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Friesen P, Wusinich C, Lynch K, Russell D. "A Light at the End of the Tunnel": Experiences With Peer Specialists in the Open Dialogue Model. Psychiatr Serv 2024; 75:283-286. [PMID: 37752824 DOI: 10.1176/appi.ps.20230126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVE The authors examined participants' experiences with peer specialists in Parachute NYC, a community mental health program of support teams trained in Open Dialogue and intentional peer support. METHODS Qualitative interviews were conducted with eight enrollees and 10 network members (enrollees' family members). All excerpts coded as pertaining to peers were thematically analyzed. RESULTS Experiences with peer specialists were mostly positive. Participants especially valued peers' relatability and tendency to instill hope and engender empathy among enrollees and network members; peers' ability to foster community connections was also highly regarded. Generally, enrollees benefited from having peers and other health care professionals on a Parachute team because of their different forms of expertise. Concerns about peer specialists in dialogic care were reported by some network members, who questioned peers' degree of shared experiences, professionalism, and contributions to team unity. CONCLUSIONS Despite generally positive findings, the optimal role for peers within the Open Dialogue model needs further exploration.
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Affiliation(s)
- Phoebe Friesen
- Department of Equity, Ethics and Policy and Department of Social Studies of Medicine (Friesen) and Division of Social and Transcultural Psychiatry, Department of Psychiatry (Lynch), McGill University, Montreal; Department of Applied Psychology, New York University, New York City (Wusinich); Center for Home Care Policy and Research, VNS Health, New York City, and Department of Sociology, Appalachian State University, Boone, North Carolina (Russell)
| | - Christina Wusinich
- Department of Equity, Ethics and Policy and Department of Social Studies of Medicine (Friesen) and Division of Social and Transcultural Psychiatry, Department of Psychiatry (Lynch), McGill University, Montreal; Department of Applied Psychology, New York University, New York City (Wusinich); Center for Home Care Policy and Research, VNS Health, New York City, and Department of Sociology, Appalachian State University, Boone, North Carolina (Russell)
| | - Katherine Lynch
- Department of Equity, Ethics and Policy and Department of Social Studies of Medicine (Friesen) and Division of Social and Transcultural Psychiatry, Department of Psychiatry (Lynch), McGill University, Montreal; Department of Applied Psychology, New York University, New York City (Wusinich); Center for Home Care Policy and Research, VNS Health, New York City, and Department of Sociology, Appalachian State University, Boone, North Carolina (Russell)
| | - David Russell
- Department of Equity, Ethics and Policy and Department of Social Studies of Medicine (Friesen) and Division of Social and Transcultural Psychiatry, Department of Psychiatry (Lynch), McGill University, Montreal; Department of Applied Psychology, New York University, New York City (Wusinich); Center for Home Care Policy and Research, VNS Health, New York City, and Department of Sociology, Appalachian State University, Boone, North Carolina (Russell)
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Abstract
Predictive coding models of brain processing propose that top-down cortical signals promote efficient neural signaling by carrying predictions about incoming sensory information. These "priors" serve to constrain bottom-up signal propagation where prediction errors are carried via feedforward mechanisms. Depression, traditionally viewed as a disorder characterized by negative cognitive biases, is associated with disrupted reward prediction error encoding and signaling. Accumulating evidence also suggests that depression is characterized by impaired local and long-range prediction signaling across multiple sensory domains. This review highlights the electrophysiological and neuroimaging evidence for disrupted predictive processing in depression. The discussion is framed around the manner in which disrupted generative predictions about the sensorium could lead to depressive symptomatology, including anhedonia and negative bias. In particular, the review focuses on studies of sensory deviance detection and reward processing, highlighting research evidence for both disrupted generative predictions and prediction error signaling in depression. The role of the monoaminergic and glutamatergic systems in predictive coding processes is also discussed. This review provides a novel framework for understanding depression using predictive coding principles and establishes a foundational roadmap for potential future research.
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Affiliation(s)
- Jessica R. Gilbert
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
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Padgett DK, Bond L, Wusinich C. From the streets to a hotel: a qualitative study of the experiences of homeless persons in the pandemic era. J Soc Distress Homeless 2022; 32:248-254. [PMID: 38213878 PMCID: PMC10782809 DOI: 10.1080/10530789.2021.2021362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/16/2021] [Indexed: 01/13/2024]
Abstract
In the wake of COVID-19, programs for housing homeless individuals in hotels have emerged in the U.S., though research has yielded little information about the impact of these programs on participants expressed in their own words. In this qualitative study conducted in a major northeastern city, 13 previously street homeless individuals recount their experiences of hotel housing during the pandemic. Participants were recruited from an advocacy-initiated collaborative that operated with a housing first approach, providing private rooms without requirements or intrusive oversight typically found in shelter environments. Benefits of hotel housing reported include improvements in physical health, sleep, personal hygiene, privacy, safety, nutrition, and overall well-being. Inductive coding by consensus and thematic development yielded three themes. Participants described hotel living as (1) a platform for stability; (2) protection from COVID and other hazards; and (3) freeing mental space for future planning. As research shows hotel programs' success, an unprecedented opportunity has arisen from the pandemic to end homelessness for many. Given current federal budget increases, it is recommended that hotels become part of a larger effort to reduce shelter populations and increase access to independent housing.
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Affiliation(s)
| | - Lynden Bond
- Silver School of Social Work, New York, NY, USA
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Abstract
Rapid-acting interventions for the suicide crisis have the potential to transform treatment. In addition, recent innovations in suicide research methods may similarly expand our understanding of the psychological and neurobiological correlates of suicidal thoughts and behaviors. This review discusses the limitations and challenges associated with current methods of suicide risk assessment and presents new techniques currently being developed to measure rapid changes in suicidal thoughts and behavior. These novel assessment strategies include ecological momentary assessment, digital phenotyping, cognitive and implicit bias metrics, and neuroimaging paradigms and analysis methodologies to identify neural circuits associated with suicide risk. This review is intended to both describe the current state of our ability to assess rapid changes in suicide risk as well as to explore future directions for clinical, neurobiological, and computational markers research in suicide-focused clinical trials.
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Affiliation(s)
- Elizabeth D. Ballard
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
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Wusinich C, Lindy DC, Russell D, Pessin N, Friesen P. Experiences of Parachute NYC: An Integration of Open Dialogue and Intentional Peer Support. Community Ment Health J 2020; 56:1033-1043. [PMID: 32036517 DOI: 10.1007/s10597-020-00556-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Abstract
Guided by the principles of Open Dialogue and Intentional Peer Support (IPS), Parachute NYC was designed to provide a "soft landing" for people experiencing psychiatric crisis. From 2012 to 2018, Parachute's teams of clinicians and peer specialists provided home-based mental health care to enrollees and their networks (family, friends), seeking to engage and improve their natural support networks. This qualitative study examined the experiences of enrollees and network members who participated in Parachute. Participants reported that they valued the accessibility and flexibility of Parachute as well as their relationships with, and the lack of hierarchy within, the Parachute team. Responses to the structure of network meetings and Parachute's approach to medication were mixed, with a few participants struggling with what they felt was a lack of urgency and others experiencing the approach as holistic. Many enrollees and network members reported that Parachute improved their self-understanding and relationships with each other.
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Affiliation(s)
- Christina Wusinich
- Visiting Nurse Service of New York, Community Mental Health Services, 286 Lenox Ave., New York, NY, 10027, USA.
| | - David C Lindy
- Visiting Nurse Service of New York, Community Mental Health Services, 286 Lenox Ave., New York, NY, 10027, USA.,College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - David Russell
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th Floor, New York, NY, 10001, USA.,Department of Sociology, Appalachian State University, 209 Chapell Wilson Hall, 480 Howard Street, Boone, NC, 28608, USA
| | - Neil Pessin
- Visiting Nurse Service of New York, Community Mental Health Services, 286 Lenox Ave., New York, NY, 10027, USA
| | - Phoebe Friesen
- Visiting Nurse Service of New York, Community Mental Health Services, 286 Lenox Ave., New York, NY, 10027, USA.,Biomedical Ethics Unit, Social Studies of Medicine, McGill University, 3647 Peel St., Montreal, QC, H3A 1X1, Canada
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Wusinich C, Bond L, Nathanson A, Padgett DK. "If you're gonna help me, help me": Barriers to housing among unsheltered homeless adults. Eval Program Plann 2019; 76:101673. [PMID: 31228636 DOI: 10.1016/j.evalprogplan.2019.101673] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/25/2019] [Accepted: 06/12/2019] [Indexed: 06/09/2023]
Abstract
Despite a legally-mandated right to shelter and extensive outreach efforts, an estimated 3,675 homeless individuals were living on the streets of New York City in 2018. Through interviews with 43 unsheltered homeless individuals in the borough of Manhattan (age range 21-74 years), this qualitative study examined barriers they face in accessing housing and other services as well as experiences surviving on the street. Through thematic analysis of the interview data, the most common barriers found were obtaining required identification documents, lack of accessibility of shelters amid complex healthcare needs, waiting as part of the process, and exclusion of pets from shelters and housing options. Themes capturing survival on the street included sleeping safe, avoiding shelters, and meeting daily needs. Virtually all barriers street homeless New Yorkers face stem from bureaucratic policies that, however well-intentioned, do not address their diverse needs. Thus, long delays and poor communication, combined with crowded, unsafe shelters, lead to frustration and alienation. While homelessness is ultimately the result of a severe and chronic shortage of affordable housing, creating accessible, safe, pet-friendly shelter and safe haven options and instituting a smoother, more transparent process for moving from the streets could substantially reduce street homelessness.
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Affiliation(s)
- Christina Wusinich
- New York University Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, United States.
| | - Lynden Bond
- New York University Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, United States.
| | - Anna Nathanson
- New York University Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, United States.
| | - Deborah K Padgett
- New York University Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, United States.
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