Social Workers and Self-Help Services: Forging Positive Relationships.

Self-help and peer-provided services for mental health and addictions have grown rapidly in recent years. Many individuals who seek professional social work services are also involved in peer-provided recovery activities. Although many social workers have positive relationships with peer-provided organizations in their communities, there is a need for social workers to increase their understanding of the goals and principles of peer-provided services, so that collaborative relationships can be established. This article provides an overview of several kinds of self-help and peer-provided services, detailing the ways in which these services can be helpful and outlining how social workers can work more closely in partnership with peer providers.

Improving arm function in chronic stroke: a pilot study of sensory amplitude electrical stimulation via glove electrode during task-specific training.

OBJECTIVE: To investigate the effects of sensory amplitude electrical stimulation (SES) delivered by glove electrode during task-specific exercise on arm movement, function, and sensation in chronic stroke. METHODS: The design was an intervention pilot study, pre-test, post-test, follow-up design. The settings used were a university research laboratory and home-based intervention. Participants comprised of 11 individuals with chronic stroke (7.2 ± 4.1 years post onset) and moderate arm paresis, 10.82/20 ± 2.27 on the Stroke Rehabilitation Assessment of Movement (STREAM) - Arm Subscale. Participants were seven males and four females (mean age: 59 years). Participants were recruited from university-based database. Intervention- Participants engaged in task-specific training at home for 30 min, twice daily, for 5 weeks, while receiving SES via glove electrode. Participants received supervised task practice at least twice during intervention period for 1 hour. Main outcome measures- Jebsen-Taylor Hand Function Test (JTHFT), STREAM - Arm Subscale, Motor Activity Log-14 (MAL-14) - Amount and Quality Subscales, and Nottingham Stereognosis Assessment (NSA). RESULTS: Significant changes were found in group mean pre- and post-test comparisons on the NSA (P = 0.042), MAL amount subscale (P = 0.047), and JTHFT (with writing item 29 excluded) (P = 0.003) and in pre-test to follow-up comparisons on NSA (P = 0.027) and JTHFT (writing item excluded) (P = 0.009). There was no significant change on the STREAM (P = 1.0). Individuals with a greater baseline motor capacity determined by STREAM scores (P = 0.048) and more recent stroke (P = 0.014) had significantly greater improvements. CONCLUSION: Combining task-specific training with glove-based SES in chronic stroke resulted in changes in arm sensation and function that were maintained at 3-month follow-up.

Healthy places, active transport and path dependence: a review of the literature.

Children walking to school, people cycling to the shops or work and neighbours chatting in the street, these are some of the gauges of an active and healthy community that can be achieved through utilising good design principles. But are these principles being applied in urban developments or are policy-makers following a 'path dependent' trajectory that severely limits the best practice outcomes sought? This review examines current research on path dependence to determine how this concept advances our understanding of barriers to change in the built environment, active transport and healthy communities. An online database search of scholarly bibliographic records identified 22 relevant articles for a critical review of studies that evaluated path dependence in the urban and built environment literature with a focus on transport, urban planning and health. A thematic analysis of the articles showed that different types of path dependence have contributed to the dominance of policies and designs supporting car-based transport to the detriment of public transport and active transport modes, leading to sub-optimal development patterns becoming 'locked-in'. However, the outcomes for active transport and physical activity are not all dire, and path dependence theory does provide some guidance on changing policy to achieve better outcomes. This review suggests that path dependence is one of the best theoretical frameworks to help health promoters understand barriers to change and can provide insights into developing future successful public health interventions. Future studies could focus further on active transport, local neighbourhood development and physical activity.

Transition-age children with mental illness: hearing the voices of mothers.

Members of a local NAMI organization were surveyed in order to explore the perspectives of mothers of transitional age (18-25) children diagnosed with mental illness. Social workers in a diversity of mental health care settings can use this information to improve competence with this population. Results indicate a dynamic shift in the mothering role during this time period. Findings also suggest mothers and their transition-age children need emotional and practical support from social workers and other mental health professionals.

Policy implications of Medicare Part D for adults with mental illness: a qualitative exploration.

The Medicare prescription drug benefit, introduced in January 2006, has had a substantial impact on the lives of adults disabled by mental illness. However, few studies have undertaken an exploration of the difference that this benefit has made to beneficiaries' access to medication. This study uses a qualitative approach to examine beneficiaries' experiences with the Medicare Part D benefit, and whether having Medicare prescription drug coverage is perceived as helpful. Twenty-six Medicare beneficiaries with mental illness were interviewed regarding their opinions of the Part D benefit, and the investigator found that most beneficiaries were highly satisfied with their prescription drug coverage. However, they would appreciate more information from the Medicare program about their benefits. In addition, beneficiaries were concerned about the possibility of increased future costs. Overall, however, these participants in the Medicare Part D program who had mental illness felt that their needs for psychotropic and other medications were met.

Case managers and the use of Medicare, Part D.

PURPOSE/OBJECTIVES: The purpose of this study was to examine the experiences and opinions of community-based mental health case managers with the Medicare prescription drug benefit. A qualitative approach, consisting of analysis of data from 3 case manager focus groups, was used to achieve an understanding of the role that case managers played in beneficiaries' access to and use of prescription medicines. PRIMARY PRACTICE SETTINGS: Two urban nonprofit community-based mental health agencies. FINDINGS/CONCLUSIONS: Adults who are disabled by mental illness depend on case managers for information about their prescription drug insurance, help with formulary and plan switching information, and assistance with tasks related to medication adherence in the community. Common themes in the case managers' discussion were managing beneficiary problems, stress for beneficiaries, information and paperwork issues, and cynicism regarding health care reform. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The critical role of case managers in the use of Medicare Part D is not well understood or appreciated. Case managers need to be informed about Medicare Part D and ready to advocate for their clients in the community. In addition, it is important for case managers to understand how Medicare Part D affects not only older adults, but also adults living with serious and persistent mental illness.

Post-high school service use among young adults with an autism spectrum disorder.

OBJECTIVES: To produce nationally representative population estimates of rates of service use among young adults with an autism spectrum disorder during their first few years after leaving high school and to examine correlates of use. DESIGN: Nationally representative telephone survey from April 2007 to February 2008. SETTING: United States. PARTICIPANTS: Parents and guardians of young adults with autism spectrum disorders aged 19 to 23 years. Main Exposure  Autism spectrum disorder. MAIN OUTCOME MEASURES: Use of the following services in the prior 2 years or since leaving high school: mental health services, medical evaluation and assessment, speech therapy, and case management. RESULTS: Rates of service use ranged from 9.1% for speech therapy to 41.9% for case management; 39.1% of youths with an autism spectrum disorder represented by the survey received no services. The adjusted odds of no services were higher among African American participants and those with low incomes. The adjusted odds of case management were lower among youths with high functional skills and those with low incomes. CONCLUSIONS: Rates of service disengagement are high after exiting high school. Disparities by race and socioeconomic status indicate a need for targeted outreach and services.

Roles of community helpers in using the Medicare Part D benefit.

OBJECTIVES: To examine the experiences of low-income Part D beneficiaries with mental illness and their use of community helpers to access prescription medicines. METHODS: Individual semi-structured interviews were conducted with 26 Medicare beneficiaries with mental illness in community settings. The transcripts were analyzed for content related to community help-seeking and attitudes toward family and professional helpers. RESULTS: Medicare Part D beneficiaries with mental illness used the assistance of community helpers extensively. Pharmacists, nurses, community mental health case managers, and family members assisted beneficiaries with understanding their benefit plans and interpreting paperwork from plans and government agencies. Community helpers also assisted with tasks related to medication adherence. Mental health consumers appreciated the help that they received from family members and professionals. CONCLUSION: This group of Medicare beneficiaries would have experienced difficulty in using their benefits and obtaining their medication without considerable help from professionals and family members.

Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda.

An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of "implementation outcomes" distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working "taxonomy" of eight conceptually distinct implementation outcomes-acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability-along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.

The consequence of the trend of decline: the life of the St. Louis Insane Asylum, ca. 1900.

Insane asylums began to decline around the turn of the 20th century. As patients with incurable illnesses filled them, asylums became warehouses for people who could not be maintained elsewhere. The St. Louis Insane Asylum exemplifies this trend of decline. Overcrowding and lack of funding led to placement of patients in the St. Louis Poorhouse and to unhealthy conditions at the asylum. Dr. Edward Runge, the superintendent, tried to counteract this trend of decline, but the asylum was able to offer little more than custodial care.

Why I am not a "mental health consumer".

"Mental health consumer" is now a widely-accepted term used to identify individuals living with mental illness. Though this language may be an improvement over the word "patient," it can still be limiting and disempowering. The author explains her concern regarding the word "consumer" and explores the advantages of using the term "psychiatric disability" to describe the experience of those who live with mental illness.