Judith A. Cook

University of Illinois at Chicago | UIC · Department of Psychiatry (Chicago)

The current demand for mental health services is exacerbated by an ongoing shortage of behavioral health care providers in the United States. The Health Resources and Services Administration has identified 5,833 Mental Health Professional Shortage Areas (MHPSAs), many of which are rural, and could be served by Certified Peer Specialists (CPSs). Thi...

Objective: Self-directed care (SDC) is a treatment model in which recipients self-manage funds designated for provision of services. The model is designed to cost no more than traditional services while achieving superior participant outcomes. The authors examined the model's impact on outcomes, service costs, and user satisfaction among medically...

Objective: The purpose of this study was to examine the efficacy of the Nutrition and Exercise for Wellness and Recovery (NEW-R) intervention for improving competency and behaviors related to diet, physical activity, and weight management. Methods: Participants with psychiatric disabilities were recruited from four community mental health agenci...

Objective: The authors sought to determine whether staff at a peer-run agency could deliver supported employment services with high fidelity to the individual placement and support (IPS) model and whether employment outcomes of peer-delivered IPS plus work-specific health promotion were superior to usual supported employment services. Methods: T...

Certified peer specialists (CPSs) are a growing workforce that uses their lived experience of a behavioral health disorders plus skills learned in formal training to deliver support services. Despite their important role in the mental health care system and research on their working conditions, experiences of burnout have not been widely studied am...

Objective: A 3-year study explores employment outcomes of certified peer specialists (CPSs). Analyses reported here identified relationships between demographic, clinical, work history, and geographic characteristics and employment status and current employment in peer services jobs versus other jobs. Methods: The study recruited adults who rece...

Objective: Little is known about the employment experiences of people with preexisting behavioral health conditions during the coronavirus disease of 2019 (COVID-19) pandemic, despite the recognized importance of work for this group. Method: Two hundred and seventy two adults with behavioral health conditions, recruited through statewide mental...

Objective: Longitudinal changes in health outcomes of patients with serious mental illness and co-occurring diabetes were examined after introduction of an intervention involving electronic disease management, care coordination, and personalized patient education. Methods: This observational cohort study included 179 patients with serious mental...

People with behavioral health disorders may be particularly vulnerable to the impact of the COVID-19 pandemic, yet little is known about how they are faring. A mixed-methods, anonymous needs assessment was conducted to understand changes in the lives of adults with mental health and substance use disorders since the pandemic onset. A cross-sectiona...

Objective Prior research has not addressed whether both serious mental illness (SMI) and other mental health (OMH) disorders affect the likelihood of 30-day readmissions after medical hospitalizations, or whether post-discharge use of outpatient medical, mental health, and pharmacy services is associated with readmission likelihood. Methods Using...

Objective: Adults with serious mental illness have high rates of general medical comorbidity and encounter challenges in dealing with multiple health conditions. Chronic illness self-management programs may help them more effectively cope with comorbid illnesses, especially when instructors are certified peer specialists. This study assessed the l...

While evidence suggests that adults with serious mental illness have an elevated rate of 30-day readmissions after medical hospitalizations, most studies are of patients who are privately insured or Medicare beneficiaries, and little is known about the differential experiences of people with schizophrenia, bipolar disorder, and major depression. We...

Objective:: Self-directed care allows individuals with disabilities and elderly persons to control public funds to purchase goods and services that help them remain outside institutional settings. This study examined effects on outcomes, service costs, and user satisfaction among adults with serious mental illness. Methods:: Public mental health...

We used the World Health Organization’s Composite International Diagnostic Interview to determine the prevalence, comorbidity, and correlates of lifetime and 12-month behavioral health disorders in a multisite cohort of 1027 women living with HIV in the United States. Most (82.6%) had one or more lifetime disorders including 34.2% with mood disorde...

As the authors complete the 2017 publication cycle of Psychiatric Rehabilitation Journal and their term as editors draws to a close, they take the opportunity to welcome the new leadership of PRJ , to thank the many people who have contributed to its success, and to reflect on the importance of the journal’s focus and scope to the field. They are p...

Objective: Psychological risk factors (PRFs) are associated with impaired learning and memory in HIV-infected (HIV+) women. We determined the dynamic nature of the effects of PRFs and HIV serostatus on learning and memory over time. Design: Multi-center, prospective cohort study METHODS:: Every two years between 2009 and 2013 (3 times), 646 HIV+...

Objective: Recovery from mental illness is influenced by one's social location along multiple dimensions of identity, such as race, class, gender, age, and ability, and by how these social locations are expressed through structural and institutional barriers. This project was developed using an intersectional policy analysis framework designed to...

Objective: As part of a study of health status among 457 adults with diagnostically heterogeneous serious mental illnesses served by the public mental health system in four U.S. states, we assessed predictors of current cigarette smoking. Methods: We examined bivariate relationships between smoking status and risks for drug and alcohol use disor...

The prevalence of depression among women living with HIV/AIDS is elevated, compared with women in the general population and men diagnosed with HIV/AIDS. Although symptoms of HIV may overlap with somatic symptoms of depression, little research has explored how well screening tools accurately assess depression rather than symptoms of HIV/AIDS among...

As psychiatric rehabilitation practitioners, we have solid evidence that our field’s services are effective in helping people become employed, participate in social and civic life, avoid restrictive and coercive psychiatric treatment, and thrive in stable and secure community residences. Yet, hundreds of thousands of people with psychiatric disabil...

Objective: This study examined the prevalence and correlates of co-occurring obesity and diabetes among community mental health program members. Methods: Medical screenings of 457 adults with serious mental illnesses were conducted by researchers and peer wellness specialists in four U.S. states. Body mass index was measured directly. Diabetes w...

Work is one of the most valued social rules in modern society, contributing to a person’s sense of economic well-being, self-esteem, personal identity, and social status. Conversely, the inability to work or sustain employment due to a psychiatric condition is the primary factor in determining eligibility for disability benefits, such as Social Sec...

The prevalence of obesity and its associations with gender, clinical factors, and medical co-morbidities were examined among 457 adults attending public mental health programs in 4 U.S. states. BMI was measured directly and other information was gathered by interview. Over half (59 %, n = 270) were obese including 18 % (n = 83) who were morbidly ob...

Motivational interventions help people with mental illness try to quit smoking, but few studies have evaluated factors associated with this groups’ cessation with community treatment. We examined predictors of abstinence after a brief motivational intervention among smokers with severe mental illness. Education, stage of change post intervention, a...

Objective: This study examines the long-term effects of evidence-based supported employment services on three vocational outcomes: labor force participation, earnings, and attainment of Social Security Administration (SSA) nonbeneficiary status through suspension or termination of disability cash payments due to work (NSTW). Method: Data from 44...

The year 2010 saw passage of an historic piece of legislation in Public Law 111-148, entitled the Patient Protection and Affordable Care Act or ACA (2010). Since that time, the ACA has contributed to a number of improvements to the U.S. health care system including a large decrease in the number of uninsured individuals, substantially expanded acce...

The authors of this editorial discuss whether or not the value of exercise is being underestimated for wellness. One response to these alarming findings has been to develop or adapt illness self-management programs specifically targeting frequently co-occurring physical disorders in this population, such as diabetes, hypertension, and coronary arte...

The prevalence of post-traumatic stress disorder (PTSD) is higher among HIV-infected (HIV+) women compared with HIV-uninfected (HIV-) women, and deficits in episodic memory are a common feature of both PTSD and HIV infection. We investigated the association between a probable PTSD diagnosis using the PTSD Checklist-Civilian (PCL-C) version and verb...

We explored the relative effects of adverse working conditions, job satisfaction, wages, worker characteristics, and local labor markets in explaining voluntary job separations (quits) among employed workers with psychiatric disabilities. Data come from the Employment Intervention Demonstration Program in which 2,086 jobs were ended by 892 workers...

The focus of community health workers on health disparities in vulnerable communities means that they address issues of poverty, while many recipients of psychiatric rehabilitation services live at or below the poverty line. Their focus on improving health in low-income populations of color is in line with some of our field's biggest challenges at...

Presentation to the Texas Health and Human Services Commission on June 26, 2014

Physical health screenings were conducted by researchers and peer wellness specialists for adults attending publicly-funded community mental health programs. A total of 457 adults with serious mental illnesses attended health fairs in 4 U.S. states and were screened for 8 common medical co-morbidities and health risk factors. Also assessed were sel...

This purpose of this study was to evaluate the Nutrition and Exercise for Wellness and Recovery (NEW-R) weight loss intervention. Using a pretest/posttest design, 18 participants recruited from a community-based mental health program were assessed at baseline, immediately following the intervention (8 weeks), and at 6-month follow-up. The intervent...

In contrast to findings from cohorts comprised primarily of HIV-infected men, verbal memory deficits are the largest cognitive deficit found in HIV-infected women from the Women's Interagency HIV Study (WIHS), and this deficit is not explained by depressive symptoms or substance abuse. HIV-infected women may be at greater risk for verbal memory def...

This study examined the prevalence and treatment of 17 co-occurring physical health conditions among adults with serious mental health disorders, and factors associated with prevalence of the 5 most common medical co-morbidities. Data were collected from 457 adults attending publicly funded mental health programs who participated in community healt...

This editorial reviews the challenges of treating people who first experience a psychotic episode, and the core elements of effective programs for these individuals. It then describe the NIMH Recovery After Initial Schizophrenia Episode (RAISE) initiative, and other related developments in the U.S., and their implications for psychiatric rehabilita...

Objective: This multisite study examined outcomes of mothers with mental illnesses receiving integrated clinical, rehabilitation, and parenting services for their preschool-age children. Mothers' outcomes included independent living and employment status, custody loss and reunification, psychiatric hospitalization, and substance abuse. Method: R...

Depression has been shown to moderate the effects of physical illness self-management (ISM) programs. We attempted to replicate these findings for a mental ISM intervention. Outpatients with serious mental illness (N = 428) from eight Tennessee communities were randomly assigned to receive a peer-led self-management intervention called Building Rec...

Despite many challenges, recent developments in the field of psychiatric rehabilitation offer opportunities for an increased focus on serving parents with psychiatric disabilities and their children. One such trend is the growth of psychosocial rehabilitation (PSR) programs that serve children and youth. The new Certificate in Children's Psychiatri...

We evaluated the separate and interactive associations of menopausal stage, menopausal symptoms, and human immunodeficiency virus (HIV) infection with cognition. We hypothesized that HIV-infected perimenopausal women would show the greatest cognitive difficulties and that menopausal symptoms would be inversely associated with cognition. This cross-...

This study addressed whether psychopharmacologic and psychotherapeutic treatment of depressed HIV+ women met standards defined in the best practice literature, and tested hypothesized predictors of standard-concordant care. 1,352 HIV-positive women in the multi-center Women's Interagency HIV Study were queried about depressive symptoms and mental h...

This study addressed whether psychopharmacologic and psychotherapeutic treatment of depressed HIV+ women met standards defined in the best practice literature, and tested hypothesized predictors of standard-concordant care. 1,352 HIV-positive women in the multi-center Women's Interagency HIV Study were queried about depressive symptoms and mental h...

The active involvement of consumers with a serious mental illness as partners in their own treatment and the facilitation of illness self-management strategies are hallmarks of recovery-oriented services. The articles in this special issue are evidence of the explosion in the development, evaluation, adaptation, and implementation of programs aimed...

Objective: The purpose of this study was to assess the impact of a mental illness self-management intervention, called Wellness Recovery Action Planning (WRAP), on the use of and need for mental health services over time compared with nutrition and wellness education. Method: Participants were recruited from outpatient community mental health se...

Many individuals with major mental disorders live with medical comorbidities that contribute to poor quality of life and shortened life span (Parks, Svendsen, Singer, Foti, & Mauer, 2006). We conducted a study to screen for, identify, and document co-occurring physical health conditions, health risk factors, and use of health care services among in...

In an ecological model of obesity, people in obesogenic environments struggle against a culture that promotes high-fat, sugar-laden foods and sedentary behaviors. The average American lives in obesogenic environments that are behaviorally determined by poor diet and lack of exercise. For people with psychiatric disabilities, obesogenic environments...

Trauma can affect anyone's life. However, some people are more likely than others to have experienced trauma in their lives and are more sensitive to its effects. In particular, people with a serious mental illness tend to have been exposed to high levels of trauma, both before and after the onset of their mental illness, and not surprisingly they...

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 unkno...

People with psychiatric disabilities often face complex financial situations that make them unable to exercise choice in how their financial resources are allocated to needs including health care, housing, education, leisure pursuits, and other important life activities. One avenue to address these barriers is by helping people increase their finan...

Supported Employment (SE) can help transition age youth and young adults to obtain employment and develop meaningful careers and financial security. The purpose of this analysis is to examine the role of SE in achieving employment outcomes for youth (ages 18-24) and young adults (ages 25-30), compared to outcomes for older adults. Given the importa...

Two articles in the current issue of the Psychiatric Rehabilitation Journal bring into focus the important question of the importance of work, and in particular meaningful employment, in people with a serious mental illness. Gewurtz, Cott, Rush, and Kirsh (see record 2012-34112-003) present findings from a change in policy in Canada for the funding...

Objective: People with severe mental illnesses are more likely to have nicotine dependence than the general population and do not use effective cessation treatment when they try to quit. Previous research has shown that a web-based motivational decision support system tailored for this population is associated with increased use of evidence-based c...

Objective: The risk of clinically significant depressive symptoms increases during perimenopause. With highly active antiretroviral treatment (HAART), more human immunodeficiency virus (HIV)-infected women survive to transition through menopause. In a cross-sectional analysis, we evaluated the association of menopausal stage and vasomotor symptoms...

Background: The prevalence of depressive disorders (DD) was assessed in a multi-site cohort of Women's Interagency HIV Study (WIHS) HIV+ participants. We hypothesized that: 1) DD prevalence would be higher than among women in the general population; and 2) those with treated DD would be more likely than untreated women to be on highly active antire...

Background: We assessed prevalence of medical co-morbidities among adults with serious mental illnesses via community health fairs at which peer health educators reviewed results with participants post-assessment. We hypothesized that co-morbidities would be more prevalent than in the general population, and predicted significant post-test improvem...

With this issue of Psychiatric Rehabilitation Journal, we reflect on the fact that change is a constant in our society and in the field of psychiatric rehabilitation. With this editorial, we would also like to inform our readership about a number of exciting changes to the Psychiatric Rehabilitation Journal. (PsycINFO Database Record (c) 2012 APA,...

HIV-infected women with excessive alcohol consumption are at risk for adverse health outcomes, but little is known about their long-term drinking trajectories. This analysis included longitudinal data, obtained from 1996 to 2006, from 2,791 women with HIV from the Women's Interagency HIV Study. Among these women, the proportion in each of five dist...

The purpose of this study was to test the effectiveness of the Wellness Recovery Action Planning (WRAP) self-management intervention in reducing depression and anxiety and in increasing self-perceived recovery among individuals with a serious mental illness. Participants were recruited from outpatient community mental health settings in six Ohio co...

This study examined the effectiveness of the Building Recovery of Individual Dreams and Goals (BRIDGES) peer-led education intervention in empowering mental health consumers to become better advocates for their own care. A total of 428 adults with mental illness were randomly assigned to BRIDGES (intervention condition) or a services as usual wait...

A fundamental aspect of successful illness self-management for people with serious mental illnesses is the ability to advocate for themselves in health and rehabilitation settings. This study reports findings from a randomized controlled trial comparing propensity for patient self-advocacy among those who received a peer-led mental illness self-man...

Background. HIV-infected women with excessive alcohol consumption have an increased risk of adverse health outcomes, but little is known about their long-term drinking trajectories. Our objectives were to identify long-term drinking trajectories in women with and without HIV infection, and to identify characteristics associated with distinct drinki...

Research literature exploring the importance of service integration to positive employment outcomes is relatively sparse. One study in this area was conducted by Drake and colleagues (2003), and focused on the Individual Placement and Support (IPS) model of supported employment (SE). Investigators analyzed quantitative and qualitative data from thr...

This issue of Psychiatric Rehabilitation Journal focuses on the peer-delivered wellness recovery services. A growing body of evidence suggests that peer-provided, recovery-oriented mental health services produce outcomes as good as and, in some cases superior to, services from non-peer professionals. The field of psychiatric rehabilitation has long...

Depression is common among HIV-infected women, predicts treatment nonadherence, and consequently may impact vertical transmission of HIV. We report findings from a study evaluating preconception, pregnancy, and postpartum depressive symptoms in HIV-infected vs. at-risk, HIV-uninfected women. We examined the prevalence and predictors of elevated per...

Recent in vitro and in vivo research has suggested that cocaine has a direct effect on the pathogenesis of AIDS. These findings are confirmed by epidemiological studies linking the use of injected, inhaled, and smoked (crack) cocaine and indicators of HIV disease progression, even among adherent users of highly active antiretroviral therapy. Recent...

On average, people with serious mental illnesses die 25 years earlier than the general population, and 60% of these deaths are due to preventable, treatable medical conditions such as cardiovascular disease, diabetes, and high blood pressure. Access to medical treatment and coordination of care is also poor due to inadequate insurance coverage and...

The purpose of this study was to determine the efficacy of a peer-led illness self-management intervention called Wellness Recovery Action Planning (WRAP) by comparing it with usual care. The primary outcome was reduction of psychiatric symptoms, with secondary outcomes of increased hopefulness, and enhanced quality of life (QOL). A total of 519 ad...

Numerous studies have shown that substantial proportions of individuals with psychiatric disabilities have annual incomes falling at or below the federal poverty level. Other studies have shown that asset development programs can enhance the economic security of low-income populations. The purpose of this report was to describe how asset developmen...

Previous studies of the association of the C17T polymorphism of the mu opiate receptor gene with substance dependence compared cases with substance dependence to controls and usually found no significant association. However, the studies were limited by small sample size-no study had more than 12 subjects with the TT genotype, a genotype that is ra...

Peer-led education interventions have the potential to provide mental health consumers with the knowledge, skills and support they need to live successful and rewarding self-determined lives. However, few studies have explored whether and how these interventions enhance recovery. This study addresses this knowledge gap by examining changes among 16...

Studies indicate that asset development programs such as Individual Development Accounts (IDAs) can enhance the economic security of low-income populations; however, only a handful of asset development programs have been implemented specifically to serve people with psychiatric disabilities, and larger programs have not collected disability-specifi...

The purpose of this analysis was to evaluate the outcomes of two statewide initiatives in Vermont and Minnesota, in which self-management of mental illness was taught by peers to people in mental health recovery using Wellness Recovery Action Planning (WRAP). Pre-post comparisons were made of reports from 381 participants (147 in Vermont and 234 in...

The study explored perceptions of adults with psychiatric disabilities regarding cultural competency of peer-run mental health support groups and programs. Methods: Web survey respondents were recruited via mental health list-servs, web sites, newsletters, emails, and word of mouth. A total of 527 peers were surveyed about cultural competency barri...

This article describes a curricular transformation initiative, the Recovery Education in the Academy Program (REAP), spearheaded by the University of Illinois at Chicago's National Research and Training Center on Psychiatric Disability. REAP is designed to integrate principles of recovery, self-determination, and other evidence-based practices for...

This article describes a public-academic collaboration between a university research center and the Texas state mental health authority to design and evaluate a unique "money follows the person" model called self-directed care (SDC). SDC programs give participants control over public funds to purchase services and supports for their own recovery. T...

In this special section, we present a series of articles describing the work of the National Research and Training Center on Psychiatric Disability, located at the University of Illinois at Chicago, Department of Psychiatry. The effectiveness of peer–led education in a supportive group context is the topic of the first article. The next article foc...

In the 1990s, US welfare reform legislation imposed a 5-year lifetime limit on financial support for low-income families with young children (younger than 18 years). With increasing numbers of single mothers and their children reaching the end of their welfare eligibility, there is concern about potentially high rates of untreated psychiatric and s...

Hazardous alcohol consumption among women with human immunodeficiency virus (HIV) infection is associated with several adverse health and behavioral outcomes, but the proportion of HIV-positive women who engage in hazardous drinking over time is unclear. The authors sought to determine rates of hazardous alcohol consumption among these women over t...

This study examined changes in psychosocial outcomes among participants in an eight-week, peer-led, mental illness self-management intervention called Wellness Recovery Action Planning (WRAP). Eighty individuals with serious mental illness at five Ohio sites completed telephone interviews at baseline and one month after the intervention. Paired t t...

Depression is a common condition among patients with HIV. This paper uses panel data for 1234 participants from the Women's Interagency HIV Study to estimate the effect of antidepressant use on the likelihood of being employed among women receiving highly active antiretroviral therapy (HAART) in the United States from 1996 to 2004. We show that nai...

This study examined the relationship between levels of depressive symptoms and subsequent increases in substance use among 784 youth with severe emotional disturbance enrolled in Medicaid-funded behavioral health care plans. Youth at five sites nationwide were interviewed about their emotional and behavior problems, as well as their use of cigarett...

Longitudinal associations between patterns of crack cocaine use and progression of HIV-1 disease are poorly understood, especially among women. This study explores relationships between crack use and HIV-1 disease outcomes in a multicenter cohort of infected women. Subjects were 1686 HIV-seropositive women enrolled at six US research centers in the...

Self-directed care programs give participants control over public funds to purchase services and supports for their own recovery. Data were examined for 106 individuals and showed that compared with the year before enrollment, in the year after enrollment, participants spent significantly less time in psychiatric inpatient and criminal justice sett...

IntroductionHomelessness, Mental Illness, and Substance AbuseTreatment Programmes and OutcomesThe Access ProgrammeThe Access Illinois ProgrammeConclusions References