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Objective Motivation deficits remain an unmet treatment need in schizophrenia. Recent research has identified mechanisms underlying motivation deficits (i.e., impaired effort-cost computations, reduced future reward-value representation maintenance) that may be effective treatment targets to improve motivation. This study tested the feasibility and preliminary effectiveness of Mobile Enhancement of Motivation in Schizophrenia (MEMS), an intervention that leverages mobile technology to target these mechanisms with text messages. Method Fifty-six participants with a schizophrenia-spectrum disorder were randomized to MEMS (n = 27) or a control condition (n = 29). All participants set recovery goals to complete over 8 weeks. Participants in the MEMS group additionally received personalized, interactive text messages on their personal cellphones each weekday. Results Retention and engagement in MEMS were high: 92.6% completed 8 weeks of MEMS, with an 86.1% text message response rate, and 100% reported being satisfied with the text messages. Compared to participants in the control condition, the participants in the MEMS condition had significantly greater improvements in interviewer-rated motivation and anticipatory pleasure and attained significantly more recovery-oriented goals at 8 weeks. There were no significant group differences in purported mechanisms (performance-based effort-cost computations and future reward-value representations) or in self-reported motivation, quality of life, or functioning. Conclusion Results demonstrate that MEMS is feasible as a brief, low-intensity mobile intervention that could effectively improve some aspects of motivation (i.e., initiation and maintenance of goal-directed behaviors) and recovery goal attainment for those with schizophrenia-spectrum disorders. More work is needed with larger samples and to understand the mechanisms of change in MEMS. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Evidence-based supported employment has become a core community mental health service in much of the U.S. Although a national learning community has facilitated progress in about half of the states, other states have tried to implement evidence-based supported employment on their own. Many studies have examined site-level factors influencing implementation of supported employment, but few have focused on the role of state agency policies and actions. This study examined four states that have not joined the learning community, comparing two that have implemented with success (adopting states) and two that have faced challenges (non-adopting states). This comparative case study approach compared barriers, facilitators, and strategies in two states adopting IPS to two states that did not. The authors examined quantitative data from public records and conducted content analysis of qualitative and quantitative data from key informant interviews. The two non-adopting states lacked model clarity, funding, focus on people with serious mental illness, and collaboration between state mental health and vocational rehabilitation agencies. The two successful states experienced similar barriers but overcame them following lawsuit settlements that required implementation of evidence-based supported employment. Key strategies for successful implementation were funding, fidelity monitoring, technical assistance, and collaboration between state mental health and vocational rehabilitation agencies. With legal settlements serving as the catalyst, states facing challenges to implementing evidence-based supported employment can achieve success using standard implementation strategies to fund and ensure the quality of services.

Objective Currently there is no universally agreed upon language for those seeking psychiatric treatment, and labels commonly include patient, client, consumer, and service user. Although there is some research regarding preferences for label (Dickens & Picchioni, 2012), little is known about how people perceive an individual differently based on the label used. The current study examined whether specific labels were associated with more stigmatizing attitudes. Method Participants recruited through MTurk (N = 526) were randomized to read a vignette of a man named Harry, described as a patient, client, consumer, or service user with mental illness. After correctly recalling the label from the vignette, participants were assessed for stigmatizing attitudes toward Harry. Results ANOVAs indicated a no main effects of label on stigmatizing attitudes. A number of variables (e.g., overall stigma, dangerousness, segregation, and distance) revealed a significant interaction between label and prior mental health treatment: For those who have sought prior mental health treatment, the term client may be more stigmatizing than other labels. Conclusions and implications for practice The current study did not find general differences in stigmatizing attitudes associated with mental health treatment label. Although preliminary, these findings suggest treatment labels may not significantly impact stigmatizing attitudes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Purpose A small fraction of people with opioid use disorder (OUD) receives appropriate care. Public opinion about addiction contributes to the availability and accessibility of effective treatment services. Little is known about such attitudes toward OUD among young adults, a population at heightened risk for OUD onset. The current study examined endorsement of social stigma, discrimination, and policy attitudes about OUD and hypothesized correlates of such attitudes (familiarity with OUD, criminal justice involvement, respondent demographic characteristics). Methods A national sample of 190 young adults (weighted n = 408; 69% female, 42% White, non-Hispanic) aged 19–29 years completed web and telephone surveys covering opioid social stigma, discrimination, policy attitudes, personal experience with opioids, and criminal justice, and participant characteristics (age, sex, race, education, employment, income). Linear regressions were performed to examine associations between respondent characteristics and attitudes. Results Young adults, on average, endorsed moderate levels of stigma and discrimination toward people with OUD and support for treatment-oriented policies. Stigma was positively associated with discrimination and negatively associated with support for policies favorable to people with OUD. Regression results revealed that more negative attitudes toward OUD were endorsed as a function of older age and less personal experience or familiarity with OUD. Conclusions Heterogeneity in young adults’ attitudes about OUD may be explained, in part, by personal characteristics and familiarity with OUD. Adolescence may be an opportune developmental period to prevent or reduce public stigma related to OUD and MOUD and increase public attitudes in support of expanded access to effective OUD treatments.

Evidence-based supported employment has become a core community mental health service in much of the U.S. Although a national learning community has facilitated progress in about half of the states, other states have tried to implement evidence-based supported employment on their own. Many studies have examined site-level factors influencing implementation of supported employment, but few have focused on the role of state agency policies and actions. This study examined four states that have not joined the learning community, comparing two that have implemented with success (adopting states) and two that have faced challenges (non-adopting states). This comparative case study approach compared barriers, facilitators, and strategies in two states adopting IPS to two states that did not. The authors examined quantitative data from public records and conducted content analysis of qualitative and quantitative data from key informant interviews. The two non-adopting states lacked model clarity, funding, focus on people with serious mental illness, and collaboration between state mental health and vocational rehabilitation agencies. The two successful states experienced similar barriers but overcame them following lawsuit settlements that required implementation of evidence-based supported employment. Key strategies for successful implementation were funding, fidelity monitoring, technical assistance, and collaboration between state mental health and vocational rehabilitation agencies. With legal settlements serving as the catalyst, states facing challenges to implementing evidence-based supported employment can achieve success using standard implementation strategies to fund and ensure the quality of services.

OBJECTIVE: Implementation of mobile health (mhealth) interventions remains limited among those with schizophrenia. This study examined several logistical barriers to the implementation of mHealth interventions, particularly text message interventions, for people with schizophrenia. METHODS: This study examined the feasibility of leveraging personal mobile phones to deliver mHealth interventions by using data from a pilot randomized controlled trial (RCT) of a text message intervention delivered on personal mobile phones to 56 people with schizophrenia with motivation reductions. RESULTS: Among those screened for the RCT (n =100), 91% had a mobile phone. For randomized participants (n = 56), 82.1% had a smartphone, with almost all (93.5%) having an Android processing system. Most randomized participants had unlimited text messages (96.4%) or voice calls (76.8%) with their mobile service plan, with 32.1% having unlimited data each month. At baseline, most used text messages (85.2%) and the internet (59.3%), while fewer participants used mobile applications (35.2%) at least once a week. Finally, there were no significant associations between engagement in the text message intervention and participant demographics, symptoms (positive, mood, negative), neurocognition, or mobile phone or plan characteristics or changes made during the 8 week intervention. CONCLUSIONS: Even those with schizophrenia with perceived symptom barriers to mHealth engagement (i.e., motivation reductions) may have access to mobile phones and plans and familiarity with mobile features to engage meaningfully with a text message intervention. These results help to support future implementations of text message interventions, which may enhance the provision of care for those with schizophrenia.

The individual placement and support (IPS) model of supported employment for people with serious mental illness is an evidence-based practice. Factors including a national learning community promoting IPS and enforcement of the Supreme Court's Olmstead decision have spurred the growth of IPS nationwide. In this study we first evaluated the national prevalence and quality of IPS programs. We then evaluated the impact of learning community membership and Olmstead settlements on IPS program penetration and quality across the United States. We interviewed representatives from 48 state behavioral health agencies and 51 state vocational rehabilitation agencies. Survey questions examined the number of IPS programs in each state, the presence of an Olmstead settlement mandating employment services for people with serious mental illness, and the presence of three indicators of quality in IPS programs: collaboration between state behavioral health and vocational rehabilitation agencies, regular, independent fidelity monitoring, and technical assistance and training for IPS programs. Respondents from 38 (75%) states, including 19 states in the IPS Learning Community and 19 outside the learning community, reported a total of 523 IPS programs nationwide (M = 14, SD = 16). The state IPS program penetration rate (number of IPS programs per 1,000,000 people) ranged from 0.05 to 16.62 (M = 3.61, SD = 3.62) among states with IPS. The penetration rate was similar for learning community and non-learning community states with IPS, but learning community states were much more likely than non-learning community states with IPS to report the presence of each of three quality indicators. Eleven states reported Olmstead or other settlements that positively impacted employment services for people with serious mental illness, but among the 38 states with IPS programs, Olmstead states did not differ from non-Olmstead states in IPS program penetration or on the quality indicators. Nationally, most states provide IPS programs, but the within-state penetration rate and quality of implementation vary widely. While learning community and non-learning community states with IPS do not differ in the prevalence of IPS programs, learning community states are much more likely to report key quality indicators, which may enhance these states' potential for sustaining and expanding IPS. Olmstead settlements have not yet shown a direct impact on the penetration and quality of IPS, but as the Department of Justice continues to enforce the Supreme Court's Olmstead decision, their significance may increase.

Background Substance use disorders are prevalent among youth involved with the criminal justice system, however, evidence-based substance use disorder treatment is often unavailable to this population. The goal of this study was to identify barriers to effective implementation of evidence-based practices among juvenile justice and community mental health organizations through the lens of an adopter-based innovation model. Methods In this mixed-methods study, qualitative interviews were conducted with n = 15 juvenile justice staff and n = 14 community mental health staff from two counties implementing substance use services for justice involved youth. In addition, n = 28 juvenile justice staff and n = 85 community mental health center staff also completed quantitative measures of organizational effectiveness including the implementation leadership scale (ILS), organizational readiness for change (ORIC), and the implementation climate scale (ICS). Results Organizationally, staff from community mental health centers reported more “red tape” and formalized procedures around daily processes, while many juvenile justice staff reported a high degree of autonomy. Community mental health respondents also reported broad concern about their capacity for providing new interventions. Staff across the two different organizations expressed support for evidence-based practices, agreed with the importance of treating substance use disorders in this population, and were enthusiastic about implementing the interventions. Conclusions While both community mental health and juvenile justice staff express commitment to implementing evidence-based practices, systems-level changes are needed to increase capacity for providing evidence-based services.

High clinician turnover in community behavioral health settings can lead to increased costs and can have a negative impact on care quality. Few studies have examined the implications of clinician turnover for client outcomes. This study investigated changes in client outcomes associated with clinician turnover.The study used prospective observational data collected as part of a larger randomized controlled trial. Clients (N=328) from two community behavioral health centers identified the clinician (N=121) whom they saw most often. Clients completed measures of depression, anxiety, mental and physical health functioning, and patient activation at baseline, 6 months, and 12 months. Clinician turnover during the 12-month study was obtained from agency records. Latent growth curve modeling was used to analyze the data.Of the 328 clients, 24% experienced clinician turnover. For all outcomes except depression, the association with turnover was moderated by baseline status on the outcome measure. Turnover tended to be associated with clinical decline for clients who at baseline had low to moderate anxiety, high patient activation, or high physical health functioning. Surprisingly, turnover was associated with increased mental health functioning for clients who at baseline had very low mental health functioning. For physical health functioning, the association with turnover was also moderated by age. Turnover was associated with a sharper decline in functioning for older clients.Results suggest that clinician turnover was associated most strongly with decline for higher functioning or older clients, but it was not uniformly associated with worsening clinical outcomes.

OBJECTIVE People with mental illness frequently have trouble obtaining and keeping competitive employment and struggle with on-the-job performance. To address these issues, the manualized, group-based, 12-session Cognitive Behavioral Therapy for Work Success (CBTw) intervention was developed and tested in an open trial. Although posttreatment work outcomes were promising, lasting effects associated with the intervention are unknown. METHOD This article presents the 6-month posttreatment work outcomes of the open trial of CBTw in 52 adults with mental illness who were concurrently receiving VA vocational services. Work outcomes included work status, hours worked and wages earned, steady work status, and work performance and effectiveness. Data were analyzed using repeated measures analysis of variances (ANOVAs) and within groups t tests. RESULTS Findings demonstrate that 75% of unemployed participants at baseline obtained competitive work during the study period. During the 6-month follow-up period, 73% of workers attained steady work status (i.e., working at least 50% of the follow-up period). In addition, during the 6-month follow-up period, working participants averaged significantly more hours of work per week and higher wages earned per hour as compared with the baseline period and the 12-week postintervention period. Finally, among workers, reports of work effectiveness remained high at 6 months and work productivity disruptions remained low at follow-up. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These findings suggest that CBTw may potentially be a useful tool to enhance the effects of vocational programs. Future work should test CBTw in a randomized controlled trial and examine strategies for implementation in real-world vocational service settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Introduction: Prior work has found varied relationships between self-reported and clinician-rated motivation measures in schizophrenia, suggesting that moderators might impact the strength of this relationship. This current study sought to identify whether metacognition – the ability to form complex representations about oneself, others, and the world – moderates the relationship between self-reported and clinician-rated motivation measures. We also explored whether clinical insight and neurocognition moderated this relationship. Methods: Fifty-six participants with a schizophrenia-spectrum disorder completed the Motivation and Pleasure Self-Report Scale and the clinician-rated motivation index from the Heinrichs-Carpenter Quality of Life Scale. Results: Metacognition significantly moderated the relationship; self-reported and clinician-rated motivation were positively and significantly correlated only when metacognition was relatively high. Neither clinical insight nor neurocognition moderated the relationship. Discussion: Metacognition appears to be a key variable impacting the strength of the relationship between self-reported and clinician-rated motivation measures and may help to partly explain the varied relationships observed in prior work. Using a metacognitive framework to guide assessment interviews and targeting metacognition in psychosocial treatments may help to improve the synchrony between self-perceptions and clinician ratings of motivation. Keywords: Motivation, Measurement, Metacognition, Moderation, Schizophrenia

Background Public stigma may significantly impact adolescents with substance use disorders (SUDs), leading to limited treatment accessibility and utilization. However, few measures have been validated to assess public SUD stigma towards adolescents. In this study we developed the Attribution Questionnaire-Substance Use Disorder (AQ-SUD) by modifying the Attribution Questionnaire, a commonly used measure of public mental illness stigma. We examined 1) the psychometric properties of the AQ-SUD with supporting data from other stigma scales and 2) preliminary data on adults’ perceptions of public stigma toward adolescents with SUDs. Methods Adult participants (n = 304) were randomly assigned to one of four vignettes about an adolescent with a specific SUD diagnosis (opioid, marijuana, alcohol, and stimulant use disorders). Participants completed the AQ-SUD and three other measures of public stigma designed to assess convergent and divergent validity. Results Analyses indicated that the modified AQ-SUD has good psychometric properties, and revealed a four-factor structure: negative emotions, assessment of responsibility, social disengagement, and lack of empathy. Additional public stigma scales demonstrated good psychometrics and provided evidence of both convergent and divergent validity for the AQ-SUD. Preliminary analysis of public stigma towards adolescents with a SUD suggests that attitudes about marijuana use disorder differ significantly from attitudes about other SUDs. Conclusions This study is the first to modify and validate a measure designed to assess perceptions of public SUD stigma towards adolescents, the AQ-SUD. Preliminary analyses suggest that adults view adolescent marijuana use disorders as less severe compared to other SUDs, which may have implications for adults’ motivation to support youth in seeking treatment.

State leaders often promote implementation of evidence-based practices but have difficulty sustaining and expanding them over time. This paper examines the activities of leaders in 13 states that have successfully implemented, sustained, and expanded evidence-based supported employment, known as Individual Placement and Support (IPS), for 4 to 12 years. We interviewed state leaders from 13 states participating in a learning community regarding the composition of their leadership team, participation in the learning community, interagency collaboration, state policy alignment, financing, training, and monitoring of fidelity and outcome. To assess state-level performance in implementing, sustaining, and expanding IPS services, we obtained measures of sustainment, expansion, program fidelity, and employment in the subsequent year and compared them to a priori benchmarks. The majority of states (between 69 % and 77 %) met benchmarks for sustainment, expansion, fidelity, and employment. States varied widely in specific actions to advance IPS, but all had established leadership teams, participated in the national learning community, and built an infrastructure supporting IPS. Leaders in 13 states participating in a learning community have adopted and maintained multiple strategies to sustain and expand evidence-based supported employment at a high level of fidelity with good employment outcomes.

Substance use is prevalent among justice-involved youth and given the risk of recidivism and other poor outcomes associated with substance use, justice systems have implemented efforts to improve substance use screening and connection to treatment. Although many justice systems use drug screening to monitor substance use, research on patterns of substance use based on drug screen records is lacking. The current study examined court records of drug screens among youth to explore patterns of substance use as well as rates of court-ordered referral to substance use treatment and treatment completion. We also examined differences in these patterns of use and treatment referral and completion by race, ethnicity, and gender.We examined court records for N = 3440 youth with records of positive oral drug screen (ODS) between 2011 and 2016 to assess patterns of ODS results (e.g., number and of positive screens), court-ordered referrals to substance use treatment, and rates of treatment completion.Of 3440 youth with a positive ODS, 96% tested positive for cannabis and 9.8% for opioids at least once; 48.5% were court-ordered to substance use treatment. Of those referred, 67% had history of completing at least one treatment episode; black youth (OR = 0.54, p .01) were less likely to have history of completing substance use treatment.Our results underscore the need to utilize objective measures as well as validated self-reports of substance use history in both research and justice system decision-making to aid in identifying youth in need of services. Additional research should identify barriers to substance use treatment completion among this population.

Background Motivation deficits are among the strongest determinants of reduced functioning and quality of life in people with schizophrenia. Mobile interventions are a promising approach to improving these deficits because they can provide frequent cues and reinforcements to support goal-directed behavior in daily life. The objective of this study is to assess the initial feasibility/acceptability and effectiveness of Mobile Enhancement of Motivation in Schizophrenia (MEMS), a personalized mobile text message intervention, compared to a goal-setting alone intervention. Methods Fifty-six participants with a schizophrenia-spectrum disorder have been enrolled in this ongoing controlled pilot study. Twenty-seven participants have been randomized to MEMS, while 29 participants have been randomized to the goal-setting alone condition. Participants in both groups set individualized recovery goals to complete over an 8-week period. Those in the MEMS group also receive three sets of personalized, interactive text messages each weekday to reinforce and cue goal completion. Blinded assessments are conducted before and after the 8-week period and include validated measures of motivation, quality of life, and functioning. Goal attainment and self-reported satisfaction with MEMS are also assessed. Results To date, 36 participants (n = 18 in each group) have completed both baseline and follow-up assessments. Initial results suggest that relative to the goal-setting alone group, the MEMS group demonstrated significantly greater improvements in clinician-rated motivation (F(1, 33) = 7.14, p = .01; between-group d = .89). Specifically, the MEMS group demonstrated significantly higher clinician-rated motivation after 8 weeks (within-group d = .62), while clinician-rated motivation remained the same in the goal-setting alone group (within-group d = -.02). Across both groups, participants also significantly improved on clinician-rated functioning over time (t(35) = -2.56, p = .02, d = .43), but there was no difference between the two groups (F(1, 33) = .01, p = .94; between-group d = .03). No improvement on self-reported quality of life was observed in either group or across the full sample. The MEMS group reported strong satisfaction with the text-messages. Recruitment has been completed, and analyses from the full sample will be ready to present at the meeting. Discussion Initial results indicate that MEMS is acceptable and may successfully improve motivation in people with schizophrenia-spectrum disorders. However, additional analyses with the full sample are needed to more rigorously test the feasibility and effectiveness of MEMS.