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Objective: This paper examines common barriers to IPS supported employment implementation from the perspective of various stakeholders for IPS. Stakeholders describe the strategies used within their state to minimize or eliminate those problems. Methods: Six stakeholders reported barriers they encountered while implementing IPS and strategies they found helpful in overcoming those issues. The stakeholders included two senior planners from state mental health, one senior planner from state vocational rehabilitation, a mental health agency executive director, a client advocate, and a family member advocate. Barriers examined in this paper include program fee schedules that promote the use of traditional vocational assessments, difficulties funding IPS services, practitioner attitudes that conflict with IPS principles, client and family fears regarding loss of disability benefits or increased symptoms related to a return to work, and difficulties related to effective program implementation and sustainability. Conclusions: Although many service delivery systems have barriers to IPS implementation, these can be managed or eliminated through leadership from stakeholders such as state mental health and vocational rehabilitation senior planners, client and family advocates, and agency directors. [ABSTRACT FROM AUTHOR]

Mental health program leaders need vocational benchmarks for client outcomes. Outcomes from randomized controlled trials may not generalize to routine practice settings. This paper describes quarterly employment outcomes from a national learning collaborative on supported employment for people with serious mental illnesses. Benchmarks were established using the 25th, 50th, and 75th percentiles. Based on these percentiles, we recommend that state and local mental health and vocational rehabilitation administrators use a minimal benchmark of 33%, a good performance benchmark of 45%, and a high-performance benchmark of 57% for expected rates of competitive employment among active clients who receive evidence-based vocational services. [ABSTRACT FROM AUTHOR]

A review was conducted on the cross-cultural adaptation, effectiveness, and validation of social-skills training (SST), an evidence-based practice that originated in the English language, carried out in the Spanish language for persons with schizophrenia in Latin America, Spain, and the United States. This review of research delineates the methodology of the published literature that contained a wide variety of studies from empirically based evaluation of case reports to randomized, controlled trials. The weight of the evidence from all three regions revealed greater benefits to Spanish-speaking patients who received SST in symptoms, skill acquisition and community functioning than for patients who received customary treatment. To ensure the cross-cultural effectiveness of rehabilitation practices originating in English-speaking countries, it is essential that adaptations beyond language translations be made to meet the unique expectations, norms, values, and customs of Spanish-speaking patients and families in the three regions that are the focus of this report. [ABSTRACT FROM AUTHOR]

Restoring people with mental illnesses to community life after detention in jail is fraught with significant challenges. Many of these challenges mirror those faced by anyone else who has been detained in jail. Among these is the particular challenge of seeking gainful employment and financial support for day-to-day life. This challenge is intensified when individuals return from jail to impoverished communities where employment prospects are already limited for residents and where either a criminal record or a mental illness creates still additional barriers to work. To understand these barriers more fully, this study examined the process of seeking employment among people with mental illness leaving jail. Seventeen individuals with a history of mental health problems and with recent jail incarceration were recruited from either a community based employment program or a mental health service setting. The informants were interviewed using life history interview techniques. Results show that connections to the paid workforce were tenuous at best for these respondents, both before and after their jail detention. Although psychiatric symptoms, addiction, and the lack of productive social connections were individual-level factors that affected employment, the most pernicious impediments were rooted in policy, community structures, stigma, and other social and economic realities. If employment interventions are to have any traction at all in these settings, interventionists need to dig for innovative ways to address these factors, which are not complications, but bedrock realities that undergird all else. [ABSTRACT FROM AUTHOR]

Using Web-based educational software, Skype, e-mail, and periodic on-site visits, faculty members from a U.S. university have been providing consultation and training in psychiatric rehabilitation and evidence-based practices (EBPs) to the staff of a psychiatric inpatient/outpatient facility in Karachi, Pakistan. A 15-week didactic training session in psychiatric rehabilitation principles and practices was followed by an assessment of five EBPs for possible adoption with revisions. The assessment resulted in the implementation of illness management and recovery groups, which have had a positive impact. Initial progress suggests that long-distance psychiatric rehabilitation training can benefit implementation efforts when combined with programmatic initiatives, ongoing support, and periodic site visits. [ABSTRACT FROM AUTHOR]

This article seeks to explore the appropriate use of empowerment-based social work practice to increase the voter participation of those with psychiatric disabilities. Empowerment-based practice has become standard in community mental health care but has not included voting as an area of focus. The Civic Volunteerism Model is utilized to provide a theoretical framework for the natural integration of voter participation into empowerment-based practice. Barriers and their remedies to voter participation as a component of empowerment-based practice are discussed. [ABSTRACT FROM AUTHOR]

State psychiatric hospitals across the United States continue to use methodologies that predate the emergence of the evidenced-based practices movement and widespread adoption of the recovery model. The cultural legacy of state psychiatric hospitals is often heavily influenced by the era of custodial treatment with an emphasis on medication and the primacy of the medical model of care. Using a recovery and wellness philosophy, combined with practices that are evidence based, represents a vision for the future of these institutions (Smith & Bartholomew, 2006). This article describes the implementation of the evidence-based practice of illness management and recovery (SAMHSA, 2008) in a state psychiatric hospital. The role of this evidence-based program, as a way of operationalizing a recovery and wellness philosophy, is discussed in addition to some of the successful implementation strategies and program barriers. Directions for future work in this area are also discussed. [ABSTRACT FROM AUTHOR]

The following series of articles describes how a community psychiatric rehabilitation agency serving individuals with severe mental illness has integrated recovery-oriented services and evidence-based practices in its service delivery model. The lead article describes the rationale and organizational commitments required to implement the model, followed by several case studies of individual evidence-based practice implementation highlighting successes and challenges. The final article offers perspectives from three consumers of these services. [ABSTRACT FROM AUTHOR]

Expanding on the introduction to the multinational study described in the first article, this article briefly reviews informants’ contexts of treatment across Italy, Norway, Sweden, and the United States, and provides a cursory description of each informant, organized according to her or his respective country. The informant descriptions are followed by illustrative third-person narratives drawn from interviews with two informants from Sweden. As a counterpoint to themes derived across informant narratives, such as the roles of home, significant others, and coping strategies, this article attempts to illustrate how such themes are interwoven within the context of individuals’ lives and personal journeys toward recovery. [ABSTRACT FROM AUTHOR]

As part of a growing literature describing processes of recovery in psychotic disorders, this report presents findings of an intensive, international study. Open-ended qualitivite interviews were conducted in Italy, Norway, Sweden, and the United States with a total of twelve individuals who have experience of recovery in psychosis. All interviews were translated into English and transcribed. Investigators from each of these countries collaborated in analyzing the interviews and identifying common elements across the twelve narratives. Themes were identified in each of the following areas: 1) how the individual deals with his or her difficulties; 2) the role of material resources; 3) the various roles of formal and informal health systems; 4) the roles, and absence, of significant others; and 5) the roles of social and cultural factors. Salient themes included the person's determination to get better, establishing a degree of self–control, and struggling to achieve a normal life; the need for material resoures and a sense of home, and the importance of going out and engagging in normal activities; the benifits, and costs, of medication, involvement in mutual support/user groups, and participation in various psychosocial interventions; the need to be accepted as, and to accept oneself as, a normal person who exists beyond the psychosis; the impact of stigma and discrimination, and the imortance of having one's rights respected and returning to a meaningful social role through work and/or positive relationships outside of the formal mental health system. Cultural differences between participants from each country were noted primarily in the nature of the opportunities and supports offered rather than in the nature of the processes described. In closing, implications of these findings are considered both for future research on processes of recovery and for making clinical practice more recovery-oriented. [ABSTRACT FROM AUTHOR]