[show abstract][hide abstract] ABSTRACT: State administrative supports of evidence-based practices (EBPs) may critically affect sustainability. As part of a larger follow-up to the multistate National Implementing Evidence-Based Practices Project, 13 leaders from eight States reported on recent statewide policies and resources that influenced the maintenance of 49 EBP programs 6 years after implementation. Nearly three-quarters (71 %) of the programs were currently operational and adhering to State fidelity standards. Most of the programs had level or increased funding over the last few years, and most received other State support and resources, such as training and technical assistance. Steady State funding as well as State-sponsored training and expertise appear critical to long-term EBP program maintenance.
The Journal of Behavioral Health Services & Research 09/2013; · 0.78 Impact Factor
[show abstract][hide abstract] ABSTRACT: Topic: A growing research literature indicates that cognitive enhancement (CE) interventions for people with schizophrenia can improve cognitive functioning and may benefit psychosocial functioning (e.g., competitive employment, quality of social relationships). Debate continues regarding the strength of evidence for CE and related policy implications, such as the appropriateness of funding CE services. Purpose: This paper summarizes and updates a meeting of experts and stakeholders convened in 2008 by the New York Office of Mental Health to review evidence on the impact of CE for people with schizophrenia and other serious mental illnesses, and addresses whether the evidence base for CE interventions is sufficient to warrant funding. Sources Used: Specific recommendations based on the extant literature are provided regarding the structure and components of CE programs that should be present in order to improve cognitive and psychosocial outcomes and therefore merit consideration of funding. Conclusions and Implications for Practice: These recommendations may serve as a starting point in developing standards for CE programs. Establishing evidence-based practice standards for implementing CE interventions for people with serious mental illnesses may facilitate dissemination of programs that have the greatest potential for improving individuals' functional outcomes while minimizing incremental costs associated with providing CE services. Important open questions include how the performance of CE programs should be monitored and which individuals might be expected to benefit from CE as evidenced by improved functioning in their everyday lives. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
[show abstract][hide abstract] ABSTRACT: OBJECTIVE People with psychiatric impairments (primarily schizophrenia or a mood disorder) are the largest and fastest-growing group of Social Security Disability Insurance (SSDI) beneficiaries. The authors investigated whether evidence-based supported employment and mental health treatments can improve vocational and mental health recovery for this population. METHOD Using a randomized controlled trial design, the authors tested a multifaceted intervention: team-based supported employment, systematic medication management, and other behavioral health services, along with elimination of barriers by providing complete health insurance coverage (with no out-of-pocket expenses) and suspending disability reviews. The control group received usual services. Paid employment was the primary outcome measure, and overall mental health and quality of life were secondary outcome measures. RESULTS Overall, 2,059 SSDI beneficiaries with schizophrenia, bipolar disorder, or depression in 23 cities participated in the 2-year intervention. The teams implemented the intervention package with acceptable fidelity. The intervention group experienced more paid employment (60.3% compared with 40.2%) and reported better mental health and quality of life than the control group. CONCLUSIONS Implementation of the complex intervention in routine mental health treatment settings was feasible, and the intervention was effective in assisting individuals disabled by schizophrenia or depression to return to work and improve their mental health and quality of life.
American Journal of Psychiatry 08/2013; · 14.72 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objective: The present demonstration project involved development of a training program designed to teach recovering consumers employed as peer advocates how to provide evidence-based supported employment services to consumers with severe mental illness. Methods: A training curriculum was developed to teach the core competencies of the Individual Placement and Support (IPS) model of supported employment. Three peers participated in training and provided work outcome data from their caseloads. Assessments were conducted of peers' competence in implementing IPS and effectiveness in promoting job placements. Peer competency was assessed by the following: (a) a formal IPS fidelity review performed by two external reviewers to evaluate service implementation, and (b) the Kansas Employment Specialist Job Performance Evaluation, an objective measure of employment specialist attitudes and skills. Program efficacy was assessed by examining the number of job placements and corresponding tenure. Results: The fidelity review revealed that peers met IPS standards of implementation on 7 of 14 items assessing service delivery. The Kansas scale results revealed attitudes to be a relative strength and job performance competency ratings fell in the average to above average range across skill areas assessed (e.g., vocational assessment, job development). Thirty-three percent of consumers from the peers' caseloads got competitive jobs; mean tenure was 26.1 weeks. Conclusions and Implications for Practice: This demonstration project provides a starting point for future efforts aimed at expanding the role of peers as providers of evidence-based mental health services and provides a measured degree of optimism that this is a realistic, attainable goal. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
[show abstract][hide abstract] ABSTRACT: Few studies have examined predictors of long-term sustainability of evidence-based practices in mental health. This study used assessments of five evidence-based practices implemented in 49 sites in eight states at baseline and years 2, 4, and 8. Program characteristics, implementation characteristics, reinforcement activities, and sustainability factors were used to predict program survival status. The majority of predictors were not significant. Supervisor turnover in year 4 predicted survival status in year 8, but site characteristics, fidelity at implementation, quality improvement activities, and post-implementation activities had little impact on long-term program survival. This study extends previous sustainability research by examining the long-term impact of internal program factors over a substantial period of time using longitudinal prediction. Future research should also consider the influence of external factors such as financial policies.
The Journal of Behavioral Health Services & Research 05/2013; · 0.78 Impact Factor
[show abstract][hide abstract] ABSTRACT: Health concerns are common reasons for wanting to quit smoking among smokers with mental illnesses. Motivational interventions have used feedback from a carbon monoxide monitor to increase awareness of health concerns, but this device is not commonly available. Whether brief motivational interventions can be effective without this feedback is unknown. Using a randomized controlled trial, this study tested the effect of carbon monoxide feedback within a brief, multi-component, computerized motivational intervention among 124 smokers with schizophrenia or mood disorders. The main outcome was initiating cessation treatment over two months. Although participants in the carbon monoxide group increased their knowledge about the carbon monoxide, (χ(2)=6.97, df=1, p=.008), the main and secondary outcomes did not differ significantly between groups. Overall, 32% of participants initiated treatment. This study suggests that a computerized motivational decision support system can lead users to initiate cessation treatment, and that carbon monoxide feedback is not a necessary component.
Journal of substance abuse treatment 05/2013; · 2.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Employment may be an important factor in helping patients with early psychosis to recover rapidly and to avoid involvement in disability and welfare programs. METHODS: This study followed 351 patients with early psychoses, either primary psychoses or substance-induced psychoses, for two years to examine their patterns of competitive employment in relation to service use, psychosocial outcomes, and disability and welfare payments. RESULTS: Workers differed from non-workers at baseline and over two years. At baseline, they had better educational and employment histories, were more likely to have substance-induced psychoses rather than primary psychoses, were less likely to have drug dependence, had fewer negative symptoms, and had better psychosocial adjustment. Over two years, baseline psychosocial differences persisted, and the workers used fewer medications, mental health services, and disability or welfare payments. CONCLUSIONS: Employment predicts less service use and fewer disability claims among early psychosis patients. Thus, greater attention to supported employment early in the course of illness may reduce federal insurance costs and disability payments.
Schizophrenia Research 03/2013; · 4.59 Impact Factor
[show abstract][hide abstract] ABSTRACT: Count data with skewness and many zeros are common in substance abuse and addiction research. Zero-adjusting models, especially zero-inflated models, have become increasingly popular in analyzing this type of data. This paper reviews and compares five mixed-effects Poisson family models commonly used to analyze count data with a high proportion of zeros by analyzing a longitudinal outcome: number of smoking quit attempts from the New Hampshire Dual Disorders Study. The findings of our study indicated that count data with many zeros do not necessarily require zero-inflated or other zero-adjusting models. For rare event counts or count data with small means, a simpler model such as the negative binomial model may provide a better fit.
Journal of substance abuse treatment 02/2013; · 2.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: A high proportion of people with severe mental health problems are unemployed but would like to work. Individual Placement and Support (IPS) offers a promising approach to establishing people in paid employment. In a randomized controlled trial across six European countries, we investigated the economic case for IPS for people with severe mental health problems compared to standard vocational rehabilitation. Individuals (n=312) were randomized to receive either IPS or standard vocational services and followed for 18 months. Service use and outcome data were collected. Cost-effectiveness analysis was conducted with two primary outcomes: additional days worked in competitive settings and additional percentage of individuals who worked at least 1 day. Analyses distinguished country effects. A partial cost-benefit analysis was also conducted. IPS produced better outcomes than alternative vocational services at lower cost overall to the health and social care systems. This pattern also held in disaggregated analyses for five of the six European sites. The inclusion of imputed values for missing cost data supported these findings. IPS would be viewed as more cost-effective than standard vocational services. Further analysis demonstrated cost-benefit arguments for IPS. Compared to standard vocational rehabilitation services, IPS is, therefore, probably cost-saving and almost certainly more cost-effective as a way to help people with severe mental health problems into competitive employment.
World psychiatry: official journal of the World Psychiatric Association (WPA) 02/2013; 12(1):60-8. · 8.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study examined rates of sustainability, defined as program continuation, and factors associated with sustainability 6 years after full implementation of five evidence-based practices in 49 sites in the National Implementing Evidence-Based Practices Project. Based on interviews with agency leaders and state leaders, 47 % of sites sustained the practice for 6 years, 16 % restarted the practice after a period of discontinuation, and 37 % discontinued the practice permanently. Agency leaders from discontinuing sites identified inadequate financial support, lack of prioritization, and workforce issues as barriers to continuation. Adequate financing, ongoing supervision, and monitoring of fidelity and outcome may promote long-term sustainability.
Administration and Policy in Mental Health 12/2012; · 2.09 Impact Factor
[show abstract][hide abstract] ABSTRACT: Individual Placement and Support (IPS) is an evidence-based practice for helping people with severe mental illness (SMI) gain competitive employment, yet those who could benefit often find it difficult to obtain IPS services. We summarize the evidence supporting the effectiveness of IPS and the benefits of working, discuss the barriers to implementing IPS in the U.S., and suggest policy changes that could expand its access.
Administration and Policy in Mental Health 11/2012; · 2.09 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background There is a 20-year delay between the development of effective interventions for individuals with severe mental illness and widespread adoption in public mental health care settings. Academic-provider collaborations can shorten this gap, but establishing and maintaining partnerships entail significant challenges. Aims This paper identifies potential barriers to academic-provider research collaborations and provides guidelines to overcome these obstacles. Method Authors from an academic institution and community mental health organization outline the components of their long-standing partnership, and discuss the lessons learned that were instrumental in establishing the collaborative model. Results Realistic resource allocation and training, a thorough understanding of the service model and consumer characteristics, systemic and bidirectional communication and concrete plans for post-project continuation are necessary at all project phases. Conclusions A shared decision-making framework is essential for effective academic institution and community mental health agency collaborations and can facilitate long-term sustainability of novel interventions.
Journal of Mental Health 10/2012; 21(5):469-77. · 1.01 Impact Factor
[show abstract][hide abstract] ABSTRACT: Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medication adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important outcomes such as engagement, patient-prescriber communication, quality of care, self-management, and long-term clinical and functional outcomes.
Community Mental Health Journal 07/2012; · 1.03 Impact Factor
[show abstract][hide abstract] ABSTRACT: Virtually all studies of the individual placement and support (IPS) model of supported employment measure outcomes for job acquisition, but studies are less consistent in measuring job tenure, hours worked, and employment earnings. Lack of a common set of employment measures limits comparisons across studies and cumulative knowledge about IPS. To lay the groundwork for standardization, this study examined measures in four employment domains and their interrelationships.
Using a combined data set from four randomized controlled trials of IPS, this study examined mean differences between IPS participants (N=307) and participants in other vocational services (control sample) (N=374) in four domains (job acquisition, job duration, hours worked per week, and total hours and wages). Eight competitive employment measures were examined (employed at any time, total weeks worked, tenure in the longest-held job, total hours worked, average hours per week worked, total wages, days to first job, and working ≥ 20 hours per week during follow-up). Correlations between measures within both the IPS and control samples were determined.
IPS participants had significantly better outcomes across all employment measures and domains. Correlations between measures were strong within each domain, but they were variable between domains.
In addition to improving job acquisition, IPS improved job duration, hours worked per week, and total hours and wages. The correlational findings suggest proxy measures to assist meta-analysts in the synthesis of studies for which direct measures are unavailable. Initial steps toward a cross-disciplinary theoretical framework for employment outcomes are described.
[show abstract][hide abstract] ABSTRACT: The individual placement and support (IPS) model of supported employment for people with severe mental illness is an evidence-based practice. The 15-item IPS Fidelity Scale (IPS-15) was developed to measure program fidelity and has been shown to have good psychometric properties, including predictive validity. On the basis of field experience and research updates, the authors developed an expanded and revised version of this scale, the IPS-25, also known as the Supported Employment Fidelity Scale. This study evaluated the psychometric properties of the IPS-25.
In addition to data on the local unemployment rate and program longevity, the authors collected IPS-25 ratings and employment data for 79 sites in eight states participating in a learning collaborative devoted to implementing the IPS model. Descriptive data for items and the total scale and predictive validity were examined.
Internal consistency reliability for the IPS-25 was .88. Predictive validity, measured as the correlation between the IPS-25 and site-level employment rate, was .34. Eight of the IPS-25 items were significantly positively correlated with employment rate. Items related to the vocational generalist role, disclosure, follow-along support, and vocational unit were the most strongly correlated with employment. Program longevity was positively associated with employment, whereas the unemployment rate was not.
The IPS-25 has promising psychometric properties, with greater precision and content coverage than the IPS-15. However, it has not demonstrated an advantage over the IPS-15 in predictive validity. Research directly comparing the two scales is needed.
[show abstract][hide abstract] ABSTRACT: Several national bodies have proposed using mobile technology to improve mental health services. But rates of current use and interest in using technology to enhance services among individuals with serious mental illness are uncertain. The authors surveyed 1,592 individuals with serious mental illness regarding their use of mobile devices and interest in using mobile technologies to enhance mental health services. Seventy-two percent of survey respondents reported currently owning a mobile device, a rate approximately 12 % lower than the general adult population. The most common uses were for talking, followed by texting, and internet activities. Both mobile device users and nonusers expressed interest in future mobile services.
Administration and Policy in Mental Health 05/2012; · 2.09 Impact Factor
[show abstract][hide abstract] ABSTRACT: Employment promotes recovery for persons with serious mental illness by providing extra income and a valued social role, but the impact of employment on other psychosocial and clinical outcomes remains unclear. This study examined non-vocational outcomes in relation to steady employment over 10 years among people with serious mental illness and co-occurring substance use disorders.
Researchers interviewed people with co-occurring disorders at baseline and yearly for 10 years and tracked employment in relation to five non-vocational outcomes: independent living, psychiatric symptoms, substance use disorder, healthy (non-substance-abusing) relationships, and life satisfaction. Latent class trajectory analysis identified steady workers, and mixed-effects regression models compared steady workers with non-workers.
Both steady workers (n=51) and non-workers (n=79) improved substantially; for example, a majority of each group achieved independent housing and stable remission of substance use disorders. Steady workers achieved independent housing and higher quality of life during the first 5 years of follow-up, but the two groups achieved similar outcomes by 10 years.
People with co-occurring disorders can improve markedly. Those with steady employment may improve faster, but those without employment may achieve similar long-term outcomes at a slower pace.
Schizophrenia Research 04/2012; 138(2-3):233-9. · 4.59 Impact Factor
[show abstract][hide abstract] ABSTRACT: This paper summarizes the findings for North America of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. Community mental health has evolved over five decades in the United States and Canada. The United States has led the world in innovation and spending, but provide variable quality of care; Canada has steadily developed a more uniform public health system for less cost. Lessons learned from North America include: team-based approaches and other evidence-based practices, when implemented with high fidelity, can improve outcomes in routine mental health care settings; recovery ideology and peer support enhance care, though they have not been studied rigorously; effective community-based care for people with serious mental disorders is expensive.
World psychiatry: official journal of the World Psychiatric Association (WPA) 02/2012; 11(1):47-51. · 8.97 Impact Factor