Barriers and Facilitators to Work Success for Veterans in Supported Employment: A Nationwide Provider Survey

bjective: Veterans with mental illness are at serious risk of poor work outcomes and career stagnation. Supported employment (SE) is an evidence-based model of vocational services that assists persons with mental illness to obtain competitive employment. The purpose of this study was to gain a rich understanding of barriers and facilitators related to competitive work success from the perspective of a nationwide sample of U.S. Department of Veterans Affairs (VA) SE staff, supervisors, and managers. Methods: This study utilized a mixed-methods approach in which 114 VA SE personnel completed an online questionnaire consisting of a survey of work barriers and facilitators; open-ended questions elicited additional factors affecting work success. Descriptive statistics characterized factors affecting work success, and an emergent, open-coding approach identified qualitative themes describing other key elements influencing employment. Results: The most prominent work facilitators were perceived veteran motivation, job match, the assistance of SE services, and veteran self-confidence. The highest rated barriers were psychological stress and a range of health-related problems. Qualitative findings revealed additional areas affecting work success, notably, the availability of resources, the capacity of frontline staff to form strong relationships with veterans and employers, the ability of staff to adapt and meet the multifaceted demands of the SE job, and the need for additional staff and supervisor training. The impact of employer stigma was also emphasized. Conclusions: An array of elements influencing work success at the level of the veteran, staff, SE program, and employer was recognized, suggesting several implications for VA services

Portable Computer Technology (PCT) Research and Development Program Phase 2

The subject of this project report, focused on: (1) Design and development of two Advanced Portable Workstation 2 (APW 2) units. These units incorporate advanced technology features such as a low power Pentium processor, a high resolution color display, National Television Standards Committee (NTSC) video handling capabilities, a Personal Computer Memory Card International Association (PCMCIA) interface, and Small Computer System Interface (SCSI) and ethernet interfaces. (2) Use these units to integrate and demonstrate advanced wireless network and portable video capabilities. (3) Qualification of the APW 2 systems for use in specific experiments aboard the Mir Space Station. A major objective of the PCT Phase 2 program was to help guide future choices in computing platforms and techniques for meeting National Aeronautics and Space Administration (NASA) mission objectives. The focus being on the development of optimal configurations of computing hardware, software applications, and network technologies for use on NASA missions

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

Veterans’ Pain Management Goals: Changes During the Course of a Peer-led Pain Self-Management Program

Objective Goal setting is a common element of self-management support programs; however, little is known about the nature of patients’ goals or how goals change during pain self-management. The purpose of the current study is to explore how patients’ goals and views of goal setting change over the course of a peer-led pain self-management program. Methods Veterans (n = 16) completing a 4-month peer-led pain self-management program completed semi-structured interviews at baseline and follow-up regarding their goals for their pain. Interviews were analyzed using immersion/crystallization. Results Analyses revealed six themes: motivation to do something for their pain, more goal-oriented, actually setting goals, clarity of goal importance, more specific/measurable goal criteria, and more specific/measurable strategies. Conclusion The current analyses illustrate how participants’ goals can evolve over the course of a peer-led pain self-management program. Specifically, increased motivation, more openness to using goals, greater clarity of goal importance, more specific and measurable goals and strategies, and the influence of the peer coach relationship were described by participants. Practice implications Pain self-management interventions should emphasize goal setting, and development of specific, measurable goals and plans. Trainings for providers should address the potential for the provider-patient relationship, particularly peer providers, to facilitate motivation and goal setting

A Review of Consumer-provided Services on Assertive Community Treatment and Intensive Case Management Teams: Implications for Future Research and Practice

Background—Assertive community treatment (ACT) is an evidence-based practice that provides intensive, in vivo services for adults with severe mental illness. Some ACT and intensive case management teams have integrated consumers as team members with varying results. Methods—We reviewed the literature examining the outcomes of having consumer providers on case management teams, with attention devoted to randomized controlled trials (RCTs). Results—We identified 16 published studies, including 8 RCTs. Findings were mixed, with evidence supporting consumer-provided services for improving engagement, and limited support for reduced hospitalizations. However, evidence was lacking for other outcomes areas such as symptom reduction or improved quality of life. Conclusion—Including a consumer provider on an ACT team could enhance the outreach mechanisms of ACT, using a more recovery-focused approach to bring consumers into services and help engage them over time. More rigorous research is needed to further evaluate integrating consumer providers on teams

Correlates of Attendance in Psychiatric Services: A Critical Review

poster abstractAttendance and dropout are concerning problems in the mental health field. With dropout rates averaging around 50%, mental health agencies lose money and resources invested in missed appointments and under-attended groups, providers lose valuable time, and consumers do not receive recommended levels of services. While there is research on consumer, provider, and agency factors that affect attendance, it has not been integrated and reviewed in the context of community services for those with psychotic disorders. The authors conducted a critical review of literature examining correlates of attendance in community services provided to samples with psychotic disorders as the most prominent diagnostic category. Twenty-two studies were identified that met inclusion criteria. Over 100 unique correlates of attendance were tested; the authors categorized these into eight content areas: demographics, current functioning, history (psychiatric/functional), neurocognitive functioning, services/treatment, social functioning, self-stigma/insight, and symptoms/psychopathology. Correlates were also sorted according to how often they were examined and how many times they were found to be significantly related to consumer attendance. The category containing the most unique correlates was symptoms/psychopathology. Demographic correlates were researched the most, with three unique correlates examined in over ten studies (age, sex, and living situation). Of these demographic correlates, all but two were found significant 25% of the time or less, and none exceeded 40%. Alternatively, some correlates have been investigated few times, but with promising results and theoretical connections to attendance, such as baseline illness severity, which has been found significant in 75% of analyses. There is evidence that researchers are examining correlates for which there is little empirical evidence of a connection to attendance. This may lead to missed opportunities to maximize attendance, use of services, and resources. Implications for future research in the area are discussed

An Empirical Examination of Symptom Substitution Associated with Behavior Therapy for Tourette\u27s Disorder

Over the past six decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a long-standing concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette’s disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using four methods: (a) the onset of new tic symptoms, (b) the occurrence of adverse events, (c) change in tic medications, and (d) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette’s disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of eight sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette’s disorder. Findings provide empirical support to counter the long-standing concern of symptom substitution in response to behavior therapy for individuals with Tourette\u27s disorder

How Do Patients with Chronic Pain Benefit from a Peer-Supported Pain Self-Management Intervention? A Qualitative Investigation

Objective. Peer support is a novel and under-studied approach to the management of chronic pain. This study’s purpose was to uncover the elements of a peer-supported self-management intervention that are perceived by participants as essential to achieving positive changes. Design. Qualitative, semi-structured interviews. Methods. Veterans and veteran peer coaches who participated in a pilot study of peer support Improving Pain using Peer-Reinforced Self-Management Strategies (IMPPRESS, NCT01748227) took part in qualitative semi-structured interviews after completing the 4-month intervention. Questions were designed to facilitate understanding of how participants experienced the intervention. An immersion/crystallization approach was used to analyze data. Results. All 26 peer coaches and patients who completed the intervention were interviewed. Qualitative analysis revealed three elements of IMPPRESS that peer coaches and patients believed conferred benefit: 1) making interpersonal connections; 2) providing/receiving encouragement and support; and 3) facilitating the use of pain self-management strategies. Conclusions. Peer support represents a promising approach to chronic pain management that merits further study. The current study helps to identify intervention elements perceived by participants to be important in achieving positive results. Understanding how peer support may benefit patients is essential to optimize the effectiveness of peer support interventions and increase the implementation potential of peer-supported pain self-management into clinical practice