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Background: Despite recent advances in the development and provision of mental health and psychosocial support (MHPSS) in humanitarian settings, inadequate supervision remains a significant barrier to successful implementation. The present study sought to incorporate broad stakeholder engagement as part of the first phase of development of a new Integrated Model for Supervision (IMS) for use within MHPSS and protection services in humanitarian emergencies., Methods: Semi-structured interviews were conducted with 26 global mental health professionals. Data was analysed thematically, using a combination of inductive and deductive methods. Codes and themes were validated through co-author cross-checks and through a webinar with an expert advisory group., Results: Results reinforce the importance of effective supervision to enhance the quality of interventions and to protect supervisees' wellbeing. Participants generally agreed that regular, supportive supervision on a one-to-one basis and as a separate system from line management, is the ideal format. The interviews highlight a need for guidance in specific areas, such as monitoring and evaluation, and navigating power imbalances in the supervisory relationship. Several approaches to supervision were described, including some solutions for use in low-resource situations, such as group, peer-to-peer or remote supervision., Conclusion: An integrated model for supervision (IMS) should offer a unified framework encompassing a definition of supervision, consolidation of best practice, and goals and guidance for the supervisory process., Competing Interests: The authors have declared that no competing interests exist.

Importance: Many patients with cancer who would benefit from psychosocial care do not receive it. Implementation strategies may favor the integration of psychosocial care into practice and improve patient outcomes., Objective: To evaluate the effectiveness of the Humanization in Cancer Care (HuCare) Quality Improvement Strategy vs standard care as improvement of at least 1 of 2 domains (emotional or social function) of patient health-related quality of life at baseline and 3 months. A key secondary aim included investigation of the long-term effect., Design, Setting, and Participants: HuCare2 was a multicenter, incomplete, stepped-wedge cluster randomized clinical trial, conducted from May 30, 2016, to August 28, 2019, in three 5-center clusters of cancer centers representative of hospital size and geographic location in Italy. The study was divided into 5 equally spaced epochs. Implementation sequence was defined by a blinded statistician; the nature of the intervention precluded blinding for clinical staff. Participants included consecutive adult outpatients with newly diagnosed cancer of any type and stage starting medical cancer treatment., Interventions: The HuCare Quality Improvement Strategy comprised (1) clinician communication training, (2) on-site visits for context analysis and problem-solving, and (3) implementation of 6 evidence-based recommendations., Main Outcomes and Measures: The primary outcome was the difference between the means of changes of individual scores in emotional or social functions of health-related quality of life detected at baseline and 3-month follow-up (within each group) and during the postintervention epoch compared with control periods (between groups). Long-term effect of the intervention (at 12 months) was assessed as a secondary outcome. Intention-to-treat analysis was used., Results: A total of 762 patients (475 [62.3%] women) were enrolled (400 HuCare Quality Improvement Strategy and 362 usual care); mean (SD) age was 61.4 (13.1) years. The HuCare Quality Improvement Strategy significantly improved emotional function during treatment (odds ratio [OR], 1.13; 95% CI, 1.04-1.22; P = .008) but not social function (OR, 0.99; 95% CI, 0.89-1.09; P = .80). Effect on emotional function persisted at 12 months (OR, 1.05; 95% CI, 1.00-1.10; P = .04)., Conclusions and Relevance: In this trial, the HuCare Quality Improvement Strategy significantly improved the emotional function aspect of health-related quality of life during cancer treatment and at 12 months, indicating a change in clinician behavior and in ward organization. These findings support the need for strategies to introduce psychosocial care; however, more research is needed on factors that may maximize the effects., Trial Registration: ClinicalTrials.gov Identifier: NCT03008993.

Background: Patients with end-stage liver disease (ESLD) experience frequent readmissions; however, studies focused on patients' and caregivers' perceptions of their transitional care experiences to identify root causes of burdensome transitions of care are lacking., Aim: To explore the transitional care experiences of patients with ESLD and their caregivers in order to identify their supportive care needs., Methods: We conducted interviews with 15 patients with ESLD and 14 informal caregivers. We used semi-structured interview guides to explore their experiences since the diagnosis of ESLD including their care transitions. Two raters coded interviews independently (κ = 0.95) using template analysis., Results: Participants reported feeling unprepared to manage their informational, psychosocial, and practical care needs as they transitioned from hospital to home after the diagnosis of ESLD. Delay in the timely receipt of supportive care services addressing these care needs resulted in hospital readmissions, emotional distress, caregiver burnout, reduced work capacity, and financial hardship. Participants shared the following resources that they perceived would improve their quality of care: (1) discharge checklist, (2) online resources, (3) mental health support, (4) caregiver support and training, and (5) financial navigation., Conclusion: Transitional care models that attend to the informational, psychosocial, and practical domains of care are needed to better support patients with ESLD and their caregivers at the time of diagnosis and beyond. Without attending to the multidimensional care needs of newly diagnosed patients with ESLD and their caregivers, they are at risk of burdensome transitions of care, high healthcare utilization, and poor health-related quality of life., (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The study examined whether psychiatric/psychosomatic rehabilitation continues to have a better course of treatment for women than men., Methods: We compared the course of global symptom severity, health-related quality of life and functioning between admission and discharge in patients (848 men, 1412 women) at an Austrian psychiatric/psychosomatic rehabilitation clinic., Results: Gender-specific differences in the course of treatment were all too small to be clinically relevant. The differences were smallest in the middle-aged cohort. However, at the time of admission, women reported a slightly higher symptom burden., Conclusion: Overall, the results show a gender-fair effectiveness of the rehabilitation. The new findings could be explained by changes in living conditions, gender roles, or better treatment methods., Competing Interests: Prof. Dr. Manuel Sprung is the scientific director of the University Clinic for Psychosomatic Medicine Eggenburg, PSZW (Eggenburg and Gars). Chief physician Dr. Riffer is the medical director of the PSZW. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: People with autism spectrum disorder (ASD) face many psychosocial challenges throughout life, highlighting the need for programs and resources promoting psychosocial wellbeing. Indigenous peoples with ASD and/or other neurodevelopmental disorders must overcome cultural and social barriers to access such supports. This study aimed to identify psychosocial programs and resources developed world-wide for this population by systematically reviewing research evaluating programs aiming to promote the psychosocial wellbeing of this population and/or their caregivers; and collating and reviewing resources developed to promote their psychosocial wellbeing., Methods: Searches were last conducted in December 2019. The systematic review searched 28 electronic databases, and 25 electronic databases were searched for resources promoting psychosocial wellbeing. Additional published and unpublished studies were identified from relevant reviews, authors of eligible articles, and experts working in Indigenous Health. Articles and resources were screened for inclusion using pre-defined criteria. Articles included in the systematic review were assessed for quality using the Mixed Methods Assessment Tool. The diversity and paucity of outcomes reported precluded pooling of study findings for meta-analysis., Results: Seven articles situated in the USA (2), Canada (3) and Australia (2); and eleven resources developed in Australia (9), Canada (1) and New Zealand (1) met inclusion criteria. All articles showed some promising findings for improving psychosocial wellbeing for Indigenous children with ASD and/or another neurodevelopmental disorder, and 5 of 7 evaluated the cultural adaptation of an existing evidence-based program for an Indigenous population. However, methodological quality was moderate or low (57% and 43% of articles respectively) and no studies had adult participants. The psychosocial wellbeing supports provided by the 11 resources included psychoeducation, community support, and services/workshops., Conclusions: Despite the paucity of research and resources found, important exemplars demonstrate that existing programs can be adapted to support Indigenous people with ASD and other neurodevelopmental disorders. While future policy should endeavour to facilitate Indigenous people's access to support services, and encourage researchers to develop and evaluate programs promoting psychosocial wellbeing for this population, given complexities of designing and evaluating new programs, careful and appropriate cultural adaptations of existing evidence-based programs would increase feasibility of ongoing research without compromising outcomes.

Background : Canadian hospitals are not currently prepared to meet the psychosocial needs of children with disabilities as services are rooted in a biomedical care model. Objective : To describe a practical and holistic framework for pediatric rehabilitation hospitals to meet the health care needs of children and their families. Method : An environmental scan was conducted of best practice guidelines, policy documents, and models of integrated mental health care. Recommendations from clinical guidelines and national strategy documents were incorporated to develop a service integration approach. Results : An agency-based approach was used to develop a two-phase biopsychosocial framework. In framework Phase I, reactive care is provided to mental health concerns. In Phase II, there is a shift to proactive care and mental health wellbeing. Conclusions : Emphasis is placed on capacity building of clinical staff into best practices for mental health care. Implementation needs and consideration for uptake of the framework are also discussed.

The Veterans Health Administration (VHA) developed Psychosocial Rehabilitation and Recovery Centers (PRRCs) to enhance recovery-oriented mental health services to large populations of veterans diagnosed with serious mental illness (e.g., psychotic disorders, bipolar disorder) and significant functional challenges. Psychosocial Rehabilitation and Recovery Centers were designed to support a rehabilitation framework to help veterans obtain needed skills and support to integrate into meaningful, self-determined community roles. This study used data collected as part of VHA's development and implementation of a national system to monitor PRRC performance with the purpose of evaluating the psychometric properties and latent structure of outcome measures used in PRRCs. Baseline self-report data from 5,086 veterans and their assigned PRRC staff providers were collected and reviewed. Exploratory factor analyses were used to evaluate the psychometric properties of the Veteran-Rated Psychiatric Symptom Items (VR-PSI), the Clinician-Rated Psychiatric Symptom Items (CR-PSI), and the Internalized Stigma of Mental Illness 10-item scale (ISMI-10). Four latent factors were identified for the VR-PSI and CR-PSI for the total sample, while the ISMI-10 was reduced to 8-items to assess self-stigma as a unitary measure. All measures demonstrated good psychometric properties. This study provides initial support for the latent factor structures and psychometric properties of measures used to assess national VHA PRRC performance. Implications and limitations are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: The objective of the study is to find out and assess satisfaction of Slovak women with psychosocial aspects of perinatal care., Design and Setting: The research was designed as a quantitative cross-sectional study. The research data were collected in five pediatric outpatient clinics in Slovakia., Participants: The research sample consisted of 360 women within 0-1 year after natural delivery (average time in months from childbirth: 6.22 ± 3.64) who visited the selected pediatric outpatient clinic in the period from October 2016 to January 2018., Methods: To collect the relevant data, the original Czech questionnaire measuring psychosocial climate in maternity hospitals - KLI-P (Cronbach α = 0.95) was used to investigate the satisfaction of women with care during labor and delivery as well as with psychosocial aspects. The following six factors were assessed: (1) helpfulness and empathy of midwives and (2) of physicians, (3) superiority and lack of interest, (4) physical comfort and services, (5) control of a woman in labor and her participation in decision-making, (6) providing information. The received data were analyzed using descriptive statistics, the Shapiro-Wilk test, robust ANOVA, Post-hoc test, the Wilcoxon two-sample test, a G-test of independence and the Cochran-Armitage test of trend., Findings: We found that most women (83.1%) were generally satisfied with their care during labor and delivery as well as with psychosocial support. In terms of psychosocial aspects, the highest level of satisfaction was attributed to the approach of the health professionals and the lowest one (61.5%) to the control and participation of delivering woman in decision-making. Both perception of the course of labor and delivery and skin-to-skin contact immediately after birth were shown to be statistically significant predictors of women's satisfaction. The aspect of age was found to be statistically significant in relation to the factor of control of a woman in labor and her participation in decision-making., Key Conclusions and Implications for Practice: It can be concluded that it is necessary to pay attention to the psychosocial aspects of health care during labor and delivery, with the emphasis on strengthening interventions in the field of participation of women in decision-making. Simultaneously, it is beneficial to emphasize and support the naturalness of childbirth so that women would associate childbirth with a positive experience. Finally, it is important to promote skin-to-skin contact right after birth., Competing Interests: Declaration of Competing Interest The authors declare and confirm that there are no known conflicts of interest associated with this publication., (Copyright © 2020. Published by Elsevier Ltd.)

Many Latin American countries face the challenge of caring for a growing number of people with severe mental illnesses while promoting deinstitutionalization and community-based care. This article presents an overview of current policies that aim to reform the mental health care system and advance the employment of people with disabilities in Colombia, Costa Rica, and Peru. The authors conducted a thematic analysis by using public records and semistructured interviews with stakeholders. The authors found evidence of supported employment programs for vulnerable populations, including people with disabilities, but found that the programs did not include people with severe mental illnesses. Five relevant themes were found to hamper progress in psychiatric vocational rehabilitation services: rigid labor markets, insufficient advocacy, public subsidies that create conflicting incentives, lack of deinstitutionalized models, and lack of reimbursement for evidence-based psychiatric rehabilitation interventions. Policy reforms in these countries have promoted the use of medical interventions to treat people with severe mental illnesses but not the use of evidence-based rehabilitation programs to facilitate community integration and functional recovery. Because these countries have other supported employment programs for people with nonpsychiatric disabilities, they are well positioned to pilot individual placement and support to accelerate full community integration among individuals with severe mental illnesses.

Objective: The goal was to build a strategy before implementing individual placement and support (IPS) in the country, leveraging existing facilitators and mitigating, as much as possible, identified barriers., Methods: A qualitative study called "group analysis" was conducted: Over 2 days, two groups of stakeholders were invited for a whole-day workshop to collect information on facilitators and barriers faced by existing programs., Results: Many perceived facilitators were related to some guidelines or key principles of the IPS model. Main barriers were lack of long-time job support, lack of funding, lack of communication between stakeholders, social or financial insecurity of the beneficiary, denial of their own disease, high hiring selectivity, and on-the-job requirements by employers looking to maintain a competitive workforce. The four points of divergence between participants in relation with IPS were (a) the (dis)advantages of internships and trainings compared to standard work contracts, (b) the risk associated with the communication of a medical diagnosis and the disclosure issue, (c) the best time to start a job search or to return to work, and (d) whether priority should be given to the search for an adapted job or the adaptation of existing jobs to the specific needs of the beneficiaries., Conclusion: The IPS model appears as a potential solution to many issues faced by stakeholders in Belgium in charge of helping people with moderate to severe mental illness to find a job. A stronger legal framework could help to achieve the integration of such model. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Objectives: Supported employment (SE) was introduced to Switzerland in 2002. Since then, an increasing number of SE programs have been launched across Switzerland. This article reviews the state of SE in Switzerland., Method: Several Individual Placement and Support (IPS-SE) studies have been conducted in Switzerland. We reviewed the implementation, results, and possible future developments related to all Swiss IPS-SE studies., Findings: Studies have demonstrated that IPS-SE programs can be successfully implemented with excellent results in Switzerland, but most vocational rehabilitation programs do not provide SE., Conclusions and Implications for Practice: While SE is becoming the first choice for vocational rehabilitation in Switzerland, development and potential improvements are underway. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Objective: to analyze the perception of workers and managers about the psychosocial care network in a medium-sized municipality in the inlands of the state of Minas Gerais., Method: qualitative, descriptive and exploratory study involving twelve participants from different points of the network. The semi-structured interviews were analyzed in the light of Pierre Bourdieu's framework of constructionist structuralism., Results: the actions offered by the services were based on the perspectives of resocialization, user embracement, group and multiprofessional care, and on approaches to harm reduction, recreation and daily organization. These were configured as the network resources/capital. Tensions were identified in family embracement and in relationships between families and users, as well as in the prejudice towards people with mental disorders. Final considerations: the social agents were willing to contribute to processes of change in order to overcome the focus on specialties, the lack of training of some teams, lack of infrastructure and of some components, especially those related to leisure and community life.

Objective: to describe and analyze the role of expert nurses in mental health in the Family Health Strategy., Method: a qualitative study, with 20 Basic Health Units nurses of Teresina, Piauí. The information was collected through semi-structured interviews from March to May 2017 and analyzed using the content analysis method., Results: it was found that the conceptions of the mental health disease process were based on the biological model, there was little communication between mental health and basic network, nurses did not feel qualified to work mental health and there were few mental health actions in Primary Care. Final considerations: it becomes urgent to implement public policies that articulate mental health and Primary Care, raising awareness and continuing education for nurses.

Background: Disability support organisations have embraced Active Support, but it has proved difficult to embed in services., Aims: This study aimed to identify the factors associated with increases over time in the quality of Active Support., Method: Data were collected on the predicted variable of the quality of Active Support, and predictor variables of service user, staff and service characteristics, including practice leadership, and composition and size of services from 51 services in 8 organisations over 2-7 time points. Data were analysed using multi-level modelling., Results: There was significant linear change in Active Support scores (group mean centered at the organisational level) over time. Individuals with lower support needs received better Active Support and those with higher support needs experienced greater increases over time. Stronger practice leadership and more staff with training in Active Support were significant predictors of the quality of Active Support. Larger services with seven or more individuals and where there was a very heterogeneous mix of individuals were associated with lower quality of support., Conclusions: Ensuring strong practice leadership, and staff training in Active Support that emphasises the principle of adapting support to each individual's level of ability and preferences are key to delivering high levels of Active Support., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: The NICE clinical guidelines on psychosocial interventions for the treatment of schizophrenia and psychosis in adults are based on the results of randomized controlled trials (RCTs), which may not be studies with a pragmatic design, leading to uncertainty on applicability or recommendations to everyday clinical practice., Aim: To assess the level of pragmatism of the evidence used to develop the NICE guideline for psychosocial interventions in psychoses., Material and Methods: We conducted a systematic and critical appraisal of RCTs used to develop the 'psychological therapy and psychosocial interventions' section of the NICE guideline on the treatment and management of psychosis and schizophrenia in adults, published in 2014. For each study we assessed pragmatism using the pragmatic-explanatory continuum indicator summary-2 (PRECIS-2) and the Cochrane risk of bias tool. The mean score of PRECIS-2, averaging across nine domains, was calculated to describe the level of pragmatism of each individual study., Results: A total of 143 studies were included in the analysis. Based on the PRECIS-2 tool, 16.8% were explanatory, 33.6% pragmatic, and 49.7% were rated in an intermediate category. Compared to explanatory studies, pragmatic studies showed a lower risk of bias. Additionally, pragmatism did not significantly improve over time, and no associations were found between pragmatism and a number of trial characteristics. However, studies with a UK leading investigator had the highest mean score of pragmatism. Cognitive behavioural therapy (CBT), art therapy, family intervention, psychoeducation, and adherence therapy, showed the higher average pragmatism scores., Conclusions: Two third of studies used to produce NICE recommendations on psychosocial interventions for the treatment of schizophrenia and psychosis in adults are based on studies that did not employ a pragmatic design., Competing Interests: The authors have declared that no competing interests exist.

Objective: A site visit protocol was developed to assess recovery promotion in the organizational climate and culture of programs for veterans with serious mental illnesses., Method: The protocol was pilot-tested in 4 programs: 2 that had scored high on the pilot version of a staff survey measure of program-level recovery promotion and 2 that had scored low. Two-person teams conducted onsite visits and assigned global and organizational domain ratings. Interrater agreement was assessed by examining adjacent agreement and computing weighted kappa., Results: The on-site protocol had good interrater agreement and discriminated between sites that scored high and low on the staff survey., Conclusions and Implications for Practice: This site visit protocol and procedure shows promise for evaluating recovery promotion in milieu-based programs. After further refinement of this tool, adaptations could be developed for accreditation protocols or for program self-assessment and quality improvement efforts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective: Our goal was to develop and pilot a methodology that could reliably identify therapeutic homework tasks that are coherent with the goals of individuals receiving mental health recovery support., Method: The content of goals and therapeutic homework tasks of 66 clients were classified using the Camberwell Assessment of Need Goal-Action Plan (CAN-GAP) taxonomy. Goal-homework pairs were considered coherent if the content of the homework and goal were both independently assigned the same content domain., Results: The content of the goals and homework tasks were found to be highly coherent, with a 75% match in categories., Conclusions and Implications for Practice: It is possible to simply, and reliably, determine whether the content of goals and homework tasks are coherent. Lower coherence would require support workers to spend more time making the connection between homework and goals more explicit. Future research should determine whether higher coherence leads to greater goal attainment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective: Since previous meta-analyses of psychiatric-psychosomatic rehabilitation only rarely included studies from Austrian rehabilitation clinics a systematic review with meta-analysis of previously available evaluation results from Austrian rehabilitation clinics should be conducted., Methods: A systematic literature search in several data bases (Psyndex, PsycInfo, MEDLINE, Pubmed) and additional manual search was conducted. Evaluation results from the most commonly used assessment instruments (SCL-90/BSI, BDI, WHOQOL-BREF, GAF) were extracted from the studies included and subsequently a meta-analysis was calculated with the extracted data (pre-post comparison)., Results: 12 publications with 9 studies from 6 different Austrian rehabilitation clinics could be included in the meta-analysis, with a total of 9329 patients. Results show a significant improvement from pre- to post assessment in the medium effect size range, with a Hedges' g of 0.53 (95%-confidence interval [0.45;0.60]) for improvement in global symptom severity, a Hedges' g of 0.59 (95%-confidence interval [0.54;0.63]) for improvement in subjective quality of life and a Hedges' g of 1.00 (95%-confidence interval [0.83;1.18]) for improvement in global functioning. The effects are robust and there is no evidence for distortion or publication bias., Conclusions: On average medium effect sizes have been previously achieved with psychiatric-psychosomatic rehabilitation in Austrian rehabilitation clinics. This is comparable with the previous results of rehabilitation clinics in Germany. However, since only one controlled study is available thus far it can not be ruled out that the effects in comparison to no rehabilitation might turn out smaller. Thus, in the future increasingly controlled studies should be conducted and the quality of conducted studies should be improved.

Objective: This article describes a measure developed to assess fidelity of working with the Boston University approach to Psychiatric Rehabilitation (BPR) in Dutch mental health care. The instrument is intended to measure and improve BPR adherence and clinician competence on an individual level and within individual rehabilitation processes., Method: Rotating pairs of 4 BPR specialists used Fidelity of Rehabilitation (FiRe) to evaluate the fidelity of BPR as applied in 114 rehabilitation processes. The content of these processes was documented by the 27 rehabilitation practitioners who delivered the approach., Results: Interrater reliability (.66) was good as were correlations between the first and second assessments (.74), also increasing over time. FiRe was able to distinguish those delivering the approach at an expert level from nonexperts, expressing concurrent validity. FiRe was also related to practitioner attitude toward rehabilitation, a possibly similar construct. In this study, the average level of BPR adherence according to our fidelity model was low. During the 10.5-month review period, overall FiRe scores improved slightly, but this effect was not significant. However, practitioners reported that feedback based on FiRe helped them to enhance their skills., Conclusions and Implications for Practice: This first version of FiRe is a valid and reliable instrument with which to gain insight into the quality and fidelity of individual practitioners' rehabilitation practices. The instrument used in this study will be further developed in line with study results. More importantly, FiRe raises questions about the definition of good BPR, a topic that should be explored more extensively in future research. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Objectives: Little research has assessed the nature of veterans' departures from permanent supportive housing (PSH), which may be of positive valence (e.g., moving into more independent housing). This study aimed to identify participants appropriate for "graduation" from PSH and how to support their transitions., Method: This mixed methods study used qualitative data from PSH program staff, 445 PSH participants' responses to a survey assessing their experiences and administrative records, and qualitative data from a subsample of 10 participants who graduated from the program. Participants were classified as "stayers" (retained in PSH for at least 600 days); "graduates" (exited with improvement in community integration); or "involuntary leavers" (exited for reasons of negative valence). Template analysis of qualitative data from PSH staff described graduation processes; qualitative data from participants were analyzed using a thematic analysis approach. The study compared veterans' characteristics using chi-square and analysis of variance (ANOVA) tests; a multinomial logistic regression assessed correlates of graduates' and involuntary leavers' exits from PSH., Results: Approximately one half of participants who exited the program were graduates. Processes used by program staff to identify potential graduates varied. Participants' self-report of substance use and mental health problems was associated with involuntary leaver status. Frequency of case management, a trusting relationship between participant and case manager, and participants' receipt of compensation related to disability incurred during military service were associated with graduation., Conclusions and Implications for Practice: To support successful transitions from PSH, programs should focus on providing high-quality case management that may respond flexibly to participants' varying recovery needs. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Objective: This study examines the role of mattering to others as an intrapersonal construct that may mediate the relationship between social support and 2 separate criterion variables: recovery and internalized stigma associated with living with a serious mental health condition. Adults living with serious mental health disorders, such as schizophrenia, face numerous social challenges that may leave them feeling isolated, stigmatized, and that they do not matter to others, thus thwarting the potential for recovery. Theorists and researchers conceptualize the sense of mattering to others as the perception that 1 is valued, recognized by others along with the feelings that others are concerned about our well-being., Method: Clubhouse members (N = 119) completed 1-hr, in-depth personal interviews assessing perceived social support, experiences of mental health recovery, and stigma associated with living with a mental health condition as well as a sense of mattering to others., Results: Mediation analyses revealed the significant effects of mattering to others as explaining the relationship between social support and recovery as well as the relationship between social support and internalized stigma., Conclusions and Implications for Practice: The findings illuminate our understanding as to how social support interventions can enhance recovery and reduce stigma associated with living with a psychiatric condition by attention to perceptions of whether one is valued and recognized by others. Mattering to others among consumers of social and health care interventions can serve to engage individuals who may withdraw from supports or internalize negative self-stereotypes based on internalized stigma. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Objective: This study aims to identify consumer-level predictors of level of treatment response to illness management and recovery (IMR) to target the appropriate consumers and aid psychiatric rehabilitation settings in developing intervention adaptations., Method: Secondary analyses from a multisite study of IMR were conducted. Self-report data from consumer participants of the parent study (n = 236) were analyzed for the current study. Consumers completed prepost surveys assessing illness management, coping, goal-related hope, social support, medication adherence, and working alliance. Correlations and multiple regression analyses were run to identify self-report variables that predicted level of treatment response to IMR., Results: Analyses revealed that goal-related hope significantly predicted level of improved illness self-management, F(1, 164) = 10.93, p < .001, R2 = .248, R2 change = .05. Additionally, we found that higher levels of maladaptive coping at baseline were predictive of higher levels of adaptive coping at follow-up, F(2, 180) = 5.29, p < .02, R2 = .38, R2 change = .02. Evidence did not support additional predictors., Conclusions and Implications for Practice: Previously, consumer-level predictors of level of treatment response have not been explored for IMR. Although 2 significant predictors were identified, study findings suggest more work is needed. Future research is needed to identify additional consumer-level factors predictive of IMR treatment response in order to identify who would benefit most from this treatment program. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Topic: This column describes challenges for hiring, training, and supervising psychiatric rehabilitation service providers for positions that involve the use of digital health technology., Purpose: Adoption and implementation of any new technology or technique requires workforce development. This article outlines considerations for policymakers, funders, and service agency administrators as digital health technologies become more widespread., Sources Used: The article discusses issues based on professional experience of the authors and available literature., Conclusions and Implications for Practice: The literature on adoption of innovations in general, and the adoption of psychiatric evidence-based practices in particular, indicates that funding and adoption of new techniques and technologies are not adequate to ensure full and sustained implementation. The use of any new treatment or technology requires training and other supports to ensure that users have the competencies needed to make it work and that the workplace supports its use. As new digital health technologies become available, considerations of their cost and effectiveness need to include an examination of the required competencies of the service providers who will use them and the added cost of developing, enhancing, and maintaining those competencies. Specific attitudes, knowledge, and skills will be relevant to hiring decisions. Relevant preservice and on-the-job training opportunities, technical assistance, and supervision will be needed. Implementation needs to be monitored, not assumed, and the rights of the people who use technology-supported services must be fully protected. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

WHAT IS KNOWN ON THE SUBJECT?: There is a growing emphasis on communication as a result of the move towards the more inclusive approach associated with the community-based rehabilitation model. Therefore, more importance is attached to handovers. Besides ensuring transfer of information, handovers enhance group cohesion, socialize staff members to the practices of the service and capture its organizational culture. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: While handovers are mainly used for information transfer and to manage the services' daily routine, this paper offers an insight on how handovers can be conceived as valuable instruments to document cultural and organizational change. Only a limited amount of studies has focused on handovers in mental healthcare settings, and most of them only consider the perspectives of psychiatric nurses, while embracing a broader perspective, this paper provides valuable insights into the perspectives of various service providers. The overcoming of the dichotomy deficit-based vs. recovery-oriented model is possible if professionals use handovers to reflect upon their practice and the ways in which their cultural models are affected by the environmental context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Handovers are valuable instruments to document organizational change. It would be important for psychiatric and rehabilitation facilities to keep track of the handover records over time as they may provide insightful information about cultural change and the transformations in the core values and beliefs held by professionals., Abstract: Handovers assure a timely and correct information transfer while socializing workers to the service's culture; however, no study describes them as instruments to document organizational change and only a few have focused on psychiatric settings. Aim To investigate the change in the culture of an Italian psychiatric residential care home as perceived by its mental health workers (MHWs) over the course of two decades. Method Emotional text analysis (ETA) was used to analyse the MHWs' handovers completed from 1990 to 2011. Results The analysis generated four clusters and three main factors illustrating the change in the MHWs' representations of the residential care home and its occupants. The factors showed: (1) the shift from an individualistic, problem-focused view to an inclusive, community-based approach; (2) the presence of a descriptive as well as a specialized language; and (3) the presence of a double focus: on patients and professionals. Conclusions Handovers transcripts document the following changes: (1) a shift from a symptom-based to a recovery-oriented approach; (2) a modification of the MHWs values towards an holistic view of the patient; (3) a growing importance assigned to accountability, services integration and teamwork. The paper shows that handovers can be used diachronically to document organizational change., (© 2017 John Wiley & Sons Ltd.)

The role that people with serious mental illness (SMI) play in making decisions about their own treatment and rehabilitation is attracting increasing attention and scrutiny. This attention is embedded in a broader social/consumer movement, the recovery movement , whose agenda includes extensive reform of the mental health system and advancing respect for the dignity and autonomy of people with SMI. Shared decision-making (SDM) is an approach for enhancing consumer participation in health-care decision-making. SDM translates straightforwardly to specific clinical procedures that systematically identify domains of decision-making and guide the practitioner and consumer through making the decisions. In addition, Collaborative decision-making (CDM) is a set of guiding principles that avoids the connotations and limitations of SDM. CDM looks broadly at the range of decisions to be made in mental health care, and assigns consumers and providers equal responsibility and power in the decision-making process. It recognizes the diverse history, knowledge base, and values of each consumer by assuming patients can lead and contribute to decision-making, contributing both value-based information and technical information. This article further discusses the importance of CDM for people with SMI. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

The use of routine outcome measurement (ROM) to assess service effectiveness has been on the rise in mental health settings. However, there is a scarcity of information on the use of ROM data to provide feedback to teams of service providers. In this paper we review the existing literature to identify the principles that can guide the use of ROM data as feedback with the aim to improve quality of service provision in mental health settings. We present a pilot trial of 12 agencies participating in group feedback sessions. The guiding principles and core processes, the procedure and implementation in a pilot trial, lessons learned and future directions are discussed. Based on this experience we conclude that using ROM to implement group feedback among mental health stakeholders is feasible and can generate discussions and directions for improvement.

Evidence-based approaches and modalities for targeting and treating the cognitive impairments of schizophrenia have proliferated over the past 15 years. The impairments targeted are distributed across the cognitive spectrum, from elemental perception, attention, and memory, to complex executive and social-cognitive functioning. Cognitive treatment is most beneficial when embedded in comprehensive programs of psychiatric rehabilitation. To personalize comprehensive treatment and rehabilitation of schizophrenia spectrum disorders, practitioners and participants must select from a rapidly expanding array of particular modalities and apply them in the broad context of the participant's overall recovery. At present, no particular treatment, cognitive or otherwise, can be considered more important or primary than the context in which it is applied. Persistent difficulty in dissemination of new technology for severe and disabling mental illness compounds the significance of the context created by a full treatment array. In this article, a case-study of a mental health service system is described, showing the broad-ranging effects of degrading the rehabilitative context of treatments, obviating the benefits of cognitive treatment and other modalities. To realize the promise of cognitive treatment, the problems that prevent dissemination and maintenance of complete psychiatric rehabilitation programs have to be addressed., (© The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: This article describes the development and piloting of a bilevel intervention codeveloped by persons in recovery from mental illness and addiction and university faculty with expertise in cultural competence to improve the cultural competence of a community mental health center in the northeastern United States., Method: Two faculty and 5 persons in recovery met for 6 months to develop the bilevel training intervention. They discussed experiences of culturally responsive care and developed experiential activities and case examples for the 2-day training. Forty-five community mental health service providers attended the 2-day training. Trainees' self-reported awareness, knowledge, and skills in cultural competence were measured pre and post training and analyzed with repeated measure t tests. Next, faculty and persons in recovery provided follow-up training and helped to establish an infrastructure supported to support the agency cultural competence plan. One hundred twenty-five providers completed the Organizational Multicultural Competence Survey and between-subjects t tests measured increases in organizational cultural competence., Results: Significant increases were found in providers' multicultural knowledge, awareness, and skills. Qualitative responses demonstrated the contribution of the experiences of persons in recovery to the training. Ratings of the organizational-level cultural competence intervention showed significant improvements in the agency's cultural competence policies (e.g., implementation of strategies to hire and retain a diverse workforce)., Conclusions and Implications for Practice: These data suggest that bilevel interventions codeveloped by persons in recovery and researchers may be effective in increasing provider and organizational-level cultural competence. Future research should evaluate the effect of these interventions on consumers and health outcomes., ((c) 2016 APA, all rights reserved).)

Objective: To explore staff perceptions of the successes and barriers to implementation of the psychosocial/psychiatric rehabilitation (PSR) model in the forensic mental health setting and identify staff supports needed for greater implementation., Method: A qualitative descriptive design was used and staff focus group data was analyzed using the constant comparative method., Results: All aspects of PSR are being implemented in the forensic setting. Barriers limiting comprehensive implementation include hospital processes and functions, legal components, client clinical presentation, staff attributes and interactions, and lack of resources. To foster greater implementation, employees require support to improve interprofessional interactions and acquire additional resources and education., Conclusions and Implications for Practice: Strengthening existing successes and addressing barriers identified will foster greater PSR implementation in the forensic setting. Adjusting the physical environment, streamlining documentation, shifting focus from security to rehabilitation goals, and adapting PSR principles to various levels of illness acuity and stages of treatment would enhance PSR implementation. A management focus on improving staff morale, self-care, peer support, team cohesion, and communication would limit burnout and increase successful implementation of PSR. Additional educational opportunities and ongoing training are suggested to support a unified understanding and sustained approach to PSR implementation in the forensic setting., ((c) 2015 APA, all rights reserved).)

Topic: If an agency desires changes in practice and a consistent approach to services, psychiatric rehabilitation staff development requires more than a single session of training., Purpose: This column describes one agency's approach to a comprehensive staff training and development program, designed to enhance the 3 Cs of capacity, commitment, and culture., Sources Used: The program described has been in place, with frequent adjustments, for over 20 years, and the experiences of the authors and their colleagues form the primary source for the paper., Conclusions and Implications for Practice: Staff development requires an ongoing investment--competency-based training, supervision congruent with the service vision and mission, accountability through performance evaluation, and opportunities for growth. We have a firm belief that our employees learn to treat others, in part, from how they are treated by our agency leadership., ((c) 2015 APA, all rights reserved).)

Background: Family work is one of the best researched psychosocial interventions for patients with chronic psychosis. However, family work is less studied for patients with a first episode psychosis and the studies have revealed contradicting results. To our knowledge, no previous studies have examined qualitatively group leaders' experiences with family work. In the present study we wanted to explore challenges faced by mental health professionals working as group leaders for family interventions with first episode psychosis patients., Method: A qualitative exploratory study was carried out based on digitally recorded in-depth interviews and a focus group interview with nine experienced mental health professionals. The interviews were transcribed in a slightly modified verbatim mode and analysed by systematic text condensation., Results: Challenges faced by group leaders was classified into six categories: (1) Motivating patients to participate, encouraging potential participants was demanding and time-consuming; (2) Selecting participants by identifying those who can form a functional group and benefit from the intervention; (3) Choosing group format to determine whether a single or multi-family group is best for the participants; (4) Preserving patient independence, while also encouraging them to participate in the intervention; (5) Adherence to the protocol, while customizing adjustments as needed; (6) Fostering good problem-solving by creating a fertile learning environment and choosing the most appropriate problem to solve., Conclusions: Group leaders face challenges related to recruitment and selection of participants for family work, as well as in conducting sessions. Awareness of these challenges could help health professionals more specifically to tailor the intervention to the specific needs of patients and their families.

Background: The philosophy of recovery emphasises consumer participation and engagement in developing effective rehabilitation services. Assessment of consumer perspectives and concerns lies at the heart of responsive and relevant rehabilitation frameworks., Aim: The study aimed to document and examine patient and caregiver queries, at their first contact with Rehabilitation Services., Methods: The sample consisted of 124 consecutive inpatients and their accompanying caregiver/s, referred to Psychiatric Rehabilitation Services, within a tertiary care psychiatric hospital in India. The data were collected using the semi-structured Inpatient Intake proforma during the intake session. The spontaneous queries raised by patients and/or caregivers were documented and content analysis identified themes, separately for patients and caregivers., Results: The results indicated both similarities and differences in the frequency of themes that emerged from questions asked by patients and their caregivers. Two prominent themes centered on specific queries about rehabilitation services and the treatment and prognosis of the psychiatric illness., Conclusions: The findings have implications for training, practice and research in the field of psychosocial rehabilitation. Recommendations are made for training and practice frameworks to facilitate consumer-service provider communication towards the development of responsive recovery-oriented services.

In this article we present the design, development and implementation of the Psychiatric Rehabilitation Routine Outcome Measurement (PR-ROM) project, the first systematic effort to implement mental health routine outcome measures in Israel. The goal of the PR-ROM is to provide updated information about the process and impact of psychiatric rehabilitation services in Israel and to establish a sustainable infrastructure and foundation for routine outcome monitoring of rehabilitation services to improve care, inform policy, generate incentives for service improvement, increase informed decision-making and provide data for research purposes. The rehabilitation services evaluated and the characteristics of the population being served are described and the methods and nature of the collected data as well as some preliminary findings are presented. We discuss the major barriers encountered, our efforts to deal with them and lessons learned during the process. We conclude with a description of the current state of the initiative and plans for the future.