Statewide initiative of intensive psychiatric rehabilitation: outcomes and relationship to other mental health service use.

OBJECTIVE: This study examines the outcomes of a statewide implementation of Intensive Psychiatric Rehabilitation (IPR) for improving residential and employment status and earnings among individuals with severe mental illnesses and also examines its implementation with respect to mental health service utilization and costs. METHODS: This study employs a pre-post design with participants acting as their own controls for rehabilitation outcomes (residential status, vocational outcomes and earnings) comparing those who "completed" or had a sufficiently intense dose of IPR (one year) to those who dropped out early (before six months of service) and those who dropped out later in service (6-12 months). A separate analysis was conducted examining the relationship of IPR to other mental service use and costs using a quasi-experimental design that contrasted IPR completers with a control group matched via propensity scores. RESULTS: The results suggested significant improvement in residential status, employment status and gross monthly earnings for IPR completers relative to other groups. IPR completers also tended to use more mental health services or have more shallow decreases in use and cost of services relative to matched controls. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Gains in rehabilitation outcomes can be expected for those who engage in and complete IPR services, but IPR cannot be expected to result in reduced overall mental health service use and costs. Rather, IPR may improve service access or perhaps ameliorate any containment effect of managed care on service use.

Psychiatric rehabilitation interventions: a review.

Psychiatric rehabilitation has become accepted by the mental health field as a legitimate field of study and practice. Over the last several decades various psychiatric rehabilitation programme models and procedures have been developed, evaluated and disseminated. At the same time the process of psychiatric rehabilitation has been specified and its underlying values and practitioner technology articulated. This review describes the psychiatric rehabilitation process and in so doing differentiates psychosocial interventions that can be classified as psychiatric rehabilitation interventions from other psychosocial interventions. Furthermore, the major psychiatric rehabilitation interventions are examined within a framework of the psychiatric rehabilitation process with a review of their evidence. The review concludes that psychiatric rehabilitation interventions are currently a mixture of evidence-based practices, promising practices and emerging methods that can be effectively tied together using the psychiatric rehabilitation process framework of helping individuals with serious mental illnesses choose, get and keep valued roles, and together with complementary treatment orientated psychosocial interventions, provide a broad strategy for facilitating recovery.

Doing daily life: how occupational therapy can inform psychiatric rehabilitation practice.

TOPIC: This paper provides an overview of occupational therapy in the context of psychiatric rehabilitation and mental health recovery. PURPOSE: The paper delineates practical aspects of occupational therapy's involvement in the mental health field with a discussion of occupation and the elements of conceptual models that guide the practice of occupational therapy. SOURCES USED: CINAHL, Psych Info, Medline. CONCLUSION: Occupational therapy is a key discipline in the field of psychiatric rehabilitation and brings to the field a strong theoretical and knowledge base along with unique procedures and practices. It is important for the psychiatric rehabilitation field to learn from all disciplines, including occupational therapy.

Recovery: a common vision for the fields of mental health and addictions.

The vision of recovery is reshaping the fields of mental health and addiction services. This paper reviews how this broad vision is shaping common goals, principles, values and strategies across the two fields. We further examine how a common vision of recovery can positively impact the treatment of co-occurring disorders and speculate on how this vision can bridge the seeming differences between these two fields and reshape a mutual understanding of the essentials of recovery from severe mental illness and addiction.

A framework for health promotion services for people with psychiatric disabilities.

The concepts of wellness and its complement, health promotion, have popularized the notion that health itself is more than simply the absence of disease. Furthermore, the wellness concept has advanced the idea of the importance of engaging in certain health promoting behaviors within healthy environments, not simply for the purpose of preventing or better managing a disease, but also to enhance one's well-being and quality of life (Green & Kreuter, 1991; Mullen, 1986). Encouraging this emphasis on wellness is Healthy People 2010 (U.S. Department of Health and Human Services, 2000), a national ten-year plan intended to increase quality and years of life and eliminate disparities which for the now features a new area that recognizes the importance of health promotion and disease prevention in the lives of people with disabilities. Increasingly, the value of promoting wellness--including for people with disabilities--is being recognized (Rimmer & Braddock, 2002).

The personal and vocational impact of training and employing people with psychiatric disabilities as providers.

OBJECTIVE: This study examined the feasibility of a structured peer provider training program and its effect on peer providers with respect to their own personal and vocational recovery. METHODS: Sixty-six individuals participated in an evaluation of a 60-hour, 5-week long peer training program. Participants were assessed prior to and after the training on scales to measure recovery, empowerment and self-concept. Analyses of variance were used to examine subjective changes in these measures. Job acquisition and retention data were also examined at posttest. RESULTS: Participants experienced gains in perceived empowerment, attitudes toward recovery and self-concept. Trainees went on to obtain peer provider positions within the mental health agency in which they received the training and 89% of those trained retained employment at 12 months. Twenty-nine percent of the initial jobs into which the peer providers were placed were full-time; 52% were part-time and 19% were hourly. CONCLUSIONS: Findings suggest that a standardized program designed to provide peer training was used successfully and participants' recovery and employability were improved. Further studies are recommended to rigorously test peer providers' impact on their clients and to examine the advantages that accrue to the agency when mental health recipients are employed as peer providers.

The Napping Company: bringing science to the workplace.

Increasing emphasis is currently being given to the importance of bringing knowledge gained from science into places where people live and work, in order to increase the impact science has on the general public's quality of life. Scientific findings about the positive impact of napping on mood and performance are an example of research generated knowledge that needs to be brought to the workplace. A major goal of the Napping Company (www.napping.com) is to bring the science of napping to the workers and the workplace so that employees and employers can act on this knowledge and change worker napping behavior and employer napping policies. The present paper overviews the challenges inherent in making scientific knowledge useful to how we live our lives. The Napping Company is guided by five principles of knowledge transfer in the company's attempts to disseminate and increase utilization of napping research. Examples are given to illustrate how the Napping Company has used these principles to bridge the gap between napping science and nap behavior and policies in the workplace.

Evidence-based practices: setting the context and responding to concerns.

After nearly 20 years of progress in general medicine, the evidence-based practice movement is becoming the central theme for mental health care reform in the first decade of 2000. Several leaders in the movement met to discuss concerns raised by six stakeholder groups: consumers, family members, practitioners, administrators, policy makers, and researchers. Recurrent themes relate to concerns regarding the limits of science, diversion of funding from valued practices, increased costs, feasibility, prior investments in other practices, and shifts in power and control. The authors recommend that all stakeholder groups be involved in further dialog and planning to ensure that practices emerge that represent the integration of the best research evidence with clinical expertise and consumer values.

The integration of psychiatric rehabilitation services in behavioral health care structures: a state example.

This article describes a model for integrating psychiatric rehabilitation services in a managed behavioral health care structure. Psychiatric rehabilitation and managed care are two distinct developments in the provision of mental health services that have proceeded independently though they can have compatible methods and outcomes. Descriptive detail is provided about a state initiative in Iowa to provide psychiatric rehabilitation services to those with serious mental illness through the state-contracted managed behavioral health care corporation. The article describes factors leading to the program's implementation, service delivery structures, reimbursements, personnel requirements, and performance indicators. Evidence for supporting this innovation is provided through a case-controlled outcomes study of mental health service units used and their costs for participants and matched controls.

Another way of avoiding the "single model trap".

Another way to end the "model wars" (Hughes & Clement, 1999; IAPSRS, 1998) is to take what works best from different models and blend them. At two different sites, practitioners being trained to deliver ACT received additional training in the psychiatric rehabilitation and case management technology that had been previously developed at Boston University. Feedback from the practitioners indicated that the blending of these two "models" was helpful and additive. A 4-year period of data collection at one site using a simple pre-post test design showed inpatient days were reduced by about 90% for 80 individuals who were considered to be high utilizers of inpatient services. It appears that the integration of separately developed model approaches bears further study.

Best practices: The development and implementation of "no force first" as a best practice.

The mental health field continues to be concerned about the use of seclusion and of mechanical and chemical restraints in treatment settings. Recovery Innovations, Inc. (RI), a nonprofit corporation that operates a range of recovery-oriented programs, successfully eliminated use of seclusion and nonchemical restraints in a crisis center. This success was the impetus behind implementation and evaluation of a "no force first" (NFF) policy, described in this column, that targeted the crisis center's use of chemical restraint. Successful implementation of the policy in the crisis center led to the concurrent adoption of the NFF policy as a best practice at all of RI's 19 behavioral health programs.