The Emergence of Mental Health Self-Direction: An International Learning Exchange.

Self-direction has emerged worldwide as a promising practice for persons with serious mental health conditions and as a means toward creating more person-centered service systems. In self-direction, service users control an individualized budget, purchasing goods or services that can help them achieve personal recovery goals. This Open Forum describes an international learning exchange meeting, held in September 2015, in which experts in self-direction and mental health from seven nations convened for sharing best practices, discussing challenges, and laying the groundwork for a learning community to support the continued development of self-direction.

Happily Ever After? Pre-and-Post Disaster Determinants of Happiness Among Survivors of Hurricane Katrina.

This study investigated pre- to post-disaster changes in happiness of 491 women affected by Hurricane Katrina, and identified factors that were associated with the survivors' happiness after the storm. Participants completed surveys approximately 1 year before and 1 and 4 years after the storm. The surveys collected information on the women's happiness, social support, household characteristics, and hurricane exposure.

Workplace-based health and wellness programs: the intersection of aging, work, and health.

Workplace-based health and wellness programs (HWPs) may be an obvious yet under-utilized strategy for promoting positive health-related behaviors among older workers and for increasing their ability to continue to work. Given the unprecedented number of older adults who extend their labor force attachment beyond traditional retirement ages, a new vision of older adults' economic security and overall quality-of-life should take into account the intersections of aging, work, and health. The purpose of this article is to: (a) discuss the workplace as an increasingly important setting that can expand the reach and effectiveness of health promotion efforts; (b) examine current knowledge of barriers and facilitators that can affect older workers' participation in workplace-based HWPs; and (c) suggest new incentive structures that may increase older workers' engagement in these programs.

Where are they now? Cash and Counseling successes and challenges over time.

The positive results of the Cash & Counseling Demonstration and Evaluation (CCDE) led to the funding of a replication project that included 12 more states in 2008. Since then, the political and economic environments have changed. The authors sought to investigate how well the three original and 12 replication CCDE programs are coping with current challenges, and how their experiences may inform the growth and sustainability of emerging participant-directed programs.

The Relationship between Health and Community across Aging Cohorts.

Research is needed to examine the connection between older adults and their community as they age. This is important as increasing numbers of older adults wish to age in place. Regression models were examined across 3 cohorts testing relationships among social capital indicators (neighborhood trust, neighborhood support, neighborhood cohesion, neighborhood participation, and telephone interaction) with health outcomes (self-rated health, activities of daily living (ADL), and instrumental activities of daily living (IADL)).

Workplace characteristics and work-to-family conflict: does caregiving frequency matter?

Many workers can expect to provide care to an elder relative at some point during their tenure in the workforce. This study extends previous research by exploring whether caregiving frequency (providing care on a regular, weekly basis vs. intermittently) moderates the relationship between certain workplace characteristics and work-to-family conflict.

Caregiver evaluation of the quality of end-of-life care (CEQUEL) scale: the caregiver's perception of patient care near death.

Purpose: End-of-life (EOL) measures are limited in capturing caregiver assessment of the quality of EOL care. Because none include caregiver perception of patient suffering or prolongation of death, we sought to develop and validate the Caregiver Evaluation of Quality of End-of-Life Care (CEQUEL) scale to include these dimensions of caregiver-perceived quality of EOL care.

Patients And Methods: Data were derived from Coping with Cancer (CwC), a multisite, prospective, longitudinal study of advanced cancer patients and their caregivers (N = 275 dyads).

Abstinence self-efficacy in people with severe mental illness.

To validate the Brief Situational Confidence Questionniare (BSCQ) with people diagnosed with severe mental illness (N=129), we examined the associations between abstinence self-efficacy (BSCQ) and alcohol consumption level (within the previous 6months), drug use, and problems related to substance use while controlling for key symptoms of major mental illness and motives for alcohol use (Drinking Motives Questionnaire). Regression models revealed that abstinence self-efficacy was a significant predictor of all three substance use measures suggesting that, even when controlling for psychiatric symptoms and substance use motives, abstinence self-efficacy accounts for unique variance in alcohol use, drug use, and related problems. This study is limited by the cross sectional design and lack of structured diagnostic interviewing.

The association of self-rated health and lifestyle behaviors among foreign-born Chinese, Korean, and Vietnamese Americans.

Purpose: This study employed the 2009 California Health Interview Survey to examine the association of self-rated heath status and lifestyle behavior variables such as smoking at least 100 cigarettes or more in an entire lifetime, alcohol consumption, and physical activity level among foreign-born Chinese, Korean, and Vietnamese Americans aged 18 and older.

Methods: The total study sample consisted of 3,023 foreign-born adult Chinese (n = 812), Korean (n = 857), and Vietnamese (n = 1,354) Americans. Logistic regression via Stata 12 was employed.

The future of Cash and Counseling: the framers' view.

Objective: This paper reflects on the progress of the original Cash and Counseling states, and shows how this model has spread, how it has evolved over time, and what is left to improve. It then discusses the generalizability of the Cash and Counseling approach beyond long-term care and ventures some thoughts on what still needs to be learned. Finally, this paper suggests some of the contingencies that could affect the diffusion of this innovation.

Cash and counseling: a promising option for consumer direction of home- and community-based services and supports.

The Cash and Counseling Demonstration began as a 3-state social experiment to test the claims of members of the disability community that, if they had more control over their services, their lives would improve and costs would be no higher. The 2004 expansion to 12 states brings us closer to the tipping point when this option will be broadly available. The original demonstration was a controlled experiment with randomized assignment, supplemented by an ethnographic study and a process evaluation.

Subjective distress from stressful events and high-risk behaviors as predictors of PTSD symptom severity in clients with severe mental illness.

Survey data collected from 257 community mental health center clients tested direct and indirect relationships among subjective distress associated with stressful/traumatic events and high-risk behaviors, substance abuse, and posttraumatic stress disorder (PTSD) symptoms. Structural equation modeling (SEM) revealed substantial direct effects of subjective distress associated with lifetime physical and sexual abuse on PTSD symptom severity. Subjective distress related to high-risk behaviors (e.

Cash and counseling and managed long-term care?

This article presents the results of a survey on the interest of managed care organizations (MCOs) in developing a "cash and counseling" (C&C) option for delivering long-term personal assistance services. Forty-five percent of the respondents expressed interest, at least for some clients. Although specific experience with consumer direction did not have an effect, three organizational factors--larger size, non-PACE, and not limited to the elderly--predicted MCOs' willingness to consider this option.

Further validation of the Psycho-Social Well-Being Scale (PSWS) with community clients.

To monitor and evaluate the use of evidence-based approaches with mentally ill persons who abuse alcohol and other drugs, administrators, practitioners and evaluators will need to incorporate brief, reliable, and valid instruments into daily practice. The current two-part study provides further validation of the Psycho-Social Wellbeing Scale (PSWS), a multidisciplinary "debriefing tool" designed to capture and summarize data on clients' wellbeing from multiple sources in team-based community care. In the current investigation the PSWS was correlated with a number of valid instruments including the Brief Psychiatric Rating Scale, the Role Functioning Scale, the Social Functioning-12, the Alcohol Use Disorders Identification Test, the Alcohol Use and Drug Use Scales along with other important indices.

African American marriage in the 20th century.

It is not possible to understand African American marriages fully without attention to the social, economic, racial, and historical factors that have stressed male-female relationships beyond those stresses experienced by majority couples. I propose that the societal projection process (Bowen, 1978) has entrapped African Americans in ways that have continually and severely strained their marital and couple relationships. These experiences, and the ways in which African Americans have responded to them, have created a vulnerability that is compounded by societal shifts and changes, and is manifest in the precipitous decline of marriages at a rate higher than that found in all other racial groups in the U.

Construct validity of the MAST and AUDIT with multiple offender drunk drivers.

The construct validity of the Michigan Alcoholism Screening Test (MAST) and the Alcohol Use Disorders Identification Test (AUDIT) in screening for current DSM-IV alcohol dependence disorders with persons convicted of multiple offenses of Driving Under the Influence (DUI) is evaluated. These tests were administered to 126 DUI offenders presenting for court-ordered inpatient treatment at an agency. DSM-IV alcohol disorders are evaluated for a representative subset of clients in this program using National Longitudinal Alcohol Epidemiologic Surveys' DSM-IV Alcohol Dependence Diagnostic Criteria and Associated Questionnaire Items.

Co-occurring psychosocial distress and substance abuse in community clients: initial validity and reliability of self-report measures.

The current study examines the self-reports of 227 community support clients using a paper and pencil questionnaire that included the South Shore Problem Inventory-revised (a brief multidimensional psychosocial distress scale), a one-item index of self-rated substance abuse (SRSA), a quantity-frequency index for alcohol consumption (QFI), and a one-item index measuring the frequency of marijuana use. Results support the factor structure and internal consistency of the SSPI-r, and show significant correlations among the substance use indices. Implications for including brief mental health and substance abuse measures are discussed within the context of routine assessment and practice evaluation.

The Drinking Context Scale. A confirmatory factor analysis.

The current article examines the development and validation of the Drinking Context Scale through the use of confirmatory factor analysis. The scale measures the self-reported likelihood of excessive drinking across a number of specific social-cognitive drinking contexts. Five-hundred-and-five college students adjudicated for breaking university drinking rules filled out the anonymous questionnaire.

The future of child and family welfare: selected readings.

In the decade leading up to the 21st century, a number of authors began focusing on the future in the field of child and family welfare. This review summarizes selected readings in this area, ranging from examination of such broad topics as research and policy issues to indepth analysis of specific topics such as family foster care and child protective services.

Predicting problem drinking in college students: gender differences and the CAGE questionnaire.

Adolescents and young adults are among the highest users of alcohol and other drugs in the United States. One of the tools most commonly employed in screening for problem drinking and alcohol dependence is the CAGE questionnaire. Research has indicated, however, that not only may the CAGE be a poor detection device for identifying youthful substance abuse, but it may particularly lack strength in the detection of alcohol abuse by young women.

Psychological traumas and depression in a sample of Vietnamese people in the United States.

This article investigates the relationships among premigration stresses, nightmares, acculturation stresses, personal efficacy, and depression in a sample of 147 adult Vietnamese Americans. The analysis revealed that premigration stresses, nightmares, and acculturation stresses had significant indirect effects on depression. Acculturation stresses diminish personal efficacy, and a weakness of personal efficacy leads to higher depression.

The psychological abuse of latency age children: a survey.

Most states have included sections on psychological abuse or emotional maltreatment in their child abuse statutes, however, interest in this type of abuse has lagged in litigation, treatment, or research. Lack of public sanctions to examine or prosecute these cases may be a reason for this reluctance. This research project aimed at identifying potential definitions of psychological abuse, by submitting vignettes with adult behaviors to be rated as abuse or not by a group of citizens and also comparing these results with a professional social work cohort.

The generational equity debate: a progressive framing of a conservative issue.

This article discusses the generational equity debate in the United States--including its origins and the functions it serves. This debate has emerged in the context of concerns over the aging of the population, budgetary crises, growing health care costs, increased poverty among children, growing economic inequality, and declining faith in institutions. By potentially fragmenting support for Social Security and other social programs, the generational equity approach to framing public policy issues may serve the interests of those conservatives wishing to shrink and restructure the American approach to social welfare.