Launching into adulthood from institutional care with a serious mental health condition.

This qualitative study explores the experiences of emerging adults with serious mental health conditions (e.g., bipolar disorder, posttraumatic stress disorder) before and after they emancipate from the child welfare system and exit a transitional living program. Sixteen participants were interviewed before and 13 were interviewed after aging out. Findings suggest that transitional living programs services were appreciated for the relationships and safety net they fostered. Future plans were positive, but vague, and worries about the future were prevalent. Struggles with independence post-emancipation were common despite adult service use. Additional research is needed to understand how to best support these at-risk emerging adults.

Mobile technologies among people with serious mental illness: opportunities for future services.

Several national bodies have proposed using mobile technology to improve mental health services. But rates of current use and interest in using technology to enhance services among individuals with serious mental illness are uncertain. The authors surveyed 1,592 individuals with serious mental illness regarding their use of mobile devices and interest in using mobile technologies to enhance mental health services. Seventy-two percent of survey respondents reported currently owning a mobile device, a rate approximately 12 % lower than the general adult population. The most common uses were for talking, followed by texting, and internet activities. Both mobile device users and nonusers expressed interest in future mobile services.

Healthy eating in persons with serious mental illnesses: understanding and barriers.

OBJECTIVE: To explore the understanding of a healthy diet and the barriers to healthy eating in persons with serious mental illnesses. METHODS: In-depth semi-structured qualitative interviews about health behaviors were conducted in 31 individuals with serious mental illnesses. Participants were recruited from a mental health center in Chicago, Illinois, and ranged in age from 30 to 61 years old. RESULTS: Most participants described healthy eating as consuming fruits and vegetables, using low fat cooking methods, and limiting sweets, sodas, fast food, and/or junk food. Internal barriers to nutritional change included negative perceptions of healthy eating, the decreased taste and satiation of healthy foods, difficulty changing familiar eating habits, eating for comfort, and the prioritization of mental health. External barriers were the reduced availability and inconvenience of healthy foods, social pressures, and psychiatric medication side effects. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study revealed several modifiable barriers to healthy eating. Interventions that addressed these could aid in improving the diet and lowering the risk of cardiovascular disease in this population. Recommendations are to provide healthy eating education that is individualized, emphasizes the health consequences of poor eating, and provides opportunities to prepare and taste healthy foods. Family and friends should be included in all educational efforts. At community mental health centers and group homes, only healthy foods should be offered. Lastly, practitioners should encourage eating a healthy diet, inquire about eating in response to emotions, and explore the impact of psychiatric medications on eating behaviors.

Integrated primary and mental health care services: an evolving partnership model.

TOPIC: Persons with serious psychiatric disabilities experience high rates of medical co-morbidities that, if properly treated, could improve overall well-being and the course of recovery. PURPOSE: This brief reports describes how two organizations-Thresholds Psychiatric Rehabilitation Centers and University of Illinois College of Nursing-partnered to offer integrated behavioral and physical health care responsive to the needs of the population and committed to consumer-centered, holistic and preventative care. Most recently, the partnership offers primary care in different community settings through different service models-tele-monitoring, home visits, group visits. SOURCES USED: A combination of published literature, staff report, and quality assurance data informs this report. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The authors conclude that primary care outreach is a promising strategy in mental health settings and that the Chronic Care Model (CCM) provides a set of guidelines for designing and monitoring quality integrated care for a partnership model of integrated care.

Housing preferences and choices among adults with mental illness and substance use disorders: a qualitative study.

Housing is a crucial issue for adults with severe mental illness and co-occurring substance use disorders, as this population is particularly susceptible to housing instability and homelessness. We interviewed 40 adults with dual disorders, living in either supervised or independent housing arrangements, to examine housing preferences, decision making processes surrounding housing choices, and perceived barriers to housing. We found that many clients indicated their housing preferences had changed over time, and some clients related housing preferences to recovery. Although the majority of clients preferred independent housing, many also described benefits of supervised housing. Clients' current living situations appeared to be driven primarily by treatment provider recommendations and availability of housing. Common barriers to obtaining desired housing were lack of income and information. These findings have implications for supported housing models and approaches to providing housing for clients.

Sleep endoscopy findings in children with persistent obstructive sleep apnea after adenotonsillectomy.

OBJECTIVES: Describe the patterns of obstruction in persistent pediatric OSA and their relationship with patient weight. STUDY DESIGN: Retrospective review. METHODS: All pediatric DISE procedures performed at a tertiary care hospital between October 2010 and October 2015 were reviewed. Patients had polysomnography after adenotonsillectomy that confirmed persistent obstructive sleep apnea (OSA). Variables included age, gender, co-morbidities, and AHI. DISE findings focused on inferior turbinates, adenoid, tongue base, epiglottis, aryepiglottic (AE) folds, arytenoids, lingual tonsil and their contributions to obstruction. RESULTS: 34 patients were included with mean age of 7.85 (2-16) years, mean BMI of 23.15 (13.6-44.8) and mean AHI of 6.34 (1.5-25.2) events per hour. Obstruction occurred at the level of the epiglottis in 97%, with retropositioning by tongue base (73.6%) or lingual tonsil enlargement (70.5%). Obstruction occurred at the inferior turbinates in 76.5%, the adenoid in 64.7% and the palate in 58.8%. Shortened AE folds were less often identified (15%). Multiple sites of partial or complete obstruction were found in 97% of patients. Overweight or obese patients had a mean of 3 sites of complete obstruction and 4.69 sites of partial or complete obstruction as compared to 2.33 and 4.52 in underweight or normal weight children. Overweight or obese children were more likely to have obstruction at the lingual tonsil or adenoid than normal/underweight children. CONCLUSION: Multiple sites of obstruction in persistent pediatric OSA were found. Children with higher BMIs had slightly different findings, suggesting that attention to adenoid regrowth and lingual tonsil hypertrophy is important.

A method to detect Escherichia coli carrying the colistin-resistance genes mcr-1 and mcr-2 using a single real-time polymerase chain reaction and its application to chicken cecal and porcine fecal samples.

Colistin is one of the last-resort antibiotics for the treatment of multidrug-resistant infections in humans, but transmissible colistin-resistance genes have emerged in bacteria from animals. The rapid and sensitive detection among animals of colonization with bacteria carrying these genes is critical in helping to control further spread. Here we describe a method for broth enrichment of colistin-resistant Escherichia coli from animal fecal and cecal samples followed by real-time polymerase chain reaction (PCR) for the simultaneous detection of two of the main colistin-resistance genes, mcr-1 and mcr-2. The PCR uses a single set of nondegenerative primers, and mcr variants can be differentiated by melt-curve analysis. Overnight culture enrichment was effective for amplifying colistin-resistant E. coli, even when initially present in numbers as low as 10 bacteria per gram of sample. The mcr-1 and mcr-2 genes were not found in any of the Ontario swine and poultry samples investigated.

La colistine est un des antibiotiques de dernier recours pour le traitement d'infections causées par des bactéries multi-résistantes chez l'humain, mais des gènes transmissibles de résistance à la colistine ont émergé chez des bactéries provenant d'animaux. La détection rapide et sensible parmi les animaux de la colonisation par ces bactéries porteuses de ces gènes est critique afin d'aider à limiter la propagation. Nous décrivons ici une méthode pour un enrichissement en bouillon des souches de Escherichia coli résistantes à la colistine provenant d'échantillons de fèces animales et de caecum suivi d'une réaction d'amplification en chaine par la polymérase (ACP) en temps réel pour la détection simultanée des deux gènes principaux de résistance à la colistine, mcr-1 et mcr-2. La réaction d'ACP utilise une seule série d'amorces non-dégénératives, et les variants de mcr peuvent être différenciés par l'analyse de la courbe de fusion. Une culture d'enrichissement d'une nuit était efficace pour amplifier les E. coli résistants à la colistine, même si présents initialement en quantité aussi faible que 10 bactéries par gramme d'échantillon. Les gènes mcr-1 et mcr-2 n'ont pas été trouvés dans aucun des échantillons porcins ou aviaires étudiés.(Traduit par Docteur Serge Messier).

Integrated residential treatment for persons with severe and persistent mental illness: lessons in recovery.

This retrospective study examines 24-month outcomes for 38 participants with histories of chronic homelessness and hospitalizations in an urban, residential integrated treatment (IT) program and compares characteristics of those who stayed in the program 24 months with those who left within their first year of residence. Informed by an Assertive Community Treatment approach, characterized by outreach (or what might better be referred to as inreach), low staff to consumer ratio, and meeting of basic needs, the residential program emphasized harm reduction and motivational interventions. The longitudinal study design was supplemented with a comparative analysis of treatment completers and noncompleters. There were significant differences between the two groups at baseline in terms of engagement with treatment, alcohol use severity, and mental health diagnosis. Additionally, those who stayed with the program showed significant reductions in alcohol and drug use, significant reduction in hospitalizations, and advances in treatment engagement.

A focus group analysis of relapse prevention strategies for persons with substance use and mental disorders.

OBJECTIVE: The authors conducted a qualitative, thematic analysis of focus group data to determine the strategies and supports persons with dual diagnoses rely on in their relapse prevention efforts. METHODS: Data from four focus group sessions conducted at a large psychosocial rehabilitation center were analyzed for recurrent responses about what was most helpful in maintaining remission and grouped into major categories and subcategories. Each focus group comprised four to nine consumers who had been in remission from substance use for at least six months. A total of 27 consumers participated in the focus groups. RESULTS: The data indicate that maintaining stable housing, relying on "positive" social support, engaging in prayer or relying on a "higher power," participating in a meaningful activity, and thinking differently about life are important strategies for consumers in their attempts to stay clean. Just as frequently mentioned in the groups were conscious attempts to eat regularly, get sufficient sleep, and look presentable. CONCLUSION: Although this study was exploratory in nature, it identified areas for further qualitative study of strategies for relapse prevention among persons with dual diagnoses.

Substance abuse relapse and factors associated with relapse in an inner-city sample of patients with dual diagnoses.

OBJECTIVE: This study documented rates of substance abuse relapse and explored factors associated with sustained remission among consumers with severe mental illness in a large, urban clinical sample. METHODS: Existing clinical records of consumers with severe mental illness and co-occurring substance use disorders who had achieved remission and who were interviewed at two or more subsequent follow-up points (12 months after remission) were reviewed. Consumers who relapsed within 12 months after remission were compared with those who maintained remission on demographic, clinical, and functional indicators. RESULTS: Of the 133 consumers who achieved remission, 91 (68 percent) had maintained remission at six-month follow-up, and 69 (52 percent) had maintained remission at 12-month follow-up. The strongest factors associated with maintenance of remission at 12 months were older age and living in Thresholds residential programs. Multivariate analysis showed that consumers who were older, held jobs, and lived in Thresholds residential programs at initial remission had a higher likelihood of maintaining remission at 12 months. To explore the potential impact of program dropout on the results, supplemental analyses using a third group without 12-month follow-up data were conducted. These analyses indicated that program dropouts were younger and less likely to live in Thresholds residential programs at initial remission. CONCLUSIONS: Age, therapeutic residential programming, and, to a lesser degree, employment appear to be potential factors to consider in the development of relapse prevention models.

Gaining insight: who benefits from residential, integrated treatment for people with dual diagnoses?

This retrospective study examines 18-month outcomes for 38 participants in an urban, residential integrated treatment (IT) program, and whether residents experienced different treatment benefits. Informed by an ACT team approach, the program emphasized harm reduction and motivational interventions. The design is naturalistic, and outcomes are self-comparisons over time reported in the aggregate. Repeated measurements with three standardized scales tracked stage of treatment and extent of alcohol and drug use. Outcomes analyses reveal advancements in stage of treatment and significant reductions in use of alcohol and drugs. Participants also worked more and were hospitalized less.

Targeting consumers in the early stages of substance use treatment: a pilot study.

OBJECTIVE: Engaging persons with co-occurring disorders in substance use treatment presents a significant challenge for public mental health service providers. Standardized, user-friendly guidelines may have great benefit for community mental health outreach staff working with individuals with co-occurring disorders. The purpose of this study is to describe the impact of a brief, structured goal development curriculum ("Fresh Start") on clinicians' motivational interviewing skills and to assess clinician and consumer satisfaction with the curriculum. METHOD: Four clinicians, each working with 3-4 consumer participants, were assessed with the Yale Adherence and Competency Scale prior to and during use of Fresh Start to determine improvements in motivational interviewing and goal setting. Consumer participants were assessed in brief qualitative interviews to assess satisfaction. Chart-review of routinely collected substance use data was used to assess reductions in use. RESULTS: Clinicians demonstrated high ratings in relational motivational interviewing skills at baseline which were maintained at study conclusion. Clinicians had lower technical motivational interviewing skills at baseline and made modest improvements in motivational interviewing techniques targeting increasing change talk. Fresh Start participants completed an average of 10 sessions (SD = 2.35). Among the 16 consumers who volunteered to participate in using the Fresh Start curriculum, 12 finished the program and 9 decided to reduce use and composed a sobriety plan. CONCLUSIONS AND IMPLICATION FOR PRACTICE: High rates of completion indicate acceptability of the curriculum and feasibility for implementing the program in a community setting. Short, goal-setting interventions are needed and under proper conditions may be teachable in vivo.

Applying social and cultural capital frameworks: understanding employment perspectives of transition age youth with serious mental health conditions.

Vulnerable transition age youth, such as those in foster care and with serious mental health conditions, are at increased risk for lower rates of employment. Social capital is empirically linked to employment in the general population, yet little is known about the role of social capital in employment for at-risk transition age youth. Focus groups were conducted with young people with serious mental health conditions and their vocational specialists. Discussions reveal that both social and cultural capital influence employment processes. Those with employment experience value the motivation to work provided through others compared to those with no employment experience. Consistently employed describe strong working relationships with vocational specialists and possession of self-awareness, professionalism, and work-place knowledge as critical for employment success, while inconsistently employed describe worries about controlling emotions or behaviors on the job. Building social and cultural capital are explored as potential service provider goals.

An electronic decision support system to motivate people with severe mental illnesses to quit smoking.

OBJECTIVE: Rates of cigarette smoking are high among people with severe mental illnesses compared with the general population (45%-90% versus 20%). The authors developed a Web-based computer decision support system that is tailored for use by people with cognitive deficits and is designed to stimulate motivation to quit smoking by using evidence-based treatment. METHODS: This initial study used a quasi-experimental design to test the decision support system among a convenience sample of 41 smokers with severe mental illnesses. Researchers interviewed participants at baseline and two months later to assess for behaviors indicative of motivation to quit smoking. A negative binomial regression modeled the outcome and controlled for baseline group differences. RESULTS: Participants who used the decision support system were significantly more likely to show any behavioral motivation to quit smoking (such as meet with a clinician to discuss cessation, initiate cessation treatment, or otherwise attempt to quit) (67% versus 35%; χ(2)=4.11, df=41, p=.04). Further, using the decision support system increased by a factor of 2.97, or about 300%, the expected number of ways that a participant showed motivation. CONCLUSIONS: The encouraging results of this pilot study indicate that electronic decision supports may facilitate motivation to quit smoking and use of cessation treatment among people with severe mental illnesses.

Housing Preferences among Adults with Dual Diagnoses in Different Stages of Treatment and Housing Types.

Housing is an essential component of psychiatric rehabilitation, particularly for consumers with dual diagnoses. Research has not clearly examined why and when consumers prefer different types of housing. This exploratory study examined 1) whether housing preferences differ between stage of treatment for substance abuse, 2) whether consumers who prefer certain housing types have preferences for certain characteristics, and 3) whether consumers living in different types of housing report differences in social support, choice, and housing satisfaction. A total of 103 participants living in supervised housing (n= 65), independent apartment housing (n= 22), single room occupancy hotels (n= 11), and with family (n= 5) completed self-report questionnaires. Results showed that 1) the majority of participants preferred their own apartment or house across different stages of treatment, 2) preference for supervised housing was associated with on-site staff and peer support while preference for apartment housing was associated with autonomy and privacy, and 3) consumers in single room occupancies reported the least choice and lowest satisfaction. These findings contribute to the understanding of consumers' housing preferences and the differences consumers perceive between certain housing types.