The mothers' project for homeless mothers with mental illnesses and their children: a pilot study.

Mothers with mental illnesses, who are homeless, as well as their children, are highly vulnerable and need specialized services. This retrospective study describes the experience of the Thresholds Mothers' Project in serving 24 homeless mothers. Benchmarks suggest that the mothers and their children benefited from the program. A year after intake, 79% were still engaged in services and were all living in either independent apartments or in supportive housing. The majority of the children in their mother's care at intake were still living with them 1 year later, 77%. The Mothers' Project provides an exemplary model of how to serve this vulnerable population.

Comparison between the effects of atypical and traditional antipsychotics on work status for clients in a psychiatric rehabilitation program.

BACKGROUND: Although many studies have compared the impact of atypical antipsychotics with that of traditional antipsychotics on psychiatric symptoms, few have compared the impact on work status, especially in the context of best-practices psychiatric rehabilitation. METHOD: A cross-sectional design examined symptom and employment status for 82 clients with DSM-IV schizophrenia-spectrum disorders who had attended a psychiatric rehabilitation program for a mean of 5 years. Using chart review and client interviews, we examined the relationship between type of antipsychotic prescribed and symptom and work status in 59 clients prescribed an atypical antipsychotic (olanzapine or risperidone) for a mean of 20 months and 23 clients prescribed a traditional antipsychotic for a mean of 75 months. Measures included the Positive and Negative Syndrome Scale and 2 work status measures: an 8-point employment status scale (the Work Placement Scale) and percentage of clients working in independent employment. RESULTS: The atypical group had significantly fewer symptoms of cognitive impairment and hostility/excitement than the traditional group (p < .05). However, self-reported adverse events were similar in the 2 medication groups, and the 2 groups did not differ significantly on work status. Less severe negative, cognitive, and hostility/excitement symptoms were associated with more independent employment status. CONCLUSION: For long-term clients in a psychiatric rehabilitation program, type of medication prescribed was associated with better symptom control but not better work status. The association between symptoms and work status, however, may suggest an indirect link favoring atypical antipsychotics for achieving paid employment.

Response to vocational rehabilitation during treatment with first- or second-generation antipsychotics.

OBJECTIVE: Second-generation antipsychotics may enhance the rehabilitation of individuals with schizophrenia. The authors hypothesized that clients receiving second-generation antipsychotics would use vocational rehabilitation services more effectively and would have better employment outcomes than those receiving first-generation antipsychotics. METHODS: Ninety unemployed clients with schizophrenia and related disorders who were beginning a vocational rehabilitation program were followed for nine months. Three groups were defined according to the medication in use at study entry: olanzapine (N=39), risperidone (N=27), or first-generation antipsychotics only (N=24). Participants were interviewed monthly. RESULTS: The olanzapine and risperidone groups did not differ on any employment outcomes. On most vocational indicators, clients receiving second-generation agents did not differ from those receiving first-generation agents. However, at nine months the second-generation group had a significantly higher rate of participation in vocational training; a trend was found toward a higher rate of paid employment. All groups showed substantial improvement in employment outcomes after entering a vocational program. CONCLUSIONS: The hypothesis that second-generation antipsychotics promote better employment outcomes than first-generation antipsychotics was not upheld. However, second-generation agents appear to be associated with increased participation in vocational rehabilitation.

Jail linkage assertive community treatment services for individuals with mental illnesses.

Persons with mental illnesses who are released from jail or prison are at high risk of psychiatric decompensation and re-arrest. This paper describes an ACT jail linkage program for this population that won an American Psychiatric Association Gold Award (2001). Based on interviews with its first 24 participants, we illustrate how they experience factors that contribute to recidivism and decompensation. Pre- and post-data are examined to explore program outcomes. Results suggest that it is possible to identify, engage, and retain people in treatment who struggle with many risk factors. We conclude that this program should be expanded and replicated.

Jobs for people with the most severe psychiatric disorders: Thresholds Bridge North pilot.

This study presents findings from a 21-month study situated at a large PSR agency (Thresholds). Comparisons of vocational outcomes are reported for two groups of people who are members of an Assertive Community Treatment [ACT] program. A comparison group (n = 144) received routine ACT services. The intervention group (n = 139) received ACT and vocational services through a "blended vocational model," combining elements of the agency's extant Diversified Placement Approach with elements of the Individual Placement and Support model. The positive outcomes demonstrate that combining elements of both models is a valuable option for psychiatric rehabilitation agencies to consider.

Gaining insight: who benefits from residential, integrated treatment for people with dual diagnoses?

This retrospective study examines 18-month outcomes for 38 participants in an urban, residential integrated treatment (IT) program, and whether residents experienced different treatment benefits. Informed by an ACT team approach, the program emphasized harm reduction and motivational interventions. The design is naturalistic, and outcomes are self-comparisons over time reported in the aggregate. Repeated measurements with three standardized scales tracked stage of treatment and extent of alcohol and drug use. Outcomes analyses reveal advancements in stage of treatment and significant reductions in use of alcohol and drugs. Participants also worked more and were hospitalized less.