EXAMINING CONSUMER RACE, GENDER, AND AGE DIFFERENCES IN HOPE AND RECOVERY THROUGH NAMI’S IN OUR OWN VOICE PROGRAM

poster abstractThe United States mental health system is in the process of transforming mental health care from treating and reducing symptoms to a relatively new focus on education, awareness, and optimal consumer recovery. The Nation-al Alliance on Mental Illness (NAMI) developed the In Our Own Voice (IOOV) program where consumers present their mental illness and recovery stories as a direct educational and indirect anti-stigma tool. The purpose of this study was to examine the impact that NAMI’s IOOV Program has on con-sumer hope and recovery attitudes. Questionnaires were distributed to four NAMI sites throughout the United States and given to consumers (n = 118) both before and after the IOOV program. The Recovery Expectations Scale, an adaptation of the Consumer Optimism Scale, was used to measure con-sumer recovery attitudes. The Snyder State Hope Scale was used to meas-ure state level hope, with agency and pathways subscales. After the inter-vention, we hypothesized that younger consumers, females, and Caucasians would report greater increases in their hope and expectations for recovery. Contrary to hypotheses, overall state-level hope remained the same throughout the program. Examination of gender differences in hope agency reveals trends, in which females decrease and males only slightly increase after viewing the program. Trends towards significance are also indicated in hope pathways, in which African Americans reported decreased pathways and Caucasians reported increased pathways. In addition, recovery expecta-tions, improved overall, with no significant differences in improvement among demographic variables. Implications of these findings and their im-portance for consumer recovery programs are discussed

Mixed methods study examining work reintegration experiences from perspectives of Veterans with mental health disorders

Recent findings have demonstrated that reintegration for Veterans is often challenging. One difficult aspect of reintegration—transitioning into the civilian workplace—has not been fully explored in the literature. To address this gap and examine work reintegration, this mixed methods study examined the perspectives of Veterans with mental health disorders receiving Department of Veterans Affairs healthcare. Forty Veterans rated factors that affect work success; participants also provided narratives on their most and least successful work experiences. We used t-tests and qualitative analysis to compare participants who did and did not serve in combat. Several themes relevant to work reintegration emerged in the narratives, particularly for Veterans who served in combat. An array of work difficulties were reported in the months following military discharge. In addition, Veterans who served in combat reported significantly more work barriers than Veterans who did not serve in combat, particularly health-related barriers. In conclusion, Veterans with mental health disorders who served in combat experienced more work reintegration difficulty than their counterparts who did not serve in combat. The role of being a Veteran affected how combat Veterans formed their self-concept, which also shaped their work success and community reintegration, especially during the early transition period

Factors impacting work success in Veterans with mental health disorders: A Veteran-focused mixed methods pilot study

BACKGROUND: Veterans with mental illness often have poor employment outcomes. OBJECTIVE: This mixed-methods study sought to understand and describe Veteran perspectives of factors that impact their work success. METHODS: A sample of 40 employed and unemployed Veterans with post-traumatic stress disorder (PTSD) or other severe mental illness (SMI) completed a survey of factors that impact vocational functioning and provided narrative accounts of their most successful and challenging work experiences. RESULTS: Personal motivation, self-efficacy, work skills, interpersonal issues, health, and cognitive problems were rated as most impactful on work. There were no significant differences on ratings of work factors based on employment status. Veterans with PTSD reported significantly more barriers to work success compared with Veterans with SMI, notably, cognitive problems, physical health, and psychological stress. Veterans with SMI were more likely to receive VA vocational services and rated this assistance as beneficial to work success. Narrative findings corroborated the survey results, and yielded additional factors, including economic factors, person/job fit, and Veteran-specific issues. CONCLUSIONS: Several factors substantially impact work success in Veterans with mental illness. Veterans with PTSD and SMI experience a distinct set of barriers and facilitators, suggesting the need for tailoring clinical and rehabilitative services

Facilitators and Barriers to Illness Management and Recovery Implementation

poster abstractIllness Management and Recovery (IMR) is an evidence-based program designed to help people with severe mental illness better manage their illness and achieve personally meaningful goals. IMR has shown improved outcomes including better coping and reduced psychiatric symptoms. There have been some difficulties implementing IMR, even within programs that have received IMR training. The purpose of the current study was to examine the differences between facilitators and barriers for implementing IMR as perceived by providers of IMR and non-providers of IMR in order to identify potential targets for implementation strategies. A national online survey was conducted with VA Medical Centers (VAMCs), resulting in 151 responses representing 107 VAMCs nationwide. Survey respondents included local recovery coordinators (LRCs) and staff referred by the LRC for being knowledgeable regarding IMR. The current analyses focused on two open-ended questions pertaining to facilitators and barriers to implementation. The authors independently developed codes through an iterative process to categorize responses. We then established overall consensus on codes and applied those codes to each open-ended response. Chi-square tests were performed on each category to determine differences between provider and non-provider perceived facilitators and barriers. Differences in identified facilitators and barriers were discovered between the providers and non-providers respondents. Overall barriers and facilitators to implementation are described. Identifying facilitators and barriers that differ between providers and non-providers can provide insight into areas that may impact implementation. By understanding these differences we can provide carefully targeted interventions to increase implementation, for example, gaining support from individuals who do not directly provide IMR, could reinforce the experiences of direct service providers

Essential Components of Early Intervention Programs for Psychosis: Available Intervention Services in the United States

Programs providing interventions for early psychosis are becoming commonplace in the United States (U.S.); however, the characteristics of existing services remain undocumented. We examined program characteristics, clinical services, and program eligibility criteria for outpatient early intervention programs across the U.S. using a semi-structured telephone interview. Content analysis was used to identify the presence or absence of program components, based in part on a recent list of essential evidence-based components recommended for early intervention programs (Addington, MacKenzie, Norman, Wang and Bond, 2013) as well as program characteristics, including eligibility criteria. A total of 34 eligible programs were identified; 31 (91.2%) program representatives agreed to be interviewed. Of the examined components, the most prevalent were individual psychoeducation and outcomes tracking; the least prevalent were outreach services and communication with inpatient units. The populations served by US programs were most frequently defined by restrictions on the duration of psychosis and age. This study provides critical feedback on services for the early psychosis population and identifies research to practice gaps and areas for future improvement

Schizotypy in an online sample: Associations with functioning, wellbeing, and stigma toward psychological treatment

poster abstractBackground: Social functioning and positive attitudes toward treatment have been strongly linked with recovery in people with schizophrenia, yet less is known for schizotypy – traits that are associated with risk for schizophrenia. Previous studies of schizotypy have used primarily undergraduate or small community samples. The aim of the current study was to investigate correlates of schizotypy in a large online sample. We hypothesized that people with schizotypy traits would report lower functioning, well-being, and greater stigmatizing attitudes regarding treatment. Methods: In a sample (N=856) recruited using Amazon’s Mechanical Turk (MTurk), participants were dichotomized into non-schizotypy or schizotypy groups based on their endorsement of schizotypal traits on the Schizotypal Personality Questionnaire – Brief Revised (SPQ-BR; schizotypy group n=101; non-schizotypy group n=431). Participants completed a demographic survey and several measures related to functioning, well-being, and stigma, including the Romantic Relationship Functioning Scale (RRFS), the Social Adjustment Scale – Self-Report: Screener (SAS-SR: Screener), the SPQ-BR, the Short Form-12 Health Survey (SF-12), and the Stigma Scale for Receiving Psychological Help (SSRPH). Independent-samples t-tests were conducted to compare schizotypy groups on these variables. Results: Those who reported high levels of schizotypy reported significantly poorer social functioning, t(122.74)=-10.66, p<.001; poorer romantic relationship functioning, t(129.01)=12.00, p<.001; poorer mental wellbeing ,t(132.58)=13.42, p=.001; and greater stigma toward receiving psychological treatment, t(137.06)=-3.89, p=.037. There was no significant difference in physical wellbeing. Discussion: These findings support the use of online samples and suggest schizotypy is associated with poorer functioning and wellbeing and increased stigma toward seeking treatment. Results support the emergence of deficits in key social domains among those at risk for developing greater psychosis symptoms. Given the links between these deficits and attitudes and poorer functioning in clinical samples, these findings suggest social functioning and help-seeking attitudes may be important targets of early intervention services

Perceptions of Treatment Plan Goals of People in Psychiatric Rehabilitation

Collaborative treatment planning is a process by which providers and consumers work together to set goals for treatment, choose between alternative services, and establish a plan. Research has not examined consumers’ views of their treatment plan goals. The present study examined ways in which consumers react to their treatment plan goals. Twenty-one interviews with Veterans engaged in psychiatric rehabilitation regarding goals listed in their treatment plan were analyzed using inductive content analysis. Reactions to treatment plan goals are reported. Analyses indicate people do not vary in a linear degree regarding agreement with treatment plan goals. Clinicians and researchers should examine the extent to which treatment plan goals are consistent with the consumer’s personal goals and self-concept

The four-factor conceptualization of empathy in schizophrenia: A meta-analysis

Empathy is a complex construct, thought to contain multiple components. One popular measurement paradigm, the Interpersonal Reactivity Index (IRI), has been used extensively to measure empathic tendencies in schizophrenia research across four domains: empathic concern, perspective-taking, personal distress, and fantasy. However, no recent meta-analysis has been conducted for all four factors of this scale. The goal of this meta-analysis was to examine self-reported empathic tendencies for each factor of the IRI in people with schizophrenia as compared to healthy controls. A literature search revealed 32 eligible schizophrenia studies. The Hedges’ g standardized difference effect size was calculated for each component using a random effects meta-analytic model. Compared to healthy controls, schizophrenia samples reported significantly reduced tendencies for empathic concern, perspective-taking, and fantasy, but significantly greater tendencies for personal distress. Duration of illness significantly moderated the results for perspective-taking such that those with a longer duration exhibited greater deficits; percent female significantly moderated the results for personal distress such that samples with more females exhibited reduced effect sizes. Future work is needed to examine the impact of heightened personal distress on the empathic tendencies and abilities of those with schizophrenia, including the possible role of emotion regulation

Sexuality and intimacy among people living with serious mental illnesses: Factors contributing to sexual activity

OBJECTIVE: Limited research has focused on sexuality for those diagnosed with a severe mental illness. We aimed to extend existing work by exploring relationships between mastery (perception of control of one's life and future), sexual self-esteem (perceptions of one's capacity to engage in healthy sexual behavior), sexual attitudes (permissive ideas about sexuality), and perceived importance of relationships/sexuality and number of sexual partners. METHOD: A secondary analysis of survey data from adult participants living with a severe mental illness (N = 401) in the Indiana Mental Health Services and HIV-Risk Study (Perry & Wright, 2006) was conducted. Analysis of covariance (controlling for marital status) compared those with 0 partners, 1 partner, or multiple partners over the past 3 months on the dependent variables of mastery, sexual self-esteem, sexual attitudes, and perceived importance. RESULTS: Participants with more permissive attitudes, greater perceived importance, and higher mastery were more likely to be sexually active with multiple partners. Self-esteem did not differentiate groups. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Given the key role of sexual satisfaction in quality of life and the high rates of sexual risk behavior in this population, it is important that clinicians systematically assess mastery, perceived importance, and attitudes about sexuality when working with consumers diagnosed with a severe mental illness. Individually tailoring existing interventions on the basis of consumers' levels of mastery, related to self-efficacy for implementing changes in life, could improve long-term outcomes for these programs. Future research should examine other constructs that may account for more variance in sexual activity, such as perceptions of risk, intentions for sexual safety, or romantic relationship functioning

Why are you here again? Concordance between consumers and providers about the primary concern in recurring psychiatric visits

Patient-centered care has become increasingly important over the last decade, both in physical and mental health care. In support of patient-centered care, providers need to understand consumers׳ primary concerns during treatment visits. The current study explored what primary concerns were brought to recurring psychiatric visits for a sample of adults with severe mental illness (N=164), whether these concerns were concordant with those recognized by providers, and which factors predicted concordance. We identified 17 types of primary concerns, most commonly medications and symptoms, with only 50% of visits showing evidence of at least partial agreement between consumers and providers. Contrary to expectations, consumer demographics, activation, trust, and perceptions of patient-centeredness were not predictive, while greater preferences for autonomy predicted poorer agreement. Our findings highlight the need for interventions to promote a shared understanding of primary concerns in recurring psychiatric visits. Further attention is needed to ensure the provision of patient-centered care such that consumer concerns are acknowledged and addressed within recurring psychiatric visits