Robert E. Drake’s research while affiliated with DeVry College and other places

The Research-to-Practice Gap often hinders the translation of effective healthcare interventions from clinical trials to routine care. Individual Placement and Support (IPS), an evidence-based practice designed to help individuals with mental health conditions achieve and maintain employment, has notably bridged this gap. Unlike many interventions that struggle with widespread implementation, IPS has successfully scaled to over 2,000 programs across all U.S. states and 30 other countries. This paper examines the strategies that have facilitated the rapid and extensive adoption of IPS, offering insights into best practices for integrating randomized controlled trial (RCT) findings into everyday clinical settings. Key factors contributing to the success of IPS include conducting RCTs in settings with real-world patients and clinicians, fostering collaboration through the International IPS Learning Community, developing comprehensive implementation materials and a dynamic fidelity scale, and engaging in regular, systematic meetings with stakeholders such as providers, advocates, and policymakers. These approaches have ensured that IPS remains adaptable, responsive to patient needs, and maintains fidelity to its core principles while promoting continuous improvement. The experience with IPS underscores the importance of integrating real-world evidence with clinical practice through ongoing collaboration among all stakeholders. The principles underpinning IPS—real-world application, stakeholder engagement, and adaptability—provide a model that could guide future efforts to close the research-to-practice gap across diverse healthcare settings and interventions.

Introduction Patients’ beliefs and attitudes about medications play a role in whether they adhere to their medications or not. Knowledge on how beliefs and attitudes about medications can be influenced is therefore important. Objectives The current study aimed to assess whether patients’ perceived support from their therapists regarding use of medications was associated with their beliefs and attitudes about medications. Because non-adherence in patients with psychosis frequently results in relapses and emergencies, this knowledge may be very useful for therapists and patients. Methods This cross-sectional study included 310 patients diagnosed with psychosis from 31 clinical units in Norwegian mental health specialist care. We assessed beliefs about medications using the Beliefs about Medicines Questionnaire (BMQ). BMQ-specific consists of two subscales, BMQ-necessity and BMQ-concerns. Higher score on the necessity subscale indicates stronger beliefs in the necessity of taking the medicine. Higher score on the concern subscale indicates stronger concerns about taking the medicine. We used a newly developed self-report questionnaire, MedSupport, to assess the patients’ perceived support from therapists in dealing with their medications. Higher score on the MedSupport means that the patient experienced more support with decisions related to medications. Linear mixed effect models were used to investigate possible associations of sociodemographic factors, clinical factors and patients’ perceptions of medication support with BMQ. Results Patients’ perceptions of medication support from therapists were positively associated with positive beliefs towards medications, β = 0.20, 95% CI [0.04 to 0.35], p =0.012, and negatively associated with concerns about taking the medications, β = -0.31, 95% CI [-0.44 to -0.17], p < 0.001, when other relevant variables were taken into consideration. Conclusions The present study shows that therapists may affect patients’ beliefs and concerns about medications. Consequently, medication support may lead to improved adherence to medications prescribed. Disclosure of Interest None Declared

Objective: The COVID-19 pandemic prompted a significant shift to delivering early psychosis services using telehealth. Little is known about the experience of using telehealth in early psychosis services. This quality improvement qualitative project investigated the experiences of program participants and family members with telehealth services in OnTrackNY, an early intervention program for psychosis in New York State during the COVID-19 pandemic. Methods: The project team conducted individual interviews and focus groups. Data analyses used a matrix approach. Results: Nineteen OnTrackNY program participants and nine family members participated in five focus groups and nine individual interviews. Data were organized into five themes (a) accessibility: most individuals had a device and internet access and challenges were related to connectivity, such as image freezing and sound breaking; (b) convenience/flexibility: benefits included the reduced commute and costs; (c) levels of comfort/privacy with telehealth: program participants felt less judged and less anxiety leading up to in-person appointments while also expressing privacy concerns; (d) sense of connectedness: in-person social connections were deemed important and not replaceable by telehealth; and (e) suggestions: program participants expressed a preference for in-person group activities and suggested hybrid options, highlighting the importance of in-person visits to establish rapport at the beginning of treatment before transitioning to telehealth. Conclusions: Telehealth services were generally well accepted. Suggestions for future service delivery include offering a combination of telehealth and in-person services based on program participants' preferences and prioritizing in-person services during the early phase of treatment.

Participatory research denotes the engagement and meaningful involvement of the community of interest across multiple stages of investigation, from design to data collection, analysis, and publication. Traditionally, people with first-hand experience of psychiatric diagnoses, service users, and those living with a psychosocial disability have been seen objects rather than agents of research and knowledge production, despite the ethical and practical benefits of their involvement. The state of the art of knowledge about participatory research in mental health Brazil is poorly understood outside of its local context. The purpose of this article was to conduct a scoping review of participatory and user-led research in mental health in Brazil. We identified 20 articles that met eligibility criteria. Participation in research was not treated as separate from participation in shaping mental health policy, driving care, or the broader right to fully participate in societal life and enjoy social and civil rights. Studies identified several obstacles to full participation, including the biomedical model, primacy of academic and scientific knowledge, and systemic barriers. Our extraction, charting, and synthesis yielded four themes: power, knowledge, autonomy, and empowerment. Participation in this context must address the intersecting vulnerabilities experienced by those who are both Brazilian and labeled as having a mental illness. Participatory research and Global South leadership must foreground local epistemologies that can contribute to the global debate about participation and mental health research.

Many people with complex behavioral health conditions are reluctant to access professional services, but little is known about providing outreach and assistance to this population. This report describes the process of delivering care in the Supported Employment Demonstration, a large Social Security Administration study that attempted to engage and provide services to such individuals. In the Supported Employment Demonstration, 60 multidisciplinary teams across the U.S. attempted to provide services and supports to nearly 2000 individuals identified by an initial denial of their disability claims based on a mental health impairment. Most of the participants were initially ambivalent toward or rejecting services. Four experienced quality monitors met with the teams monthly from 2017 through 2021, providing technical assistance and linking teams with consultants. The quality monitors, along with a larger implementation team of consultants, identified common challenges that clinical teams encountered while serving these participants and the strategies they used to overcome barriers. Participants presented with four common challenges: extreme poverty, hesitance to participate in services, complex medical and psychosocial conditions, and dangerous behaviors. To address these barriers, the teams assisted with basic needs, enhanced outreach efforts, accessed expert consultations, and reframed threatening behaviors as reactions to trauma. Many people with serious behavioral health conditions are reluctant to access professional services. These individuals may need help with basic needs, extensive outreach, consultations regarding multiple complex conditions, and professionals who understand their histories of trauma to enable their participation in standard behavioral health and vocational services.

Community mental health nurses sometimes join multi-disciplinary teams, but the role has not been defined and studied carefully. This article describes the psychiatric Nurse Care Coordinator (NCC)—a unique position created to support care management, facilitate systematic medication management, and coordinate medical care in the Social Security Administration’s 30-site Supported Employment Demonstration. The authors reviewed the study’s NCC manual, supervised and consulted with the NCCs weekly over nearly three years, and reviewed data on NCC activities. Although the 984 participants assigned to NCCs experienced numerous mental health, substance use, and chronic medical conditions, only 59% completed intake assessments and engaged over time with NCCs. For those 581 participants, NCCs spent approximately 51% of their time helping with mental health issues, 35% on medical care, and 12% on substance use conditions. The NCC was critically important for complex, high-need individuals.

This Viewpoint discusses the benefits of psychiatrists using individual placement and support to help patients find and maintain employment.

Objective: A few clients in every mental health center present challenging behaviors, have difficulty engaging in services, and create stress within the treatment team. The authors provided consultations on clients with these characteristics over 4 years in the Social Security Administration's Supported Employment Demonstration (SED). Methods: Four experienced community mental health leaders provided consultations on 105 of nearly 2,000 clients receiving team-based behavioral health and employment services in the SED. Using document analysis, consultants coded their notes and identified themes that described barriers to client engagement and strategies teams used to overcome them. Results: Clients who were difficult to engage experienced complex and interacting behavioral health, medical, and social conditions, which made it hard for therapists to develop therapeutic relationships and help clients find employment. Faced with engagement barriers, staff were often discouraged and felt hopeless about achieving success. To address these barriers, consultants and teams developed several strategies: using supervisors and teammates for support, providing persistent outreach, pursuing referrals and consultations to help with complex conditions, and developing realistic goals. Conclusions: Supervisors, team leaders, and consultants in community mental health settings should help staff develop realistic strategies to manage the small number of clients whose behaviors present the greatest challenges. Effective strategies involve providing team-based outreach and support, fostering staff morale, obtaining specialist consultations regarding complex conditions, and calibrating realistic goals.

Individual placement and support (IPS) was the primary intervention in the United States Social Security Administration’s supported employment demonstration (SED), a large randomized trial that sought to increase employment and reduce disability among those whose first application for disability benefits was denied. Researchers developed a measure of participation in IPS services to quantify participation among enrollees assigned to receive IPS. The IPS participation measure, which IPS teams completed monthly for individual clients, recorded clients assigned to IPS as being either out of contact with their IPS treatment teams or, if in contact, according to their employment status (employed or not employed) and receipt of IPS job search services (participating or not participating). The measure also recorded types of IPS activities and reasons for non-participation. IPS teams completed the IPS participation measure at a rate of approximately 95% each month. Between 27 and 35% of enrollees assigned to a treatment condition participated in IPS services each month during the first 24 months of measurement. The most common activities were applying for jobs and attending job interviews. Most of those out of contact were not responding to outreach efforts (58–72%). Those in contact but not participating despite being unemployed were typically either uninterested in employment (20–44%) or difficult to reach (10–16%). As IPS expands to serve new populations, it will be important to document and understand the links between individual characteristics, variance in participation patterns, and employment outcomes. Subsequent analyses of SED data will investigate these relationships among enrollees.

Transitioning from military service is stressful for veterans with service-connected disabilities seeking civilian employment. This descriptive study examined self-assessed mental health, well-being, and substance use of men and women shortly before or after transition from US military service, compared to norms from community and military samples. As part of a prospective study evaluating an innovative employment program, researchers interviewed 229 current and former service members with service-connected disabilities transitioning from U.S. military service. Compared to published norms, respondents reported significantly poorer outcomes on 5 of 6 standardized measures, indicating less life satisfaction, poorer mental health, more symptoms of depression and posttraumatic stress disorder, and greater financial distress. In the previous year, 42% were prescribed opioid medications, over twice the annual opioid prescription rate of 19% in the general US population. Systematic strategies are needed to ensure access for transitioning veterans with serious behavioral health issues to appropriate evidence-based practices.