Fostering the community participation of individuals with psychiatric disabilities: Effectiveness of a new peer-led photovoice-based intervention.

OBJECTIVE: Having meaningful social roles and full community participation have been examined as a central tenet of the recovery paradigm. We undertook this study to test a new multimodal, peer-led intervention, which we have developed with the aim of fostering the self-efficacy of individuals with psychiatric disabilities to pursue involvement in community activities of their choice. METHOD: We evaluated the effectiveness of the 6-month manualized peer-delivered "Bridging Community Gaps Photovoice (BCGP)" program with a multisite randomized trial (N = 185), with recipients of services at five community mental health programs. Mixed-effects regression models were used to examine the impact of the program on community participation, loneliness, personal stigma, psychosocial functioning, and personal growth and recovery when compared to services as usual. Individuals who were randomized to the BCGP intervention were also invited to participate in exit focus groups, exploring the program's perceived active ingredients of mechanisms of impact. RESULTS: Participation in the BCGP program facilitated ongoing involvement in community activities and contributed to a decreased sense of alienation from other members of the community due to internalized stigma of mental illness. In addition, greater attendance of group BCGP sessions had a significant impact on participants' sense of self-efficacy in pursuing desired community activities. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study provided initial evidence about the promise of the BCGP program in enhancing community participation. Its implementation in community mental health agencies can further expand the recovery-oriented services provided to people with psychiatric disabilities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Predictors of Sustained Employment Among Individuals With Serious Mental Illness: Findings From a 5-Year Naturalistic Longitudinal Study.

Despite decades of research, understanding of the employment trajectories of individuals with serious mental illnesses remains elusive. We conducted a 5-year prospective, longitudinal study using a geographically broad sample of individuals who met established criteria for sustained competitive employment (N = 529). We collected data on an annual basis with a specifically designed survey instrument. Despite stable employment at study entry, more than half of the participants experienced work interruptions during the 5-year follow-up period. Predictors of sustained employment included the absence of a trauma diagnosis, Social Security disability income, psychiatric hospitalizations, and difficulties with daily functioning. The presence of a higher quality of life, workplace supports, and a flexible job were also predictive. Results dispel the myth that people with serious mental illnesses cannot be employed for prolonged periods. Interruptions in work trajectories, however, suggest that longer-term supports may increase individuals' capacity to maintain stable employment.

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

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

Using Photovoice and Asset Mapping to Inform a Community-Based Diabetes Intervention, Boston, Massachusetts, 2015.

INTRODUCTION: Diabetes self-management takes place within a complex social and environmental context.  This study's objective was to examine the perceived and actual presence of community assets that may aid in diabetes control. METHODS: We conducted one 6-hour photovoice session with 11 adults with poorly controlled diabetes in Boston, Massachusetts.  Participants were recruited from census tracts with high numbers of people with poorly controlled diabetes (diabetes "hot spots").  We coded the discussions and identified relevant themes.  We further explored themes related to the built environment through community asset mapping.  Through walking surveys, we evaluated 5 diabetes hot spots related to physical activity resources, walking environment, and availability of food choices in restaurants and food stores. RESULTS: Community themes from the photovoice session were access to healthy food, restaurants, and prepared foods; food assistance programs; exercise facilities; and church.  Asset mapping identified 114 community assets including 22 food stores, 22 restaurants, and 5 exercise facilities.  Each diabetes hot spot contained at least 1 food store with 5 to 9 varieties of fruits and vegetables.  Only 1 of the exercise facilities had signage regarding hours or services.  Memberships ranged from free to $9.95 per month.  Overall, these findings were inconsistent with participants' reports in the photovoice group. CONCLUSION: We identified a mismatch between perceptions of community assets and built environment and the objective reality of that environment. Incorporating photovoice and community asset mapping into a community-based diabetes intervention may bring awareness to underused neighborhood resources that can help people control their diabetes.

Exploring the work lives of adults with serious mental illness from a vocational psychology perspective.

Current vocational services for adults with serious mental illness remain largely atheoretical and disconnected from mainstream vocational psychology research and practice. This study explored the perspectives on work of adults with serious mental illness, compared perspectives of young and older adults, and assessed these perspectives for the applicability of a well-established theory of vocational psychology. A national sample of 76 individuals with mental illness engaged in the workforce completed a semistructured questionnaire. We applied the principles of a participatory approach to consensual qualitative research methodology in the study design and data analysis. Results yielded a large number of categories, which clustered under domains representative of the primary constructs of social cognitive career theory (SCCT; Lent, 2013). These domains included the antecedents of self-efficacy, namely, personal accomplishments, vicarious learning, social persuasion, and physical or emotional states as well as additional constructs of outcome expectations, personal goals, and contextual barriers. The SCCT model will likely provide a useful framework to bridge the gap between career development theory and vocational services for individuals with mental illness.

Patient navigation and financial incentives to promote smoking cessation in an underserved primary care population: A randomized controlled trial protocol.

Despite the high risk of tobacco-related morbidity and mortality among low-income persons, few studies have connected low-income smokers to evidence-based treatments. We will examine a smoking cessation intervention integrated into primary care. To begin, we completed qualitative formative research to refine an intervention utilizing the services of a patient navigator trained to promote smoking cessation. Next, we will conduct a randomized controlled trial combining two interventions: patient navigation and financial incentives. The goal of the intervention is to promote smoking cessation among patients who receive primary care in a large urban safety-net hospital. Our intervention will encourage patients to utilize existing smoking cessation resources (e.g., quit lines, smoking cessation groups, discussing smoking cessation with their primary care providers). To test our intervention, we will conduct a randomized controlled trial, randomizing 352 patients to the intervention condition (patient navigation and financial incentives) or an enhanced traditional care control condition. We will perform follow-up at 6, 12, and 18 months following the start of the intervention. Evaluation of the intervention will target several implementation variables: reach (participation rate and representativeness), effectiveness (smoking cessation at 12 months [primary outcome]), unintended consequences (e.g., purchase of illicit substances with incentive money), adoption (use of intervention across primary care suites), implementation (delivery of intervention), and maintenance (smoking cessation after conclusion of intervention). Improving the implementation of smoking cessation interventions in primary care settings serving large underserved populations could have substantial public health impact, reducing cancer-related morbidity/mortality and associated health disparities.

A randomized controlled trial of a peer-run antistigma photovoice intervention.

OBJECTIVE: Psychiatric stigma is a major barrier to the recovery of persons with serious mental illnesses. This study tested the efficacy of an innovative peer-run photography-based intervention, called antistigma photovoice, which targets self-stigma and promotes proactive coping with public stigma. METHODS: A total of 82 individuals with serious mental illnesses enrolled at a university-based recovery center were randomly assigned to the antistigma photovoice program or to a wait-list control group. Mixed-effects regression models were used to examine the impact of photovoice on self-stigma, coping with stigma, empowerment, perceived recovery, self-efficacy, and depression. RESULTS: Participation in the photovoice intervention was associated with significantly reduced self-stigma, greater use of proactive coping with societal stigma, greater increase in a sense of community activism, and perceived recovery and growth. CONCLUSIONS: The photovoice intervention demonstrated promise for reducing self-stigma and enhancing proactive coping with prejudice and discrimination.

Patterns of employment among individuals with mental illness in vocational recovery.

This article provides empirical evidence about the patterns of competitive employment among individuals with serious mental illness who are in vocational recovery. The findings are based on a 5-year longitudinal study on sustained employment, conducted with a national sample of 529 individuals with serious mental illness who were in vocational recovery at the time of study enrollment. Data analysis from the 328 participants who completed the study-from baseline through all five annual follow-up assessments-revealed three different postrecovery employment patterns: continuous, stable, and fluctuating. Although many participants demonstrated the capacity to sustain competitive employment during prolonged periods of time, others experienced employment interruptions. Work interruptions were most frequently attributed to exacerbation of psychiatric symptoms. Schizophrenia spectrum disorder, difficulties with daily functioning, and current receipt of disability benefits predicted the psychiatric-based work interruptions in this sample. Implications for clinical practice are also discussed.