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.

Development of a Nurtured Heart Approach® Questionnaire.

A training and coaching team embarked on a training and technical assistance program evaluation project to examine the development of a tool used to determine the impact of training on staff and families serving youth with behavioral health challenges and their families. The training evaluation project centered on the development of a tool to examine the impact of training on trainee attitudes. The current article provides an overview of the development of the Nurtured Heart Approach® (NHA) Questionnaire to help support training and technical assistance implementation efforts by nursing and other trainers interested in best practice approaches to empower youth with behavioral health challenges. The questionnaire was found to be internally consistent and to have relatively stable, empirically derived factors consistent with the NHA model, but differing somewhat from the theoretically derived "Stands," or areas of emphasis. The questionnaire is sensitive to changes in attitude resulting from the NHA training. Therefore, it would a viable, practical instrument to test staff acquisition of NHA-related attitudes. [Journal of Psychosocial Nursing and Mental Health Services, 60(2), 15-19.].

The Effects of Oral Health Instruction, and the Use of a Battery-Operated Toothbrush on Oral Health of Persons with Serious Mental Illness: A Quasi-Experimental Study.

People with a diagnosis of serious mental illness (SMI) have a greater incidence of poorer oral health as compared to the general population. The aim of this quasi-experimental study was to determine the effect that a combination of the use of a battery-operated toothbrush and a related educational intervention may have on the oral health of individuals with serious mental illness. Key findings include that the battery-operated toothbrush resulted in a significant improvement in the mean change in gingival index, a common indicator of oral health. The study also found that oral home care instructions, smoking and level of negative symptoms did not have an effect on the mean change in plaque or gingival indices. This project suggests that the implementation of a relatively simple, cost effective measures such as a battery-operated toothbrush may have a positive impact on the oral health in this population.

Challenges Experienced by Behavioral Health Organizations in New York Resulting from COVID-19: A Qualitative Analysis.

This paper presents a qualitative content analysis of survey data collected from behavioral health care providers from throughout New York regarding the challenges faced as a result of COVID-19. Survey responses from 295 agency and program administrators and staff, representing 238 organizations, were analyzed. Ten themes were identified: business operations, service provision, telehealth, safety, client concerns, staff concerns, supplies, technology, illness/grief/loss, and communication. These themes represent concerns that arose from the rapid transition to widespread use of telehealth, limited technology accessibility for both staff and clients, reduced revenue and billing changes, impact of COVID-19 infection itself and subsequent deaths of clients and staff, and necessary modifications for organizational communication both internally and externally. The implications of these challenges and the need for further research to identify how to best address them are discussed.

Promoting wellness of peer providers through coaching.

Peer wellness coaching is workforce innovation that empowers individuals with mental and substance use disorders to achieve recovery. This article briefly describes how this approach can help peer providers develop self-care skills to improve job tenure and promote satisfaction. Promising results of this new approach are presented.

Old before their time: Comparisons of people with SMI and healthy older adults.

OBJECTIVE: Compare physical functional measures of people with severe mental illness (SMI) to standardized geriatric values. METHOD: Retrospective analysis of physical functioning sample data of middle-aged people with SMI was compared to standardized older adult data. Compared: Sit to Stand Test (STS; n = 68), 6 min Walk Test (6MWT; n = 71), and Single Legged Stance Test (SLS; n = 55). One sample t tests were computed, using standardized values for older adult healthy populations, to identify differences for the group. RESULTS: STS (M = 11.3 SD = 5.36), for the sample were comparable to 80-89 year old. The 6MWT values were significantly worse than 80-89-year-old range for women, t(28) = -2.88, p < .01, and men, t(40) = -5.32, p =. 00. SLS values for women and men were comparable to the 70-79-year-old range in the general population. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: People with SMI have functional fitness levels that are older than chronological age, and should be assessed regularly for physical functioning to support independent living. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychometric properties of post-traumatic stress disorder (PTSD) checklist for DSM-5 in persons with serious mental illness.

BACKGROUND: PCL-5 is a self-report measure consisting of 20 items that are used to assess the symptoms of Post-Traumatic Stress Disorder (PTSD) according to the DSM-5. OBJECTIVE: This study evaluated the factor structure of the Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) in people with serious mental illness. METHOD: The sample in Study 1 included 536 participants with serious mental illness who were receiving supported employment services through community mental health agencies or supported housing programmes. Confirmatory factor analysis assessed the fit of six different models of PTSD. RESULTS: Results indicated that Armour's Hybrid 7-factor model composed of re-experiencing, avoidance, dysphoria, dysphoric arousal, anxious arousal, negative affect, anhedonia, and externalizing behaviours demonstrated the best fit. Study 2 found support for convergent validity for PCL-5 among 132 participants who met criteria for PTSD. CONCLUSION: Findings provide support for the psychometric properties of the PCL-5 and the conceptualization of the 7-factor hybrid model and the 4-factor DSM-5 model of PTSD among persons living with serious mental illness.

Antecedentes:PCL-5 es una medida de autoinforme que consta de 20 ítems que se utilizan para evaluar los síntomas del TEPT de acuerdo al DSM-5.Objetivo:Este estudio evaluó la estructura factorial de la Lista de verificación de Trastorno de Estrés Postraumático (TEPT) para DSM-5 (PCL-5) en personas con enfermedades mentales graves.Método:La muestra del Estudio 1 incluyó a 536 participantes con enfermedad mental grave que estaban recibiendo servicios de empleo subvencionado a través de agencias comunitarias de salud mental o programas de vivienda subvencionados. El análisis factorial confirmatorio evaluó el ajuste de seis modelos diferentes de TEPT.Resultados:Los resultados indicaron que el modelo híbrido de 7 factores de Armour - compuesto de reexperimentación, evitación, disforia, excitación disfórica, excitación ansiosa, afecto negativo, anhedonia y conductas de externalización - demostró el mejor ajuste. El estudio 2 encontró sustento para la validez convergente de PCL-5 entre 132 participantes que cumplieron con los criterios para TEPT.Conclusión:Los hallazgos respaldan las propiedades psicométricas del PCL-5 y la conceptualización del modelo híbrido de 7 factores y el modelo DSM-5 de 4 factores de TEPT entre personas que viven con una enfermedad mentales graves.

Evaluating Educational and Employment Services for Young People With Psychiatric Conditions: A Systematic Review.

OBJECTIVE: The authors conducted a systematic review of studies evaluating vocational interventions for young people with psychiatric conditions to determine the extent to which services were adapted for young people and whether services promoted gains in postsecondary education and employment. METHODS: Five databases (PubMed, PsycINFO, Web of Science, Academic Search Premier, and ERIC) were searched. Sources eligible for inclusion were controlled studies published between 2000 and mid-2020 that evaluated a vocational intervention and examined postsecondary educational or employment outcomes for youths or young adults (ages 14-35 years) with psychiatric conditions. RESULTS: Ten studies met the inclusion criteria. Several of the studies evaluated services that were adapted for young people, including through the incorporation of educational supports. The most consistent finding was that services based on the individual placement and support (IPS) model improved employment outcomes more effectively than did comparison approaches and treatment as usual. Fewer studies assessed educational outcomes, and they yielded mixed results; however, recent findings from a controlled trial indicate that an enhanced IPS intervention that included well-specified supported education and skills training led to significantly superior outcomes in both education and employment. CONCLUSIONS: These results provide support for the efficacy of IPS-based services to improve employment outcomes among young people with psychiatric conditions and suggest that adapting IPS to include comprehensive educational supports and skills training may be important for efforts to improve postsecondary educational outcomes. Additional well-controlled intervention studies that examine educational and longer-term outcomes should further inform the development and delivery of vocational services for this population.

Applying implementation science in mental health services: Technical assistance cases from the Mental Health Technology Transfer Center (MHTTC) network.

OBJECTIVE: Critical gaps exist between implementation of effective interventions and the actual services delivered to people living with mental disorders. Many technical assistance (TA) efforts rely on one-time trainings of clinical staff and printed guidelines that alone are not effective in changing clinical practice. The Mental Health Technology Transfer Center (MHTTC) Network uses implementation science to accelerate the use of evidence-based practices (EBPs), improve performance, and bring about systems-level change. METHOD: Four case examples illustrate how MHTTCs employ the Exploration-Preparation-Implementation-Sustainment (EPIS) implementation framework and intensive implementation strategies to educate clinicians, manage change, and improve processes. These examples include implementing motivational interviewing, cognitive-behavioral therapy for people with psychosis, strategies to decrease the no show rate for virtual appointments, and school mental health systems development. RESULTS: From Preparation through Sustainment, MHTTCs successfully employed implementation strategies including learning communities, audit and feedback, and coaching to bring about change. Each project attended to inner and outer contexts to eliminate barriers. The examples also show the benefit of integrating process improvement alongside implementation. CONCLUSIONS: The MHTTCs are a model for using implementation science to design technical assistance that leads to more successful practical execution of EBPs; thus reducing the gap between research and practice.

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.

Wellness coaching: a new role for peers.

TOPIC: This brief report presents the conceptual framework for the development of the peer wellness coach role including the definition of a new job role for peer providers and an overview of the knowledge and skills required for this role. PURPOSE: People with serious mental illnesses are at greater risk of living with untreated chronic medical conditions that severely impact their quality of life and result in premature mortality. Wellness coaching represents an intervention that can help individuals persist in the pursuit of individually chosen health and wellness goals. SOURCES USED: Literature and our personal and professional experiences developing this role and training are presented. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Wellness coaching seems an ideal role for peers in recovery that has potential to address health and wellness issues facing persons living with mental illnesses who are at high risk of comorbid medical conditions.

A study of the perceived barriers to the implementation of circles of support.

OBJECTIVE: The purpose of this study was to identity barriers to implementing the social support intervention, Circle of Support, in supported employment (SE) services for people with psychiatric disabilities. METHOD: Semi-structured interviews were administered to SE staff at three month intervals up to one year. Two focus groups were held with service recipients who did not participate in a circle of support. Interviews were conducted with two individuals receiving SE services who participated in a pilot project in which study researchers implemented circles of support. RESULTS: Common themes regarding the barriers to implementing a circle of support developed from the data. Service recipients who did not participate in a circle of support and those who did expressed the perceived and actual barriers to this approach as being: time, too much focus on the participant, and lack of control/facilitation of circle activities. Service recipients who participated in a pilot who had circles of support reported that this intervention was beneficial to them. Staff and service recipients identified time, running of the actual circle of support meetings, and supporter issues as barriers to implementing this technique. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Although certain barriers to this technique were identified, there were features of this approach that both staff and service recipients, who had a circle of support, found beneficial. Since ongoing support is a critical component of successful employment, individuals may benefit from the use of these Circles of Support techniques.

Trauma Exposure and Prolonged Grief Disorder Among Persons Receiving Community Mental Health Services: Rates and Correlates.

BACKGROUND: Persons with serious mental illnesses (SMIs) are at increased risk for exposure to trauma and posttraumatic stress disorder (PTSD). Prolonged Grief Disorder (PGD) may also impact this population but has been seldom studied. AIMS: The present study investigated the rate of both PTSD and PGD among clients receiving community mental health services, and the clinical correlates of co-occurring PTSD/PGD. METHODS: Trauma history, PTSD and PGD were assessed among 536 individuals receiving community mental health services (Study 1). A subsample of 127 individuals from Study 1 who met DSM-5 criteria for PTSD based on diagnostic interview completed measures of psychiatric symptoms (Study 2). RESULTS: In Study 1, 92.4% of participants receiving community mental health services had experienced a traumatic event, 49.6% met criteria for probable and provisional PTSD, 14.7% scored positive for probable PGD, and 11.9% met criteria for probable and provisional PTSD as well as probable PGD. In Study 2, participants meeting diagnostic DSM-5 criteria for PTSD and probable PGD had more self-reported PTSD symptoms, but did not differ on other outcomes. CONCLUSIONS: Findings highlight the need for trauma informed services including grief counseling for persons with SMI.

Hotspots of species loss do not vary across future climate scenarios in a drought-prone river basin.

Climate change is expected to alter the distributions of species around the world, but estimates of species' outcomes vary widely among competing climate scenarios. Where should conservation resources be directed to maximize expected conservation benefits given future climate uncertainty? Here, we explore this question by quantifying variation in fish species' distributions across future climate scenarios in the Red River basin south-central United States. We modeled historical and future stream fish distributions using a suite of environmental covariates derived from high-resolution hydrologic and climatic modeling of the basin. We quantified variation in outcomes for individual species across climate scenarios and across space, and identified hotspots of species loss by summing changes in probability of occurrence across species. Under all climate scenarios, we find that the distribution of most fish species in the Red River Basin will contract by 2050. However, the variability across climate scenarios was more than 10 times higher for some species than for others. Despite this uncertainty in outcomes for individual species, hotspots of species loss tended to occur in the same portions of the basin across all climate scenarios. We also find that the most common species are projected to experience the greatest range contractions, underscoring the need for directing conservation resources toward both common and rare species. Our results suggest that while it may be difficult to predict which species will be most impacted by climate change, it may nevertheless be possible to identify spatial priorities for climate mitigation actions that are robust to future climate uncertainty. These findings are likely to be generalizable to other ecosystems around the world where future climate conditions follow prevailing historical patterns of key environmental covariates.

Psychiatric rehabilitation: an emerging academic discipline.

Psychiatric rehabilitation is an emerging profession and academic discipline. This paper provides an overview of the need for psychiatric rehabilitation education, the workforce challenges this field faces and an introduction to the various efforts that institutions of higher education are making to meet this need. This paper also introduces some empirical findings in this area, reviewing three previously published evaluations of academic programs, and providing preliminary results of an unpublished evaluation from an American university with a career ladder in this field. The results of these evaluations suggest positive impact on the careers of the students, who appear to be knowledgeable and competent in psychiatric rehabilitation. More detailed evaluations of this education on the service outcomes of persons with serious mental illness are warranted as are studies of the methods of instruction used to develop the needed skills and attitudes. Replication of these existing academic programs should be considered.

Evaluation of an online learning academy of peer specialists.

OBJECTIVE: This report describes the instructional design and development process, learner feedback, and factors associated with course completion in the Academy of Peer Services (APS), an online educational platform for partial fulfillment of peer specialist state certification. METHOD: From January 2014 to August 2017, 4,064 individuals in the APS completed online courses and provided demographic information and course evaluation feedback. This report analyzed the relationship between demographic data (work role, experience with online training, level of education) and posttest performance. Course evaluation data on quality, perceived difficulty, and learner satisfaction were also analyzed. RESULTS: Overall, participants passed posttests 70.6% of the time. The effect size of work role was very small, η2 = .006. Level of education attainment was associated with differences on posttest scores, F(5, 3903) = 20.22, p < 001, but the effect size was, again, very modest, η2 = .025. Previous experience with online learning slightly influenced posttest scores, F(2, 4053) = 3.95, p < .02, η2 = .002. The great majority of students (88.2%) agreed or strongly agreed that the content was relevant to their everyday work. Similarly, 89% agreed or strongly agreed that the content contained practical tools, which they intend to use in their work. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The feedback collected from more than 4000 learners suggests that the application of instructional design principles and techniques succeeded in translating the practical knowledge of peer-provided services to an easily accessible web-based platform for persons of varying education and life experiences. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Jail Diversion for Persons with Serious Mental Illness Coordinated by a Prosecutor's Office.

Persons with serious mental illnesses (SMI) are involved in the criminal justice system at a disproportionately higher rate than the general population. While the exact causes remain unclear, it is accepted that a comprehensive strategy including mental health treatment is needed to reduce recidivism. This paper describes a unique jail diversion program coordinated by a county prosecutor's office in which individuals were diverted towards mental health services including case management, community-based services, and housing supports. Outcomes were studied over a five-year period, beyond the typical 12- to 24-month follow-up in other studies. Individuals who completed the program, compared to those who did not complete it, were at lower risk for being rearrested, arrested fewer times, and incarcerated fewer days. Gains were moderated by previous criminal justice involvement and substance use but, nevertheless, were maintained despite severity of history. The strongest gains were seen while the individual was still actively enrolled in the diversion services and these outcomes were maintained for up to four years. These findings suggest that completion of a jail diversion program facilitated by a prosecutor's office can lower recidivism and days incarcerated. Further research is needed to assess the unique contribution of prosecutor office facilitation.

Evaluation of a cognitive remediation intervention for college students with psychiatric conditions.

OBJECTIVE: Given the poor educational outcomes associated with psychiatric conditions, we developed Focused Academic Strength Training (FAST), a 12-week strategy-focused cognitive remediation intervention designed to improve academic functioning among college students with psychiatric conditions. Here we report initial results from a randomized controlled trial of FAST. METHOD: Seventy-two college students with mood, anxiety, and/or psychotic disorders were randomized to receive FAST or services as usual and were assessed at baseline and 4 months (posttreatment). RESULTS: Repeated-measures analyses of variance indicated FAST-associated improvements in self-reported cognitive strategy use (p < .001), self-efficacy (p = .001), and academic difficulties (p = .025). There were no significant treatment-related improvements in neuropsychological performance. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: FAST may lead to an increase in self-efficacy and cognitive strategy use, as well as a reduction in academic difficulties among students with psychiatric conditions. Future analyses with follow-up data through 12 months will address the potential of FAST to improve academic functioning among this population. (PsycINFO Database Record

Best practices: An initiative to curtail the use of antipsychotic polypharmacy in a state psychiatric hospital.

A performance improvement initiative was undertaken at a state psychiatric hospital to reduce antipsychotic polypharmacy. Data from physicians' order forms were used to document the prescribing practices of 14 psychiatrists in November 2001 and in August 2002. After baseline data were collected, the chief of psychiatry met with each psychiatrist to compare his or her prescribing data with data of anonymous peers. The chief also asked all psychiatrists to decrease antipsychotic polypharmacy by at least 10 percent. Antipsychotic polypharmacy fell significantly--from 42 percent of patients treated with antipsychotics in November 2001 to 31 percent in August 2002. Higher utilizers of polypharmacy at baseline continued to be high utilizers at follow-up. Less antipsychotic polypharmacy was not associated with more use of other psychotropic medications. The findings suggest that initiatives that involve the focused attention of leadership and only a modest investment of effort can result in significant change in prescribing practices in a state hospital.

A collaborative rehabilitation approach to the improvement of inpatient treatment for persons with a psychiatric disability.

With the growth of community support programs the role of the state psychiatric hospital has changed. Reduced funding levels have resulted in overcrowding, inadequate staffing and ineffective programming. In order to improve the quality of care and introduce more psychiatric rehabilitation-oriented activities into hospital programming, a large state hospital and a state health sciences university have entered into a time-limited collaborative partnership. This paper describes that partnership and its attempt to improve staff competencies, enhance service delivery and integrate a more rehabilitation-oriented philosophy of care into the hospital through undergraduate education, in-service training, program development, staff mentoring and organizational change activities.