The Competencies of Telehealth Peer Support: Perceptions of Peer Support Specialists and Supervisors During the COVID-19 Pandemic.

This report assesses the competencies and technology needed for the provision of Telehealth Peer Support by Peer Support Specialists . The online survey assessed access to technology, core competencies required for the delivery of ThPS, and resources needed by the workforce to deliver ThPS. Responses from 313 PSS and 164 managers/supervisors of PSS from New York State were analyzed. Findings indicate nearly one-quarter of the PSS workforce continues to need access to technology and one-third need training in the delivery of ThPS. Perceptions of the important, critical, and most frequently used competencies for the delivery of ThPS were rated similarly by PSS and managers/supervisors. The broad implementation of effective ThPS requires additional resources and training for the PSS workforce. Further research to validate the ThPS competencies identified in the study will enhance training programs and resources. Policy makers and those who have advocated for the continued delivery of ThPS post-stay at home orders should ensure programs delivering ThPS provide access to technology and skills training in the competencies of ThPS. The use of ThPS post COVID-19 may address some persistent service barriers such as rural access and areas with fewer available services.

Perceptions of Supervisors of Peer Support Workers (PSW) in Behavioral Health: Results from a National Survey.

This content analysis of open-ended survey responses compares and contrasts perceptions on supervision from supervisors with experience providing direct peer support services (PS) and supervisors without experience providing direct peer support services (NPS).A 16-item online survey was distributed via the National Association of Peer Supporters (N.A.P.S.) listserv and through peer networks and peer run organizations. Responses from 837 respondents, across 46 US states, were analyzed. Four open ended questions assessed supervisors' perceptions on differences supervising peer support workers (PSW) as compared to other staff, important qualities of PSW supervisors, roles when supervising a PSW, and concerns about PSWs in the organization. Among NPS and PS, three major differences in themes emerged: the knowledge required of supervisors, understanding of the role of the PSW, and supervisors' beliefs regarding PSW competencies. PS have a more nuanced understanding of the peer support worker role and the impact of lived experience in the role.

Experiences of peer support specialists supervised by nonpeer supervisors.

OBJECTIVE: This article reports on a qualitative study examining the experiences of peer support specialists (PSS) supervised by nonpeer supervisors (NPS) in adult community mental health settings. METHOD: Potential participants completed a demographic survey designed to address inclusionary criteria. From those eligible, a random number generator selected participants to be interviewed using a semistructured interview guide. The critical incident technique was used to elicit memorable experiences of supervision. Data were analyzed thematically. Twenty interviews were completed before saturation was reached. RESULTS: Thematic analysis revealed eight major themes including supervisor attitudes, role integration, trauma-informed supervisory techniques, facilitative/supportive environment, perspective-taking, mutual learning, opportunities for peer networking, and the desire for a supervisor who was a more experienced peer support worker. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: PSS are integrating into a mental health service system transitioning from a medical model to a recovery-oriented model of care. NPS are the necessary guides who assist the PSS in navigating a system not yet aligned with peer values. If the mental health system is going to successfully become recovery oriented, NPS need a unique skill set to support those with lived experience whose recovery can help point the way. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Multidimensional wellness for people aging with mental health conditions: A proposed framework.

OBJECTIVE: This project aimed to develop a synthesized framework of multidimensional wellness for people aging with serious mental health conditions (SMHC) using existing frameworks to serve as a guide for policy and interventions to address the unique needs, experiences, and strengths of the population. METHOD: A concept analysis compared a widely used wellness approach (Swarbrick, 1997) for people with SMHC and one for older adults (Fullen, 2019) to synthesize into a practical framework for people aging with SMHC. RESULTS: Nine dimensions were proposed for conceptualizing the wellness of this population including: (a) Developmental, (b) Intellectual/Cognitive, (c) Physical, (d) Emotional, (e) Social, (f) Occupational, (g) Spiritual, (h) Environmental, and (i) Financial. Practical suggestions for implementation are identified. CONCLUSIONS AND IMPLICATION FOR PRACTICE: People aging with SMHC require rehabilitation services that address their unique perspectives, strengths, and challenges. The proposed adapted wellness framework offers a guide to comprehensively address well-being in people aging with SMHC. Placing the model in the context of external factors of resources and supports available, and the impact of societal perspectives about each dimension, further delineates a holistic model of wellness that considers well-being and successful living. This model can offer structure and practical application for services, and consideration of future needs of people aging with SMHC to support psychiatric rehabilitation services, as well as offer strategies to encourage positive aging and recovery. Future work should explore the impact of multidecade experiences of mental health conditions and the mental health system to better support individual recovery. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cancer Screening in Behavioral Health Care Programs.

OBJECTIVE: Adults with serious mental illnesses have a lower life expectancy attributable to many factors including metabolic disorders and cancer. Access to cancer screening has been shown to decrease morbidity and increase chances of survival. This study examined access to cancer screening services among individuals with serious mental illnesses served by a community behavioral health care agency partial hospitalization program at four locations. METHOD: A self-administered paper-and-pencil survey was provided to adults attending partial hospitalization programs. The survey consisted of open- and closed-ended questions about utilization, access to, and barriers to cervical, breast, and colorectal cancer screenings. RESULTS: Surveys were completed by 136 individuals. Participant screening rates were above national rates for cervical and breast cancer but lower for colorectal cancer. The main cited barrier to receiving the screening tests was lack of physician recommendations. CONCLUSIONS: Psychiatric nurses are ideally suited to communicate with this population and other behavioral health care professions about the importance of these screenings. Communication should also advocate for improved education and increased support for cancer screenings to address this health care disparity.

Multi-dimensional wellness interventions for older adults with serious mental illness: A systematic literature review.

OBJECTIVE: Aging persons with serious mental illness present unique challenges for community mental health services. This population is increasing in numbers in mental health treatment settings. The combination of serious mental illness with the vicissitudes of aging suggest that a broader conceptualization of this population may improve services. SAMHSA's 8 Dimension of Wellness offers a comprehensive strengths-based framework for interventions to maximize older persons' abilities and address the complex bidirectional effects of physical, emotional, social, spiritual, occupational, financial, intellectual, and environmental challenges to wellness. This systemic literature review identifies unidimensional and multidimensional wellness interventions for older adults with mental illness. METHOD: We conducted a systematic literature review to identify wellness interventions provided to persons with serious mental illness with a mean age of 45 or higher. RESULTS: Twenty-six articles representing 14 distinct wellness interventions were identified. None of the articles used SAMHSA's 8 Dimensions of Wellness framework. The physical wellness (n = 21) and social (n = 15) dimensions were the most frequently described in the literature. There was no mention of either the intellectual or spiritual dimensions. The quality of the research of these interventions varied; 14 papers described a randomized controlled trial. CONCLUSIONS: The SAMHSA wellness framework has not been used to design interventions for older persons with serious mental illness. Interventions for aging persons should support comprehensive wellness, including the intellectual and spiritual domains. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Changes Group: A Follow-Up Report on a Group Intervention to Assist the Successful Discharge of Hospital Residents.

OBJECTIVE: This is a follow-up study of a pilot project first reported on in 2006. A group model was developed for a state psychiatric hospital setting to assist residents who had displayed characteristics of "institutionalism." This includes an aversion or ambivalence to discharge efforts and an acceptance of prolonged life in the hospital. The pilot project, while small, was promising, with five of seven people entering the community successfully within a year and a half. METHOD: The current project expanded the scope to include three groups with a total of 25 participants. Additional refinement included a standardized group curriculum, expanding outcome measures to include participant attitudes toward change, a protocol to inform and meaningfully involve clinical treatment teams in the participants' progress, and enhanced training for group facilitators. RESULTS: Of the original participants, 32% achieved discharge in the first year of participation in the group. In addition, participants who were not discharged within the first year developed more positive attitudes toward making changes in their life. DISCUSSION: The guiding principles of this model-including personal reflection, a team approach for sharing life experiences, and encouragement from participants and staff-seem conducive for supporting the attitudinal change and motivation necessary for successful discharge after prolonged hospital stays.

Sensitizing Inpatient Mental Health Staff to the Challenges of Aging.

Although the aging inpatient population in state psychiatric hospitals is growing significantly, there are few examples of available training to improve staff knowledge and practice. The current article describes a 10-week training series developed through a university and psychiatric hospital collaboration. Training was attended by 135 direct care nursing and rehabilitation staff and focused on improving aging awareness, problem solving, using person-centered therapeutic techniques, and engaging older adults. Staff reported improvements in therapeutic techniques, knowledge, concrete strategies for providing care, and stress management skills. Specialized training to improve understanding of aging processes and communication with older adults may also improve inpatient staff knowledge and skills. As the aging inpatient population in state psychiatric hospitals continues to grow, future work should develop manualized training initiatives to address communication needs of older adults and intervention strategies that can be used by mental health nursing staff when working with this population. [Journal of Psychosocial Nursing and Mental Health Services, 56(4), 12-16.].

Liver Scaffolds Support Survival and Metabolic Function of Multilineage Neonatal Allogenic Cells.

Organ scaffold bioengineering is currently limited by the inability to effectively repopulate the scaffold with appropriately distributed functional cells. We examined the feasibility of a decellularized liver scaffold to support the growth and function of multilineage allogenic cells derived from either adult or neonatal liver cells. Cell slurries from neonatal and adult rat livers containing hepatocytes, cholangiocytes, and endothelial cells were introduced into decellularized adult rat liver scaffolds via the bile duct. Recellularized grafts were perfused with cell growth medium through the portal vein for 7 days. Concurrently, the same cell slurries were incubated on culture dishes. Albumin levels were measured from graft perfusates and cell culture media. Immunofluorescent assays were used to verify the colocalization of cholangiocytes, hepatocytes, endothelial cells, and Kupffer cells in the recellularized grafts by using anti-CK7, anti-hepatocyte antigen, anti-CD34, and anti-CD68, respectively. More robust albumin production was detected in the perfusate of scaffolds recellularized with a neonatal liver cell slurry compared with those with an adult liver cell slurry. The perfusates from all recellularized grafts showed increasing albumin concentration over 7 days; higher levels were detected in the constructs compared with the cell culture. Scaffolds seeded with a neonatal liver cell slurry showed the presence of hepatocytes, cholangiocytes, endothelial cells, and Kupffer cells. Results demonstrated the superiority of neonatal allogenic cells over adult cells of the same origin, possibly because of their pluripotent behavior. Liver bio-scaffolds supported the growth of four different liver cell lines. Recellularized grafts exhibited preserved functionality as demonstrated by albumin production, and constructs seeded with a neonatal cell slurry demonstrated proliferation on Ki-67 assay, thus representing a promising model for a transplantable construct.

Recellularization via the bile duct supports functional allogenic and xenogenic cell growth on a decellularized rat liver scaffold.

Recent years have seen a proliferation of methods leading to successful organ decellularization. In this experiment we examine the feasibility of a decellularized liver construct to support growth of functional multilineage cells. Bio-chamber systems were used to perfuse adult rat livers with 0.1% SDS for 24 hours yielding decellularized liver scaffolds. Initially, we recellularized liver scaffolds using a human tumor cell line (HepG2, introduced via the bile duct). Subsequent studies were performed using either human tumor cells co-cultured with human umbilical vein endothelial cells (HUVECs, introduced via the portal vein) or rat neonatal cell slurry (introduced via the bile duct). Bio-chambers were used to circulate oxygenated growth medium via the portal vein at 37C for 5-7 days. Human HepG2 cells grew readily on the scaffold (n = 20). HepG2 cells co-cultured with HUVECs demonstrated viable human endothelial lining with concurrent hepatocyte growth (n = 10). In the series of neonatal cell slurry infusion (n = 10), distinct foci of neonatal hepatocytes were observed to repopulate the parenchyma of the scaffold. The presence of cholangiocytes was verified by CK-7 positivity. Quantitative albumin measurement from the grafts showed increasing albumin levels after seven days of perfusion. Graft albumin production was higher than that observed in traditional cell culture. This data shows that rat liver scaffolds support human cell ingrowth. The scaffold likewise supported the engraftment and survival of neonatal rat liver cell slurry. Recellularization of liver scaffolds thus presents a promising model for functional liver engineering.

Impact of peer delivered wellness coaching.

OBJECTIVE: People receiving publicly funded behavioral health services for severe mental disorders have shorter lifespans and significantly impaired health-related quality of life compared to the general population. The aim of this article was to explore how peer wellness coaching (PWC), a manualized approach to pursue specific physical wellness goals, impacted goal attainment and overall health related quality of life. METHOD: Deidentified archival program evaluation data were examined to explore whether peer delivered wellness coaching had an impact on 33 service recipients with regard to goal attainment and health-related quality of life. Participants were served by 1 of 12 wellness coach trainees from a transformation transfer initiative grant who had been trained in the manualized approach. RESULTS: Coaching participants and their coaches reported significant progress toward the attainment of individually chosen goals, 2 to 4 weeks after establishing their goals. After 8 to 10 weeks of peer delivered wellness coaching, improvements were evident in the self-report of physical health, general health, and perceived health. These improvements were sustained 90 days later. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: PWC is potentially a promising practice for helping people choose and pursue individual goals and facilitating positive health and wellness changes. Rigorous controlled research with larger samples is needed to evaluate the benefits of peer delivered wellness coaching. (PsycINFO Database Record

Cancer Screening Among Peer-Led Community Wellness Center Enrollees.

Growing evidence suggests health disparities exist in services for individuals with mental disorders served by the public mental health system. The current study assessed the use of cancer screening services among New Jersey residents in publicly funded mental health programs. Self-administered written surveys were completed by 148 adults using peer-led community wellness centers throughout New Jersey. Information was collected on (a) the use of breast, cervical, and colorectal cancer screening services; (b) barriers to receiving preventive services; and (c) perceptions of overall health. More males than females participated in the study, with equal participation among White and African American individuals. Schizophrenia spectrum disorders were the most common self-reported psychiatric condition. Colorectal cancers had lower screening levels compared to those of the general population. Physicians not advising patients to complete tests emerged as a main cause of low screening rates. Wellness initiatives designed by peers collaborating with health care providers may improve adherence to preventive cancer screening measures.

Building human capital to increase earning power among people living with mental illnesses.

OBJECTIVE: Human Capital Theory, a well-established model from the field of economics, maintains that a person's lifetime earnings are affected by the amount of education and job training they receive. This study uses Human Capital Theory to predict wages and explain employment outcomes among individuals living with psychiatric illnesses. METHODS: Hourly wages were examined between 100 individuals with mental illnesses and 100 matched comparisons who had no mental illnesses. RESULTS: The study found that participants with mental illnesses earned $12.19 an hour vs. $14.54 an hour earned by their counterparts without disability. The study also revealed that higher educational attainment and longer work history predicted higher wages among participants with mental illnesses. The severity of psychiatric symptoms and diagnosis, however, did not predict wages. CONCLUSION AND IMPLICATIONS FOR PRACTICE: These findings indicate that human capital variables are correlated with wages earned by persons living with mental illnesses. Findings also suggest that assisting mental health consumers in the pursuit of education and job training may increase earning potential which can lead to financial independence and community integration. This supports the value in developing and implementing Supported Education to assist consumers in acquiring education and job training.

Barriers to vocational effectiveness in ACT: staff perspectives.

Assertive community treatment (ACT), for persons with serious mental illness, includes a vocational focus as an important aspect of community integration. Nevertheless, research suggests that ACT does not assist significant numbers of consumers in achieving employment goals. A two-step survey of New Jersey ACT team members was designed to identify the key issues that hinder ACT staff members in assisting consumers with obtaining employment. Survey items were categorized into three sections: (a) staff attitudes, (b) consumer barriers, and (c) staff barriers to working on employment. The initial survey asked staff members to rate items in each of these categories. Highly rated items were used in a subsequent paired comparison survey to determine the relative importance of each. This method highlighted the following issues: four staff attitude items-(a) returning to work is positive, (b) employment is key to recovery, (c) abstinence from substance abuse is needed to work, and (d) consumers are too ill to work; four consumer barrier items-(a) fear of loss of Social Security Administration benefits, (b) symptoms related to the illness, (c) lack of motivation, and (d) poor social skills; and three barriers to working on employment issues items-(a) clinical issues take priority, (b) other case management issues takes priority, and (c) too many emergencies. The implications for staff training are discussed.

Consumer-operated self centers: environment, empowerment, and satisfaction.

Consumer-operated self-help centers were designed to provide social environments that promote participant empowerment and satisfaction. This exploratory, descriptive study examined how variance in empowerment and satisfaction scores could be explained by participants' perceptions of the social environment factors (relationship, personal growth, and systems maintenance and change) and quantity of participation. Participants (N = 144) involved in consumer-operated self-help centers completed a four-part, 161-item survey designed to capture perceptions of satisfaction, empowerment, social environment factors, quantity of center participation, and demographic data. Significant relationships were found between participant satisfaction and the three social environment factors. Findings also indicated that participant empowerment was related to quantity of self-help center involvement. From these exploratory analyses, recommendations are made on how to improve consumer-run self-help center operations.

Putative evidence of employment readiness.

Readiness in the work domain has been a controversial issue for the psychiatric rehabilitation community. Judgments of a lack of readiness have relegated many persons to lives of continued unemployment and service dependency. Conversely, proponents of the rapid placement strategy of supported employment have down-played the importance of readiness. Yet, a careful review of the supported employment research suggests that readiness may indeed be an important factor in vocational outcomes. This paper presents evidence that the screening criteria employed in SE studies are often related to readiness factors and that these criteria are highly predictive of vocational outcomes. Acceptance of the importance of readiness for success in the vocational arena implies new service strategies and may serve to improve vocational outcomes in general.