Best practices: A national mental health learning collaborative on supported employment.

This column describes a best practice for dissemination and implementation used by the Johnson & Johnson-Dartmouth Program: a national learning collaborative among community mental health programs on supported employment. In this two-tiered learning collaborative, researchers meet regularly with mental health and vocational rehabilitation leaders in 12 states and the District of Columbia, and state leaders oversee more than 130 individual programs in their respective states. Participants share educational programs, implementation and intervention strategies, practice experiences, outcome data, and research projects.

What predicts supported employment program outcomes?

Numerous state systems and local mental health and vocational rehabilitation programs are currently attempting to implement supported employment. This cross-sectional survey of 26 mental health agencies, partnering with federal-state vocational rehabilitation, identified differences in access to supported employment services and rates of competitive employment (efficiency) as well as predictors of access and efficiency. Access varied from 2 to 100% and was related to the percentage of supported employment specialists per consumers with serious mental illness served by the mental health agency (funding).

Best practices: the Johnson & Johnson--Dartmouth community mental health program: disseminating evidence-based practice.

This column describes a private-public-academic collaboration in six states and the District of Columbia designed to provide evidence-based supported employment for persons with psychiatric disabilities by using best practices for program implementation. Dissemination strategies included collaborative state-level administrative oversight, longitudinal training based on established fidelity criteria, outcome-based supervision, problem solving by local experts, and selection of intervention sites on the basis of their motivation to participate. The number of clients served at participating sites increased steadily over 11 quarters, and the proportion of clients competitively employed stayed consistently over 40 percent.

Correlates of anticholinergic activity in patients with dementia and psychosis treated with risperidone or olanzapine.

Background: Older individuals with dementia are highly sensitive to the effects of muscarinic receptor blockade.

Study Design: This was a 6-week multisite, randomized clinical trial.

Subjects: Eighty-six patients with probable Alzheimer's disease, vascular dementia, or mixed-etiology dementia (DSM-IV criteria) were randomly assigned to treatment with olanzapine or risperidone.

Psychosis of Alzheimer disease: validity of the construct and response to risperidone.

Objective: The authors evaluated the efficacy of risperidone in reducing psychotic and aggressive symptoms in a subgroup of patients who fulfilled operationalized criteria for psychosis of dementia.

Methods: Authors conducted a subgroup analysis of patients in the risperidone database arising from a previous double-blind, randomized, placebo-controlled study. In the primary study, patients age 55 or older, with a DSM-IV diagnosis of Alzheimer disease and/or vascular dementia were randomized to placebo or 0.

Central challenges facing the national clinical research enterprise.

Medical scientists and public health policy makers are increasingly concerned that the scientific discoveries of the past generation are failing to be translated efficiently into tangible human benefit. This concern has generated several initiatives, including the Clinical Research Roundtable at the Institute of Medicine, which first convened in June 2000. Representatives from a diverse group of stakeholders in the nation's clinical research enterprise have collaborated to address the issues it faces.

Views of potential subjects toward proposed regulations for clinical research with adults unable to consent.

Objective: The authors' goal was to assess healthy individuals' attitudes toward five of the most prominent proposed safeguards regarding the consent process for research with adults unable to consent.

Method: Telephone interviews were conducted with 246 individuals with a family history of Alzheimer's disease who had participated in clinical research.

Results: The majority of respondents said that they were willing to participate in research if they lost the ability to consent.