Youth motivation as a predictor of treatment outcomes in a community mental health system

Objective: The purpose of this study was to examine the relationship between youth motivation and psychotherapy outcomes in routine community mental health settings. Method: One hundred fifty youth, ages 12–17, from three community mental health clinics completed the Youth Outcome Questionnaire and Treatment Support Measure at frequent intervals over the course of treatment. Results: Increases in motivation followed a curvilinear trajectory. On average, youth motivation significantly increased over the course of therapy according to both self- and parent reports (p?p?Conclusions: Our findings demonstrate that youth show increases in motivation over the course of therapy with most gains occurring in the first few sessions. Because increases in motivation over the course of therapy were related to decreases in mental health symptoms, further research is needed to examine how treatment interventions or other factors such as parent motivation may moderate this relationship. Additional research examining the likely complex relationship between initial youth motivation and treatment outcomes in community mental health settings is needed.     

A virtual reality application in role-plays of social skills training for schizophrenia: a randomized, controlled trial

Although social skills training (SST) is an effective approach for improving social skills for schizophrenia, the motivational deficit attenuates its efficacy. Virtual reality (VR) applications have allowed individuals with mental disabilities to enhance their motivation for rehabilitations. We compared SST using VR role-playing (SST-VR) to SST using traditional role-playing (SST-TR). This randomized, controlled trial included 91 inpatients with schizophrenia who were assigned to either SST-VR (n = 46) or SST-TR (n = 45). Both groups were administered over 10 semiweekly group sessions. An experienced, blinded rater assessed vocal, nonverbal and conversational skills. We also obtained data on motivation for SST and various social abilities. Throughout the 10 sessions, the SST-VR group (n = 33) showed greater interest in SST and generalization of the skills than the SST-TR group (n = 31). After SST, the SST-VR group improved more in conversational skills and assertiveness than the SST-TR group, but less in nonverbal skills. The VR application in role-plays of SST for schizophrenia may be particularly beneficial in terms of improving the conversational skills and assertiveness, possibly through its advantages in enhancing motivation for SST and generalization of the skills, and thus it may be a useful supplement to traditional SST.     

Is there a role for music therapy in the recovery approach in mental health?

The recovery approach in mental health care emphasises the importance of the service user leading a fulfilling, meaningful life beyond the limitations of illness or symptomatology. This approach to care is increasingly included as a central part of mental health policy and service provision in a number of countries including the UK and Ireland, to address the needs of people who have severe and enduring mental disorders. It is an autonomous, holistic and empowering way of working with individuals as they journey towards healing. Fundamental to this model is the relationship fostered between service users and health professionals. The recovery philosophy of care mirrors some of the core principles of music therapy, including the importance of the therapeutic relationship and the possibilities for change and growth within this. This paper explores the congruence between music therapy and the recovery approach by providing: (1) An overview of current published evidence for music therapy in mental health care. (2) A discussion of this psycho-social creative arts therapy intervention within the specialized area of recovery in psychiatry, and (3) case vignettes to illustrate the application of this philosophy in music therapy work within a recovery service.     

Identifying the core competencies of community support providers working with people with psychiatric disabilities

The study was intended to identify core competencies for community support providers working with people with psychiatric disabilities. Using multiple methods developed from previous research in the field of developmental disabilities, 18 consumers receiving services and 16 staff members from two mental health community support programs identified a list of 68 competencies that included personal attributes, knowledge, and skills. Based on a card sort task, 34 consumers receiving services and 34 support workers from six mental health community support programs rated 59 of the 68 competencies as being either absolutely necessary or desirable. Results of a second card sort task found that a majority of competencies identified as being needed pre-employment were personal attributes consistent with adopting a person-centered approach. Competencies categorized as to be learned on the job involved special knowledge and skills specific to working with people with psychiatric disabilities. The range of personal attributes, knowledge, skills represented in the identified competencies reflects the complexity of contemporary mental health community support. Findings are indicative of the need for specialized training and supervision that has not been typically available in the community mental health sector.     

Training needs of community staff: WHAT DO THEY WANT?

The development of care in the community services has training implications for direct care staff and their managers. An analysis of the training needs of staff working in a range of residential settings in the context of a joint health and social services programme for adults with mental handicaps was carried out in one area. The results of this study are described. The findings indicate that special competencies are required within community settings in addition to the well established competencies necessary in working with people with mental handicaps in other situations.     

Peer Models in Mental Health for Caregivers and Families

Peer-delivered mental health models may hold important benefits for family members, yet their prevalence, components, and outcomes are unknown. We conducted a review of peer-delivered services for families of children and adults with mental health problems. Randomized studies of interventions published between 1990 and 2014 were included if the intervention contained a component for family members and examined familial outcomes. Of 77 studies that were assessed for their eligibility, six met criteria. Familial components included coping and parenting skills, knowledge about mental health, and emotional support. Outcomes were uneven, although significant improvements in family functioning, knowledge about mental illness, parental concerns about their child, and parenting skills were associated with the intervention. Peer-delivered services for family members may have important benefits to family members and individuals with mental health problems; however, the research base remains thin. A research agenda to develop and examine these models is discussed.     

Competencies of More and Less Successful Employment Specialists

The competencies of individual employment specialists influence rates of competitive employment among consumers and programs. Identifying competencies can lead to the development of more effective specialists and improve employment outcomes for consumers enrolled in employment services in community mental health care settings. The purpose of this study was to examine how more successful employment specialists performed supported employment duties in comparison to less successful employment specialists. Ethnographic researchers observed more and less successful employment specialists performing job duties related to the five phases of supported employment. Using grounded theory, they identified factors that differentiated the two groups. More successful employment specialists worked efficiently, developed egalitarian relationships with consumers, and collaborated well with other partners. Less successful employment specialists understood the model but lacked these behavioral skills. Service providers should screen and train employment specialists for efficiency, flexibility, and interpersonal skills.     

Bridging the Behavioral Health Gap in Serious Illness Care: Challenges and Strategies for Workforce Development

Comorbidity with behavioral health conditions is highly prevalent among those experiencing serious medical illnesses and is associated with poor outcomes. Siloed provision of behavioral and physical healthcare has contributed to a workforce ill-equipped to address the often complex needs of these clinical populations. Trained specialist behavioral health providers are scarce and there are gaps in core behavioral health competencies among serious illness care providers. Core competency frameworks to close behavioral health training gaps in primary care exist, but these have not extended to some of the distinct skills and roles required in serious illness care settings. This paper seeks to address this issue by describing a common framework of training competencies across the full spectrum of clinical responsibility and behavioral health expertise for those working at the interface of behavioral health and serious illness care. The authors used a mixed-method approach to develop a model of behavioral health and serious illness care and to delineate seven core skill domains necessary for practitioners working at this interface. Existing opportunities for scaling-up the workforce as well as priority policy recommendation to address barriers to implementation are discussed.     

Music therapy for depression: it seems to work, but how?

Evidence is beginning to emerge that music therapy can improve the mental health of people with depression. We examine possible mechanisms of action of this complex intervention and suggest that music therapy partly is effective because active music-making within the therapeutic frame offers the patient opportunities for new aesthetic, physical and relational experiences.     

Demoralization in Mental Health Organizations: Leadership and Social Support Help

Demoralization is a commonly observed feeling state that is characterized by a sense of loss of or threat to one??s personal values or goals and a perceived inability to overcome obstacles toward achieving these goals. Demoralization has features in common with burnout and may precede or accompany it. Psychiatrists working in many mental health care organizational settings, be they in the public or private sectors, may be at particular risk for demoralization. This is due partly to stressors that threaten their own professional values because of factors such as programmatic cut backs, budgetary reductions and changing social emphases on the value of mental health treatments. They also may be at risk for demoralization because of the effects on them of the governance styles of the agencies in which they are employed. The leadership or governance style in large organizational settings often is authoritarian, hierarchical and bureaucratic, approaches that are antithetical to the more participative leadership styles favored by many mental health professionals in their clinical activities. Clinical leaders in mental health organizations must exhibit various competencies to successfully address demoralization in clinical staff and to provide a counterbalance to the effects of the governance style of many agencies in which they are employed. Appropriate leadership skills, sometimes too simplistically termed ??social support??, have been found to reduce burnout in various populations and are likely to lessen demoralization as well. This paper reviews these important leadership issues and the relationship of social support to recognized leadership competencies.     

What Makes a Good CAMHS Primary Mental Health Worker?

Background:  The role of primary mental health worker (PMHW) in CAMHS was established in 1995 although comparatively little research has explored the attributes required to successfully undertake this role.
Method:  Qualitative interviews with PMHWs and staff working in primary care were conducted and thematic analysis was performed.
Results:  In addition to clinical skills and mental health knowledge all respondents consistently emphasised the importance of inter-personal attributes such as general accessibility, flexibility, and self-motivation.
Conclusions:  Both professional competencies and inter-personal skills are perceived as important characteristics for PMHWs. It therefore seems appropriate for these to be made more explicit in competency frameworks.     

Towards a Model of Time-Effective Family Psychotherapy

Significant numbers of people now receive mental health services in managed health care settings (HMOs). The growth of HMOs, and with them, the need to provide quality cost-efficient mental health treatment have served to challenge the HMO clinician to develop more parsimonious, time-efficient and effective mental health treatment approaches. In the current paper, the author describes the application of a brief therapy model in working with children and families in a HMO. Principles and illustrative case examples are presented and support the idea that the family psychotherapies are especially well-suited for mental health practice in managed care settings. The model discussed is relevant to clinicians in other settings which emphasize time-efficient mental health practice.     

The effects of an arts intervention program in a community mental health setting: A collaborative approach

Throughout history, musical and visual arts have played positive roles in healing the human body, mind, and spirit. In traditional treatment settings, arts interventions offer opportunities for emotional expression and social interaction and have been shown to improve motivation, to increase personal empowerment and to relieve negative symptoms associated with mental illness. The purpose of the current project was to examine the effectiveness an arts program for individuals with chronic mental illness served by a community “Clubhouse”. Another goal was to develop a model for serving this population based on collaboration between a practitioner-based arts in healthcare program and a clinician-based music therapy program. Results showed that arts sessions improved feelings of well-being, and member-participants reported that sessions provided fun, relaxation, socialization, creativity and a sense of belonging. Improvements also were noted in the ability to manage self-care and in overall quality of life. Implications of the project's results and recommendations for future research also are discussed.     

Validation of a Self-Assessment Scale for Therapists’ Perception of Cognitive Behavioural Therapy Skills in China: A Mixed Method

Cognitive behavioural therapy (CBT) is a first-line psychotherapy in Western countries, yet there have been limited studies examined the required skills based on perception of CBT therapists in the context of Western countries, and there has been no such research in China. Currently, there is no exist of a selfassessment scale to evaluate the required competence perceived by CBT therapists in China. This study used both qualitative and quantitative method to develop a self-assessment tool by CBT therapist to provide their perception about required skills in the treatment of mental disorders in China. Qualitative research used semistructured behavioural event interviews to identify the essential competences perceived by CBT therapists in China. Based on the qualitative research results, quantitative research was further used to develop a self-rated instrument with 52 questions. Three-hundred therapists who were conducting CBT therapy for clients with mental disorders were invited to participate in the study, 278 of which answered the survey. Among 25 therapists in the qualitative research, three key themes relating to the success of treatment using CBT were extracted from the interview. These themes including generic psychotherapy competencies, common CBT theory, mastering basic CBT techniques are essential skills in the effective application of CBT treatment. Another two themes on challenges and difficulties in the application of CBT include formulating clients’ problems and plans and using CBT techniques properly. Among 52 questions, 44 questions were analysed, which identified four CBT competence related factors: 1. generic psychotherapy competencies; 2. mastering CBT theory and skills; 3. using CBT techniques properly; 4. formulating clients’ problems and plans. The reliability using Cronbach’s α and half-reliability coefficient analysis showed that the therapist competence self-assessment scale had a high level of reliability of 0.94. The content validity, convergent validity and discriminant validity were high, and the structure of the instrument was reasonable. The self-assessment scale may provide a reliable and valid tool to self-assess the required competence and skills perceived by CBT therapists in China, and provide useful information for CBT training curriculum and program in China.     

The effect of working alliance on adherence and outcome in cognitive remediation therapy

Cognitive remediation therapy (CRT) for schizophrenia has been effective in improving cognitive and global functioning outcomes. It is now important to determine what factors maximize benefit. The quality of relationship--or working alliance--between clients and therapists may be one such factor that improves outcome. To investigate this, 49 individuals with schizophrenia were recruited into a naturalistic study of the impact of CRT on work and structured activity outcomes. Participant's cognitive skills, severity of symptoms, and social skills were assessed at baseline. Both client and therapist working alliance ratings were gathered early in therapy. After controlling for depression, clients who rated the alliance more favorably stayed in therapy longer and were more likely to improve on their main target complaint but notably not on working memory performance or self-esteem. Therapist's ratings of the alliance were not associated with memory outcome. These findings indicate that working alliance is important for client satisfaction with therapy.     

Role conflict and role ambiguity among creative arts therapists

Creative arts therapists, as professionals, have progressed from their nascent position in developing training programs and defining skills and competencies for qualified art, dance/movement and music therapists in particular. It appears, however, that we Mill may he in a nascent position in defining our role with relationship to other mental health professionals in the work setting.Cashell, an an therapist and Miner, a dance/movement therapist, present a provocative survey and discussion of this issue, identify some problems and suggest we have much to do to clarify our role as members of the mental health profession with specific skills that are valuable and valued.We invite our readers to contribute their thoughts about this issue, either in the form of letters to the Editor or as articles on the subject.     

Process evaluation of outpatient treatment in a community mental health center

A system for evaluating treatment process at a behaviorally-oriented community mental health center is described. Three separate evaluation procedures were employed. First, ongoing inservice training programs were evaluated routinely to establish and maintain therapists' cognitive-verbal skills in behavior therapy. Second, therapists were supervised by audiotaping or the co-therapist approach in order to assess their treatment skills, in vivo. Finally, a system was devised which measured whether or not behavioral techniques were administered consistently as determined by recordkeeping competencies (such as specifying goals in behavioral terms, maintaining data, graphing, etc.). Basing salary increments upon recordkeeping skills markedly improved performances. As interest in outcome evaluation has risen (e.g. Eysenck, 1952, 1966; Baer, Wolf and Risley, 1968; Bergin, 1971; Fox and Rappaport, 1972) the necessity for process evaluation has become apparent.     

A review of educational outcomes in the children's mental health treatment literature

We examined the measurement of educational outcomes related to children's mental health treatments. A total of 85 papers describing 88 randomized controlled trials that included at least one educational outcome and one mental health outcome were included in these analyses. Forty-five different measures were identified as the primary educational outcome of interest in these studies. Educational measures reflected academic achievement (64.2%), academic and behavioural skills (20.1%), attendance (11.2%), quality of the learning environment (3.4%) and academic self-efficacy (1.1%). Positive educational outcomes were demonstrated by treatments delivered in school and non-school settings. There was a significant association between improvement on educational and mental health outcomes. Within the literature of children's mental health treatments, few studies (14.86%) measure educational outcomes. Of those that do, there is significant diversity in measurement methods. Nevertheless, these results offer promise that mental health treatments can succeed in improving both mental health symptoms and educational performance.     

Cognitive behaviour therapy for adolescent offenders with mental health problems in custody

Many studies have identified high levels of mental health problems among adolescents in custody and there is increasing evidence that mental health problems in this population are associated with further offending and mental health problems into adulthood. Despite recent improvements in mental health provision within custodial settings there is little evidence of structured interventions being offered or of their effectiveness being evaluated. A cognitively based intervention was developed and offered to adolescents with a variety of mental health problems in different secure settings, and the outcomes compared with a control group. Although this small-scale study did not identify significant differences in outcomes for the two groups, both recruitment and retention in therapy were good, and potential candidates were not excluded on the basis of learning difficulties or co-morbidity. The study demonstrated the viability of a delivering cognitively based intervention for common mental health problems within secure settings.     

Enhancing medication adherence: clinician outcomes from the Medication Alliance training program

OBJECTIVE: Patient nonadherence to psychiatric medication is a key cause of relapse but clinicians do not appear to possess specific adherence skills. We sought to demonstrate that a brief training program on medication adherence strategies could improve the adherence skills, attitudes and knowledge of mental health clinicians. METHODS: Twenty-three Tasmanian mental health workers were provided a 3 day training workshop on strategies to enhance patient adherence to medications (Medication Alliance). Pre- and post-training measures were taken of clinician knowledge about adherence strategies, ability to identify predictors of nonadherence, attitudes toward working with nonadherent patients, and optimism about treatment outcomes for patients. Videotapes of clinicians demonstrating key adherence therapy skills were also collected before and after training and blind-rated by two experienced therapists. RESULTS: A series of paired samples t-tests indicated significant improvements in skills, knowledge and attitudes. CONCLUSIONS: Compared with similar studies in the UK, Medication Alliance was found to be an effective and efficient training program. However, there is a need for further research to assess maintenance of training effects over time and patient outcomes.