Individual Placement and Support (IPS) for High School Aged Youth: Provider Perspective and Practice.

Semi-structured interviews were conducted with nine Individual Placement and Support (IPS) employment specialists who expanded and enhanced the IPS model for the youngest of working age youth with mental health conditions (ages 16-21). Semi-structured interviews were conducted with 100% of the providers delivering IPS-based career services for high school aged youth during an exploratory pilot. Content coding was applied to interview transcripts. Findings reflect the complexities of providing career services to high school age youth, suggesting components needed for effective services. These components include: provision of supports that help youth complete high school and negotiate the transition to college, coaching and skill development to improve executive functioning for work and school, coping skills coaching for mental health symptoms, flexible engagement strategies that assure youth self-determination of goals, longer range career and goal planning, and close collaboration with families.

Development and Validation of an Instrument to Measure Staff Perceptions of Recovery Climate and Culture in Mental Health Programs.

OBJECTIVE: Few existing instruments measure recovery-oriented organizational climate and culture. This study developed, psychometrically assessed, and validated an instrument to measure recovery climate and culture. METHODS: Organizational theory and an evidence-based conceptualization of mental health recovery guided instrument development. Items from existing instruments were reviewed and adapted, and new items were developed as needed. All items were rated by recovery experts. A 35-item instrument was pilot-tested and administered to a national sample of mental health staff in U.S. Department of Veterans Affairs Psychosocial Rehabilitation and Recovery Centers (PRRCs). Analysis entailed an exploratory factor analysis (EFA) and inter-item reliability and scale correlation assessment. Blinded site visits to four PRRCs were performed to validate the instrument. RESULTS: The EFA determined a seven-factor solution for the data. The factors identified were staff expectations, values, leadership, rewards, policies, education and training, and quality improvement. Seven items did not meet retention criteria and were dropped from the final instrument. The instrument exhibited good internal consistency (Cronbach's α=0.81; subscales, α=0.84-0.88). Scale correlations were between 0.16 and 0.61, well below the threshold (α=0.9) for indicating overlapping constructs. Site visitors validated the instrument by correctly identifying high-scoring and low-scoring centers. CONCLUSIONS: These findings provide a psychometrically tested and validated instrument for measuring recovery climate and culture in mental health programs. This instrument can be used in evaluation of mental health services to determine the extent to which programs possess the organizational precursors that drive recovery-oriented service delivery.

A site visit protocol for assessing recovery promotion at the program level: An example from the Veterans Health Administration.

OBJECTIVE: A site visit protocol was developed to assess recovery promotion in the organizational climate and culture of programs for veterans with serious mental illnesses. METHOD: The protocol was pilot-tested in 4 programs: 2 that had scored high on the pilot version of a staff survey measure of program-level recovery promotion and 2 that had scored low. Two-person teams conducted onsite visits and assigned global and organizational domain ratings. Interrater agreement was assessed by examining adjacent agreement and computing weighted kappa. RESULTS: The on-site protocol had good interrater agreement and discriminated between sites that scored high and low on the staff survey. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This site visit protocol and procedure shows promise for evaluating recovery promotion in milieu-based programs. After further refinement of this tool, adaptations could be developed for accreditation protocols or for program self-assessment and quality improvement efforts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Peer specialists: Exploring the influence of program structure on their emerging role.

Although peer specialists play an increasing role in mental health service delivery, little is known about the best program structures for maximizing effective service delivery. This study reports on qualitative data from a larger study on peer specialists working with veterans in a Veterans Affairs homelessness program who were dually diagnosed with substance abuse and mental health concerns. Peer specialists were trained to deliver a recovery support program that is carried out weekly over 9 months and includes 20 structured sessions using a workbook and 20 unstructured, individually planned sessions. A sample of 20 veterans who were in the program were interviewed, along with 8 case managers and 3 peer specialists involved with the program. Interview transcripts were coded for 3 elements of program structure: time, content, and delivery. Results show that the program structure allowed flexibility for individual needs and that the workbook sessions were useful. Veterans ascribed value to the peer specialist delivering the content, compared to working alone on the material. Deliberate use of unstructured time with the peer specialist was seen as reducing isolation, increasing community integration, and encouraging recovery activities. The weekly, dependable nature of the program was seen as highly positive, whereas the 9-month duration was seen as too short. All groups interviewed expressed satisfaction with the program, although the case managers reported some reservations related to supervision and boundaries. Results suggest that, compared to completely structured or unstructured approaches that are common for peer specialist services, a middle level of structure for peer specialist programs could be a useful alternative. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Career Services for Young Adults with Serious Mental Health Conditions: Innovations in the Field.

This study examined careers services provided to young adults with serious mental health conditions. Based on an internet survey and key informant telephone interview of 31 programs nominated for delivering innovative practices for young adults, the state of the field for career services was described. Most programs offered supported education and supported employment along with mental health services. Detailed and written planning was a key feature. Programs emphasized working closely with families, inter-agency collaboration, and use of normative community resources. Programs provided direct skills training for school and work and other life skills. Largely, existing models are being applied. However, providers described unique adaptations including greater flexibility in service delivery, attending to the turbulence and developmental changes characteristic of this age group, use of social media, and a heightened willingness to meet young people where "they are at" both literally and figuratively.

A supported education service pilot for returning veterans with posttraumatic stress disorder.

A randomized controlled pilot of supported education services was conducted with 33 Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF, OIF, OND, respectively) veterans with posttraumatic stress disorder (PTSD) who had higher education goals. Veteran peers delivered supported education services to an intervention group; for the control group, peers provided "matched attention" of generalized support without supporting educational goals. The intervention was based on a manualized veteran-centric program of supported education using principles of supported employment for individuals living with mental illness and components of civilian models of supported education. The attrition rate was high, with 30% lost to services between the baseline screening and the first peer session, although this drop-out rate is comparable to other rehabilitation studies. Despite a small sample and a matched attention control that could have diluted possible effects, significant positive differences were found, with the intervention group spending greater amounts of time on educational activities than did the control group. Effect sizes for the impact of the intervention were large between Time 1 and Time 2, and moderately large between Time 2 and Time 3. PTSD-symptom severity and recovery attitudes did not predict the impact of the supported education intervention. Implementation of the veteran supported education program using veteran peers appears feasible, although assertive outreach may be necessary to recruit and engage veterans with PTSD. Findings suggest that supported education services can have a measurable effect on time spent attaining an educational goal. Future studies will need to be longitudinal, as well as attend to the attrition issue and capture the impact on other education outcomes, such as successful program completion. (PsycINFO Database Record

Explication and Definition of Mental Health Recovery: A Systematic Review.

This review assessed the concordance of the literature on recovery with the definition and components of recovery developed by the Substance Abuse and Mental Health Services Administration (SAMHSA). Each SAMHSA identified recovery component was first explicated with synonyms and keywords and made mutually exclusive by authors. Inter-rater reliability was established on the coding of the presence of 17 recovery components and dimensions in 67 literature reviews on the recovery concept in mental health. The review indicated that concordance varied across SAMHSA components. The components of recovery with greatest concordance were: individualized/person centered, empowerment, purpose, and hope.

Patterns and predictors of engagement in peer support among homeless veterans with mental health conditions and substance use histories.

OBJECTIVES: Patterns and predictors of engagement in peer support services were examined among 50 previously homeless veterans with co-occurring mental health conditions and substance use histories receiving services from the Veterans Health Administration supported housing program. METHOD: Veteran peer specialists were trained to deliver sessions focusing on mental health and substance use recovery to veterans for an intended 1-hr weekly contact over 9 months. Trajectories of peer engagement over the study's duration are summarized. A mixed-effects log-linear model of the rate of peer engagement is tested with three sets of covariates representing characteristics of the veterans. These sets were demographics, mental health and substance use status, and indicators of community participation and support. RESULTS: Data indicate that veterans engaged with peers about once per month rather than the intended once per week. However, frequency of contacts varied greatly. The best predictor of engagement was time, with most contacts occurring within the first 6 months. No other veteran characteristic was a statistically significant predictor of engagement. Older veterans tended to have higher rates of engagement with peer supporters. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Planners of peer support services could consider yardsticks of monthly services up to 6 months. Peer support services need a flexible strategy with varying levels of intensity according to need. Peer support services will need to be tailored to better engage younger veterans. Future research should consider other sources of variation in engagement with peer support such as characteristics of the peer supporters and service content and setting. (PsycINFO Database Record

Conceptualization and measurement of mental health providers' recovery-promoting competence: the recovery promoting relationships scale (RPRS).

OBJECTIVE: The purpose of this study was to construct and validate an instrument that measures practitioners' competence to promote the recovery among individuals with psychiatric disabilities from the perspective of the person served. Items were developed based upon input from individuals served and practitioners as well as the extant literature on recovery. "Recovery-promoting competence" was conceptualized as a set of practitioner capabilities that promote the recovery process and enhance the working alliance. METHOD: A scale was developed using a two-stage process that initially identified specific recovery-promoting competencies and then tested candidate items measuring those competencies. Item Response Theory and Classical Test Theory approaches were used to validate the instrument and assess its psychometric properties with a national sample of 382 individuals with psychiatric disabilities. RESULTS: Analyses revealed two distinct sets of recovery-promoting competencies: (a) competencies that enhance clients' recovery, and (b) competencies that build and maintain a strong therapeutic or working alliance. The first set further differentiated into subcompetencies-enhancing clients' hopefulness, empowerment, and self-acceptance. The instrument had high internal consistency and acceptable stability over time, convergent, criterion, and known groups' validity. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This scale is a tool for assessing mental health and rehabilitation practitioners' competencies from the perspective of the individual served which can be used both in research and program evaluation of agencies serving individuals with psychiatric disabilities.

Supporting the education goals of post-9/11 veterans with self-reported PTSD symptoms: a needs assessment.

PURPOSE: The influx of young adult veterans with mental health challenges from recent wars combined with newly expanded veteran education benefits has highlighted the need for a supported education service within the Veterans Administration. However, it is unknown how such a service should be designed to best respond to these needs. This study undertook a qualitative needs assessment for education supports among veterans with post-9/11 service with self-reported PTSD symptoms. METHODS: Focus groups were held with 31 veterans, 54% of whom were under age 30. Transcripts were analyzed and interpreted using a thematic approach and a Participatory Action Research team. RESULTS: Findings indicate a need for age relevant services that assist with: education planning and access, counseling for the G.I. Bill, accommodations for PTSD symptoms, community and family re-integration, and outreach and support. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The veterans recommended that supported education be integrated with the delivery of mental health services, that services have varied intensity, and there be linkages between colleges and the Veterans Health Administration.

Statewide initiative of intensive psychiatric rehabilitation: outcomes and relationship to other mental health service use.

OBJECTIVE: This study examines the outcomes of a statewide implementation of Intensive Psychiatric Rehabilitation (IPR) for improving residential and employment status and earnings among individuals with severe mental illnesses and also examines its implementation with respect to mental health service utilization and costs. METHODS: This study employs a pre-post design with participants acting as their own controls for rehabilitation outcomes (residential status, vocational outcomes and earnings) comparing those who "completed" or had a sufficiently intense dose of IPR (one year) to those who dropped out early (before six months of service) and those who dropped out later in service (6-12 months). A separate analysis was conducted examining the relationship of IPR to other mental service use and costs using a quasi-experimental design that contrasted IPR completers with a control group matched via propensity scores. RESULTS: The results suggested significant improvement in residential status, employment status and gross monthly earnings for IPR completers relative to other groups. IPR completers also tended to use more mental health services or have more shallow decreases in use and cost of services relative to matched controls. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Gains in rehabilitation outcomes can be expected for those who engage in and complete IPR services, but IPR cannot be expected to result in reduced overall mental health service use and costs. Rather, IPR may improve service access or perhaps ameliorate any containment effect of managed care on service use.

Recovery-promoting professional competencies: perspectives of mental health consumers, consumer-providers and providers.

OBJECTIVES: The purpose of this study was to empirically validate a set of conceptually derived recovery-promoting competencies from the perspectives of mental health consumers, consumer-providers and providers. METHODS: A national sample of 603 consumers, 153 consumer-providers and 239 providers completed an anonymous survey via the Internet. The survey evaluated respondents' perceptions about a set of 37 competencies hypothesized to enhance clients' hope and empowerment and inquired about interactions with providers that enhanced clients' recovery process. We used descriptive statistics and ranking to establish the relevance of each competency and generalized linear models and post-hoc tests to examine differences in the consumers', consumer-providers' and providers' assessments of these competencies. RESULTS: Analyses confirmed the recovery relevance of several competencies and their relative importance within each group of study participants. They also revealed that while most competencies tended to have universal significance, others depended more strongly on the client's preferences. Finally, differences in the perceptions of consumers, consumer-providers and providers about the recovery relevance of these competencies were established. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The study highlighted the crucial role practitioners play in enhancing recovery from serious mental illnesses through specific strategies and attitudes that acknowledge clients' personhood and foster their hopefulness, empowerment and illness management. It informed the development of a new instrument measuring providers' recovery-promoting competence and provides guidelines for sharpening the recovery focus of a wide range of mental health and rehabilitation services.

The relationship of personal assistance service utilization to other Medicaid payments among working-age adults with disabilities.

This study examined changes in Medicaid provider payments prior to and following approval for personal assistance services (PAS) among 471 PAS users compared to 295 nonusers who qualified for but did not use PAS, adjusting for differences between users and nonusers using propensity scores. PAS users showed a significantly greater increase in total monthly payments from pre- to post-PAS approval compared to nonusers (35% vs. -9) due to high average monthly payments for PAS ($1325). However, users showed a decrease in non-PAS payments compared to nonusers (1%-9% vs. -9%), with significant decreases in payments for both acute/rehabilitation hospitalizations and for nursing home/other long-term residential stays among users. While costly, savings in other areas may help reduce the net cost of PAS.

Professionals and managers with severe mental illnesses: findings from a national survey.

This study explores the capacity of individuals with severe mental illness to be employed in managerial or professional jobs and the correlates of their vocational success. Using purposive sampling techniques, we identified a national sample of 347 individuals for a mail survey who had succeeded in obtaining and retaining mid to upper level managerial or professional positions. The majority worked full-time and held their job for more than 2 years. Their vocational success was operationalized based on 4 employment outcomes: employment status (full-time vs. part-time), job tenure, occupational rank, and annual income. Key factors that contributed to respondents' vocational success were lesser severity of the illness as indicated by lack of lifetime receipt of disability benefits, capacity to manage one's own psychiatric condition, and higher education. Study findings point to the role of supported education and self-efficacy in promoting the employment outcomes among individuals with severe mental illnesses.

The integration of psychiatric rehabilitation services in behavioral health care structures: a state example.

This article describes a model for integrating psychiatric rehabilitation services in a managed behavioral health care structure. Psychiatric rehabilitation and managed care are two distinct developments in the provision of mental health services that have proceeded independently though they can have compatible methods and outcomes. Descriptive detail is provided about a state initiative in Iowa to provide psychiatric rehabilitation services to those with serious mental illness through the state-contracted managed behavioral health care corporation. The article describes factors leading to the program's implementation, service delivery structures, reimbursements, personnel requirements, and performance indicators. Evidence for supporting this innovation is provided through a case-controlled outcomes study of mental health service units used and their costs for participants and matched controls.