The technology specialist: a 21st century support role in clinical care.

Mental health clinicians, clients, and researchers have shown keen interest in using technology to support mental health recovery. However, technology has not been routinely integrated into clinical care. Clients use a wide range of digital tools and apps to help manage their mental health, but clinicians rarely discuss this form of self-management in clinical interactions. This absence of communication is concerning because the safety and quality of the digital tools and apps people use may negatively affect their mental health outcomes. Mental health systems could benefit from someone to help identify technology-based supports that reflect current evidence and minimize privacy and security concerns. This technology specialist may also enhance the therapeutic bond between the client and the clinician. In working with a technology specialist, clients may begin to gain a sense of control over their mental health, and perhaps use fewer mental health services.

Use of Mobile and Computer Devices to Support Recovery in People With Serious Mental Illness: Survey Study.

BACKGROUND: Mental health recovery refers to an individual's experience of gaining a sense of personal control, striving towards one's life goals, and meeting one's needs. Although people with serious mental illness own and use electronic devices for general purposes, knowledge of their current use and interest in future use for supporting mental health recovery remains limited. OBJECTIVE: This study aimed to identify smartphone, tablet, and computer apps that mental health service recipients use and want to use to support their recovery. METHODS: In this pilot study, we surveyed a convenience sample of 63 mental health service recipients with serious mental illness. The survey assessed current use and interest in mobile and computer devices to support recovery. RESULTS: Listening to music (60%), accessing the internet (59%), calling (59%), and texting (54%) people were the top functions currently used by participants on their device to support their recovery. Participants expressed interest in learning how to use apps for anxiety/stress management (45%), mood management (45%), monitoring mental health symptoms (43%), cognitive behavioral therapy (40%), sleep (38%), and dialectical behavior therapy (38%) to support their recovery. CONCLUSIONS: Mental health service recipients currently use general functions such as listening to music and calling friends to support recovery. Nevertheless, they reported interest in trying more specific illness-management apps.

Real-World Technology Use Among People With Mental Illnesses: Qualitative Study.

BACKGROUND: There is growing interest in using technology-based tools to support mental health recovery. Yet, despite evidence suggesting widespread access to technology among people with mental illnesses, interest in using technology to support mental health, and effectiveness of technology-based tools developed by researchers, such tools have not been widely adopted within mental health settings. Little is currently known about how mental health consumers are using technology to address mental health needs in real-world settings outside of controlled research studies. OBJECTIVE: This qualitative study examined current practices and orientations toward technology among consumers in 3 mental health settings in the United States. METHODS: Ethnographic observations and semistructured interviews were conducted. Observations focused on if and how technology was salient within the setting and documented relevant behaviors, interactions, and dialogue in fieldnotes. Ethnographic data informed the development of a semistructured interview that inquired into technology use and interest among consumers (n=15) in a community mental health setting. Fieldnotes and interview transcripts were reviewed and coded by multiple researchers. Key concepts and patterns identified were refined by the research team to develop the main findings. RESULTS: Ownership of technology, although common, was not ubiquitous and was varied across the sites. Participants had varying levels of awareness regarding the key capabilities of modern technologies. Participants used technology for many purposes, but there was limited evidence of technology use to support mental health. Technology-based tools specific to mental health were not routinely used, although some participants found widely available mobile apps to be helpful in recovery. CONCLUSIONS: Qualitative findings suggest that many, but not all, clients will be interested in using technology to support mental health needs. The variability in type and quality of technology owned by participants suggests the need to design for a range of functionality in the development of mental health tools. Findings also suggest thinking broadly about using existing platforms and widely available tools to support consumers in mental health recovery.

An Adapted Measure of Sibling Attachment: Factor Structure and Internal Consistency of the Sibling Attachment Inventory in Youth.

Parent-youth and peer relationship inventories based on attachment theory measure communication, trust, and alienation, yet sibling relationships have been overlooked. We developed the Sibling Attachment Inventory and evaluated its psychometric properties in a sample of 172 youth ages 10-14 years. We adapted the 25-item Sibling Attachment Inventory from the Inventory of Parent and Peer Attachment-Revised peer measure. Items loaded onto three factors, identified as communication, trust, and alienation, α = 0.93, 0.90, and 0.76, respectively. Sibling trust and alienation correlated with depression (r s = -0.33, r s = 0.48) and self-worth (r s = 0.23; r s = -0.32); sibling trust and alienation correlated with depression after controlling for parent trust and parent alienation (r s = -0.23, r s = 0.22). Preliminary analyses showed good internal consistency, construct validity, and incremental predictive validity. Following replication of these properties, this measure can facilitate large cohort assessments of sibling attachment.

Barriers and Facilitators to Sustainment of an Evidence-Based Supported Employment Program.

Large-scale initiatives to expand evidence-based practices are often poorly implemented and rarely endure. The purpose of this study was to identify the perceived barriers and facilitators to sustainment of an evidence-based supported employment program, Individual Placement and Support (IPS). Within a 2-year prospective study of sustainment among 129 IPS programs in 13 states participating in a national learning community, we interviewed IPS team leaders and coded their responses to semi-structured interviews using a conceptual framework adapted from another large-scale implementation study. Leaders in 122 agencies (95%) that sustained their IPS programs identified funding, prioritization, and workforce characteristics as both key facilitators and barriers. Additional key factors were lack of local community supports as a barrier and leadership and structured workflow as facilitators. Within the IPS learning community, team leaders attributed the sustainment of their program to funding, prioritization, workforce, agency leadership, and structured workflow. The actions of the learning community's leadership, state governments, and local programs together may have contributed to the high sustainment rate.

Barriers to Employment for Transition-age Youth with Developmental and Psychiatric Disabilities.

Youth with developmental and psychiatric disabilities encounter significant vocational challenges, even when they receive supported employment services. We examined the barriers to employment for 280 transition-age youth with disabilities enrolled in supported employment in eight community rehabilitation centers. Employment team members identified each youth's top three barriers to employment using a 21-item checklist. Lack of work experience, transportation problems, and program engagement issues represented common barriers for both youth with developmental disabilities (53, 36, and 25%) and youth with psychiatric disabilities (20, 33, and 26%). Additional common barriers among youth with developmental disabilities included cognitive problems (32%) and lack of social skills (23%) and among youth with psychiatric disabilities included poor control of psychiatric symptoms (23%). Despite receiving evidence-based employment services, youth with disabilities encounter many barriers to employment. Awareness of typical barriers for transition-age youth, including those specific to different disability groups, may help employment programs anticipate challenges and develop strategies that avoid these barriers and their effects on employment opportunities.

The IPS Learning Community: A Longitudinal Study of Sustainment, Quality, and Outcome.

OBJECTIVE: Implementations of evidence-based mental health practices often disappear quickly, and few studies have examined sustainment. Since 2001, the Individual Placement and Support (IPS) learning community has promoted dissemination, implementation, sustainment, and expansion of IPS by using multiple strategies: online training, in-person training and technical assistance, technical assistance teleconferences, annual meetings, stakeholder conference calls, fidelity assessments, and transparency of outcomes. This study examined sustainment of IPS over a two-year period among programs in the learning community in the United States. METHODS: The authors interviewed IPS team leaders in 129 programs actively participating in the learning community in 2012 and 2014. The structured interview addressed questions about program status, funding, and quality improvement activities. Simultaneously, the learning community tracked program-level data on IPS fidelity and employment rates. The study examined two-year program sustainment and changes in employment rates, fidelity, funding, and quality improvement activities. RESULTS: In 2012, 129 participating sites had been active for an average of 4.5 years. At two-year follow-up, 124 (96%) sites were sustained. The sustaining sites maintained quality improvement activities, expanded funding sources, and increased employment rates (41% to 43%; p=.04) and fidelity scores (103.8 to 108.4; p=.002). CONCLUSIONS: Nearly all programs participating in a learning community in 2012 continued to provide IPS services over the next two years, exceeding sustainment rates for evidence-based practices reported in the literature. Quality indicators also improved, suggesting that learning community activities fostered sustainment and quality. Controlled studies must compare specific learning community approaches with usual methods of sustainment.

A meta-analytic review of the role of child anxiety sensitivity in child anxiety.

Conflicting findings exist regarding (1) whether anxiety sensitivity (AS) is a construct distinct from anxiety in children and (2) the specific nature of the role of AS in child anxiety. This study uses meta-analytic techniques to (1) determine whether youth (ages 6-18 years) have been reported to experience AS, (2) examine whether AS differentiates anxiety disordered youth from youth without diagnoses, and (3) ascertain whether AS distinguishes youth with panic disorder from those with other anxiety disorders. The weighted mean effect size analyses included 15 studies and 6,579 participants. Results suggested positive correlational relationships between AS and anxiety for children (r = 0.26) and adolescents (r = 0.36) and higher levels of AS for anxiety disordered youth than non-clinical youth (d = 0.64). Findings tentatively suggested higher levels of AS for youth with panic disorder than youth diagnosed with other anxiety disorders. Implications and future directions in the research of child AS are discussed.