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).

Client, family, and clinician experiences of Open Dialogue-based services.

The last 2 decades have seen tremendous growth in programs to address first-episode psychosis, which typically affects adolescents and young adults. Open Dialogue is a program that has shown promise in FEP treatment in Finland and is gaining popularity internationally. Implementation of this model in cultural and health care contexts that differ from Finland has not been studied. We conducted a qualitative study as part of the first pilot study of Open Dialogue in the United States to understand factors critical for implementation of the model. We interviewed 6 clients, 10 family members, and 9 clinicians. They identified several unique and beneficial features of the approach, focusing particularly on the value of family involvement, transparency, respectfulness, and the collaborative nature of Open Dialogue. Contextual factors, particularly regarding funding for this model in the current United States health care environment, are key determinants to address for future implementation of Open Dialogue in the United States. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Ready to roll: Strategies and actions to enhance organizational readiness for implementation in community mental health.

Background: Organizational readiness for implementation (ORI) is a barrier to disseminating recovery-oriented evidence-based practices for people with severe mental illnesses. However, there is a knowledge gap regarding implementation strategies and specific actions related to those strategies that may enhance ORI across organizations. The Transtheoretical Model (TTM) is a well-established stage-based model used to support organizational change. In TTM, the first three stages-Pre-contemplation, Contemplation, and Preparation-represent the pre-implementation phase, during which ORI should be developed. This study explored ORI enhancement strategies reported as useful by different stakeholders in the field of community mental health (CMH) and tested the applicability of the TTM readiness stages as an organizing framework to direct ORI development. Methods: The study included the following two phases: (1) a qualitative exploration of ORI enhancement actions reported by various stakeholders in the CMH field (N = 16) based on their experience in successful implementation projects and (2) a consolidation process performed by the research team to create coherent groups of actions and their overarching implementation strategies per readiness stage. Results: A comprehensive list of strategies and related actions was created. The strategies and actions correspond with each of the first three stages of the TTM. Stakeholders differed in their methods of facilitating engagement across the organization and in their level of involvement in developing ORI. Conclusions: This study is a first step in conceptualizing a systematic process for developing ORI using the TTM as a theoretical framework. Future studies should test the transferability and effectiveness of this repository to other implementation efforts, expend the lists per stage, and further explore differences between stakeholders' role in ORI development. Plain language abstract: Interventions that were proven effective in supporting the recovery of people with mental illnesses are not sufficiently available in the field of community mental health. One barrier to getting those interventions implemented is the lack of willingness and preparedness of organizations to change their practice, also referred to as organizational readiness for implementation (ORI). Little is known about how to enhance ORI to increase the availability of interventions. This study explored actions used to enhance ORI by people in different roles who successfully implemented new recovery-oriented interventions in community mental health settings. The actions were organized into three stages of readiness development based on the Transtheoretical Model (TTM) of behavioral change. Differences were found between administrators, consultants, supervisors, and providers in the type and number of strategies they described. The results show the applicability of the TTM as an organizing framework for ORI development and provide sets of strategies and specific actions to support different readiness needs across the organization.

Empowering individuals with mental illness to develop healthy eating habits through mindful eating: results of a program evaluation.

INTRODUCTION: Lifestyle factors like unhealthy eating habits contribute significantly to high rates of obesity and cardiovascular disease, and premature mortality among individuals with serious mental illness (SMI). Approaches focusing only on nutritional education and portion control do not address underlying challenges, e.g. effects of medication, mood, stress and anxiety on eating behaviors. We developed a program to enhance self-efficacy and self-regulation based on mindful eating. Mindful eating has been effective in reducing obesity related eating patterns in other populations, but these studies have not included individuals with SMI. METHODS: Forty six individuals participated over four rounds of the 14-week mindful eating and nutrition education program, responded to questionnaires about eating behaviors and provided qualitative feedback between January 2013 and December 2016. RESULTS: Pre-post analysis of the Mindful Eating Questionnaire and the Three Factor Eating Questionnaire showed that participants ate with significantly greater awareness, less distraction, greater cognitive restraint, and engaged less in over eating and emotional eating at the end of the program. The program was well-received by participants. CONCLUSIONS: Mindful eating could improve the long term success of interventions to address unhealthy eating among individuals with SMI. More research is needed with rigorous experimental design, larger samples, and different settings.

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

Randomized controlled trial of an internet cognitive behavioral skills-based program for auditory hallucinations in persons with psychosis.

OBJECTIVE: Despite strong evidence supporting the effectiveness of cognitive-behavioral therapy for psychosis (CBTp), most clinicians in the United States have received little or no training in the approach and access remains very low, indicating a potential role for technology in increasing access to this intervention. Coping With Voices (CWV) is a 10-session, interactive, Web-based CBTp skills program that was developed to meet this need, and was shown to be feasible and associated with reduced severity of auditory hallucinations in a previous pilot study. To more rigorously evaluate this program, a randomized controlled trial was conducted comparing the efficacy of CWV to usual care (UC). METHOD: The trial was conducted with a sample of 37 community mental health center clients with schizophrenia and moderate-to-severe auditory hallucinations, with assessments conducted at baseline, posttreatment, and 3-month follow-up. RESULTS: Engagement in and satisfaction with the CWV program were high. Both the CWV and UC groups improved comparably in severity of auditory hallucinations and other symptoms over the treatment and at follow-up. However, participants in the CWV program showed significantly greater increases in social functioning and in knowledge about CBTp. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The results suggest that the CWV program has promise for increasing access to CBTp, and associated benefits in the management of distressing psychotic symptoms and improving social functioning. (PsycINFO Database Record

Adapting Open Dialogue for Early-Onset Psychosis Into the U.S. Health Care Environment: A Feasibility Study.

Open Dialogue (OD) is a Finnish approach to crisis intervention and ongoing care for young people experiencing psychosis and other psychiatric crises. OD engages the individual and family (or other supports) in meetings, with open discussions of all aspects of the clinical situation, and in decision making. Although psychiatric assessment and treatment occur, the initial emphasis is on engagement, crisis intervention, and promoting dialogue. Finnish studies are encouraging, with excellent clinical and functional outcomes after five years. The authors conducted a one-year study of the feasibility of implementing an outpatient program based on OD principles, serving 16 young people ages 14-35 experiencing psychosis-the first study of OD in the United States. Qualitative and quantitative findings suggest that this model can be successfully implemented in the United States and can achieve good clinical outcomes, high satisfaction, and shared decision making.

Individual peer support: a qualitative study of mechanisms of its effectiveness.

Peer-delivered services for individuals with psychiatric conditions have proliferated over the past three decades. The values and principles underlying peer support have been explored, but we lack an understanding of its mechanisms of action. To shed light on the processes of peer support, we conducted a study with individuals who had received substantial individual peer support. We completed individual interviews, audiotaped, transcribed, and examined them using a thematic analysis approach. Our analyses suggest that individual peer support provided various practical, emotional, and social supports which were perceived as beneficial. Participants valued having someone to rely on, a friend, and someone to socialize with. We, however, found that individuals' expectations of peer support did not always comport with available services. Participants viewed peer support as especially valuable because of the opportunity for a non-treatment based, normalizing relationship. We conclude that peer support complements rather than supplants needed traditional mental health services.

Challenges experienced by paid peer providers in mental health recovery: a qualitative study.

Peer providers are increasingly employed in mental health services. We explored challenges experienced by 31 peer providers in diverse settings and roles using in-depth interviews, as part of a larger study focusing on their recovery (Moran et al. in Qual Health Res, 2012). A grounded theory approach revealed three challenge domains: work environment, occupational path, and personal mental health. Challenges in the work environment differed between conventional mental health settings and consumer-run agencies. Occupational domain challenges included lack of clear job descriptions, lack of skills for using one's life story and lived experience, lack of helping skills, and negative aspects of carrying a peer provider label. Personal mental health challenges included overwork and symptom recurrence. Implications for all domains are discussed, with focus on training and skill development.

Benefits and mechanisms of recovery among peer providers with psychiatric illnesses.

Providing peer support to individuals with psychiatric disabilities has emerged as a promising modality of mental health services. These services are delivered by individuals who experience mental illnesses themselves. The purpose of this study was to explore how working as a peer provider can enhance personal recovery. The study was conducted with 31 peer providers employed in a variety of mental health agencies. Data were collected through face-to-face semistructured interviews and analyzed using a grounded theory approach. Qualitative analysis revealed a wide range of recovery benefits for the peer providers. The benefits span across five wellness domains: foundational, emotional, spiritual, social, and occupational. In addition, analysis revealed five role-related and five work-environment-related mechanisms of beneficial impact. The role of sharing one's personal story is highlighted as contributing to positively reauthoring one's self-narrative. Implications for peer training, job development, and workplace supports are discussed.

A qualitative study: barriers and facilitators to health care access for individuals with psychiatric disabilities.

OBJECTIVE: This qualitative study was conducted as part of a larger randomized trial to examine barriers and facilitators to accessing and providing comprehensive primary health care for individuals with serious mental illnesses. We examined the perspectives of administrators and providers in a behavioral health organization surrounding the use of a nurse practitioner model of delivering primary healthcare. METHODS: Ten key informant interviews were conducted and analyzed using qualitative data analysis software. Concepts and themes regarding access to and delivery of primary healthcare were inductively derived from the data. RESULTS: Results confirmed significant issues related to chronic physical health problems among individuals with psychiatric disabilities and detailed a host of barriers to receiving health care as well as the perceived benefits of the nurse practitioner intervention. Financial challenges played a significant role in the organization's ability to make primary and mental health care integration a sustainable endeavor. In addition, staff faced increased burdens on their time due to adding a focus on physical health to their existing job duties. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A nurse practitioner stationed in a behavioral healthcare setting is viewed by administrators and providers as extremely beneficial in addressing issues of access to comprehensive and integrated primary healthcare for individuals with severe psychiatric disabilities but sustaining such a model of care is not without organizational challenges.