Promoting the Readiness of Minors in Supplemental Security Income (PROMISE) [CFDA 84.418P]

Over the past two decades, New York State (NYS) has been actively and collaboratively engaged in systems change across three primary domains: 1) to develop a comprehensive employment system to reduce barriers to work and improve employment outcomes of individuals with disabilities; 2) to enhance the post-school adult outcomes of youth with disabilities, by collaboratively advancing evidence-based secondary transition practices at the regional, school district and individual student levels; and, 3) to support the return-to-work efforts of individuals with disabilities who receive Social Security Administration (SSA) disability benefits under the Supplemental Security Income (SSI) program and Social Security Disability Insurance (SSDI). These domains have been supported by numerous federal and state initiatives including: the US Department of Education’s Office of Special Education and Rehabilitation Services (OSERS)-sponsored Transition Systems Change grant; the SSA-sponsored State Partnership Initiative (NYWORKS); two Youth Transition Demonstrations (YTD); the Benefits Offset National Demonstration (BOND); and, three cycles of funding for the National Work Incentives Support Center (WISC); the US Department of Labor (DOL)-sponsored Work Incentive Grant, Disability Program Navigator Initiative, and Disability Employment Initiative; three rounds of funding from the Center for Medicaid and Medicare Services (CMS) for Medicaid Infrastructure Grants (MIG, NY Makes Work Pay); the NYS Education Department (NYSED) sponsored Model Transition Program (MTP); and three multi-year cycles of the statewide Transition Coordination Site network. Most recently, NYS has sponsored the Statewide Transition Services Professional Development Support Center (PDSC); the NYS Developmental Disability Planning Council (DDPC)-sponsored Transition Technical Assistance Support Program (T-TASP), NYS Work Incentives Support Center (NYS WISC), and NYS Partners in Policy Making (PIP); the NYS Office of Mental Health (OMH)-sponsored Career Development Initiative; and others. The growing statewide and gubernatorial emphasis on employment for New Yorkers with disabilities developed over the past two decades stemming from these initiatives, supported by service innovations and shared vision across state agencies and employment stakeholders, establishes a strong foundation for implementing and sustaining a research demonstration to “Promote the Readiness of Minors in Supplemental Security Income” (PROMISE). The NYS PROMISE will build upon NYS’ past successes and significantly support NYS in removing systems, policy and practice barriers for transition-age youth who receive SSI and their families. The NYS OMH through the Research Foundation for Mental Hygiene (RFMH), with their management partners the New York Employment Support System (NYESS) Statewide Coordinating Council (SCC) and Cornell University Employment and Disability Institute, along with the proposed research demonstration site community, join the NYS Governor’s Office in designing and implementing a series of statewide strategic service interventions to support the transition and employment preparation of youth ages 14-16 who receive SSI

Creating an innovative youth mental health service in the United Kingdom: The Norfolk Youth Service

Aims: Young people attempting to access mental health services in the United Kingdom often find traditional models of care outdated, rigid, inaccessible and unappealing. Policy recommendations, research and service user opinion suggest that reform is needed to reflect the changing needs of young people. There is significant motivation in the UK to transform mental health service for young people and this paper aims to describe the rationale, development and implementation of a novel youth mental health service in the UK, the Norfolk Youth Service. Methods: The Norfolk Youth Service model is described as a service model case study. The service rationale, national and local drivers, principles, aims, model, research priorities and future directions are reported. Results: The Norfolk Youth Service is an innovative example of mental health transformation in the United Kingdom, comprising a pragmatic, assertive and ‘youth friendly’ service for young people aged 14-25 that transcends traditional service boundaries. The service was developed in collaboration with young people and partnership agencies and is based upon an engaging and inclusive ethos. The service is social recovery oriented, evidence based and aims to satisfy recent policy guidance. Conclusions: The redesign and transformation of youth mental health services in the United Kingdom is long overdue. The Norfolk Youth Service represents an example of reform that aims to meet the developmental and transitional needs of young people, while remaining youth oriented

A guiding framework - family/supportive person administration of prescribed anti-psychotic depot injections within mental health

This guiding framework arose out of the the doctoral study 'Enabling Carers to administer Depot Injections: an action research study PhD thesis (available on GALA). The guiding framework evolved through a collaborative process between family members, involved in the research process, Oxleas NHS Trust R&D department and the author. The framework is designed for collaborative working between service users, family members/supportive persons, mental health services and practitioners should a person, prescribed a depot injection, request someone other than a nurse, administer their depot injection

The experiences and meanings of recovery for Swazi women living with ‘Schizophrenia’

Introduction: Globally, twenty-four million people live with schizophrenia, 90% living in developing countries. While most Western cultures recognise service user expertise within the recovery process this is not evident in developing countries. In particular, Swazi women diagnosed with schizophrenia experience stigma from family, community and care providers, thus compromising their recovery process. Aim: This study aimed to explore the experiences and meanings of recovery for Swazi women living with schizophrenia. Methodology: Interpretive Phenomenological Analysis was used. Fifteen women were recruited from Swaziland National Psychiatric Hospital out patients’ department, and face to face interviews were conducted. Findings: Four super-ordinate themes were identified: (1) The emotionality of ‘illness of the brain’; (2) Pain! Living with the illness and with others; (3) She is mad just ignore her; and (4) Being better. Discussion: Discussion focuses on the findings of this study and a number of positive and negative implications emanating from them; labelling, stigma and the roles of family, culture and religious beliefs on the process of recovery. Implications for practice: This study provides practitioners with insight into the importance of the socio-cultural context of the lives of women diagnosed with schizophrenia and how, in understanding this, mental health care could be improved

A Whole School Approach to Supporting Children and Young People’s Mental Health

Purpose Supporting the mental health of children and young people is a global priority. The issue is not specific to England. However, evidence suggests that one in ten children and young people in England has a mental health need. This represents approximately three students in every classroom. The purpose of this paper is to highlight the role of schools in supporting children and young people’s mental health. Whilst the paper acknowledges that teachers are not trained health professionals, it is argued that a whole-school approach to mental health can support individuals in schools to remain mentally healthy. The elements of a whole-school approach are identified and discussed and some of the challenges in relation to implementation are considered. Critical to the development of a whole-school approach is the commitment from the school leadership team to promoting student and staff wellbeing. Design/methodology/approach This is a policy paper not an empirical study. Findings This paper has outlined the policy context in the UK in relation to children and young people’s mental health. It has addressed the risk and protective factors which can cause or mitigate against mental ill health and it has outlined the elements of a whole-school approach to mental health. Originality/value This paper explores the contribution that schools can make to supporting students’ mental health. There is limited research which addresses mental health in young people from a non-therapeutic angle

A Golf Programme for People with Severe and Enduring Mental Health Problems

This article reports a pioneering golf programme for people with severe and enduring mental health problems. Following a discussion of the problems and possibilities of golf as a form of physical activity for this group, we outline the structure, organisation, and ethos of the golf programme. Through an analysis of qualitative case study data collected during the programme, we discuss the response to the programme from service users and mental health professionals. We conclude by highlighting aspects of the programme which were critical to its success and offering suggestions for further initiatives in this area

A longitudinal exploration of mental health resilience, cognitive impairment and loneliness

Objective: There is a growing interest in how people living with dementia may achieve good outcomes and be resilient despite their health challenges. Understanding what might be important for resilience in this population is largely untested theory. Methods: The analysis draws a subsample with cognitive impairment (N = 579) from two waves of the Cognitive Function and Ageing Studies Wales study, a nationally representative study of community-dwelling people aged 65+ in Wales. We constructed a measure of mental health resilience (MHR) defined as no depression, no anxiety and high well-being. Drawing on a resilience framework, we tested univariate and cumulative effects models of the factors that enable MHR, and then examined whether MHR is important for reducing loneliness over time. Results: Across both waves of data 22% (n = 121) met the criteria for MHR. The cumulative effects model found the odds of MHR were greater for male gender, higher self-esteem, greater social resources and no subjective memory complaints. Controlling for these significant predictors, MHR significantly predicted lower total and sub-scale scores for loneliness at wave 2. Sensitivity analysis shows these effects held at lower levels of cognitive function when the Mini-Mental State Examination score was <25, but not at <23. Conclusions: This paper addresses a gap in research regarding the conceptualisation and measurement of resilience when facing cognitive impairment. Understanding what aspects of a person's life might enable good mental health despite cognitive impairment—to be resilient—could inform effective strategies for friends and families, along with health, and social policy and practice

Improving outcomes for people in mental health crisis: a rapid synthesis of the evidence for available models of care

BACKGROUND: Crisis Concordat was established to improve outcomes for people experiencing a mental health crisis. The Crisis Concordat sets out four stages of the crisis care pathway: (1) access to support before crisis point; (2) urgent and emergency access to crisis care; (3) quality treatment and care in crisis; and (4) promoting recovery. OBJECTIVES: To evaluate the clinical effectiveness and cost-effectiveness of the models of care for improving outcomes at each stage of the care pathway. DATA SOURCES: Electronic databases were searched for guidelines, reviews and, where necessary, primary studies. The searches were performed on 25 and 26 June 2014 for NHS Evidence, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database, and the Health Technology Assessment (HTA) and PROSPERO databases, and on 11 November 2014 for MEDLINE, PsycINFO and the Criminal Justice Abstracts databases. Relevant reports and reference lists of retrieved articles were scanned to identify additional studies. STUDY SELECTION: When guidelines covered a topic comprehensively, further literature was not assessed; however, where there were gaps, systematic reviews and then primary studies were assessed in order of priority. STUDY APPRAISAL AND SYNTHESIS METHODS: Systematic reviews were critically appraised using the Risk Of Bias In Systematic reviews assessment tool, trials were assessed using the Cochrane risk-of-bias tool, studies without a control group were assessed using the National Institute for Health and Care Excellence (NICE) prognostic studies tool and qualitative studies were assessed using the Critical Appraisal Skills Programme quality assessment tool. A narrative synthesis was conducted for each stage of the care pathway structured according to the type of care model assessed. The type and range of evidence identified precluded the use of meta-analysis. RESULTS AND LIMITATIONS: One review of reviews, six systematic reviews, nine guidelines and 15 primary studies were included. There was very limited evidence for access to support before crisis point. There was evidence of benefits for liaison psychiatry teams in improving service-related outcomes in emergency departments, but this was often limited by potential confounding in most studies. There was limited evidence regarding models to improve urgent and emergency access to crisis care to guide police officers in their Mental Health Act responsibilities. There was positive evidence on clinical effectiveness and cost-effectiveness of crisis resolution teams but variability in implementation. Current work from the Crisis resolution team Optimisation and RElapse prevention study aims to improve fidelity in delivering these models. Crisis houses and acute day hospital care are also currently recommended by NICE. There was a large evidence base on promoting recovery with a range of interventions recommended by NICE likely to be important in helping people stay well. CONCLUSIONS AND IMPLICATIONS: Most evidence was rated as low or very low quality, but this partly reflects the difficulty of conducting research into complex interventions for people in a mental health crisis and does not imply that all research was poorly conducted. However, there are currently important gaps in research for a number of stages of the crisis care pathway. Particular gaps in research on access to support before crisis point and urgent and emergency access to crisis care were found. In addition, more high-quality research is needed on the clinical effectiveness and cost-effectiveness of mental health crisis care, including effective components of inpatient care, post-discharge transitional care and Community Mental Health Teams/intensive case management teams. STUDY REGISTRATION: This study is registered as PROSPERO CRD42014013279. FUNDING: The National Institute for Health Research HTA programme