The Relationship Between Serious Mental Illness and Criminal Offending in Persons Experiencing Homelessness: The Role of Substance Use Disorder.

Individuals who live with mental illness are encumbered by related risk factors that increase the probability of legal involvement. The goal was to determine how homelessness and substance use disorder are intervening factors in the relationship between symptoms of serious mental illness (SMI) and criminal offending. A sample of 210 chronically homeless adults receiving SAMHSA-funded outreach and psychiatric rehabilitation services between 2014 and 2016 was recruited in a study of interventions to address housing in homeless persons with a SMI. Participants were interviewed and data collected were analyzed using structural equation modeling. Statistical analysis showed that homelessness severity mediated the relationship between SMI symptom severity and criminal offenses committed in the past 30 days in participants with a substance use disorder but not in those with no substance use diagnosis. Results show that homelessness and substance use are important to address to possibly alter trajectories for criminal justice involvement.

Machine Learning with Human Resources Data: Predicting Turnover among Community Mental Health Center Employees.

BACKGROUND: Human resources (HR) departments collect extensive employee data that can be useful for predicting turnover. Yet, these data are not often used to address turnover due to the complex nature of recorded data forms. AIMS OF THE STUDY: The goal of the current study was to predict community mental health center employees' turnover by applying machine learning (ML) methods to HR data and to evaluate the feasibility of the ML approaches. METHODS: Historical HR data were obtained from two community mental health centers, and ML approaches with random forest and lasso regression as training models were applied. RESULTS: The results suggested a good level of predictive accuracy for turnover, particularly with the random forest model (e.g., Area Under the Curve was above .8) compared to the lasso regression model overall. The study also found that the ML methods could identify several important predictors (e.g., past work years, wage, work hours, age, job position, training hours, and marital status) for turnover using historical HR data. The HR data extraction processes for ML applications were also evaluated as feasible. DISCUSSION: The current study confirmed the feasibility of ML approaches for predicting individual employees' turnover probabilities by using HR data the organizations had already collected in their routine organizational management practice. The developed approaches can be used to identify employees who are at high risk for turnover. Because our primary purpose was to apply ML methods to estimate an individual employee's turnover probability given their available HR data (rather than determining generalizable predictors at the wider population level), our findings are limited or restricted to the specific organizations under the study. As ML applications are accumulated across organizations, it may be expected that some findings might be more generalizable across different organizations while others may be more organization-specific (idiographic). IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The organization-specific findings can be useful for the organization's HR and leadership to evaluate and address turnover in their specific organizational contexts. Preventing extensive turnover has been a significant priority for many mental health organizations to maintain the quality of services for clients. IMPLICATIONS FOR HEALTH POLICIES: The generalizable findings may contribute to broader policy and workforce development efforts. IMPLICATIONS FOR FURTHER RESEARCH: As our continuing research effort, it is important to study how the ML methods and outputs can be meaningfully utilized in routine management and leadership practice settings in mental health (including how to develop organization-tailored intervention strategies to support and retain employees) beyond identifying high turnover risk individuals. Such organization-based intervention strategies with ML applications can be accumulated and shared by organizations, which will facilitate the evidence-based learning communities to address turnover. This, in turn, may enhance the quality of care we can offer to clients. The continuing efforts will provide new insights and avenues to address data-driven, evidence-based turnover prediction and prevention strategies using HR data that are often under-utilized.

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).

Barriers to Client Engagement and Strategies to Improve Participation in Mental Health and Supported Employment Services.

OBJECTIVE: A few clients in every mental health center present challenging behaviors, have difficulty engaging in services, and create stress within the treatment team. The authors provided consultations on clients with these characteristics over 4 years in the Social Security Administration's Supported Employment Demonstration (SED). METHODS: Four experienced community mental health leaders provided consultations on 105 of nearly 2,000 clients receiving team-based behavioral health and employment services in the SED. Using document analysis, consultants coded their notes and identified themes that described barriers to client engagement and strategies teams used to overcome them. RESULTS: Clients who were difficult to engage experienced complex and interacting behavioral health, medical, and social conditions, which made it hard for therapists to develop therapeutic relationships and help clients find employment. Faced with engagement barriers, staff were often discouraged and felt hopeless about achieving success. To address these barriers, consultants and teams developed several strategies: using supervisors and teammates for support, providing persistent outreach, pursuing referrals and consultations to help with complex conditions, and developing realistic goals. CONCLUSIONS: Supervisors, team leaders, and consultants in community mental health settings should help staff develop realistic strategies to manage the small number of clients whose behaviors present the greatest challenges. Effective strategies involve providing team-based outreach and support, fostering staff morale, obtaining specialist consultations regarding complex conditions, and calibrating realistic goals.

Happiness, well-being, and recovery: Experiences of adults receiving psychiatric rehabilitation services.

OBJECTIVES: Although recovery for people with serious mental illness (SMI) has received considerable attention, there is a research gap on the related topics of well-being and happiness-subjects that have been widely studied in the general population. The objective of this study was to explore the experiences of happiness, well-being, and recovery from the perspectives of persons with SMI, and to examine similarities and differences among these constructs. METHOD: This qualitative study used semistructured interviews with a purposive sample of 30 adults with SMI to explore experiences of happiness, well-being, and recovery. Reflexive thematic analysis was applied to generate themes related to each concept. RESULTS: Happiness was facilitated through relationships with natural and professional supports, engaging in meaningful activities that conferred a sense of accomplishment, using coping skills to reduce distress, engaging in recreational activities, and meeting basic material needs. Well-being was promoted through self-care activities and enhanced through relationships with professional supports. However, nearly one-fourth of participants expressed uncertainty about what well-being meant to them. Recovery was characterized as a process of overcoming illness or adversity through which personal control over symptoms and stressors is increased; recovery is also facilitated by supportive professional relationships. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Most factors relating to the happiness of people with SMI are also factors that have been identified in theory and research as facilitating the happiness of the general population. Findings suggest that happiness should be considered an important new area of research, policy, and practice in the fields of psychiatric rehabilitation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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).

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).

The well-being and perspectives of community-based behavioral health staff during the COVID-19 pandemic.

With high levels of burnout, turnover, and secondary traumatic stress, the well-being of the behavioral health workforce was an area of concern prior to the coronavirus disease 2019 (COVID-19) pandemic. How the COVID-19 crisis has impacted social workers, psychologists, psychiatrists, and other behavioral health professionals is unclear but should be examined. A brief survey evaluated the impact of the pandemic on the well-being of 168 behavioral health clinical and administrative staff serving in an urban behavioral health center in the United States. Staff experienced several personal and organizational-related challenges related to work-life balance, emotional distress, and organizational communication. Nevertheless, staff found an abundance of positive experiences when engaging with clients. Supportive, positive feedback and statements of appreciation from clients, colleagues, and supervisors helped staff to feel at their best. The well-being of behavioral health staff may be facilitated by consistent and supportive communication at the team, supervisory, and organizational levels and by involving staff in planning agency policy.

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).

Implementing illness management and recovery within assertive community treatment teams: A qualitative study.

OBJECTIVE: The study purpose was to assess the feasibility, advantages/disadvantages, and factors that hinder or facilitate the implementation of illness management and recovery (IMR) within assertive community treatment (ACT) teams. METHOD: A qualitative study was conducted with 11 ACT teams that implemented IMR. We conducted semistructured individual interviews with 17 persons enrolled in services and 55 ACT staff in individual and focus groups. Questions were designed to assess perceptions of IMR implementation, effects of IMR, staff training considerations, and recommendations. Data were analyzed using an inductive, consensus-building, thematic analysis, which included multiple research staff reviewing interview transcripts and field notes, developing and refining a codebook, constructing data summaries, and thematic synthesis. RESULTS: The analysis revealed six major themes: (a) a generally positive fit exists between the two models and population served, (b) both people with serious mental illness and staff benefited from ACT + IMR, (c) ACT teams encountered significant implementation barriers, (d) relationships and engagement with participants facilitated implementation, (e) taking a flexible approach to IMR and ACT improved implementation, and (f) programs should focus on greater integration of IMR within ACT teams. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: While there can be barriers to implementing IMR within ACT teams, there is generally a positive fit, it is feasible to implement, and it offers meaningful benefits. ACT teams should improve their recovery orientation by more widespread implementation of IMR. Future research on ACT + IMR should include mixed-methods approaches, implementation methodologies to identify barriers and facilitators, and idiographic measures that capture the individualized recovery goals of people with serious mental illness. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Improving outcomes for homeless people with alcohol disorders: a multi-program community-based approach.

Background: Relatively few community-based programs have been found to be helpful for homeless people with alcohol disorders, even though this group represents a high-risk, vulnerable population prone to poor outcomes.Aims: This study sought to implement and evaluate intensive community-based programs for homeless people with alcohol disorders.Method: The project worked closely with a homeless outreach team for referrals, and then provided two different, intensive substance abuse treatment approaches matched to the needs of two subgroups: homeless individuals with alcohol disorders without severe mental illness received community reinforcement approach (CRA) and case management services, while those with alcohol and severe mental illness were assigned to assertive community treatment and integrated dual disorders (ACT/IDDT) services. The study enrolled 322 homeless people with alcohol disorders and outcomes were assessed at six months and program discharge.Results: Participants improved significantly over the first six months in a number of outcome areas, including substance abuse, mental health, housing, employment and health; progress generally remained stable between six months and discharge.Conclusions: Community-based programs that coordinate with mobile outreach teams and then provide CRA and ACT/IDDT appear to be promising approaches for helping individuals with alcohol disorders out of homelessness and into recovery.

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.

Implementing Illness Management and Recovery Within Assertive Community Treatment: A Pilot Trial of Feasibility and Effectiveness.

OBJECTIVE: In a pilot feasibility and effectiveness study, illness management and recovery (IMR), a curriculum-based program to help people with serious mental illness pursue personal recovery goals, was integrated into assertive community treatment (ACT) to improve participants' recovery and functioning. METHODS: A small-scale cluster randomized controlled design was used to test implementation of IMR within ACT teams in two states. Eight high-fidelity ACT teams were assigned to provide IMR (ACT+IMR; four teams) or standard ACT services (ACT only; four teams). Clinical outcomes from 101 individuals with schizophrenia-spectrum or bipolar disorders were assessed at baseline, six months, and one year. RESULTS: Exposure to IMR (session attendance and module completion) varied between the ACT+IMR teams, with participants on one team having significantly less exposure. Results from intent-to-treat analyses showed that participants in ACT+IMR demonstrated significantly better outcomes with a medium effect size at follow-up on clinician-rated illness self-management. A nonsignificant, medium effect size was found for one measure of functioning, and small effect sizes were observed for client-rated illness self-management and community integration. Session and module completion predicted better outcomes on four of the 12-month outcome measures. CONCLUSIONS: Findings support the feasibility of implementing IMR within ACT teams. Although there were few significant findings, effect sizes on some variables in this small-scale study and the dose-response relationships within ACT+IMR teams suggest this novel approach could be promising for improving recovery for people with serious mental illness. Further large-scale studies utilizing a hybrid effectiveness-implementation design could provide a promising direction in this area.

Working overtime in community mental health: Associations with clinician burnout and perceived quality of care.

OBJECTIVE: Funding cuts have increased job demands and threatened clinicians' ability to provide high-quality, person-centered care. One response to increased job demands is for clinicians to work more than their official scheduled work hours (i.e., overtime). We sought to examine the frequency of working overtime and its relationships with job characteristics, work-related outcomes, and quality of care in community health clinicians. METHOD: One hundred eighty-two clinicians completed demographic and job characteristics questions and measures of burnout, job satisfaction, turnover intention, work-life conflict, and perceived quality of care. Clinicians also reported the importance of reducing stress and their confidence in reducing their stress. Clinicians who reported working overtime were compared to clinicians that did not on demographic and job characteristics and work-related outcomes. RESULTS: Ninety-four clinicians (52%) reported working overtime in a typical week. Controlling for exempt status and group differences in time spent supervising others, those working overtime reported significantly increased burnout and work-life conflict and significantly lower job satisfaction and quality of care than those not working overtime. Clinicians working overtime also reported significantly greater importance in reducing stress but less confidence in their ability to reduce stress than those not working overtime. There were no significant group differences for turnover intention. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Working overtime is associated with negative consequences for clinician-related work outcomes and perceived quality of care. Policies and interventions aimed at reducing overtime and work-related stress and burnout may be warranted in order to improve quality of care. (PsycINFO Database Record

First Record of Aedes japonicus In Florida.

The presence of Aedes j. japonicus in Florida is reported for the first time. Four adult females were collected by a Mosquito Magnet® X trap baited with pressurized CO2 in Okaloosa County, FL, in August 2012 and later identified as Ae. japonicus in 2014. Additional adult and larval specimens were collected during 2014-17 from Bay, Leon, Okaloosa, Santa Rosa, or Walton counties, Florida. Notes are provided on the location, general habitats, and mosquito associates that may be found with Ae. japonicus in northwestern Florida. The role of Ae. japonicus in arbovirus transmission within Florida is currently unknown and should be further explored.

Comparative Effectiveness of a Burnout Reduction Intervention for Behavioral Health Providers.

OBJECTIVES: Prior research found preliminary effectiveness for Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE), a daylong workshop for reducing burnout among behavioral health providers. Using a longer follow-up compared with prior research, this study compared the effectiveness of BREATHE and a control condition. METHODS: Behavioral health providers (N=145) from three U.S. Department of Veterans Affairs facilities and two social service agencies were randomly assigned to BREATHE or person-centered treatment planning. Burnout and other outcomes were compared across groups over time. RESULTS: Analyses yielded no significant differences between groups. However, BREATHE participants showed small but statistically significant improvements in cynicism (six weeks) and in emotional exhaustion and positive expectations for clients (six months). Participants in the control condition showed no significant changes over time. CONCLUSIONS: Although it did not demonstrate comparative effectiveness versus a control condition, BREATHE could be strengthened and targeted toward both distressed providers and their organizations.

ACT and Recovery: What We Know About Their Compatibility.

While assertive community treatment (ACT) is a widely implemented evidence-based practice, the extent of its recovery orientation has been debated. A literature search identified 16 empirical articles studying recovery and ACT. These 16 studies were classified as involving stakeholder perceptions, interventions, or fidelity measurement. Stakeholders generally viewed ACT as being recovery oriented; research on both interventions and fidelity measurement showed promising approaches. Overall the literature yielded encouraging findings regarding ACT and recovery, though there remains a dearth of research on the topic. We discuss future directions for research and practice to ensure that ACT programs skillfully support recovery.

Ecology of Culiseta Melanura and Other Mosquitoes (Diptera: Culicidae) from Walton County, FL, During Winter Period 2013-2014.

Winter ecology of putative vectors of eastern equine encephalomyelitis virus (EEEV) in northern Florida was investigated at field locations with evidence of historic EEEV winter transmission. Light traps and resting shelters were used to sample the mosquito community in the vicinity of eight sentinel flocks throughout the winter period (November-April) of 2013 and 2014 in Walton County, FL. Overall mosquito activity was relatively low, although mosquitoes were captured during each week of the study period. Mosquito activity was linked to morning temperature, and females were captured when ambient morning temperatures were quite low (1-5°C). Anopheles crucians Wiedemann, Culex erraticus (Dyar and Knab), Culex territans Walker, and Culiseta melanura (Coquillett) were the most commonly collected mosquito species (of 20 total species). Analysis of blood-engorged mosquitoes revealed a number of mosquito species feeding upon chickens, other birds, amphibians, and domestic and wild mammals. Cs. melanura fed primarily upon chickens and songbirds (Passeriformes), suggesting that this mosquito species is the likely winter vector of EEEV to sentinel chickens in northern Florida. Both resident and nonresident songbird species were fed upon, constituting 63.9 and 36.1% of total songbird meals, respectively. Our results suggest important roles for Cs. melanura and songbird hosts for the winter transmission of EEEV in northern Florida.

A brief intervention for posttraumatic stress disorder in persons with a serious mental illness.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is common in people with a serious mental illness, but it is often not diagnosed or treated. Recent progress has been made in developing and validating interventions for PTSD in this population, but dropout from treatment can be problematic. The present study evaluated the feasibility and clinical outcomes of a Brief program (three sessions) for the treatment of PTSD in persons with a serious mental illness. METHOD: An open clinical trial was conducted to evaluate the Brief program, which comprises three individual weekly sessions and includes education about trauma and PTSD, as well as instruction in breathing retraining for the self-management of anxiety. Eighteen predominantly minority persons with serious mental illness and PTSD were enrolled in the Brief program and assessed at baseline, 1-month posttreatment, and 3-month follow-up. RESULTS: Acceptability and tolerability of the program were high, with 15 of 18 (83%) study participants completing all three sessions. Interview-based and self-report assessments indicated significant reductions in PTSD symptoms, depression, and other symptoms at posttreatment, with treatment gains maintained at the 3-month follow-up. CONCLUSION AND IMPLICATION FOR PRACTICE: The results suggest the Brief program may be clinically beneficial to persons with serious mental illnesses and PTSD and indicate that more rigorous research is needed to evaluate the program.