An Investigation of Employment Hope as a Key Factor Influencing Perceptions of Subjective Recovery among Adults with Serious Mental Illness Seeking Community Work.

INTRODUCTION: Employment is an important contributor to recovery in people with serious mental illness (SMI), yet studies have not explored how subjective elements of employment hope contribute to perceptions of global recovery in this population. METHODS: The current study examined the relationship between employment hope and subjective recovery in 276 unemployed adults with SMI participating in a multi-site clinical trial of a cognitive behavioral group intervention tailored toward work and combined with vocational rehabilitation. Participants had diagnoses of schizophrenia spectrum, bipolar, depressive, and posttraumatic stress disorders, and were receiving services at three Veterans Affairs healthcare facilities in the United States. Data were collected at study baseline. Linear regression analysis examined the relationship between employment hope (Short Employment Hope Scale; EHS-14) and subjective recovery (Recovery Assessment Scale; RAS) after controlling for psychiatric symptom severity and mental-health-related burden on daily life. RESULTS: After accounting for covariates, employment hope significantly contributed to the regression model explaining subjective recovery. The overall model of predictor variables explained 52.5% of the variance in recovery. The results further explore the relationships between EHS-14 and RAS subscales. CONCLUSIONS: The findings suggest that employment hope is a key intervention target to bolster subjective recovery in this vulnerable population.

Outcomes of a peer-led navigation program, PARTNER-MH, for racially minoritized Veterans receiving mental health services: a pilot randomized controlled trial to assess feasibility and acceptability.

This pilot study explored the feasibility and acceptability of PARTNER-MH, which aimed to engage racially diverse Veterans in mental health services, facilitate their active participation in care, and improve their communication with providers. Fifty participants were randomized to the intervention or a waitlist control group. For primary outcomes, we assessed the feasibility of the study design and PARTNER-MH's feasibility and acceptability. For secondary outcomes, we explored preliminary effects on patient engagement, patient activation, shared decision-making, and health-related outcomes. The study had a recruitment rate of 68%, enrollment rate of 91%, and a follow-up retention rate of 72%. For intervention feasibility and acceptability, fidelity scores were satisfactory and improved over time, session attendance was modest with 33% of participants completing ≥6 sessions, and 89% of participants were satisfied with the intervention. For secondary outcomes, patients in the intervention arm showed significant improvement on self-reported mental health and depression, compared with those in the control group at both 6- and 9-month follow-ups. However, there were no significant differences between study arms on the other measures. Pilot results provide support for future testing of PARTNER-MH in a larger trial, although modifications are needed to increase session attendance and follow-up retention rate. CLINICAL TRIAL INFORMATION: The study was preregistered at Clinical Trials.gov. The study Trial registration number is ClinicalTrials.gov NCT04515771.

This study tested whether a peer-led navigation program, PARTNER-MH, can be delivered effectively by peer specialists in the Veterans Health Administration (VHA) healthcare system to racially minoritized Veterans who are receiving mental healthcare. The study evaluated our ability to recruit and retain participants, deliver the intervention, and examined satisfaction with the program. We also explored preliminary effects of the program. Participants were successfully recruited for the study and peers were able to deliver the program effectively. Participants reported high satisfaction with the program and significant improvements in mental health outcomes, although completion rate of the program was low. Results provide support for future testing of PARTNER-MH in a larger trial, with modifications to increase program session attendance and retention.

Racial disparities in the workplace: The impact of isolation on perceived organizational support and job satisfaction.

OBJECTIVE: Prior research indicates Black employees may be particularly vulnerable to job dissatisfaction and that social support at work is a potential resource that could influence employee outcomes. This study examined racial differences in workplace social networks and support, and how these factors may contribute to perceived organizational support and, ultimately, job satisfaction among mental health workers. METHOD: Using data from an all-employee survey in a community mental health center (N = 128), we assessed racial differences in social network supports, hypothesizing that Black employees would report smaller and less supportive social networks, and lower levels of organizational support and job satisfaction compared to White employees. We also hypothesized that workplace network size and support would be positively associated with perceived organizational support and job satisfaction. RESULTS: Hypotheses were partially supported. Compared to Whites, Blacks had smaller workplace networks that were less likely to include supervisors, were more likely to report workplace isolation (naming no workplace social ties), and were less likely to seek advice from their social ties at work. Regression analyses showed that Blacks and employees with smaller networks were more likely to perceive lower levels of organizational support, even after controlling for background variables. However, race and network size did not predict overall job satisfaction. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These findings suggest that Black mental health services staff are less likely to have rich, diverse workplace networks than their White colleagues, which may put them at a disadvantage in terms of accessing support and other resources. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exploring Factors Impacting the Implementation of Recovery-Oriented Treatment Planning on Acute Inpatient Mental Health Units.

PURPOSE: The current literature on operationalizing and implementing recovery-oriented inpatient care in diverse settings remains limited. The present study systematically examined factors affecting the implementation of one aspect of recovery-oriented care in a large and diverse national sample of Veterans Health Administration (VHA) inpatient mental health units. METHOD: VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient scale (RAIN). Sites scoring either one standard deviation above (n = 8; i.e., high-scoring sites) or one standard deviation below (n = 5; i.e., low-scoring sites) the mean on the RAIN factor of inpatient treatment planning subscale were included for additional analyses (N = 13). We used a qualitative approach known as emergent thematic analysis to assess the implementation of inpatient treatment planning elements (e.g., goal setting, shared decision-making) from qualitative interviews, observation notes, and chart reviews collected for the 13 sites. The analysis was guided by Normalization Process Theory. RESULTS: The eleven themes that emerged across the elements of recovery-oriented inpatient treatment planning mostly represented commonalities across sites, such as a shared treatment philosophy of acute care. However, five themes emerged as "differentiators" that distinguished high- and low-scoring sites and included veteran input, elicitation of recovery goals, the value of group programming, and the purpose of family involvement. CONCLUSION: Findings provide insight into contextual factors and processes that impacted the implementation of recovery-oriented treatment planning at these VHA inpatient mental health units. To further facilitate the implementation of recovery-oriented inpatient treatment planning elements, future research should examine staff's collective understanding of recovery-oriented inpatient care.

Recovery-oriented inpatient mental health care and readmission.

OBJECTIVE: This article examines the relationship between inpatient mental health units' adherence to recovery-oriented care and 30-day patient readmission. METHOD: The sample included patients admitted to one of 34 Veterans Health Administration inpatient mental health units. Recovery-oriented care was assessed using interviews and site visits. Patient characteristics and readmission data were derived from administrative data. FINDINGS: Overall recovery orientation was not associated with readmission. Exploratory analyses found higher scores on a subsample of items pertaining to inpatient therapeutic programming were associated with lower patient readmissions. Additionally, patients with more prior service use and substance abuse or personality disorders were more likely to be readmitted. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A growing body of literature supports the association between psychotherapeutic services in inpatient units and better patient outcomes. However, further research is needed to examine this association. More work is needed to develop appropriate psychotherapy services for the inpatient setting and support their implementation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH), a Peer-Led Patient Navigation Intervention for Racially and Ethnically Minoritized Veterans in Veterans Health Administration Mental Health Services: Protocol for a Mixed Methods Randomized Controlled Feasibility Study.

BACKGROUND: Mental health care disparities are persistent and have increased in recent years. Compared with their White counterparts, members of racially and ethnically minoritized groups have less access to mental health care. Minoritized groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental health care experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental health care and treatment decisions may help reduce mental health care disparities. Designed to achieve this goal, the Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) is a peer-led patient navigation intervention that aims to engage minoritized patients in mental health treatment, support them to play a greater role in their care, and facilitate their participation in shared treatment decision-making. OBJECTIVE: The primary aim of this study is to assess the feasibility and acceptability of PARTNER-MH delivered to patients over 6 months. The second aim is to evaluate the preliminary effects of PARTNER-MH on patient activation, patient engagement, and shared decision-making. The third aim is to examine patient-perceived barriers to and facilitators of engagement in PARTNER-MH as well as contextual factors that may inhibit or promote the integration, sustainability, and scalability of PARTNER-MH using the Consolidated Framework for Implementation Research. METHODS: This pilot study evaluates the feasibility and acceptability of PARTNER-MH in a Veterans Health Administration (VHA) mental health setting using a mixed methods, randomized controlled trial study design. PARTNER-MH is tested under real-world conditions using certified VHA peer specialists (peers) selected through usual VHA hiring practices and assigned to the mental health service line. Peers provide PARTNER-MH and usual peer support services. The study compares the impact of PARTNER-MH versus a wait-list control group on patient activation, patient engagement, and shared decision-making as well as other patient-level outcomes. PARTNER-MH also examines organizational factors that could impact its future implementation in VHA settings. RESULTS: Participants (N=50) were Veterans who were mostly male (n=31, 62%) and self-identified as non-Hispanic (n=44, 88%) and Black (n=35, 70%) with a median age of 45 to 54 years. Most had at least some college education, and 32% (16/50) had completed ≥4 years of college. Randomization produced comparable groups in terms of characteristics and outcome measures at baseline, except for sex. CONCLUSIONS: Rather than simply documenting health disparities among vulnerable populations, PARTNER-MH offers opportunities to evaluate a tailored, culturally sensitive, system-based intervention to improve patient engagement and patient-provider communication in mental health care for racially and ethnically minoritized individuals. TRIAL REGISTRATION: ClinicalTrials.gov NCT04515771; https://clinicaltrials.gov/ct2/show/NCT04515771. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37712.

Health care workers' perspectives on care for patients with injection drug use associated infective endocarditis (IDU-IE).

BACKGROUND: Despite high morbidity and mortality, patients with injection drug use associated infective endocarditis (IDU-IE) lack standardized care, and experience prolonged hospitalization and variable substance use disorder (SUD) management. Our study's objective was to elicit perspectives of health care workers (HCWs) who deliver care to this population by understanding their perceived patient, provider, and system-level resources and barriers. METHODS: This qualitative study included interviews of HCWs providing care to patients with IDU-IE from January 2017 to December 2019 at a single Midwest academic center. Based on electronic medical record queries to determine high and low rates of referral to SUD treatment, HCWs were selected using stratified random sampling followed by convenience sampling of non-physician HCWs and a patient. Study participants were recruited via email and verbal consent was obtained. The final sample included 11 hospitalists, 3 specialists (including 2 cardiovascular surgery providers), 3 case managers, 2 social workers, 1 nurse, and 1 patient. Qualitative semi-structured interviews explored challenges and resources related to caring for this population. Qualitative Data Analysis (QDA) Minor Lite was used for thematic data using an inductive approach. RESULTS: Three major thematic categories emerged relative to patient-level barriers (e.g., pain control, difficult patient interactions, social determinants of health), provider-level barriers (e.g., inequity, expectations for recovery, varying levels of hope, communication style, prescribing medication for SUD), and system-level barriers (e.g., repeat surgery, placement, resources for SUD and mental health). The need to address underlying SUD was a prominent theme. CONCLUSION: Practical steps we can take to improve treatment for this population include training and coaching HCWs on a more person-centered approach to communication and transparent decision-making around pain management, surgery decisions, and expectations for SUD treatment.

Inpatient Mental Healthcare before and during the COVID-19 Pandemic.

Prior studies have demonstrated disruption to outpatient mental health services after the onset of the COVID-19 pandemic. Inpatient mental health services have received less attention. The current study utilized an existing cohort of 33 Veterans Health Affairs (VHA) acute inpatient mental health units to examine disruptions to inpatient services. It further explored the association between patient demographic, clinical, and services variables on relapse rates. Inpatient admissions and therapeutic services (group and individual therapy and peer support) were lower amongst the COVID-19 sample than prior to the onset of COVID-19 while lengths of stay were longer. Relapse rates did not differ between cohorts. Patients with prior emergent services use as well as substance abuse or personality disorder diagnoses were at higher risk for relapse. Receiving group therapy while admitted was associated with lower risk of relapse. Inpatient mental health services saw substantial disruptions across the cohort. Inpatient mental health services, including group therapy, may be an important tool to prevent subsequent relapse.

Introduction to the special section: A call to action to address psychiatric rehabilitation workers' well-being.

The well-being of the psychiatric rehabilitation workforce is a growing concern, particularly as a result of the stresses of the COVID-19 pandemic on demand for mental health services. Research focusing on this aspect of psychiatric rehabilitation services remains limited but is important in supporting a resilient mental health workforce. This special section presents four papers that focus on aspects of worker well-being and burnout, including drivers of well-being and other outcomes, as well as exploring potential action steps and contexts that organizations could consider in their efforts to bolster well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Determinants of Long Immunization Clinic Wait Times in a Sub-Saharan African Country.

The wait time clients spend during immunization clinic visits in low- and middle-income countries is a not well-understood reported barrier to vaccine completion. We used a prospective, observational design to document the total time from client arrival-to-discharge and all sequential provider-client activities in 1 urban, semi-urban, and rural immunization clinic in Nigeria. We also conducted caregiver and provider focus group discussions to identify perceived determinants of long clinic wait times. Our findings show that the time from arrival-to-discharge varied significantly by the clinic and ranged between 57 and 235 minutes, as did arrival-to-all providers-client activities. Focus group data attributed workflow delays to clinic staff waiting for a critical mass of clients to arrive for their immunization appointment before starting the essential health education talk or opening specific vaccine vials. Additionally, respondents indicated that complex documentation processes caused system delays. Research on clinic workflow transformation and simplification of immunization documentation is needed.

Recovery-oriented acute inpatient mental health care: Operationalization and measurement.

OBJECTIVE: The current article describes efforts to develop and test a measure of recovery-oriented inpatient care. METHOD: The Recovery-oriented Acute INpatient (RAIN) scale was based on prior literature and current Veterans Health Administration (VHA) policy and resources and further revised based on data collection from 34 VHA acute inpatient units. RESULTS: A final scale of 23, behaviorally anchored items demonstrated a four-factor structure including the following factors: inpatient treatment planning, outpatient treatment planning, group programming, and milieu. While several items require additional revision to address psychometric concerns, the scale demonstrated adequate model fit and was consistent with prior literature on recovery-oriented inpatient care. Conclusions and Implementations for Practice: The RAIN scale represents an important tool for future implementation and empirical study of recovery-oriented inpatient care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Organizational conditions that influence work engagement and burnout: A qualitative study of mental health workers.

Objective: Clinician burnout in healthcare is extensive and of growing concern. In mental health and rehabilitation settings, research on interventions to improve burnout and work engagement is limited and rarely addresses organizational drivers of burnout. This study sought to elaborate on the organizational influence of burnout and work engagement in mental health. Methods: We randomly selected 40 mental health clinicians and managers who were participating in a burnout intervention and conducted semi-structured interviews to understand their views of organizational conditions impacting burnout and work engagement. Data were analyzed using a thematic analytical approach. Results: Analyses yielded three major themes where organizational contexts might reduce burnout and increase work engagement: (a) a work culture that prioritizes person-centered care over productivity and other performance metrics, (b) robust management skills and practices to overcome bureaucracy, and (c) opportunities for employee professional development and self-care. Participants also referenced three levels of the organizational context that they believed influenced burnout and work engagement: front-line supervisors and program managers, organizational executive leadership, and the larger health system. Conclusions and Implications for Practice: Findings point to several possible targets of intervention at various organizational levels that could guide the field toward more effective ways to reduce burnout and improve work engagement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Factors that affect quality of care among mental health providers: Focusing on job stress and resources.

Objective: High-quality, person-centered care is a priority for mental health services. The current study conducted secondary data analysis to examine the impact of job stress (i.e., interaction with high-risk consumer cases, increased caseload, emotional exhaustion) and resources (i.e., increased organizational and supervisory support, autonomy, role clarity) on providers' perceived quality of care. Methods: Data consisted of 145 direct care providers from an urban community mental health center. Structural equation modeling was used for testing the hierarchical regression model, sequentially adding job stress and resource variables in the prediction models for the quality of care (i.e., person-centered care, discordant care [conflict with consumers and tardiness]). Results: Person-centered care was positively associated with increased role clarity, organizational support, and larger caseload size, while a lower level of discordant care was associated with lower emotional exhaustion, smaller caseload size, less interaction with high-risk consumer cases, and with increased role clarity. Conclusions and Implications for Practice: Resources on the job may be particularly important for improved person-centered care, and lowering job stress may help reduce discordant care. The current study suggests the need for the mental health organizations to attend to both job stress and resources for providers to improve the quality of care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychosocial outcomes of a pilot study of work-tailored cognitive behavioral therapy intervention for adults with serious mental illness.

OBJECTIVE: Many people with serious mental illness (SMI) continue to struggle with work functioning despite the receipt of supported employment (SE) services. In response, adjunctive interventions to SE have begun to be developed. One such approach, the cognitive behavioral therapy for work success (CBTw) intervention, targets cognitive and behavioral barriers to competitive work success in adults with SMI. Using a pre-post design, this pilot study examined the psychosocial outcomes of the CBTw program in 52 adults with SMI receiving SE. METHOD: Recovery attitudes, work-related self-efficacy, self-esteem, and symptom domains (depression, anxiety, psychosis) were measured at baseline and after the 12-week intervention. Paired samples t-tests examined changes in outcomes over time. RESULTS: At posttreatment, participants had significant improvements in recovery attitudes, self-esteem, depressive, and negative symptoms. Other psychosocial outcomes did not significantly change. CONCLUSIONS: This pilot work demonstrates CBTw is a promising intervention to improve recovery and wellness in SMI.

The Relationship Between Clinician Turnover and Client Outcomes in Community Behavioral Health Settings.

OBJECTIVE: High clinician turnover in community behavioral health settings can lead to increased costs and can have a negative impact on care quality. Few studies have examined the implications of clinician turnover for client outcomes. This study investigated changes in client outcomes associated with clinician turnover. METHODS: The study used prospective observational data collected as part of a larger randomized controlled trial. Clients (N=328) from two community behavioral health centers identified the clinician (N=121) whom they saw most often. Clients completed measures of depression, anxiety, mental and physical health functioning, and patient activation at baseline, 6 months, and 12 months. Clinician turnover during the 12-month study was obtained from agency records. Latent growth curve modeling was used to analyze the data. RESULTS: Of the 328 clients, 24% experienced clinician turnover. For all outcomes except depression, the association with turnover was moderated by baseline status on the outcome measure. Turnover tended to be associated with clinical decline for clients who at baseline had low to moderate anxiety, high patient activation, or high physical health functioning. Surprisingly, turnover was associated with increased mental health functioning for clients who at baseline had very low mental health functioning. For physical health functioning, the association with turnover was also moderated by age. Turnover was associated with a sharper decline in functioning for older clients. CONCLUSIONS: Results suggest that clinician turnover was associated most strongly with decline for higher functioning or older clients, but it was not uniformly associated with worsening clinical outcomes.

Characteristics and Job Stressors Associated With Turnover and Turnover Intention Among Community Mental Health Providers.

OBJECTIVE: This study aimed to examine the provider characteristics and job stressors that are related to turnover intention and actual turnover among community mental health providers. METHODS: Secondary analyses were conducted with data collected from 186 community mental health providers from two agencies. Self-reported provider characteristics, job stressors, and turnover intention data were collected with the baseline survey, and actual turnover data were obtained from the agencies 12 months later. Bivariate analyses were conducted to examine factors associated with each turnover variable. RESULTS: Turnover intention and actual turnover were correlated, yet a distinct set of variables was associated with each outcome. Namely, job stressors were related to turnover intention, while provider characteristics were related to actual turnover. CONCLUSIONS: Given that both turnover intention and actual turnover have important implications for both providers and agencies, it is critical to consider differential factors associated with each.

Measuring Quality of Care in Community Mental Health: Validation of Concordant Clinician and Client Quality-of-Care Scales.

Measuring quality of care can transform care, but few tools exist to measure quality from the client's perspective. The aim of this study was to create concordant clinician and client self-report quality-of-care scales in a sample of community mental health clinicians (n = 189) and clients (n = 469). The client scale had three distinct factors (Person-Centered Care, Negative Staff Interactions, and Inattentive Care), while the clinician scale had two: Person-Centered Care and Discordant Care. Both versions demonstrated adequate internal consistency and validity with measures related to satisfaction and the therapeutic relationship. These measures are promising, brief quality assessment tools.

A Comparative Effectiveness Trial to Reduce Burnout and Improve Quality of Care.

Clinician burnout is presumed to negatively impact healthcare quality; yet scant research has rigorously addressed this hypothesis. Using a mixed-methods, randomized, comparative effectiveness design, we tested two competing approaches to improve care-one addressing clinician burnout and the other addressing how clinicians interact with consumers-with 192 clinicians and 469 consumers at two community mental health centers. Although qualitative reports were promising, we found no comparative effectiveness for either intervention on burnout, patient-centered processes, or other outcomes. Discussion includes identifying ways to strengthen approaches to clinician burnout.

A Pilot Test of Group Based Cognitive Behavioral Therapy to Augment Vocational Services for Persons With Serious Mental Illness: Feasibility and Competitive Work Outcomes.

Persons with serious mental illness (SMI) struggle with work functioning even with the assistance of vocational services. The current study sought to address this problem by examining a cognitive-behavioral therapy to augment vocational services. Fifty-two adults with SMI receiving vocational services participated in a pre-post feasibility trial of the Cognitive Behavior Therapy for Work Success (CBTw) intervention. CBTw is a 12-week manualized intervention that addresses cognitive and behavioral factors that impact work functioning. Competitive work outcomes were assessed in the 12 weeks preceding baseline and after the intervention. The results demonstrate strong session attendance and a low attrition rate. There were also significant improvements in work outcomes. Specifically, among participants unemployed at baseline, 50.0% attained work during follow-up. These findings provide preliminary evidence that CBTw may be a feasible intervention to augment vocational services; further controlled research should examine its benefit to work outcomes in people with SMI.

Social capital and burnout among mental healthcare providers.

BACKGROUND: Provider burnout is a critical problem in mental health services. Contributing factors have been explicated across three domains: personal, job and organizational characteristics. Of these, organizational characteristics, including workplace environment, appear to be particularly important given that most interventions addressing burnout via the other domains (e.g. bolstering personal coping skills) have been modestly effective at best. AIMS: This study builds on previous research by using social capital as a framework for the experience of work social milieu, and aims to provide a richer understanding of how workplace social environment might impact burnout and help create more effective ways to reduce burnout. METHODS: Providers (n = 40) taking part in a larger burnout intervention study were randomly selected to take part in interviews regarding their workplace environment and burnout. Participant responses were analyzed thematically. RESULTS: Workplace social milieu revolved around two primary themes: workplace social capital in provider burnout and the protective qualities of social capital in cohesive work teams that appear to mitigate burnout. CONCLUSIONS: These results imply that work environments where managers support collaboration and social interaction among work teams may reduce burnout.