An action model of socially disruptive behaviors committed by persons with severe mental illness: the role of self-reported childhood abuse and suspiciousness-hostility

Espousing an Action Theory approach (Brandstadter, 1998; Lerner, 1982), the authors hypothesized that socially disruptive behaviors committed by people with severe mental illness will be at least partly influenced by incidents of childhood sexual and physical abuse. They further hypothesized that this effect of child abuse on disruptive behaviors in severe mental illness will be mediated by patients' suspiciousness and hostility. Structural equation modeling analyses conducted on data collected from 109 people with severe mental illness provided support for this mediating model. Our results encourage further exploration of the role of childhood maltreatment in the adaptation of people with severe mental illness.     

Differences in HIV care between patients with and without severe mental illness

OBJECTIVE: This study explored how HIV care differs for infected persons with and without severe mental illness. METHODS: Data were obtained through interviews with and chart review of 295 patients with severe mental illness and HIV from public mental health agencies in Los Angeles County and New York City. Data were compared with data from 1,294 HIV patients without severe mental illness from a separate national probability sample. Measures were difficulty obtaining care, whether patients recommend their HIV care provider, hospital problem score, functional health status, and disability days. RESULTS: In Los Angeles, HIV patients with severe mental illness were more likely than those without severe mental illness to have difficulty obtaining care (p<.001); to not recommend their provider (10% versus 5%, p=.007); and to have problematic hospital care (p=.001), poor health status (p=.001), and more disability days (p<.001). In New York City, HIV patients with severe mental illness were more likely than patients without severe mental illness to have difficulty obtaining care (p=.002) and not recommend their provider (p=.02). The relationship between severe mental illness and health status in Los Angeles and access in New York City became insignificant after adjustment for sociodemographic factors, drug use, and CD4 cell count. Further adjustment for higher case management rates among HIV patients with severe mental illness reduced disparities only in the West. CONCLUSIONS: Patients with severe mental illness experienced more problems with HIV care than patients without severe mental illness, although high case management rates for patients with severe mental illness may have offset some problems.     

The Premises is the Premise: Understanding Off- and On-premises Alcohol Sales Outlets to Improve Environmental Alcohol Prevention Strategies

Environmental strategies to prevent the misuse of alcohol among youth—e.g., use of public policies to restrict minors’ access to alcohol—have been shown to reduce underage drinking. However, implementation of policy changes often requires public and private partnerships. One way to support these partnerships is to better understand the target of many of the environmental strategies, which is the alcohol sales outlet. Knowing more about how off-premises outlets (e.g., liquor and convenience stores) and on-premises outlets (e.g., bars and restaurants) are alike and different could help community-based organizations better tailor, plan, and implement their environmental strategies and strengthen partnerships between the public and commercial sectors. We conducted a survey of managerial or supervisory staff and/or owners of 336 off- and on-premises alcohol outlets in six counties in South Carolina, comparing these two outlet types on their preferences regarding certain alcohol sales practices, beliefs toward underage drinking, alcohol sales practices, and outcomes. Multilevel logistic regression showed that while off- and on-premises outlets did have many similarities, off-premises outlets appear to engage in more practices designed to prevent sales of alcohol to minors than on-premises outlets. The relationship between certain Responsible Beverage Service (RBS) practices and outcomes varied by outlet type. This study furthers the understanding of the differences between off- and on-premises alcohol sales outlets and offers options for increasing and tailoring environmental prevention efforts to specific settings.     

Influence of an Implementation Support Intervention on Barriers and Facilitators to Delivery of a Substance Use Prevention Program

Prevention Science - Implementation support interventions have helped organizations implement programs with quality and obtain intended outcomes. For example, a recent randomized controlled trial...     

Promoting evidence‐based practices: the adoption of a prevention support system in community settings

Prevention support systems (PSSs) are designed to help communities implement evidence‐based practices (EBPs). Little is known about the factors that influence their adoption. In this article, we examined adoption of a PSS for substance abuse prevention called Getting To Outcomes (GTO)^® among staff in two community coalitions with varying levels of exposure to it over a 2‐year period. A multistage regression model was used to determine the relative predictive power of organizational, innovation‐related, and practitioner characteristics on adoption. Findings indicate that GTO adoption occurred through increased exposure, especially via staff training. Perceptions of the system's complexity moderated this effect. Individuals with high GTO exposure were less likely to adopt it if they perceived it as complex. Other organizational, innovation‐related, and practitioner characteristics did not predict adoption. Results from this study are useful for understanding the factors associated with PSS adoption and suggest ways to increase their use in typical delivery settings. © 2009 Wiley Periodicals, Inc.     

Patterns of HIV care for patients with serious mental illness

Individuals with serious mental illness are at higher risk for HIV than are members of the general population. Although studies have shown that individuals with serious mental illness experience less adequate care and worse physical health outcomes than comparable patients without serious mental illness, little is known about HIV care among individuals with serious mental illness who become infected with HIV. In the present study, we describe patterns of highly active antiretroviral treatment (HAART) use and physician monitoring received by 154 patients with serious mental illness infected with HIV. Participants were recruited from mental health agencies in Los Angeles, California. Data from 762 HIV-only patients from a separate Western U.S. probability sample were used for comparison. High proportions of serious mental illness patients with HIV in our sample appeared to be receiving adequate HIV care. Fifty-one percent of all serious mental illness patients with serious mental illness with HIV were taking HAART, and the majority received close monitoring of their CD4 counts (84%) and viral loads (82%) throughout a 1-year period. HAART use and patterns of CD4 count and viral load monitoring did not differ significantly between patients with both serious mental illness and HIV, and patients with HIV only (all p > 0.05). Specialized programs providing assistance to serious mental illness populations with HIV may be helping to narrow health care disparities as a result of having serious mental illness.     

Comparing consumer and nonconsumer provided case management services for homeless persons with serious mental illness

This study compared the outcomes of services provided by case managers who are mental health system consumers and case managers who were not consumers. The study focused on the first two cohorts that entered the ACCESS program, a 5-year demonstration program funded by the Center for Mental Health Services between 1994 and 1996. We tested the associations between the type of case manager and clinical outcomes at three time points (baseline, 3 months, and 12 months). A series of one-way repeated measures of analyses of variance were conducted on clients from ACCESS sites that hired consumer providers. Although there were significant effects of Time for almost every outcome measure (clients improved over time), there were no significant Time x Case Manager Type interactions. Staff age, race, or gender did not significantly alter the pattern of these results. Given that services provided by consumers and nonconsumers were associated with equivalent client outcomes, the present study shows, using a large sample, the ability of consumers to provide mental health services as members of a case management team.     

The Connecticut Mental Health Center Patient Profile Project: application of a service needs index

This article describes a quality assurance effort aimed at defining the characteristics of the patient population of the Connecticut Mental Health Center, a statefunded agency that provides comprehensive clinical and rehabilitative services to persons with mental illness. Also described is how this information guided management decisions in both caseload distribution and clinical service development. This "Patient Profile Project" was informed by research principles which view evaluation as continual, rather than terminal activity that involves key stakeholders from all levels within the mental health system of care and makes maximum use of data in ongoing performance improvement initiatives. The service-need index that the project produced represents our first efforts to accurately capture service need and use it in clinical decision making. This review of the Connecticut Mental Health Center Patient Profile Project illustrates the utility of a continuous evaluation system in promoting improvements in a large mental health treatment system.     

Toward a Model of Adolescent Empowerment: Theoretical and Empirical Evidence

Empowering adolescents can serve as a preventive intervention for many of the problems that confront this population. While much of the literature on empowerment has focused on adults, this paper offers a model of empowerment for adolescents that draws from appropriate developmental theory, bonding and social control theory, and rolelessness. Literature that supports the adolescent empowerment model is reviewed. Popular interventions and activities are assessed using their empowerment potential as a yardstick. Common features that are consistent with the adolescent empowerment model are identified; and future directions for research are discussed.