Understanding engagement in the Program of Assertive Community Treatment (PACT) from the perspectives of individuals receiving treatment

ABSTRACT

Engagement of individuals with serious mental illnesses in community mental health services is a significant challenge. The Program of Assertive Community Treatment (PACT) is an individual-centered and self-contained mental health program that provides psychiatric treatment, rehabilitation, and support services to persons with serious mental illness who have a history of or likelihood of disengagement with services. Understanding what helps and hinders consumers’ involvement in PACT services may provide information on how to tailor engagement strategies to individuals based on their treatment needs and preferences. The current study builds on existing studies by exploring factors that help and hinder engagement in PACT services from the perspectives of individuals receiving treatment. We conducted open-ended, semi-structured interviews with 17 individuals receiving PACT services. Nine themes were identified through thematic analysis: Desirable qualities of PACT, Focusing on positive outcomes, PACT as a safety net, Recovery orientation, Practical barriers, Conflictual relationships, and Medication side-effects. We conclude that the development of a trusting, therapeutic relationship that is collaborative and person-centered and that is facilitated by both practical and emotional support is critical to engaging individuals in treatment and maximizing positive outcomes.     

In search of rigor, relevance, and legitimacy: what drives the impact of publications?

In this study, we introduce the concept of legitimacy to the rigor-relevance debate and investigate empirically how rigor, relevance, and legitimacy are related to the process of knowledge dissemination within a research field. We argue that this analysis has been a missing piece in the debate on rigor and relevance when institutional logics about what constitutes both elements lead researchers to act according to what they perceive to be appropriate behavior in the research field. We draw on insights from the micro and macro levels of institutional theory to show how researchers aiming to bestow legitimacy on their own work conform to these “rules of the game”. Using meta-analytical techniques, we focus on the field of strategic entrepreneurship and analyze how rigor- and relevance-related characteristics of studies in this field are linked to their legitimacy and therefore to the impact they have in the research community.     

Supporting child welfare supervisors to improve worker retention

Recent child welfare research has identified supervisors as key to retaining qualified and committed workers. This paper describes implementation of a federally funded child welfare training initiative designed to improve worker retention largely through developing, implementing, and evaluating a statewide supervisor training program in a Midwestern state. Unique to this collaborative effort was involving all child welfare supervisors in identifying needed content components, developing competencies, and conducting self-assessments.     

Love in Times of Cholera: Systemic Reflections on Supporting Families Through the Journey(s) of Illness

This paper is the result of our increasing interest in the experience of illness in families and the concomitant reflections on how best to therapeutically support these families through this process. This interest led us to reflect on the nuanced way in which language establishes a play with the experience of illness, a play that can amplify or reduce its effects. Such an interplay in turn led us to consider the valuable role that family therapists have in helping families and treating practitioners to create a safe space for conversation about illness. Further questions are also explored in relation to whether there is a role for family therapists in facilitating the interface between our clinical practice with clients and the wider treating medical community. And, if so, what shape would such an interface take? Considerations at this level would include the anticipation of psychological reactions to diagnosis of chronic and life‐threatening illnesses, in particular the importance of ‘normalisation’ of the psychological reactions to such chronic and/or life threatening diagnoses; the complex dynamics emerging from the interface between the effects of illness in the subjectivity of the ill person and the grief experienced by the other family members; different family members’ narratives of the illness; relevant community contexts; and, lastly, ways to help the family members and/or the ill person navigate the medical system including the use of second opinions, cyberspace information, and other systems in their ecology, such as the spiritual dimension. Some aspects of children's narratives of illness are also identified. The paper has been organised around the dialogue that the authors had around one of their clinical cases.     

German family policy at the crossroads: analysing the impact of parental leave reform through simulation

Comparative studies of welfare reforms encounter two problems. First, the counterfactual problem is that in the real world schemes and their reforms do not coexist simultaneously and are hard to compare. Second, the contextual problem derives from the absence of comparable measures for change. Microsimulation helps to overcome these problems. It compares policy options – actual reforms or reform plans – simultaneously and provides a comparable measure: the disposable income of model families. This article uses a type–case approach to investigate recent reforms of the German parental leave benefit. Simulation makes those reforms comparable over time and across countries. Results show that the profile of the German scheme is changing from 'general family' towards 'dual-earner' support. Furthermore, the recent reforms make the German scheme converge towards the Swedish leave scheme. The recent reforms introduce a new concept of fairness and a focus on gender equality to German family policies.     

Perceived Equity in the Gendered Division of Household Labor

Despite huge imbalances in the division of housework between women and men, previous studies have found perceptions of equity on the part of women to be much more frequent than feelings of injustice. Taking a comparative perspective on the basis of International Social Survey Program (ISSP) 2002 data (N = 8,556), we find that, on the individual level, the explanatory frameworks that have been found to influence the actual inequality of household division of labor (time availability, resource dependence, and gender ideology) contribute to the explanation of perceptions of equity, in that they interact with the inequality of the household division of labor. On the country level, the gender‐wage ratio and the average level of inequality are important predictors.     

Welfare analysis of a tax reform for Germany: a comparison of the unitary and collective models of household labour supply

We compare results of a tax reform analysis obtained with the collective and unitary models of household behaviour. We simulate real world micro-data by means of a collective approach, using a compound procedure of estimation and calibration based on the 1998 wave of the German socio-economic panel. We estimate a unitary model on this ‘collective’ data set. Investigating a move from joint to individual taxation on the basis of both models, we obtain important discrepancies between predicted adjustments to labour supply and distortions in the welfare analysis of the reform on the basis of unitary estimates.