompanied aging; the profound losses experienced by the participants when they were younger as a result of having schizophrenia; and how these losses have affected their present lives in terms of limiting available informal support, creating dependency on formal programs and services, and participants' fears of the future. Based on the study findings, implications for mental health practice and services are considered and suggestions are made to guide future research.

The passage to adulthood: Psychiatric rehabilitation service and transition-related needs of young adult women with emotional and psychiatric disorders.

Abstract: This review addresses the needs and experiences of young adult women, aged 16 to 21, who have a diagnosis of serious emotional disturbance (SED) or mental illness. Given the large numbers of young women with SED, evidence that they are underserved, and the continuity of many disorders from adolescence to adulthood, an integrative review in this area can enhance our ability to better address these young women's needs.

Cognitive rehabilitation with patients having persistent, severe psychiatric disabilities.

Abstract: The effectiveness of cognitive rehabilitation in ameliorating the symptomatic, cognitive, and functional deficits associated with schizophrenia and schizoaffective disorders was assessed in this prospective study. Thirty-eight participants who met DSM-IV criteria were assigned to cognitive rehabilitation treatment or treatment as usual (TAU) groups, using the method of minimization to equalize groups on prognostic variables believed to affect outcome (i.e., duration and severity of illness, Clozapine). Participants were assessed at baseline, treatment end, and 3-month follow-up. Improvement across time was found for both groups in delayed visuospatial memory and visual information processing speed, and the participant's status on the prognostic variables was found to be related to level of performance on measures of delayed visuospatial memory, negative symptoms, and speech disturbance. However, the findings did not provide evidence that cognitive rehabilitation is associated with greater improvement than TAU. Nor did the findings indicate that prognosis interacted with treatment to produce differential treatment outcomes.

A two-faceted work participation approach to employment and career development as applied to persons with a psychiatric disability.

Abstract: The work histories of persons with severe and persistent psychiatric disabilities are generally characterized by sporadic employment interspersed with long periods of unemployment during which they are supported by and often become dependent upon such forms of public aid as SSI or SSDI. This paper first describes a multifaceted work participation approach to employment and career building. It then explores the implications that this approach has for establishing future directions for research and interventions aimed at improving the quantity and quality of the participation in the work life domain of persons with a psychiatric disability.

Improving community-based care for the treatment of schizophrenia: lessons from native Africa.

Abstract: Recent innovations in the treatment of schizophrenia reflect a growing trend towards community-based care, such as Assertive Community Treatment (ACT). These programs reduce psychiatric hospitalization rates, improve residential stability, and result in improved satisfaction with care; however, they fail to show any consistent reduction in psychiatric symptoms or long-term improvement in social adjustment. As growing evidence suggests that the course and outcome of schizophrenia is significantly more favorable in undeveloped countries where community interventions are primary, this paper is an attempt to identify key factors in native African healing practices and their potential application to community-based treatment in the West.

The current and future state of mental health insurance parity legislation.

Abstract: Health insurance plans typically provide less coverage for mental health and chemical dependency treatment than for general medical services. In 1996 the federal government responded to these inequities by passing the Mental Health Parity Act, requiring equal annual lifetime dollar limits for mental health benefits. However, provisions within the law are easily circumvented, rendering it relatively ineffective as implemented. The Senator Paul Wellstone Mental Health Equitable Treatment Act of 2003 measures (S. 486 & H.R. 953) currently in Congress would expand the language and effectiveness of the Mental Health Parity Act. This paper reviews the limitations of both the 1996 federal law and existing state laws, and explains why federal action to expand the Mental Health Parity Act is so critical to people with mental illnesses.

An evaluation of a family psychoeducation program in community mental health.

Abstract: The aim of the research project was to identify the efficacy of the family psychoeducation program as a strategy for reducing the hospital admissions of young people. It also aimed to determine if the family psychoeducation program had an impact on the experience of caregiving and knowledge and satisfaction of services provided by the mental health service. A retrospective chart audit compared readmission history of 27 clients whose families attended a psychoeducation program with readmission history of a matched group of young people whose families did not attend the program. A telephone survey was conducted for both groups of families to investigate knowledge and understanding of services and burden of care. The results indicated that family participation in a brief multiple family psychoeducation program did not reduce the number or duration of admissions of the young people. There was no impact on the level of care for families who attended the psychoeducation program, however, this group showed some evidence of increased knowledge and understanding of services as compared to the control group.