Health literacy training: A model for effective implementation and sustainability.

OBJECTIVE: Training the mental health workforce to provide health promotion and support to people using their services to manage comorbid conditions is essential if full integration of physical and mental health is to become a reality. We document how a training model was explicitly designed to extend curricula beyond the classroom in order to increase the frequency and quality of physical health interventions. We also show how implementation was supported by a strong project structure and a facilitative administration. METHOD: This article was informed by the workforce development literature, process observations, and key informant interviews. RESULTS: Passive dissemination cannot change practice. Buy-in and commitment from agency leaders facilitates collaboration between consultant-trainers and trainees. Organizations with strong implementation structures help ensure training uptake. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: When contracting with trainers, ensure that they understand the need for and are willing to commit to sustainability. Additionally, organizations will benefit by using lessons from implementation science when approaching workforce.

A Controlled Trial of Supported Employment for People With Severe Mental Illness and Justice Involvement.

OBJECTIVE: Employment is a key to participation in community life for people with severe mental illness, especially those who have been involved in the criminal justice system. Although the Individual Placement and Support (IPS) model of supported employment has been established as an evidence-based practice for helping people with severe mental illness attain competitive employment, little is known about whether IPS is effective for people with severe mental illness who have a history of arrest or incarceration. This study examined this question. METHODS: A randomized controlled trial examined competitive employment outcomes for 85 participants with severe mental illness and justice involvement who were assigned to IPS or to a comparison group that offered a job club approach with peer support. RESULTS: At one-year follow-up, a greater proportion of participants in the IPS group than in the comparison group had obtained competitive employment (31% versus 7%; p<.01). The IPS and comparison groups did not differ significantly during follow-up in rates of hospitalization (51% versus 40%) or justice involvement-either arrests (24% versus 19%) or incarceration (2% for both groups). CONCLUSIONS: Although IPS was shown to be an effective model for helping justice-involved clients with severe mental illness achieve employment, the outcomes were modest compared with those in prior IPS studies. The IPS model provided a useful framework for employment services for this population, but augmentations may be needed.

Adapting supported employment for emerging adults with serious mental health conditions.

Effective services are needed to assist young people with serious mental health conditions to successfully transition to employment or education, especially among those with intensive adolescent mental health service utilization. To meet these needs, the Individual Placement and Support (IPS) model of supported employment was adapted and its feasibility was tested in a psychiatric treatment program for early-emerging adults. Participants were 17-20 years old (mean age = 18.5 years). Most were African American, under the custody of the state, with a primary mood disorder diagnosis. Adaptations to IPS included adding the following: near age peer mentors, a supported education component, and a career development focus. This open trial feasibility study tracked the model's development, recruitment, and retention and tracked vocational and educational outcomes for 12 months. Model refinement resulted in the development of a separate educational specialist position, greater integration of the peer mentor with the vocational team, and further specification of the role of peer mentor. There was an 80% retention rate in the feasibility evaluation. Of the 35 participants, 49% started a job and/or enrolled in an education program over the 12-month period.

Remote "hovering" with individuals with psychotic disorders and substance use: feasibility, engagement, and therapeutic alliance with a text-messaging mobile interventionist.

OBJECTIVE: People with serious mental illnesses and substance abuse problems (i.e., dual diagnosis) constitute a particularly challenging and costly clinical group. This study evaluated the feasibility and acceptability of a novel model of care in which a mobile interventionist used mobile phone text messaging to remotely monitor and provide daily support to individuals with psychotic disorders and substance use. METHODS: Seventeen participants with dual diagnosis were enrolled in a 12-week single-arm trial. A clinical social worker served as the mobile interventionist and sent daily text messages to participants' privately owned mobile phones to assess their medication adherence and clinical status. The mobile interventionist provided text-message feedback and support and suggested various coping strategies flexibly, in response to participants' replies to prompts. At the end of the trial, participants completed a usability and satisfaction measure and two self-rated measures of therapeutic alliance with their clinicians. In one version, participants rated their relationship with their mobile interventionist; in the second version, they rated their relationship with their community-based treatment team. RESULTS: Participants received an average of 139 text messages (SD = 37.5) each from the mobile interventionist over the 12-week trial. On average, participants responded to 87% of the mobile interventionist's messages that required a reply. More than 90% of participants thought the intervention was useful and rewarding and that it helped them be more effective and productive in their lives. Participants' assessments of their relationship with the mobile interventionist were positive. Paired-sample t-test found that the therapeutic alliance ratings participants provided for their mobile interventionist were significantly higher than those provided for their community-based treatment team clinicians, who they met with regularly. CONCLUSIONS: Our findings suggest that text-message "hovering" can be conducted successfully with individuals with psychotic disorders and substance abuse. Developing a cadre of mobile interventionists who are specifically trained on how to engage patients via mobile devices while adhering to ethical guidelines and regulatory standards may be an effective way to strengthen service delivery models, improve patient outcomes, and reduce costs.