Training peer specialists with mental illness in motivational interviewing: A pilot study.

OBJECTIVE: The objective of this study was to evaluate the effects of providing motivational interviewing (MI) training to peer specialists in the Veterans Affairs (VA) health-care system. METHODS: Fourteen peer specialists at a local VA medical center received a 2-day workshop on MI and 2 monthly booster sessions afterward. A total of 55 therapy sessions between peer specialists and their peer service recipients were audio-recorded and independently rated on MI fidelity before the workshop and each month after the workshop for 3 months. Sessions were rated on fidelity scales assessing Fundamental MI Adherence and Competence, Advanced MI Adherence and Competence, and MI Inconsistent Adherence scales. One item was created for this study that assessed Sharing Lived Experiences. Repeated measures analysis was conducted to examine change in MI fidelity over time. RESULTS: Peer specialists had a significant decline in MI Inconsistent Adherence scale scores over time. Specifically, they showed reductions in providing unsolicited advice and emphasizing absolute abstinence. Peer specialists also showed a significant decline in the Sharing Lived Experience Adherence item score. There were no significant changes on MI Fundamental and Advance scale scores. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Training peer specialists in MI is feasible and may lead to some change in practices, but comprehensive training and ongoing supervision is needed to incur and sustain changes. Guidance and assessment of how peer specialists share their lived experiences with fellow veterans may be needed to capitalize on their unique experiences and skill sets. (PsycINFO Database Record

Los pacientes del manicomio La Castañeda y sus diagnósticos. Una propuesta desde la historia cuantitativa (México, 1910-1968) / The patients and their diagnosis at La Castañeda General Asylum. An approach from quantitative history (México, 1910-1968)

El Manicomio General La Castañeda, fundado en la Ciudad de México, albergó a 61.480 pacientes entre 1910 y 1968. El objetivo de este artículo es presentar un panorama general de la población que ingresó a esta institución y los diagnósticos que recibieron los internos, análisis realizado a partir de una base de datos construida con una muestra de 20% de la población total. El artículo se divide en tres partes: en la primera, proponemos tres etapas para comprender la historia de La Castañeda cuya periodización es definida por cambios demográficos que coinciden con reformas administrativas; en la segunda, exponemos las características generales de la población psiquiátrica de La Castañeda; y finalmente, describimos los principales cambios demográficos, los cuales obedecieron a factores socio-políticos, innovaciones tecnológicas y transformaciones en la clínica. Como características principales de la población de La Castañeda tenemos la brevedad del encierro (18 meses en promedio) y la reducida mortalidad (23.8%) en comparación con otras instituciones del mismo tipo. En dicha circulación poblacional encontramos que las familias desempeñaron un papel determinante al asumir el cuidado de sus parientes locos. Así, el encierro prolongado de pacientes crónicos no fue un problema que aquejara al Manicomio General de forma tan severa como se ha creído (AU)

During its 58 years in operation (1910-1968), the Manicomio General La Castañeda housed 61,480 people. In this paper, we present an overview of the general characteristic of the patients based on a 20% sample of the overall population. We divided the text in three sections: in the first part we argue that the history of the institution comprises three distinctive periods characterized by demographic changes that coincide with administrative reforms. In the second, we present the general characteristics of La Castañeda's psychiatric population. Finally, we describe the most salient demographic changes, which stemmed either from socio-political events, technological innovations or clinical transformations. Some of the most salient results of the analysis of the sample show that the inmate population had short periods of hospitalization in the asylum (an average of 18 month), as well as a lower mortality rate (24.2%) in comparison to contemporary mental institutions. Families played a fundamental role in the care of their mad relatives, which accounts for the relatively short periods of hospitalization as well as the low death rates. Consequently, for this particular institution, chronic patients weren't such a serious problem as believed (AU)

Reduction of chronic aggressive behaviour 10 years after brain injury.

This study demonstrates the successful management of aggressive behaviour with a client 10 years post-injury in a small, residential neurorehabilitation unit. The case presented is unusual for two main reasons. First, it proved possible to significantly modify previously chronic challenging behaviour many years after brain injury had been sustained. Secondly, the rehabilitation environment in which treatment was conducted did not comprise a highly specialized neurobehavioural service, Instead, staff were specifically trained regarding the administration of the treatment programme, which was based on principles derived from behaviour modification and applied neuropsychology. Specific interventions used included those of differential reinforcement and graduated increase of expectations. Recordings made over the course of 85 weeks demonstrate a significant decrease in the frequency and severity of aggression. Successful inhibition of challenging behaviour attained a level which facilitated transfer of the client to a non-institutionalized community home. Reasons underlying the success of the intervention, and the limitations inherent in attempting to manage aggression within neurorehabilitation environments will be discussed.

Preparing psychiatric rehabilitation specialists through undergraduate education.

This report outlines the development of a new undergraduate psychiatric rehabilitation curriculum designed to prepare students for entry-level positions. The program, which opened in January 1993, has graduated 25 students with Associate of Science degrees in Psychiatric Rehabilitation as of May 1995. The need for the program, a brief overview of its curriculum, and the evaluation of its impact on students and agencies are presented.

Nursing staff educational preparation and patient inflicted injuries in a 160 bed psychiatric hospital.

This is a retrospective study of the incidence and severity of patient inflicted injuries upon nursing staff in a 160 bed psychiatric hospital over a period of two years. The investigation explored possible relationships between the basic educational preparation of the injured staff members, the severity of their injuries, and whether they used the behavior management techniques learned in the Mandt System classes. (The Mandt System has been used at Alaska Psychiatric Institute since 1979 to train nursing staff in how to safely deal with assaultive people.)

Training older adults to work as psychiatric case management aides.

Adults who were age 55 and over were trained to work as case management aides for individuals with serious and persistent mental illness. The training program was a cooperative effort of several state, academic, and private agencies in the New Orleans area, including the department of psychiatry at a state university medical center, the State Office of Mental Health, a consortium of colleges and universities providing educational opportunities for older adults, and the American Association of Retired Persons. The program curriculum included ten weeks of classroom instruction and a four-month field practicum. Of the 14 participants in the initial group of trainees, 13 sought and received employment as case aides. At follow-up three months after employment, supervisors of the case aides rated their job performance as excellent.

Enfermagem psiquiátrica: que papel é este? / Psychiatric nursing: what role is this?

A presente pesquisa estuda a representaçäo e a prática de Enfermagem Psiquiátrica, sob a perspectiva de seu próprio pessoal, nas várias categorias, dos demais profissionais da área e dos clientes. A esses diferentes olhares, aparecem vários aspectos insatisfatórios. Constata-se que a questäo está relacionada basicamente à indefiniçäo do papel da Enfermagem Psiquiátrica, determinada em parte por distorçöes na formaçäo, onde predominam os aspectos técnicos. As lacunas säo entäo preenchidas através do preparo no local de trabalho ou, quando este näo é realizado, de forma empírica no dia-a-dia dos profissionais. Outro fator a considerar é a diversidade de teorias em Psiquiatria, com características peculiares e até opostas, a influenciar o pensamento do grupo hegemônico na instituiçäo, bem como o saber da Enfermagem, criando-se, nesse contexto, relaçöes de saber e de poder.

A history of the training of asylum nurses.

The national training scheme for asylum attendants, devised in the late 19th century, did not arise ex nihilo. Several philanthropic and imaginative madhouse keepers of the previous century had understood the link between successful treatment of lunatics and the quality of staff who cared for them. They had therefore aimed to recruit a 'good class' of person to work in their institutions, and to create an environment which would tend towards the civilization of the patients. A few even entertained the notion that training attendants would enhance their ability to understand and care for those in their charge. Training received increasing attention in both medical and political circles throughout the 19th century until a national scheme was inaugurated in 1891. The scheme achieved only a modest success in that, while it drew upon the undoubted enthusiasm of those who trained under it, it did not enhance the attendants' career opportunities or their pay once they had qualified. Training as a means of solving management problems was doomed to failure, and widespread dissatisfaction amongst asylum nurses erupted during the 1920s, only 30 years after the scheme had started.

Training paraprofessionals for psychiatric support. New supports in expanding care for the elderly.

The need for mental health services for the elderly continues to grow while access to those services is critically limited. Gaps in service delivery become even more pronounced as elderly services increasingly shift from acute care and long-term care to the home. Home care aides could serve pivotal roles in providing support for clients experiencing mental health problems, as evidenced by the following results of implementing a training and demonstration grant for preparing psychiatric home care aides.

The psychiatric technician: trespasser or welcomed ally?

1. The increasing shortage of nurses, higher patient acuity levels, and greater demands placed on nursing to meet standards of care have contributed to the use of psychiatric technicians to alleviate the burden on nursing and ensure the delivery of quality patient care. 2. Psychiatric technicians provide care for a select group of patients under the supervision of the primary nurse. The patients assigned to psychiatric technicians require minimal direct nursing intervention. 3. Psychiatric technicians reported increased self-confidence and self-esteem; the nurses were able to perform more professional nursing activities, increasing their job satisfaction and promoting staff retention; and the patients received high-quality care.

Creating a supportive environment using staff psychoeducation in a supervised residence.

The prevailing approach to rehabilitation in residential care emphasizes goal attainment. This approach often produces considerable stress for residents, most of whom have schizophrenia. Based on the view that low-demand environments, incorporating graduated expectations, may be more appropriate for this patient population, a three-component model for creating and maintaining a calm, supportive environment in a supervised residence was developed. The model utilizes staff psychoeducation, which is based on the principles of family psychoeducation, a highly effective intervention for patients with schizophrenia. The three components of the model are training in supportive interaction, a medication-monitoring program, and a behavioral approach to problem solving. Resident groups promote each of these components. The groups' goals are encouragement of positive, low-key interactions, compliance with medications, and slow, steady rehabilitation.

[Training of interviewers in the utilization of standardized questionnaires in psychiatry: studies realized with the Present State Examination (PSE)]. / La formation d'interviewers à l'utilisation de questionnaires standardisés en psychiatrie: travaux réalisés avec l'Examen Psychiatrique Standardisé (EPS).

Interview questionnaires offer more validity than self-administered format in exploring psychopathological or psychosocial phenomena of interest in psychiatric research. If used, special care needs to be paid to interviewers' training and ensuring that they maintain their reliability. No widespread training standards exist and each schedule may carry its own procedure. Our aims are to indicate how we trained interviewers with the French version of the Present State Examination (Wing, Cooper and Sartorius, 1974) and how we checked and kept acceptable interraters reliability during one study. We will provide data on the interraters reliability during the training and the study, as well as the test-retest reliability. These results will be used to support some guidelines when using this sort of psychiatric research questionnaires in order to ensure comparability both within the study and between studies.

Further evaluation of verbal ability selection test and work performance validity with psychiatric aides.

Verbal selection test and work performance validity based on two samples of psychiatric aides were both .25, with corrected validities of .60 (n = 40) and .46 (n = 60). When combined with three previous samples (N = 273), meta-analysis yielded a mean validity of .25 (cumulative p = .00003) which provided further evidence of the validity of cognitive ability tests in selection of psychiatric aides.

Impact of therapeutic management on use of seclusion and restraint with disruptive adolescent inpatients.

Use of seclusion and restraint on three inpatient adolescent psychiatric units was examined during two five-month periods before and after implementation of a "therapeutic management" protocol. Under the protocol, staff classified disruptive behaviors into four stages and provided verbal and behavioral interventions to control behavior at each stage. Patients who required seclusion and restraint had significant latitude to determine the timing of their release from the interventions and met with staff one hour and 24 hours after their release to explore alternatives to aggression. The number of episodes of seclusion and restraint fell by 64 percent after the protocol was adopted, and the number of patients who required those interventions dropped by 39 percent. The mean duration of episodes of seclusion and restraint was reduced by 59 percent. Therapeutic management provides a corrective experience by addressing the developmental needs, deficient cognitive skills, and poor internalized controls of disruptive adolescents.