Using GPS and Self-Report Data to Examine the Relationship Between Community Mobility and Community Participation Among Autistic Young Adults.

IMPORTANCE: Community participation of autistic adults is important for health and well-being. Many clinical efforts and interventions aim to enhance community participation in this population. OBJECTIVE: To empirically examine the relationship between community participation and community mobility. DESIGN: A randomized controlled trial using data from baseline and 4- to 6-wk follow-up. SETTING: Community organizations serving autistic adults in Philadelphia. PARTICIPANTS: Sixty-three autistic young adults with data on community mobility and participation from a prior study on public transportation use. OUTCOMES AND MEASURES: Participants were tracked with GPS-enabled cell phones over a 2-wk period. A spatiotemporal data mining algorithm was used to compute the total number of destinations, nonhome destinations, unique destinations, percentage of time spent outside the home, and median daily activity space area from the GPS data. The Temple University Community Participation measure was used to collect self-report data in 21 different areas, and total amount, breadth, and sufficiency of participation were calculated. RESULTS: Moderate and statistically significant associations were found between community mobility and participation variables at baseline and follow-up. However, changes in community mobility were not related to changes in community participation. CONCLUSION: Health policymakers and providers should consider community mobility as a factor that can affect community participation in autistic individuals. Plain-Language Summary: Lower levels of community participation among autistic young adults affect health outcomes and overall quality of life. Community mobility is often a barrier to community participation. An understanding of the relationship between community mobility and community participation can lead to occupational therapists tailoring specific interventions and policies that support autistic young adults to engage in important life activities within the community.

Independence through community access and navigation: A supported leisure intervention for individuals with negative symptoms.

OBJECTIVE: Promoting leisure participation requires a collaborative approach that emphasizes personal interests, strengths, and motivations. The purpose of this article was to test the effectiveness of the Independence through Community Access and Navigation (ICAN) intervention on community participation, recreation participation, and positive emotions among individuals with schizophrenia spectrum disorders. Using motivational interviewing and an individualized placements and support framework, the ICAN intervention focuses on working with participants to identify and participate in personally meaningful leisure activities by connecting with personal motivations and mainstream community opportunities. METHOD: This randomized controlled trial was conducted with 74 participants diagnosed with schizophrenia with assessments conducted at baseline and posttreatment. Intervention effects were examined with repeated-measures analysis of variance (ANOVA). Multiple regression analysis was also performed using a change score as an outcome variable and baseline negative symptoms score, condition, and interaction as predictors. RESULTS: There was no significant main effect of ICAN on positive emotions, recreation participation, or community participation; however, among those in the experimental group, those with impairments in motivation and pleasure experienced improvements in community participation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: For individuals experiencing greater negative symptoms, a supported leisure intervention may be an effective strategy to explore personal motivations and increase leisure participation. Future research should test the intervention effectiveness specifically targeting a larger sample of individuals with more severe negative symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Self-determination and self-efficacy as predictors of campus engagement among college students with serious mental illnesses.

OBJECTIVE: Campus engagement, including participation in student organizations and groups, is important for both academic and health outcomes. Yet, college students with serious mental illnesses demonstrate lower levels of campus engagement compared to peers without mental illnesses. To inform psychiatric rehabilitation approaches that might enhance this outcome, the purpose of this study was to test an integrated model of self-determination and self-efficacy theories to predict campus engagement within this student population. METHODS: Sixty-seven college students with serious mental illnesses completed measures assessing self-determination constructs (autonomy, competence, and relatedness), college self-efficacy, and campus engagement. Correlational and path analytic models examined relationships among these variables. RESULTS: Bivariate and multivariate analyses supported the interrelationships among the variables. Specifically, the theory-driven path model demonstrated that autonomy (but not competence or relatedness) was a significant predictor of college self-efficacy, which in turn was associated with campus engagement. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings particularly highlight the importance of autonomy and self-efficacy for promoting campus engagement among college students with serious mental illnesses. As such, they may be relevant targets for psychiatric rehabilitation interventions, such as supported education, that are designed to enhance student success. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Employment of Certified Peer Specialists in Mental Health Professional Shortage Areas.

The current demand for mental health services is exacerbated by an ongoing shortage of behavioral health care providers in the United States. The Health Resources and Services Administration has identified 5,833 Mental Health Professional Shortage Areas (MHPSAs), many of which are rural, and could be served by Certified Peer Specialists (CPSs). This paper examines the relationship between CPS employment and MHPSA residency. Data are from a 2020 survey of 572 CPS certified in one of four states. Random effects logistic regression models were used to test the relationship between MHPSA residence and employment outcomes. Of 166 unique counties identified by participant zip codes, 47 were characterized as being MHPSAs with 14% of participants residing in one of these counties. A higher proportion of those living in MHPSAs were employed in peer support jobs (rather than other job types or unemployed) compared to those living in non-MHPSAs (68% vs. 54%, p = .020). MHPSA residential status was not a significant predictor of employment status (OR = 1.14, p = .728) but was significantly associated with greater likelihood of employment in peer support compared to other jobs, both for the entire sample (OR = 2.13, p = .026), and among those currently employed (OR = 2.90, p = .032). The greater likelihood of working in peer support among those residing in MHPSAs suggests that CPSs may leverage their credential to address shortages. As a result, peer support may become a more necessary part of the traditional service array. Policies that enable CPS to practice in MHPSAs should be encouraged.

The Role of Acceptance in Everyday Loneliness Among Adults with Serious Mental Illness.

There is a high prevalence of loneliness among adults with serious mental illness (SMI) with most research focusing on stable contributing factors. This study sought to identify the role of dispositional loneliness and internalized stigma, as well as the momentary feelings of acceptance on experiential loneliness among adults with SMI. Data were collected using ecological momentary assessment via smart phones, and 89 adults with a SMI were included. Hierarchical linear modeling was used to identify the role of dispositional and experience factors in experiential loneliness. Findings indicated that (a) dispositional internalized stigma, (b) being at home, (c) being alone and, (d) a cross-level interaction between dispositional loneliness and feelings of acceptance best fit the data. The relationship of acceptance to experiential loneliness was strongest among the most lonely. Supporting people with SMI to develop social connections contributing to their relational value may enhance feelings of acceptance and reduce loneliness.

Short Report on Effectiveness of an Autistic-Delivered Peer Support Program: Preliminary Results.

There is little research on the effectiveness of autistic peer-delivered services. This study examines early outcomes associated with the Community Autism Peer Specialist program (CAPS), which was created in partnership with autistic individuals and is delivered by autistic adults who have received training in the delivery of peer support services to enhance the community functioning of autistic youth and adults. A single group pre-test/post-test design was used to examine early outcomes in the areas of independent living needs, social functioning, service engagement, and quality of life. A total of 23 individuals with autism aged 14-41 years were included in the study. Reductions were found in social functioning impairments and unmet needs after three months in the program. Participants also reported greater engagement in mental health services and activities that promote wellness compared with before the program. This study suggests that peer support services delivered by autistic peers may be an effective intervention approach for autistic youth and adults. Future studies with a more rigorous study design (e.g., randomized controlled trials), a larger sample size, and longer-term outcome measurements are needed to further investigate the effectiveness of CAPS and similar autistic-delivered services.

Community Participation of Individuals with Mental Illnesses in Rural Areas: Stakeholder Perspectives on Barriers and Facilitators.

Community inclusion and participation are social determinants of physical and mental health. This study examines activity preferences, barriers to engagement, and potential strategies for facilitating community participation for individuals with serious mental illness living in rural communities. Data for this qualitative study were collected in a series of focus groups with a stakeholders in rural Pennsylvania. Written responses to questions on activities, barriers, facilitators, and solutions were analyzed by members of the research team. The activities that are important to our participants included both those readily accessible in rural areas and those only accessible in more urban areas. Many of the barriers identified aligned with prior research (e.g., poverty, community mobility issues). A number of novel and feasible solutions to overcome barriers were provided at the policy, program, and practice levels, some of which that can be implemented immediately, to increase participation, and improve overall health of people with mental illnesses.

Disparities in severe loneliness between adults with and without a serious mental illness.

OBJECTIVE: Severe loneliness infrequently occurs in the general population but has very significant impacts on health and quality of life. This study examined the extent to which severe loneliness is experienced by adults with serious mental illnesses (SMIs) relative to adults in the general population and its possible implications for psychiatric rehabilitation services. METHOD: Data were gathered from samples of individuals with SMI (N = 231) and a general community sample of adults (N = 300) using the University of California, Los Angeles Loneliness Scale. RESULTS: The results indicate that loneliness was much greater among those with SMI than the general adult population sample (Cohen's d = 1.220) and approximately 41% of the participants with SMI were "severely lonely" versus 7.3% of the non-SMI adult sample. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Severe loneliness is extremely common among individuals with SMI. Psychiatric rehabilitation services that focus on socialization and mattering are needed to address this significant public health issue. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Participation in arts and culture among individuals with serious mental illnesses and its relationship to quality of life and recovery.

OBJECTIVE: Engagement in arts and cultural activities is valued and yields positive outcomes but may be understudied in populations with serious mental illness (SMI). Our aims are to evaluate the extent to which individuals with SMI deem participation areas related to arts and culture (e.g., going to a theater) to be important, and if important, how often they are being done and if it is enough in comparison to a nonSMI sample. METHODS: We conducted analyses using a sample of 1,120 individuals with SMI from nine research studies between 2008 and 2016 and a sample of 300 individuals without SMI that were part of the Truven Health Analytics PULSE survey. All participants completed a survey containing questions related community participation. Analyses were conducted using independent samples t tests, followed by analysis of variances, and chi-square tests. RESULTS: The results indicate that adults with SMI are as, or more interested in arts and cultural activities as adults in the general population, but do not participate in those areas as much as they would like in comparison. We also found that, as with the general population, participation in these areas is positively associated with quality of life and to a lesser degree, recovery. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Engagement in arts and culture activities may be an overlooked compared to other areas of participation, such as employment. Psychiatric rehabilitation practitioners may need to pay greater attention to areas related to art appreciation, rather than just art production. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Peer-Facilitated Decision Making in Mental Health: Promises, Pitfalls, and Recommendations for Research and Practice.

Recognition has grown that peer support workers serve an important role in facilitating decision making about treatment and recovery among people with mental health conditions. This article provides examples of peer-facilitated decision support interventions in the literature, discusses promises and potential pitfalls associated with peers serving in decision support roles, and offers recommendations for research and practice. Examples were selected from the literature on decision support interventions for people with serious mental illnesses, such as schizophrenia, bipolar disorder, and major depression. Promises, pitfalls, and recommendations were informed by this research and by the literature on lived experience perspectives, the helper-therapy principle, and reported barriers to and facilitators of peers assisting with decision making. According to the included studies, peers may facilitate decision making in several ways (e.g., by asking service users about their goals or preferences, assisting them with using decision support tools, sharing stories, and facilitating access to information and resources). Peer-facilitated decision support may be associated with positive decision making and health outcomes for service users and peer support workers. However, providers need to carefully consider barriers to implementation of this support, such as inadequate resourcing, poor integration, and compromising of peer support values.

Housing and loneliness among individuals with serious mental illnesses.

BACKGROUND: People with serious mental illnesses (SMI) have higher levels of loneliness than the general population. Furthermore, people with SMI tend to be less satisfied with their housing and tend to move more frequently. AIM: This study aims to examine relationships between housing variables (whom they live with, duration of residence, and satisfaction) and loneliness among individuals with SMI. METHODS: Data were collected from 188 adults with SMI in greater Philadelphia area. Classification and Regression Trees (CART) were used to examine whether whom they live with, duration of residence, and housing satisfaction were associated with loneliness. RESULTS: Housing satisfaction was found to be the most prominent predictor of loneliness. Those who were unsatisfied with their overall housing conditions always had the highest level of loneliness, regardless of other factors. Even if they were satisfied with their housing conditions, their loneliness was higher if they had just moved to the new residence. Participants had lower loneliness the longer they lived in a residence and had the lowest loneliness levels after about three years. CONCLUSION: Housing is associated with loneliness among people with SMI. Psychiatric service providers should increase support to factors contributing to housing satisfaction and duration of residence, including active engagement in the community.

Autistic-Delivered Peer Support: A Feasibility Study.

Peer support has been an undeveloped pathway for filling the service gap and to generate employment opportunities for autistic individuals. Peer supports have been deployed widely in mental health and among veterans and understanding the utility of this service modality among autistic individuals illuminates opportunities for research, policy, and practice. This study examined characteristics of participants in an autistic-delivered peer support program and reports on use of and satisfaction with the program. Half of autistic participants had a co-occurring mental health diagnosis. Participants reported multiple areas of unmet needs and participant satisfaction with the program was high (90%). The findings of this study point toward autistic-delivered peer support as a promising avenue for future development.

Community participation differences between Black and White adults with serious mental illness.

Promoting community participation is a core goal of behavioral health services for persons with serious mental illness (SMI) regardless of their racial/ethnic background. While practitioners are trained to respect diversity and culture, little is known about how racial/ethnic minorities participate in their communities during the recovery process. This is especially true for Black adults, who are disproportionately represented in current services. This study sought to compare differences in community participation experiences and interests between Black and White adults with SMI. Secondary data (n = 799) were analyzed from studies involving Black and White adults with SMI using the Temple University Community Participation Measure. Regression analyses were conducted to identify potential differences in four areas: amount of participation in a variety of community activities; number of activities participants deemed important; number of important activities actually performed; and the percentage of important activities performed as much as desired (i.e., sufficiency). Compared to White adults, Black adults had greater amounts of community participation overall and in a number of specific community activities (e.g., worship, visiting park/recreation center). Black adults also reported more community activities as important and were more likely to engage in their important activities. Relative to White adults, results suggest that Black adults with SMI were interested in and engaged more in social activities-potentially enhancing their sense of group solidarity and personal mental health recovery. Accordingly, practitioners should be aware of, and attend to, possible racial/ethnic differences in community participation, and its possible role in promoting or hindering recovery across diverse populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Employment Outcomes After Certification as a Behavioral Health Peer Specialist in Four U.S. States.

OBJECTIVE: A 3-year study explores employment outcomes of certified peer specialists (CPSs). Analyses reported here identified relationships between demographic, clinical, work history, and geographic characteristics and employment status and current employment in peer services jobs versus other jobs. METHODS: The study recruited adults who recently became a CPS, regardless of current employment status, in four states. Online survey data were collected from March to October 2020 and included demographic information, health status and diagnoses, mental health service use, motivations for becoming certified, employment history, and job characteristics, including job satisfaction. Descriptive statistics and logistic regression models were used to compare groups. RESULTS: Of 681 respondents, 591 provided data on current employment and were included. Participants who received Social Security Disability Insurance or Supplemental Security Income, veterans, those who used outpatient counseling or therapy, and those who did not disclose their mental health status in the workplace were less likely to report current employment. Lack of disclosure and higher local unemployment rates contributed to a lower likelihood of working in peer services jobs, whereas individuals reporting depressive disorders were more likely to hold such jobs. Compared with those in other jobs, those in peer services jobs reported longer job tenure, and a larger proportion received employee benefits. Job satisfaction was significantly higher among those with peer services jobs. CONCLUSIONS: Workers with a CPS credential had higher employment rates, compared with adults with psychiatric disabilities, and the quality of peer specialist jobs was equal to or higher than the quality of other jobs held by study participants.

Self-reported COVID-19 vaccination acceptance and hesitancy among autistic adults.

Identifying factors associated with COVID-19 vaccination acceptance among vulnerable groups, including autistic individuals, can increase vaccination rates and support public health. The purpose of this study was to determine differences among autistic adults who reported COVID-19 vaccination acceptance from those who did not. In this study we describe COVID-19 vaccination status and self-reported preferences among autistic adults and identify related factors. Vaccine accepters were more likely to report increased loneliness during COVID-19, lived in more populous counties (p = 0.02), and lived in counties won by President Biden in the 2020 US presidential election (p < 0.001). Positive correlations were found between desire to protect others, concern about contracting COVID-19, and trusting vaccine safety (p < 0.001). Concern about vaccine safety was common among the vaccine hesitant, while lack of concern about COVID-19 overall was not. Identifying health promotion strategies based on self-reported, lived experiences about COVID-19 among vulnerable groups is key for public health impact.

Living arrangements and community participation among autistic adults: Exploring the possible influences of living alone or with others.

BACKGROUND: With the increasing prevalence of autistic individuals, it is greatly needed to examine the factors impacting their community participation experiences. Where autistic adults live and how that may be related to their participation and quality of life is one environmental factor that has received little attention. AIMS: This study explored the association between living arrangements in the community and community participation for autistic adults. METHOD: This study used data from a statewide survey of autistic adults (N = 744) to investigate the relationship between living arrangements (live alone with or without support, live with roommate/spouse, or live with family) and the amount, breadth, and sufficiency of community participation. RESULTS: After controlling for sociodemographic and clinical factors known to be associated with community participation, autistic adults living with family members participated less frequently in community activities over 30 days than those living with a roommate/spouse. However, they experienced similar levels of sufficiency with their participation. Autistic adults living alone with support reported the lowest levels of sufficiency with their participation, although the amount and breadth of their participation were no different from other adults. CONCLUSION: These findings have several implications for providing support to enable autistic adults to participate in the areas that are important to them and to the extent they desire. Future research is needed to gain a better understanding of how interests and expectations for participation may be influenced by living situations.

Identifying indicators of community participation-promoting efforts within coordinated specialty care: A modified e-Delphi study of stakeholder perspectives.

AIM: Community participation in occupational, social, recreational, and other domains is critically important during young adulthood. Coordinated Specialty Care (CSC) programs provide developmentally tailored care to young adults experiencing early psychosis within the United States, but little is known about the breadth of efforts to promote community participation. This study aimed to develop and evaluate indicators of these efforts based on the perspectives of a national multi-stakeholder group. METHODS: Seventeen stakeholders (i.e., young adults with early psychosis, family members, experts by profession) participated in a modified e-Delphi study, conducted in two rounds. The purpose of round one was to generate a comprehensive list of community participation-promoting indicators. During round two, stakeholders rated the importance and feasibility of the implementation of each indicator. Descriptive statistics and percentage of agreement regarding round two ratings were assessed. RESULTS: During round one, 186 indicators of activities and/or practices designed to promote community participation were identified; this list was reduced to 44 by eliminating redundancies or indicators not related to community participation. In round two, we found broad agreement regarding the importance, but significant variation in perceived feasibility of indicators. The highest-rated indicators in both categories pertained to staff knowledge (regarding barriers and supports to participation and the importance of participation to health) and strategies for addressing participation barriers. CONCLUSIONS: This study is expected to facilitate the identification and development of promising CSC activities and practices designed to promote community participation among young adults while potentially also enhancing engagement in services and improving clinical outcomes.

Lifespan service receipt and unmet needs among individuals on the autism spectrum.

Timely data on service use and needs across the lifespan are essential to developing an effective and efficient service delivery system that is responsive to developmental issues. This study uses data from one of the largest statewide surveys conducted between 2017 and 2018 to compare service use and unmet needs among individuals on the autism spectrum across the lifespan. A statewide sample of 5792 caregivers of autistic children and adults were included in the study. Logistic regressions were conducted to compare service use and need among six age groups ranging from early childhood (0-5 years) to later adulthood (31+) while adjusting for sociodemographic characteristics. We found that the transition-age adult group (18-21 years) was less likely to receive services, including speech/language therapy, occupational therapy, one-on-one support, and social skill training, than adolescents. However, case management and mental health services increased with age. Young adults (22-30 years) were more likely to report unmet needs than both adolescents and transition-age adult groups. The use of services overall decrease and service needs increased compared to results from an earlier statewide survey that was conducting in 2009-2010. These results can be used to inform developmentally appropriate autism-related healthcare policies and service development and delivery. This study offers a more detailed look at differences between adult age subgroups that are novel. Further research is needed about the prevalence of ASD in adulthood, clinical trajectories, and outcomes in order to support autistic adults in getting the appropriate services and supports.