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Salvo D, Resendiz E, Stefancic A, Cabassa LJ. Examining Place-Based Neighborhood Factors in a Multisite Peer-Led Healthy Lifestyle Effectiveness Trial for People with Serious Mental Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095679. [PMID: 37174197 PMCID: PMC10178706 DOI: 10.3390/ijerph20095679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/15/2023]
Abstract
People with severe mental illness (SMI) experience significantly higher obesity-related comorbidities and premature mortality rates than healthy populations. The physical and social characteristics of neighborhoods where people with SMI reside can play an important role in promoting or hindering healthy eating and physical activity. However, this is seldom considered when designing and testing health behavior interventions for these populations. This study used baseline data from an obesity control trial for low-income, minority people with SMI to demonstrate the utility of assessing neighborhood- and city-level place-based factors within the context of lifestyle interventions. GIS was used to create a zip-code-level social and built environment geodatabase in New York City and Philadelphia, where the trial occurred. Chi-square and t-tests were used to assess differences in the spatial distribution of health-related built and social environment characteristics between and within cities and diet and physical activity outcomes. All types of neighborhood characteristics showed significant environmental differences between and within cities. Several neighborhood characteristics were associated with participants' baseline healthy eating and physical activity behaviors, emphasizing that place-based factors may moderate lifestyle interventions for SMI patients. Future behavioral interventions targeting place-dependent behaviors should be powered and designed to assess potential moderation by place-based factors.
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Affiliation(s)
- Deborah Salvo
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX 78712, USA
| | - Eugen Resendiz
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Ana Stefancic
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Leopoldo J Cabassa
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
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2
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"Getting the Staff to Understand It:" Leadership Perspectives on Peer Specialists Before and After the Implementation of a Peer-Delivered Healthy Lifestyle Intervention. Community Ment Health J 2022; 59:904-913. [PMID: 36580183 DOI: 10.1007/s10597-022-01074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
Over the past two decades, there has been increased recognition of the effectiveness of peer delivered services, with prior research highlighting the benefits for both recipients of peer services and peer providers. Despite this, peer specialists report challenges to their work such as experiencing stigma associated with their role and difficulty integrating into a non-peer dominated workforce. The study sought to explore the perceptions of agency leadership from three supportive housing agencies regarding peer specialists and peer-delivered services within their organization before and after a peer-led intervention to promote healthy lifestyles for people with SMI. Semi-structured qualitative interviews were conducted with agency leadership and analyzed using a content analysis approach. Findings from this study contribute to the literature on the peer specialist workforce by identifying factors (e.g., agency's prior experience employing peer specialists) and potential strategies (e.g., exposure to peer services) impact the level of workplace integration of peer specialists.
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Blonigen D, Smelson D, Smith J, Baldwin N, McInnes DK, Raikov I, Weber J, Hyde J. Peer support and whole health coaching to address the healthcare needs of homeless veterans: a pilot study. BMC PRIMARY CARE 2022; 23:331. [PMID: 36529718 PMCID: PMC9760553 DOI: 10.1186/s12875-022-01927-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Homelessness is a robust social determinant of acute care service utilization among veterans. Although intensive outpatient programs have been developed for homeless veterans who are high utilizers of acute care ("super utilizers"), few scalable programs have been implemented to address their needs. OBJECTIVE Describe the development and pilot testing of a novel intervention that integrates the roles of a peer and whole health coach ("Peer-WHC") in coordination with primary care teams to reduce homeless veterans' frequent use of acute care. DESIGN Single-arm trial in three outpatient primary care clinics at a Veterans Health Administration (VHA) medical center; pre/post design using mixed-methods. PARTICIPANTS Twenty veterans from VHA's homeless registry who were super-utilizers of acute care and enrolled in primary care. INTERVENTION Weekly health coaching sessions with a peer over 12 weeks, including discussions of patients' health care utilization patterns and coordination with primary care. MAIN MEASURES Rates of session attendance and intervention fidelity, patient-reported satisfaction and changes in patient engagement and perceptions of health, pre/post utilization of acute and supportive care services, and qualitative interviews with multiple stakeholders to identify barriers and facilitators to implementation. KEY RESULTS On average, patients attended 6.35 sessions (SD = 3.5, Median = 7). Satisfaction scores (M = 28.75 out of 32; SD = 2.79) exceeded a priori benchmarks. Patients' perceptions of health improved from pre to post [t(df)=-2.26(14), p = 0.04]. In the 3-months pre/post, 45% (n = 9) and 15% (n = 3) of patients, respectively, were hospitalized. Qualitative feedback from patients, providers, and peers and fidelity metrics suggested value in increasing the length of the intervention to facilitate goal-setting with patients and coordination with primary care. CONCLUSION Findings support the feasibility, acceptability, and utility of Peer-WHC to address the healthcare needs of homeless veterans. A future trial is warranted to test the impact of Peer-WHC on reducing these patients' frequent use of acute care.
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Affiliation(s)
- Daniel Blonigen
- Department of Veterans Affairs Palo Alto Health Care System, Health Services Research and Development Center for Innovation to Implementation, 795 Willow Road (152), Menlo Park, CA, 94025, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - David Smelson
- HSR&D Center for Health Care Organization and Implementation Research, VA Bedford HealthCare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jennifer Smith
- Department of Veterans Affairs Palo Alto Health Care System, Health Services Research and Development Center for Innovation to Implementation, 795 Willow Road (152), Menlo Park, CA, 94025, USA
| | - Nicole Baldwin
- Clinical Psychology Program, Palo Alto University, Palo Alto, USA
| | - D Keith McInnes
- HSR&D Center for Health Care Organization and Implementation Research, VA Bedford HealthCare System, Bedford, MA, USA
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Ivan Raikov
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jillian Weber
- Veterans Health Administration, Homeless Program Office, Washington, DC, USA
| | - Justeen Hyde
- HSR&D Center for Health Care Organization and Implementation Research, VA Bedford HealthCare System, Bedford, MA, USA
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Cabassa LJ, Stefancic A, Chen JH, Park M, Tuda D, Hawes MR, Guo S. Impact of Moderating Demographic Variables on a Health Intervention for People with Serious Mental Illness. RESEARCH ON SOCIAL WORK PRACTICE 2022; 32:952-962. [PMID: 38741792 PMCID: PMC11090479 DOI: 10.1177/10497315221102403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Purpose Healthy lifestyle interventions can improve the health of people with serious mental illness (SMI). Little is known whether demographic variables moderate the effectiveness of these interventions on health outcomes. Method Data from an effectiveness trial of a peer-led healthy lifestyle intervention (PGLB) for people with SMI examine whether age, racial/ethnic minoritized status, and gender moderated the effectiveness of PGLB compared to usual care (UC) in achieving clinically significant improvements in weight, cardiorespiratory fitness, and cardiovascular disease (CVD) risk reduction. Results Compared to UC, PGLB was most beneficial for participants age 49 and younger for achieving clinically significant weight loss and from racial/ethnic minoritized communities for achieving clinically significant weight loss and reductions in CVD risk. Conclusions These findings suggest the impact of healthy lifestyle interventions for people with SMI may not be uniform and adaptations may be needed to make these interventions responsive to the needs of diverse populations.
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Affiliation(s)
| | | | - Jun-Hong Chen
- Brown School of Social Work at Washington University in St. Louis
| | - Michael Park
- Brown School of Social Work at Washington University in St. Louis
| | - Daniela Tuda
- Brown School of Social Work at Washington University in St. Louis
| | - Mark R. Hawes
- Brown School of Social Work at Washington University in St. Louis
| | - Shenyang Guo
- Brown School of Social Work at Washington University in St. Louis
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5
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An Update of Peer Support/Peer Provided Services Underlying Processes, Benefits, and Critical Ingredients. Psychiatr Q 2022; 93:571-586. [PMID: 35179660 PMCID: PMC8855026 DOI: 10.1007/s11126-022-09971-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 01/20/2023]
Abstract
The purpose of this article is to delineate the current state-of-the-knowledge of peer support following the framework employed in the 2004 article (Solomon, Psychiatr Rehabil J. 2004;27(4):392-401 1). A scoping literature was conducted and included articles from 1980 to present. Since 2004, major growth and advancements in peer support have occurred from the development of new specializations to training, certification, reimbursement mechanisms, competency standards and fidelity assessment. Peer support is now a service offered across the world and considered an indispensable mental health service. As the field continues to evolve and develop, peer support is emerging as a standard of practice throughout various, diverse settings and shows potential to impact clinical outcomes for service users throughout the globe. While these efforts have enhanced the professionalism of the peer workforce, hopefully this has enhanced the positive elements of these services and not diluted them.
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6
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Haddad R, Badke D'Andrea C, Ricchio A, Evanoff B, Morrato EH, Parks J, Newcomer JW, Nicol GE. Using Innovation-Corps (I-Corps™) Methods to Adapt a Mobile Health (mHealth) Obesity Treatment for Community Mental Health Settings. Front Digit Health 2022; 4:835002. [PMID: 35721796 PMCID: PMC9197731 DOI: 10.3389/fdgth.2022.835002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background We employed Innovation Corps (I-Corps™) methods to adaptation of a mobile health (mHealth) short-message-system (SMS) -based interactive obesity treatment approach (iOTA) for adults with severe mentall illness receiving care in community settings. Methods We hypothesized "jobs to be done" in three broad stakeholder groups: "decision makers" (DM = state and community clinic administrators), "clinician consumers" (CC = case managers, peer supports, nurses, prescribers) and "service consumers" (SC = patients, peers and family members). Semistructured interviews (N = 29) were recorded and transcribed ver batim and coded based on pragmatic-variant grounded theory methods. Results Four themes emerged across groups: education, inertia, resources and ownership. Sub-themes in education and ownership differed between DM and CC groups on implementation ownership, intersecting with professional development, suggesting the importance of training and supervision in scalability. Sub-themes in resources and intertia differed between CC and SC groups, suggesting illness severity and access to healthy food as major barriers to engagement, whereas the SC group identified the need for enhanced emotional support, in addition to pragmatic skills like menu planning and cooking, to promote health behavior change. Although SMS was percieved as a viable education and support tool, CC and DM groups had limited familiarity with use in clinical care delivery. Conclusions Based on customer discovery, the characteristics of a minimum viable iOTA for implementation, scalability and sustainability include population- and context-specific adaptations to treatment content, interventionist training and delivery mechanism. Successful implementation of an SMS-based intervention will likely require micro-adaptations to fit specific clinical settings.
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Affiliation(s)
- Rita Haddad
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Carolina Badke D'Andrea
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Amanda Ricchio
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Bradley Evanoff
- Center for Healthy Work, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Elaine H. Morrato
- Parkinson School of Health Sciences and Public Health, Loyola University of Chicago, Chicago, IL, United States
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Joseph Parks
- National Council for Mental Wellbeing, Washington, DC, United States
| | - John W. Newcomer
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Thriving Mind South Florida, Miami, FL, United States
| | - Ginger E. Nicol
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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7
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Tuda D, Stefancic A, Hawes M, Wang X, Guo S, Cabassa LJ. Correlates of Attendance in a Peer-Led Healthy Lifestyle Intervention for People with Serious Mental Illness Living in Supportive Housing. Community Ment Health J 2022; 58:761-769. [PMID: 34417635 PMCID: PMC8858335 DOI: 10.1007/s10597-021-00881-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
Healthy lifestyle interventions can improve the physical health of people with serious mental illness (SMI; e.g., schizophrenia). Yet, people with SMI report challenges participating in these interventions, thus limiting their potential benefits. This study examined attendance of participants (N = 155), largely comprised of racial and ethnic minorities, in a peer-led healthy lifestyle intervention living in supportive housing. A logistic regression model was used to identify correlates associated with attendance. Results indicated that females, those with at least a high school education, and a diagnosis of schizophrenia were more likely to attend. In contrast, the odds of attending at least one session were significantly lower for those who reported any drug use and for those who rated their health as good or excellent. Our findings indicate certain subgroups of people with SMI could benefit from tailored motivational strategies and supports to improve their participation in healthy lifestyle interventions. clinicaltrials.gov (NCT02175641).
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Affiliation(s)
- Daniela Tuda
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ana Stefancic
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Mark Hawes
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Xiaoyan Wang
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Shenyang Guo
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Leopoldo J Cabassa
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
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8
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Matthews EW, Cowman M, Brannigan M, Rosenbaum S, Sloan D, Ward PB, Denieffe S. Implementing experience-based co-design to develop a physical activity programme in recovery-focused outpatient mental health services. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims As mental health services focus on recovery orientated service delivery, there is a need to adopt recovery orientated approaches in interventions that promote physical activity. This article presents a process of using and modifying an experience-based co-design approach to develop an intervention that can be used to promote physical activity in mental health services: the ‘Move with Recovery’ programme. Methods A facilitated experience-based co-design approach was undertaken over four sessions. This approach included the use of a trigger film of touchpoints and sample physical activity experiences of service users, in addition to the use of a storyboard for emotional mapping and prioritising exercises. The final two co-design sessions involved programme prototyping and development using the TIDieR framework. Results The outcome of this process, the Move with Recovery programme, was a peer-developed and peer-led, community-focused programme structured around nine action points. It is made up of a combination of motivation, education and support sessions, together with light intensity aerobic activity sessions that is structured using the TIDieR framework, and intended for implementation in the recovery college. In this regard, the developed programme is inherently recovery orientated in its design and its aim. Conclusions The developed programme can be embedded into existing mental health services that lack integrated exercise resources. This articles details the experience-based co-design process undertaken here and offers future learning for using experience-based co-design to promote physical activity in mental health.
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Affiliation(s)
- Evan W Matthews
- School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
- Nursing and Midwifery Planning and Development Unit, South-East, The Health Service Executive, Ireland
| | - Mary Cowman
- School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - Michele Brannigan
- The Health Service Executive, Mental Health Services, South-East, Ireland
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Darina Sloan
- The Health Service Executive, Mental Health Services, South-East, Ireland
| | - Philip B Ward
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Suzanne Denieffe
- School of Humanities, Waterford Institute of Technology, Waterford, Ireland
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9
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Lee C, Piernas C, Stewart C, Michalopoulou M, Hajzadeh A, Edwards R, Aveyard P, Waite F. Identifying effective characteristics of behavioral weight management interventions for people with serious mental illness: A systematic review with a qualitative comparative analysis. Obes Rev 2022; 23:e13355. [PMID: 34672069 PMCID: PMC8952200 DOI: 10.1111/obr.13355] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022]
Abstract
People with serious mental illness (SMI) have identified barriers to engaging in behavioral weight management interventions (BWMIs). We assessed whether BWMIs that addressed these barriers were more effective. First, we systematically reviewed qualitative literature and used a thematic analysis to identify the characteristics of BWMIs that promote engagement for adults with SMI. Second, we systematically reviewed randomized controlled trials (RCTs) of BWMIs in adults with SMI. Data on the characteristics that promoted engagement and weight outcomes were extracted. We then used a crisp-set qualitative comparative analysis (CsQCA) to identify which characteristics were associated with weight loss. For the qualitative review, 20 studies in 515 people with SMI were analyzed and nine characteristics were reported to promote engagement in BWMIs. For the systematic review, 34 RCTs testing 36 interventions in 4305 participants were included. The active interventions resulted in more weight loss (mean = -4.37 to +1 kg at 6 weeks to 18 months follow-up) compared with controls (-1.64 to +3.08 kg). The CsQCA showed BWMIs that offered regular contact, tools to support enactment, and tailored materials were associated with effectiveness. As these are all supplementary strategies, it may be possible to augment BWMIs available for the general population to engage people with SMI.
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Affiliation(s)
- Charlotte Lee
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
| | - Carmen Piernas
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
| | - Cristina Stewart
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
| | - Moscho Michalopoulou
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
| | - Anisa Hajzadeh
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
| | - Rhiannon Edwards
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
- Bassetlaw HospitalDoncaster and Bassetlaw Teaching Hospitals NHS Foundation TrustWorksopNottinghamshireUK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
| | - Felicity Waite
- Department of PsychiatryUniversity of Oxford, Warneford HospitalOxfordOxfordshireUK
- Oxford Health NHS Foundation TrustOxfordOxfordshireUK
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Aschbrenner KA, Naslund JA, Reed JD, Fetter JC. Renewed call for lifestyle interventions to address obesity among individuals with serious mental illness in the COVID-19 era and beyond. Transl Behav Med 2021; 11:1359-1364. [PMID: 34160055 DOI: 10.1093/tbm/ibab076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Behavioral health has the opportunity to lead the way in using lifestyle interventions to address obesity and health disparities in people with serious mental illness (SMI) in the COVID-19 era. Evidence-based interventions for weight loss in individuals with SMI exist, and the field has developed strategies for implementing these interventions in real-world mental health care settings. In addition to promoting weight loss, lifestyle interventions have the potential to address social isolation and loneliness and other patient-centered outcomes among individuals with SMI, which will be especially valuable for mitigating the growing concerns about loneliness attributed to the COVID-19 pandemic restrictions on in-person encounters. In this commentary, we discuss practice, policy, and research implications related to using evidence-based lifestyle interventions for individuals with SMI during the COVID-19 pandemic and sustaining these programs in the long-term.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jeffrey D Reed
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Jeffrey C Fetter
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
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11
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Cabassa LJ, Stefancic A, Bochicchio L, Tuda D, Weatherly C, Lengnick-Hall R. Organization leaders' decisions to sustain a peer-led healthy lifestyle intervention for people with serious mental illness in supportive housing. Transl Behav Med 2021; 11:1151-1159. [PMID: 32949137 DOI: 10.1093/tbm/ibaa089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Healthy lifestyle interventions that increase physical activity and healthy dietary habits can help improve the physical health of people with serious mental illness (SMI). Yet, these interventions are not implemented in routine practice settings. This mixed methods study examined the decisions that leaders from three supportive housing agencies made as they planned to sustain a peer-led healthy lifestyle intervention for people with SMI at the end of a clinical trial. A combination of implementation strategies that addressed cost concerns, generated local evidence of the intervention's benefits, and provided ongoing training was identified as important for sustainability. A sustainability model illustrating implementation strategies and mechanisms for supporting three sustainability domains (funding, organizational capacity, and adaptation) was prioritized by participants. Study findings can inform future studies testing strategies and mechanisms to support the sustainability of interventions in routine practice settings to improve the physical health of people with SMI.
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Affiliation(s)
- Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St. Louis Campus Box 1196, St. Louis, MO, USA
| | - Ana Stefancic
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - Daniela Tuda
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Christopher Weatherly
- Brown School of Social Work, Washington University in St. Louis Campus Box 1196, St. Louis, MO, USA
| | - Rebecca Lengnick-Hall
- Brown School of Social Work, Washington University in St. Louis Campus Box 1196, St. Louis, MO, USA
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12
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Stefancic A, Bochicchio L, Tuda D, Harris Y, DeSomma K, Cabassa LJ. Strategies and Lessons Learned for Supporting and Supervising Peer Specialists. Psychiatr Serv 2021; 72:606-609. [PMID: 33657843 PMCID: PMC8656242 DOI: 10.1176/appi.ps.202000515] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As peer-delivered services are increasingly embedded within behavioral health organizations, a need has arisen to identify practices that facilitate supervision and support of peer providers. The authors present supervision strategies and lessons learned that emerged during a large pragmatic trial in three supportive housing agencies that examined a peer-delivered healthy lifestyle intervention for people with serious mental illness. Strategies included access to multiple supervisors, formal and informal support, acknowledgment of lack of role clarity, ongoing role negotiation, a collaborative approach to troubleshooting challenges, explicit emphasis on peer specialists' value, and linking peer specialists to opportunities for mutual support and professional development.
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Affiliation(s)
- Ana Stefancic
- Department of Psychiatry (Stefancic), School of Nursing (Bochicchio), and School of Social Work (Harris), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Edward J. Bloustein School of Planning and Public Policy at Rutgers, State University of New Jersey, New Brunswick (DeSomma). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Lauren Bochicchio
- Department of Psychiatry (Stefancic), School of Nursing (Bochicchio), and School of Social Work (Harris), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Edward J. Bloustein School of Planning and Public Policy at Rutgers, State University of New Jersey, New Brunswick (DeSomma). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Daniela Tuda
- Department of Psychiatry (Stefancic), School of Nursing (Bochicchio), and School of Social Work (Harris), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Edward J. Bloustein School of Planning and Public Policy at Rutgers, State University of New Jersey, New Brunswick (DeSomma). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Yonnie Harris
- Department of Psychiatry (Stefancic), School of Nursing (Bochicchio), and School of Social Work (Harris), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Edward J. Bloustein School of Planning and Public Policy at Rutgers, State University of New Jersey, New Brunswick (DeSomma). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Kendra DeSomma
- Department of Psychiatry (Stefancic), School of Nursing (Bochicchio), and School of Social Work (Harris), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Edward J. Bloustein School of Planning and Public Policy at Rutgers, State University of New Jersey, New Brunswick (DeSomma). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
| | - Leopoldo J Cabassa
- Department of Psychiatry (Stefancic), School of Nursing (Bochicchio), and School of Social Work (Harris), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Edward J. Bloustein School of Planning and Public Policy at Rutgers, State University of New Jersey, New Brunswick (DeSomma). Debra A. Pinals, M.D., Enrico G. Castillo, M.D., M.S.H.P.M., and Ayorkor Gaba, Psy.D., are editors of this column
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Stefancic A, Bochicchio L, Tuda D, Gurdak K, Cabassa LJ. Participant Experiences With a Peer-Led Healthy Lifestyle Intervention for People With Serious Mental Illness. Psychiatr Serv 2021; 72:530-538. [PMID: 33657839 PMCID: PMC8500678 DOI: 10.1176/appi.ps.202000311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explored the experiences of individuals with serious mental illness who were predominantly Black, were living in supportive housing, and participated in the Peer-Led Group Lifestyle Balance (PGLB) intervention. The authors examined how participants engaged in the process of behavior change and applied intervention concepts. METHODS Focus groups and interviews with 63 participants explored their motivation for engaging with PGLB, challenges to behavior change, and how they integrated intervention strategies into their lives. Interviews were transcribed and analyzed with grounded theory. RESULTS A grounded model summarized the description of the cycle of behavior change and provided insight into participants' decision-making processes. Challenges to engaging in healthy lifestyle change were related to participants' general medical health, time constraints, lack of knowledge, difficulties breaking old habits and changing self-perceptions, mood state, and the social-physical environment. Participants applied many intervention strategies, such as addressing problematic social cues, contexts, and food associations; planning ahead; starting with smaller changes; portion control; food substitution; mindful eating; and integrating changes into their daily lives. They reported various behavior changes with respect to eating and physical activity and more limited shifts in self-monitoring. CONCLUSIONS Improving the health of people with serious mental illness will require expanding their access to healthy lifestyle interventions in community-based settings. The findings suggest that future interventions should expand support for self-monitoring, meal planning, tailored physical activity, and advocacy. Such interventions should also enhance participants' understanding of the corresponding impact of changes on weight loss and emphasize subjective wellness outcomes to maintain motivation.
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Affiliation(s)
- Ana Stefancic
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
| | - Lauren Bochicchio
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
| | - Daniela Tuda
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
| | - Kristen Gurdak
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
| | - Leopoldo J Cabassa
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
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Cabassa LJ, Stefancic A, Lewis-Fernández R, Luchsinger J, Weinstein LC, Guo S, Palinkas L, Bochicchio L, Wang X, O'Hara K, Blady M, Simiriglia C, Medina McCurdy M. Main Outcomes of a Peer-Led Healthy Lifestyle Intervention for People With Serious Mental Illness in Supportive Housing. Psychiatr Serv 2021; 72:555-562. [PMID: 33334158 PMCID: PMC8607694 DOI: 10.1176/appi.ps.202000304] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The effectiveness of the Peer-led Group Lifestyle Balance (PGLB) intervention, a 12-month manualized healthy lifestyle intervention delivered by peer specialists, was investigated in a sample of persons with serious mental illness who were overweight or obese and living in supportive housing. METHODS The authors randomly assigned 314 participants from three supportive housing agencies to PGLB or usual care, with assessments at baseline and 6, 12, and 18 months. Outcomes were clinically significant changes from baseline in weight (≥5% weight loss), cardiorespiratory fitness (CRF; increase of ≥50 meters in the 6-minute walk test), and cardiovascular disease (CVD) risk reduction (clinically significant weight loss or CRF improvement). RESULTS Most participants were from racial-ethnic minority groups (82%, N=255). The mean±SD baseline weight of this sample was 218.8±54.0 pounds, and the body mass index was 33.7±7.2. Compared with the usual care group, a larger proportion of the PGLB group achieved clinically significant changes in study outcomes at 12 and 18 months, but none of these changes was statistically significant. Outcomes differed by site: two sites reported no significant differences between the two groups, and one reported that PGLB significantly outperformed usual care on clinically significant weight loss at 18 months and CVD risk reduction at 6 and 12 months. CONCLUSIONS The null findings indicate that PGLB was not superior to usual care in helping participants achieve clinically significant changes in weight, CRF, and CVD risk reduction at 12 and 18 months. Questions remain regarding how PGLB works, for whom, and in which settings.
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Affiliation(s)
- Leopoldo J Cabassa
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Ana Stefancic
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Roberto Lewis-Fernández
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - José Luchsinger
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Lara Carson Weinstein
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Shenyang Guo
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Lawrence Palinkas
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Lauren Bochicchio
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Xiaoyan Wang
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Kathleen O'Hara
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Michael Blady
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Christine Simiriglia
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Monica Medina McCurdy
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
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Cheung A, Cui Z, Hamada K, Selland J, Chiang M, Fan X. Walking together: Exploring perspectives, attitudes, and barriers on nutrition and exercise among individuals with serious mental illness. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01630-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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"Being There" vs "Being Direct:" Perspectives of Persons with Serious Mental Illness on Receiving Support with Physical Health from Peer and Non-Peer Providers. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:539-550. [PMID: 33479782 DOI: 10.1007/s10488-020-01098-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/16/2022]
Abstract
Individuals with serious mental illness (SMI) face significant health disparities and multiple barriers to engaging in health behavior change. To reduce these health disparities, it is necessary to enhance the support individuals with SMI receive through the collaboration of different healthcare providers. This study explored how people with SMI living in supportive housing perceived receiving support from peer and non-peer providers for their physical health. Qualitative interviews were conducted with 28 participants receiving a peer-led healthy lifestyle intervention in the context of a randomized trial in supportive housing agencies. Interviews explored participants' experiences working with the healthy lifestyle peer specialist and a non-peer provider who assisted them with health. Interviews were audio recorded, transcribed, and analyzed using strategies rooted in grounded theory. Participants viewed their relationships with peer and non-peer providers positively, but described differences in the approach to practice, power dynamics present, and how they identified with each provider. Participants described peers as process-oriented while non-peer staff as task-oriented, focusing on accomplishing concrete objectives. Each provider sought to boost participants' motivation, but peers built hope by emphasizing the possibility of change, while non-peer providers emphasized the consequences of inaction. Participants related to peer staff through shared experiences, while identifying the importance of having a shared treatment goal with their non-peer provider. Overall, participants appreciated the unique roles of both peer and non-peer staff in supporting their health. Study findings have implications for integrating the use of peer-based health interventions to improve the health of people with SMI.
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Froehlich-Grobe K, Betts AC, Driver SJ, Carlton DN, Lopez AM, Lee J, Kramer MK. Group Lifestyle Balance Adapted for Individuals With Impaired Mobility: Outcomes for 6-Month RCT and Combined Groups at 12 Months. Am J Prev Med 2020; 59:805-817. [PMID: 33160798 PMCID: PMC7810163 DOI: 10.1016/j.amepre.2020.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION This study examines the feasibility and effectiveness of an intensive lifestyle intervention adapted for people with impaired mobility. STUDY DESIGN This was a randomized, wait-list controlled trial. The experimental group immediately received the 12-month weight loss program; the wait-list control group received it after a 6-month delay. Between-group comparisons were conducted for the 6-month RCT study design. Repeated measures were conducted for both groups combined after receiving the 12-month intervention. Data were collected August 2015-February 2017 and analyzed in 2017. SETTING/PARTICIPANTS A community-based sample received 23, group-based sessions via a mix of telephone and in-person sessions in a hospital-based setting. Participants with impaired mobility (n=66) were middle-aged (49.80 [SD=11.37] years), mostly White (66.7%), female (66.7%), and most commonly had spinal cord injury (47.0%). INTERVENTION The 12-month intervention delivered 23 group-based sessions that promoted weight loss through reducing caloric intake and increasing physical activity. MAIN OUTCOME MEASURES Primary outcomes were effectiveness measured as change in weight and time spent in moderate physical activity. Feasibility was assessed in 12-month combined group analyses, measured as retention, attendance, and dietary self-monitoring. RESULTS The 6-month RCT results showed that the immediate and delayed groups differed significantly (p<0.05) in weight (-1.66 [SD=4.42] kg loss vs 0.05 [SD=4.15] kg gain) and moderate physical activity (52.93 [SD=90.74] minutes/week increase vs -14.22 [SD=96.02] minutes/week decrease), accounting for baseline weight, time with disability, and age of onset. The 12-month results with groups combined demonstrated 74.2% retention and 77.7% core session attendance. Self-monitoring was higher in the delayed group (77.3%), who used a smartphone app, than the immediate group (47.3%), who mostly used paper trackers. Participants achieved significant 12-month weight loss of 3.31 (SD=10.13) kg (d=0.33) in mixed modeling analyses with groups combined yet did not significantly increase moderate physical activity. CONCLUSIONS Group Lifestyle Balance Adapted for Individuals with Impaired Mobility is a feasible, effective approach to teach healthy lifestyle skills to individuals with mobility impairment, yielding modest weight loss and enhanced self-efficacy. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT03307187.
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Affiliation(s)
| | - Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Dallas, Texas
| | - Simon J Driver
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas
| | | | | | - Jaehoon Lee
- Department of Educational Psychology and Leadership, Texas Tech University, Lubbock, Texas
| | - M Kaye Kramer
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Peer navigation for individuals with serious mental illness leaving jail: a pilot randomized trial study protocol. Pilot Feasibility Stud 2020; 6:114. [PMID: 32821420 PMCID: PMC7429745 DOI: 10.1186/s40814-020-00659-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Serious mental illness (SMI) is a prevalent public health problem affecting 25% of individuals in jail. Re-entry to the community following incarceration is a vulnerable time for justice-involved individuals with SMI. SMI requires prompt and ongoing access to mental health and other healthcare services. Methods The study will (1) develop a Mentoring And Peer Support (MAPS) intervention for post-release mental health and other service connection among jailed individuals with SMI and (2) pilot test the MAPS intervention to determine its feasibility and acceptability. The primary outcomes will be to evaluate the feasibility and acceptability of the proposed recruitment methods and research design, of the intervention training methods, and of delivering the enhanced peer-navigator and control interventions. Study samples include focus groups (n=36), open trial (n=15), and a randomized pilot trial in a sample of 40 individuals with SMI re-entering the community after jail release. Secondary outcomes will include post-release enrollment in mental health, medical care, and substance use services. We will also evaluate reduction in psychiatric symptoms, improvements in functioning, adherence to psychiatric medications, fewer substance using days, fewer hospitalizations and suicide attempts, nights unstably housed, and time until rearrest. Discussion This pilot study will evaluate the feasibility and acceptability of a peer navigation intervention for individuals with serious mental illness leaving jails. The study will serve as a formative work for a larger randomized controlled trial assessing the effectiveness of peer navigator intervention for (include the primary outcome) in this population.
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Bitter N, Roeg D, van Nieuwenhuizen C, van Weeghel J. Recovery in Supported Accommodations: A Scoping Review and Synthesis of Interventions for People with Severe Mental Illness. Community Ment Health J 2020; 56:1053-1076. [PMID: 32016620 PMCID: PMC7289772 DOI: 10.1007/s10597-020-00561-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/26/2020] [Indexed: 11/30/2022]
Abstract
Research on the recovery domains beside clinical recovery of people with severe mental illness in need of supported accommodations is limited. The aim of this study was (1) to investigate which recovery interventions exist for this group of people and (2) to explore the scientific evidence. We conducted a scoping review, including studies with different designs, evaluating the effectiveness the recovery interventions available. The search resulted in 53 eligible articles of which 22 focused on societal recovery, six on personal recovery, five on functional recovery, 13 on lifestyle-interventions, and seven on creative and spiritual interventions. About a quarter of these interventions showed added value and half of them initial promising results. The research in this area is still limited, but a number of recovery promoting interventions on other areas than clinical recovery have been developed and evaluated. Further innovation and research to strengthen and repeat the evidence are needed.
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Affiliation(s)
- Neis Bitter
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands
| | - Diana Roeg
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
| | - Chijs van Nieuwenhuizen
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.,GGzE Institute for Mental Health Care, PO Box 909, 5600, AX, Eindhoven, The Netherlands
| | - Jaap van Weeghel
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.,Phrenos Centre of Expertise, PO Box 1203, 3500, BE, Utrecht, The Netherlands.,Parnassia Group, Dijk en Duin Mental Health Centre, PO Box 305, 1900, AH, Castricum, The Netherlands
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Bochicchio L, Stefancic A, Gurdak K, Swarbrick M, Cabassa LJ. "We're All in this Together": Peer-specialist Contributions to a Healthy Lifestyle Intervention for People with Serious Mental Illness. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:298-310. [PMID: 30565004 DOI: 10.1007/s10488-018-0914-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This qualitative study explored peer specialists' contributions to a healthy lifestyle intervention for obese/overweight individuals with serious mental illness (SMI) living in supportive housing. Intervention participants, peer specialists, and supervisors were interviewed and a grounded model emerged from the data identifying essential interpersonal attributes of the peer specialist-participant relationship. Peer specialists' disclosure of their own experiences making health behaviors changes was critical for building participants' motivation and ability to try lifestyle changes. Findings can inform peer specialist training and practice standards and facilitate the expansion of peer-delivered interventions to improve the physical health of people with SMI.
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Affiliation(s)
- Lauren Bochicchio
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Ana Stefancic
- Department of Psychiatry, Columbia University, 1051 Riverside Dr., Rm 6203, New York, NY, 10031, USA
| | - Kristen Gurdak
- Department of Psychiatry, Columbia University, 1051 Riverside Dr., Rm 6203, New York, NY, 10031, USA
| | - Margaret Swarbrick
- Collaborative Support Programs of New Jersey, Rutgers Behavioral Health Care, 11 Spring Street, Freehold, NJ, 07728, USA
| | - Leopoldo J Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
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Cabassa LJ, Stefancic A. Context before implementation: a qualitative study of decision makers' views of a peer-led healthy lifestyle intervention for people with serious mental illness in supportive housing. Transl Behav Med 2019; 9:217-226. [PMID: 29660091 DOI: 10.1093/tbm/iby034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
People with serious mental illness die at an earlier age than people in the general population largely due to cardiovascular disease. Healthy lifestyle interventions can help reduce this health inequity. In this qualitative study, we examined the perceptions that decision makers in supportive housing agencies had toward a peer-led healthy lifestyle intervention and their views of contextual factors that could shape implementation at these agencies. A purposive sample of 12 decision makers from three supportive housing agencies was recruited. We presented participants a vignette describing our peer-led intervention and used semistructured qualitative interviews to examine their views. Interviews were recorded, professionally transcribed, and analyzed using directed content analysis. Participants reported positive views toward the intervention with the most valued intervention attributes being relative advantage over existing services, compatibility to clients' needs, ability to pilot the intervention, and cost. A model emerged from our data depicting multilevel contextual factors believed to shape the implementation of our intervention at these agencies, including system- (funding, marketability, and external regulations), organization- (leadership support, fit with organization, staff buy-in and burden), and client-level (adaptability to clients' needs, and clients' buy-in) factors. Study findings illustrate the importance of understanding the context of practice before implementation. This examination can help identify critical views from decision makers that could undermine or advance the integration of peer-led interventions in supportive housing agencies and help identify structures, policies, and organizational practices that can inform the implementation process.
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Affiliation(s)
- Leopoldo J Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Ana Stefancic
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Wu C, Chiang M, Natarajan R, Fusaro-Davis M, Cimpeanu C, Liu M, Harrington A, Fan X. Pilot lifestyle education intervention for patients with severe mental illness during the inpatient stay. Asian J Psychiatr 2019; 40:15-17. [PMID: 30673623 DOI: 10.1016/j.ajp.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/09/2019] [Accepted: 01/16/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Carrie Wu
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, United States
| | - Mathew Chiang
- University of Rochester, Rochester, NY, United States
| | - Radhika Natarajan
- Psychotic Disorders Program, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, United States
| | | | | | - Mark Liu
- Psychotic Disorders Program, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, United States
| | - Amy Harrington
- Psychotic Disorders Program, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, United States
| | - Xiaoduo Fan
- Psychotic Disorders Program, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, United States.
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Vélez-Grau C, Stefancic A, Cabassa LJ. Keeping the Peer in Peer Specialist When Implementing Evidence-Based Interventions. HEALTH & SOCIAL WORK 2019; 44:57-60. [PMID: 30561634 PMCID: PMC6676967 DOI: 10.1093/hsw/hly037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/04/2018] [Accepted: 06/11/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Carolina Vélez-Grau
- Carolina Vélez-Grau, LCSW, is a doctoral student and graduate research assistant, School of Social Work, Columbia University, New York. Ana Stefancic, PhD, is associate research scientist, Department of Psychiatry, Columbia University, New York. Leopoldo J. Cabassa, PhD, MSW, is associate professor, George Warren Brown School of Social Work, Washington University in St. Louis
| | - Ana Stefancic
- Carolina Vélez-Grau, LCSW, is a doctoral student and graduate research assistant, School of Social Work, Columbia University, New York. Ana Stefancic, PhD, is associate research scientist, Department of Psychiatry, Columbia University, New York. Leopoldo J. Cabassa, PhD, MSW, is associate professor, George Warren Brown School of Social Work, Washington University in St. Louis
| | - Leopoldo J Cabassa
- Carolina Vélez-Grau, LCSW, is a doctoral student and graduate research assistant, School of Social Work, Columbia University, New York. Ana Stefancic, PhD, is associate research scientist, Department of Psychiatry, Columbia University, New York. Leopoldo J. Cabassa, PhD, MSW, is associate professor, George Warren Brown School of Social Work, Washington University in St. Louis
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Quiñones MM, Lombard-Newell J, Sharp D, Way V, Cross W. Case study of an adaptation and implementation of a Diabetes Prevention Program for individuals with serious mental illness. Transl Behav Med 2018; 8:195-203. [PMID: 29346678 DOI: 10.1093/tbm/ibx064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Diabetes Prevention Program (DPP) is an evidence-based lifestyle intervention developed to decrease the risk for type 2 diabetes and promote weight loss in individuals at risk for diabetes. Individuals with serious mental illness have a greater risk for developing diabetes compared with the general population. In this article, the authors provide a detailed description of the adaptation process of the DPP for individuals with serious mental illness (DPP-SMI). The adaptation process was based on a cultural adaptation framework for modifying evidence-based interventions. To assess the effectiveness of the DPP-SMI, 11 individuals from a community mental health residential agency completed a 22-session pilot study of the adapted program and provided physiological measures before and after the intervention. As primary outcomes, participants were expected to report decreased body weight and increased physical activity per week. Completers had an average weight loss of 19 lbs (8%) and their physical activity increased from 161 to 405 min per week. These preliminary results together with participants' feedback informed further refinement of the DPP-SMI. This case study supports that individuals with serious mental illness can benefit from the DPP-SMI, which is tailored to meet the unique needs of this population group.
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Affiliation(s)
- Maria M Quiñones
- School of Nursing, University of Rochester Medical Center, Rochester, NY
| | | | - Daryl Sharp
- School of Nursing, University of Rochester Medical Center, Rochester, NY
| | | | - Wendi Cross
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
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Mueller NE, Panch T, Macias C, Cohen BM, Ongur D, Baker JT. Using Smartphone Apps to Promote Psychiatric Rehabilitation in a Peer-Led Community Support Program: Pilot Study. JMIR Ment Health 2018; 5:e10092. [PMID: 30111526 PMCID: PMC6115596 DOI: 10.2196/10092] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/18/2018] [Accepted: 05/29/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Management of severe and persistent mental illness is a complex, resource-intensive challenge for individuals, their families, treaters, and the health care system at large. Community-based rehabilitation, in which peer specialists provide support for individuals managing their own condition, has demonstrated effectiveness but has only been implemented in specialty centers. It remains unclear how the peer-based community rehabilitation model could be expanded, given that it requires significant resources to both establish and maintain. OBJECTIVE Here, we describe the results from a study of one such program implemented within Waverley Place, a community support program at McLean Hospital, emphasizing psychiatric rehabilitation for individuals with severe and persistent mental illness, as well as describing the challenges encountered during the implementation of the program. Key questions were whether the patients could, and would, successfully use the app. METHODS The smartphone app offered multiple features relevant to psychiatric rehabilitation, including daily task lists, activity tracking, and text messaging with peer specialists. A 90-day program of activities, goals, and content specific to the community support program was created on the basis of a prior pilot, in collaboration between members of the app development team (WellFrame), and peers, clinical, and research staff associated with the program. Hospital research staff recruited patients into the study, monitored peer and patient engagement, and handled all raw data acquired from the study. RESULTS Of 100 people approached for the study, a total of 13 provided consent, of which 10 downloaded and used the app. Two patients were unable to complete the app installation. Five used the app regularly as part of their daily lives for at least 20 days of the 90-day program. We were unable to identify any specific factors (eg, clinical or demographic) that affected willingness to consent or engage with the app platform in the very limited sample, although the individuals with significant app use were generally satisfied with the experience. CONCLUSIONS Smartphone apps may become a useful tool for psychiatric rehabilitation, addressing both psychiatric and co-occurring medical problems. Individualizing functions to each patient and facilitating connection with a certified peer specialist may be an important feature of useful apps. Unlike prior reports emphasizing that patients with schizophrenia will adopt smartphone platforms, we found that implementation of digital tools into existing community support programs for severe and persistent mental illness has many challenges yet to be fully overcome to realize the potential benefits such apps could have to promote systematization and cost reduction for psychiatric rehabilitation.
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Affiliation(s)
- Nora E Mueller
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
| | | | - Cathaleene Macias
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Bruce M Cohen
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Dost Ongur
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Justin T Baker
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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