"It Makes us Realize that We Have Been Heard": Experiences with Open Dialogue in Vermont.

The Open Dialogue approach was developed in Finland as a form of psychotherapy and a way to organize mental health systems. Open Dialogue has drawn global interest leading to adaptations worldwide, including in Vermont-US where it is called Collaborative Network Approach. Our study aimed to investigate the experiences of families who received Collaborative Network Approach in two agencies in Vermont. Qualitative interviews were conducted with 17 persons receiving services. Seven themes emerged: 1) network focus, 2) decision-making, 3) structure of care, 4) use of reflections, 5) medications, 6) hospitalizations, 7) challenges. Our study provides evidence that CNA is well-received, appreciated, and for many people an empowering form of mental health care. The findings suggest that elements of Open Dialogue are highly consistent with the vision for recovery-oriented care, in that they are flexible, person-centered, encourage processes of negotiation, and highlight the importance of family and social supports in care.

Implanting Rhizomes in Vermont: a Qualitative Study of How the Open Dialogue Approach was Adapted and Implemented.

The Open Dialogue approach was developed in Finland in the 1980s as a form of psychotherapy and a way to organize mental health systems. It has been adapted and implemented in several countries in recent years. This qualitative study sought to explore staff and developers' experiences with one adaptation of the Open Dialogue approach in the state of Vermont called the Collaborative Network Approach. In total twenty two staff members from two agencies participated in focus groups and three developers of the approach were interviewed. Three dominant topics emerged in the analysis process: impact of training; buy-in across levels; and shift in organizational culture. Findings revealed that 1) participants experienced the Collaborative Network Approach as positively impacting their clinical work, relationship with clients and families, and with colleagues; 2) buy-in across levels - colleagues, management and department of mental health - was perceived as crucial to the development and implementation of the approach; 3) the main challenges to full implementation were: inadequate billing structures, costly and lengthy training, and resistance to shift organizational culture to integrate the Collaborative Network Approach into agencies. We hope to have contributed to the field in a way that will support further efforts to develop and implement Open Dialogue-informed approaches by pointing to potential successes and challenges future program developers may face.

Intensive Outpatient Treatment (IOP) of Behavioral Health (BH) Problems: Engagement Factors Predicting Subsequent Service Utilization.

The purpose of the study is to 1) better understand patterns of utilization of Intensive Outpatient Treatment (IOP) Programs and Services in the State of Connecticut by adult Medicaid recipients experiencing a serious mental illness, substance use disorder, or co-occurring disorders; and 2) to determine the relationship between the duration of an IOP episode and connection to care rates for higher (i.e., rehospitalization) or lower levels of care following discharge. We hypothesized that the duration of an IOP episode would impact positively in reducing the use of higher levels of care while increasing the use of lower levels of care. In order to examine the frequency and duration of use of Intensive Outpatient (IOP) services by the CT Medicaid population, a two-year timeframe was selected: July 1, 2012 to June 30, 2014. A survival analysis was conducted to assess the risk of readmission to an IOP within 180 days based on demographic and utilization factors including, Age (in years on date of discharge), Race and Ethnicity, Gender, Homeless Status (at least one day in CY 2013), and Engagement Group (Intent to Treat, Early Termination, Minimally Adequate Dosage, & Target or More). To better understand the patterns of utilization associated with Adult IOP services, the average length of stay, number of treatment days, and average number of treatment days per week were explored. The number of unique individuals who were part of this analysis is 11,473, of which 2050 were mental health IOP utilizers (18%), 4598 were co-occurring IOP utilizers (40%), and 4825 (42%) were substance use IOP utilizers. For the total population, the average length of stay (ALOS) in days was 42 and the average number of treatment days attended per week was 2.5, for an average of 15 treatment days per episode of care. Among the IOP Cohorts, the Mental Health Cohort had the longest ALOS at 44.15 days, an average of 2.34 days of service per week, for an average of 14.76 days of IOP service per episode of care. The Substance Use Cohort had the shortest ALOS at 41.33 days, but had the highest intensity of services per week at 2.71 for an average of 16 days of service per episode of care. The Co-Occurring Cohort presented an ALOS of 41.74 days, an average of 2.32 services per week and an average of 13.83 sessions per episode. Overall there is evidence supporting an association between the number of days of care and protection from hospitalization, up to a certain number of days of care or number of days in IOP. Above the Minimally Adequate Dosage, the IOP protection factor seems to reach a plateau. This means that after 16 days of care, the chances of hospitalization remain the same regardless of the additional days provided.

Personal Recovery Among People at Risk for Developing Serious Mental Health Problems: A Qualitative Systematic Review.

OBJECTIVE: Personal recovery refers to a person's pursuit of a full, meaningful life despite the potentially debilitating impact of a mental illness. An evidence base describing personal recovery among people at risk for developing a mental illness is lacking, limiting the potential for mental health services to support personal recovery. To address this gap, the authors synthesized the extant research describing personal recovery among people at risk for developing a mental illness. METHODS: A systematic search of several literature databases (MEDLINE, Embase, APA PsycInfo, Web of Science Core Collection, and Cochrane Library) was conducted to retrieve qualitative and case studies and first-person accounts. The Joanna Briggs Institute guidelines for systematic reviews were followed. Included studies reported on participants at variable risk for developing a schizophrenia spectrum, bipolar, major depressive, or borderline personality disorder. Articles were retrieved through a librarian-assisted search and through use of additional strategies (e.g., expert consultation). Abstracts were screened by the research team, and themes were developed by using thematic synthesis. RESULTS: The 36 included articles were synthesized, and six themes were generated: difficulties and challenges; establishing an understanding of, and finding ways to cope with, one's mental health challenges; reestablishing a sense of agency and personhood; receiving support from people and services, as well as restoring relationships; reestablishing hope, meaning, and purpose; and overcoming stigma and destigmatizing mental illness in others. CONCLUSIONS: These findings provide a conceptual foundation that can guide future research on personal recovery and clinical interventions that foster it among people at risk for mental illness.

State of the Art of Participatory and User-led Research in Mental Health in Brazil: A Scoping Review.

Background: Participatory research denotes the engagement and meaningful involvement of the community of interest across multiple stages of investigation, from design to data collection, analysis, and publication. Traditionally, people with first-hand experience of psychiatric diagnoses, services users and those living with a psychosocial disability have been seen objects rather than agents of research and knowledge production. This, despite the ethical and practical benefits of their involvement. The state of the art of knowledge about participatory research in mental health Brazil is poorly understood outside of its local context. The purpose of this article was to conduct a scoping review of participatory and user-led research in mental health in Brazil. Findings: We identified 20 articles that met eligibility criteria. Participation in research was not treated as separate from participation in shaping mental health policy, driving care, or the broader right to fully participate in societal life and enjoy social and civil rights. Studies identified several obstacles to full participation, including the biomedical model, primacy of academic and scientific knowledge, and systemic barriers. Our extraction, charting, and synthesis yielded four themes: power, knowledge, autonomy, and empowerment. Implications of the work: Participation in this context must address the intersecting vulnerabilities experienced by those who are both Brazilian and labeled as having a mental illness. Participatory research and Global South leadership must foreground local epistemologies that can contribute to the global debate about participation and mental health research.

Generativity among persons providing or receiving peer or mutual support: A scoping review.

OBJECTIVE: People with lived experience of mental illness or distress can help others recover through peer or mutual support. One way they may help others recover is by fostering generativity, which refers to one's concern for and contributions toward the betterment of others, including future generations (e.g., through caregiving, engaging in civics). Generativity may add purpose to one's life, benefit society, and improve areas which persons with lived experience feel are important for their recovery. Despite its importance, the state of knowledge on experiences and facilitators of generativity, as well as the impact that engaging in generativity has on the lives of persons engaged in peer or mutual support, is unclear. METHOD: A librarian-assisted scoping review of the literature was conducted in five steps: identifying the research question and relevance; selecting studies; charting data; and coding and summarizing the results. RESULTS: Out of 11,862 articles that were screened, only 18 met eligibility criteria. Most studies were conducted in the United States and included White/Caucasian participants. Our synthesis produced themes related to generative actions, which included helping others, changing organizations and systems, and sharing personal stories. Themes describing facilitators of generativity included individual-level and organizational-level factors. One theme reflecting the positive psychosocial impact of engaging in generativity was produced. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings from this study point to several knowledge gaps to be investigated in future research and can facilitate the implementation of peer support initiatives aimed at fostering generativity, which may in turn promote recovery. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Youths' and Young Adults' Experiences of Police Involvement During Initiation of Involuntary Psychiatric Holds and Transport.

Over the past decade, police involvement in behavioral health crisis response has generated concern and controversy. Despite the salience and timeliness of this topic, the literature on service user experiences of interactions with officers is small and studies of youths and young adults are nonexistent. The authors aimed to investigate youths' and young adults' experiences of police involvement in involuntary psychiatric hold initiation and transport. In-depth interviews were conducted with 40 participants (ages 16-27) who had experienced an involuntary hold; the 28 participants who reported police involvement are the focus of this analysis. Data were inductively coded, and codes were grouped into larger themes. A majority of participants reported negative experiences; major themes characterizing negative encounters were the framing of distress as criminal or of intervention as disciplinary rather than therapeutic, perceived aggression and callousness from police officers, and poor communication. The authors also characterized the positive experiences of officer involvement reported by a minority of participants and youths' perspectives on the degree of control officers could exert over initiation and transport decisions. Findings help center the voices of youths and young adults with mental health challenges and raise important questions about contemporary policies regarding police involvement in crisis response and, more broadly, about coercive responses to distress or emotional crisis.

Epithelial production of elastase is increased in inflammatory bowel disease and causes mucosal inflammation.

Imbalance between proteases and their inhibitors plays a crucial role in the development of Inflammatory Bowel Diseases (IBD). Increased elastolytic activity is observed in the colon of patients suffering from IBD. Here, we aimed at identifying the players involved in elastolytic hyperactivity associated with IBD and their contribution to the disease. We revealed that epithelial cells are a major source of elastolytic activity in healthy human colonic tissues and this activity is greatly increased in IBD patients, both in diseased and distant sites of inflammation. This study identified a previously unrevealed production of elastase 2A (ELA2A) by colonic epithelial cells, which was enhanced in IBD patients. We demonstrated that ELA2A hyperactivity is sufficient to lead to a leaky epithelial barrier. Epithelial ELA2A hyperactivity also modified the cytokine gene expression profile with an increase of pro-inflammatory cytokine transcripts, while reducing the expression of pro-resolving and repair factor genes. ELA2A thus appears as a novel actor produced by intestinal epithelial cells, which can drive inflammation and loss of barrier function, two essentials pathophysiological hallmarks of IBD. Targeting ELA2A hyperactivity should thus be considered as a potential target for IBD treatment.

Effect of different prebiotics on the fermentation kinetics, probiotic survival and fatty acids profiles in nonfat symbiotic fermented milk.

The simultaneous effects of different binary co-cultures of Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillus rhamnosus and Bifidobacterium lactis with Streptococcus thermophilus and of different prebiotics on the production of fermented milk were investigated in this paper. In particular, we determined and compared the kinetics of acidification of milk either as such or supplemented with 4% (w/w) maltodextrin, oligofructose and polydextrose, as well as the probiotic survival, chemical composition (pH, lactose, lactic acid and protein contents), fatty acids profile and conjugate linoleic acid (CLA) content of fermented milk after storage at 4 degrees C for 24 h. Fermented milk quality was strongly influenced both by the co-culture composition and the selected prebiotic. Depending on the co-culture, prebiotic addition to milk influenced to different extent kinetic acidification parameters. All probiotic counts were stimulated by oligofructose and polydextrose, and among these B. lactis always exhibited the highest counts in all supplemented milk samples. Polydextrose addition led to the highest post-acidification. Although the contents of the main fatty acids were only barely influenced, the highest amounts of conjugated linoleic acid (38% higher than in the control) were found in milk fermented by S. thermophilus-L. acidophilus co-culture and supplemented with maltodextrin.

A abordagem Open Dialogue: história, princípios e evidências / The Open Dialogue approach: history, principles and observations / El enfoque Open Dialogue: historia, principios y evidencias

A abordagem Open Dialogue foi desenvolvida na Finlândia na década de 1980, como um conjunto de práticas e princípios que modificou o modelo de atenção aos problemas de saúde mental da região. Através da proposta de reuniões familiares envolvendo a rede social das pessoas em crise em uma perspectiva dialógica, a abordagem Open Dialogue reduziu o número de internações em hospitais psiquiátricos e o tempo não tratado da doença; incorporou o uso seletivo de neurolépticos e promoveu taxas de recuperação de 84% das pessoas tratadas. O objetivo deste artigo é apresentar uma revisão narrativa da literatura sobre a abordagem Open Dialogue trazendo a história de seu desenvolvimento, os sete princípios que orientam suas práticas e estudos de efetividade. Por fim, convidamos o leitor ao debate de estratégias de cuidado aos primeiros episódios psicóticos, contando que a abordagem Open Dialogue possa oferecer pistas para a Atenção Psicossocial brasileira. (AU)

The Open Dialogue approach was developed in Finland in the 1980's as a set of practices and principles that changed the model of mental health care delivery in the Western Lapland region. Through family meetings conducted in accordance with a dialogical perspective involving the person in crisis and their social network, the Open Dialogue approach reduced the number of hospitalisations in psychiatric hospitals, diminished the duration of untreated illness, incorporated the selective use of neuroleptics and promoted recovery in 84% of persons treated. This paper presents a literature review of the Open Dialogue approach outlining its history and development, as well as the seven principles that guide clinical practice and effectiveness studies. Finally, we invite the reader to participate in the debate regarding care strategies for first episode psychosis, given to understand that the Open Dialogue approach may provide new paths for Brazilian Psychosocial Care. (AU)

El enfoque Open Dialogue fue desarrollado en Finlandia en la década de 1980 como un conjunto de prácticas y principios que modificó el modelo de atención a los problemas de salud mental de la región. A través de la propuesta de reuniones familiares incluyendo a la red social de las personas en crisis desde una perspectiva dialógica, el enfoque Open Dialogue redujo el número de internaciones en hospitales psiquiátricos y el tiempo no tratado de la enfermedad; incorporó el uso selectivo de neurolépticos y promovió tasas de recuperación de 84% de las personas tratadas. El objetivo de este artículo es presentar una revisión narrativa de la literatura sobre el enfoque Open Dialogue trayendo la historia de su desarrollo, los siete principios que orientan sus prácticas y estudios de efectividad. Por último, invitamos al lector al debate de estrategias de cuidado a los primeros episodios psicóticos, contando que el abordaje Open Dialogue pueda ofrecer pistas para la Atención Psicosocial brasileña. (AU)

Fatty acid profile, trans-octadecenoic, α-linolenic and conjugated linoleic acid contents differing in certified organic and conventional probiotic fermented milks.

Development of dairy organic probiotic fermented products is of great interest as they associate ecological practices and benefits of probiotic bacteria. As organic management practices of cow milk production allow modification of the fatty acid composition of milk (as compared to conventional milk), we studied the influence of the type of milk on some characteristics of fermented milks, such as acidification kinetics, bacterial counts and fatty acid content. Conventional and organic probiotic fermented milks were produced using Bifidobacterium animalis subsp. lactis HN019 in co-culture with Streptococcus thermophilus TA040 and Lactobacillus delbrueckii subsp. bulgaricus LB340. The use of organic milk led to a higher acidification rate and cultivability of Lactobacillus bulgaricus. Fatty acids profile of organic fermented milks showed higher amounts of trans-octadecenoic acid (C18:1, 1.6 times) and polyunsaturated fatty acids, including cis-9 trans-11, C18:2 conjugated linoleic (CLA-1.4 times), and α-linolenic acids (ALA-1.6 times), as compared to conventional fermented milks. These higher levels were the result of both initial percentage in the milk and increase during acidification, with no further modification during storage. Finally, use of bifidobacteria slightly increased CLA relative content in the conventional fermented milks, after 7 days of storage at 4°C, whereas no difference was seen in organic fermented milks.

Use of lactulose as prebiotic and its influence on the growth, acidification profile and viable counts of different probiotics in fermented skim milk.

Lactulose can be considered as a prebiotic, which is able to stimulate healthy intestinal microflora. In the present work, the use of this ingredient in fermented milk improved quality of skim milk fermented by Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus bulgaricus and Bifidobacterium lactis in co-culture with Streptococcus thermophilus. Compared to control fermentations without lactulose, the addition of such a prebiotic in skim milk increased the counts of all probiotics, with particular concern to B. lactis (bifidogenic effect), the acidification rate and the lactic acid acidity, and concurrently reduced the time to complete fermentation (t(pH4.5)) and the pH at the end of cold storage for 1 to 35 days.