Improving knowledge about mental illness through family-led education: the journey of hope.

OBJECTIVE: Families often do not receive the information that they need to care for their adult relatives with mental illness. This study examined the effectiveness of a family-led education intervention, the Journey of Hope, in improving participants' knowledge about mental illness and its treatment and decreasing their information needs. METHODS: A total of 462 family members of adults with mental illness in Louisiana participated in the study; 231 were randomly assigned to immediate receipt of the Journey of Hope course (intervention group), and 231 were randomly assigned to a nine-month waiting list for the course (control group). Participants completed in-person, structured interviews assessing their knowledge of mental illness and problem-solving skills and their information needs at study enrollment (baseline), three months postbaseline, and eight months postbaseline. RESULTS: Random regression analyses indicate that at three and eight months postbaseline, compared with participants assigned to the control group, those in the intervention group reported greater knowledge gains (beta=.84, p< or =.01) and fewer needs for information on coping with positive symptoms (beta=-.63, p< or =.05), coping with negative symptoms (beta=-.80, p< or =.001), problem management (beta=-1.00, p< or =.001), basic facts about mental illness and its treatment (beta=-.73, p< or =.01), and community resources (beta=-.07, p< or =.05). These significant differences in knowledge and information needs were maintained over time and were significant even when controlling for participants' demographic characteristics and their relatives' clinical characteristics. CONCLUSIONS: Participation in family-led education interventions, such as the Journey of Hope, may provide families with the information they need to better cope with their relative's mental illness.

Psychological well-being and relationship outcomes in a randomized study of family-led education.

CONTEXT: Family members of adults with mental illness often experience emotional distress and strained relationships. OBJECTIVE: To test the effectiveness of a family-led educational intervention, the Journey of Hope, in improving participants' psychological well-being and relationships with their ill relatives. DESIGN AND SETTING: A randomized controlled trial using a waiting list design was conducted in the community in 3 southeastern Louisiana cities. PARTICIPANTS: A total of 462 family members of adults with mental illness participated in the study, with 231 randomly assigned to immediate receipt of the Journey of Hope course and 231 assigned to a 9-month course waiting list. Intervention The Journey of Hope intervention consisted of 8 modules of education on the etiology and treatment of mental illness, problem-solving and communication skills training, and family support. MAIN OUTCOME MEASURES: Participants' psychological well-being and relationships with their ill relatives were assessed at study enrollment, 3 months after enrollment (at course termination), and 8 months after enrollment (6 months after course termination). Mixed-effects random regression analysis was used to predict the likelihood of decreased depressive symptoms, increased vitality, and overall mental health, and improved relationship ratings. RESULTS: Intervention group participants reported fewer depressive symptoms, greater emotional role functioning and vitality, and fewer negative views of their relationships with their ill relatives compared with control group participants. These improved outcomes were maintained over time and were significant (P<.05 for all) even when controlling for participant demographic and relative clinical characteristics. CONCLUSION: Results show that family-led educational interventions are effective in improving participants' psychological well-being and views of their relationships with ill relatives.

Changes in caregiving satisfaction and information needs among relatives of adults with mental illness: results of a randomized evaluation of a family-led education intervention.

The authors examined changes in caregiving satisfaction and information needs among 462 relatives of individuals with mental illness who participated in a study of a family-led education course, the Journey of Hope (JOH). Participants were randomly assigned to receive JOH or to a control group waiting list and followed for 9 months. General linear model repeated measures analysis of variance found that, compared with the control group, the intervention group showed significant improvement in caregiving satisfaction and information needs following course completion and maintained these gains for another 6 months. Education and support from other family members in the form of a structured course is effective in meeting the caregiving needs of relatives of persons with mental illness.

Integration of psychiatric and vocational services: a multisite randomized, controlled trial of supported employment.

OBJECTIVE: Although large-scale surveys indicate that patients with severe mental illness want to work, their unemployment rate is three to five times that of the general adult population. This multisite, randomized implementation effectiveness trial examined the impact of highly integrated psychiatric and vocational rehabilitation services on the likelihood of successful work outcomes. METHOD: At seven sites nationwide, 1,273 outpatients with severe mental illness were randomly assigned either to an experimental supported employment program or to a comparison/services-as-usual condition and followed for 24 months. Data collection involved monthly services tracking, semiannual in-person interviews, recording of all paid employment, and program ratings made by using a services-integration measure. The likelihood of competitive employment and working 40 or more hours per month was examined by using mixed-effects random regression analysis. RESULTS: Subjects served by models that integrated psychiatric and vocational service delivery were more than twice as likely to be competitively employed and almost 1(1/2) times as likely to work at least 40 hours per month when the authors controlled for time, demographic, clinical, and work history confounds. In addition, higher cumulative amounts of vocational services were associated with better employment outcomes, whereas higher cumulative amounts of psychiatric services were associated with poorer outcomes. CONCLUSIONS: Supported employment models with high levels of integration of psychiatric and vocational services were more effective than models with low levels of service integration.

Church-based support groups for African American families coping with mental illness: outreach and outcomes.

To better understand how church-based support groups help African American families of persons with mental illness, this study examined the outreach efforts used to provide information about the support group to congregants as well as the participation outcomes reported by families who attended support group meetings. Results indicate that advertising group information in the church bulletin and families sharing their experiences with other congregants may be effective outreach strategies. Respondents' improved knowledge and morale outcomes suggest that church-based support groups may be a valuable coping resource for African American families of persons with mental illness.

Family education and support: just for women only?

Studies of education and support programs for families of adults with mental illness' show that the majority of participants are women. In examining why women are more likely than men to take part in these programs, this article reviews the role of women in caring for an adult with mental illness, with a focus on the demands experienced by mothers, sisters, and adult daughters. Given that most family education and support program participants are caring for male relatives, the differences in the demands of providing care to male versus female relatives also are explored. The ways in which education and support programs may be geared toward helping women cope with their unique caregiving demands, as well as methods to increase the participation of men in these programs, are discussed.

Family contact and housing stability in a national multi-site cohort of homeless adults with severe mental illness.

This study examined associations between family contact and housing stability among 4,778 homeless persons with mental illness who received intensive outreach and case management services through the national multi-site ACCESS project. Ordinary-least squares regression analysis found that, at 12-months post-study entry, greater contact with relatives to whom participants feel close, more frequent telephone contact, and greater satisfaction with family relationships were associated with a greater number of nights in stable housing. Program and policy implications for strengthening family ties as a means to reduce homelessness among this population are discussed.

Clinical factors associated with employment among people with severe mental illness: findings from the employment intervention demonstration program.

Research has shown that supported employment programs are effective in helping psychiatric outpatients achieve vocational outcomes, yet not all program participants are able to realize their employment goals. This study used 24 months of longitudinal data from a multisite study of supported employment interventions to examine the relationship of patient clinical factors to employment outcomes. Multivariate random regression analysis indicated that, even when controlling for an extensive series of demographic, study condition (experimental versus control), and work history covariates, clinical factors were associated with individuals' ability to achieve competitive jobs and to work 40 or more hours per month. Poor self-rated functioning, negative psychiatric symptoms, and recent hospitalizations were most consistently associated with failure to achieve these employment outcomes. These findings suggest ways that providers can tailor supported employment programs to achieve success with a diverse array of clinical subpopulations.

Employment histories of homeless persons with mental illness.

This study examined the work histories of 7,228 homeless persons with mental illness who were enrolled into the multi-site Access to Community Care and Effective Services and Supports (ACCESS) research demonstration program. Multiple logistic regression analyses suggest that use of vocational services is significantly associated with increased likelihood of paid employment. The role of vocational rehabilitation services in removing persons from homelessness and improving their quality of life is discussed.