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Sacco R, Camilleri N, Eberhardt J, Umla-Runge K, Newbury-Birch D. A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe. Eur Child Adolesc Psychiatry 2022:10.1007/s00787-022-02131-2. [PMID: 36581685 PMCID: PMC9800241 DOI: 10.1007/s00787-022-02131-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 12/14/2022] [Indexed: 12/31/2022]
Abstract
Most mental disorders appear by age 14, but in most cases, they remain undiagnosed and untreated well into adulthood. A scoping review showed an absence of systematic reviews that address prevalence rates of mental disorders among children and adolescents in Europe that are based on community studies conducted between 2015 and 2020. To estimate the updated pooled prevalence of Anxiety Disorder, Depressive Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), Autism Spectrum Disorder, Eating Disorders, Substance Use Disorders (SUD), among children and adolescents living in Europe, a search strategy was conducted using MEDLINE, Embase and Psych Info and studies were also identified from reference lists and gray literature. Eligible studies were evaluated for reliability, validity, and bias. Trends of prevalence rates for each mental disorder were calculated. Almost one in five young people in Europe were found to suffer from a mental disorder, with a pooled prevalence rate of 15.5%. Anxiety disorders had the highest pooled prevalence rate (7.9% (95% CI 5.1-11.8%, I2: 98.0%)), followed by ADHD (2.9% (95% CI 1.2-6.9%, I2 = 94.3%)), ODD (1.9% (95% CI 1.0-3.7%, I2 = 98.4%)), depressive disorder (1.7% (95% CI 1.0-2.9%, I2 = 97.7%)), CD (1.5% (95% CI 0.6-3.8%, I2 = 98.8%)) and ASD (1.4% (95% CI 0.4-5.4%, I2 = 99.7%). No studies on SUD were identified. The mental health of children and adolescents may be improved by introducing routine screening, refining diagnostic sensitivity, raising awareness of mental disorders, minimizing stigma and socioeconomic inequality, as well as developing early intervention services. These facilitators of good mental health need to be prioritized, especially at a time of unprecedented risk factors for poor mental health.
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Affiliation(s)
- Rosemarie Sacco
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK.
- School of Medicine, Cardiff University, Cardiff, Wales.
- School of Medicine and Surgery, University of Malta, Msida, Malta.
- Mental Health Services, Attard, Malta.
| | - Nigel Camilleri
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
- School of Medicine and Surgery, University of Malta, Msida, Malta
- Mental Health Services, Attard, Malta
| | - Judith Eberhardt
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | | | - Dorothy Newbury-Birch
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
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2
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Lu W, Oursler J, Herrick SJ, Gao N, Beninato J, Bazan C, Hill K, Minor T. Feasibility of Work-Related Interviewing and Conversational Skills Trainings for Individuals With Psychiatric Disabilities. REHABILITATION COUNSELING BULLETIN 2022. [DOI: 10.1177/00343552221102398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the feasibility of group interventions using the Direct Skills Teaching (DST) approach to teach interview preparedness skills (“Presenting Qualifications”) and basic work-related conversational skills (“Conversing with Others”) to individuals with psychiatric disabilities. This quasi-experimental pilot study included 87 participants in Study 1 and 55 participants in Study 2, all with various psychiatric diagnoses. Each group intervention consisted of four sessions delivered by graduate counseling students. Participants reported increased confidence in presenting qualifications at interviews in Study 1, and in conversational skills at work in Study 2. Participants in both studies reported high levels of satisfaction with the respective group intervention. The results of the study supported the feasibility of DST group interventions designed to teach work-related skills to individuals with psychiatric disabilities.
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Affiliation(s)
- Weili Lu
- Rutgers, The State University of New Jersey, Piscataway, USA
| | - Janice Oursler
- Rutgers, The State University of New Jersey, Piscataway, USA
| | | | - Ni Gao
- Rutgers, The State University of New Jersey, Piscataway, USA
| | - John Beninato
- Rutgers, The State University of New Jersey, Piscataway, USA
| | - Carolyn Bazan
- Rutgers, The State University of New Jersey, Piscataway, USA
| | - Kendall Hill
- Rutgers, The State University of New Jersey, Piscataway, USA
| | - Tameika Minor
- Rutgers, The State University of New Jersey, Piscataway, USA
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3
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Hong JP, Lee CH, Lee YH, Escorpizo R, Chiang YC, Liou TH. Functional status and return to work in people with major depression: a 3-year national follow-up study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1179-1188. [PMID: 35150307 DOI: 10.1007/s00127-022-02240-y] [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: 08/03/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Major depressive disorder (MDD) affects a person's function of daily activities, including work participation. Such functional impairments often persist even when other symptoms of MDD are remitted. Increasing evidence highlights the health-promoting effects of returning to work (RTW) in various diseases. However, limited data are available regarding the impact of return to work on functional recovery in MDD. We explored the association between RTW and functional improvements in people with MDD using a large nationally representative database and a 3-year follow-up. METHODS Data of people with an MDD diagnosis were selected from the Taiwan Data Bank of Persons with disability for the period between July 11, 2012, and October 31, 2018. We included 4038 adults aged 18-64 years. The World Health Organization Disability Assessment Schedule 2.0 was used for functional assessment. The association between RTW and functional improvements was investigated using a multivariable regression analysis adjusted for confounding variables. RESULTS Women aged ≥ 45 years with a lower education level were vulnerable to prolonged unemployment. RTW was significantly associated with better functional improvements in cognition, mobility, self-care, getting along, life activity, and participation than unemployment. CONCLUSIONS RTW was positively associated with functional improvements in patients with MDD. A referral system targeting re-employment may be suggested during MDD treatment, especially for individuals at risk of prolonged unemployment.
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Affiliation(s)
- Jia-Pei Hong
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291 Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan
| | - Chih-Hong Lee
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Department of Neurology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hao Lee
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291 Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Yu-Chen Chiang
- Department of Psychiatry, Taipei Medical University Shuang Ho Hospital, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291 Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan. .,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Hill A, Mann DR, Gellar J. Predicting program outcomes for vocational rehabilitation customers: A machine learning approach. JOURNAL OF VOCATIONAL REHABILITATION 2022. [DOI: 10.3233/jvr-221176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The Vocational Rehabilitation (VR) program provides support and services to people with disabilities who want to work. OBJECTIVE: Approximately one-third of eligible VR customers are employed when they exit the program. The remainder either exit without ever receiving services or without employment after receiving services. In this study, we explore how customer characteristics and VR services predict these outcomes. METHODS: We examined VR case level data from the RSA-911 files. Machine learning techniques allowed us to explore a large number of potential predictors of VR outcomes while requiring fewer assumptions than traditional regression methods. RESULTS: Consistent with existing literature, customers who are employed at application are more likely to exit with employment, and those with mental health conditions or low socioeconomic status are less likely to exit with employment. Some customers with low or no earnings at application who are not identified in prior studies are more likely than others to have poor program outcomes, including those with developmental disability who are under 18, customers without developmental or learning disabilities, and customers who do not receive employment or restoration services. CONCLUSIONS: VR counselors and administrators should consider implementing early, targeted interventions for newly identified at-risk groups of VR customers.
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Zheng K, Stern BZ, Wafford QE, Kohli-Lynch CN. Trial-Based Economic Evaluations of Supported Employment for Adults with Severe Mental Illness: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:440-452. [PMID: 35037105 DOI: 10.1007/s10488-021-01174-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
To identify, appraise, and summarize outcomes reported in trial-based economic evaluations of Individual Placement and Support programs for adults with severe mental illness. Six databases were searched, including Medline, PsycINFO, CINAHL, Cochrane, Scopus, and EconLit. Inclusion criteria were trial-based, full economic evaluations comparing Individual Placement and Support programs to traditional vocational rehabilitation programs for adults 18 years and older with severe mental illness. Study quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards statement. Of the 476 articles identified in the database search, seven were included in the review. Studies conducted across Europe (n = 4) and Japan (n = 1) suggested that Individual Placement and Support may be a cost-effective alternative to traditional vocational rehabilitation programs. Two studies conducted in the United States demonstrated that Individual Placement and Support led to better vocational outcomes, but at neutral or higher costs than traditional vocational rehabilitation, depending on the benefit measure used. Trial-based economic evaluations of supported employment for adults with severe mental illness are limited and heterogeneous. The interpretation of economic outcomes warrants consideration of factors that may impact cost-effectiveness, such as geographical location. Future studies should evaluate whether the benefits of IPS outweigh additional costs for patients and other stakeholders.
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Affiliation(s)
- Katherine Zheng
- Feinberg School of Medicine, Northwestern University, 633 N. Saint Clair St, 20th Floor, Chicago, IL, 60611, USA.
| | - Brocha Z Stern
- Feinberg School of Medicine, Northwestern University, 633 N. Saint Clair St, 20th Floor, Chicago, IL, 60611, USA
| | - Q Eileen Wafford
- Feinberg School of Medicine, Northwestern University, 633 N. Saint Clair St, 20th Floor, Chicago, IL, 60611, USA
| | - Ciaran N Kohli-Lynch
- Feinberg School of Medicine, Northwestern University, 633 N. Saint Clair St, 20th Floor, Chicago, IL, 60611, USA
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Park AL, Rinaldi M, Brinchmann B, Killackey E, Aars NAP, Mykletun A, McDaid D. Economic analyses of supported employment programmes for people with mental health conditions: A systematic review. Eur Psychiatry 2022; 65:e51. [PMID: 35983840 PMCID: PMC9491084 DOI: 10.1192/j.eurpsy.2022.2309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Abstract
Background
Employment is intrinsic to recovery from mental health conditions, helping people live independently. Systematic reviews indicate supported employment (SE) focused on competitive employment, including individual placement and support (IPS), is effective in helping people with mental health conditions into work. Evidence is limited on cost-effectiveness. We comprehensively reviewed evidence on the economic case for SE/IPS programmes.
Methods
We searched PubMed/MEDLINE, EMBASE, PsycINFO, CINAHL, IBSS, Business Source Complete, and EconLit for economic and return on investment analyses of SE/IPS programmes for mental health conditions. Traditional vocational rehabilitation, sheltered work, and return to work initiatives after sickness absence of less than 1 year were excluded. Studies were independently screened by two reviewers. We assessed quality using the Consolidate Health Economic Evaluation Reporting Standards checklist. The protocol was preregistered with PROSPERO-CRD42020184359.
Results
From 40,015 references, 28 studies examined the economic case for IPS, four IPS augmented by another intervention, and 24 other forms of SE. Studies were very heterogenous, quality was variable. Of 41 studies with quality scores over 50%, 10 reported cost per quality-adjusted life year gained, (8 favourable to SE/IPS), 14 net monetary benefits (12 positive), 5 return on investment (4 positive), and 20 cost per employment outcome (14 favorable, 5 inconclusive, 1 negative). Totally, 24 of these 41 studies had monetary benefits that more than outweighed the additional costs of SE/IPS programmes.
Conclusions
There is a strong economic case for the implementation of SE/IPS programmes. The economic case is conservative as evidence on long-term impacts of programmes is limited.
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Golberstein E, Busch SH, Sint K, Rosenheck RA. Insurance Status and Continuity for Young Adults With First-Episode Psychosis. Psychiatr Serv 2021; 72:1160-1167. [PMID: 33971726 PMCID: PMC8488003 DOI: 10.1176/appi.ps.201900571] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Insurance status and continuity may affect access to and quality of care. The authors characterized patterns of and changes in insurance status over 1 year among people with first-episode psychosis (FEP), comparing insurance patterns with adults of similar age in the general population. METHODS Longitudinal data on insurance status and predictors of insurance status among adults with FEP were obtained from RAISE-ETP (Recovery After an Initial Schizophrenia Episode-Early Treatment Program) study participants with complete 1-year data (N=288). The frequencies of insurance status and transitions are presented. Bivariate comparisons were used to assess the impact of the comprehensive coordinated care intervention in RAISE-ETP on insurance changes. These data were compared with contemporaneous longitudinal data in the 2011 Medical Expenditures Panel Study. RESULTS The RAISE-ETP experimental intervention did not significantly change insurance status. At baseline, levels of uninsurance (47%) and public insurance (31%) were higher among RAISE-ETP participants than among a similar age group in the general public (29% and 13%, respectively). Insurance transitions were common among people with FEP, although 79% of those with public insurance at baseline also had public insurance at 1 year. Of studied RAISE-ETP participants, 60% had a period of uninsurance during the year studied. CONCLUSIONS Compared with a national sample, people with FEP were more likely to use public insurance but still had high persistence of 12-month uninsurance. That over half of the RAISE-ETP participants had a period of uninsurance suggests that more research is needed on whether these periods affect treatment continuity and medication adherence.
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Affiliation(s)
- Ezra Golberstein
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein); Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut (Sint); Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, and Mental Illness Research, Education and Clinical Center of New England, U.S. Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (Rosenheck)
| | - Susan H Busch
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein); Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut (Sint); Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, and Mental Illness Research, Education and Clinical Center of New England, U.S. Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (Rosenheck)
| | - Kyaw Sint
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein); Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut (Sint); Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, and Mental Illness Research, Education and Clinical Center of New England, U.S. Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (Rosenheck)
| | - Robert A Rosenheck
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein); Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut (Sint); Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, and Mental Illness Research, Education and Clinical Center of New England, U.S. Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (Rosenheck)
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McGinty EE, Murphy KA, Dalcin AT, Stuart EA, Wang NY, Dickerson F, Gudzune K, Jerome G, Thompson D, Cullen BA, Gennusa J, Kilbourne AM, Daumit GL. A Model for Advancing Scale-Up of Complex Interventions for Vulnerable Populations: the ALACRITY Center for Health and Longevity in Mental Illness. J Gen Intern Med 2021; 36:500-505. [PMID: 32869192 PMCID: PMC7878664 DOI: 10.1007/s11606-020-06137-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
Many of the most pressing health issues in the USA and worldwide require complex, multi-faceted solutions. Delivery of such solutions is often complicated by the need to reach and engage vulnerable populations facing multiple barriers to care. While the fields of quality improvement and implementation science have made valuable gains in the development and spread of individual strategies to improve evidence-based practice delivery, models for coordinated deployment of numerous strategies to simultaneously implement multiple evidence-based interventions in vulnerable populations are lacking. In this Perspective, we describe a model for this type of comprehensive research-practice translation effort: the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness, which is focused on reducing premature mortality in the population with serious mental illness. We describe the Center's conceptual framework, which is built upon an integrated set of quality improvement and implementation science frameworks, provide an overview of the Center's organizational structure and core research-practice translation activities, and discuss our vision for how the Center may evolve over time. Lessons learned from this Center's efforts could inform models to address other critical health issues in vulnerable populations that require multi-component solutions at the policy, system, provider, and patient levels.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Karly A Murphy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Arlene T Dalcin
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Kim Gudzune
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gerald Jerome
- Department of Kinesiology, Towson University, Towson, MD, USA
| | - David Thompson
- Department of Anesthesiology and Critical Care and Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bernadette A Cullen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Joseph Gennusa
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amy M Kilbourne
- Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MD, USA
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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9
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McGinty EE, Stone EM, Kennedy-Hendricks A, Bandara S, Murphy KA, Stuart EA, Rosenblum MA, Daumit GL. Effects of Maryland's Affordable Care Act Medicaid Health Home Waiver on Quality of Cardiovascular Care Among People with Serious Mental Illness. J Gen Intern Med 2020; 35:3148-3158. [PMID: 32128686 PMCID: PMC7661675 DOI: 10.1007/s11606-020-05690-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nineteen US states and D.C. have used the Affordable Care Act Medicaid health home waiver to create behavioral health home (BHH) programs for Medicaid beneficiaries with serious mental illness (SMI). BHH programs integrate physical healthcare management and coordination into specialty mental health programs. No studies have evaluated the effects of a BHH program created through the Affordable Care Act waiver on cardiovascular care quality among people with SMI. OBJECTIVE To study the effects of Maryland's Medicaid health home waiver BHH program, implemented October 1, 2013, on quality of cardiovascular care among individuals with SMI. DESIGN Retrospective cohort analysis using Maryland Medicaid administrative claims data from July 1, 2010, to September 30, 2016. We used marginal structural modeling with inverse probability of treatment weighting to account for censoring and potential time-dependent confounding. PARTICIPANTS Maryland Medicaid beneficiaries with diabetes or cardiovascular disease (CVD) participating in psychiatric rehabilitation programs, the setting in which BHHs were implemented. To qualify for psychiatric rehabilitation programs, individuals must have SMI. The analytic sample included BHH and non-BHH participants, N = 2605 with diabetes and N = 1899 with CVD. MAIN MEASURES Healthcare Effectiveness Data and Information Set (HEDIS) measures of cardiovascular care quality including annual receipt of diabetic eye and foot exams; HbA1c, diabetic nephropathy, and cholesterol testing; and statin therapy receipt and adherence among individuals with diabetes, as well as HEDIS measures of annual receipt of cholesterol testing and statin therapy and adherence among individuals with CVD. KEY RESULTS Relative to non-enrollment, enrollment in Maryland's BHH program was associated with increased likelihood of eye exam receipt among individuals with SMI and co-morbid diabetes, but no changes in other care quality measures. CONCLUSIONS Additional financing, infrastructure, and implementation supports may be needed to realize the full potential of Maryland's BHH to improve cardiovascular care for people with SMI.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Elizabeth M Stone
- Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sachini Bandara
- Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karly A Murphy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael A Rosenblum
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Klodnick VV, Malina C, Fagan MA, Johnson RP, Brenits A, Zeidner E, Viruet J. Meeting the Developmental Needs of Young Adults Diagnosed with Serious Mental Health Challenges: the Emerge Model. J Behav Health Serv Res 2020; 48:77-92. [PMID: 32394412 DOI: 10.1007/s11414-020-09699-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Adult providers struggle to engage 18-25-year olds despite high rates of serious mental health challenges observed among this age group. A new model, called "Emerge," combines the intensive outreach and multidisciplinary team-based approach used in Assertive Community Treatment with Positive Youth Development principles and practices used in the Transition to Independence Process Model. Emerge bridges youth and adult services, focuses on supporting transition-to-adulthood milestone achievement, and is a sister team to Coordinated Specialty Care for recent psychosis onset. This paper describes Emerge components, practices, and findings from a feasibility pilot study using agency administrative data. Most prevalent goals were employment and social support/relationship related. The majority made progress on individual goals, engaged in employment and education, and experienced decreased psychiatric hospitalizations. Community mental health policy and practice implications are discussed, including funding blending of evidence-based practices for those transitioning to adulthood with youth-onset serious mental health conditions.
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Affiliation(s)
- Vanessa V Klodnick
- Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA.
- Research & Innovation, Youth & Young Adult Services, Thresholds, Chicago, IL, USA.
| | - Candy Malina
- Youth & Young Adult Services, Thresholds, Chicago, IL, USA
| | - Marc A Fagan
- Youth & Young Adult Services, Thresholds, Chicago, IL, USA
| | - Rebecca P Johnson
- Research & Innovation, Youth & Young Adult Services, Thresholds, Chicago, IL, USA
| | - Ariel Brenits
- Research & Innovation, Youth & Young Adult Services, Thresholds, Chicago, IL, USA
| | - Eva Zeidner
- Youth & Young Adult Services, Thresholds, Chicago, IL, USA
| | - Jose Viruet
- Youth & Young Adult Services, Thresholds, Chicago, IL, USA
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Implementing Adapted Individual Placement and Support (IPS) Supported Employment for Transition-Age Youth in Texas. Community Ment Health J 2020; 56:513-523. [PMID: 31768929 DOI: 10.1007/s10597-019-00508-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
Transition-age youth (TAY, ages 14-26) diagnosed with serious mental health conditions are at high risk for vocational struggles. This paper examines the implementation and process evaluation of Individual Placement and Support (IPS) and Supported Employment enhanced to better meet developmental needs of TAY. Enhancements include the integration of a TAY development focus, engagement best-practices, Supported Education and Peer Support. Community mental health providers participated in a process evaluation to explore the feasibility of a larger scale implementation. Common organizational barriers were encountered across provider sites including: leadership support, agency structures and funding mechanisms; compounded by the complexity of bridging child and adult systems. Findings have implications for both child and adult community mental health providers as they adapt and integrate programming for TAY.
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12
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Cubillos L, Muñoz J, Caballero J, Mendoza M, Pulido A, Carpio K, Udutha AK, Botero C, Borrero E, Rodríguez D, Cutipe Y, Emeny R, Schifferdecker K, Torrey WC. Addressing Severe Mental Illness Rehabilitation in Colombia, Costa Rica, and Peru. Psychiatr Serv 2020; 71:378-384. [PMID: 31896339 DOI: 10.1176/appi.ps.201900306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many Latin American countries face the challenge of caring for a growing number of people with severe mental illnesses while promoting deinstitutionalization and community-based care. This article presents an overview of current policies that aim to reform the mental health care system and advance the employment of people with disabilities in Colombia, Costa Rica, and Peru. The authors conducted a thematic analysis by using public records and semistructured interviews with stakeholders. The authors found evidence of supported employment programs for vulnerable populations, including people with disabilities, but found that the programs did not include people with severe mental illnesses. Five relevant themes were found to hamper progress in psychiatric vocational rehabilitation services: rigid labor markets, insufficient advocacy, public subsidies that create conflicting incentives, lack of deinstitutionalized models, and lack of reimbursement for evidence-based psychiatric rehabilitation interventions. Policy reforms in these countries have promoted the use of medical interventions to treat people with severe mental illnesses but not the use of evidence-based rehabilitation programs to facilitate community integration and functional recovery. Because these countries have other supported employment programs for people with nonpsychiatric disabilities, they are well positioned to pilot individual placement and support to accelerate full community integration among individuals with severe mental illnesses.
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Affiliation(s)
- Leonardo Cubillos
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Juliana Muñoz
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - July Caballero
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - María Mendoza
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Adriana Pulido
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Karen Carpio
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Anirudh K Udutha
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Catalina Botero
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Elizabeth Borrero
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Diana Rodríguez
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Yuri Cutipe
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Rebecca Emeny
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Karen Schifferdecker
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - William C Torrey
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
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13
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Gao N, Eissenstat SJ, Giacobbe G. Poor physical health: A major barrier to employment among individuals with serious mental illness. JOURNAL OF VOCATIONAL REHABILITATION 2020. [DOI: 10.3233/jvr-191063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ni Gao
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - SunHee J. Eissenstat
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Giovanna Giacobbe
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
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14
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Pelham WE, Page TF, Altszuler AR, Gnagy EM, Molina BSG, Pelham WE. The long-term financial outcome of children diagnosed with ADHD. J Consult Clin Psychol 2020; 88:160-171. [PMID: 31789549 PMCID: PMC6940517 DOI: 10.1037/ccp0000461] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Characterize the early trajectories of financial functioning in adults with history of childhood ADHD and use these trajectories to project earnings and savings over the lifetime. METHOD Data were drawn from a prospective case-control study (PALS) following participants with a rigorous diagnosis of ADHD during childhood (N = 364) and demographically matched controls (N = 240) for nearly 20 years. Participants and their parents reported on an array of financial outcomes when participants were 25 and 30 years old. RESULTS At age 30, adults with a history of ADHD exhibited substantially worse outcomes than controls on most financial indicators, even when they and their parents no longer endorsed any DSM symptoms of ADHD. Between ages 25 and 30, probands had exhibited considerably slower growth than controls in positive financial indicators (e.g., monthly income) and substantially less reduction than controls in indicators of financial dependence (e.g., living with parents), indicating worsening or sustained deficits on nearly all measures. When earnings trajectories from age 25 to age 30 were extrapolated using matched census data, male probands were projected to earn $1.27 million less than controls over their working lifetime, reaching retirement with up to 75% lower net worth. CONCLUSION The financial deficit of adults with history of childhood ADHD grows across early adulthood. Projections based on early financial trajectories suggest very large cumulative differences in earnings and savings. With or without persistence of the DSM symptoms, the adult sequela of childhood ADHD can be conceptualized as a chronic condition often requiring considerable support from others during adulthood. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Timothy F. Page
- Health Policy and Management, Florida International University, Miami, FL 33199
- Center for Children and Families, Florida International University, Miami, FL 33199
| | - Amy R. Altszuler
- Center for Children and Families, Florida International University, Miami, FL 33199
| | - Elizabeth M. Gnagy
- Center for Children and Families, Florida International University, Miami, FL 33199
| | | | - William E. Pelham
- Department of Psychology, Florida International University, Miami, FL 33199
- Center for Children and Families, Florida International University, Miami, FL 33199
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15
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Zafar N, Rotenberg M, Rudnick A. A systematic review of work accommodations for people with mental disorders. Work 2019; 64:461-475. [DOI: 10.3233/wor-193008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nayab Zafar
- Previously: McMaster University, Hamilton, Ontario, Canada
| | - Martin Rotenberg
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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16
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Carstens C, Massatti R. Predictors of Labor Force Status in a Random Sample of Consumers with Serious Mental Illness. J Behav Health Serv Res 2019; 45:678-689. [PMID: 29651601 DOI: 10.1007/s11414-018-9597-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Employment among persons with severe mental illness has been challenging. Supported employment programs have had some success; however, much remains to be understood about client motivations for employment. A labor force participation study was mailed to persons receiving services in a Midwestern state's publicly funded behavioral health system, and a random sample of participants resulted in 964 valid surveys. Analysis showed significant differences between Medicaid coverage program and labor force status, with some programs likely to have higher percentages of employed persons. A multinomial logistic regression model explored the odds of employment and unemployment to not being in the labor force. Perception of incentives to employment greatly increased the odds, while age and perception of barriers to employment decreased the odds for both groups when compared to those not in the labor force. Findings have implications for the design of employment programs and coverage benefits.
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Affiliation(s)
- Carol Carstens
- Ohio Department of Mental Health and Addiction Services, 30 East Broad Street, Columbus, OH, 43215, USA.
| | - Richard Massatti
- Ohio Department of Mental Health and Addiction Services, 30 East Broad Street, Columbus, OH, 43215, USA
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17
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Gewurtz RE, Lahey P, Cook K, Kirsh B, Lysaght R, Wilton R. Fear and Distrust Within the Canadian Welfare System: Experiences of People With Mental Illness. JOURNAL OF DISABILITY POLICY STUDIES 2018. [DOI: 10.1177/1044207318796839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While experiences of fear and distrust have been documented as a part of recipients’ interactions with disability benefits, there have been few attempts to explore how they are shaped by system features and their impact on employment pursuits. The purpose of this article is to unpack how fear and distrust emerge among people with mental illness who have recently entered the welfare system. Using an interpretative qualitative approach, the authors draw on the findings from 69 in-depth interviews with key stakeholders about their experiences with employment. Stakeholders included recipients, welfare program and policy staff, and service providers in the community. Data were analyzed by exploring similarities and differences across perspectives and contexts. The findings highlight how system features shape and perpetuate fear and distrust through poorly communicating information about the system, a chaotic state of constant change and complexity, a lack of attention to building trusting relationships between caseworkers and recipients, ongoing system errors, and excessive reporting requirements. The impact of the current state of affairs is significantly harmful to recipients, especially those living with mental illness. Our findings also highlight a possible way forward by building trusting relationships and finding ways to improve communication channels.
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Affiliation(s)
| | | | - Katie Cook
- Wilfrid Laurier University, Kitchener, Ontario, Canada
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18
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McGinty EE, Kennedy-Hendricks A, Linden S, Choksy S, Stone E, Daumit GL. An innovative model to coordinate healthcare and social services for people with serious mental illness: A mixed-methods case study of Maryland's Medicaid health home program. Gen Hosp Psychiatry 2018; 51:54-62. [PMID: 29316451 PMCID: PMC5869105 DOI: 10.1016/j.genhosppsych.2017.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We conducted a case study examining implementation of Maryland's Medicaid health home program, a unique model for integration of behavioral, somatic, and social services for people with serious mental illness (SMI) in the psychiatric rehabilitation program setting. METHOD We conducted interviews and surveys with health home leaders (N=72) and front-line staff (N=627) representing 46 of the 48 total health home programs active during the November 2015-December 2016 study period. We measured the structural and service characteristics of the 46 health home programs and leaders' and staff members' perceptions of program implementation. RESULTS Health home program structure varied across sites: for example, 15% of programs had co-located primary care providers and 76% had onsite supported employment providers. Most leaders and staff viewed the health home program as having strong organizational fit with psychiatric rehabilitation programs' organizational structures and missions, but noted implementation challenges around health IT, population health management, and coordination with external providers. CONCLUSION Maryland's psychiatric rehabilitation-based health home is a promising model for integration of behavioral, somatic, and social services for people with SMI but may be strengthened by additional policy and implementation supports, including incentives for external providers to engage in care coordination with health home providers.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205, United States.
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States
| | - Sarah Linden
- Division of General Internal Medicine, Johns Hopkins School of Medicine, United States
| | - Seema Choksy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, United States
| | - Elizabeth Stone
- Division of General Internal Medicine, Johns Hopkins School of Medicine, United States
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, United States
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19
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Dolce JN, Waynor WR. Effect of Psychiatric Symptoms on Employment Outcomes for Individuals Receiving Supported Employment Services: A Preliminary Study. J Psychosoc Nurs Ment Health Serv 2018; 56:33-38. [DOI: 10.3928/02793695-20171027-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/11/2017] [Indexed: 11/20/2022]
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20
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Townley G, Brusilovskiy E, Snethen G, Salzer MS. Using Geospatial Research Methods to Examine Resource Accessibility and Availability as it Relates to Community Participation of Individuals with Serious Mental Illnesses. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:47-61. [PMID: 29251348 DOI: 10.1002/ajcp.12216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Greater community participation among individuals with serious mental illnesses is associated with better psychosocial and health outcomes. Typically, studies examining community participation have utilized self-report measures and been conducted in limited settings. The introduction of methodological advances to examining community participation of individuals with serious mental illnesses has the potential to advance the science of community mental health research and invigorate the work of community psychologists in this area. This study employed an innovative geospatial approach to examine the relationship between community participation and resource accessibility (i.e., proximity) and availability (i.e., concentration) among 294 individuals utilizing community mental health services throughout the United States. Findings suggest small but significant associations between community participation and the accessibility and availability of resources needed for participation. Furthermore, findings demonstrate the importance of car access for individuals residing in both urban and non-urban settings. The methods and results presented in this study have implications for community mental health research and services and provide an illustration of ways that geospatial methodologies can be used to investigate environmental factors that impact community inclusion and participation of individuals with serious mental illnesses.
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Affiliation(s)
- Greg Townley
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Eugene Brusilovskiy
- Department of Rehabilitation Sciences, Temple University, Philadelphia, PA, USA
| | - Gretchen Snethen
- Department of Rehabilitation Sciences, Temple University, Philadelphia, PA, USA
| | - Mark S Salzer
- Department of Rehabilitation Sciences, Temple University, Philadelphia, PA, USA
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21
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Peterson E, Busch S. Achieving Mental Health and Substance Use Disorder Treatment Parity: A Quarter Century of Policy Making and Research. Annu Rev Public Health 2018; 39:421-435. [PMID: 29328871 DOI: 10.1146/annurev-publhealth-040617-013603] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 changed the landscape of mental health and substance use disorder coverage in the United States. The MHPAEA's comprehensiveness compared with past parity laws, including its extension of parity to plan management strategies, the so-called nonquantitative treatment limitations (NQTL), led to significant improvements in mental health care coverage. In this article, we review the history of this landmark legislation and its recent expansions to new populations, describe past research on the effects of this and other mental health/substance use disorder parity laws, and describe some directions for future research, including NQTL compliance issues, effects of parity on individuals with severe mental illness, and measurement of benefits other than mental health care use.
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Affiliation(s)
- Emma Peterson
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut 06520-8034, USA; ,
| | - Susan Busch
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut 06520-8034, USA; ,
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22
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Hoagwood KE, Atkins M, Kelleher K, Peth-Pierce R, Olin S, Burns B, Landsverk J, Horwitz SM. Trends in Children's Mental Health Services Research Funding by the National Institute of Mental Health From 2005 to 2015: A 42% Reduction. J Am Acad Child Adolesc Psychiatry 2018; 57:10-13. [PMID: 29301659 DOI: 10.1016/j.jaac.2017.09.433] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/12/2017] [Accepted: 10/03/2017] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Kelly Kelleher
- The Ohio State University, Columbus, and the Nationwide Children's Hospital, Center for Pediatric Innovation, Columbus
| | | | - Serene Olin
- New York University School of Medicine, Child Study Center, New York
| | - Barbara Burns
- Duke University, Duke University School of Medicine, Services Effectiveness Research Program, Durham, NC
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23
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Pratt SI, Jerome GJ, Schneider KL, Craft LL, Buman MP, Stoutenberg M, Daumit GL, Bartels SJ, Goodrich DE. Increasing US health plan coverage for exercise programming in community mental health settings for people with serious mental illness: a position statement from the Society of Behavior Medicine and the American College of Sports Medicine. Transl Behav Med 2017; 6:478-81. [PMID: 27146275 DOI: 10.1007/s13142-016-0407-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Adults with serious mental illness die more than 10 years earlier than the average American. Premature mortality is due to the high prevalence of preventable diseases including cardiovascular disease and diabetes. Poor lifestyle behaviors including lack of exercise and physical inactivity contribute to the epidemic levels of obesity, diabetes, and cardiovascular disease observed among adults with serious mental illness. Not surprisingly, people with serious mental illness are among the most costly consumers of health services due to increased visits for poorly managed mental and physical health. Recent studies have demonstrated that exercise interventions based on community mental health settings can significantly improve physical and mental health in people with serious mental illness. However, current funding regulations limit the ability of community mental health settings to offer exercise programming services to people with serious mental illness. Policy efforts are needed to improve the dissemination and sustainability of exercise programs for people with serious mental illness.
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Affiliation(s)
- Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 105 Pleasant Street, Main Building, Dartmouth College, Concord, NH, 03301, USA.
| | - Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, MD, USA.,Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Matthew P Buman
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | - Mark Stoutenberg
- American College of Sports Medicine, Indianapolis, IN, USA.,Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen J Bartels
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 105 Pleasant Street, Main Building, Dartmouth College, Concord, NH, 03301, USA
| | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, 48105, USA
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24
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Impacting Entry into Evidence-Based Supported Employment: A Population-Based Empirical Analysis of a Statewide Public Mental Health Program in Maryland. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 45:328-341. [DOI: 10.1007/s10488-017-0827-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Mellor-Marsá B, Caballero FF, Cabello M, Ayuso-Mateos JL, Setién-Suero E, Vázquez-Bourgon J, Crespo-Facorro B, Ayesa-Arriola R. Disability multilevel modelling in first episodes of psychosis at 3-year follow-up. Schizophr Res 2017; 185:101-106. [PMID: 28062261 DOI: 10.1016/j.schres.2016.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 11/30/2022]
Abstract
The description of longitudinal bio-psycho-social profiles in FEP samples may be useful for the prediction of disability trajectories. This study aimed to describe the differences between disability status of FEP patients at baseline and their change over time, analysing how variables associated to the psychological status, and the environment of the patient can affect his or her disability trajectory, once the influence of health condition and socio-demographic variables has been controlled for. Using data from a 3-year follow-up study on early psychosis (PAFIP), a multilevel structure in which the longitudinal measurements (within level) were nested within the individuals (between level), was modeled. The contribution of the different time-varying and time-invariant variables to the patients' disability outcomes was tested through eight nested models. Consecutive models, that successively added health related, socio-demographic, psychological and environmental variables to the unconditional model were estimated, by means of deviance and fit statistics. The present work revealed the importance of psychological and environmental factors in the explanation of disability changes in the context of FEP. We may conclude that longitudinal assessments of time-varying predictors - living situation (b=-0.10, p<0.05), economic support (b=0.11, p<0.01) and insight (b=-0.08, p<0.05) - explain a relevant amount of disability variation over time, independently from symptoms' severity, duration of untreated psychosis, age, gender and years of education. Additionally, the level of premorbid adjustment (b=0.05, p<0.001) was associated to differences in disability outcomes among FEP patients.
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Affiliation(s)
- Blanca Mellor-Marsá
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Instituto de Investigación de la Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Francisco Félix Caballero
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Instituto de Investigación de la Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - María Cabello
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Instituto de Investigación de la Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Instituto de Investigación de la Princesa (IIS-IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Esther Setién-Suero
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Javier Vázquez-Bourgon
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Benedicto Crespo-Facorro
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Rosa Ayesa-Arriola
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain; Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain.
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Latimer E. Extending the Quality and Reach of IPS. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 44:374-377. [PMID: 28361473 DOI: 10.1007/s10488-017-0801-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Eric Latimer
- Mental Health and Society Research Program, Douglas Hospital Research Centre, Perry 3C, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, Montreal, Canada.
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Karakus M, Riley J, Goldman H. Federal Policies and Programs to Expand Employment Services Among Individuals with Serious Mental Illnesses. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 44:339-344. [PMID: 28213672 DOI: 10.1007/s10488-017-0794-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Previous studies suggest that providing employment services to individuals with serious mental illnesses can help them obtain competitive, real-world employment. However, these services are still not easily accessible to this population. This paper provides a brief summary of recent federal initiatives that may influence widespread implementation of employment services. While there is an increasing recognition of the need to remove barriers and provide supported employment services to individuals with mental illnesses, a wide-spread coordination across Federal polices, financing and regulatory changes are necessary to promote measurable and lasting effects on the broad availability of employment services among this population.
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Affiliation(s)
| | | | - Howard Goldman
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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Noel VA, Oulvey E, Drake RE, Bond GR. Barriers to Employment for Transition-age Youth with Developmental and Psychiatric Disabilities. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 44:354-358. [DOI: 10.1007/s10488-016-0773-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mechanic D. More people than ever before are receiving behavioral health care in the United States, but gaps and challenges remain. Health Aff (Millwood) 2016; 33:1416-24. [PMID: 25092844 DOI: 10.1377/hlthaff.2014.0504] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The high prevalence of mental illness and substance abuse disorders and their significant impact on disability, mortality, and other chronic diseases have encouraged new initiatives in mental health policy including important provisions of the Affordable Care Act and changes in Medicaid. This article examines the development and status of the behavioral health services system, gaps in access to and quality of care, and the challenges to implementing aspirations for improved behavioral and related medical services. Although many more people than ever before are receiving behavioral health services in the United States-predominantly pharmaceutical treatments-care is poorly allocated and rarely meets evidence-based standards, particularly in the primary care sector. Ideologies, finances, and pharmaceutical marketing have shaped the provision of services more than treatment advances or guidance from a growing evidence base. Among the many challenges to overcome are organizational and financial realignments and improved training of primary care physicians and the behavioral health workforce.
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Affiliation(s)
- David Mechanic
- David Mechanic is the René Dubos University Professor at the Institute for Health, Health Care Policy, and Aging Research at Rutgers University, in New Brunswick, New Jersey
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Rao GP, Ramya VS, Bada MS. The rights of persons with Disability Bill, 2014: How "enabling" is it for persons with mental illness? Indian J Psychiatry 2016; 58:121-8. [PMID: 27385843 PMCID: PMC4919954 DOI: 10.4103/0019-5545.183795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
India ratified the United Nations Convention on the Rights of Person with Disabilities (UNCRPD) in 2007. This is a welcome step towards realizing the rights of the persons with disability. The UNCRPD proclaims that disability results from interaction of impairments with attitudinal and environmental barriers which hinders full and active participation in society on an equal basis with others. Further, the convention also mandates the signatory governments to change their local laws, to identify and eliminate obstacles and barriers and to comply with the terms of the UNCRPD in order to protect the rights of the person with disabilities, hence the amendments of the national laws. Hence, the Government of India drafted two important bill the Right of Persons with Disabilities Bill, 2014 (RPWD Bill, 2014) and Mental Health Care Bill, 2013 (MHC Bill, 2013). There is no doubt that persons with mental illness are stigmatized and discriminated across the civil societies, which hinders full and active participation in society. This situation becomes worse with regard to providing mental health care, rehabilitation and social welfare measures to persons with mental illness. There is an urgent need to address this issue of attitudinal barrier so that the rights of persons with mental illness is upheld. Hence, this article discusses shortcomings in the Right of Persons with Disabilities Bill, 2014 (RPWD Bill, 2014) from the perspective of persons with mental illness. Further, the article highlights the need to synchronize both the RPWD Bill, 2014 and Mental Health Care Bill, 2013 to provide justice for persons with mental illness.
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Affiliation(s)
- Gundugurti Prasad Rao
- Consultant Psychiatrist, President of Indian Psychiatric Society Director, Schizophrenia and Psychopharmacology Division, Asha Hospital, Hyderabad, Telangana, India
| | | | - Math Suresh Bada
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (Institute of National Importance), Bengaluru, Karnataka, India
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Killackey E. Resignation not accepted: employment, education and training in early intervention, past, present and future. Early Interv Psychiatry 2015; 9:429-32. [PMID: 26487488 DOI: 10.1111/eip.12292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eóin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Do comprehensive, coordinated, recovery-oriented services alter the pattern of use of treatment services? Mental health treatment study impacts on SSDI beneficiaries' use of inpatient, emergency, and crisis services. J Behav Health Serv Res 2015; 41:434-46. [PMID: 24481541 DOI: 10.1007/s11414-013-9388-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Current arrangements for financing and delivering behavioral health services to U.S. working-age adults with severe and persistent mental disorders (SPMD) have major inadequacies in funding for and access to critical elements of a recovery-oriented, comprehensive, and coordinated package of community-based treatment and rehabilitation services. This study presents results from a nation-wide 2-year randomized trial, involving 2,238 SSDI beneficiaries with SPMD, of a comprehensive intervention including evidence-based treatment and employment services. Estimates of impacts of the MHTS service intervention package, from a variety of regression specifications, showed clearly significant treatment group reductions in four outcomes (hospital stays and days, ER visits for mental health problems, and psychiatric crisis visits); these estimates suggest annual inpatient hospital treatment cost savings in excess of approximately $900 to 1,400. Negative estimated MHTS effects on three other utilization outcomes (hospital stays and days for mental health problems, overall ER visits) generally did not achieve statistical significance. Possible study implications for cost offsets from further expansions/replications of the MHTS intervention model are considered within the context of health reform.
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Townley G. “It Helps You Not Feel So Bad—Feel Like You Again”: The Importance of Community for Individuals with Psychiatric Disabilities. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s40737-015-0036-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chow CM, Croft B, Cichocki B. Evaluating the potential cost-savings of job accommodations among individuals with psychiatric disability. JOURNAL OF VOCATIONAL REHABILITATION 2015. [DOI: 10.3233/jvr-150755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Clifton M. Chow
- Harvard Medical School, Cambridge Health Alliance, Cambridge, MA, USA
- Southern New Hampshire University, Medford, MA, USA
| | - Bevin Croft
- Heller School, Brandeis University, Waltham, MA, USA
- Human Services Research Institute, Cambridge, MA, USA
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Janssen EM, McGinty EE, Azrin ST, Juliano-Bult D, Daumit GL. Review of the evidence: prevalence of medical conditions in the United States population with serious mental illness. Gen Hosp Psychiatry 2015; 37:199-222. [PMID: 25881768 PMCID: PMC4663043 DOI: 10.1016/j.genhosppsych.2015.03.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 02/25/2015] [Accepted: 03/05/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Persons with serious mental illness (SMI) have high rates of premature mortality from preventable medical conditions, but this group is underrepresented in epidemiologic surveys and we lack national estimates of the prevalence of conditions such as obesity and diabetes in this group. We performed a comprehensive review to synthesize estimates of the prevalence of 15 medical conditions among the population with SMI. METHOD We reviewed studies published in the peer-reviewed literature from January 2000 to August 2012. Studies were included if they assessed prevalence in a sample of 100 or more United States (US) adults with schizophrenia or bipolar disorder. RESULTS A total of 57 studies were included in the review. For most medical conditions, the prevalence estimates varied considerably. For example, estimates of obesity prevalence ranged from 26% to 55%. This variation appeared to be due to differences in measurement (e.g., self-report versus clinical measures) and underlying differences in study populations. Few studies assessed prevalence in representative, community samples of persons with SMI. CONCLUSIONS In many studies, the prevalence of medical conditions among the population with SMI was higher than among the overall US population. Screening for and monitoring of these conditions should be common practice in clinical settings serving persons with SMI.
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Affiliation(s)
- Ellen M Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 359, Baltimore, MD 21205, USA.
| | - Susan T Azrin
- National Institute of Mental Health, 6001 Executive Boulevard, Room 7145 MSC 9631, Rockville, MD 20852, USA.
| | - Denise Juliano-Bult
- National Institute of Mental Health, 6001 Executive Boulevard, Room 7144 MSC 9631, Rockville, MD 20852, USA.
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-620, Baltimore, MD 21205, USA.
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Chuang WF, Hwang E, Lee HL, Wu SL. An in-house prevocational training program for newly discharged psychiatric inpatients: exploring its employment outcomes and the predictive factors. Occup Ther Int 2015; 22:94-103. [PMID: 25783143 DOI: 10.1002/oti.1388] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 11/07/2022] Open
Abstract
Individuals with severe mental disorders continue to experience low employment rates. Occupational therapists play an important role in helping these individuals develop the skills and obtain the supports necessary for productive living. This retrospective cohort study aimed to explore employment outcomes and identify factors predictive of the outcomes of an in-house prevocational training program designed for newly discharged psychiatric inpatients. Data retrieved from the files of 58 participants including demographics, diagnostic history, physical fitness, functional assessment results, the use of vocational counselling service and employment status were analyzed. The overall employment rates among the participants were high (67.2-79.3%) within the 6 months following the prevocational training program. No significant differences were found in the employment rates across the 1, 3 and 6-month time periods post-training. Vocational counselling service post-training and hand function were two factors predictive of participants' employment outcomes. Occupational therapists should attend to the clients' need for continuous vocational support and carefully identify the personal, functional and environmental factors contributing to successful employment. Caution in interpreting the results is warranted because of the lack of control and randomization in this retrospective study. Additional longitudinal cohort or experimental studies would add further certainty to the current findings.
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Affiliation(s)
- Wen-Fang Chuang
- Tsao-Tun Psychiatric Center, Department of Occupational Therapy, Nantou County, Taiwan
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Margolies PJ, Broadway-Wilson K, Gregory R, Jewell TC, Scannevin G, Myers RW, Fernandez HA, Ruderman D, McNabb L, Chiang IC, Marino L, Dixon LB. Use of learning collaboratives by the center for practice innovations to bring IPS to scale in New York State. Psychiatr Serv 2015; 66:4-6. [PMID: 25321348 PMCID: PMC5846102 DOI: 10.1176/appi.ps.201400383] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This column focuses on use of learning collaboratives by the Center for Practice Innovations to help programs implement the evidence-based individual placement and support model of supported employment in New York State. These learning collaboratives use fidelity and performance indicator data to drive the development of program-specific individualized quality improvement plans. As of 2014, 59 (69%) of 86 eligible programs have joined the initiative. Programs are achieving employment outcomes for consumers on par with national benchmarks, along with improved fidelity.
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Affiliation(s)
- Paul J Margolies
- Dr. Margolies, Mr. Scannevin, and Dr. Dixon are with New York State Psychiatric Institute and the Department of Psychiatry, Columbia University, New York City (e-mail: ). Ms. Broadway-Wilson, Dr. Jewell, Ms. Chiang, and Dr. Marino are with New York State Psychiatric Institute. Mr. Gregory is with the Department of Psychiatry, Columbia University. Dr. Myers, Mr. Fernandez, Mr. Ruderman, and Mr. McNabb are with the New York State Office of Mental Health, Albany. Marcela Horvitz-Lennon, M.D., is editor of this column
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Rosen MI, Ablondi K, Black AC, Mueller L, Serowik KL, Martino S, Mobo BH, Rosenheck RA. Work outcomes after benefits counseling among veterans applying for service connection for a psychiatric condition. Psychiatr Serv 2014; 65:1426-32. [PMID: 25082304 PMCID: PMC4713007 DOI: 10.1176/appi.ps.201300478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study's objective was to determine the efficacy of benefits counseling in a clinical trial. There has been concern that disability payments for psychiatric disorders reduce incentives for employment and rehabilitation. Benefits counseling, with education about opportunities to work and the financial implications of work on receipt of disability benefits, may counter these disincentives. METHODS This single-blind, six-month randomized clinical trial enrolled 84 veterans who had applied for service-connected compensation for a psychiatric condition. Veterans were randomly assigned to either four sessions of benefits counseling or of a control condition involving orientation to the U.S Department of Veterans Affairs health care system and services. Days of paid work and work-related activities were assessed at follow-up visits by using a timeline follow-back calendar. RESULTS Veterans assigned to benefits counseling worked for pay for significantly more days than did veterans in the control group (effect size=.69, p<.05), reflecting an average of three more days of paid employment during the 28 days preceding the six-month follow-up. Benefits counseling was associated with increased use of mental health services, but this correlation did not mediate the effect of benefits counseling on working. CONCLUSIONS Barriers to employment associated with disability payments are remediable with basic counseling. More research is needed to understand the active ingredient of this counseling and to strengthen the intervention.
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Affiliation(s)
- Marc I Rosen
- Dr. Rosen, Ms. Ablondi, Dr. Black, Ms. Serowik, and Dr. Martino are with the Department of Psychiatry, Yale University School of Medicine, New Haven, and with the Department of Psychiatry, U.S. Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven (e-mail: ). Dr. Rosenheck is with the Department of Psychiatry, Yale University School of Medicine, and with the Mental Illness Research, Education and Clinical Center, VA New England Healthcare System, where Dr. Mueller is affiliated. Dr. Mueller is also with the Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts. Dr. Mobo is with the Christiana Care Health System, Newark, Delaware
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Serowik KL, Rowe M, Black AC, Ablondi K, Fiszdon J, Wilber C, Rosen MI. Financial motivation to work among people with psychiatric disorders. J Ment Health 2014; 23:186-90. [PMID: 25054368 DOI: 10.3109/09638237.2014.924046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Supported employment is an effective intervention for people with serious mental illnesses (SMI) but is underutilized. Clients' desire to work might be heightened by programs that provide counseling about managing one's funds, since money management helps people become more aware of the advantages of having money. AIM To analyze the thoughts of recently homeless or hospitalized persons with SMI concerning their personal finances and employment. METHODS We interviewed 49 people with SMI about their finances, reviewed transcripts and analyzed their baseline characteristics. RESULTS Twenty of the 49 participants spontaneously expressed a desire to work in order to earn more money. Those who expressed a desire to work managed their money significantly better than those who did not. CONCLUSION Discussion of finances, such as that fostered by money management programs, may promote engagement in vocational rehabilitation and working for pay.
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Affiliation(s)
- Kristin L Serowik
- Department of Psychiatry, Yale University School of Medicine , New Haven, CT , USA
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Hansen H, Bourgois P, Drucker E. Pathologizing poverty: new forms of diagnosis, disability, and structural stigma under welfare reform. Soc Sci Med 2014; 103:76-83. [PMID: 24507913 PMCID: PMC3920192 DOI: 10.1016/j.socscimed.2013.06.033] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 06/17/2013] [Accepted: 06/18/2013] [Indexed: 10/25/2022]
Abstract
In 1996 the U.S. severely restricted public support for low income people, ending "welfare as we know it." This led to dramatic increases in medicalized forms of support for indigent people, who increasingly rely on disability benefits justified by psychiatric diagnoses of chronic mental illness. We present case studies drawn from ethnographic data involving daily participant-observation between 2005 and 2012 in public clinics and impoverished neighborhoods in New York City, to describe the subjective experience of structural stigma imposed by the increasing medicalization of public support for the poor through a diagnosis of permanent mental disability. In some cases, disability benefits enable recipients to fulfill important social roles (sustaining a vulnerable household and promoting stable parenting). The status of family members who receive a monthly disability check improves within their kin and neighborhood-based networks, counterbalancing the felt stigma of being identified by doctors as "crazy". When a diagnosis of mental pathology becomes a valuable survival strategy constituting the basis for fulfillment of household responsibilities, stigmatizing processes are structurally altered. Through the decades, the stigmatized labels applied to the poor have shifted: from being a symptom of racial weakness, to the culture of poverty, and now to permanent medical pathology. The neoliberal bureaucratic requirement that the poor must repeatedly prove their "disabled" status through therapy and psychotropic medication appears to be generating a national and policy-maker discourse condemning SSI malingerers, resurrecting the 16th century specter of the "unworthy poor".
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Affiliation(s)
- Helena Hansen
- New York University, Departments of Anthropology and Psychiatry, New York, NY 10003, USA; Nathan Kline Institute for Psychiatric Research, USA.
| | - Philippe Bourgois
- University of Pennsylvania, Departments of Anthropology and Family and Community Medicine, USA
| | - Ernest Drucker
- John Jay College of Criminal Justice, Department of Public Health and Environmentalism, USA
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Green CA, Estroff SE, Yarborough BJH, Spofford M, Solloway MR, Kitson RS, Perrin NA. Directions for future patient-centered and comparative effectiveness research for people with serious mental illness in a learning mental health care system. Schizophr Bull 2014; 40 Suppl 1:S1-S94. [PMID: 24489078 PMCID: PMC3911266 DOI: 10.1093/schbul/sbt170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Greve J, Nielsen LH. Useful beautiful minds-an analysis of the relationship between schizophrenia and employment. JOURNAL OF HEALTH ECONOMICS 2013; 32:1066-1076. [PMID: 24103500 DOI: 10.1016/j.jhealeco.2013.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 08/15/2013] [Accepted: 08/20/2013] [Indexed: 06/02/2023]
Abstract
This paper examines the relationship between schizophrenia and employment. We use longitudinal register data and show a considerable drop in the employment rate for people with schizophrenia six years before the first treatment at a psychiatric facility. After the first treatment, the employment rate stabilizes at 18%. The difference in the employment rate in 2007 for siblings with and without schizophrenia is estimated at 67%. This difference is reduced to 62% when we include additional control variables. The results remain unchanged when we apply a sibling fixed effects approach that controls for the unobserved family specific characteristics that the siblings share.
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Affiliation(s)
- Jane Greve
- Rockwool Foundation Research Unit, Sølvgade 10, 2. tv., 1307 Copenhagen K, Denmark.
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Lockett H, Bensemann C. Employment as a health intervention--the role of psychiatry in bridging the evidence to practice gap. Aust N Z J Psychiatry 2013; 47:417-20. [PMID: 23653061 DOI: 10.1177/0004867412466594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Drake RE, Xie H, Bond GR, McHugo GJ, Caton CLM. Early psychosis and employment. Schizophr Res 2013; 146:111-7. [PMID: 23490762 DOI: 10.1016/j.schres.2013.02.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 02/03/2013] [Accepted: 02/06/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Employment may be an important factor in helping patients with early psychosis to recover rapidly and to avoid involvement in disability and welfare programs. METHODS This study followed 351 patients with early psychoses, either primary psychoses or substance-induced psychoses, for two years to examine their patterns of competitive employment in relation to service use, psychosocial outcomes, and disability and welfare payments. RESULTS Workers differed from non-workers at baseline and over two years. At baseline, they had better educational and employment histories, were more likely to have substance-induced psychoses rather than primary psychoses, were less likely to have drug dependence, had fewer negative symptoms, and had better psychosocial adjustment. Over two years, baseline psychosocial differences persisted, and the workers used fewer medications, mental health services, and disability or welfare payments. CONCLUSIONS Employment predicts less service use and fewer disability claims among early psychosis patients. Thus, greater attention to supported employment early in the course of illness may reduce federal insurance costs and disability payments.
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Affiliation(s)
- Robert E Drake
- Dartmouth Psychiatric Research Center 85 Mechanic Street, Suite B4-1 Lebanon, NH 03766, United States.
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Making the Case for IPS Supported Employment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2012; 41:69-73. [DOI: 10.1007/s10488-012-0444-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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McHugo GJ, Drake RE, Xie H, Bond GR. A 10-year study of steady employment and non-vocational outcomes among people with serious mental illness and co-occurring substance use disorders. Schizophr Res 2012; 138:233-9. [PMID: 22546432 DOI: 10.1016/j.schres.2012.04.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 04/02/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Employment promotes recovery for persons with serious mental illness by providing extra income and a valued social role, but the impact of employment on other psychosocial and clinical outcomes remains unclear. This study examined non-vocational outcomes in relation to steady employment over 10 years among people with serious mental illness and co-occurring substance use disorders. METHODS Researchers interviewed people with co-occurring disorders at baseline and yearly for 10 years and tracked employment in relation to five non-vocational outcomes: independent living, psychiatric symptoms, substance use disorder, healthy (non-substance-abusing) relationships, and life satisfaction. Latent class trajectory analysis identified steady workers, and mixed-effects regression models compared steady workers with non-workers. RESULTS Both steady workers (n=51) and non-workers (n=79) improved substantially; for example, a majority of each group achieved independent housing and stable remission of substance use disorders. Steady workers achieved independent housing and higher quality of life during the first 5 years of follow-up, but the two groups achieved similar outcomes by 10 years. CONCLUSIONS People with co-occurring disorders can improve markedly. Those with steady employment may improve faster, but those without employment may achieve similar long-term outcomes at a slower pace.
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Affiliation(s)
- Gregory J McHugo
- Dartmouth Psychiatric Research Center, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766, USA.
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Unmet need for disability-related health care services and employment status among adults with disabilities in the Massachusetts Medicaid program. Disabil Health J 2012; 4:209-18. [PMID: 22014668 DOI: 10.1016/j.dhjo.2011.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 05/05/2011] [Accepted: 05/11/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND The employment rate among adults with disabilities is significantly lower than that among adults without disabilities. Ensuring access to rehabilitative and other health care services may help to address health-related barriers to employment for working-age people with disabilities. This study examined the relationship of unmet need for 6 disability-related health care services to current employment status among working-age adults with disabilities enrolled in the Massachusetts Medicaid (MassHealth Standard) program. METHODS Study participants included 436 MassHealth Standard members aged 19 to 64 who responded to the 2005/2006 MassHealth Employment and Disability Survey. Variables included members' demographic characteristics; Medicaid health plan and Medicare enrollment; members' self-report of potentially disabling conditions and current health status; access to health care as well as need and unmet need for 6 specific disability-related health care services (medications, mental health services, substance abuse services, medical supplies, durable medical equipment, personal assistance services); and current employment status. RESULTS Fifteen percent of members reported currently working. Logistic regression analysis showed that (controlling for demographics, disability, health status, and other factors) members with greater unmet need were significantly less likely to be working (odds ratio = 0.58; 95% confidence interval = 0.33 to 0.99). Members' experience of unmet need was significantly greater for physical health services (supplies, durable medical equipment, personal assistance services) than for behavioral health services (mental health and substance abuse services) or medications. Working members generally rated services as important to work. Approximately 10% to 22% of nonworking members thought they would be able to work if needs were met. CONCLUSIONS Meeting unmet needs for disability-related health care services may result in modest increases in employment among certain working-age adults with disabilities enrolled in the Massachusetts Medicaid program.
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Shepherd S, Depp CA, Harris G, Halpain M, Palinkas LA, Jeste DV. Perspectives on schizophrenia over the lifespan: a qualitative study. Schizophr Bull 2012; 38:295-303. [PMID: 20603443 PMCID: PMC3283145 DOI: 10.1093/schbul/sbq075] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Longitudinal data suggest heterogeneity in the long-term course of schizophrenia. It is unclear how older adults with schizophrenia perceive changes in their experience of schizophrenia over the lifespan. We interviewed 32 adults aged 50 years and older diagnosed with schizophrenia (mean duration 35 years) about their perceived changes in the symptoms of schizophrenia and functioning over the lifespan. Interview transcripts were analyzed using grounded theory techniques of coding, consensus, co-occurrence, and comparison. The study was conducted by a research partnership involving a multidisciplinary team of academic researchers, community members, and mental health clients engaged in all aspects of study design, interviewing, and analysis and interpretation of data. Results revealed that, in regard to early course of illness, participants experienced confusion about diagnosis, active psychotic symptoms, and withdrawal/losses in social networks. Thereafter, nearly all participants believed that their symptoms had improved, which they attributed to increased skills in self-management of positive symptoms. In contrast to consistency among participants in describing illness course, there was marked heterogeneity in perceptions about functioning. Some participants were in despair about the discrepancy between their current situations and life goals, others were resigned to remain in supported environments, and others working toward functional attainments and optimistic about the future. In conclusion, middle-aged and older adults with schizophrenia believed that their symptoms had improved over their lifespan, yet there was substantial variability among participants in how they perceived their functioning. Functional rehabilitation may need to be tailored to differences in perceptions of capacity for functional improvement.
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Affiliation(s)
- Sally Shepherd
- National Alliance on Mental Illness, San Diego Affiliate, San Diego, CA
| | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego, CA,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA,To whom correspondence should be addressed; Stein Institute for Research on Aging, University of California, San Diego, CA 92093-0664, USA; tel: 858-534-4020, fax: 858-552-7404, e-mail:
| | - Gloria Harris
- National Alliance on Mental Illness, San Diego Affiliate, San Diego, CA
| | - Maureen Halpain
- Department of Psychiatry, University of California, San Diego, CA,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA
| | | | - Dilip V. Jeste
- Department of Psychiatry, University of California, San Diego, CA,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA
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Drake RE, Bond GR, Thornicroft G, Knapp M, Goldman HH. Mental Health Disability. JOURNAL OF DISABILITY POLICY STUDIES 2011. [DOI: 10.1177/1044207311427403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mental health disability imposes an enormous cost to patients, families, and society. Across free market countries, the rate of mental health disability is growing and now constitutes about one third of all disability claimants. Living on disability benefits begets demoralization and passivity. This article reviews (a) the current status of mental health disability and mental health disability systems, (b) the encouraging findings related to research on evidence-based treatments and supported employment, and (c) policy changes that might ameliorate the problem of rising rates (and costs) of mental health disability. Mental health treatments, employment services, and disability policies powerfully shape the disability experience. Evidence-based mental health and employment services can ameliorate disability and could potentially prevent disability if applied as early interventions. Yet evidence-based mental health treatments and supported employment services are rarely available. Furthermore, current disability policies tend to trap people in a “disability benefits culture.” Policy changes should recognize that people with mental health disabilities usually want to work, that they are often able to work when provided with appropriate mental health and vocational services, and that employment is highly therapeutic. Disability policies need to strengthen work incentives for beneficiaries, providers, and employers.
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Affiliation(s)
| | - Gary R. Bond
- Dartmouth Psychiatric Research Center, Lebanon, NH, USA
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Latimer EA, Bond GR, Drake RE. Economic approaches to improving access to evidence-based and recovery-oriented services for people with severe mental illness. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:523-9. [PMID: 21959027 DOI: 10.1177/070674371105600903] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During the past 3 decades, research has identified several psychosocial evidence-based practices (EBPs) for people with severe mental illness (SMI). Starting from a different origin, the recovery movement has influenced perceptions of how EBPs and other services should be delivered, and also emphasized the value of peer supports. We now know much more than 30 years ago about the kinds of services that help people with SMI live satisfying lives in the community. Evidence-based and recovery-oriented services require additional resources but use them sparingly: they are highly individualized, often result in reductions in costs of other mental health services, such as hospitalizations, and favour reliance on and integration into community settings rather than mental health services. Nevertheless, access to such services remains very limited. During the same period, the place of medications in the services system has become a source of growing concern, and there are several reasons to believe that current spending on medications is excessive. Inadequate housing and community supports that increase lengths of stay unnecessarily and spending on ineffective, nonrecovery-oriented vocational services are only 2 additional forms of misallocation of resources. Devolving control over medication budgets to regional or local health authorities, introducing program budgeting and marginal analysis, and implementing individual budgets to give more control to service users (in addition to promoting shared decision making) merit further investigation as potential strategies to improve outcomes for people with SMI in Canada in the context of limited budgets.
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Affiliation(s)
- Eric A Latimer
- Douglas Hospital Research Centre, Montreal, Quebec, Canada.
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