Showing papers in "Psychiatric Rehabilitation Journal in 2018"

The Global Need for Lived Experience Leadership

Abstract: Common challenges and experiences of the lived experience/peer workforce globally are considered, with an emphasis on ensuring that future developments both protect and promote the unique lived experience perspective. Purpose: In the Western world, rapid growth in lived experience roles has led to an urgent need for training and workforce development. However, research indicates the roles risk being coopted without clear lived experience leadership, which is often not occurring. In developing countries and in many Western contexts, the lived experience role has not yet been accepted within the mental health workforce. The need for lived experience leadership to guide these issues is highlighted. Sources: Peer-reviewed research, relevant gray literature, and professional experience in countries where little published material currently exists. Conclusions and Implications for Practice: A window of opportunity currently exists to maximize lived experience leadership, and that window may be closing fast if broad-based actions are not initiated now.

Benefits and challenges of using service dogs for veterans with posttraumatic stress disorder.

Abstract: Objective Veterans with posttraumatic stress disorder (PTSD) are increasingly seeking service dogs to help them manage trauma-related symptoms, yet literature describing service dog use in this population is scant. The goal of this study was to document the benefits and challenges experienced by veterans with service dogs trained to assist with PTSD-related needs. Method Participants were veterans (N = 41) with service dogs, and their caregivers (n = 8), recruited through community-based service dog training agencies. We conducted in-depth interviews and observed training sessions as part of a larger study, and used thematic analysis to characterize data. Results Veterans reported that service dogs reduced hypervigilance by alerting and creating boundaries, and disrupted nightmares, improving sleep quality and duration. Dogs also helped veterans turn their attention away from invasive trauma-related thoughts. Additional reported benefits included improved emotional connections with others, increased community participation and physical activity, and reduced suicidal impulses and medication use. Demands of training, adjustment to life with a service dog, and delayed benefits were challenging for many veterans and caregivers. Conclusions and implications for practice Veterans report that service dogs help reduce PTSD symptoms and facilitate recovery and realization of meaningful goals. Service dogs may be a reasonable option for veterans who are reluctant to pursue or persist with traditional evidence-based treatments. Additional rigorous research on the effectiveness of service dogs for this population is warranted. (PsycINFO Database Record

What is social inclusion? A thematic analysis of professional opinion.

Abstract: OBJECTIVE Social inclusion is increasingly recognized as an important contributor to positive mental health outcomes, particularly for people with mental illness. There is a lack of consensus regarding what it means to be socially included and what the key contributors to social inclusion may be. The aim of this investigation was to determine such key contributors, as identified by those with professional experience. METHOD A thematic analysis of literature regarding social inclusion was conducted to obtain the opinions of professionals regarding key contributors of social inclusion. Seventy-one pieces of literature were reviewed: peer-reviewed literature (academic literature regarding social inclusion in general [n = 25] and social inclusion and mental illness [n = 26]), and gray literature (organizational reports [n = 20]). Within- and between-groups analyses were performed to determine group differences and increase understanding of which contributors were deemed important consistently across groups. RESULTS A comprehensive list of 90 contributors to social inclusion and exclusion was compiled, categorized into 13 domains based on commonalities. Contributors related to employment and education, housing and neighborhood, and social activities and support were highly cited. Differences were observed between-groups regarding specificity of contributors, with organizational reports reporting more detailed contributors. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE A comprehensive and specific understanding of social inclusion was obtained. This improved understanding will allow for better measurement of social inclusion which will assist in evaluating programs and interventions, identifying areas of greatest need, and in planning services, policy and strategies to target specific contributors proven to improve social inclusion and subsequent mental health outcomes. (PsycINFO Database Record

Empowering individuals with psychiatric disabilities to work: Results of a randomized trial.

Abstract: Objective Supported employment has experienced immense growth as an evidence-based intervention targeting the disproportionately high rates of unemployment among individuals with psychiatric disabilities who actively want to work. However, employment services are often not available to individuals who are ambivalent about work or lack work self-efficacy. The purpose of this study was to pilot-test the efficacy of a new peer-run photography-based group intervention (Vocational Empowerment Photovoice [VEP]) designed to empower individuals with psychiatric disabilities to consider employment services and pursue work. Method A total of 51 individuals with serious mental illnesses enrolled at a university-based recovery center, who were not employed or enrolled in any vocational services, were randomly assigned to the VEP program or to a wait-list control group. Mixed-effects regression models were used to examine the impact of the VEP program on both extrinsic (enrollment in employment services and employment rates) and intrinsic (work hope, motivation and self-efficacy, vocational identity, overall empowerment and internalized stigma) work-related outcomes. Results Participation in the VEP program was associated with a significantly higher rate of engagement in employment services over the course of the intervention and with significantly higher overall empowerment and decrease of internalized stigma sustained through the 3-month follow-up assessment. Stronger engagement in the VEP program was associated with increased work hope, self-efficacy and sense of vocational identity. Conclusions and implications for practice The study highlights the malleable nature of defeatist beliefs which prevent many individuals with mental illnesses from pursuing employment services despite their inherent interest in working. (PsycINFO Database Record

Reducing perceived stigma: Work integration of people with severe mental disorders in Italian social enterprise.

Abstract: Objective People with mental illnesses face stigma that hinders their full integration into society. Work is a major determinant of social inclusion, however, people with mental disorders have fewer opportunities to work. Emerging evidence suggests that social enterprises help disadvantaged people with their work integration process. The purpose of this study is to enhance our understanding about how perceptions of stigma can be decreased for people with mental disorders throughout their work experience in a social enterprise. Method Using a longitudinal study design, 310 individuals with mental disorders employed in Italian social enterprises completed a battery of questionnaires on individual (e.g., severity of symptoms; occupational self-efficacy) and environmental (e.g., social support; organizational constraints) variables. Of the 223 individuals potentially eligible at the 12-month follow up, 139 completed a battery of questionnaires on social and working skills, perceived work productivity and perceived stigma. Path analyses were used to test a model delineating how people with mental disorders working in social enterprises improve social and work outcomes (i.e., motivation, skills and productivity), and reduce the perception of being stigmatized. Results Working in a social enterprise enhances working social skills, which leads to a perception of higher productivity and, consequently, the perception of being discriminated against and stigmatized is reduced. Conclusions and implications for practice Social enterprise provides a context in which people with mental disorders reach a sense of work-related and social competence. This sense of competence helps them to reduce perceived stigma, which is a crucial step toward social inclusion. (PsycINFO Database Record

Race and gender differences in attitudes toward help seeking among marginalized young adults with mood disorders: A mixed-methods investigation.

Abstract: Objective Race and gender differences in help seeking are well-established; however, reasons for these differences are less clear. This study examined race and gender differences in two potential contributors-perceptions of illness and attitudes toward treatment-in a sample of marginalized young adults. Method Interviews were conducted with young adults (age 18-25) with prior involvement in public systems of care and mood disorder diagnoses (n = 60). A quantitative interview assessed illness perceptions and attitudes followed by a qualitative interview focused on perceptions of mental illness and treatment. Analyses examined quantitative differences across four race/gender subgroups-White women (n = 13), White men (n = 6), women of color (n = 27), and men of color (n = 14), then qualitative results were reviewed for a subset of cases (n = 30) to understand differences revealed in the quantitative analyses. Results Women of color had lower scores on illness understanding compared to other groups and men of color had lower scores on chronicity. Attitudes including propensity toward help seeking and stigma resistance were lowest in men of color, followed by women of color. Qualitative findings supported that men of color viewed their symptoms as less chronic and managed symptoms by changing their mindset rather than formal treatments. White participants talked more about their illnesses as chronic conditions and spoke more positively of treatment. Conclusion and implications for practice Race/gender differences were identified, particularly in relation to views of mental illness and stigma. Messaging that highlights independence and strength in relation to managing symptoms may be particularly important for young people of color. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Subtle ways of stigmatization among professionals: The subjective experience of consumers and their family members

Abstract: Objective Subtle expressions of stigmata or microaggressions consist of insensitive and demeaning remarks or statements which negate an individual's perception of their reality. They are differentiated from more traditional and overt forms of discrimination in that they are often voiced by well-intentioned individuals who are unaware of the negative underpinnings and potentially harmful effects of their comments. This study aimed to explore the subjective experience of stigma and macroaggression among consumers and their family members during their encounters with mental health care providers. Method Sixteen individuals who were recently diagnosed with schizophrenia spectrum disorders and 15 of their family members were interviewed. The interviews were recorded, transcribed verbatim, and analyzed using grounded theory. Results Three major forms of subtle stigma expressions or microaggressions were identified: that lived experience is not relevant, people diagnosed with a psychosis have no hope for recovery, and sharing and discussing professional knowledge is not necessary. Conclusions and implications for practice Encounters with mental health care providers include subtle conveyance of stigmatizing messages that are well recognized as a barrier to recovery. Psychoeducational interventions for staff that emphasize the importance of lived experience and sharing professional knowledge are recommended, as well as further studying the subtle ways of stigmatization among staff. (PsycINFO Database Record

Understanding the Lived Experience of Cognitive Remediation in Schizophrenia: A Qualitative Comparison With an Active Control

Abstract: Objective Cognitive remediation (CR) is a promising method of improving cognitive functioning in people with schizophrenia. Nevertheless, the lived experience of participation, and whether this differs from computer game (CG) playing control conditions, remains poorly understood. This study aimed to qualitatively compare the experience of participating in these 2 interventions. Method Forty-two outpatients with schizophrenia or schizoaffective disorder completed a qualitative survey with 7 open-ended questions after completing 10 weeks of CR (n = 22) or CG (n = 20). An iterative and inductive thematic analysis was used to identify and tally reoccurring codes and facilitate their organization into overarching themes. Results Four high-order themes summarized the data: (a) Perceived benefits; (b) Experience of group; (c) Operation of group; and (d) Suggestions for improvement. Participation was described as enjoyable with similar levels of social and intrinsic benefits reported by study completers in both CR and CG groups. CR completers were more likely to report improvements in memory and everyday functioning as well as greater opportunities to acquire new cognitive skills and experience personal and cognitive challenge. CR completers also described the pursuit of shared goals with other peers. Conclusions and implications for practice CR and CG share qualitative benefits in schizophrenia. CR may, however, offer a supportive environment where participants can encounter and surmount personal challenges, learn new abilities that may be functionally relevant and experience team-based success. These benefits may be unique to CR and contribute to increases in self-efficacy, which could bridge the gap between capacity and real world functioning in schizophrenia. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A manual-based phenomenological art therapy for individuals diagnosed with moderate to severe depression (PATd): A randomized controlled study.

Abstract: Objective This study investigated the effects of manual-based Phenomenological Art Therapy for individuals living with depression in addition to treatment as usual (PATd/TAU) compared with only treatment as usual (TAU) for individuals diagnosed with moderate to severe depression. Method 79 adults (men = 29.1%) were included in this randomized-controlled-trial (RCT), multicenter study in Sweden with an intention-to-treat design. Participants were randomized into either the PATd/TAU-group (n = 43) or TAU-group (n = 36). Data were collected at baseline and at end of treatment. The main outcomes were depression levels and self-esteem. Secondary outcomes were suicide ideation and sickness absence. Results The PATd/TAU-group showed a significant decrease of depression levels. The PATd/TAU-group returned to work to a higher degree than the TAU-group. Self-esteem significantly improved in both groups. Suicide ideation was unaffected. Conclusion and implications for practice Manual-based PATd works as expected, being an effective treatment, and contributes to recovery for individuals with moderate to severe depression. This outcome needs to be confirmed and its long-term effects examined in further studies. (PsycINFO Database Record

Three agendas for changing the public stigma of mental illness.

Abstract: Objective Antistigma programs may be guided by 3 differing agendas: services (promote treatment engagement), rights (help people achieve rightful goals), and self-worth (facilitate self-worth and efficacy). This study examined the construct validity of this perspective by examining the factor structure of importance ratings of the 3 agendas. The study examined how importance might be viewed differently by the population as a whole versus a subsample of people who reported previous experience with mental health services and hence could be directly harmed by stigma. Methods 373 individuals recruited using Mechanical Turk completed importance ratings for each of the 3 agendas. Measures of public stigma were completed to examine concurrent validity of importance ratings. Those who reported taking medications for a psychiatric disorder were divided into a separate group and completed a measure of self-stigma. Results Outcomes seemed to confirm the factor structure of the 3 agendas model thereby offering partial support for the framework. Group analyses showed the services agenda was viewed as more important than rights or self-worth. People with mental health experience viewed the services agenda as more important than the other 2. However, dividing the mental health group into low and high self-stigma revealed that those with low self-stigma rated the rights agenda as more important. Conclusions and Implication for Practice: Participants with lower self-stigma identify the harm brought by stigma and thus endorse rights and self-worth more than those with higher self-stigma. Implications of these findings are discussed to assist to prioritize agendas for public health campaigns. (PsycINFO Database Record

Aging out or continuing on? Exploring strategies to prepare marginalized youth for a transition to recovery in adulthood

Abstract: Objective This study aimed to improve our understanding of how to best assist marginalized youth during their transition to adulthood, and how to provide them services that help them achieve independence within existing public systems of care. Method Using purposive sampling methods, 17 direct service providers and supervisors of a large behavioral health organization participated in individual interviews and focus groups. Results A team of analysts identified eight primary themes: (a) the primacy of consistent and caring relationships with adults; (b) working with youth and family concurrently; (c) the complicated dance of autonomy and independence; (d) engagement of alumni and peers in service delivery; (e) transition navigator: an active not passive approach to becoming an adult; (f) youth as the drivers of treatment and recovery; (g) provider training and resources to address the unique needs of transition-age youth; and (h) broadening the definition of treatment. Conclusions and implications for practice Our findings have important implications for practice, including (a) adapting clinical practice to meet the unique needs of transition-age youth and young adults; (b) engaging and expanding positive support systems; and (c) shifting the mindset of transition-age youth and young adults, their caregivers, and providers from a perspective of "aging out" of the mental health system to a perspective of "continuing on" in the management of their mental health through treatment and rehabilitation as needed as young adults. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Defining "peerness": Developing peer supports for parents with mental illnesses.

Abstract: TOPIC This article addresses critical considerations in the development of peer supports for parents with mental illnesses, focusing on the question of what makes a peer a peer in the parent peer specialist domain. PURPOSE The implementation and testing of parent peer supports requires specification of the critical components of the model, including the qualities, characteristics, and unique contributions of the parent peer specialist. SOURCES USED Themes emerged in Parent Peer Specialist Project Advisory Group discussions, with members drawing from lived experience, practice expertise, and conversations with experts. In addition to literature review, strategic stakeholder interviews were conducted. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Lived experience of mental illness and family life, training, and ongoing support for parent peer specialists, along with key ingredients conveyed by perceived peer-parent similarity, will likely enhance the benefits of peer supports to parents and promote job satisfaction and career advancement for parent peer specialists. (PsycINFO Database Record

Implementing cognitive behavioral therapy for psychosis: An international survey of clinicians' attitudes and obstacles.

Abstract: OBJECTIVE This study aimed to better understand the implementation of cognitive behavioral therapy for psychosis (CBTp) by exploring the impact of clinicians' attitudes toward CBTp within the Theory of Planned Behavior framework (i.e., by considering attitudes, behaviors, intention, and social norms) as well as perceived obstacles and response to proposed solutions. METHOD One hundred forty-two clinicians from 2 sites in Canada and 1 site in Australia answered an online survey involving both Likert scales and open-ended questions. The role of attitudes, social norms, and behavioral control (i.e., freedom to decide or act) on intention of offering CBTp delivering CBTp were analyzed using linear and logistic regressions. Sites were compared using analysis of variance. Reponses to perceived obstacles were thematically analyzed. RESULTS Results were similar across settings. Entered together in the model, attitudes, social norms, and behavioral control were significant in predicting the intention of offering CBTp, F(3, 125) = 38.49, p < .001, with 49% of the variance explained, although behavioral control did not significantly contribute to the model. CBTp training (odds ratio = 0.23, confidence interval = 0.06-0.58) and social norms (odds ratio = 0.79, confidence interval = 0.68-0.93) significantly predicted CBTp delivery. Six themes that emerged regarding perceived obstacles are provided. Training, supervision, and local support were the most frequently endorsed solutions. Brief or modular CBTp and group or online delivery were also positively endorsed. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Clinicians' individual and collective attitudes should be targeted by more and better training to increase their delivery of CBTp. Given organizational barriers, CBTp-informed interventions warrant further investigation. (PsycINFO Database Record

Functional Recovery of Individuals With Serious Mental Illnesses: Development and Testing of a New Short Instrument for Routine Outcome Monitoring

Abstract: Objective: This article describes the development and testing of the Functional Recovery tool (FR tool), a short instrument for assessing functional recovery during routine outcome monitoring of people living with serious mental illnesses. Methods: To assess functional recovery, mental health professionals conducted semistructured interviews with people living with serious mental illnesses on three areas of social functioning: daily living and self-care, work and study, and social contacts. Functioning in each of these areas over the past 6 months was rated on a 3-point scale: 0 (independent), 1 (partially independent), and 2 (dependent). The dichotomous overall outcome of the tool is defined as independent functioning in all areas. We analyzed interrater and test-retest reliability, sensitivity to change, and correlations with constructs that are assumed to be similar to the FR tool (quality of life in daily living, work, and social contacts) or divergent from it (symptomatic functioning). Results: The FR tool was administered to 840 individuals with serious mental illnesses in Dutch mental health care services, 523 of whom were followed up for 1 year (response rate 62%). The tool was easy to complete and was appropriate for policy evaluation and practice. However, when it was combined with more elaborate instruments, it added little extra clinical information. Interrater and test-retest reliability, convergent and discriminant validity, and sensitivity to change were rated sufficient to good. Conclusions and Implications for Practice: The FR tool could be a useful measure of functional recovery in addition to current measures of symptomatic remission and personal recovery in routine outcome monitoring.

Tobacco use and smoking behaviors of individuals with a serious mental illness.

Abstract: Objectives The purpose of this study was to determine the prevalence of tobacco use and overall smoking behaviors within a sample of individuals with a serious mental illness who were homeless or vulnerably housed and receiving community mental health services. Methods In 2010, individuals (N = 639) were interviewed, and identified smokers completed the Fagerstrom Test for Nicotine Dependence (FTND) and additional questions related to their smoking behaviors. Results Tobacco use prevalence was 72%, and 62% of smokers had high or very high levels of nicotine dependence. Smoking behaviors included smoking contraband cigarettes (47%) and smoking cigarettes remade from discarded cigarette butts (25%). Smokers were found to be over 9 times as likely to have a co-occurring substance use disorder. Conclusions and implications for practice Significant tobacco prevalence and dependency in this population highlights the need to provide integrated treatment opportunities. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Vocational coaches for justice-involved emerging adults.

Abstract: Objective The purpose of this study was to determine whether vocational supports for emerging adults with serious mental health conditions who are at high risk for rearrest are more effectively served within Multisystemic Therapy for Emerging Adults (MST-EA) through vocationally enhanced MST-EA Coaches or through referral to state vocational rehabilitation services. Method A pilot randomized controlled trial examined two MST-EA Coaching approaches. In the Standard Coach + VR condition (n = 16), MST-EA Coaches delivered standard skills curricula to participants and referred them to state vocational rehabilitation (VR) services for vocational supports. In the Vocational Coach (VC) condition (n = 16), MST-EA Coaches delivered the standard skills curricula enhanced with extensive education/employment components. Analyses included pre- to posttreatment comparisons of vocational outcomes, and between groups comparisons of fidelity, satisfaction, and services utilization. Results Those in the VC condition had a 12-fold increase in the odds of posttreatment vocational activity compared with those in the Standard Coach + VR condition (92.9 vs. 57.1% employed or in school, respectively). Subgroup analyses of those who engaged in Coaching showed that there was specifically an increase in the odds of posttreatment educational engagement among those in the VC condition compared with those in Standard Coach + VR. Conclusions and implications for practice Based on the strength of the findings in this small pilot study the VC should be included in future clinical trials of MST-EA to maximize treatment impact for supporting emerging adult vocational functioning and thus reducing antisocial behavior. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Reading and recovery expectations: Implementing a recovery-oriented bibliotherapy program in an acute inpatient psychiatric setting.

Abstract: Objective This study examined the feasibility and acceptability of developing a recovery-oriented book club in an acute inpatient psychiatric setting, and the impact of participation on measures of hope and recovery orientation. Method Participants were recruited from an inpatient psychiatric hospital and assigned to control (N = 13) or experimental (N = 13) conditions. Participants completed the Herth Hope Index (HHI) and the Mental Health Confidence Scale (MHCS) at baseline and follow-up. Book club participants completed a satisfaction survey. ANOVA was performed to examine changes on HHI and MHCS. Results No significant differences were found between conditions on HHI or MHCS. On the satisfaction survey, most book club participants agreed "somewhat" or "strongly" that the intervention increased self-understanding (92.3%) and hope (61.6%). Conclusions and implications for practice Book club groups may help individuals in inpatient psychiatric settings feel more hopeful. Future research may examine the adaptability of this intervention for outpatient settings. (PsycINFO Database Record

Initial development of the recovery-oriented services assessment: A collaboration with peer-provider consultants.

Abstract: Objective The Recovery Self-Assessment (RSA) is a reliable and valid tool used to measure recovery-oriented services. Recent studies, however, suggest that the length and reading level of the RSA makes its routine use in service settings difficult. Recognizing the importance of including people with lived experience of a mental health challenge in research processes and the need to enhance the utility of tools that measure recovery-oriented services, this paper describes an innovative researcher-peer provider consultant multistep process used to revise the provider version of the RSA to create a new instrument-the Recovery-Oriented Services Assessment (ROSA). Methods The authors conducted an exploratory factor analysis (EFA) with principal axis factoring extraction and direct oblimin rotation to evaluate the underlying structure of the provider RSA using data from mental health employees (n = 323). To triangulate the findings of the EFA, quantitative and qualitative data were collected from peer provider consultants (n = 9) on the importance of and language of RSA items. Results EFA results indicated that a 1-factor solution provided the best fit and explained 48% of the total variance. Consultants triangulated EFA results and recommended the addition of 2 items and language revisions. These results were used to develop the ROSA-a 15-item instrument measuring recovery-oriented services with accessible language. Conclusions and implications for practice Two versions of the ROSA were developed: a staff version and a people-in-services version. The ROSA may provide organizations with a more accessible way to measure the extent to which their services are recovery oriented. (PsycINFO Database Record

Sociodemographic characteristics, health conditions, and functional impairment among older adults with serious mental illness reporting moderate-to-severe pain

Abstract: Objective To compare adults aged ≥50 years with serious mental illness reporting moderate-to-severe pain to older adults with serious mental illness without pain with respect to sociodemographic characteristics, health conditions, and functional impairment. Method Secondary data analyses were conducted using baseline assessments of 183 participants recruited for the Helping Older People Experience Success (HOPES) study from three community mental health centers. The primary outcome was self-reported, nonexperimentally induced, moderate-to-severe pain (referent = no-to-mild pain). Predictor variables consisted of sociodemographic characteristics, health conditions, and functional impairment. We conducted univariable and multivariable logistic regression analyses to examine the associations between these variables. Results Sixty-one participants (33.3%) from our sample reported pain. Pain was associated with all of the sociodemographic and health-related factors in univariable analyses. In the multivariable model, only older age, pain-related activity interference, and physical and emotional health-related social limitations were significantly associated with pain. Conclusions and implications for practice The presence of moderate-to-severe pain in older adults with serious mental illness is associated with pain-attributable impairment of activities and social problems above and beyond the substantial functional limitations routinely experienced by this high-risk, high-need group. Given the high rates of preexisting conditions and persistent social impairment among these older adults, our findings suggest that pain may contribute to worse overall functional outcomes. Future research and clinical interventions focused on improving outcomes should include an evaluation of pain as a contributor to decreased functioning and assess the need for early intervention, nonpharmacological pain management, or other health promotion services in psychiatric rehabilitation. (PsycINFO Database Record

The Contribution of Employment Duration to 18-Month Neurocognitive Outcomes in First-Episode Psychosis

Abstract: OBJECTIVE: Increased employment duration has been associated with change in performance on specific neurocognitive domains in populations with schizophrenia, but not in first-episode psychosis. The aim of this exploratory study was to examine whether employment duration over 18 months is associated with neurocognitive outcomes over 18 months among individuals with first-episode psychosis. METHOD: Eighty-eight young people with first-episode psychosis completed a neurocognitive battery at baseline and 18 months. Setwise (hierarchical) multivariate linear regressions were used to examine predictors of change in neurocognitive performance over 18 months. Total hours employed over 18 months were entered after accounting for age, gender, premorbid IQ, and negative symptom change scores. RESULTS: Total hours employed was significantly associated with change in Symbol Digit Modalities Test raw score (p = .020), Letter-Number Sequencing scaled score (p = .016), Digit Span total scaled score (p = .047) and Rey Complex Figure Test delayed recall raw score (p = .016) over 18 months, after controlling demographic characteristics, premorbid IQ, and changes in negative psychotic symptoms. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Total hours worked over 18 months was associated with small improvements on one test of processing speed and one test of working memory. However, total hours worked over 18 months was also associated with decline on one test of attention and working memory and visual organization and memory. The findings implicate that work alone may not be entirely effective in changing neurocognitive functioning for young people with first-episode psychosis. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Trauma and posttraumatic stress disorder in Spanish public mental health system clients with severe psychiatric conditions: Clinical and demographic correlates.

Abstract: OBJECTIVE Compared with the general population, those with severe psychiatric conditions have a substantially higher likelihood of trauma exposure, increased probability of developing posttraumatic stress disorder (PTSD), and more severe consequences if trauma is left untreated Nevertheless, identification of trauma/PTSD continues to be a neglected mental health system priority In Spain, few investigations have examined the prevalence of trauma, particularly in persons with severe psychiatric conditions METHOD This study reports findings from a trauma/PTSD screening within a large Madrid public mental health agency serving clients with severe psychiatric conditions RESULTS Of the 323 participants, 272 (842%) reported at least 1 traumatic event; and 124 (384%) met criteria for "probable" PTSD, although none had a medical record diagnosis of PTSD Those with probable PTSD were predominantly male, were in their mid-40s, had received mental health services for 16 years on average, and endorsed 564 types of lifetime traumatic events The most frequent and distressing traumatic event was the sudden, unexpected death of a loved one The number of traumatic event types reported was positively correlated with PTSD symptom severity CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Despite lower Spanish general population prevalence of trauma/probable PTSD (compared with the United States and other Western countries), rates within those with co-occurring severe psychiatric conditions are high These findings reinforce the importance of conducting system-wide screening in public mental health clinics serving persons with severe psychiatric conditions in Spain (and beyond), in order to address this ongoing but neglected issue, and begin to offer much-needed recovery services (PsycINFO Database Record

Evaluating correlations between physical activity, psychological mediators of physical activity, and negative symptoms in individuals living with psychosis and diabetes.

Abstract: OBJECTIVE This study examines the relationship among physical activity, psychological mediators of physical activity, and negative symptoms in people living with psychosis and prediabetes or Type II diabetes mellitus to identify which variables should be targeted in future physical activity interventions. METHOD A total of 63 individuals were recruited and filled out questionnaires with the assistance of trained research staff. RESULTS Spearman's correlations showed a positive significant association between physical activity and self-efficacy. Negative significant associations were found between physical activity and negative symptoms of psychosis as well as perceived barriers of physical activity. There was no significant relationship between physical activity and perceived benefits of physical activity. CONCLUSION AND IMPLICATIONS FOR PRACTICE Future physical activity interventions need to focus on enhancing the confidence individuals have being physically active and how barriers to activity can be recognized and managed. Interventions should be conducted alongside treatment of negative symptoms of psychosis. (PsycINFO Database Record

Schizophrenia, narrative, and neurocognition: The utility of life-stories in understanding social problem-solving skills.

Abstract: OBJECTIVE Schizophrenia researchers have focused on phenomenological aspects of the disorder to better understand its underlying nature. In particular, development of personal narratives-that is, the complexity with which people form, organize, and articulate their "life stories"-has recently been investigated in individuals with schizophrenia. However, less is known about how aspects of narrative relate to indicators of neurocognitive and social functioning. The objective of the present study was to investigate the association of linguistic complexity of life-story narratives to measures of cognitive and social problem-solving abilities among people with schizophrenia. METHOD Thirty-two individuals with a diagnosis of schizophrenia completed a research battery consisting of clinical interviews, a life-story narrative, neurocognitive testing, and a measure assessing multiple aspects of social problem solving. Narrative interviews were assessed for linguistic complexity using computerized technology. RESULTS The results indicate differential relationships of linguistic complexity and neurocognition to domains of social problem-solving skills. More specifically, although neurocognition predicted how well one could both describe and enact a solution to a social problem, linguistic complexity alone was associated with accurately recognizing that a social problem had occurred. In addition, linguistic complexity appears to be a cognitive factor that is discernible from other broader measures of neurocognition. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Linguistic complexity may be more relevant in understanding earlier steps of the social problem-solving process than more traditional, broad measures of cognition, and thus is relevant in conceptualizing treatment targets. These findings also support the relevance of developing narrative-focused psychotherapies. (PsycINFO Database Record

Youth and young adult mental health: Interventions, services, systems, and rehabilitation

Abstract: What are the needs, perceptions and experiences of individuals with serious mental health conditions during the transition to adulthood? How can services best support them during this stage of life? These are the two interrelated questions that the articles in this special section address. The populations of focus in these articles are diverse: college students receiving educational supports, White and Latino young adults receiving employment supports, youth and young adults with justice system involvement, young adults with mood disorders, and service providers for youth in transition to adulthood in large urban behavioral health centers. The focus on diverse samples highlights some of the progress in the field. Questions about the needs of, and effective services for, individuals with serious mental health conditions as they transition into adulthood have moved from asking broad questions to including questions about more specific marginalized subgroups. As editors, we hope this special section provides readers with up-to-date literature syntheses and new knowledge, while also moving the field forward toward more research, more effective services for this age group, and services that will enhance their recovery and overall life outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Consumer perspectives on physical activity interventions within assertive community treatment programs.

Abstract: OBJECTIVE The purpose of this study was to identify strategies for encouraging greater levels of physical activity among community-dwelling individuals living with serious mental illness participating in assertive community treatment (ACT). METHOD Eighteen individuals living with serious mental illness participated in focus group interviews. Participants were recruited from an ACT provider located in the Midwestern United States. A semistructured interview protocol was developed specifically for this study. Participants responded to a series of questions on ACT physical activity programming, providing (a) information about their personal experiences with physical activity-related interventions and (b) suggestions for intervention strategies that may enhance physical activity participation in this population. Consensual qualitative research conventions, a qualitative methodology used in social sciences, were followed for organizing, coding, quantifying, and interpreting participant responses. RESULTS Several unique themes emerged from the data. Participants identified a variety of strategies used by their ACT provider to encourage physical activity, such as group physical activities and incentive programs. A number of recommendations related to skills training, intervention characteristics, and motivational strategies were identified by the participants as well. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Physical activity is an important part of successful treatment for individuals with serious mental illness. In this study, participants identified a variety of strategies that may be useful for incorporating within the ACT treatment paradigm. Participant responses were frequently consistent with the tenets of popular health behavior theory (e.g., self-determination theory). Future research should focus on the efficacy of the recommended intervention strategies and their implementation within ACT treatment settings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The association between time incarcerated and the search for employment in a veteran sample with substance use disorders.

Abstract: Objective Incarceration and substance use disorders/mental illness can have a significant negative impact on finding employment. However, it is unclear in what phase of the search for employment, that is, applying for jobs, obtaining interviews, being offered employment, does time incarcerated have the most effect. This study will determine how time incarcerated in the past 10 years is associated with negative job search process outcomes. Method This study evaluates 84 (81 men and 3 women) veterans with substance use disorders and histories of felony convictions. Four path analyses were conducted to evaluate models that incorporated time incarcerated at the different phases. Results The superior model incorporated time incarcerated negatively affecting the number of interviews obtained. Models that assessed the association between time incarcerated with applications submitted and likelihood of being offered employment did not demonstrate adequate goodness-of-fit. Conclusion and implications for practice Overall, the findings demonstrate the ex-offenders enrolled exhibited similar effort in searching for employment across time incarcerated. Also, employers are equally likely to hire those with felony histories, regardless of the time incarcerated, once the applicant has been met and interviewed. The results highlight the need for services focusing on breaking down stigma and reducing barriers that screen out ex-offenders from being interviewed by employers. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Helping veterans achieve work: A Veterans Health Administration nationwide survey examining effective job development practices in the community.

Abstract: OBJECTIVE Veterans Health Administration vocational services assist veterans with mental illness to acquire jobs; one major component of these services is job development. The purpose of this study was to characterize the nature of effective job development practices and to examine perceptions and intensity of job development services. METHOD A national mixed-methods online survey of 233 Veterans Health Administration vocational providers collected data regarding frequency of employer contacts, perceptions of job development ease/difficulty, and effective job development practices when dealing with employers. Qualitative responses elucidating effective practices were analyzed using content analysis. RESULTS Vocational providers had a modest number of job development employer contacts across 2 weeks (M = 11.0, SD = 10.6) and fewer were face-to-face (M = 7.6, SD = 8.4). Over 70% of participants perceived job development to be difficult. Six major themes emerged regarding effective job development practices with employers: using an employer-focused approach; utilizing a targeted marketing strategy; engaging in preparation and follow-up; going about the employer interaction with genuineness, resilience, and a strong interpersonal orientation; serving as an advocate for veterans and educator of employers; utilizing specific employer-tailored strategies, such as arranging a one-on-one meeting with a decision maker and touring the business, individualizing a prescripted sales pitch, connecting on a personal level, and engaging in ongoing communication to solidify the working relationship. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Respondents highlight several potentially effective job development strategies; tools and resources may be developed around these strategies to bolster job development implementation and allow opportunities for fruitful employer interactions. (PsycINFO Database Record

Examining the reliability and factor structure of the Malay version of the Recovery Self-Assessment in a sample of individuals with schizophrenia.

Abstract: Objective Without a reliable and valid tool, it is neither possible to gauge recovery orientation of persons with serious mental illness nor to evaluate whether existing mental health system encourages recovery in both its policies and current practice in Malaysia. Therefore, the aim of this study was to examine the reliability and factor structure of the Malay version of the Recovery Self-Assessment (RSA-PIRV-M) in a psychiatric sample. Method Psychiatric patients were eligible for recruitment to the study, when they fulfilled the following criteria: a diagnosis of schizophrenia, were aged between 18- and 65-years-old, and were able to give consent themselves. We recruited 118 individuals with schizophrenia. They were selected via systematic random sampling technique. All RSA-PIRV-M items were derived from the parent scale. These items were translated based on established procedures. The reliability estimates of the RSA-PIRV-M were based on Cronbach's alpha. We performed confirmatory factor analyses to examine the factor structure of the RSA-PIRV-M. Results All Cronbach's alphas for the RSA-PIRV-M subscales were at least .70. With respect to the factor structure of the RSA-PIRV-M, our structural equation modeling findings suggest a five-factor model encompassing life goals, involvement, diversity of treatment options, choice, and individually-tailored services. Conclusions and implications for practice The interpretation of our findings is limited by small sample size, unique sample characteristics, and lack of further evidence for convergent validity. Notwithstanding these limitations, the RSA-PIRV-M is a promising tool in bridging gaps between our knowledge on recovery orientation and existing mental health service provision in Malaysia. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Race analysis in an African American sample with serious mental illness and comorbid diabetes.

Abstract: Objectives Targeted Training in Illness Management (TTIM) focuses on enhancing care engagement for people living with serious mental illness and diabetes This secondary analysis from a 60-week, randomized controlled trial of TTIM versus treatment as usual evaluated racial subgroup outcomes Method Demographics, clinical characteristics, and diabetes status were evaluated for those self-identifying as non-Hispanic White, African American, and Hispanic Longitudinal response to TTIM was evaluated using a multiple domain risk index Due to their small sample size; those identifying as Hispanic were excluded from this analysis Results Non-Hispanic White participants had greater baseline socioeconomic advantages Baseline risk scores, glycosylated hemoglobin (HbA1c) values, and HbA1c differences over time were similar for African American and non-Hispanic White participants Conclusions and implications for practice African American participants living with serious mental illness and diabetes receiving TTIM did as well as non-Hispanic White participants Inclusive approaches that feature peer support and are situated in safety-net health care settings need to be further investigated with respect to potentially impacting health disparities (PsycINFO Database Record

Feasibility of implementing a recovery education center in a Veterans Affairs medical center

Abstract: OBJECTIVE The purpose of this study was to determine the feasibility of implementing a recovery education program in a Veterans Affairs medical center. METHOD This case study describes development and implementation of a mental health and wellness curriculum offered through a centralized location. Referral and utilization data (n = 781) from the first 18 months of implementation were used to evaluate feasibility. FINDINGS Access to programming with zero exclusion was prioritized and average time from referral to enrollment was 9.6 days. Fifty-six percent of veterans admitted to mental health services during the 18-month evaluation period were referred to the program, and this level of utilization continued to be sustained. A broad range of classes was available. Opportunities to change classes as recovery goals evolved was encouraged and data indicate veterans actively tailored their individual recovery curriculum. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Educational recovery programming was easily incorporated into a large integrated health facility, was well received, and offered greater opportunity for choice and individualization of recovery curriculum. (PsycINFO Database Record