Care integration goes Beyond Co-Location: Creating a Medical Home.

How to successfully integrate mental health and primary care remains a critically important question given the continued morbidity and early mortality of people with serious mental illness. This study investigated integration in a community mental health center (MHC) primarily treating people with SMI in a large, urban northeastern city where an on-site primary care center (PCC) was opened resulting in co-located mental health and primary care services being provided. Using focus groups and online surveys this study asked participants about their thoughts and interactions with the on-site PCC.

"If You Want to Know About the Book, Ask the Author": Enhancing Community Engagement Through Participatory Research in Clinical Mental Health Settings.

Participatory research, in which people with lived experience of the study phenomenon are involved as collaborators, has been conducted for decades; however, these innovations have struggled to take hold in mental health settings-until recently. The slow uptake of community partnered research in mental health has been unfortunate, especially because this field already suffers from poor community relations, pervasive community mistrust, and racial and ethnic disparities. But now, people with lived experience of severe mental illness-long considered to be "incapable" of functioning as co-researchers-are beginning to be included on research teams.

A Pilot Study of Motive Control to Reduce Vengeance Cravings.

Violence is a serious public health problem in the United States, and a common risk factor for many forms of violence is the perpetrator's motivation to achieve personal justice for past wrongs and injustices. Using a fictional transgression scenario to stimulate revenge feelings, we studied the preliminary efficacy of an intervention designed to mitigate revenge desires among victims of perceived injustice. The intervention consisted of a guided role-play of key figures in the justice system (e.

Outcomes of a Peer Mentor Intervention for Persons With Recurrent Psychiatric Hospitalization.

Objective: This article presents findings from a randomized controlled trial of a peer support mentorship intervention designed for individuals with serious mental illness and frequent, recurrent psychiatric hospitalizations.

Methods: Seventy-six individuals who were diagnosed as having a major psychotic or mood disorder and who had at least two psychiatric hospitalizations or more than three emergency department visits within the 18 months prior to the index hospitalization participated in this trial. Participants were randomly assigned to one of two conditions: standard care or a peer mentor plus standard care.

Enhancing outcomes for persons with co-occurring disorders through skills training and peer recovery support.

: "Recovery supports", often provided by persons in recovery themselves, have emerged over the last decade as important components of recovery-oriented systems of care for persons with substance use disorders.: This study assesses the benefit of adding peer recovery supports to the care of adults with co-occurring psychosis and substance use.: 137 adults with both disorders who had at least one prior admission within the past year were recruited during an index hospitalization into a randomized trial of standard care vs skills training with and without a peer-led social engagement program.

Impact of Supported Housing on Social Relationships Among Homeless Veterans.

Objective: This study examined social network structure and function among a sample of 460 homeless veterans who participated in an experimental trial of the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program.

Methods: Participants were randomly assigned to HUD-VASH (housing subsidies and case management), case management only, or standard care. Mixed-model longitudinal analysis was used to compare treatment groups on social network outcomes over 18 months.

Reliability and Validity of a Newly Developed Measure of Citizenship Among Persons with Mental Illnesses.

Following development of a 46-item of measure citizenship, a framework for supporting the full membership in society of persons with mental illness, this study tested the measure's reliability and validity. 110 persons from a mental health center completed a questionnaire packet containing the citizenship measure and other measures to assess internal consistency and validity of the citizenship instrument. Correlation matrices were examined for associations between the citizenship instrument and other measures.

Validation of the brief version of the Recovery Self-Assessment (RSA-B) using Rasch measurement theory.

Objective: In psychiatry, the recovery paradigm is increasingly identified as the overarching framework for service provision. Currently, the Recovery Self-Assessment (RSA), a 36-item rating scale, is commonly used to assess the uptake of a recovery orientation in clinical services. However, the consumer version of the RSA has been found challenging to complete because of length and the reading level required.

The impact of current alcohol and drug use on outcomes among homeless veterans entering supported housing.

Permanent supported housing has increasingly been identified as a central approach to helping homeless individuals with disabilities exit from homelessness. Given that one third or more of homeless individuals actively use substances, it is important to determine the extent to which individuals who report using alcohol and/or drugs at the time of housing benefit from such programs. The current study examines data from the evaluation of the United States Department of Housing and Urban Development-Veterans Affairs (HUD-VA) Supported Housing (HUD-VASH) program to determine differences in housing and clinical outcomes among participants with two different levels of active alcohol or drug use at time of housing entry.

Differential impact of supported housing on selected subgroups of homeless veterans with substance abuse histories.

Objective: Studies have demonstrated that supported housing is an effective intervention for individuals who are homeless and have a mental illness or substance use disorder. This study examined data from an experimental trial of the U.S.

The Citizenship Project part II: impact of a citizenship intervention on clinical and community outcomes for persons with mental illness and criminal justice involvement.

This study assessed the effectiveness of an intervention based on a theoretical framework of citizenship on reducing psychiatric symptoms, alcohol use, and drug use, and increasing quality of life for persons with serious mental illness (SMI) and criminal justice involvement. One-hundred fourteen adults with SMI and a history of criminal justice involvement participated in a 2 × 3 longitudinal randomized controlled trial of a four-month citizenship intervention versus usual services. Linear mixed model analyses were used to assess the intervention's impact on quality of life, symptoms, and substance use.

Going to the source: creating a citizenship outcome measure by community-based participatory research methods.

Objective: This study used participatory methods and concept-mapping techniques to develop a greater understanding of the construct of citizenship and an instrument to assess the degree to which individuals, particularly those with psychiatric disorders, perceive themselves to be citizens in a multifaceted sense (that is, not in a simply legal sense).

Methods: Participants were persons with recent experience of receiving public mental health services, having criminal justice charges, having a serious general medical illness, or having more than one of these "life disruptions," along with persons who had not experienced any of these disruptions. Community-based participatory methods, including a co-researcher team of persons with experiences of mental illness and other life disruptions, were employed.

From adherence to self-determination: evolution of a treatment paradigm for people with serious mental illnesses.

Treatment adherence and nonadherence is the current paradigm for understanding why people with serious mental illnesses have low rates of participation in many evidence-based practices. The authors propose the concept of self-determination as an evolution in this explanatory paradigm. A review of the research literature led them to the conclusion that notions of adherence are significantly limited, promoting a value-based perspective suggesting people who do not opt for prescribed treatments are somehow flawed or otherwise symptomatic.

Effectiveness of peer support in reducing readmissions of persons with multiple psychiatric hospitalizations.

Objective: The study examined the feasibility and effectiveness of using peer support to reduce recurrent psychiatric hospitalizations.

Methods: A randomized controlled design was used, with follow-up at nine months after an index discharge from an academically affiliated psychiatric hospital. Patients were 18 years or older with major mental illness and had been hospitalized three or more times in the prior 18 months.

The relationship between case manager expectations and outcomes of persons diagnosed with schizophrenia.

The present study examined the relationship between case managers' expectations about the abilities of persons diagnosed with schizophrenia and the outcomes (as indicated via chart review) of a randomly selected sample of clients diagnosed with schizophrenia on their caseload. Results indicate that clients of case managers with higher expectations averaged significantly more months of progress in employment than clients of case managers with lower expectations. Case manager expectations were also better predictors of the number of days employed than other case manager and consumer characteristics, however the type of expectation was a critical determinant of the direction of the effect.

Rates and risk factors for homelessness after successful housing in a sample of formerly homeless veterans.

Objective: Research suggests that subsidized housing combined with mental health services may be an effective intervention for successfully placing individuals who have a mental illness and a history of homelessness into community housing. However, there is limited longitudinal information available about the risk of loss of housing after a successful exit from homelessness.

Methods: The study presented here examined the risk and predictors of returning to homelessness after successful housing in a sample of 392 formerly homeless veterans involved in an experimental trial of case management plus rent subsidy vouchers, case management only, or standard care.

Creating a recovery-oriented system of behavioral health care: moving from concept to reality.

This article describes challenges and successes seen in the first four years of efforts the state of Connecticut has made to reorient its behavioral health system to promoting recovery. Beginning in 2000, the Connecticut initiative was conceptualized as a multi-year, systemic process that involved the following interrelated steps: a) developing core values and principles based on the input of people in recovery; b) establishing a conceptual and policy framework based on this vision; c) building workforce competencies and skills; d) changing programs and service structures; e) aligning fiscal and administrative policies; and, finally, f) monitoring, evaluating, and adjusting these efforts. Following descriptions of the first four steps, the authors offer a few lessons that might benefit other states engaged in similar processes of transformation.

A peer-support, group intervention to reduce substance use and criminality among persons with severe mental illness.

Objective: This study compared the effectiveness of two interventions in reducing alcohol use, drug use, and criminal justice charges for persons with severe mental illnesses: first, a community-oriented group intervention with citizenship training and peer support that was combined with standard clinical treatment, including jail diversion services, and second, standard clinical treatment with jail diversion services alone.

Methods: A total of 114 adults with serious mental illness participated in a 2 x 3 prospective longitudinal, randomized clinical trial with two levels of intervention (group and peer support for the experimental condition and standard services for the control) and three interviews (baseline, six months, and 12 months). Self-report questionnaires assessed alcohol and drug use, and program databases assessed criminal justice contacts.

Workforce competencies in behavioral health: an overview.

Competency-based training approaches are being used more in healthcare to guide curriculum content and ensure accountability and outcomes in the educational process. This article provides an overview of the state of competency development in the field of behavioral health. Specifically, it identifies the groups and organizations that have conducted and supported this work, summarizes their progress in defining and assessing competencies, and discusses both the obstacles and future directions for such initiatives.

Psychiatric advance directives: perspectives of community stakeholders.

The present study compares the familiarity with and attitudes about psychiatric advance directives among multiple community stakeholders in two Ohio communities. One community was involved in a pilot psychiatric advance directive education project, and one was not. A total of 272 legal and law enforcement personnel, clergy, healthcare professionals, mental health professionals, consumers, and family members completed a newly developed measure of opinions about psychiatric advance directives.

Innovation in behavioral health workforce education.

This article describes an effort to promote improvement in the quality and relevance of behavioral health workforce education by identifying and disseminating information on innovative training efforts. A national call for nominations was issued, seeking innovations in the education of behavioral health providers, consumers, and family members. A review committee evaluated each nomination on four dimensions: novelty, significance, transferability, and effectiveness.

Best practices in behavioral health workforce education and training.

Dramatic changes have occurred in the delivery of mental health and substance abuse services over the past decade and a half. There is growing concern that education programs have not kept pace with these changes and that reforms are needed to improve the quality and relevance of training efforts. Drawing on the published works of experts and a national initiative to develop a consensus among stakeholders about the nature of needed reforms, this article outlines 16 recommended "best practices" that should guide efforts to improve workforce education and training in the field of behavioral health.

Student voices: perspectives on behavioral health education.

The Annapolis Conference on Behavioral Health Workforce Education and Training was convened in September 2001 to address the relevance and quality of efforts to educate those who provide mental health and addiction services. It was essential that students, as the consumers of educational programs, be represented in the dialogue. Four students and one recent graduate joined a diverse group in Annapolis, which included professionals, administrators, educators, consumers of behavioral health services, and family members.