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Objective: The International Classification of Functioning, Disability, and Health (ICF) is a comprehensive and universally accepted framework for describing functioning and disability in a...

This study was conducted to investigate how adults with serious mental illness learn and utilize an illness self-management framework for pursuing recovery through a program called Wellness Recovery Action Plan (WRAP). The researchers employed an interpretive descriptive methodology with thematic analysis. Data were collected from three focus groups ( n = 26) and in-depth interviews with follow-up member checks with 10 participants ( n = 20 interviews). Findings aligned with main constructs of self-determination theory (SDT) to explain how an autonomy-supportive environment created opportunities for participants to build competency, implementing personalized recovery strategies that are socially endorsed by peers, resulting in internalized motivation for continued application of WRAP’s framework. SDT appears to explain mechanisms of change for WRAP. Recommendations for mental health organizations include broadly ensuring autonomy-supportive environments and services that maximize opportunities to build competence in recovery strategies in collaboration with peers. Future research may utilize SDT as the theoretical basis for investigating self-management programs.

The objective of this community-based participatory research project was to develop a clinically useful, psychometrically-sound scale to measure community integration for adults with severe mental illness. Two researchers and an administrator of a behavioral health agency (BHA) recruited a group of providers, half with lived-experience of severe mental illness. Through a series of five focus groups, provider participants guided identification of four major domains of community integration and the development of 95 scale items; items and domains were reviewed by three external researchers with subject matter expertise. Initial pilot: BHA providers administered the scale to clients (n = 51) with 19 completing it twice to investigate internal consistency, test-retest reliability, and restricted variance and collinearity of items. Further piloting: providers at two BHAs administered the scale to clients (n = 178) to conduct exploratory factor analysis and analyze internal consistency. After initial pilot, 50 items remained post item reduction for restricted variance and collinearity, with Cronbach's alpha of .95 and test-retest reliability of .90. After a larger pilot, a four-factor solution emerged, aligning conceptually with the four domains as anticipated; 33 items loaded (factor loadings ≥ .4), with RMSEA of .069 and overall Cronbach's alpha of .89 (subdomains ranging .78-.86). The scale has good preliminary psychometric properties and appears to be feasible for use in BHAs for the purposes of research and evaluation, with clinical utility for assessment and treatment planning.

Objective: We examined the extent to which judges’ personal or family history with psychiatric disorders influenced their perception of violence risk among criminal defendants diagnosed with/withou...

This is a post-peer-review, pre-copyedit version of an article published in Psychiatric Quarterly. The final authenticated version is available online at: https://doi.org/10.1007/s11126-020-09717-6., This pilot study evaluated a video-based educational program for improving communication skills and reducing family violence between parents and their adult children with schizophrenia. We used a one group pretest-posttest design. The program included a main 90-min video and six stories, each 20–30 min long. We made assessments at baseline and program completion (three months after baseline). Sixty-six parent participants completed the intervention. The average frequency of acts of family violence significantly decreased from 11.4 (SD = 26.2) at pretest to 5.1 (SD = 13.2) at posttest (p = 0.016). Our findings showed significant improvements regarding expressed emotion, psychological distress, family empowerment, and hope, demonstrating preliminary positive results for this video-based educational program. The program was shown to be feasible for support/educational groups of family members of adults with mental disorders to deliver and may also be useful for practitioner-led educational groups for families in public health centers or medical settings to offer.

There are a variety of educational interventions for families who have a relative with a mental health disorder. However, for those with one or more emotion dysregulation disorders, there are limited options. This article reports on the results of a pilot project using a quasi-experimental design with a sample of 270 (intervention = 217, control = 53) to assess an intervention, Getting Off the Emotional Roller Coaster Skill-Building Family Education Course (GOER Family Course), for families coping with and managing emotion regulation disorders in a loved one which are often misdiagnosed or co-occurring. This intervention was effective in reducing caregiver burden [F(1, 120) = 12.25, p = 0.001], while improving attitudes, knowledge, and skills [F(1, 170) = 6.16, p = 0.014]. It fills an important gap in available resources for families faced with challenges and responsibilities that these disorders can present, especially when inaccurately diagnosed or receiving ineffective treatment. While there is a need for further research and adaptation to virtual learning, the preliminary results show positive effects.Existen varias intervenciones educativas para las familias que tienen un familiar con un trastorno de salud mental. Sin embargo, para aquellos que padecen uno o más trastornos de desregulación emocional, existen pocas opciones. En este artículo se informan los resultados de un proyecto piloto usando un diseño cuasiexperimental con una muestra de 270 personas (intervención=217, de referencia=53) para evaluar una intervención llamada Bajarse de la montaña rusa emocional: curso de capacitación familiar para el desarrollo de habilidades (Curso familiar GOER, por sus siglas en inglés), orientado a familias que enfrentan y manejan trastornos de regulación emocional en un ser querido, los cuales generalmente están mal diagnosticados o son concomitantes. Esta intervención fue eficaz para reducir el agobio de los cuidadores [F (1,120 )=12.25, p=.001] y a la vez mejorar las actitudes, el conocimiento y las habilidades [F (1,170)=6.16, p=.014]. Además, llena un vacío importante en los recursos disponibles para las familias que enfrentan las dificultades y las responsabilidades que estos trastornos pueden presentar, especialmente cuando tienen un diagnóstico impreciso o reciben un tratamiento ineficaz. Si bien es necesario continuar investigando y adaptarse a la enseñanza virtual, los resultados preliminares indican efectos positivos.对于亲属患有精神健康障碍的家庭有各种教育干预措施。然而，对于那些有一种或多种情绪失调障碍的人来说，选择则是有限的。本文报告了一个试点项目的研究结果，使用的是一项针对需要应对和管理亲人情绪调节障碍的准实验设计(干预=217，对照=53)来评估GOER家庭课程的干预效果（即get Off the Emotional Roller Coaster技能建设家庭教育课程）。他们的亲人的精神障碍疾病经常被误诊或与物质滥用是同时发生的。这种干预措施可以有效地减轻护理人员的负担 [F (1,120 )=12.25, p=.001]，同时改善态度、知识和技能 [F (1,170)=6.16, p=.014]。面临这些精神疾病带来的挑战和责任的家庭，特别是在疾病诊断不准确或病人接受无效治疗时，有哪些可用资源，此研究填补了针对这个话题研究方面的空白。虽然虚拟学习还需要进一步地去研究和适应，但初步研究结果显示有积极的效果。.

Objective: Adults with serious mental health conditions (SMHC) experience higher rates of disengagement from treatment. Factors associated with engagement in treatment in general for this population include therapeutic alliance, provider empathy, and perceived coercion. This cross-sectional exploratory study addressed the question: To what extent do client perceptions of therapeutic alliance, therapist empathy, and perceived coercion explain the degree of engagement in outpatient therapy for adults with SMHC? Method: An anonymous online survey measuring study variables was completed by 131 participants. The relationship between variables was tested using multivariate regression analysis with hierarchical blocks. Results: After separating therapeutic alliance and therapist empathy in the analysis due to multicollinearity and accounting for the influence of control variables, therapeutic alliance (B = .43, p < .01) and therapist empathy (B = .25, p < .01), but not perceived coercion, were associated with the degree of client engagement. Conclusions and Implications for Practice: For adults with SMHC enrolled in outpatient therapy, therapeutic alliance explained the greatest variation in the degree of engagement. Participants appeared to use outpatient therapy as a main strategy for pursuing recovery, and engagement in therapy may be increased if providers utilize strategies to strengthen expressions of empathy and bolster alliance. Additional research is needed to enhance understanding of engagement in therapy for this population and to develop more sensitive measures for evaluating these constructs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

NIMH requires intervention research to utilize an experimental therapeutic approach, identifying mediators to examine causal mechanisms of change. The authors propose utilizing self-determination theory (SDT) to guide research design for self-management interventions, using Wellness Recovery Action Plan (WRAP) as an exemplar. To delineate the theory's relevance to self-management interventions and recovery outcomes, the authors describe the main constructs of SDT and demonstrate its applicability to WRAP and recovery. Suggestions for research design and measurement strategies are provided.

Relational challenges often associated with interpersonal trauma may hinder survivors’ abilities to fully benefit from group therapy. This quasi-experimental study compared clinical outcomes of a 16-week version of the Trauma Recovery and Empowerment Model (TREM) for women and an attachment-informed adaptation (ATREM). Prior findings of TREM are extended by demonstrating that both group conditions can facilitate comparable clinical outcomes, creating options for group facilitators. Only ATREM resulted in statistically significant improvement in individual attachment avoidance, and it trended toward a slightly higher completion rate. This study provides insight into the emerging concept of group attachment.

It is widely documented that persons with mental illness (MI) experience much stigma, contributing to undesirable outcomes for persons with MI and posing barriers to their psychosocial rehabilitation. It is our argument that stigma and violence have a reciprocal relationship. In particular, stigma increases the risk of violence by this population by acting as a barrier to treatment participation and by increasing criminogenic risk factors among this population. Discrimination in social relationships, housing, and employment increases the likelihood that persons with MI will experience substance abuse, unemployment, stressed family relationships, antisocial characteristics, and less engagement in prosocial activities, all of which are known to increase the risk of criminal behavior. It is well documented that family members are the most common victims of violence by persons with MI. However, many family victims do not report acts of violence to authorities due to fear of exacerbating the stigma of MI. As such, not only does stigma increase the risk of violence by persons with MI, it also decreases the likelihood that family victims will report violence, preventing them from receiving victim services and other valuable supports. Reduction in stigma may be an essential element of a comprehensive approach to decreasing the risk of violence by persons with MI and increasing reporting and service use among family members who have been victims by persons with MI.

The link between interpersonal trauma and negative biopsychosocial outcomes has been well-documented. Integrated treatments that address trauma, mental health, and substance use among women with trauma histories have been found to be more effective than treatments that focus separately on these concerns. Since the early 2000s, the Trauma Recovery and Empowerment Model (TREM) has been described as a “promising” integrated trauma group therapy for women. Despite widespread recognition and implementation of TREM, its effectiveness has not been clearly established. The present scoping review is the first systematic effort to describe the extant literature on TREM and aims to provide an understanding of TREM’s effectiveness by organizing and synthesizing the available empirical data. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, a systematic search was conducted using PubMed, PsycINFO, SW Abstracts, Scopus, Embase, and Web of Science. Quantitative dissertation findings not published elsewhere and peer-reviewed journal articles published in English that reported outcomes from TREM intervention research with adult women were included. Twelve of the initial 385 publications identified met the inclusion criteria and reported data from nine studies. TREM demonstrated statistically significant effects on posttraumatic stress disorder, anxiety, psychological/psychosomatic distress, and substance use. A more limited set of findings suggests that TREM may also be associated with additional gains, including self-esteem, relationship power, social support, attachment, and spiritual well-being. Future research should replicate findings, use random assignment to groups, involve larger sample sizes and more representative samples, examine optimal duration, and identify components that facilitate change.

Two diametrically opposed positions predominate discourse for the care and treatment of persons with severe mental illness: anti-deinstitutionalization and anti-institutionalization. Both share the same goal of ensuring best quality of life for those with severe psychiatric disorders, but pathways to achieving this goal are very different and have resulted in much contention. Supporters of each position espouse a different belief system regarding people with psychiatric disorders and their presumed capabilities, placing varying emphasis on maximizing protection of the community versus protection of individual rights, and result in contrasting mental health policies and practice orientations. The authors delineate the history from which these positions evolved, consequent views, and policies and practices that emerged from these differing attitudes. The article culminates in a proposed practice approach that offers a more balanced approach to serving adults with mental illness -navigating risk management by preserving freedom and opportunities of risk while affording mutually satisfactory "risk control."

BackgroundDespite a sizable minority of persons with serious mental illness (SMI) acting aggressively toward family members, little is known about this topic. The objectives of the present analyses are to examine the association of offenders' SMI status with offender behaviors and victim outcomes and to compare the immediate contextual characteristics of incidents involving offenders with and without SMI.MethodsUsing a cross-sectional design, all incidents of domestic violence to which police were called between adult children and their parents in Philadelphia, PA, in 2013 (N = 6191) were analyzed. Additionally, incidents in which the offender was indicated to have SMI (n = 327) were matched with a sample of incidents in which the offender was not indicated to have SMI (n = 327).ResultsOffenders having SMI was not associated with using a bodily weapon or gun, threatening victims, or damaging property. Offenders having SMI was associated with a decreased risk of offenders using a non-gun external weapon and victims being observed to have a complaint of pain or visible injuries. When offenders had SMI, conflict was less likely to focus on family issues and more likely to focus on offenders' behaviors and to involve contextual characteristics related to mental illness.ConclusionsEfforts to prevent gun and other violence between non-intimate partner family members should target factors more strongly associated with violence than SMI (e.g. history of domestic violence, substance abuse). Intervening in family aggression by persons with SMI likely requires addressing unique circumstances these parties experience.

Background Previous studies have found that suicide rates are likely to increase after the occurrence of earthquakes. Most existing studies that examined the relationship between PTSD and suicidality focus on risk factors. It remains unclear whether protective factors, such as post-traumatic growth (PTG) and social support, play a role in this relationship. Objectives The aim of this study was to investigate the role of PTG and social support in the association between PTSD and suicidality, using data from a cross-sectional study conducted in China. Methods 1,369 participants were recruited from two study sites that were severely affected by the Wenchuan earthquake. Univariate and multivariate regression analyses were conducted to examine the relationship between PTSD, PTG, social support, and suicidality. Results The results indicate that the prevalence of suicidal ideation, suicide plans, and suicide attempts among adult survivors were 9.06%, 2.97% and 3.31%, respectively, even after 8 years following the Wenchuan earthquake. Furthermore, the findings show that PTSD was significantly associated with suicidality (OR = 1.96; 95% CI = 1.53, 2.52). Additionally, individuals reporting lower levels of social support and the acquisition of PTSD (OR = 5.99; 95% CI = 1.66, 21.56) were significantly related to suicidality. Moreover, compared to individuals who reported no presence of PTSD and high PTG, those who lived with PTSD and lower levels of PTG (OR = 2.33; 95%CI = 1.00, 5.42) were more likely to report suicidality. Limitations The cross-sectional design of this study limits our ability to determine causal relationships. Effects of other related factors, such as cultural and life events, were not examined in this study. Conclusions Suicidality is a long-term health issue among survivors of the Wenchuan earthquake. PTG and social support play important roles on the association between PTSD and suicidality and are important contributing factors to understanding this relationship. These results contribute new knowledge of suicidal risk for a number of years after an earthquake and have implications for further mental health promotion following earthquakes.

Background: Although breastfeeding is a major public health priority and provides numerous benefits, women veterans encounter many barriers to initiating and sustaining breastfeeding. Women veterans are a growing population with unique health care needs related to exposures and injuries experienced during military service. These military experiences are linked to health diagnoses known to impact postpartum health behaviors, such as breastfeeding. Research aim: The aim of this study was to identify factors associated with breastfeeding at 4 weeks postpartum among women veterans. Methods: We used 2016-to-2018 survey data from women veterans ( N = 420), interviewed before and after delivery, who were enrolled in maternity care coordination at a national sample of Veterans Health Administration facilities. Using the social ecological model, logistic regression was employed to explore the relationship between breastfeeding at least 4 weeks and postpartum and maternal/infant characteristics, interpersonal dynamics, community influences, and system factors. Results: The rate of breastfeeding at 4 weeks postpartum was 78.6% among this sample of veterans. Self-employed participants were 2.8 times more likely to breastfeed than those who were employed outside the home. Participants who had been deployed at any point in their military career were twice as likely to breastfeed compared with those who never deployed. In this study sample, race independently predicted lower rates of breastfeeding, with African American participants being 48% less likely to breastfeed as compared with white participants. Conclusion: Our analysis suggests significant racial disparities in breastfeeding within veteran populations utilizing Veterans Health Administration, despite access to multiple sources of support from both the Veterans Health Administration and the community.

OBJECTIVE Wellness Recovery Action Plan (WRAP), an illness self-management intervention used internationally, enhances perceived recovery for adults with psychiatric disabilities, but the magnitude of positive change is modest at best. As part of a larger study about how adults with serious mental illness learn and use illness self-management strategies through WRAP, this paper reports on an investigation of the relationship between problem-solving and perceived recovery for WRAP users and addresses the question: To what extent is the degree of problem-solving confidence associated with the degree of perceived recovery for WRAP users? METHOD An anonymous online survey was administered to adults with serious mental illness (N = 82) who had completed the Wellness Recovery Action Plan in the previous 6-24 months, with standardized scales to measure perceived recovery, problem-solving appraisal and confidence, self-reflection and insight, symptoms, and social support. Data were analyzed using multiple regression. RESULTS Problem-solving confidence (p = .013) and social support (p < .001) were associated with degree of perceived recovery, and the model accounted for 40% of the variance. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Whereas WRAP alone is modestly efficacious, it may be that adding a problem-solving intervention for small groups of adults with serious mental illness will increase the magnitude of change in perceived recovery by enhancing problem-solving confidence and increasing ongoing social support through group processes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Mental Health Recovery Model is an empowering service philosophy which has been transforming the field of mental health. An important service approach to actualizing this model is hirin...

In this period of post-deinstitutionalization, much of the care for people with severe psychiatric disorders (PD) is provided by their families. A primary stressor for caregivers is fears regarding their own safety and that of others, which has been virtually unexplored. To fill this gap, factors in three domains were assessed: (1) relatives with PD, (2) family caregivers, and (3) interactions with each other. This investigation was a secondary analysis of data obtained from a national survey of caregivers of adults with mental illness conducted by the National Alliance for Caregiving. A subsample of 1,505 was used in the present study. Fear of harm was positively associated with the following factors: relatives with PD-serious mental health problem, alcohol and substance abuse, receipt of crisis mental health treatment, history of arrest; interaction-greater difficulty getting relative to take medications as prescribed; and fear that relative would be hurt by others or die by suicide. Social workers need to be cognizant of risk of potential violence against caregivers and ensure the safety of these family members, even if they may not be their primary clients. The article includes recommendations for family inclusion in the treatment of people with PD.

This is a post-peer-review, pre-copyedit version of an article published in Psychiatric Quarterly. The final authenticated version is available online at: https://doi.org/10.1007/s11126-017-9537-4., There have been several violence-related deaths in Japan due to family violence by persons with severe mental illness against their caregivers. However, it is not often acknowledged that these violent acts are mainly directed at family members. This study aimed to clarify what acts of violence family caregivers experienced from their relative with schizophrenia, and how frequently these violent incidents occurred in their lifetime. We also examined caregivers’ thoughts of death about themselves and their relatives, as well as their consultation efforts and escape from the violence perpetrated by their relative. Of the 277 caregivers, 87.7% had experienced psychological violence and 75.8% had experienced physical violence perpetrated by their relative. Of 210 caregivers who had experienced physical violence, 26.7% had thought of murder-suicide and 31.0% had wished for their relative’s death. Family violence by persons with schizophrenia is not rare but a common occurrence in Japan and may have fatal consequences.

Mental health resources are designed to facilitate recovery for adults with psychiatric disabilities. Two participants of an autovideography intervention described systems barriers to recovery. Researchers employed narrative analysis, guided by the capabilities approach, to evaluate how participants storied their experiences. Participants made meaning from encounters with barriers in ways that oppose the spirit and advancement of recovery while engendering adaptive preferences. Findings indicate that inadequate resources attenuate wellbeing by increasing barriers that actively oppose recovery, and positive reframing of unaccommodating environments reinforces adaptive preferences and incapacity. Adequate resources are essential for successful recovery transformation within the mental health system.

This seemed like an opportune time to devote a special issue of the Journal of the Society for Social Work and Research ( JSSWR) to the topic of the etiology and treatment of individuals with a severe mental illness. More than a decade ago, the report from the President’s New Freedom Commission on Mental Health (2003) called for a transformation of the fragmented delivery system of mental health services to a coordinated delivery system with a recovery orientation. This policy represented a fundamental shift in thinking that was markedly different than prior reform efforts, which were basically “a new environmental approach to treatment and innovative type of facility or locus of care” (Morrissey & Goldman, 1984, p. 785). The public mental health policy moved away from focusing on changes in the setting in which care was delivered to modifying the public’s values, attitudes, and philosophy of the way we treat and think about people with severe mental illness (SMI; e.g., schizophrenia spectrum disorders, major depression and bipolar disorders), regardless of service location. The recovery movement is about seeing people who experience mental illness as whole persons with the capability of making their own decisions about their life and their care, endorsing their self-determination, seeing them as experts on what works for them, ensuring their full involvement in their treatment planning, and providing opportunities to ensure that those with SMI have equality of rights and responsibilities of any other citizen. These values and approaches are a break from the past when the medical model reigned supreme and mental health providers were the only experts who paternalistically knew what was in the best interest of those with SMI; consequently, it was the mental health care provider who made all decisions with limited, if any, input from the patient. The shift in thinking is about changing the way in which we practice mental health care, the way we view

Objective: The act of moving, tailoring, and sustaining evidence-based practices (EBP) into real world settings has proven formidable. Schools of social work are responsible for preparing students to deliver EBP interventions while trying to engender the practice of routinely using evidence for decision making. Given the difficulty of accomplishing these objectives and cognizant that field education is the heart of the experiential component of graduate social work curricula, we developed FIELD as an educational intervention for dyads of field instructors and their students. FIELD is a multiphase didactic and experiential intervention driven by the interests of field instructors. This article presents findings from a pilot randomized controlled trial that examined the effectiveness of FIELD using motivational interviewing as the focal EBP. Methods: A convenience sample of 40 dyads (composed of a field instructor and a field student) was randomly assigned to experimental (n = 38) or control conditi...

The Edutainment Violence Intervention/Prevention Model (EVIP) is an exciting intervention to be used with Black adolescents who have been or will be exposed to the trauma of police brutality. Since such exposure to violence is associated with a diversity of negative consequences in developing adolescents, social workers need interventions to help Black adolescents acquire skills to navigate police interactions and to make sense of the brutality they witness. This article delineates the conceptual rationale, needed skills, and steps for implementing EVIP. EVIP incorporates the Centers for Disease Control’s best practices for violence prevention programs and is congruent with Bandura’s theory of self-efficacy. EVIP uses media, such as live theater, to give educational messages in an entertaining format. A pilot study has indicated that this intervention has promise. Furthermore, it is engaging and enables participants to explore multiple perspectives. This intervention can be seamlessly embedded by ...

Mental health services have been transforming toward a recovery orientation for more than a decade, yet a robust understanding of recovery eludes many providers, and consensus on a conceptual definition has yet to be reached. This article examines mental health consumers' lived experience of recovery and evaluates the usefulness and comprehensiveness of CHIME, a major framework conceptually defining recovery for adults with serious mental illness. Researchers partnered with a mental health association in a major US city to engage in research with graduates of a recovery and education class for adults diagnosed with serious mental illness. Twelve participants were loaned video cameras and invited to "Tell us about your recovery" through autovideography. Of the 12 participants, six produced videos directly responding to the overall research question and were subsequently included in the present analysis. Data were analyzed thematically, and CHIME adequately represented the major domains presented in consumer videos with two notable modifications: subdomains of "reciprocity" within relationships and "contributing to others" were added to comprehensively represent consumer perspectives about recovery. Adding two subdomains to CHIME more effectively represents consumer narratives about recovery, contributes to the social construction of the personhood of people with serious mental illness, and offers a more robust description of the process of recovery.

Objective The extent to which psychiatric diagnosis, treatment compliance, and violence risk influenced judges perceived benefits of Mental Health Court (“MHC”) for defendants with psychiatric disorders was examined. Method 81 judges completed one vignette in which psychiatric diagnosis (Schizophrenia, Major Depressive Disorder, Posttraumatic Stress Disorder), treatment compliance (yes/no), and violence risk (high/low) were randomized. The online survey was distributed via email and following the vignette, judges answered a question about the appropriateness of MHC. Results Judges assessed defendants with severe psychiatric disorders (Schizophrenia and Major Depressive Disorder) – compared to defendants with PTSD – as more likely to benefit from MHCs. If deemed at low treatment compliance and/or high violence risk, judges were unlikely to appraise MHCs as beneficial, regardless of psychiatric diagnosis. Implications Judges appear to consider relevant factors when determining whether MHC will benefit defendants with psychiatric disorders; however, future research should include more variables (e.g., addictions, history of violence) to examine the combined influence on judges' perception of MHC suitability.

Although links between mental health and intimate partner violence (IPV) have been discussed extensively in the scholarly literature, little empirical data exist about these phenomena in Botswana. This study addressed this gap by examining the nature, extent, and risk factors associated with symptoms of major depressive disorders (MDD) using cross-sectional data collected in 2009-2010 in northwestern Botswana. A random sample of 469 women participated in semistructured interviews about their lives, health, and experiences with violence. Thirty-one percent of respondents were found to meet the symptom criteria for MDD. Factors associated with MDD included emotional or physical violence by an intimate partner and being in a relationship in which both partners consumed alcohol. One in five women reported a recent experience of emotional violence, while 37% of respondents reported recent physical IPV. Women who have experienced emotional or physical IPV in the last 12 months have 89% and 82% greater odds, respectively, of having symptoms of MDD ( p < .05) than women who have not recently experienced either form of violence. Women in relationships in which both partners consumed alcohol had more than twice the odds of MDD compared with women in relationships where neither partner or only one partner drank. Given the significant association of violence, alcohol, and MDD, screening for all three conditions should be part of routine care in health care settings in Botswana. Interventions to reduce IPV and alcohol consumption may help alleviate the burden of MDD in women in this setting.

Though expression of sexuality is correlated with improved physiological, psychological, and social well-being, persons with psychiatric disabilities battle a myriad of forces preventing their full inclusion in this cherished domain of adult life. Powerful side effects of psychotropic medications are partly to blame for this complex problem. More troubling are providers that adopt silent or admonishing positions with clients struggling with issues of sexuality and intimacy. Despite an international embrace of the recovery framework in mental health systems of care, providers often behave in ways that do not support the sexuality and intimacy interests of their clients. Since social workers are the main providers of service for this population, they must lead in developing novel pedagogical techniques infusing social work curriculum with practice competencies for addressing sexuality and intimacy for persons with psychiatric disabilities. Furthermore, as field instructors are most influential in shaping practice habits of social work students, any effort at structural change must feasibly include them. This article delineates an adaptation of the Field Instructors Extending EBP Learning in Dyads (FIELD) Model, for the field instructor and social work student dyad. Utilizing motivational interviewing techniques, FIELD imparts sexuality and intimacy practice competencies for collaboration with persons living with psychiatric disabilities.

Objective Women are serving in the armed forces and deployed to areas of conflict in increasing numbers. Problems such as depressive symptoms and risks related to combat exposure can have negative effects on adjustment following service; understanding the relationship between these problems may contribute to strategies providers can use to facilitate healthy adjustment after deployment. The purpose of this study is to examine social factors as they relate to mental health adjustment, namely depressive symptoms among female veterans who served in Iraq and Afghanistan as part of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OND). We hypothesized that combat exposure would predict higher levels of depressive symptoms and that social support would moderate the relationship between combat exposure and depression. Methods In a cross-sectional design, 128 female Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans completed an online survey about combat experience, social support, depression, demographic characteristics, and behavioral health symptom history. We conducted multiple regression analyses to examine linear and moderating relationships. Results There was no significant relationship between combat exposure and depression; social support did not significantly moderate the relationship between combat exposure and depression. However, higher levels of social support and financial comfort were significantly related to lower levels of depression. Conclusion This study highlights the role of social factors, specifically social support and perceived financial status, as potential barriers to healthy emotional readjustment following deployment. These findings suggest that it may be beneficial for mental health providers to screen female veterans and refer them to appropriate services to reduce financial stressors and strengthen their use of social support. More research should continue to examine more fully the impact of combat exposure on female service members' mental health and work to isolate the factors most strongly related to depression.

Objective This study examined the effectiveness of an Internet parenting education and support intervention among mothers with a serious mental illness (SMI). Methods Sixty mothers diagnosed with a schizophrenia spectrum or mood disorder who had primary/shared custody for a child 18 or younger were enrolled in a randomized controlled trial (RCT) with two conditions. The experimental condition involved participation in the online parental education course and a listserv co-moderated by a parent with a mental illness and a mental health professional. The control condition involved participation in online education healthy lifestyle course. Standardized measures were used at baseline and 3 months to assess outcomes. Using an intent-to-treat approach, group differences over time were assessed using a two-tailed independent sample t test on all dependent variables, including parental efficacy, skills, coping, support, and stress. Results Participation in an online parenting intervention for mothers with a SMI enhanced parenting and coping skills, and decreased parental stress. No support was found for improved efficacy or support. Conclusion This RCT establishes that mothers with a SMI are interested in and capable of receiving online parenting education and support. Findings demonstrate that an online parenting intervention can improve parenting and coping skills and decrease parental stress.

This study explores the potential that current efforts to limit access to firearms for individuals with serious mental illness (SMI) have for reducing overall rates of murder by firearm in the United States. Official arrest, court and health records provided data on personal and offense characteristics of 95 individuals with SMI and 423 without, all of whom had been convicted of murder in the State of Indiana between 1990 and 2002. Bivariate analyses examined differences between the two groups and logistic regression models examined the relationship between SMI and offense characteristics. Compared to those without, a relatively small proportion of convicted murderers had a diagnosis indicating SMI. The presence of SMI was associated with reduced likelihood of targeting a stranger and was not associated with having multiple-victims or firearm use. Focusing on access to firearms exclusively by individuals with SMI will have little impact on multiple-victim or firearm-related homicides.

Introduction Bullying is a prevalent concern among adolescents and causes great mental/behavioral consequences. In addition to the direct association between bullying victimization and adolescent physical health (measured by self-rated health), this study investigates the indirect effect of mental health and the moderating role of gender to such relationship. Methods Study participants comprised a national sample of adolescents (n = 3435) aged 15 to 16 years old in the United States. Results Structural equation modeling analyses showed that, in addition to the main effect of bullying on adolescents physical health, (based on joint significance test) mental health has an indirect effect on and gender moderates the relationship between bullying victimization and adolescents' self-rated health. Conclusions Bullying has negative impact on adolescent health. Prevention and intervention programs need to take into account the critical roles of gender and mental health in addressing the negative consequences of bullying victimization.

We examine how the Hospital Anxiety and Depression Scale (HADS) was modified to measure anxiety and depression among HIV-infected sex workers in India. Supervised by a community advisory group, HADS was translated and administered to 100 HIV-infected sex workers in Sonagachi, Kolkata, India. Confirmatory factor analysis was used to examine validity. Results indicate that the inability to remain calm is experienced as depression rather than anxiety, whereas functional impairment induces anxiety rather than depression. The cross-loadings were interpreted in the context of prevalent cultural norms. The modified instrument identified a high prevalence of depression (30%) and anxiety (44%).

As the recovery paradigm proliferates throughout systems of mental health care, social workers are being required to provide recovery-oriented services. Yet there has been little discussion about what changes need to be made in social work education to produce recovery-oriented social workers. This article uses Paulo Freire's theory of pedagogy to help social work educators understand how they can develop problem-posing relationships with their students in order to teach students about the relationships that social workers ought to have with people in recovery.

Objective: The goal of this study was to test the degree to which client clinical characteristics and environmental context and social workers’ practice values and experience influenced support for client’s autonomy and willingness to engage in shared decision making (SDM), and whether willingness to engage in SDM was mediated by support for autonomy. Method: A randomized factorial survey of social workers working with adults with severe mental illness was employed. Eighty-seven social workers responded yielding 435 vignettes. Results: Hypotheses were partially supported. Diagnosis, symptomology, threats of harm, treatment adherence, substance use, and social workers’ values and experience predicted support for autonomy and willingness to engage in SDM. Willingness to engage in SDM was modestly mediated by support for autonomy. Conclusion: Helping social workers avoid bias in decision making is critical to the goal of supporting clients’ autonomy, building their capacity, minimizing disempowerment, and promoting recovery.

Witnessing violence is one adverse childhood experience (ACE) associated with living in impoverished Black urban communities. Youth with higher violence avoidance self-efficacy and positive coping are more likely to avoid violence. This study evaluates educational entertainment (edutainment) as an intervention with Black adolescents exposed to community violence. Edutainment has shown success in increasing self-efficacy and positive coping skills in other domains. Self-administered scales were used to measure stress, anxiety, violence avoidance self-efficacy, and coping strategies. Data were collected pre- and nine days post-interventions/no intervention from 20 subjects receiving the edutainment intervention, 19 subjects participating in a group discussion about violence, and 21 subjects receiving no intervention (N = 60). Edutainment and no intervention were more effective than group discussion alone in increasing violence avoidance self-efficacy. Violence avoidance self-efficacy was found to have an intervening relationship between edutainment and the outcome of stress. This study indicates limited but positive effects for edutainment.

Objective To develop and test a pictorial-based assessment tool, the Cameron Complex Trauma Interview (CCTI), evaluating complex trauma history and symptomatology in children ages 5 to 11. Method 21 participating clinicians (master's level or higher) were asked to utilize a prototype version of the CCTI and the UCLA Posttraumatic Stress Disorder Reaction Index (PTSD-RI) with 1 client, ages 5-11, with known exposure to trauma, provide demographic information, scores, and complete a Clinical Utility and Feasibility Survey (CUFS). Results The CCTI Symptomatology scale was internally consistent (a = .931). CCTI convergent validity was supported by robust correlations between the CCTI and UCLA PTSD-RI trauma history and symptomatology scales, r = .677 and .810, respectively, p Conclusion Clinicians responding to the CUFS described the CCTI as comprehensive, developmentally and culturally appropriate, easy to use, and engaging. Survey data illustrated that while clinicians reported positive experiences using the CCTI, some struggled with the symptomatology scale and did not elicit information from the child on several domains of impairment. (PsycINFO Database Record

The authors investigated the impact of organizational justice on social workers' intention to leave Korean social service agencies. Specifically, this study concentrated on the moderating effect of organizational justice on the relationship between burnout and intention to leave. The authors surveyed 218 front-line social workers from 51 social welfare service centers in Korea. Data were collected from a sample of social workers indentified through a multistage cluster sampling process. The authors used a linear mixed model to analyze the multilevel data structure. This study had three major findings. First, higher levels of burnout of individual social workers corresponded to increased intention to leave. Second, higher levels of organizational justice of social welfare service centers corresponded to decreased intention to leave. Finally, and most important, the organizational justice of social welfare service centers moderated the impact of burnout on individual social workers' intention to leave. On the basis of these results, the authors discuss the importance of organizational justice to social service agencies. KEY WORDS: burnout; intention to leave; moderating effect; organizational justice ********** Within a human service agency, the primary workforce is social workers (Sung, 1993). Frequent turnover among social workers causes practical problems for social work agencies in terms of service discontinuance and loss of skilled practitioners (Carmeli & Weisberg, 2006; Loewenberg, 1979). Given the high costs of social worker turnover, finding effective strategies to reduce turnover rates has been a great concern and challenge in social work settings (Abu-Bader, 2000; Curry, McCarragher, & Dellmann-Jenkins, 2005; Vandervort, Pott Gozalez, & Coulborn Failer, 2008). Previous literature has consistently demonstrated that intention to leave is one of the strongest predictors and an immediate precursor of social worker turnover (Harrington, Bean, Pintello, & Mathew, 2001; Vandervort et al., 2008). A number of social work administrators and professionals have attempted to determine the factors that affect social workers' intention to leave social service agencies (Chiu & Lai, 1997; Ulrish et al., 2007). Several studies have revealed associations between the psychological and demographic characteristics of individual social workers and their intention to leave (Drake & Yamada, 1996; Harrington et al., 2001). Generally, the results of these studies have determined that burnout of social workers significantly increased their intention to leave (Drake & Yamada, 1996; Harrington et al., 2001). These studies, however, have focused primarily on individual factors of social workers as the predictors of intention to leave, ignoring the influence of the social-environmental context of social work agencies. Currently, organizational theory emphasizes the leverage effect of organizational factors on intention to leave among organizational members (Acker, 2004; DePanfilis & Zlotnik, 2008). As George and Jones (1996) pointed out, the impact of individual factors on turnover may be moderated by other organizational factors, such as a supportive organizational climate. Current organizational research has shown increasing interest in organizational justice as a potential factor that creates benefits for both organizations and their individual members (Judge & Colquitt, 2004; Lain, Schaubroeck, & Aryee, 2002). Other fields--including education, public administration, and business--have investigated the dynamic between organizational justice and the intention to leave or turnover rates among organizational members. Prior studies conducted in these fields have indicated that enhancing organizational justice is an efficient strategy to decrease intention to leave or reduce turnover rates and, therefore, increase service quality and clients' satisfaction (DeConinck & Bachmann, 2005; Foley, Ngo, & Wong, 2005; Kickul, Lester, & Finkl, 2002; Parker & Kohlmeyer, 2005). …

OBJECTIVE Persons with psychiatric disabilities are at greater risk for medical comorbidity, and prior research suggests these persons may underutilize health services. In response, this study examined the impact of engagement in psychiatric rehabilitation services, including case management, on utilization of general health services among persons with psychiatric disabilities engaged in supported housing, while controlling for demographic and clinical characteristics. METHODS Poisson regression analyses were used to examine the impact of socio-demographic, clinical, and service characteristics on reported utilization of general health services in the past year. RESULTS Findings indicated supported housing residents receiving case management coupled with weekly contact with residential support services visited a general health practitioner more frequently than those with less support services. CONCLUSIONS AND IMPLICATIONS Study results suggest psychiatric rehabilitation services provided to persons in the context of safe and affordable housing may represent an important mechanism for enabling persons with psychiatric disorders to access needed medical care.

Family members often set limits with relatives with psychiatric disorders (PD), however, no scale currently exists measuring the use of such limit-setting practices. The present article describes the development and results of a new measure, the Family Limit-Setting Scale (FLSS). Via a national online survey, the FLSS was completed by 573 adults residing in the U.S. who report having an adult relative with PD. We conducted exploratory and confirmatory factor analyses, examined internal consistencies and other indicators of construct validity, and performed invariance analyses assessing the generality of the optimal factor model to men, women, Caucasian respondents, and non-Caucasian respondents. Results indicate that the FLSS has an acceptable two factor structure (routine limit-setting and crisis prevention limit-setting) with both factors being highly generalizable to all groups of respondents examined. Internal consistencies and other indicators provide additional evidence of the FLSS' construct validity. Use of the FLSS will enable the conduction of quantitative research in this area. In addition, this measure may be employed in education/support organizations for families with a member with mental illness in an effort to identify persons using high levels of limit-setting practices who may benefit from extra support and/or guidance.

While the majority of women with mental health problems (MHPs) are mothers, little is known about the community integration (CI) of these women and their children. Given that poorer mental health status has been linked with lower CI, CI has become a long standing goal of mental health policy. Data from a national survey examined the association of maternal mental health status with the physical, social, and psychological integration of families. After adjusting for sociodemographics, mothers with MHPs reported similar physical integration but less social and psychological integration. Interventions focused on improving social networks, scarce resources, and neighborhood safety are needed for families impacted by maternal MHPs.

The present study conducted in Japan aimed to clarify the relationship between violence directed towards parents by patients with schizophrenia and parents' risk of post-traumatic stress disorder (PTSD). Questionnaire data from 353 parents were analyzed. In total, 84 of the 353 parents (23.8%) reported the Impact of Event Scale-Revised (IES-R) score ≥ 25 (high-IES-R), indicative of a high risk of developing PTSD. The rate of high-IES-R scores was significantly higher among parents who had experienced an act of violence that was likely to result in severe injury by their adult child with schizophrenia (OR = 2.03; 95% CI 1.09-3.80; using "never experienced" as a reference) and in parents of patients who were hospitalized at the time of the survey (OR = 2.47; 95% CI 1.01-6.06; using "regularly visited a psychiatrist" as a reference). Therefore, parents experiencing violence by their adult child with schizophrenia are at a risk of developing PTSD. Parents of patients with schizophrenia, who are at a high risk of PTSD, are not usually provided the required support in Japan. To prevent violence and provide support for family members who may develop PTSD, it is necessary to establish crisis intervention programs, especially given the current emphasis on deinstitutionalization policy in Japan.

This study investigated the patterns and risk factors of multiple child maltreatment recurrence compared to single recurrence and no recurrence. The sample was drawn from all the records of Child Protective Services (CPS) in seven Florida counties covering 5.4 years, resulting in a study population of 32,163 families with one or more substantiated child abuse and neglect report. Among the sample families, 27,865 families (86.6%) had no recurrence, 3419 families (10.6%) had only one recurrence, and 879 families (2.7%) had two or more recurrences. This study employed bivariate analyses and multinomial logit analyses to examine risk factors of multiple child maltreatment recurrence. Study findings show that younger age of child victim, single mother or stepparent, and large family significantly predicted the likelihood of multiple child maltreatment recurrence relative to single recurrence as well as no recurrence. Also reporter type, contacts by CPS workers, intensity of investigation level, and service type were significantly associated with the likelihood of multiple recurrences being identified. Study results will serve to provide a knowledge base to interventions and preventions for child maltreatment recurrence.

Background Expressed emotion (EE) has been studied in families of a relative with schizophrenia as well as other psychiatric disorders; and high EE (hostile, critical, and overinvolved) families have been found to be strongly related to relapse among their relatives. EE has been assessed on a limited basis among non-familial care providers and determined that providers can also have high EE which results in poor quality of life and negative consequences for their clients. Methods The present study assessed 42 case managers serving clients with schizophrenia spectrum disorder regarding their EE for specific clients enrolled in a larger study examining the reliability and validity of two alliance measures. Case managers and clients were personally interviewed at baseline, 3, 6, 6 plus 2 weeks, and 9 months post-client entry into case management. The EE measure was inserted into the 6 months plus 2 week case manager interview. Generalized Estimating Equation analysis was employed to examine predicted outcomes of EE. Results High EE was found to be related to client attitudes toward medication compliance and social contact. Conclusions Family psychoeducation interventions, an evidence-based practice, have been demonstrated to be effective in reducing relapse of relatives with serious mental illness. Given the clinical evidence that EE is modifiable, it is expected that such educational training for non-familial caregivers will have the same potential as for family caregivers. Providers dealing with challenging clients may also need support and skills to better handle difficult situations, especially direct support providers like case managers who are not clinically trained.

Objective: Disengagement from services by people with serious mental illnesses continues to be a major challenge for the mental health system. Assertive community treatment combined with Housing First services is an intervention targeted toward consumers whom the system has failed to engage. The processes involved in engaging and maintaining consumers in mental health services play an important role but remain an understudied aspect of the intervention. This study examined the social interaction between consumers and case managers from the perspective of consumers. Methods: Seventy service contacts between unique consumer–case manager dyads were sampled. Consumers with co-occurring serious mental illness and substance use disorders completed interviews after each service contact. They provided information on sociodemographic characteristics, service contact characteristics, consumer-provider relationship, utilization of coercive strategies, perceived coercion, and service contact evaluation. Multivariate regression analyses examined the association of consumer-provider relationship and perceived coercion with service contact evaluation. Results: Consumer-provider relationship was negatively associated with perceived coercion (effect size=.08). Perceived coercion was negatively associated with service contact evaluation (effect size=.34). Perceived coercion was positively associated with time in the program (effect size=.17) and negatively associated with length of the service contact (effect size=.14). Effect sizes ranging from .08 to .34 are typically considered small to medium. Conclusions: Findings demonstrate that for consumers, a positive response to service contacts indicated that they did not feel coerced. With consumers whose connection to services is tenuous, an immediate positive response to service contacts may be vital to maintain engagement. Research is needed to identify supportive case manager strategies that facilitate relationship building. (Psychiatric Services 60:183–188, 2009)

Objective An important step in research using the Theory of Reasoned Action and Theory of Planned Behavior (TRA/TPB) is conducting an elicitation process to identify topic and population specific cognitions. This study explored HIV risk behaviors in persons with mental illnesses and introduces findings from focus groups conducted during the development phase of an HIV primary and secondary prevention intervention study. Methods Researchers held four focus groups with persons with mental illnesses focused on HIV risks and condom use. Results Participants discussed sexual side effects of psychotropic medications as a potential cause of both medication non-adherence and HIV risk behaviors. The intersection of these two issues is specific to this population. Conclusions We conclude with the recommendation that HIV primary and secondary prevention intervention for persons with mental illnesses must incorporate the promotion of healthy sexuality, including attention to sexual side effects of psychotropic medications.