A ten-year follow-up of a supported employment program

OBJECTIVE: Supported employment has steadily increased in prominence as an evidence-based mental health practice, and research shows that the service significantly improves employment outcomes over one to two years. The objective of this study was to examine the outcomes of supported employment ten years after an initial demonstration project. METHODS: The study group consisted of 36 clients who had participated in a supported employment program at one of two mental health centers in 1990 or 1992. Clients were interviewed ten years after program completion about their employment history, facilitators to their employment, and their perceptions of how working affected areas of their lives. RESULTS: Seventy-five percent of the participants worked beyond the initial study period, with 33 percent who worked at least five years during the ten-year period. Current and recent jobs tended to be competitive and long term; the average job tenure was 32 months. However, few clients made the transition to full-time employment with health benefits. Clients reported that employment led to substantial benefits in diverse areas, such as improvements in self-esteem, hope, relationships, and control of substance abuse. CONCLUSIONS: On the basis of this small sample, supported employment seems to be more effective over the long term, with benefits lasting beyond the first one to two years.     

A 13 year follow-up of child psychiatry training

The graduates from two child psychiatry training programmes over a 13 year period responded to a questionnaire designed to elicit their retrospective evaluations of various aspects of their educational experience. Information is presented about areas of knowledge judged important, specific experiences which were helpful and unhelpful, and current patterns of practice of these graduates. Their attitudes toward supervision and supervisors are discussed, as are implications for recruitment of future trainees and teachers/faculty.     

A competency-based model for research training during psychiatry residency

The Institute of Medicine recently identified a critical shortage of psychiatrist-researchers and highlighted the need for competency-based curricula that promote research training during psychiatry residency as a way to address that shortage. In this article we review extant approaches to research training during psychiatry residency. We then identify five core elements necessary for promoting research training: (1) mentoring, (2) education, (3) experience, (4) time, and (5) support. We describe six interrelated domains of core research competencies that can be mastered gradually over the course of residency training: (1) research literacy, (2) content mastery of specific research topics, (3) principles of research design and methods, (4) principles of biostatistics, (5) presentation and writing skills, including grant writing, and (6) principles of responsible conduct of research. Finally, we propose a broadly applicable, developmental, competency-based framework for applying these core elements to research training during psychiatry residency.     

Psychiatric adolescent inpatients: eight- to ten-year follow-up.

Seventy-seven adolescent psychiatric inpatients, whose index hospitalization was at a mean age of 16, were followed up for eight to ten years after discharge. The important findings at follow-up were as follows. Twelve patients had bipolar affective disorder and were severely disabled (of these, 11 had a long-term clinical course and three committed suicide). Sixteen patients had unipolar depression: five had one depressive episode and were well throughout the follow-up period, one patient had many episodes with complete remissions, and the remaining ten patients had only partial remissions and their impairment of functioning corresponded to the severity of their symptoms. One of the ten committed suicide. Eighteen (23%) patients were psychiatrically well and functioned adequately throughout the follow-up period. Five had primary depressions, five had undiagnosed psychiatric illness, and eight were diagnosed as not having a psychiatric disorder.     

Two year follow-up study of an outreach program in geriatric psychiatry

In Canada and the U.S. the percentage of elderly people is increasing and more funds are being spent on institutional programs. Yet many are not so impaired that they cannot be looked after by relatives. A number of community outreach programs are available. From an inpatient psychogeriatric unit in Hamilton Provincial Hospital an outreach program is described. A follow-up study was done during a 2 year period by contacting the referral sources. The 24% who had been admitted were compared with the 75.9% who remained in the community. While patients' relatives and referring sources were mostly pleased with the assessments, and those patients not admitted were less institutionalized, those admitted with affective disorder showed a higher recovery rate than those remaining in the community. The total number admitted to hospital showed a lower mortality rate than those not admitted, even though the latter three considered less mentally ill because of the criteria for admission to the hospital.     

Child psychiatry education in early child development: Description of a training program

Career training in child psychiatry, though provided from a developmental perspective, often lacks opportunity for directly observing normally developing infants. This paper describes a training program in which child psychiatry fellows, in collaboration with residents in pediatrics, follow a young couple and their first child from the third trimester of pregnancy through infancy and early childhood. Case illustrations and discussion of approximately 10 years' experience demonstrate how the program can enhance understanding of normal child development, development of the nuclear family, liaison between child psychiatrist and pediatrician and early detection of psychopathology in infants.     

On line self-assessment system for psychiatry training program]

A radical reform in Japan had been done on the postgraduate clinical training system since April 2004. The subject point of the change was that in the past, mainly in the University hospitals, where the postgraduate clinical training system was made by the Department of a resident's planned medical staff, to enter in the future; in the new system, resident is incorporated in a 2-year training program with contents of internal medicine, surgery and emergency, not just bounded to particular field, in order to master basic and general clinical abilities. This new system included psychiatry rotation for 1 to 3 months. The new postgraduate clinical training system is also expected for the hospital's side to become activated by remaining the clinical training system. As a matter of course, the System has given a great effort to the curriculums of medical education. This super rotation system will be evaluated in 5-year after the introduction. The problem is whether psychiatry rotation is effective or not in a new system. If not so, psychiatry rotation might be omitted in this system. Therefore, we psychiatrists will prepare for the evidence of the effectiveness of psychiatry rotation. I developed on line self-assessment system with reference to Accreditation Council for Graduate Medical Education (ACGME) in the United States. I have introduced this system in the paper.     

A seven-year evaluation of a career-escalation training program for indigenous nonprofessionals.

A community mental health center in an urban ghetto offers a career-escalation program in which indigenous nonprofessional mental health workers can earn a master's degree in the behavioral sciences. The program allows them paid time off for classes and study and also pays for their tuition and course materials. An evaluation of the first seven years of the program showed that only 56 of the 91 staff members who were eligible for the program entered it, and 23 subsequently dropped out. Only three trainees earned a master's degree, although 24 were pursuing or had received an associate-in-arts degree. The author briefly discusses changes that could make the program more effective, but he believes a community mental health center is not the best setting for a career-escalation program.     

The liaison clinic: A model for liaison psychiatry funding,training, and research

While liaison or similar clinics have existed since at least 1931, they remain uncommon. The Mount Sinai Medical Center Liaison Clinic is presented as a model for psychiatric evaluation and care of medical patients as well as training, research, and funding. In addition, it is a model for linking general and mental health systems in the tertiary care setting. The first year of operation of the clinic is described, including the sources of referral, demographic data, psychiatric, and medical diagnoses, and type of clinic contact. A total of 96 patients were seen in 390 visits, equaling three quarters of a liaison fellow's salary.     

Progressive psychiatry: A research agenda

It is possible to create a new research agenda based on an alternative perspective of human behavior and mind. After describing the theoretical tenets of this alternative perspective, illustrations of a new research agenda are presented. Such a research agenda would: (1) create new points of departure; (2) examine social relations underlying all variables; (3) more fully explore unexplained variance; (4) focus on the adaptive interaction of individuals within their world. Such research aims towards enhancing human uniqueness, action, and spirit.