Clinical correlates of initial treatment disengagement in first-episode psychosis

Aim: Early engagement in care is thought to reduce disabling social losses related to the duration of untreated psychosis (DUP), such as school dropout, homelessness, and incarceration, which contribute to chronic disability. Early intervention services that promote recovery will not be effective if eligible persons drop out of treatment after an initial hospitalization for a psychotic disorder. We had the unique opportunity to examine the treatment disengagement rate of patients with early psychosis after an initial hospitalization.Methods: In a predominantly male, African American, and socioeconomically disadvantaged group of 33 participants with first-episode psychosis assessed at initial hospitalization and six months after discharge, we compared clinical characteristics (medication adherence attitudes and behaviors, knowledge about schizophrenia, insight, symptom severity, and persistence ofalcohol and drug use) among those who disengaged and people who engaged in care.Results: More than half (18, 54.5%) attendeddischarge, and of those, nearly all (15, 83.3%) attended no outpatient appointments. Disengaged people were much less adherent to medications in the past month and six months, and scored lower on medication adherence attitudes, knowledge about psychosis, and insight. They had greater positive symptom severity and a higher likelihood of continuing drug use.Clinical Relevancy: Initial treatment disengagement is very common among young people with first-episode psychosis and associated with poorer clinical status. More research is needed onthe causes of disengagement during this critical period, and ways to improve initial treatment engagement among people with first-episode psychosis

Law enforcement officers’ perceptions of and responses to traumatic events: a survey of officers completing Crisis Intervention Team training

Law enforcement officers work in ever-changing and sometimes stressful environments. However, to date, little research has been conducted on officers’ perceptions of, and responses to, stressful and traumatic events. We surveyed 575 officers in Crisis Intervention Team (CIT) training regarding such perceptions and responses. Results indicate that many officers have experienced traumatic events, and/or know a fellow officer who has experienced trauma on the job. Yet, these officers are reluctant to disclose their experiences to their agency. Moreover, results indicate that many officers are hesitant to seek help within their agency, suggesting barriers such as pervasive stigma. Results also indicate that agencies are providing some resources (e.g. training) to help their officers cope; yet the empirical evidence on this is scant. We expect that our findings will help contribute to the literature on CIT and interactions between officers and persons with mental illnesses, and inspire new, rigorous training and programme development

Surveys of Police Chiefs and Sheriffs and of Police Officers About CIT Programs.

OBJECTIVE: Two surveys were conducted on the crisis intervention team (CIT) model, a police-based program designed to improve responses to individuals with mental illnesses. METHODS: Data were collected between July and September 2013 from 171 police chiefs and sheriffs (42 had implemented CIT in their agency), and 353 law enforcement officers (273 had CIT training) in Georgia. RESULTS: Police chiefs and sheriffs reported barriers to implementing CIT, such as not having enough officers and insufficient access to mental health services. CIT-trained officers differed from non-CIT-trained officers only with regard to being less likely to use force in response to a man with psychotic agitation described in a vignette, when the analysis controlled for whether the officer carried an electronic control device. CONCLUSIONS: Some hypothesized differences, such as in job satisfaction and work burnout, were not observed. However, CIT-trained officers appeared to be less likely to revert to force in a situation involving psychotic agitation

Development and initial reliability and validity of four self-report measures used in research on interactions between police officers and individuals with mental illnesses

There currently exists a dearth of reliable and valid instruments to examine key police officer variables of importance in the growing research on their interactions with individuals with mental illnesses. This study tested reliability and validity of four newly designed measures of the constructs of self-efficacy (Self-Efficacy Scale; SES), referral decisions and de-escalation skills (Behavioral Outcomes Scale; BOS), attitudes toward psychiatric treatment (Opinions about Psychiatric Treatment; OPT), and social distance (Adapted Social Distance Scale; ASDS) in a sample of law enforcement officers. Self-administered, anonymous surveys, which included the measures of interest, were completed by 177 officers—68 of whom were undergoing Crisis Intervention Team (CIT) training and 109 of whom were not—at the beginning and end of week-long trainings. Analyses examined the internal consistency reliability, test-retest reliability, and construct validity of the instruments. The four measures of interest were found to be reliable and valid. Specifically, internal consistency coefficients and test-retest reliability correlations were generally acceptable, all four demonstrated sensitivity to change, and validity correlations were significant and in the expected direction. Findings demonstrated the ability to measure key constructs related to attitudes and intended behaviors in law enforcement officers utilizing psychometrically sound instruments. Further testing and the development of additional reliable and valid instruments focused on attitudinal and behavioral domains among officers who have frequent interactions with individuals with mental illnesses would be of great value

Measuring insight through patient self-report: An in-depth analysis of the factor structure of the Birchwood Insight Scale

Little research has focused on item analysis and factor structure of the most commonly used measures of insight. We examined the factorial structure of the Birchwood Insight Scale (BIS), a brief, easy-to-administer, self-report measure. We studied the BIS in 327 first-episode psychosis patients, including a test sample (n=163) and a validation sample (n=164). We then used data from 100 patients with chronic serious mental illnesses as a second, external validation sample. Exploratory factor analysis was conducted with the test subsample, and confirmatory factor analyses with the two validation samples. Confirmatory factor analyses (in both the first-episode psychosis validation sample and the chronic serious mental illness sample) indicated that a single-factor solution, with seven items loading on a single factor with item 1 ( Some of your symptoms are made by your mind ) eliminated was the best-fitting model. Seven of the eight original BIS items loading on a single factor fit the data well in these samples. Researchers using this efficient measure of patient-reported insight should assess the item distributions and factor structure of the BIS in their samples, and potentially consider eliminating item 1. (C) 2014 Elsevier Ireland Ltd. All rights reserved

A mixed-methods study of the recovery concept, a meaningful day, in community mental health services for individuals with serious mental illnesses.

The recovery concept encompasses overcoming or managing one\u27s illness, being physically and emotionally healthy, and finding meaningful purpose through work, school, or volunteering, which connects one to others in mutually fulfilling ways. Using a mixed-methods approach, we studied the emphasis on a meaningful day in the new Opening Doors to Recovery (ODR) program in southeast Georgia. Among 100 participants, we measured the meaningful day construct using three quantitative items at baseline (hospital discharge) and at 4-, 8-, and 12-month follow-up, finding statistically significant linear trends over time for all three measures. Complementary qualitative interviews with 30 individuals (ODR participants, family members, and ODR\u27s Community Navigation Specialists and program leaders) revealed themes pertaining to companionship, productivity, achieving stability, and autonomy, as well as the concern about insufficient resources. The concept of a meaningful day can be a focus of clinical attention and measured as a person-centered outcome for clients served by recovery-oriented community mental health services