Are we there yet? The four-year impact of a VA fellowship program on the recovery orientation of rehabilitation programs.

OBJECTIVE: This study represents the first program evaluation of the impact of a Psychosocial Rehabilitation (PSR) fellowship program within the Veterans Health Administration (VHA). Specifically, it examines the recovery orientation of five mental health rehabilitation programs at the Edith Nourse Rogers Memorial VA Medical Center (ENRM VAMC) in Bedford, MA by comparing program stakeholder rating of the "recovery orientation" between the initial data and the four-year follow-up during which the PSR fellowship was in operation. The goal of this fellowship program is to increase the VHA's fidelity to recovery-oriented best practice recommendations. METHOD: Participants were mental health consumers and staff members within five key psychiatric rehabilitation programs at the ENRM VAMC. Perception of programs' recovery orientation was measured at the start of the fellowship (Time 1) and after the fellowship was in place for four years (Time 2). RESULTS: Results demonstrate that across the entire sample of stakeholders, perceptions of recovery orientation significantly improved from Time 1 to Time 2. Results also reveal a significant overall increase in program recovery orientation over time in three out of the five rehabilitation programs, with years of fellow involvement in particular programs significantly and positively correlating with increases in ratings of program recovery-orientation gains. DISCUSSION: Implications for using fellowships as agents of program change, and specifically, recovery-oriented change, are discussed.

Expressed emotion, communication deviance, and culture in families of patients with schizophrenia: a review of the literature.

The aim of this article is to critically review the literature on expressed emotion (EE), communication deviance (CD), and culture in families of patients with schizophrenia. There is growing evidence that EE and CD are highly linked. Yet the two constructs together predict the development of schizophrenia and the associated symptoms better than either construct alone. In this article, the authors review data indicating that both the expression and the levels of high EE and CD vary by ethnicity. It may be especially difficult for family members to communicate coherently and in a less critical manner when focusing on patients' inability to sustain particular cultural norms and values that are endorsed by their family and ethnic background. The authors propose that more attention to the role of culture in EE and CD and greater focus on the proper assessment of these variables would further enhance our understanding of these constructs.

Expressed emotion and interdependence in White and Latino/Hispanic family members of patients with schizophrenia.

This study examined associations among ethnicity, expressed emotion (EE) and interdependence in a sample of 41 Latino/Hispanic and White family members of patients with schizophrenia. EE was assessed using both the Camberwell Family Interview (CFI) and the Five Minute Speech Sample (FMSS). These measures were found to be highly concordant for rating EE. However, the CFI appears to identify high EE more often than does the FMSS. Whites were designated as high EE significantly more often than were Latinos/Hispanics, regardless of assessment method. Using the interdependence subscale of the Self-Construal Scale, we found a strong trend for Latino/Hispanics to report a more interdependent self-construal than did Whites. However, contrary to expectations, interdependence was not found to mediate the relationship between ethnicity and EE. EE and interdependence may both play a role in the better course of illness observed for patients from traditional cultures. However, these two constructs may relate to patient functioning through different mechanisms.

Ethnicity, expressed emotion, and schizophrenia patients' perceptions of their family members' criticism.

Expressed emotion is a widely researched construct. However, less is known about patients' own perceptions of their relatives' expressed emotion. Using a sample of 42 patient/family member dyads with schizophrenia, we examined the concordance between the number of criticisms expressed by relatives during the Camberwell Family Interview and patients' perceptions of how critical they perceived their relative to be. As predicted, white and Latino family members who expressed more criticism during the Camberwell Family Interview were indeed perceived as more critical by patients. Among blacks, however, no significant association was found between relatives' expressed criticism and patients' perceptions of their relatives' criticism. Findings from this study suggest that cultural/ethnic values may influence how criticism from relatives is perceived and experienced by patients.

Ethnicity, expressed emotion, and communication deviance in family members of patients with schizophrenia.

This study examined the relationships among expressed emotion (EE), communication deviance (CD), and ethnicity in a sample of 57 white, Latino, and black relatives of patients with schizophrenia. A new method of assessing CD from the Five Minute Speech Sample was also developed and evaluated against an existing method (the Camberwell Family Interview; CFI). As hypothesized, high expressed emotion rated (from the CFI) was associated with higher levels of CD, and the Five Minute Speech Sample and CFI methods of assessing CD were concordant. CD statements made by white family members focused most on patient behaviors/symptoms that reflected a lack of independent functioning. CD statements of Latino and black relatives, however, focused most on patient behaviors that interfered with the family's interdependent functioning. Family members may have particular difficulty communicating coherently when discussing patients' inability to uphold important values and behaviors that are sanctioned by their ethnic background.