Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes.

OBJECTIVE: To examine the association between adverse childhood experiences and adverse pregnancy outcomes. METHODS: This cohort study included individuals who enrolled in a perinatal collaborative mental health care program (COMPASS [the Collaborative Care Model for Perinatal Depression Support Services]) between 2017 and 2021. Participants completed psychosocial self-assessments, including an adverse childhood experiences screen. The primary exposure was adverse childhood experiences measured by the ACE (adverse childhood experience) score, which was evaluated as a dichotomized variable, with a high ACE score defined as greater than three. Secondary analyses used the ACE score as a continuous variable. Adverse pregnancy outcomes including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age (SGA) births were abstracted from the electronic health record. Bivariable and multivariable analyses were performed, including mediation analyses. RESULTS: Of the 1,274 women with a completed adverse childhood experiences screen, 904 (71%) reported one or more adverse childhood experiences, and 290 (23%) reported a high ACE score (more than three adverse childhood experiences). Adverse childhood experience scores were not associated with gestational diabetes or SGA births. After controlling for potential confounders, individuals with high ACE score had 1.55-fold (95% CI 1.06-2.26) increased odds of having hypertensive disorders of pregnancy and 2.03-fold (95% CI 1.38-2.99) increased odds of preterm birth. Each point increase in ACE score was not associated with a statistically increased odds of hypertensive disorders of pregnancy (adjusted odds ratio [aOR] 1.07, 95% CI 0.99-1.15); however, each additional point on the adverse childhood experiences screen was associated with increased odds of preterm birth (aOR 1.13, 95% CI 1.05-1.22). Mediation analyses demonstrated tobacco use, chronic medical problems, and obesity each partially mediated the observed association between high ACE scores and hypertensive disorders of pregnancy. Having chronic medical comorbidities partially mediated the observed association between high ACE scores and preterm birth. CONCLUSION: One in four individuals referred to a perinatal mental health program who were pregnant or postpartum had a high ACE score. Having a high ACE score was associated with an increased risk of hypertensive disorders of pregnancy and preterm birth. These results underscore how remote events may reverberate through the life course.

Effectiveness of a Psychosocial Care Quality Improvement Strategy to Address Quality of Life in Patients With Cancer: The HuCare2 Stepped-Wedge Cluster Randomized Trial.

Importance: Many patients with cancer who would benefit from psychosocial care do not receive it. Implementation strategies may favor the integration of psychosocial care into practice and improve patient outcomes. Objective: To evaluate the effectiveness of the Humanization in Cancer Care (HuCare) Quality Improvement Strategy vs standard care as improvement of at least 1 of 2 domains (emotional or social function) of patient health-related quality of life at baseline and 3 months. A key secondary aim included investigation of the long-term effect. Design, Setting, and Participants: HuCare2 was a multicenter, incomplete, stepped-wedge cluster randomized clinical trial, conducted from May 30, 2016, to August 28, 2019, in three 5-center clusters of cancer centers representative of hospital size and geographic location in Italy. The study was divided into 5 equally spaced epochs. Implementation sequence was defined by a blinded statistician; the nature of the intervention precluded blinding for clinical staff. Participants included consecutive adult outpatients with newly diagnosed cancer of any type and stage starting medical cancer treatment. Interventions: The HuCare Quality Improvement Strategy comprised (1) clinician communication training, (2) on-site visits for context analysis and problem-solving, and (3) implementation of 6 evidence-based recommendations. Main Outcomes and Measures: The primary outcome was the difference between the means of changes of individual scores in emotional or social functions of health-related quality of life detected at baseline and 3-month follow-up (within each group) and during the postintervention epoch compared with control periods (between groups). Long-term effect of the intervention (at 12 months) was assessed as a secondary outcome. Intention-to-treat analysis was used. Results: A total of 762 patients (475 [62.3%] women) were enrolled (400 HuCare Quality Improvement Strategy and 362 usual care); mean (SD) age was 61.4 (13.1) years. The HuCare Quality Improvement Strategy significantly improved emotional function during treatment (odds ratio [OR], 1.13; 95% CI, 1.04-1.22; P = .008) but not social function (OR, 0.99; 95% CI, 0.89-1.09; P = .80). Effect on emotional function persisted at 12 months (OR, 1.05; 95% CI, 1.00-1.10; P = .04). Conclusions and Relevance: In this trial, the HuCare Quality Improvement Strategy significantly improved the emotional function aspect of health-related quality of life during cancer treatment and at 12 months, indicating a change in clinician behavior and in ward organization. These findings support the need for strategies to introduce psychosocial care; however, more research is needed on factors that may maximize the effects. Trial Registration: ClinicalTrials.gov Identifier: NCT03008993.

Sex Differences in Recovery-Related Outcomes and Needs for Psychiatric Rehabilitation in People With Schizophrenia Spectrum Disorder.

BACKGROUND: Female sex/gender has been associated with better longitudinal outcomes in schizophrenia spectrum disorders (SSDs). Few studies have investigated the relationships between female gender and recovery-related outcomes. Women's specific psychiatric rehabilitation needs remain largely unknown. OBJECTIVE: The objectives of the present study are to investigate sex differences in (1) objective and subjective aspects of recovery and (2) psychiatric rehabilitation needs in a multicenter non-selected psychiatric rehabilitation SSD sample. METHODS: 1,055 outpatients with SSD (DSM-5) were recruited from the French National Centers of Reference for Psychiatric Rehabilitation (REHABase) cohort between January 2016 and November 2019. Evaluation included standardized scales for quality of life, satisfaction with life, and well-being and a broad cognitive battery. Socially valued roles at enrollment were recorded. Functional recovery was measured using the Global Assessment of Functioning scale (GAF) and personal recovery with the Stages of Recovery Instrument (STORI). RESULTS: Female sex was the best predictor of having more than 2 socially valued roles in the multivariate analysis (P < .001; OR [95% CI] = 5.42 [2.34-13.06]). No sex differences were found for functional recovery or personal recovery. Female gender was positively associated with self-stigma (P = .036) and suicidal history (P < .001) and negatively correlated with quality of life (P = .004) and satisfaction with interpersonal relationships (P = .029), an area in which women reported more unmet needs (P = .004). CONCLUSIONS: The present study found that women had poorer subjective recovery-related outcomes and more unmet needs than men. It would therefore be beneficial to develop recovery-oriented interventions addressing women's specific needs and implement these in psychiatric rehabilitation services.

Family-centeredness of services for young children with Down syndrome: an observational study from Turkey

Background/aim: Physicians require information on the family centeredness of services for children with Down syndrome, one of the most frequently encountered disabilities in childhood. We aimed to determine the family-centeredness of services for young children with Down syndrome and using a bioecological theory framework we hypothesized that child, family and service-related factors would be associated with such services. Materials and methods: In a crosssectional design, children with Down syndrome seen at Ankara University Developmental Pediatrics Division (AUDPD) between February 2020 and June 2020 were included if they had received services in the community for at least 12 months. Mothers responded to the measure of process of care-20 (MPOC-20) used to measure family centeredness. Results: All 65 eligible children were included; 57% were boys and median age was 25.0 (IQR: 18.5­38.0) months. The MPOC-20 subscale scores were highest for the "respectful and supportive care (RSC)" (median 6.0; IQR: 4.8­6.8) and lowest for the "providing specific information" (median 3.0; IQR: 4.4­6.5) subscales. On univariate analyses, maternal education

Adherence to treatment in collective multiprofessional activities and factors associated with adherence in a specialized center for psychosocial care

Abstract Introduction Specialized psychosocial care centers (Centros de Atenção Psicossocial [CAPS]) are mental health services focused on social rehabilitation and reducing hospitalization of patients with severe and persistent mental illness. Collective multiprofessional activities (CMPA) are the main therapeutic tools used at CAPS. This study aimed to determine rates of adherence to CMPA and identify factors associated with adherence. Methods This is a cross-sectional study in which 111 CAPS users were evaluated using questionnaires covering patient characteristics, clinical status, and treatment and incorporating the Functioning Assessment Short Test (FAST), the Clinical Global Impression - Severity scale (CGI-S), and the Clinical Global Impression - Improvement scale (CGI-I). Adherence was defined as attendance at 50% or more CMPA during the previous 3 months. Data were analyzed using descriptive statistics, bivariate analysis, and Poisson logistic regression with robust variance to estimate prevalence ratios. Results CPMA adherence was 43%. Having children aged 14 years or younger was significantly associated with non-adherence (71%, p = 0.001). Poor or partial adherence to psychotropic drugs tended to be associated (p = 0.066) with poor adherence (33% higher risk), as was the number of psychiatric hospitalizations during CAPS (p = 0.076), with a cumulative association of 5% non-adherence per hospitalization. Conclusions CMPA adherence was low in the study. It is necessary to consider the environment in which the individual lives and invest in support networks, providing patients and family members with explanations about the importance of CMPA to rehabilitation and attempting to tailor the care provided to each patient's needs. There was an association between greater number of psychiatric hospitalizations and non-adherence, suggesting that CAPS are fulfilling a preventive role.

Adherence to treatment in collective multiprofessional activities and factors associated with adherence in a specialized center for psychosocial care.

INTRODUCTION: Specialized psychosocial care centers (Centros de Atenção Psicossocial [CAPS]) are mental health services focused on social rehabilitation and reducing hospitalization of patients with severe and persistent mental illness. Collective multiprofessional activities (CMPA) are the main therapeutic tools used at CAPS. This study aimed to determine rates of adherence to CMPA and identify factors associated with adherence. METHODS: This is a cross-sectional study in which 111 CAPS users were evaluated using questionnaires covering patient characteristics, clinical status, and treatment and incorporating the Functioning Assessment Short Test (FAST), the Clinical Global Impression - Severity scale (CGI-S), and the Clinical Global Impression - Improvement scale (CGI-I). Adherence was defined as attendance at 50% or more CMPA during the previous 3 months. Data were analyzed using descriptive statistics, bivariate analysis, and Poisson logistic regression with robust variance to estimate prevalence ratios. RESULTS: CPMA adherence was 43%. Having children aged 14 years or younger was significantly associated with non-adherence (71%, p = 0.001). Poor or partial adherence to psychotropic drugs tended to be associated (p = 0.066) with poor adherence (33% higher risk), as was the number of psychiatric hospitalizations during CAPS (p = 0.076), with a cumulative association of 5% non-adherence per hospitalization. CONCLUSIONS: CMPA adherence was low in the study. It is necessary to consider the environment in which the individual lives and invest in support networks, providing patients and family members with explanations about the importance of CMPA to rehabilitation and attempting to tailor the care provided to each patient's needs. There was an association between greater number of psychiatric hospitalizations and non-adherence, suggesting that CAPS are fulfilling a preventive role.

Provider-Level Caseload of Psychosocial Services for Medicaid-Insured Children.

OBJECTIVE: We estimated the caseload of providers, practices, and clinics for psychosocial services (including psychotherapy) to Medicaid-insured children to improve the understanding of the current supply of such services and to inform opportunities to increase their accessibility. METHODS: We used 2012-2013 Medicaid claims data and data from the 2013 National Plan and Provider Enumeration System to identify and locate therapists, psychiatrists, and mental health centers along with primary, rehabilitative, and developmental care providers in the United States who provided psychosocial services to Medicaid-insured children. We estimated the per-provider, per-location, and state-level caseloads of providers offering these services to Medicaid-insured children in 34 states with sufficiently complete data to perform this analysis, by using the most recent year of Medicaid claims data available for each state. We measured caseload by calculating the number of psychosocial visits delivered by each provider in the selected year. We compared caseloads across states, urbanicity, provider specialty (eg, psychiatry, psychology, primary care), and practice setting (eg, mental health center, single practitioner). RESULTS: We identified 63 314 providers, practices, or centers in the Medicaid claims data that provided psychosocial services to Medicaid-insured children in either 2012 or 2013. The median provider-level per-year caseload was <25 children and <250 visits across all provider types. Providers with a mental health center-related taxonomy accounted for >40% of visits for >30% of patients. Fewer than 10% of providers and locations accounted for >50% of patients and visits. CONCLUSIONS: Psychosocial services are concentrated in a few locations, thereby reducing geographic accessibility of providers. Providers should be incentivized to offer care in more locations and to accept more Medicaid-insured patients.

Jail diversion: a practical primer.

The United States has the highest incarceration rate in the world. With a substantial number of inmates diagnosed with mental illness, substance use, or both, various diversion strategies have been developed to help decrease and avoid criminalization of individuals with mental illness. This article focuses primarily on the first three Sequential Intercept Model intercept points as related to jail diversion and reviews types of diversion programs, research outcomes for diversion programs, and important components that contribute to successful diversion.

Individual placement and support in the Netherlands: Past, present, and future directions.

OBJECTIVE: This article addresses the rise of individual placement and support (IPS) within vocational services for people with severe mental illness (SMI), the current state of affairs, and future directions of IPS in the Netherlands. METHOD: Review of the literature on IPS in the Netherlands, analysis of registration data, and exploration of future avenues for IPS in Dutch mental health care. FINDINGS: In the first decade of this century, an implementation study showed that IPS was feasible in the Netherlands, and a multisite randomized controlled trial (RCT) indicated that IPS was also effective in the Dutch context. Nationwide, from the start of 2016 to the end of 2017, the number of enrolled IPS participants doubled from 1,038 to 2,100, which was largely due to the introduction of preliminary national funding of IPS. Future directions include expanding the IPS practice in terms of target groups, types of providers, goals, and added interventions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Involvement of clinicians and the employment opportunities for people with SMI have increased, which is mainly due to the successes of IPS. However, considerable efforts are still needed to make IPS more widely available. Important facilitators are regular meetings of stakeholders in mental health care and vocational rehabilitation, stakeholders' experienced ownership of IPS and collaboration, the mandate and influence of the decision makers involved, and secured IPS funding. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Relationships between addictive Facebook use, depressiveness, insomnia, and positive mental health in an inpatient sample: A German longitudinal study.

BACKGROUND AND AIMS: Individuals with high level of negative mental health often tend to use the social platform Facebook to escape from daily stress. They are at risk to develop an emotional bond to Facebook linked to a need to stay permanently online. The current work investigated addictive use of Facebook and its conceptual framework in clinical context. METHODS: In a longitudinal study design, duration of daily use of Facebook, addictive Facebook use, depressiveness, insomnia, and positive mental health (PMH) were assessed in a sample of 349 inpatients [Mage (SDage) = 50.13 (9.41)] of a psychosomatic rehabilitation clinic in Germany over a period of on average 6 weeks. RESULTS: Regression analyses revealed that duration of daily Facebook use at the first measurement time point (T1) served as significant positive predictor of addictive Facebook use at the second measurement time point (T2). Addictive Facebook use (T1) significantly positively predicted depressiveness and insomnia (T2). Its prediction of PMH (T2) was significantly negative. Mediation analyses showed that PMH (T1) partially mediated the association between addictive Facebook use (T1) and depressiveness (T2), and fully mediated the relationship between addictive Facebook use (T1) and insomnia (T2). DISCUSSION AND CONCLUSIONS: Current longitudinal results indicate that addictive Facebook use might negatively impact the recovery process of inpatients. Thus, it might be relevant to assess and consider addictive Facebook use in the clinical context. Therapeutic interventions are suggested to focus on the enhancement of inpatients' PMH level, which may buffer the negative effect of problematic Facebook use.

[Psychosocial rehabilitation and severe mental illness: Factors that influence patients' attendance in a support group].

Psychosocial rehabilitation for people with chronic-severe mental illness mainly aims to social integration by restoring independent functioning in the community, improving quality of life, and addressing risk factors that lead to social disability. Support groups (SG) are usually part of this multilevel mental health process. Given that non-adherence to treatment is a common phenomenon in people with chronic- severe mental illness, the aim of the current study was to identify which factors influence members' attendance in a support group in a vocational training Program of the Psychosocial Rehabilitation Unit of Byron-Kaissariani Community Mental Health Centre. The SG sessions were weekly, with 45-minute duration, opened to any new member of the Program and coordinated by two therapists. Members' demographic and psychiatric data were gathered from the medical records of the Center. Information about SG was obtained from the reports of the sessions. The sample consisted of 18 women, with mean age 38.56 (±6.92) years. Most of them were high school graduates (61.1%), unmarried (83.3%), with low socioeconomic status (55.5%), suffering from a schizophrenic spectrum disorder (61.1%) with a mean duration 15.22 (±8.44) years. Out of 83 sessions in total, twenty-two (26.5%) were in absence of a co-therapist, 11 (13.3%) after a member's entrance or withdrawal and 11 (13.3%) after a session cancellation. Furthermore, an average of four issues was discussed per session, with mental illness (62.7%) and interpersonal relationships (73.5%) being the most popular topics during the sessions. The statistical analysis demonstrated that members' demographic (age, education, marital status, residence, socioeconomic status, working experience) and psychiatric characteristics (diagnosis, illness duration, rehabilitation program experience) were not associated with the attendance rate in the SG. Similarly, the proportion of participants attending the sessions did not seem to be significantly related to the absence of a co-therapist, to a member's entrance or withdrawal and to a session cancellation. In contrast, attendance seemed to be significantly reduced when the topic of a session focused on members' future expectations/goals (having a family, further education, finding a job) (Beta=-0.32, p=0.006). This finding highlights the need for future research in order to incorporate interventions that promote and address future goals and expectations of people with chronic-severe mental illness in psychosocial rehabilitation services.

Depression Remission From Community Coalitions Versus Individual Program Support for Services: Findings From Community Partners in Care, Los Angeles, California, 2010-2016.

Objectives. To explore effects of coalitions (Community Engagement and Planning [CEP]) versus technical assistance (Resources for Services [RS]) for depression collaborative care and the effects of social determinants on long-term remission outcomes. Methods. We randomized 95 health care and community programs in Los Angeles County, California, to CEP or RS. In 2010, 1246 depressed (Patient Health Questionnaire [PHQ-8] ≥ 10) adults enrolled and were invited for baseline and 6-, 12-, and 36-month surveys. Of 598 3-year completers, 283 participated at 4 years (2016). We examined effects of CEP versus RS, social factors (e.g., family income, food insecurity) on time to and periods in clinical (PHQ-8 < 10) and community-defined (PHQ-8 < 10 or PHQ-2 < 3; mental health composite score [MCS-12] > 40, or mental wellness) remission during the course of 3 years, and at 4 years. Results. We found that CEP versus RS increased 4-year depression remission and, for women, community-defined remission outcomes during the course of 3 years. Social factors and clinical factors predicted remission. Conclusions. At 4 years, CEP was more effective than RS at increasing depression remission. Public Health Implications. Coalitions may improve 4-year depression remission, while addressing social and clinical factors associated with depression may hold potential to enhance remission.

Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study.

BACKGROUND: Evaluation of complex interventions should include a process evaluation to give evaluators, researchers, and policy makers greater confidence in the outcomes reported from RCTs. Implementation fidelity can be part of a process evaluation and refers to the degree to which an intervention is delivered according to protocol. The aim of this implementation fidelity study was to evaluate to what extent a dialogue-based psychosocial intervention was delivered according to protocol. A modified conceptual framework for implementation fidelity was used to guide the analysis. METHODS: This study has an explanatory, sequential two-phase mixed methods design. Quantitative process data were collected longitudinally along with data collection in the RCT. Qualitative process data were collected after the last data collection point of the RCT. Descriptive statistical analyses were conducted to describe the sample, the intervention trajectories, and the adherence measures. A scoring system to clarify quantitative measurement of the levels of implementation was constructed. The qualitative data sources were analyzed separately with a theory-driven content analysis using categories of adherence and potential moderating factors identified in the conceptual framework of implementation fidelity. The quantitative adherence results were extended with the results from the qualitative analysis to assess which potential moderators may have influenced implementation fidelity and in what way. RESULTS: The results show that the core components of the intervention were delivered although the intervention trajectories were individualized. Based on the composite score of adherence, results show that 80.1% of the interventions in the RCT were implemented with high fidelity. Although it is challenging to assess the importance of each of the moderating factors in relation to the other factors and to their influence on the adherence measures, participant responsiveness, comprehensiveness of policy description, context, and recruitment appeared to be the most prominent moderating factors of implementation fidelity in this study. CONCLUSIONS: This evaluation of implementation fidelity and the discussion of what constitutes high fidelity implementation of this intervention are crucial in understanding the factors influencing the trial outcome. The study also highlights important methodological considerations for researchers planning process evaluations and studies of implementation fidelity. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02338869; registered 10/04/2014.

[Impact of therapeutic advice on prescription of psychotropics for patients with serious mental illness]. / Impact sur la prescription de psychotropes des conseils thérapeutiques formalisés dans un centre référent de réhabilitation psychosociale.

INTRODUCTION: The improvement of prescription constitutes a major challenge for public health. In France, medication is the third cause of serious adverse reaction. The report of the Parliamentary Commission for Evaluation of Health Policy on adequate use of psychotropics mentions their overconsumption. Promoting practices' dissemination and guidelines' respect is one of the missions of the referral psychosocial rehabilitation centers. Therapeutic advice that is offered consists of suggestions for revision in the patient's treatment with the aim of improving the patient's health. To our knowledge, to date no study has focused on the evaluation of therapeutic advice in psychiatry. The present study aimed at analyzing benefits of therapeutic advice for the patients. To this end: (1) a state of things related to actual practices was carried out: psychotropics prescriptions' problems and therapeutic advice proposed by psychiatrists (quantitative and qualitative assessment); (2) the impact of advice on prescription was assessed; (3) patients' benefits were identified. METHOD: This monocentric trial was carried out at the referral psychosocial rehabilitation center of Lyon. This audit was a retrospective observation of electronic medical records (software CortexteNet V2.6). This project was developed by a multidisciplinary staff (pharmacists and psychiatrists) during summer 2015. All patients treated in this center between September 2010 and December 2014 were included. The collection of data was made by two auditors (pharmacist students) thanks to a collection grid with six parts: identification and epidemiology of patients with therapeutic advice, coding tips, benefits, quantitative and qualitative assessment of prescriptions before and after advice. RESULTS: Of the 601 records explored during this study, 66 advices (8.3% of patients) were identified. Patients concerned by therapeutic advice were mainly men with schizophrenia between 35 and 40 years, living in a town and addressed by public psychiatrists. Advice was taken into account in 81.7%, partially in 8.1%, and was beneficial in 97%. The main benefits were clinical improvement (48.5%) and reduction of adverse drug events (36.4%). There were no statistically significant differences between prescriptions (quantitatively and qualitatively) before and after therapeutic advice. CONCLUSION: In most cases, prescriptions of psychotropics were adequate since only 66 advices (8.3% of patients) were given. Psychosocial rehabilitation centers give medication prescribing advice and promote respect of the guidelines. The collaboration between rehabilitation's psychiatrists and other psychiatrists optimizes patient management. It reduces iatrogenic disorders and improves quality and safety of care. Very few studies deal with the prescription of psychotropics in adult psychiatry. This work highlights the positive effect of therapeutic advice for this population. Further controlled studies should clarify the benefits of therapeutic advice.

Gender differences in social functioning in people with schizophrenia in psychosocial rehabilitation services using one-dimensional and multidimensional instruments.

Women with schizophrenia have shown better social and clinical functioning than men in several previous studies. The aim of this study was to assess gender differences in social functioning of people with a diagnosis of schizophrenia who are in psychosocial rehabilitation treatment in Catalonia, using several different one-dimensional and multidimensional measures of clinical and social functioning. Gender differences were found only in several daily life activities, in which women showed better functioning: independence-competence (p = 0.006) and independence-performance (p = 0.017). No other differences between genders were observed. Our results clearly suggest that women with schizophrenia undergoing the rehabilitation process could benefit as do men from psychosocial intervention in order to improve social skills and functioning.

Client personal recovery and recovery orientation of an Irish suicide intervention charity.

BACKGROUND: Recovery is a key goal for individuals, and services' recovery orientation can facilitate this process. The independent mental health sector is increasingly important in Ireland, particularly in counselling and suicide prevention. We aimed to evaluate Pieta House as a recovery-oriented service through clients' self-rated recovery; and clients' and therapists' evaluation of the service. METHODS: Clients completing therapy over a 3-month period were invited to complete the Recovery Assessment Scale (RAS) and the Recovery Self Assessment-Revised (RSA-R). Therapists completed the RSA-R staff version. RESULTS: Response rate was 36.7% for clients (n=88), 98% for therapists (n=49). Personal recovery was endorsed by 73.8% of clients, with highest agreement for factors 'Willingness to Ask for Help' (84.5%), and 'Reliance on Others' (82.1%). A smaller number agreed with factors 'Personal Confidence and Hope' (61.3%) and 'No Domination by Symptoms' (66.6%). Clients' and therapists' evaluation of the service showed high levels of agreement with factors of 'Choice' (90.9% clients, 100% therapists); 'Life Goals' (84.1% clients, 98% therapists) and 'Individually Tailored Services' (80.6% clients, 79.6% therapists). Client involvement in service management had the lowest level of agreement (36.4% clients, 30.6% therapists). Clients' self-rated recovery correlated with their rating of the service (correlation value 0.993, p=0.01). CONCLUSIONS: Clients' self-rated recovery and the recovery orientation of Pieta House were rated highly, with areas for improvement in service user involvement, peer support and advocacy. The correlation of personal recovery and recovery orientation of the service may merit further study.

Psychosocial rehabilitation in the west network of the municipality of São Paulo: potentialities and challenges. / A reabilitação psicossocial na rede oeste do município de São Paulo: potencialidades e desafios.

OBJECTIVE: To describe the strategies of the Psychosocial Rehabilitation conducted in the Network of Psychosocial Care of the western region of the municipality of São Paulo. METHODOLOGY: Descriptive qualitative study, carried out with 123 professionals, from September 2015 to July 2016. Data processed by the software Alceste and analyzed in light of the analytical category Psychosocial Rehabilitation of Benedetto Saraceno and complementary literature. RESULTS: Three classes emerged that address the potential and scarcity of therapeutic residential services as a space to resume the daily life; importance of cultural activities for the exchange of identities and care beyond the scope of health; the potential of projects to generate work and income to regain the contractual power. CONCLUSION: The strategies contribute to the construction of subjectivity and the resumption of the citizenship. In order to sustain the Psychosocial Rehabilitation it is necessary to overcome the weaknesses of human, physical and structural resources. Still, there is potential in the collaborative work and accountability of the teams.

Predictors of General Functioning and Correlates of Quality of Life: A Cross-Sectional Study among Psychiatric Outpatients.

INTRODUCTION: Functioning and quality of life (QOL) are negatively impacted as a result of mental illness. This study aimed to determine the: i) socio-demographic and clinical correlates of functioning and; ii) associations between functioning and QOL in a multiethnic sample of psychiatric outpatients. MATERIALS AND METHODS: This was a cross-sectional study of outpatients receiving treatment from a tertiary psychiatric hospital. Functioning was assessed using the Global Assessment of Functioning (GAF) scale, while QOL was measured using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) which comprises 4 domains: physical health, psychological health, social relationships and environment. RESULTS: Various socio-demographic and clinical correlates were associated with functioning including employment and marital status, education and diagnosis. Depression was the only clinical characteristic which negatively correlated with functioning (P = 0.035). Amongst the whole sample, multiple linear regressions revealed that functioning was positively associated with all 4 QOL domains (physical health [P <0.001], psychological health [P <0.001], social relationships [P <0.001] and environment [P <0.001]). Further analysis of each diagnostic group revealed that functioning was positively associated with all 4 QOL domains in the anxiety, depression and obsessive compulsive disorder subsamples, while in the schizophrenia subsample, functioning was only significantly associated with all environment domain. CONCLUSION: Functional impairments were associated with different socio-demographic and clinical characteristics, which should be addressed when planning tailored treatment and interventions. Given that functioning is significantly associated with QOL, it is crucial to regularly assess and monitor them (in addition to symptomatic outcomes and adopting a more holistic and biopsychosocial approach).

Motivational impairment predicts functional remission in first-episode psychosis: 3-Year follow-up of the randomized controlled trial on extended early intervention.

OBJECTIVE: Functional remission represents an intermediate functional milestone toward recovery. Differential relationships of negative symptom sub-domains with functional remission in first-episode psychosis are understudied. We aimed to examine rate and predictors of functional remission in people with first-episode psychosis in the context of a 3-year follow-up of a randomized controlled trial comparing 1-year extension of early intervention (i.e. 3-year early intervention) with step-down psychiatric care (i.e. 2-year early intervention). METHOD: A total of 160 participants were recruited upon completion of a 2-year specialized early intervention program for first-episode psychosis in Hong Kong and underwent a 1-year randomized controlled trial comparing 1-year extended early intervention with step-down care. Participants were followed up and reassessed 3 years after inclusion to the trial (i.e. 3-year follow-up). Functional remission was operationalized as simultaneous fulfillment of attaining adequate functioning (measured by Social and Occupational Functioning Scale and Role Functioning Scale) at 3-year follow-up and sustained employment in the last 6 months of 3-year study period. Negative symptom measure was delineated into amotivation (i.e. motivational impairment) and diminished expression (i.e. reduced affect and speech output). Data analysis was based on 143 participants who completed follow-up functional assessments. RESULTS: A total of 31 (21.7%) participants achieved functional remission status at 3-year follow-up. Multivariate regression analysis showed that lower levels of amotivation (p = 0.010) and better functioning at study intake (p = 0.004) independently predicted functional remission (Final model: Nagelkerke R2 = 0.40, χ2 = 42.9, p < 0.001). Extended early intervention, duration of untreated psychosis and diminished expression did not predict functional remission. CONCLUSION: Only approximately one-fifths of early psychosis patients were found to achieve functional remission. Functional impairment remains an unmet treatment need in the early stage of psychotic illness. Our results further suggest that amotivation may represent a critical therapeutic target for functional remission attainment in early psychosis.

Referral patterns and implementation costs of the Partners in Recovery initiative in Gippsland: learnings for the National Disability Insurance Scheme.

OBJECTIVE:: The purpose of this paper is to provide some learnings for the NDIS from the referral pattern and cost of implementing the Partners in Recovery initiative of Gippsland. METHOD:: Information on referral areas made for each consumer was collated from support facilitators. Cost estimates were determined using budget estimates, administrative costs and a literature review and are reported from a government perspective. RESULTS:: Sixty-three per cent of all referrals were made to organisations that provided multiple types of services. Thirty-one per cent were to Mental Health Community Support Services. Eighteen per cent of referrals were made to clinical mental health services. The total cost of providing the service for a consumer per year (set-up and ongoing) was estimated to be AUD$15,755 and the ongoing cost per year was estimated to be AUD$13,434. The cost of doing nothing is likely to cost more in the longer term, with poor mental health outcomes such as hospital admission, unemployment benefits, prison, homelessness and psychiatric residential care. CONCLUSIONS:: Supporting recovery in persons with Severe and Persistent Mental Illness is likely to be economically more beneficial than not doing so. Recovery can be better supported when frequently utilised services are co-located. These might be some learnings for the NDIS.