Organizational Climate and Support Among Peer Specialists Working in Peer-Run, Hybrid and Conventional Mental Health Settings.

As the peer specialist workforce continues to expand, it is critical to better understand peer providers' working conditions and workplace experiences. The current study utilized a targeted non-probability sample of 801 peer specialists to explore whether key organizational climate and support variables would yield distinct multivariate groups, and to investigate the correlates of these groups. Analyses yielded a seven-group solution, with peer run organizations comprising a substantially greater proportion of the groups with high organizational climate and support scores.

Development of a Measure of Housing and Housing Services.

The Housing Program Measure (HPM) was designed to document critical elements of a range of housing program types and associated services. Qualitative methods, including literature review and open-ended interviews, were used to determine pertinent HPM domains and to develop the pool of items. The measure was pre-tested, and reliability and validity analyses were applied to revise and strengthen the measure.

Fidelity to recovery-oriented ACT practices and consumer outcomes.

Objective: A previous study of a recovery-oriented assertive community treatment initiative (PACT) in Washington State found reductions in state psychiatric hospital use and related costs for PACT participants, especially in the first six months after enrollment and for consumers who were high users of the state psychiatric hospital before ACT enrollment. This study examined whether these outcomes varied by team fidelity to recovery-oriented ACT practices.

Methods: Generalized estimating equations (GEE) were used to examine the relationship between scores on the Tool for Measurement of Assertive Community Treatment (TMACT), a recently developed tool for assessing fidelity to recovery-oriented ACT, and the use of state hospitals, local hospitals, emergency departments, local crisis stabilization units, and arrests for 631 PACT consumers.

Advances in fidelity measurement for mental health services research: four measures.

Mental health intervention research requires clear and accurate specification of treatment conditions in intervention studies. Measures are increasingly available for community-based interventions for persons with serious mental illnesses. Measures must go beyond structural features to assess critical processes in interventions.

The impact of mental health services on arrests of offenders with a serious mental illness.

This study examines the impact of mental health services on arrests of offenders with a serious mental Illness (SMI) by assessing changes in associations between receipt of outpatient and emergency room/inpatient services and arrests one, two, and three quarters later. A variety of data sets were used for identifying 3,769 offenders who were in the Pinellas County Florida jail between 7/1/2003 and 6/30/ 2004, and 7,755 offenders who were in the Harris County Texas jail between 10/1/2005 and 9/30/2006. Arrests, out-patient and emergency room/inpatient services were assigned to one of 16 ninety-day periods between 7/1/2002 and 6/10/2006 in Pinellas County and one of 12 such periods between 10/1/2004 and 9/15/2007 in Harris County.

The TMACT: a new tool for measuring fidelity to assertive community treatment.

Background: Fidelity assessment is important for implementation of evidence-based practices (EBPs), including assertive community treatment (ACT).

Objectives: The TMACT, an enhanced fidelity tool, was developed and pilot-tested to better assess critical ACT structures and processes.

Design: Ten ACT teams were administered the TMACT and the long-standing ACT fidelity measure, the Dartmouth Assertive Community Treatment Scale (DACTS), at baseline, 6, 12, and 18 months.

Recovery orientation of treatment, consumer empowerment, and satisfaction with services: a mediational model.

Objective: This study explores the relationship between the recovery orientation of treatment and subjective experiences of consumer empowerment and satisfaction with services for individuals with severe and persistent mental illness.

Methods: Instruments measuring perceptions of empowerment, recovery orientation of treatment, and satisfaction with services were administered to 45 participants enrolled in two demographically similar mental health treatment programs in Tampa, Florida - a community mental health center and an Assertive Community Treatment team. Analyses were conducted according to traditional mediation models.

Short-term impact of preferred drug list changes on health care use and Medicaid costs: injectable risperidone.

Objective: This study assessed short-term effects of the removal of injectable risperidone long-acting therapy from the Florida Medicaid preferred drug list (PDL) in April 2006.

Methods: A difference-in-difference approach was used to contrast changes (60 days pre and post) in health care utilization and costs of Medicaid recipients who were receiving risperidone long-acting therapy when the policy was changed (N=247) and of a matched sample who received risperidone long-acting therapy in April 2005 (non-PDL, N=247).

Results: The policy change was associated with increased acute care events.

Characteristics and experiences of adults with a serious mental illness who were involved in the criminal justice system.

Objective: This study identified characteristics and experiences of arrestees and jail inmates with a serious mental illness that were associated with misdemeanor and felony arrests and additional days in jail.

Methods: County and statewide criminal justice records and health and social service archival data sets were used to identify inmates with serious mental illness who were in the Pinellas County, Florida, jail between July 1, 2003, and June 30, 2004, and their health and social service contacts from July 1, 2002, to June 10, 2006. Criminal justice and mental health services were recorded longitudinally across 16 quarters, or 90-day periods.

Effects of participation in consumer-operated service programs on both personal and organizationally mediated empowerment: results of multisite study.

The number of empowerment-oriented consumer-operated service programs (COSPs) in mental health has increased dramatically over the past decade; however, little empirical evidence exists about the effects of such programs on their intended outcomes. This study examined the effects of COSPs on various aspects of empowerment within the context of a multisite, federally funded, randomized clinical trial of COSPs. Results suggest that the individuals who received the consumer-operated services perceived higher levels of personal empowerment than those in the control intervention; overall, effect sizes were very modest when all sites were examined together in intent-to-treat analyses.

Evidence-based practices: setting the context and responding to concerns.

After nearly 20 years of progress in general medicine, the evidence-based practice movement is becoming the central theme for mental health care reform in the first decade of 2000. Several leaders in the movement met to discuss concerns raised by six stakeholder groups: consumers, family members, practitioners, administrators, policy makers, and researchers. Recurrent themes relate to concerns regarding the limits of science, diversion of funding from valued practices, increased costs, feasibility, prior investments in other practices, and shifts in power and control.

Fundamental principles of evidence-based medicine applied to mental health care.

This article discusses the fundamental principles of evidence-based medicine: using the best available evidence, individualizing the evidence, attending to patient preferences, and expanding clinical expertise. These principles have important implications for the adoption of evidence-based practices in mental health care.

Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment.

Despite growing interest in assessment of program implementation, little is known about the best way to evaluate whether a particular program has implemented the intended service to a level that is minimally acceptable to a funding source, such as a state mental health authority. Such is the case for assertive community treatment (ACT), an evidence-based practice being widely disseminated. Using an exploratory, actuarial approach to defining program standards, this study applies different statistical criteria for determining whether or not a program meets ACT standards using the 28-item Dartmouth Assertive Community Treatment Scale.