A randomized evaluation of consumer versus nonconsumer training of state mental health service providers

Rreliminary evidence suggests that mental health consumers can successfully serve as peer companions, case management aides, case managers, job coaches, and drop-in center staff. However, few empirical investigations have addressed the use of consumers to train mental health professionals. This project employed a randomized design to test the effects of using consumers as trainers for mental health service providers. Fifty-seven state mental health professionals participated in a two-day training designed to acquaint trainees with the attitudes and knowledge necessary for delivering assertive case management services. Participants were randomly assigned to one of two conditions: one in which they received the second day of training from a consumer and the other involving training by a nonconsumer. Analyses revealed that post-training attitudes were significantly more positive for those participants trained by the consumer. Subjective evaluations also reflected positive reactions to the use of consumers as trainers. Implications for further use of mental health consumers as trainers are explored.Funded, in part, by contract #MH19359 and #C151038092 from the Illinois Department of Mental Health and Developmental Disabilities, Springfield, Illinois. Also supported by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, and the U.S. Department of Education, National Institute on Disability and Rehabilitation Research (Cooperative agreement #H133B00011). The opinions expressed herein do not reflect the position or policy of any agency and no official endorsement should be inferred. The authors gratefully acknowledge Elise Brooks, Mark Gervain, Eleanor Guzzio, Karen Lee, and Mardi Solomon, as well as participants in the training, for their valuable contributions to this research project.     

A study of paraprofessionals in mental health

This article summarizes data gathered on 15 paraprofessional training programs sponsored by the National Institute of Mental Health (NIMH). Data on the backgrounds of trainees working as paraprofessionals are presented along with a breakdown of the kinds of tasks in which they are employed, as well as characteristics linked with ratings of success and retention in the programs. Trainees tended to be employed in a wide variety of tasks, often at rather sophisticated levels. Analysis of the tasks indicates that projects are fulfilling the NIMH New Careers goal of contributing to greater community impact in mental health. Results corroborate earlier findings that paraprofessionals have been accepted both by professionals and clients.The work upon which this publication is based was performed pursuant to Contract No. HSM-42-72-143 with the National Institute of Mental Health; Alcohol, Drug Abuse, and Mental Health Administration.     

Remediation of arabic numeral processing in a case of developmental dyscalculia

In this case study we investigated numeral transcoding in CM, a young man with developmental dyscalculia. Our initial assessment revealed that CM's difficulties in numeral transcoding occurred mainly on tasks requiring the production of Arabic numerals. His errors on these tasks were most often syntactically ill-formed strings in which the basic lexical elements are retained, but the overall structure is incorrect (e.g. nine hundred two thousand seventy → 92,70). We then implemented a training programme designed to overcome CM's syntactic impairment. Pre-training/post-training comparisons revealed significant improvement on the trained written-verbal-to-Arabic task as well as on an untrained spoken-verbal-to-Arabic task presumed to share the same Arabic numeral production process. A comparison of CM's numeral transcoding performance with control children showed that CM's performance improved from a third-grade level to approximately a fourthgrade level (i.e. the grade in which most children begin to display proficient number transcoding skills). Further analyses revealed that the syntactic errors produced by CM and the control subjects were inconsistent in terms of length, a finding that contrasts with the results of previous studies of numeral transcoding in children. In the general discussion we mention possible reasons for the discrepant outcomes across studies.     

Psychosocial aspects of occupational injury

Summary The authors examined the association between a number of factors (individual predisposition, psychosocial stress, job dissatisfaction) and accidents at work and the neurotic disability that may follow them. The concept of individual proneness and of environmental stress are discussed in the light of the relevant literature. Data was collected from an automotive industrial plant in Ontario and from a large department store in Toronto during 1974 and 1975. A questionnaire including a list of life events, a job dissatisfaction scale and a brief mental health rating scale was used. Data from the company medical records as well as an assessment by the plant physician at the time of the accident were also included. A positive past history of medical, surgical, psychiatric episodes and accidents significantly differentiated between a group of workmen which had accidents and controls that did not. Job dissatisfaction was related to the probability of missing excessive time from work and of developing a neurotic complication after an accident. The authors concluded that accidents are part of a larger pattern of surgical, medical and psychiatric episodes in the life of a particular individual and that job dissatisfaction as an index of occupational stress tends to have an adverse effect on the overall psychological response and recovery following accidents.A research project carried out with the support of the Workmen's Compensation Board of Ontario, General Motors of Canada and the Clarke Institute of Psychiatry Research Fund.     

Project WINS: Integrating vocational services on mental health case management teams

In an effort to expand employment opportunities available to psychiatric consumers, a research demonstration project was developed to incorporate vocational services into case management teams. Following psychiatric rehabilitation principles, Project WINS employs professionals as Vocational Specialists and consumers as Peer Support Specialists to work with clients and their case managers. This report describes the characteristics of clients eligible for WINS services, the implementation of the program, and the impact of WINS on clients and on the mental health and vocational systems. It also describes the challenges and barriers this innovative service is confronting.Funded in part by Grant #R18MH46081, from the National Institute of Mental Health, awarded to the Michigan Department of Mental Health.This paper summarizes a workshop presentation at the International Association of Psychosocial Rehabilitation Services Conference, Anaheim, California, May 1992.     

Mental health service priorities and the BSW

New Priorities in mental health service delivery call for the exploration of previously overlooked sources of mental health personnel whose preparation for practice is adapted to historically underserved populations and service delivery approaches geared to their special needs. One such source are baccalaureate level social workers. This exploratory study of 29 purposively selected baccalaureate social work education programs observes and describes their extensive mental health field instruction, in which the predominant student assignments include case management and related functions stressed in current mental health policy. Implications are drawn regarding the allocation of federal training funds and labor force issues.The research for this study was supported by a grant from the Social Work Education Branch of the National Institute of Mental Health (grant no. 5T01 MH 13758-03).     

Performance measures for mental health programs: Something better,something worse,or more of the same?

Current pressures for establishment of accountability systems based on performance measures for mental health programs are likely to improve services only if such systems are accompanied by supportive research, preparatory orientation, wide participation, tested data systems, and elimination of other redundant accountability procedures. A 4-phase, 3-functional level model is proposed to guide implementation.The authors are all affiliated with the National Institute of Mental Health. The views are those of the authors and do not necessarily reflect the policies of the National Institute of Mental Health. The authors wish to acknowledge the help of Del Kole.     

A contemporary protocol to assist primary care physicians in the treatment of panic and generalized anxiety disorders

Anxiety disorders are prevalent in primary care practice and generate a significant excess of morbidity, health services utilization, and health care expenditures. Complexities in delivering effective care for such disorders have led to stepped collaborative care models that involve nonphysician care managers following guideline-based protocols under the direction of patients' primary care physicians and a medical specialist. With the goal of aiding colleagues attempting to improve the primary care for panic and generalized anxiety disorders, we detail the collaborative care strategy for treatment of these conditions used by our National Institute of Mental Health (NIMH)-funded clinical trial in which a telephone-based care manager performs timely, patient-specific clinical and case management tasks. We illustrate the clinical considerations underlying the steps taken to implement and then sustain our care manager intervention at four geographically dispersed primary care practices linked by a common electronic medical record system and the modifications made as we encountered clinical situations common to typical practice settings. This report serves to familiarize physicians contemplating use of a similar strategy for improving the quality of primary care for an anxiety disorder or any other chronic mental health condition.     

Does race/ethnicity moderate the association between job strain and leisure time physical activity?

Background: Racial/ethnic minorities report myriad barriers to regular leisure time physical activity (LTPA), including the stress and fatigue resulting from their occupational activities.Purpose: We sought to investigate whether an association exists between job strain and LTPA, and whether it is modified by race or ethnicity.Methods: Data were collected from 1,740 adults employed in 26 small manufacturing businesses in eastern Massachusetts. LTPA and job strain data were self-reported. Adjusted mean hours of LTPA per week are reported.Results: In age and gender adjusted analyses, reports of job strain were associated with LTPA. There was a significant interaction between job strain and race or ethnicity (p = .04). Whites experiencing job strain reported 1 less hr of LTPA per week compared to Whites not reporting job strain. Collectively, racial/ethnic minorities reporting job strain exhibited comparatively higher levels of LTPA compared to their counterparts with no job strain, although patterns for individual groups did not significantly differ.Conclusions: Job strain was associated with LTPA in a lower income, multiethnic population of healthy adult men and women. The association between job strain and LTPA was modified by race or ethnicity, highlighting the importance of investigating the differential effects of psychosocial occupational factors on LTPA levels by race or ethnicity. This research was supported by grant no. 5 P01 CA75308 from the National Institutes of Health and support to the Dana—Farber Cancer Institute by Liberty Mutual, National Grid, and the Patterson Fellowship Fund. G. G. Bennett is also supported by an award from the Dana— Farber/Harvard Cancer Center. K. Y. Wolin was supported in part by a National Cancer Institute training grant (5 T32 CA09001–28). We gratefully acknowledge the efforts of Sandy Askew and Jodi Anna Saia—Witte for their assistance with the preparation of this article. We especially appreciate the consultation provided by Jeff Johnson and Paul Landsbergis and the input of this article’s anonymous reviewers.     

Mental health consumers as case management aides

Mental health consumers with chronic mental illness were trained for employment as case management aides in a psychiatric rehabilitation project in Denver. The project incorporated cooperative arrangements between the mental health system and vocational rehabilitation and occupational education agencies. The process used to recruit, select, train, and employ the consumer case management aides is described. Eighteen of the 25 trainees who began the training completed the program, and 17 moved on to employment as case management aides. At two-year follow-up, the 15 trainees who were still employed as case management aides had required a total of only two bed-days of psychiatric hospitalization since the training ended.     

Does Assertive Community Treatment Reduce Burnout? A Comparison with Traditional Case Management

We examined burnout and job satisfaction among 216 case managers serving clients with severe mental illness, comparing assertive community treatment (ACT) workers with traditional case managers (TCMs) in two Midwestern states. Compared to TCM, ACT workers reported significantly lower levels of burnout, higher levels of job satisfaction, and more favorable perceptions of their work environment. In the TCM sample, length of time in current job was associated with greater burnout, and severity of client problems was associated with greater burnout and job dissatisfaction. Neither of these sets of factors predicted burnout in the ACT sample, however. Instead, no case manager characteristics, caseload characteristics, or service delivery variables, except for age, predicted burnout in the ACT sample. The findings suggest that the ACT model may be especially suited to protect against burnout in case managers serving clients with the most severe disabilities and who are most prone to psychiatric readmissions. However, the small effect sizes and the lack of a prospective, experimental design suggest that further research is needed before drawing firm conclusions.     

Occupational Stress and Implementation of Information Technology Among Nurses Working on Acute Psychiatric Wards

PURPOSE: The study describes nurses' occupational stress and implementation of information technology on acute psychiatric wards. DESIGN AND METHODS: The sample consisted of 146 Finnish nurses. The data were collected using a structured questionnaire in 2006. FINDINGS: Eleven percent of the nurses felt that work was very mentally strenuous and 45% felt that it was rather mentally strenuous. Male nurses reported more stress and dissatisfaction than female nurses. Nurses with very positive attitudes towards Internet use reported less stress and more job satisfaction than nurses with neutral attitudes towards Internet use. PRACTICE IMPLICATIONS: By supporting positive attitudes to information technology in nurses' daily work, we may increase their job satisfaction and thereby reduce their stress experiences.     

Middle managers in mental health: A study of management tasks

Middle managers with formal management training who responded to a questionnaire, rated their preparation for competence in management tasks higher than middle managers with no management training. There were significant differences in the importance and preparation ratings of both manager groups for some tasks, with these differences related to both different roles and training. Managers indicated a preference for a combination of academic and formal on-the-job training.     

Learning style preferences of community mental health professionals

Programs of continuing education in mental health are increasing at a rapid pace. This study examines selected personal and occupational characteristics of enrollees in one such program and classifies the nature of enrollee motivation for participating in specialized programs of community mental health training. The learning-style preferences of these highly experienced professionals are also explored and recommendations are made concerning the design of similar educational programs under development elsewhere.He has frequently served as a preceptor and guest lecturer in postgraduate programs of continuing professional education in mental health. Research for this paper was supported in part by funds from the California Department of Mental Hygiene and the National Institute of Mental Health. The staff and director of the Health Training Resources Center (Berkeley) are graciously acknowledged for their cooperation with this study.     

Do work-related stress and reactivity to stress predict dementia more than 30 years later?

The purpose of this study was to examine associations for work-related stress, reactivity to stress, and subsequent risk of dementia. The sample consisted of members of the population-based Swedish Twin Registry who were participants in the HARMONY study (n=2,049). We used case control and cotwin control designs, with information on work-related stress and reactivity to stress collected as part of a questionnaire completed in 1967. Dementia was diagnosed approximately 30 years later using a 2-stage procedure-screening for cognitive impairment followed by full clinical evaluation. We found that measures of work-related stress (job dissatisfaction and high job demands) were not associated with dementia risk. Greater reactivity to stress predicted higher risk of dementia controlling for age, education, sex, occupational status, alcohol use, and smoking status (odds ratio=1.57, 95% confidence interval 1.08-2.31). Cotwin control analyses also showed that dementia probands were more likely to report high reactivity to stress than their nondemented cotwins. We did not find evidence of an interaction between work stress and reactivity in predicting dementia. Overall, indicators of stress due to environment (ie, work) were not associated with dementia, whereas the individual characteristic of reactivity to stress predicted dementia risk.     

Youth mental health promotion in the Hunter region

OBJECTIVE: To describe the work of the Hunter Institute of Mental Health, with special emphasis on its role in mental health promotion and prevention with adolescents. METHOD AND RESULTS: The Ottawa Charter for Health Promotion is used as a framework to describe the varied functions of this organisation. Four youth mental health promotion programs are given as examples of the Institute's work. Results of preliminary evaluation of the Youth Suicide Prevention - National University Curriculum Project are provided. CONCLUSION: The Hunter Institute of Mental Health, a self-funding unit of the Hunter Area Health Service, provides innovative health promotion programs as part of its role as a provider of mental health education and training. The model may be particularly applicable to mental health services in regional Australia.     

The clinician-researcher in psychiatry

As clinical research in psychiatry has grown in importance and promise in the past decade, the need for a growing pool of skilled clinician-researchers has been increasingly recognized. Compared with physicians in other specialties, psychiatrists in academic positions have less training in research and devote less time to it, which is reflected in the growing concentration of research funds from the National Institute of Mental Health in just a few of the strongest medical school departments. To focus attention on the need for developing the role of clinician-researchers, the authors examine four major tasks faced by clinician-researchers and present a developmental perspective on the transition to research.     

Training psychologists for work with the chronically mentally ill

While clinical psychologists have made a strong contribution to research and service delivery to the chronically mentally ill, the profession still experiences a shortage of human resources for work in this area. The roles and functions of clinical psychologists are specified and the prevalent model of training is described in light of the needs for services to CMI.Preparation of this article was supported in part by Clinical Psychology Training Grant 5 TO0 MH18737 from the National Institute of Mental Health to David S. Hargrove.