Adding consumer-providers to intensive case management: does it improve outcome?

OBJECTIVE: Over the past decade, there has been increasing interest in the employment of mental health consumers in various roles as providers of services. Although integration of consumers into case management services has been studied, the roles of consumers have been poorly defined and the benefits have not been established. The goal of this study was to evaluate whether consumers enhance case management outcome through the provision of social support. METHODS: This study compared consumer-assisted and non-consumer-assisted case management with standard clinic-based care. The consumer role focused on the development of social support by using peer staff who matched the profile of participants. A total of 203 clients with severe and persistent mental illness were randomly assigned to one of the three conditions and followed for 12 months. RESULTS: All three programs yielded the same general pattern of improvement over time for symptoms, health care satisfaction, and quality of life. Clients in the three programs also showed similar but small changes in measures of social network behavior. Consumer-assisted case management was unique in its use of peer-organized activities. Non-consumer-assisted case management made greater use of individual contacts with professional staff. Standard clinic-based care relied more on group and on individual therapy. Despite these variations in the pattern of services over a 12-month period, no one program emerged as categorically superior to the others. CONCLUSIONS: Although more research is needed to determine optimal roles for consumers in mental health service delivery, a randomized trial found no evidence that the presence of consumers enhances case management outcome.

Resonance Raman spectroscopy of oxoiron(IV) porphyrin pi-cation radical and oxoiron(IV) hemes in peroxidase intermediates.

The catalytic cycle intermediates of heme peroxidases, known as compounds I and II, have been of long standing interest as models for intermediates of heme proteins, such as the terminal oxidases and cytochrome P450 enzymes, and for non-heme iron enzymes as well. Reports of resonance Raman signals for compound I intermediates of the oxo-iron(IV) porphyrin pi-cation radical type have been sometimes contradictory due to complications arising from photolability, causing compound I signals to appear similar to those of compound II or other forms. However, studies of synthetic systems indicated that protein based compound I intermediates of the oxoiron(IV) porphyrin pi-cation radical type should exhibit vibrational signatures that are different from the non-radical forms. The compound I intermediates of horseradish peroxidase (HRP), and chloroperoxidase (CPO) from Caldariomyces fumago do in fact exhibit unique and characteristic vibrational spectra. The nature of the putative oxoiron(IV) bond in peroxidase intermediates has been under discussion in the recent literature, with suggestions that the Fe(IV)O unit might be better described as Fe(IV)-OH. The generally low Fe(IV)O stretching frequencies observed for proteins have been difficult to mimic in synthetic ferryl porphyrins via electron donation from trans axial ligands alone. Resonance Raman studies of iron-oxygen vibrations within protein species that are sensitive to pH, deuteration, and solvent oxygen exchange, indicate that hydrogen bonding to the oxoiron(IV) group within the protein environment contributes to substantial lowering of Fe(IV)O frequencies relative to those of synthetic model compounds.

Reducing restraints: alternatives to restraints on an inpatient psychiatric service--utilizing safe and effective methods to evaluate and treat the violent patient.

This paper describes the violence safety program instituted at Elmhurst Hospital Center in Queens, New York City in 2001, which significantly reduced the use of restraints and seclusion department wide, while providing a safe and therapeutic environment for patient recovery. The hospital service and program instituted is described, followed by restraint and seclusion data since 1998, and the program's results through 2003. Concurrent data in areas that could be affected by a reduction in restraint and seclusion such as self-injurious behaviors and altercations; use of emergency medication; use of special observation and length of stay data are also presented. In addition, types and frequency of alternative methods utilized to avoid restraints and seclusion are described.

The safe treatment of the suicidal patient in an adult inpatient setting: a proactive preventive approach.

This paper focuses on the work of an inpatient service in an acute care safety net hospital in the prevention of suicide on its inpatient service and during the high-risk period post discharge. The strategy utilized a comprehensive proactive systems approach to the suicidal patient including: a formalized suicide assessment jointly done by medical and nursing staff, accurate diagnosis and best practice treatment, a flexible nursing observation policy, groups on inpatient units focused on suicide and key risk factors and triggers, and a communication tool to the next level of care that describes the strategies learned by the patient to deal with his or her suicidality. Incidents of self-injurious behaviors and special observation hours were monitored.