Paxton house: integrating mental health and diabetes care for people with serious mental illnesses in a residential setting.

OBJECTIVE: This report provides a program description of a supported housing residence for individuals with co-occurring diabetes and serious mental illnesses and preliminary health outcome data. METHODS: Weight, blood glucose levels and satisfaction survey data were collected retrospectively on 13 individuals referred to the program. RESULTS: Results indicate that individuals lost weight and fasting glucose readings fell into the ADA recommended range in the first six months of participation. Overall, consumers participating in the program were satisfied with the diabetes education and monitoring services provided. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: While preliminary results suggest that consumers benefit, this study only begins to address how integrated behavioral health and diabetes-specific programming in residential settings meets the needs of persons with severe mental illnesses and diabetes. A more thorough understanding of the impact of these programs on consumers' health outcomes is needed to inform how to deliver diabetes management curricula and support consumers to improve their overall health.

Trial of an electronic decision support system to facilitate shared decision making in community mental health.

OBJECTIVES: Involvement of community mental health consumers in mental health decision making has been consistently associated with improvements in health outcomes. Electronic decision support systems (EDSSs) that support both consumer and provider decision making may be a sustainable way to improve dyadic communication in a field with approximately 50% workforce turnover per year. This study examined the feasibility of such a system and investigated proximal outcomes of the system's performance. METHODS: A cluster randomized design was used to evaluate an EDSS at three urban community mental health sites. Case managers (N=20) were randomly assigned to the EDSS-supported planning group or to the usual care planning group. Consumers (N=80) were assigned to the same group as their case managers. User satisfaction with the care planning process was assessed for consumers and case managers (possible scores range from 1 to 5, with higher summary scores indicating more satisfaction). Recall of the care plan was assessed for consumers. Linear regression with adjustment for grouping by worker was used to assess satisfaction scores. A Wilcoxon rank-sum test was used to examine knowledge of the care plan. RESULTS: Compared with case managers in the control group, those in the intervention group were significantly more satisfied with the care planning process (mean ± SD score=4.0 ± .5 versus 3.3 ± .5; adjusted p=.01). Compared with consumers in the control group, those in the intervention group had significantly greater recall of their care plans three days after the planning session (mean proportion of plan goals recalled=75% ± 28% versus 57% ± 32%; p=.02). There were no differences between the clients in the intervention and control groups regarding satisfaction. CONCLUSIONS: This study demonstrated that clients can build their own care plans and negotiate and revise them with their case managers using an EDSS.

Criminal justice involvement of individuals with severe mental illness and supported employment outcomes.

This study examined the impact of criminal justice involvement on competitive employment outcomes for clients with severe mental illness enrolled in supported employment. Based on chart reviews of 154 clients enrolled in supported employment, the CJI and no CJI groups differed on several clinical and demographic variables, but did not differ on competitive employment outcomes. This study suggests that clients with criminal justice involvement do benefit from supported employment. Further research should track employment outcomes for a longer interval with a larger study group in order to provide a more complete picture of the extent to which CJI impacts employment.

Access to supported employment for consumers with criminal justice involvement.

OBJECTIVE: This paper aims to provide further understanding of the influence of severe mental illness (SMI) and criminal justice involvement (CJI) on access to Supported Employment (SE) services. The authors investigate differences between consumers with and without CJI regarding access to SE and explore reasons for group differences. METHOD: This study employs a mixed-methods design. The quantitative portion compares employment service utilization of consumers with CJI to consumers without CJI to examine hypothesized differences in frequency of access and time to receipt of SE services. The qualitative portion includes in-depth, individual interviews with consumers with CJI and service providers to gain various perspectives on consumers' with CJI entry to SE. RESULTS: Consumers with CJI take longer to access SE services. Consumers with CJI and service providers identify the following as barriers or facilitators to access to SE: competing challenges for consumers with CJI such as mental health probation, the adverse impact of CJI on consumers' psychosocial functioning, social networks, consumers' relationships with practitioners, and practitioners' relationship with SE. CONCLUSIONS: Consumers with CJI do receive SE services at the same rate as those without CJI, but it takes them substantially longer to engage in SE services. Both programmatic and policy level interventions and modifications may ameliorate this problem.