Lived Experiences of a Sustained Mental Health Recovery Process Without Ongoing Medication Use.

Serious mental health conditions have historically been considered lifelong conditions, with substantial literature supporting pharmaceutical approaches to remission. More recently, the recovery movement has emphasized lasting recovery, which can occur through a variety of pathways. With the traditional focus on medication, less is known about the recovery process of persons who achieve sustained recovery without ongoing medication use. This qualitative study used a grounded theory approach to explore the recovery process of 19 participants with diagnoses of schizophrenia, bipolar disorder, or major depression who were in recovery and not taking medications for at least twelve months. Participants identified internal recovery processes (cognitive changes, emotional processes, and spirituality/faith) leading to a perspective change about self and symptoms. Participants also identified external recovery processes including both support received and productive ways of giving back. The study findings highlight the importance of self-efficacy, emotion management, and social giving in mental health recovery.

The Power of Perception: Lived Experiences with Diagnostic Labeling in Mental Health Recovery without Ongoing Medication Use.

The recovery movement in mental health emphasizes holistic and individualized treatment through many pathways to recovery, though the majority of mental health treatment and existing literature emphasize pharmacotherapy and medication adherence for major mental health conditions. The reimbursement system and research literature are oriented around formal diagnostic categories based in a biomedical perspective of mental health problems, but diagnostic labels also carry stigma and influence how clients perceive themselves and their mental health problems. To investigate the influence of labeling and perception in alternate pathways to recovery, this qualitative study explores the lived experience of diagnostic labeling and self-perception among persons in sustained recovery without ongoing medication use. The study used a grounded theory approach to analyze data from in-depth interviews with 19 participants. Participants had previously received diagnoses of schizophrenia, bipolar disorder, and/or major depression, met criteria for functional recovery, and were no longer taking psychotropic medications for 12 months. The participants identified positive perceptions-externalization of the problem and hope for an external "cure"-and negative perceptions-stigma and powerlessness-following a diagnostic label. Notably, the theme of powerlessness related to the initially positive themes as the diagnosis placed the problem outside their control and some participants experienced treatments as unhelpful. Participants succeeded in overcoming powerlessness by finding internalized solutions and redefining their mental health experience as transformative. Rather than pressing clients to accept their diagnosis or "illness," mental health providers can support multiple pathways to recovery by emphasizing empowerment and personal meaning-making in the recovery process.

Integrative Body-Mind-Spirit (I-BMS) Practices for Schizophrenia: An Outcome Literature Review on Randomized Controlled Trials.

Prior reviews show that certain complementary and alternative practices are promising for patients with schizophrenia. The aim of this study is to review the outcome literature on intervention studies using integrative body-mind-spirit (I-BMS) practices on schizophrenia. This is an outcome literature review of randomized controlled trials (RCTs) on I-BMS practices from 2004 to 2016. The review used a modified Delphi List to assess methodological rigor and the California Evidence-Based Clearinghouse Scientific Rating Scale to evaluate the level of research support for each identified I-BMS practice. This review identified 13 RCTs of I-BMS practices, including mindfulness interventions (5), yoga (3), tai-chi (2), and relaxation (3). I-BMS practices were effective with medium to large effect sizes for alleviating symptoms, decreasing anxiety and stress, improving insight and mindfulness, subjective well-being and social/occupational functioning, as well as decreasing the frequency and duration of re-hospitalization. This review expands the knowledge base of treatment effectiveness pertaining to patients with schizophrenia.

Treatment Efficacy of Integrative Family and Systems Treatment (I-FAST) With and Without Consultation: The Role of Model Training in the Sustainability of Evidence-Based Family Treatments.

This study examined the efficacy of the Integrative Family and Systems Treatment (I-FAST) training model that seeks to support development of model expertise within the agency in the context of facilitating the sustainability of evidence-based family treatment within community mental health settings. A quasi-experimental design was used to examine treatment outcomes of I-FAST among agencies that received ongoing Consultation and agencies that received No Consultation upon completion of I-FAST training. χ (2) analyses and independent samples t test analyses showed that there were no significant differences between the two groups on clients who had achieved reliable change on Problem Severity and Functioning based on parents' assessments. Significance of this study is discussed in the context of the role of evidence-based family therapy (EBFT) training in facilitating its sustainability in community mental health settings.

A Mixed-Method Social Network Analysis of Low-Income Diverse Older Volunteers.

Although volunteering has been associated with numerous social benefits for diverse older adults, there is little information on how they establish relationships within a multicultural volunteering program outside of their co-ethnic communities. This convergent mixed-method social network study adopts the bonding and bridging social capital theory to explore the structures and dynamics of social interactions within a multicultural volunteer program. Low-income Russian, Khmer, Somali, Nepali, and English-speaking older volunteers in the Senior Companions Program (SCP) in a Midwest metropolitan (N = 83) participated in the surveys and focus groups. Homophily coefficients (r) show that the SCP volunteers mostly interacted with people who identified with the same nationality (r = .86), race (r = .87), and gender (r = .50). Qualitative results suggested that volunteers strengthened their social networks through within-cultural social bonding while appreciating opportunities for cross-cultural social bridging. Compared with within-cultural social bonding, cross-cultural social bridging in multicultural volunteer programs require intentional facilitation, resources, and organizational commitment.

The Loneliness of Low-Income Older Adults in a Federal Volunteering Program: A Network Perspective.

Volunteering has been associated with increased social interactions and reduced feelings of loneliness among older adults. However, a growing number of social network analyses (SNA) conducted in the general population outside of volunteering contexts suggest that lonely individuals tended to interact with other lonely individuals in the network, reinforcing loneliness through peer associations. To better understand the psychosocial impact of peer interactions among older adults within volunteer programs, this study examines how older adults' loneliness is correlated with their peers' loneliness within the Senior Companions Program (SCP). This study collected information on the social networks within an SCP in a Midwest Metropolitan and feelings of loneliness among low-income Russian, Khmer, Somali, Nepali, and English-speaking older volunteers (N = 41). A linear network autocorrelation model (LNAM) was constructed to quantify how volunteers' loneliness is correlated with their peers' loneliness within SCP. The LNAM results indicated that less lonely volunteers tended to make friends with lonelier volunteers (ρ = -.06, p < .05) in SCP even when accounting for statistical controls. The finding that more and less lonely individuals connect indicates an altruistic tendency for less lonely individuals to interact with those who are lonelier. This may be an important pathway by which volunteering addresses loneliness.

Key processes, ingredients and components of successful systems collaboration: working with severely emotionally or behaviorally disturbed children and their families.

Systems collaboration has repeatedly been cited as a component of successful social service delivery. Through qualitative data, this study explored the process involved in inter-agency collaboration when providing Integrative Family and Systems Treatment (I-FAST) for families with severely emotionally or behaviorally disturbed children. Data were collected through a series of eight focus groups with 26 agency collaborators across 11 counties in Ohio. Data analysis revealed two emergent phenomena: the process of developing collaboration, consisting of making initial contact, a trial period and developing trust; and the key ingredients of collaboration, focusing on interpersonal and professional qualities. Implications of each theme are discussed.

Neighborhood influences on early childhood behavioral problems: Child maltreatment as a mediator.

BACKGROUND: A sizable number of previous research investigated the influences of untreated behavior problems in children's early age, as well as how different environmental factors affect child behavior problems (King et al., 2004; Vaillancourt et al., 2013). However, few studies focused on the influences of different types of neighborhood factors on early childhood internalizing and externalizing symptoms via adverse childhood experiences. OBJECTIVE: This study aims to capture the specific pathways from neighborhood structural factors and process factors to early childhood internalizing and externalizing symptoms. PARTICIPANTS AND SETTING: The restricted version of the Fragile Family Child Wellbeing Study (FFCWS) dataset at ages 3 and 5 were used, and 2722 children were included in the final model. METHODS: The Structural Equation Model was used to estimate the pathways from neighborhood structural and process factors to early childhood internalizing (INT) and externalizing (EXT) symptoms. Neighborhood structural factors were measured at the census tract level. Neighborhood collective efficacy, child maltreatment experiences, and early childhood internalizing, and externalizing symptoms were reported by the focal child's mother. RESULTS: Neighborhood process factors and structural factors showed both direct and indirect effects on early childhood EXT and INT differently. Emotional assault and neglect worked as mediators in this relationship. CONCLUSIONS: Findings emphasize the importance for researchers and practitioners to involve neighborhood context when assisting children with early childhood behavior problems. Implications for research and interventions are further discussed.

Societal, Organizational, Relational, and Individual Perceptions of Sexual Violence Against Older Adults and Its Prevention: A Systematic Scoping Review.

BACKGROUND AND OBJECTIVES: Older adults are not regarded as sexual and are widely excluded from sexual violence (SV) research, policies, and practice; little is known about SV against older adults and its prevention. RESEARCH DESIGN AND METHODS: An 8-database scoping review explored perceptions of SV against older adults, barriers to prevention, and solutions for prevention. Included were peer-reviewed and gray sources published since 2010, supported by primary research, on perceptions of SV in later life and prevention. A thematic analysis was conducted to explore key themes. RESULTS: Of 148 potentially relevant sources returned, 95 were fully read after screening titles and abstracts; 19 were critically appraised and 18 were assessed for analysis. Seven overarching themes emerged, surrounding (a) knowledge and awareness, (b) research, (c) policy changes and development, (d) intersectional prejudice, (e) SV being taboo, (f) sociocultural differences, and (g) confusion regarding the definition and nature of SV. DISCUSSION AND IMPLICATIONS: These findings offer relevant considerations for practice, policy, and research, which will be further discussed.

Does Self-Efficacy and Team Leader Equity Matter for Older Workers' Mental Health?

BACKGROUND AND OBJECTIVES: Prolonged working life is not necessarily associated with good mental health. Despite the importance of healthy working life in later years, little research has been conducted on predictors of mental health in the workplace among older workers. This study aimed to investigate how personal (self-efficacy) and team (leader equity) factors are associated with older workers' mental health through work engagement. RESEARCH DESIGN AND METHODS: We analyzed responses of 508 U.S. workers aged 50 years and older from the Age and Generations Study data using structural equation modeling. RESULTS: Results showed that perceived self-efficacy was a strong predictor of mental health. Also, work engagement was a powerful mechanism for promoting older adults' mental health; engagement partially mediated the relationship between perceived self-efficacy and mental health, and fully mediated the relationship between team leader equity and mental health. DISCUSSION AND IMPLICATIONS: The findings highlight how important it is for employers to invest in human capital development, suggesting human resource programs should focus on strategies that target older adults' engagement through tailored self-efficacy programs and inclusive leadership training programs. Such attempts would contribute to enhancing the mental health of older workers.

Impact of Meditation on Mental Health Outcomes of Female Trauma Survivors of Interpersonal Violence With Co-Occurring Disorders: A Randomized Controlled Trial.

This study was a randomized controlled trial that examined the impact of meditation practice on the mental health outcomes of female trauma survivors of interpersonal violence who have co-occurring disorders. Sixty-three female trauma survivors were randomly assigned to the meditation condition and the control condition. Treatment conditions consisted of a 6-week meditation curriculum that was influenced by Tibetan meditation tradition and focused on breathing, loving kindness, and compassion meditation. Clients in the meditation condition made significant changes in mental health symptoms ( t = 5.252, df = 31, p = .000) and trauma symptoms ( t = 6.009, df = 31, p = .000) from pre-treatment to post-treatment, whereas non-significant changes were observed among the control condition clients. There were significant group differences between clients in the meditation condition and in the control condition on their mental health symptoms, F(1, 54) = 13.438, p = .001, and trauma symptoms, F(1, 54) = 13.395, p = .001, with a generally large effect size of eta squared .127 and .146, respectively. In addition, significantly more clients in the meditation condition achieved reliable change in mental health symptoms (35.5% vs. 8.3%) and trauma symptoms (42.3% vs. 4.8%) than clients in the control condition. Significance of the study is discussed with respect to the empirical evidence of meditation practice as a complementary behavioral intervention for treating female trauma survivors of interpersonal violence who have co-occurring disorders.

Cultural dissonance among generations: a solution-focused approach with East Asian elders and their families.

In traditional East Asian cultures, high value is assigned to family harmony and filial piety coupled with the expectation that elders will be honored and obeyed. A lifetime of such expectations shapes how elders perceive their role and status in the family. Problems can arise when younger, less traditional, generations do not share these expectations. This article describes a solution-focused approach that facilitates the family in creating a beneficial harmony in situations of cultural dissonance. Family members are empowered to draw on personal strengths in which multiple worldviews and values of individual members are recognized, incorporated, and negotiated.

Integrative Families and Systems Treatment: a middle path toward integrating common and specific factors in evidence-based family therapy.

A moderate common factors approach is proposed as a synthesis or middle path to integrate common and specific factors in evidence-based approaches to high-risk youth and families. The debate in family therapy between common and specific factors camps is reviewed and followed by suggestions from the literature for synthesis and creative flexibility in manual development. A preliminary integrative model termed Integrative Family and Systems Treatment is offered as one option in developing and testing a moderate common factors approach. Such a model might then be studied in eventual clinical trials with other well-developed evidence-based protocols to further address the common versus specific factor debate. Implications for further research and practice are offered.

Utilizing family strengths and resilience: integrative family and systems treatment with children and adolescents with severe emotional and behavioral problems.

Community mental health agencies are consistently challenged to provide realistic and effective home-based family-centered treatment that meets local needs and can realistically fit within available budget and resource capabilities. Integrated Family and Systems Treatment (I-FAST) is developed based on existing evidence-based approaches for working with at-risk children, adolescents, and families and a strengths perspective. I-FAST identified 3 evidence-based, core treatment components and integrated them into a coherent treatment protocol; this is done in a way that builds on and is integrated with mental health agencies' existing expertise in home-based treatment. This is an intervention development study in which we conducted an initial feasibility trial of I-FAST for treating families with children at risk of out-of-home placement. The outcomes of the study provide initial empirical evidence that supports the effectiveness of I-FAST. Findings indicate that there were significant improvements in child behavior, significant increases in parental competency, and significant increases in the level of cohesion and adaptability in these families. All observed changes were significant from pre- to posttreatment with the families able to maintain these positive changes at 6-month follow-up. A more rigorous and robust research design, however, will be needed to establish definitive evidence of the effectiveness of I-FAST.