A qualitative approach to the evaluation of psychosocial interventions for persons with severe mental illness.

This article describes the development and assessment of a qualitative interview for comprehensively assessing both the process and the outcome of interventions for persons with severe mental illness (SMI). A open-ended 16-question Narrative Evaluation of Intervention Interview (NEII) was developed. The NEII contains questions that ask the participants to evaluate and describe both process and outcome of interventions for persons with SMI. Research participants were 64 persons with SMI attending rehabilitation programs in the community. Analysis of participants' responses to the NEII, using the open step of the grounded theory approach, produced a comprehensive set of themes. Interrater reliabilities for these themes ranged from moderate to high, and these themes differentiated between the three psychosocial interventions. Ways of modifying the NEII so as to make it more sensitive to participants' expectations and experiences are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing substance use disorder in persons with severe mental illness

Assessment of dually diagnosed patients consists of three steps: detection, diagnosis, and specialized assessment for treatment planning. Each of these is informed by recent research.     

Safer-sex education for persons with mental illness

1. Safer-sex education is crucial for controlling the spread of HIV and this education is within the realm of nursing practice. 2. Safer-sex education for persons with mental illness must include repetitive, interactive education capitalizing on verbal, visual, written, tactile, and motor skill teaching methods to compensate for learning disabilities that have been identified in this population. 3. In this study, individual rather than a group teaching approach to the sensitive subject of safer-sex provided the most learning. The study subjects did not exhibit overt sexual behavior, increased sexual acting out, regression, or overstimulation when safer-sex education was presented.     

The helping alliance in case management for homeless persons with severe mental illness

This study examined the role of the helping alliance in case management with homeless persons who have a severe mental illness. A strong alliance after two months of treatment was marginally associated with three outcomes: higher consumer satisfaction, less severe global symptom severity, and greater hostility. The only outcome associated with the alliance after fourteen months of treatment was consumer satisfaction. Several variables predicted a strong helping alliance at month two, including: being African American, low hostility, more perceived needs, and more program contacts. The only variable that predicted a strong alliance at month fourteen was a strong alliance at month two.     

Gaining control: family members relate to persons with severe mental illness

Nine isolates of methicillin-resistant Staphylococcus aureus (MRSA) collected in a Warsaw hospital in 1996 were typed by phenotypic (resistograms) and genotypic (PFGE and plasmid restriction analysis-REAP) methods. Twenty-four (MRSA) strains collected in this hospital during a period of the same duration in 1992 and typed earlier using resistograms and PFGE were also typed by REAP. Comparison of typing results obtained for isolates from 1992 and 1996 showed that strains characterised by PFGE patterns of two distinct types described as specific of the two clonally related groups of Polish MRSA in a multicentre study in 1992 are continuously present in the hospital. However, MRSA strains representing PFGE patterns not observed before were also found within the collection from 1996. REAP typing has proved to have a discriminatory power similar to that of PFGE analysis. Nevertheless, due to the lack of plasmids or difficulties in plasmid DNA isolation in 3 out of 33 studied strains, the typability of REAP turned out to be lower than that of PFGE.     

A randomized controlled trial comparing two vocational models for persons with severe mental illness.

The authors compared 2 approaches to vocational rehabilitation for individuals with severe mental illness: the individual placement and support (IPS) model of supported employment and the diversified placement approach (DPA), which emphasizes work readiness and offers a range of vocational options, including agency-run businesses and agency-contracted placements with community employers. In all, 187 unemployed participants with severe mental illness were randomly assigned to IPS or DPA. Over 2 years, IPS had significantly better competitive employment outcomes than DPA. Competitive employment rates over the 2-year follow-up were 75.0% for IPS and 33.7% for DPA. However, IPS and DPA did not differ on paid employment outcomes. The authors conclude that IPS is more effective than DPA in achieving competitive employment, but not paid employment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of methods for detecting substance use disorder in persons with severe mental illness.

Substance use disorders are frequently undiagnosed in psychiatric settings. One possible reason for this underdiagnosis is the lack of screening procedures designed or validated specifically for psychiatric patients. To evaluate the utility of current detection methods, (a) criterion diagnoses were established of alcohol use disorder and drug (cannabis or cocaine) use disorder on 320 patients with severe mental illness recently admitted to a psychiatric hospital, using a combination of structured diagnostic interviews and clinician ratings, and (b) the classification accuracy of several substance abuse measures developed for the general population was examined. For this particular sample, demographic variables, clinical variables, medical exams, laboratory tests, and collateral reports did not yield accurate detection. Screens based on self-report were superior to these other approaches but still yielded modest sensitivity. The results suggest that many individuals are classified incorrectly with current techniques. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Designing websites for persons with cognitive deficits: Design and usability of a psychoeducational intervention for persons with severe mental illness.

The purpose of this study was to develop an understanding of the design elements that influence the ability of persons with severe mental illness (SMI) and cognitive deficits to use a website, and to use this knowledge to design a web-based telehealth application to deliver a psychoeducation program to persons with schizophrenia and their families. Usability testing was conducted with 98 persons with SMI. First, individual website design elements were tested. Based on these results, theoretical website design models were used to create several alternative websites. These designs were tested for their ability to facilitate use by persons with SMI. The final website design is presented. The results indicate that commonly prescribed design models and guidelines produce websites that are poorly suited and confusing to persons with SMI. Our findings suggest an alternative model that should be considered when designing websites and other telehealth interventions for this population. Implications for future studies addressing the characteristics of accessible designs for persons with SMI and cognitive deficits are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating risk and functioning in persons with serious and persistent mental illness.

The Current Evaluation of Risk and Functioning-Revised (CERF-R), an assessment instrument designed for use with adults with severe and persistent mental illness (SPMI) delineates 18 areas of risk and functioning along with judgments regarding level of care needs. Consensus treatment team ratings were obtained on 736 state hospital patients and 2,607 clients receiving public sector mental health services in the community. Results indicate that the CERF-R exhibits a high level of internal consistency, test-retest, and interrater reliability. Concurrent validity was evident for the functional subscale. The functional and risk items successfully discriminate level of service needs. Factor analysis of the CERF-R is consistent with the three primary reasons persons with SPMI need public mental health services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing assertiveness skills to reduce HIV risk among women living with a severe and persistent mental illness.

This study examined whether training women living with a severe mental illness to be assertive in sexual situations would decrease their risk for HIV infection. Twenty female outpatients were randomly assigned to either a 10-session assertiveness training intervention or a waiting-list control condition. All participants completed measures of HIV-related information, motivation, skills, and sexual risk behavior pre- and postintervention and at 2- and 4-month follow-ups. Compared with controls, women in the intervention group increased their assertiveness skill, HIV knowledge, and frequency of condom-protected intercourse. It is concluded that assertiveness training for women living with a severe mental illness can serve as 1 part of a comprehensive HIV-risk-reduction program for this vulnerable population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk for human immunodeficiency virus (HIV) infection among persons with severe mental illnesses

Individuals diagnosed with a severe mental illness are at significantly enhanced risk for infection with the human immunodeficiency virus (HIV). To better understand elevated seroprevalence in this population, we review the research literature that has investigated HIV-related risk behavior among adults who have a severe and persistent mental illness. This review indicates that 54%-74% of adults report that they have been sexually active in the last year with approximately one third reporting two or more partners. Among those who were sexually active, condom use was inconsistent. A significant minority (4%-35%) of adults also reported a history of injection drug use. Overall, the data indicate that the severely mentally ill engage regularly in practices known to involve increased risk for HIV transmission. We introduce and modify Fisher and Fisher's (1992) theoretical model to organize the possible determinants of HIV-related risk taking among severely mentally ill adults, and encourage use of this model in the design of behavioral epidemiological and risk reduction studies. We also identify several methodological challenges to HIV-related research, including problems associated with the use of self-report measures; diagnostic imprecision; and participant recruitment and retention.     

Approaches for coordinating primary and specialty care for persons with mental illness

Selection of an orbital imaging technique requires a thorough understanding of pertinent anatomy applied to relevant clinical history and detailed ophthalmic examination. The clinical finding should direct the clinician to the imaging study that provides maximum information and narrows diagnostic considerations for the individual patient. Clinical examples are provided to illustrate the rationale in ordering magnetic resonance images, computed tomography, ocular ultrasound, and color Doppler arteriography of orbital processes.     

Clinical psychologists' perceptions of persons with mental illness.

Clinical psychologists have an ethical responsibility to monitor the nature and appropriateness of their attitudes toward persons with mental illness. This article presents the results of a survey of randomly selected clinical psychologists who were asked to rate the effectiveness, understandability, safety, worthiness, desirability, and similarity (to the rater) of persons with moderate depression, borderline features, and schizophrenia. The results show that psychologists perceive these individuals differently with respect to these characteristics. The results also suggest that psychologists disidentify or distance themselves from persons with personality and psychotic conditions. Implications for quality improvement and stigma reduction in the field of professional psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Work and nonvocational domains of functioning in persons with severe mental illness: a longitudinal analysis

In this study we sought to understand the relationship between obtaining competitive employment and changes in nonvocational domains of functioning (symptoms, substance abuse, hospitalizations, self-esteem, quality of life) in persons with severe mental illness. A group of 143 unemployed patients participating in a study of vocational rehabilitation programs were assessed in nonvocational areas of functioning at baseline and 6, 12, and 18 months later. Statistical analyses examined the relationship between work status at the follow-up assessments and nonvocational functioning, controlling for baseline levels of nonvocational variables. Patients who were working at follow-up tended to have lower symptoms (particularly thought disorder and affect on the Brief Psychiatric Rating Scale), higher Global Assessment Scores, better self-esteem, and more satisfaction with their finances and vocational services than unemployed patients. Employment is associated with better functioning in a range of different nonvocational domains, even after controlling for baseline levels of functioning.     

Psychometric evaluation of trauma and posttraumatic stress disorder assessments in persons with severe mental illness.

Interrater reliability, internal consistency, test-retest reliability, and convergent validity were examined for the Trauma History Questionnaire (THQ), the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (CAPS), and the PTSD Checklist (PCL) in 30 clients with severe mental illnesses. Interrater reliability for the THQ and CAPS was high, as was internal consistency of CAPS and PCL subscales. The test-retest reliability of the THQ was moderate to high for different traumas. PTSD diagnoses on the CAPS and PCL showed moderate test-retest reliability. Lower levels of test-retest reliability for PTSD diagnoses were related to psychosis diagnoses and symptoms. However, when more stringent criteria for PTSD were used on the CAPS, it had excellent test-retest reliability across all clients. CAPS and PCL diagnoses of PTSD showed moderate convergent validity. The results support the reliability of trauma and PTSD assessments in clients with severe mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial rehabilitation of deaf persons with severe mental illness: A multivariate model of residential outcomes.

[Correction Notice: An erratum for this article was reported in Vol 39(3) of Rehabilitation Psychology (see record 2007-10691-001). The article "Psychosocial Rehabilitation of Deaf Persons with Severe Mental Illness: A Multivariate Model of Residential Outcomes" by Judith A. Cook, Karen Kozlowski Graham, and Lisa Razzano was published with an excessive number of typographical errors. The publisher apologizes to the Journal's readers, the article authors, and the Guest Editor of the Special Issue on Deafness, for the confusion these misprints caused. Revised reprints of both articles may be obtained from the Publisher at the following address: Springer Publishing Co., Journals Department, 536 Broadway, New York, NY 10012.] Focuses on an innovative model of community treatment that integrates the fields of psychosocial rehabilitation (PSR) and deaf culture. A longitudinal research design was used to evaluate the progress of 60 Ss with mental illness and deafness toward living in the community due to a PSR program. Results suggest that deaf, mentally ill clients can increase their residential independence through PSR program participation. The number of Ss living in normal, commercial housing rose 25% after program participation. Multivariate regression analysis revealed that 5 factors account for 47% of the variance in the residential outcomes of the Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics of persons with mental illness in a representative payee program

This study compared the characteristics of 56 clients with severe mental illness in a community mental health agency's representative payeeship program with those of 54 clients who did not participate in the program. Based on data from a two-year period, participants in the representative payee program were characterized by disability or financial distress, indicated by a diagnosis of schizophrenia, homelessness, lack of rent money, and lack of financial skills; long-term dependence on income from Social Security and services provided by the mental health system, evidenced by receipt of Supplemental Security Income and frequent hospitalizations; and lack of financial independence, as reflected by inability to earn income from employment and lack of financial support from family.     

Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness

OBJECTIVES: This study evaluated the hypothesis that greater integration and coordination between agencies within service systems is associated with greater accessibility of services and improved client housing outcomes. METHODS: As part of the Access to Community Care and Effective Services and Supports program, data were obtained on baseline client characteristics, service use, and 3-month and 12-month outcomes from 1832 clients seen at 18 sites during the first year of program operation. Data on interorganizational relationships were obtained from structured interviews with key informants from relevant organizations in each community (n = 32-82 at each site). RESULTS: Complete follow-up data were obtained from 1340 clients (73%). After control for baseline characteristics, service system integration was associated with superior housing outcomes at 12 months, and this relationship was mediated through greater access to housing agencies. CONCLUSIONS: Service system integration is related to improved access to housing services and better housing outcomes among homeless people with mental illness.     

Relationships over time between mental health symptoms and transmission risk among persons living with HIV.

Relationships between mental health symptoms (anxiety and depression) or a positive state of mind and behavior associated with HIV transmission (substance use and risky sexual behavior) were explored in a longitudinal study of persons living with HIV (PLH; N = 936) who were participants in a transmission-prevention trial. Bivariate longitudinal regressions were used to estimate the correlations between mental health symptoms and HIV-related transmission acts for 3 time frames: at the baseline interview, over 25 months, and from assessment to assessment. At baseline, mental health symptoms were associated with transmission acts. Elevated levels of mental health symptoms at baseline were associated with decreasing alcohol or marijuana use over 25 months. Over 25 months, an increasingly positive state of mind was associated with decreasing alcohol or marijuana use; an increasingly positive state of mind in the immediate intervention condition and increasing depressive symptoms in the lagged condition were related to increasing risky sexual behavior. Our findings suggest that mental health symptoms precede a decrease in substance use and challenge self-medication theories. Changes in mental health symptoms and sexual behavior occur more in tandem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spiritual dimensions of a mind-body group for people with severe mental illness

In a mind-body group designed to address issues of well-being for people with severe mental disorders, experiences with spiritual themes of optimal functioning and ultimate meaning emerged with surprising clarity.