Intervention Programs for Children of Parents with a Mental Illness: A Critical Review

There is widespread acknowledgement that children in families affected by parental mental illness are at risk for a range of poor life outcomes. There is also a growing number of interventions to meet the needs of this group of young people. This review evaluates the quality of the existing evidence for such intervention programs. Five hundred and twenty articles were reviewed, and twenty-six studies were judged to be relevant. The majority of the studies were randomised trials (n=8) and pre-post interventions with no comparison or control groups (n=8). None of the studies measured cost-effectiveness or included consumer or carer consultation, and few outlined the theoretical basis for the development of the intervention program. Seven studies were rated as methodologically strong, four as of moderate quality and fifteen as methodologically weak. This data provides very limited evidence of program effectiveness as determined by well-being or illness outcomes for the child. Practitioners should use a recognised theory in developing intervention programs, link program components to identified risk factors for this target group, select intervention components from across the public health spectrum and incorporate greater intersectoral collaboration. Future programs should be rigorously evaluated and widely disseminated, with long-term follow-up of participants.     

Future Involvement of Siblings in the Lives of Persons with Mental Illness

Siblings are considered logical replacements for aging parental caregivers of persons with severe mental illness. For workshops on future planning conducted with 400 elderly parents, 60 siblings answered a survey regarding their future caregiving expectations, anticipated difficulties, and need for help. Nearly all expected to be involved, but were more likely to provide social and emotional support than the instrumental support offered by their parents. Nearly half indicated that the consumer’s hostility and lack of cooperation were major barriers to effective care. It was suggested that siblings need education and help from professionals in assessing behaviors, interacting appropriately, and conferring control of their own lives to their ill relatives. For consumers, social skills and self-esteem training in psychiatric rehabilitation programs should address the area of sibling relationships and reciprocity. Such issues should be dealt with early, rather than later in the course of illness     

Nurses' Views on Training Needs to Increase Provision of Primary Care for Consumers With Serious Mental Illness

PURPOSE: The study aims to ascertain nurses' views on their preparedness to provide physical health care, and their identified training needs. DESIGN AND METHODS: The study used a qualitative exploratory design. Thirty‐eight nurses working in a regional mental health setting participated in focus groups. FINDINGS: Three main themes were identified: (a) the need for physical healthcare training, (b) modes of training, (c) access to training, and (d) organizational commitment. PRACTICE IMPLICATIONS: The philosophy and design of training must reflect workplace context, and take into account individual learning styles. Organizational support is crucial.     

Brief Report: Exploring Mental Health Service Needs for the Elderly: Results of a Modified Delphi Study

Identified key informants with professional experience in the broad domain of mental health services reported current and future mental health service needs of elderly Harris County residents as part of a three-round modified Delphi study. Forty-one professionals from various housing, psychosocial, medical, and protective service provider groups were surveyed during three consecutive rounds. The consensus achieved through the Delphi process served to describe the gaps in the mental health services currently available to elderly Harris County residents as well as identify the service needs of this population into the future, thereby providing direction for future service development.     

Outcomes of a Family Peer Education Program for Families of Youth and Adults with Mental Illness

Abstract:

Family members of consumers with mental illness often play important roles in initiating and supporting treatment. Self-help programs such as the National Alliance on Mental Illness (NAMI) Family-to-Family Education Program (FTF) have been shown to provide a variety of benefits for family members. Despite recognizing the benefits of FTF, little is known about who may benefit most, and in what ways they might benefit. One group of interest is family members of younger consumers, a group shown to report more negative caregiving experiences and more depression and anxiety than caregivers of older consumers. The current study assesses whether relatives of youth (ages 8–18) differ in their response to FTF as opposed to relatives of adults (19 years and older). Results suggest that all members benefit from FTF. Family members of youth in FTF, however, reported gains more pronounced on their depressive symptoms, and negative perceptions and experiences, relative to family members of adults. The importance of peer support programs is discussed, as well as the specific usefulness of these programs to effectively address concerns of relatives of youth with serious mental health concerns.     

The Development and Introduction of an In-Patient Student Law Services for Persons with Serious Mental Illness: A Case Study

There is a need to provide legal assistance to persons who suffer with serious mental illness for legal problems over and above problems associated with mental illness. This paper describes a single-case study of the development and introduction of a pilot of a hospital-based, legal service, in partnership with The University of Western Ontario Faculty of Law. The data sources included direct observation and documentation. Law students provide legal services reflecting the application of a therapeutic jurisprudence approach. Interprofessional education and training occurs with law, medical, nursing and other students, and professionals on the principles and scholarship of therapeutic jurisprudence, mental illness and legal rights. A programmatic organizational template, the program logic model, was used to conceptualize the activities, and process, short-term, long-term and ultimate objectives, and indicators. The four core activities were: (1) patient access point to law students; (2) supervision of law students at the London Health Sciences Centre; (3) intake and access to other services, and (4) teaching and additional training of law and other students, physicians and other health caregivers. The development, issues and challenges of the introduction of an in-patient student law service is described.     

Successful Application of a Canadian Mental Health Curriculum Resource by Usual Classroom Teachers in Significantly and Sustainably Improving Student Mental Health Literacy

Objective:

To investigate whether the significant and substantive findings from a previous study of youth mental health literacy (MHL) could be replicated using the same methods in another population.

Method:

We examined the impact of a curriculum resource, the Mental Health and High School Curriculum Guide (The Guide), taught by usual classroom teachers on students’ knowledge and attitudes related to mental health and mental illness in Canadian secondary schools. Survey data were collected before, immediately after, and 2 months after implementation of The Guide by teachers in usual classroom teaching. We conducted paired-sample t tests and calculated the Cohen d value to determine outcomes and impact of the curriculum resource application.

Results:

One hundred fourteen students were matched for analysis of knowledge data and 112 students were matched for analysis of attitude data at pre-intervention, post-intervention, and 2-month follow-up time periods. Following classroom exposure to the curriculum resource, students’ knowledge scores increased significantly and substantively, compared with baseline (P < 0.001, d = 1.11), and this was maintained at 2-month follow-up (P < 0.001, d = 0.91). Similar findings for attitude improvement were found (P < 0.001, d = 0.66), and this improvement was maintained at 2-month follow-up (P < 0.001, d = 0.52).

Conclusions:

These findings corroborate those from a previous study conducted in a different location. Taken together these results suggest a simple but effective approach to improving MHL in young people by embedding a classroom resource, delivered by usual classroom teachers in usual school settings.     

Clinical Supervision for the Treatment of Adults With Severe Mental Illness: Pertinent Issues When Assisting Graduate Nursing Students

PURPOSE. There is little to guide advanced practice nurses to provide supervision for graduate students conducting psychotherapy with persons with serious mental illness. This article provides concrete suggestions for clinical supervision. CONCLUSIONS. Supervision should focus on assisting students to conduct recovery-based psychotherapy in terms of the therapeutic alliance, methods to provide empathy, collaborative goal setting, the management of countertransference, and the development of self-awareness. PRACTICE IMPLICATIONS. In providing clinical supervision, preceptors should assist students to become more aware of their own thoughts and feelings as well as stigmatizing beliefs in order to help clients move toward recovery.     

Effective Components of a Nationwide Case Management Program in Japan for Individuals with Severe Mental Illness

This study identified effective components in a case management program based on the Japan Case Management Guidelines (JCM-GL). Subjects (n=295) with severe mental illness were enrolled throughout Japan. Four outcome scales were utilized. The independent variable, Fidelity to the JCM-GL was the subject of interest. Case management components comprised three factors, extracted from factor analysis to fidelity scales, with the needs-oriented approach factor displaying the highest score. Subjects demonstrating high fidelity on this factor showed significantly higher quality of life and service satisfaction than low scorers. This component should be established first in countries where community care is underdeveloped.     

Field Test of the Feasibility and Validity of Using the Hoosier Assurance Plan Instrument for Adults in a State Mental Health Program

The current paper reports on the feasibility of using the HAPI-A, an instrument designed to assess a person’s level of functioning in the community: (1) to help determine eligibility to receive behavioral health services, (2) to assign reimbursement case rates; and (3) to provide data for a service provider report card. A 3-year field study of the use of the instrument across an entire state mental health system explored the effectiveness of methods to enhance data accuracy, including annual training and a professional clinical record audit, and the ability of the test to detect differences in improvement rates within risk-adjusted groupings. The combination of training and auditing produced statistically significant, cumulative reductions in data errors across all 3 years of the field test. The HAPI-A also was sensitive in detecting differences among service providers in outcome improvements for six of six risk-adjusted groups rated at the moderate level of impairment and for five of six groups rated at the mild level of impairment, but was inconsistent in detecting outcome differences for persons rated at the severe level of impairment.

The Hoosier Assurance Plan Instrument for Adults (HAPI-A): The Psychometric Properties of a Level of Functioning Assessment Instrument Designed for Use in a State Managed Care Mental Health Program

The psychometric properties of the HAPI-A were examined at intake and 90-day follow-up in consumers with mental illness (MI) or chronic addiction (CA) being served at one of 11 treatment facilities (n = 1168). A 4-factor subscale structure was confirmed and factor invariance tests indicated a single model for the CA and MI samples. Internal consistency and inter-rater reliability were good (ICCs = 0.72–0.88). Factor scores correlated with GAF ratings and predicted membership in severity/cost groupings proposed for setting reimbursement rates. Sensitivity to change was confirmed for all four factors for the CA sample and for three of four factors for the MI sample. John McGrew and Frederick L. Newman—Order of authorship is arbitrary and does not indicate relative contributions to the paper. John McGrew is an Associate Professor of Psychology, Indiana University Purdue University of Indianapolis, Indianapolis, USA. Frederick L. Newman is a Professor of Health Policy and Management, Florida International University, Miami, USA. Richard N. DeLiberty is Chief Deputy Director, Yolo County Department of Alcohol, Drug & Mental Health, Woodland, CA, USA.     

Using Information Technology to Evaluate the Detection of Co-Occurring Substance Use Disorders Amongst Patients in a State Mental Health System: Implications for Co-Occurring Disorder State Initiatives

The current study describes a system-wide method of evaluating detection strategies for co-occurring disorders within a state mental health system. Information technology was used to merge administrative datasets from the New Jersey mental health and substance abuse systems and identify individuals treated in both systems. We measured a 53% detection rate of substance use disorders amongst adult patients in the mental health system with particularly low detection rates in acute settings (49.0%) and among female (43.7%), older (36.2%), and psychotic patients (43.6%). The methodology described here could help evaluate critical aspects of ongoing state co-occurring disorder quality improvement initiatives. This paper was presented at the 2005 American Psychiatric Association Annual Meeting (May 21–26, 2005) in Atlanta, Georgia.     

Training and Management of a Multisite Neuropsychological Testing Protocol for the Department of Veterans Affairs Cooperative Study Evaluating on- and Off-pump Coronary Artery Bypass Graft Procedures

Research study coordinators from 17 sites participating in a cardiac surgery study were trained to administer and score a brief neuropsychological test battery. Results were sent to the study's centralized laboratory for review and feedback. The average examiner errors on the first six protocols were compared with the average errors on the last six protocols over 12 months for each site. Overall, errors for the first six protocols were 4.42, and errors for the last six protocols were 1.83, representing a significant overall decline. Errors for instruction, administration, and recording showed a significant decrease over time. Despite ongoing feedback to examiners, scoring errors did not decline significantly overall; this suggests that a review of all protocols is necessary to achieve reliable scoring. However, when examiners' number of protocols completed was compared with number of scoring errors per protocol, there was a trend for examiners who had completed more protocols to show more improvement in scoring.