Short Report on Effectiveness of an Autistic-Delivered Peer Support Program: Preliminary Results.

There is little research on the effectiveness of autistic peer-delivered services. This study examines early outcomes associated with the Community Autism Peer Specialist program (CAPS), which was created in partnership with autistic individuals and is delivered by autistic adults who have received training in the delivery of peer support services to enhance the community functioning of autistic youth and adults. A single group pre-test/post-test design was used to examine early outcomes in the areas of independent living needs, social functioning, service engagement, and quality of life. A total of 23 individuals with autism aged 14-41 years were included in the study. Reductions were found in social functioning impairments and unmet needs after three months in the program. Participants also reported greater engagement in mental health services and activities that promote wellness compared with before the program. This study suggests that peer support services delivered by autistic peers may be an effective intervention approach for autistic youth and adults. Future studies with a more rigorous study design (e.g., randomized controlled trials), a larger sample size, and longer-term outcome measurements are needed to further investigate the effectiveness of CAPS and similar autistic-delivered services.

Autistic-Delivered Peer Support: A Feasibility Study.

Peer support has been an undeveloped pathway for filling the service gap and to generate employment opportunities for autistic individuals. Peer supports have been deployed widely in mental health and among veterans and understanding the utility of this service modality among autistic individuals illuminates opportunities for research, policy, and practice. This study examined characteristics of participants in an autistic-delivered peer support program and reports on use of and satisfaction with the program. Half of autistic participants had a co-occurring mental health diagnosis. Participants reported multiple areas of unmet needs and participant satisfaction with the program was high (90%). The findings of this study point toward autistic-delivered peer support as a promising avenue for future development.

The implementation of opioid prescribing report cards in Medicaid managed care: a community quality collaborative.

Philadelphia, Pennsylvania, is an urban epicenter of the opioid epidemic, and inappropriate opioid prescribing remains a top concern. To help address this issue, the Philadelphia Medicaid Opioid Prescribing Initiative, a type of community quality collaborative, mailed thousands of local Medicaid providers an individualized prescribing report card in 2017 and 2018. The report card featured details of providers' opioid prescribing, including peer comparison measures and inappropriate prescribing measures like concomitant opioid and benzodiazepine prescribing. This case study describes the unique process of developing and distributing the opioid prescribing report cards, with a particular focus on the role of Medicaid managed care organizations. Using Medicaid pharmacy claims, the extensive variation in prescribing measures within and across specialties is also illustrated. The report card's implementation points to the potential value of collaborations between public health departments and Medicaid managed care organizations and can provide insight for other locally grown policies.

Risk Factors Associated With Child Protective Services Involvement Among Parents With a Serious Mental Illness.

OBJECTIVE: People with serious mental illnesses are as likely to be parents as people in the general population but are much more likely to have contact with child protective services (CPS) and experience an out-of-home placement of their children. This study sought to identify risk factors for CPS involvement among parents with serious mental illnesses. METHODS: Parents with a serious mental illness were identified through a national, representative survey. Data from a follow-up interview were used to compare characteristics of parents who had a CPS contact (N=36) with those who did not (N=38). The interview assessed demographic and health characteristics, social support, traumatic life events, and other general risk factors for CPS involvement. RESULTS: Compared with parents without CPS contact, parents with a CPS contact were more likely to be nonwhite and to be less educated. They were also more likely to have less attachment-related social support, more parenting-related needs in numerous areas, and more substance use-related issues and to have experienced adverse childhood and traumatic events. One-quarter of the parents with CPS contact reported not having a mental disorder diagnosis at the time of the first contact, and those in the CPS group were less likely to have taken medications at the time of the first contact than were parents who did not have a CPS contact. CONCLUSIONS: Results suggest a need for policies, programs, and practices that attend to common risk factors associated with CPS involvement that are present in the general population rather than concentrating efforts on addressing behavioral health factors specific to parents with serious mental illness.

Custody challenges experienced by parents with serious mental illnesses outside of child protective services proceedings.

Objective: The primary purpose of this study is to examine the experience of parents with a serious mental illness with custody challenges outside the child protective services (CPS) system. Methods: Interview data from 596 parents with serious mental illnesses were obtained in a national survey. Survey questions assessed the presence of a serious mental illness, parenting status, experiences with CPS, and other custody challenges they may have experienced. Results: One third of respondents experienced a non-CPS custody challenge, and most had their mental health issues brought up in the proceedings. Certain factors were found to increase risk of custody challenge and loss of custody or change in parenting time. Conclusions and Implications for Practice: Psychiatric rehabilitation practitioners should be aware of all threats to parenting and expand efforts to prevent custody loss through interventions aimed at enhancing parenting knowledge, skills, supports, and advocacy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Randomized Controlled Trial of an Internet-Based Educational Intervention for Mothers With Mental Illnesses: An 18-Month Follow-Up.

OBJECTIVE: A randomized controlled trial was conducted to examine the effectiveness of an Internet-based educational intervention plus a peer support-moderated listserv for improving parenting skills and coping and reducing parental stress among mothers with serious mental illnesses. The analyses examined whether positive results achieved immediately after the intervention were improved upon during the 18-month postbaseline period. METHODS: Mothers with serious mental illnesses (N=131) were randomly assigned to an experimental or an active control condition. Outcomes were assessed over time by using a repeated-measures analysis of variance. RESULTS: Participants in the experimental condition experienced statistically greater reduction in parental stress at the 18-month follow-up than those in the active control condition. CONCLUSIONS: This relatively low-cost intervention, along with the Internet's advantages of accessibility, anonymity, and insulation from child care issues, suggests potential utility for reducing parenting stress for busy mothers. These results provide a foundation for enhancing this intervention to achieve other targeted outcomes related to parenting.

Child Protective Service Disparities and Serious Mental Illnesses: Results From a National Survey.

OBJECTIVE: Involvement with child protective services (CPS) can have detrimental effects on children and parents alike. This study provided updated information about the prevalence of parenting among individuals with a serious mental illness and established the first contemporaneous and comparative national prevalence estimates of CPS involvement for parents with and without a serious mental illness. METHODS: Data came from the Truven Health Analytics PULSE national survey of 42,761 adults conducted between September 2014 and December 2015. Survey questions assessed the presence of a serious mental illness, parenting status, contact with CPS, and types of CPS involvement. RESULTS: Prevalence of parenthood was similar between individuals with (69%) and without (71%) a serious mental illness. Parents with a serious mental illness were approximately eight times more likely to have CPS contact and 26 times more likely to have a change in living arrangements compared with parents without a serious mental illness. Even when the analysis was limited to parents who had CPS contact, parents with a serious mental illness were at greater risk of custody loss compared with parents without mental illness. CONCLUSIONS: These results further heighten the need to attend to parenting among individuals with a serious mental illness and better understand the factors associated with CPS involvement to reduce the identified disparities between parents with and without a mental illness. Efforts to reduce CPS involvement would likely reduce stress and enhance recovery and mental health for parents and their children.

Assessing an Internet-based parenting intervention for mothers with a serious mental illness: a randomized controlled trial.

OBJECTIVE: This study examined the effectiveness of an Internet parenting education and support intervention among mothers with a serious mental illness (SMI). METHODS: Sixty mothers diagnosed with a schizophrenia spectrum or mood disorder who had primary/shared custody for a child 18 or younger were enrolled in a randomized controlled trial (RCT) with two conditions. The experimental condition involved participation in the online parental education course and a listserv co-moderated by a parent with a mental illness and a mental health professional. The control condition involved participation in online education healthy lifestyle course. Standardized measures were used at baseline and 3 months to assess outcomes. Using an intent-to-treat approach, group differences over time were assessed using a two-tailed independent sample t test on all dependent variables, including parental efficacy, skills, coping, support, and stress. RESULTS: Participation in an online parenting intervention for mothers with a SMI enhanced parenting and coping skills, and decreased parental stress. No support was found for improved efficacy or support. CONCLUSION: This RCT establishes that mothers with a SMI are interested in and capable of receiving online parenting education and support. Findings demonstrate that an online parenting intervention can improve parenting and coping skills and decrease parental stress.

Community participation as a predictor of recovery-oriented outcomes among emerging and mature adults with mental illnesses.

OBJECTIVE: The promotion of recovery and quality of life is a major focus of national and local mental health system transformation efforts. There has been simultaneous interest in enhancing community participation as a facilitator of recovery. This study examines the community participation experiences of emerging adults and mature adults with serious mental illnesses and the relationship between various types of participation and recovery, quality of life, and meaning of life. METHODS: Baseline data from the Consumer-Operated Service Program multisite study were utilized. The sample was recruited from traditional mental health services and consisted of 233 emerging adults and 1,594 mature adults. Ten areas of participation were examined: parenting, employment, volunteering, college student, group membership, civic engagement, peer support, friendships, intimate relationships, and engagement in religious/spiritual activities. RESULTS: Emerging and mature adults differed in developmentally appropriate ways. Emerging adults and those who participated more had higher scores on the recovery, quality of life and meaning of life measures. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The higher scores on the dependent variables may be explained by younger adults having greater hope and higher expectations that are typical for those at that stage of life and that living longer with a serious mental illness and being exposed longer to the mental health system may dampen hope. Participation in general, and specific areas of participation, were predictive of recovery-oriented outcomes. These results should inspire future developmentally-oriented research examining factors that facilitate recovery and provide direction to providers about participation areas that may be most beneficial in facilitating recovery.

Internet peer support for individuals with psychiatric disabilities: A randomized controlled trial.

Despite the prevalence of Internet support groups for individuals with mental illnesses little is known about the potential benefits, or harm, of participating in such groups. Therefore, this randomized controlled trial sought to determine the impact of unmoderated, unstructured Internet peer support, similar to what is naturally occurring on the Internet, on the well-being of individuals with psychiatric disabilities. Three hundred individuals resident in the USA diagnosed with a Schizophrenia Spectrum or an Affective Disorder were randomized into one of three conditions: experimental Internet peer support via a listserv, experimental Internet peer support via a bulletin board, or a control condition. Three measurement time points, baseline, 4- and 12 months post-baseline, assessed well-being by examining measures of recovery, quality of life, empowerment, social support, and distress. Time × group interactions in the repeated measures ANOVA showed no differences between conditions on the main outcomes. Post-hoc repeated measures ANOVAs found that those individuals who participated more in Internet peer support reported higher levels of distress than those with less or no participation (p = 0.03). Those who reported more positive experiences with the Internet peer support group also reported higher levels of psychological distress than those reporting less positive experiences (p = 0.01). Study results therefore do not support the hypothesis that participation in an unmoderated, unstructured Internet listserv or bulletin board peer support group for individuals with psychiatric disabilities enhances well-being. Counterintuitive findings demonstrating those who report more positive experiences also experienced higher levels of distress are discussed but we also point to the need for additional research. Future research should explore the various structures, formats, and interventions of Internet support, as well as the content and quality of interactions. Knowledge generated from such research can help to inform policies and guidelines for safely navigating online resources and supports to gain maximum benefit.

A randomized, controlled study of Internet peer-to-peer interactions among women newly diagnosed with breast cancer.

OBJECTIVE: Peer-to-peer interactions are associated with enhanced psychosocial adjustment among women with breast cancer. Millions of women with cancer and others with various health conditions use the Internet to establish peer relationships, usually without professional moderation. This paper reports findings from the first randomized, controlled study of the benefits of these types of Internet-based peer interactions. METHODS: This pilot study involved seventy-eight women who were recently diagnosed with breast cancer. Participants were randomly assigned to either an Internet peer support condition or Internet-based educational control condition. Data were gathered at baseline and 4- and 12-months. Primary outcomes of interest were psychological distress and quality of life. RESULTS: Contrary to hypotheses, participants in the Internet peer support condition tended to do worse over time on primary outcome measures. There were no differences between groups on secondary outcomes of perceived social support, self-efficacy, or hope. Paradoxically, many women in the Internet peer support condition actively participated and reported high levels of satisfaction, suggesting some self-perceived benefits. CONCLUSIONS: These results suggest that Internet based peer-to-peer interactions may not necessarily be universally beneficial despite the positive experiences reported by many participants. Further research is needed to understand the magnitude of this effect with a larger sample. Moreover, these results raise questions about the need to understand the comparative effectiveness of Internet-based communications by group structure (i.e., unstructured/structured; unmoderated/moderated) and the effect of content (i.e., expression of fear/anxiety, insightful disclosures, etc.) on outcomes.

Adoption and safe families act state statutes regarding parents with mental illnesses: a review and targeted intervention.

TOPIC: This paper describes an intervention targeting states that list a parental mental illness/disability as an "aggravated circumstance" under the Adoption and Safe Families Act of 1997 (ASFA), resulting in reasonable efforts not required to reunify a family. PURPOSE: This paper delineates the results from our review of ASFA state statutes, the development of a model ASFA statute, and strategies to educate legislators and the public about the impact of discrimination that parents with mental illnesses encounter because of ASFA legislation with the intent of modifying state ASFA legislation. SOURCES USED: The following sources were used for this educational initiative: a literature review and a review of ASFA state statutes. CONCLUSIONS: Adoption of the model ASFA state statute is simply a first step in an effort to end the discrimination that parents with psychiatric disabilities face; additional efforts are also noted.

State psychiatric hospital census after the 1999 Olmstead Decision: evidence of decelerating deinstitutionalization.

OBJECTIVE: The Supreme Court ruled in the 1999 Olmstead decision that "unjustified isolation" of individuals with disabilities in institutions is a violation of the Americans With Disabilities Act. This study examined the extent to which state psychiatric hospital census across the United States has changed significantly post-Olmstead. METHODS: Twenty years of national state hospital census data (1984-2003) were used to assess trends in the rate of declines from pre- to post-Olmstead periods. Data were organized into five four-year periods. RESULTS: Steady declines in the hospital census nationally were found over all periods, with especially large decreases in the 1990s. However, when the percent change in hospital census in the two periods immediately before the Olmstead decision (between 1992-1995 and 1996-1999) were compared with the percent change in the periods immediately before and immediately after the Olmstead decision (between 1996-1999 and 2000-2003), an 8 percent decrease in the magnitude of decline was seen. CONCLUSIONS: State hospital census continues to decline but has slowed significantly during the post-Olmstead period. More study of the factors associated with this decline is needed.