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Little is known regarding the specific types of service models and collaborations that are necessary to support diverse populations of youth in transition out of homelessness. Transitional supports addressing the complex needs of this population are needed to stabilize the array of housing arrangements that youth access. This study was a pilot randomized controlled trial of one such critical time intervention, called the Housing Outreach Program-Collaboration (HOP-C). HOP-C is a multicomponent, multidisciplinary intervention that provides 6 months of mental health and peer support, along with transitional case management to youth who have transitioned into some form of stable housing out of homelessness. In this trial, 65 youth were randomized to receive HOP-C plus treatment as usual or transitional case management plus treatment as usual. Outcome assessments were completed by 30 treatment and 28 control participants. The findings suggest that this intervention is feasible with mental health, employment or education, and housing metrics favoring HOP-C with odds ratios ranging from 2.28 to 3.18 and better subjective housing stability. Other indicators showed less change. HOP-C appears feasible and should be tested in a fully powered trial, providing the intervention for a duration longer than 6 months. Overall, these data suggest the potential benefit in fostering city-level, multidisciplinary teams sourced from several organizations to support youth transitioning out of homelessness. Pragmatic trial method considerations for this population are also addressed as are the ethical considerations pertinent to engaging highly marginalized youth in clinical trials. (PsycInfo Database Record (c) 2020 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Hospitals, with their unique practice constraints and opportunities, are one of the most important arenas wherein the field of clinical psychology has developed throughout its history. However, there have been few efforts to comprehensively examine the literature on this topic. This is a literature worth examining, not only out of historical interest but also in the effort to provide direction for the field. Accordingly, systematic, scoping review methods were used to address the question: What does the psychology literature tell us about the nature and evolution of psychology practice in hospitals? The review identified 115 papers on this topic dating from 1916–2017, primarily in the form of practice commentaries and case studies. Analysis of the papers revealed 2 broad themes. One involved the nature of hospital practice, which concentrated on the major domains of assessment, psychotherapy and research activities along with issues related to training. The second involved structural and policy-related considerations such as cost-effectiveness and reimbursement models, leadership, the structure of practice, relationship to physicians, and hospital privileges. Implications of the review include the need for better data on the hospital practices of psychologists and continued work on role definition and the unique value of psychology. Other implications include direction for training models, practice models such as stepped care and a compromise between program and department-based management, privileges, and mental health reform. [ABSTRACT FROM AUTHOR]

This article examines the feasibility of a complex intervention designed to facilitate the transition of youth out of homelessness. It is intended to contribute to efforts to build out the youth homelessness intervention literature, which is underdeveloped relative to descriptive characterizations of risk. The 6-month intervention examined here, referred to as the Housing Outreach Program-Collaboration (HOP-C), is comprised of transitional outreach-based case management, individual and group mental health supports, and peer support. The intervention was delivered through a multiagency, interdisciplinary collaboration. Feasibility was assessed using a mixed methods design that included prepost intervention metrics and the study site was a large Canadian urban center. A total of 31 youth participated in the study with 28 completing the intervention. Overall, implementation and youth engagement was successful though patterns and intensity of engagement were quite variable. While prepost, self-report metrics improved modestly, substantial gains were observed in employment, education, and mental health service connectedness. Qualitative themes focused on the benefits of a flexible, multicomponent approach, close attention to seamless delivery and common factors, and supporting youth in the balance of isolation versus independence. These findings suggested that this tertiary prevention approach is feasible and warrants further investigation. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Objective: There is a paucity of accessible, evidence-based tools for caregivers of individuals with schizophrenia. This study examines changes in the self-assessed and caregiver-assessed outcomes of people with schizophrenia after exposure to a cognitive adaptation training (CAT) guide that addressed pragmatic, in-home approaches to offset the cognitive impacts of the illness. Method: This study examined the 4-month, pre-post outcomes of a CAT guide, as compared with a popular, general manual, for families of individuals with schizophrenia. A total of 17 caregiver-supported individual dyads completed all measures, having been randomized to either a CAT-guide group or a support-manual group. Measures included medication adherence, adaptive functioning, quality of life, and caregiver burden. Semistructured interviews assessed use and utility questions. Results: Caregiver-assessed improvements in community functioning with medium-high effect sizes were observed in both study conditions. Self-report ratings by supported individuals did not change from baseline to 4 months and no change was observed in medication adherence or quality of life for either condition. Caregiver-burden ratings significantly declined with a large effect size, again with no difference as a function of manual type. Conclusion and Implications for Practice: These findings suggest that there is some promise in providing families with evidence-based information in manual form. Further research informed by this study's findings should include assessments of whether and how environmental cognitive supports can be of specific benefit to families affected by schizophrenia. [ABSTRACT FROM AUTHOR]

Objective: This paper describes outcome and feasibility findings for a novel, brief intervention to facilitate discharge from lengthy psychiatric hospitalization. The examination of such transitional interventions is important given the suboptimal outcomes for many individuals with severe mental illness at discharge, particularly in the first month. Method: In this study a mixed methods design was used to examine a 6-week peer support worker-provided transitional intervention called the 'Welcome Basket.' The intervention involves contact on hospital wards immediately prior to discharge and 1-1 community contacts along with the provision of a 'welcome basket' of needed/desired items and environmental supports to facilitate greater independence and illness self-management. The study took place in a large Canadian city. Results: Thirty-one individuals with severe mental illness were referred and 23 completed the intervention. Pre-post analysis indicated no change in psychiatric symptoms but improvement in community functioning, community integration, and quality of life. Compared with mean rehospitalization rates for referring inpatient units, significant differences in rates for the study participants were not observed. Qualitative feasibility and process findings were very positive and suggested domains for improvement. Conclusions and Implications for Practice: These findings suggest that this brief transitional intervention is feasible and promising, although further investigation is warranted. Study findings also support the need for transitional interventions to address the service disconnects at the time of discharge for people with severe mental illness. [ABSTRACT FROM AUTHOR]

Objective: While the term "recovery" is routinely referenced in clinical services and health policy, few studies have examined the relationship between recoveryoriented service provision and client outcomes. The present study was designed to examine the relationship between recovery-orientation of service provision for persons with severe mental illnesses and outcomes in Assertive Community Treatment (ACT). Methods: Client, family, staff, and manager ratings of service recovery-orientation and outcomes across a range of service utilization and community functioning indicators were examined among 67 ACT teams in Ontario, Canada. Results: Significant associations were found between ratings of recoveryoriented service provision and better outcomes in the domains of legal involvement, hospitalization days, education involvement, and employment. Results were not uniformly positive or consistent, however, across stakeholder Recovery Self-Assessment (RSA) ratings or outcomes. Conclusions and Implications for Practice: These findings provide some preliminary support for an association between recovery-oriented service delivery for persons with severe mental illnesses and better outcomes. In line with the current practice commentary, this association would suggest the importance of evaluating and cultivating recovery-oriented values and practices in ACT contexts. This is a particularly salient point given that ACT standards minimally address key domains of recovery-oriented service provision. Further study is required, however, to determine if these findings apply to the implementation of ACT in other jurisdictions or generalize to other community support programs. [ABSTRACT FROM AUTHOR]

This study examined the protective role of self-esteem, social involvement, and secure attachment among homeless youths. These protective factors were examined as they ameliorate risks among 208 homeless youths surveyed in New York City and Toronto. Both mental and physical health indicators were employed in this study, including loneliness, feeling trapped, suicidal ideation, subjective health status, and substance use. Self-esteem emerged as a key protective factor, predicting levels of loneliness, feeling trapped, and suicide ideation, and buffering against the deleterious effect of fearful attachment on loneliness. Findings highlight the role of the self-concept in risk and resilience among homeless youth. [ABSTRACT FROM AUTHOR]

This article provides an overview of several core theoretical and practical aspects of participatory action research (PAR). An effort is made to define PAR and the types of work that fall under that rubric. Historical underpinnings, roles of the individuals involved, contexts, methods, and the challenges and benefits of this mode of inquiry are discussed. The authors argue that the approach and mindset of the researcher, referred to here as a type of "attitude," are key in the development of a successful and genuine participatory process. The authors situate PAR methodology within psychology and, more specifically, propose it as an approach to knowing that has the potential to make significant contributions in areas relevant to counseling psychology. [ABSTRACT FROM AUTHOR]

Objective: Computer education has become a standard component of many psychiatric rehabilitation programs. Despite this trend, little research has examined the effectiveness of such training programs and the experiences of those who participate. The present study was designed to further knowledge in this area. Methods: This paper describes an exploratory, qualitative examination of factors that aid in the acquisition of computer skills by 12 adults across 2 settings: a structured, professionally-taught program and a less structured peer-taught setting. Participants were surveyed longitudinally over a 2-month period. Results: Participant narratives suggested the importance of social inclusion as a key source of motivation, with benefits of training described as including improved self-esteem and self-efficacy. Challenges described by some participants included anxiety and attention/concentration difficulties. Conclusions: These pilot findings highlighted the importance to teaching effectiveness of striking a balance between flexibility and structure, with computer knowledge having broader implications for social inclusion. [ABSTRACT FROM AUTHOR]

Youth who have experienced homelessness are impacted by disproportionately high levels of mental health symptoms, which contribute to vastly decreased well-being and early mortality. Despite a salient need for mental health support, several recent reviews have shown that few, if any, interventions currently applied to this group appear to improve mental health consistently. Furthermore, community mental services present many barriers to access for this population, given the impacts of social determinants of health on youths' ability to engage in the available supports, the ongoing instability faced by many of these youths, and the lack of applicability of existing services to youth. A challenge exists for clinicians who work with this population of youth and wish to provide effective supports, given these obstacles and an inadequate evidence base on which to inform treatment. The purpose of this article is to propose a framework for care to inform psychotherapeutic treatment for clinicians providing mental health supports to youth with experiences of homelessness. This framework is cross-modality, transdiagnostic, and research-informed and seeks to provide a structure with which to frame treatment that acknowledges and responds to the various obstacles that practitioners frequently encounter in working with this population. The framework is accompanied by illustrative case studies to demonstrate how this framework may be applied using different treatment modalities. The hope in sharing this framework is to promote more intentional and effective interventions with this chronically underserved population of youth and also to increase the self-efficacy of those practitioners who are doing this important work. Public Significance Statement: Youth who have experiences of homelessness often face mental health challenges that significantly impact their well-being and overall life expectancy. This article addresses a critical gap in existing interventions by proposing a comprehensive framework for mental health professionals providing psychotherapy to this population. By offering evidence-informed strategies and case studies, this framework aims to support clinicians in providing more effective and tailored support, promoting clinician self-efficacy, and ultimately fostering improved mental health outcomes for this vulnerable population. [ABSTRACT FROM AUTHOR]

There is a dearth of effective, evidence-based programming to support youth experiencing homelessness, particularly in low- and middle-income countries where the majority of these young people live. Programs focused on youth engagement and leadership appear to be promising means to effectively engage and promote positive outcomes in this population. By Youth for Youth (BYFY) is a peer-led youth leadership framework developed to promote youth engagement, empowerment, and skill development. To date, BYFY has been successfully implemented with promising process and outcome indicators for youth experiencing homelessness, both in Toronto and with Indigenous youth in Thunder Bay. In this article, we present the application of BYFY with 30 street-involved youth in Managua, Nicaragua. We highlight the key implementation factors leading to BYFY's success in Nicaragua as perceived by facilitators from the implementing organization, Covenant House International, and youth leaders. Using a General Inductive analysis of interview data, field notes, and artistic output generated by the project (rap video, graffiti art, street theater), we identify the processes that appeared to underlie positive outcomes observed in participants, including creating a sense of safety and providing opportunities to challenge negative self-perceptions. This article provides evidence for a scaleable model for youth engagement and empowerment that (a) is practical to implement in low-resource settings and (b) is effective at engaging street-involved youth across diverse cultures and contexts. We summarize practical implications and actionable measures that can be taken by stakeholders to capitalize on these findings. Public Policy Relevance Statement: Limited programming options are available to meet the wide-ranging needs of youth experiencing homelessness, particularly in low- and middle-income countries with the majority of this population lives. The present study describes the implementation of a novel, youth-led program in Nicaragua with a group of youth experiencing homelessness in this context, with suggestions for successful implementation and adaptation of this framework in other diverse settings with this population. [ABSTRACT FROM AUTHOR]

Objectives: This pilot study evaluated the feasibility and potential impacts of delivering the Psychosocial Rehabilitation (PSR) Toolkit for people with serious mental illness within a health care setting in Kenya. Method: This study used a convergent mixed-methods design. Participants were people with serious mental illness (n = 23), each with an accompanying family member, who were outpatients of a hospital or satellite clinic in semirural Kenya. The intervention consisted of 14 weekly group sessions of PSR cofacilitated by health care professionals and peers with mental illness. Quantitative data were collected from patients and family members using validated outcome measures before and after the intervention. Qualitative data were collected from focus groups with patients and family members, and individual interviews with facilitators, after the intervention. Results: Quantitative findings indicated that patients experienced moderate improvement in illness management and, in contrast to qualitative findings, family members experienced moderate worsening in attitudes toward recovery. Qualitative findings revealed positive outcomes for both patients and family members, as reflected in greater feelings of hope and mobilization to reduce stigma. Factors that facilitated participation included: helpful and accessible learning materials; committed and involved stakeholders; and flexible solutions to promote continued involvement. Conclusions and Implications for Practice: This pilot study found that delivery of the Psychosocial Rehabilitation Toolkit was feasible within a health care setting in Kenya and associated with overall positive outcomes among patients with serious mental illness. Further research on its effectiveness on a larger scale and using culturally validated measures is needed. Impact and Implications: This pilot study examined the feasibility and potential impacts of a psychosocial rehabilitation program for people with serious mental illness within a health care setting in Kenya. The program provided a more engaged and inclusive approach to mental health services, through which patients experienced a sense of possibility for their future lives and stakeholders became advocates for mental health recovery within their communities. Study findings also indicated improvements in recovery and increased connections with community among patients, and discussion of opportunities for improving mental health service delivery among stakeholders. [ABSTRACT FROM AUTHOR]

Objective: The experience of personal recovery from mental health has been theorized to occur through several pathways. CHIME is a seminal theoretical framework of personal recovery that is widely endorsed by the existing literature. Few studies have examined the utility of the CHIME framework with those experiencing acute challenges in their engagement in the recovery process. The purpose of the present study was to examine part of the CHIME framework for individuals with schizophrenia spectrum diagnoses in the period immediately following hospitalization. Specifically, the impact of social support and community integration on personal recovery was examined. Methods: The present study involved a secondary analysis of a Phase 2 clinical trial. Assessment measures were administered to participants 1-month (n = 82) and 6-months (n = 72) postdischarge from a psychiatric hospital. Hierarchical regression and mediation analyses were conducted to assess the relationship between social support, community integration, and 1-month and 6-month personal recovery. Results: Hierarchical regression analysis indicated that community integration and social support significantly predicted personal recovery. Mediation analyses indicated social support partially accounts for the relationship between community integration and personal recovery at 1- and 6-months postdischarge, providing evidence for social support as a mechanism of personal recovery during this time. Conclusion and Implications for Practice: This quantitative investigation of CHIME highlights the mechanism of social support for individuals who are experiencing acute challenges in their recovery. These findings point to the need for interventions that enhance community integration and social support postdischarge. Impact and Implications: The results of the present study suggest that social support is a significant mediator in the relationship between community integration and personal recovery for those who have recently been discharged from inpatient psychiatric hospital. These results can be used to inform the development of recovery-promoting interventions for individual's postdischarge. [ABSTRACT FROM AUTHOR]

There is a high prevalence of Indigenous youth experiencing either precarious housing or homelessness in northwestern Ontario. Given that Indigenous pathways to homelessness can differ from non-Indigenous youth, interventions that address homelessness must also adapt to meet diverse needs. The Housing Outreach Program Collaborative (HOP-C) is a tertiary prevention intervention designed to provide congruent housing and peer and mental health supports for youth experiencing homelessness in Toronto, Ontario. Less is known regarding its adaptability to adequately serve Indigenous youth in northwestern Ontario. This study assessed the preliminary effectiveness and feasibility of an adaptation of the HOP-C North program for transitional aged Indigenous youth exiting homelessness in Thunder Bay, Ontario. Participants completed premeasures (n = 15) and postmeasures (n = 8) as well as qualitative interviews regarding their experiences in the program. Qualitative interviews were also conducted with staff (n = 14) engaged in implementing the program. After completing the HOP-C North program, participants reported improvements in a number of outcomes, including increased educational enrollment, attainment of employment, reduced hospitalizations, and increased engagement in clinical mental health services. Specific program aspects that participants found helpful included increased program flexibility, accessibility, emphasis on relationships, relevance of programming, fostering participant autonomy, and an adaptive approach to program implementation. These findings suggest that the HOP-C North model, when adapted, is a helpful program for Indigenous youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Homeless youth represent a chronically vulnerable segment of society whose mental health needs, despite their acuity and complexity, are often unmet. This article describes the development and implementation of a pilot mental health group intervention, the Housing Outreach Project-Collaborative Wellness and Mindfulness Group, for young people in their first year of transitioning from homelessness/precarious housing to independent living. The intervention aimed to provide evidence-based mental health support to a traditionally difficult to engage population. The development of group framework and content, implementation, resultant client engagement, and perceived successes and challenges are described. Considerations for future mental health interventions and research with this population are discussed. [ABSTRACT FROM AUTHOR]

Community participation is often cited as a crucial component of wellness for people with mental health diagnoses. Few studies explore community participation from the perspective of lesbian, gay, bisexual, trans, and queer (LGBTQ) people with diagnoses of schizophrenia and bipolar disorder. This article describes an in-depth qualitative study with 16 LGBTQ people; 18 social service workers; and 2 key informants in Toronto, Ontario that examined access to communities for LGBTQ people with mental health diagnoses. Results indicate that community participation is particularly relevant to this group given the functions of communities for marginalized people as a source of support and resistance. However, the participants faced barriers to accessing support and creating social networks due to the lack of intersectional inclusion in various contexts, including LGBTQ communities and mental health/mad communities. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Objective: In psychiatry, the recovery paradigm is increasingly identified as the overarching framework for service provision. Currently, the Recovery Self-Assessment (RSA), a 36-item rating scale, is commonly used to assess the uptake of a recovery orientation in clinical services. However, the consumer version of the RSA has been found challenging to complete because of length and the reading level required. In response to this feedback, a brief 12-item version of the RSA was developed (RSA-B). This article describes the development of the modified instrument and the application of traditional psychometric analysis and Rasch Measurement Theory to test the psychometrics properties of the RSA-B., Methods: Data from a multisite study of adults with serious mental illnesses (n = 1256) who were followed by assertive community treatment teams were examined for reliability, clinical meaning, targeting, response categories, model fit, reliability, dependency, and raw interval-level measurement. Analyses were performed using the Rasch Unidimensional Measurement Model (RUMM 2030)., Results: Adequate fit to the Rasch model was observed (χ2 = 112.46, df = 90, p = .06) and internal consistency was good (r = .86). However, Rasch analysis revealed limitations of the 12-item version, with items covering only 39% of the targeted theoretical continuum, 2 misfitting items, and strong evidence for the 5 option response categories not working as intended., Conclusions: This study revealed areas for improvement in the shortened version of the 12-item RSA-B. A revisit of the conceptual model and original 36-item rating scale is encouraged to select items that will help practitioners and researchers measure the full range of recovery orientation., ((c) 2015 APA, all rights reserved).)

The acceptance of qualitative research in 15 journals published and distributed by the American Psychological Association (APA) was investigated. This investigation included a PsycINFO search using the keyword qualitative, an analysis of 15 APA journals for frequency of qualitative publication, a content analysis of the journal descriptions, and the results of qualitative interviews with 10 of the chief editors of those journals. The results indicate that there exists a substantial amount of interest in the potential contribution of qualitative methods in major psychological journals, although this interest is not ubiquitous, well defined, or communicated. These findings highlight the need for APA to state its position regarding the applicability of qualitative methods in the study of psychology.