Employment services for persons with serious mental illness in northeastern Ontario: The case for partnerships

Objective: To better understand why employment success is low, a case study was conducted to examine the influence of place on access to employment for persons with serious mental illness (SMI) residing in two northeastern Ontario communities (Rebeiro, in progress). Methods: Community-based participatory research methods were used to engage persons who experience SMI, decision-makers and providers in the research. Forty-six interviews were conducted, complemented by primary and secondary quantitative data sources.Results: While most consumers consider employment to be a key element of their recovery, employment rates for persons with SMI remain limited in northeastern Ontario, Canada. The findings of this case study reveal the importance of collaborative partnerships to fostering better employment outcomes in northeastern Ontario. Conclusion: The challenges of collaboration due to rural and northern tensions, as well as various jurisdictional and funding tensions existing at the level of community support the case for partnerships in the provision of employment services in northern and rural places.     

Facilitators and barriers to employment: the perspectives of people with psychiatric disabilities and employment service providers

This study examined the perspectives of people with psychiatric disabilities and employment service providers regarding factors that most directly help or hinder consumer efforts to obtain and maintain employment. Forty-four adults with serious mental illness (SMI) (consumers) and 30 providers participated in 12 focus groups across Massachusetts. We began both consumer and provider groups by posing two broad questions: 1) what factors most help people with SMI get and keep jobs (facilitators), and 2) what factors most prevent people with SMI from getting and keeping jobs (barriers)? Data were analyzed qualitatively and both person and environmental factors were highlighted. Among facilitators, participants agreed that quality consumer-provider relationships and individualized employment services are most instrumental in helping consumers achieve employment goals. Participants identified a range of environmental barriers, including issues related to the service system, entitlement programs, non-human resources, and social stigma. Implications for services are discussed.     

An Evaluation of a Community Collaboration Approach to Psychosocial Rehabilitation

ABSTRACT

This article reports on the results of a multiagency collaboration demonstration project that was designed to replicate the salient features of an exemplary practice, single-agency program of psychosocial rehabilitation for persons with serious mental illness (SMI). The community collaboration extended over two phases for 2 years and involved over 20 mental health service providers. The demonstration project itself was designed to be a replication of the Village Integrated Services Agency (Village ISA) of Long Beach, California. Additionally, this article reports the results of a rigorous evaluation of the project. The treatment group outcomes were substantially superior to all control group measures at or beyond the 0.05 level of significance. With due regard for limitations imposed by a small sample size (n = 50), the project demonstrates that the replicated model of intervention can be effectively implemented through a collaborative organizational structure involving a coalition of agency service providers.     

Maximizing potential: innovative collaborative strategies between one-stops and mental health systems of care

Barriers to seamless service delivery between workforce development and mental health systems of care have kept both entities from maximizing their potential in regards to employment for job seekers with mental illness who are capable of work and seeking employment. Using a multiple case study design, this study examined the nature of collaboration between workforce development and mental health systems to understand the policies and practices in place to assist individuals with mental illness to find and keep work. The paper presents innovative strategies that involved staff from both workforce development and mental health agencies. Findings from this research identified the following collaborative strategies: (a) the creation of liaison positions and collaborative teams; (b) staff training on mental health and workforce issues; and (c) multi-level involvement of individuals with mental illness. Implications for workforce professionals are offered as a way to stimulate implementation of such strategies.     

Barriers to Utilization of Mental Health Services amongst Male Child Sexual Abuse Survivors: Service Providers’ Perspective

ABSTRACT

Most research on child sexual abuse has been on survivors to the exclusion of service providers. This paper focuses on one group of findings from a larger qualitative study. The aim of the paper is to identify existing services and highlight the gaps in the current programs available for male CSA survivors from the perspective of service providers. Semi-structured interviews were conducted with 11 mental health service providers, recruited from two Southern and Central Ontario cities. Findings presented here report service providers’ perspective of gaps in services for male CSA survivors. “Limited Male CSA Programs”, “Institutional Barriers”, “Attitudinal Barriers”, and “Systemic Gaps” emerged as four major themes from the data analysis. Findings demonstrate the need to re-evaluate currently available service and highlights gaps in mental health service available for male CSA survivors. Implications for policy, practice, and research are discussed.     

Physical health decision making and decision aid preferences of individuals with severe mental illness

Individuals with severe mental illness (SMI) often suffer from comorbid physical health conditions that reduce quality of life and longevity. The integrated care movement has improved access to primary care services, but system change does not necessarily impact health behaviors. In an effort to better understand health behaviors of persons with SMI in integrated care, we explored physical health decision making and decision aid preferences. We conducted three focus groups, including two consumer groups and one mental health staff group. Data were analyzed using a grounded theory approach, employing independent coding, thematic analysis, and meaning-making processes. Data suggest that overall, the consumer groups preferred a shared decision making process, with the doctor making the final treatment decision. Staff indicated that decision making depended on a consumer’s functioning level. Consumers liked the idea of using a decision aid, and reported preferring the computerized aid. Staff felt that decision aids were dependent on consumer level of functioning. Consumers generally view primary care doctors as experts, but like the idea of using decision aids to assist in making medical decisions. Staff feel that consumers may need help in both decision making and decision aid use in primary care.     

Necessary Steps in Designing a Successful Contract

Abstract

Parents with a history of serious mental illness are vulnerable in many ways and are therefore likely to be accessing services from a range of government and community agencies. The use of multiple services, sometimes with conflicting practice frameworks, can result in sub-optimal management of these families. This study surveyed 77 service providers from a range of government and non-government agencies targeting their views regarding parents with a serious mental illness (specified in this study as schizophrenia, bipolar disorder and psychotic depression). They were asked what they perceived were difficulties for this population, interventions required to meet the needs of this group and finally, barriers to effective service delivery. We found that service providers reported that current services were inadequate for these parents. Parent-based interventions were seen as being more beneficial than those targeting children. Lack of liaison between agencies and lack of coordinated service provision were seen as the greatest barrier to effective service delivery. The results highlight the need for policy planners and service providers to develop strategies to ensure effective coordination between services that work with this population.     

The Decision-Making Context and Its Impact on Local Human Service Nonprofits

One significant factor affecting an organization's functioning is the decisions made by other organizations that are important to it. We examine decision-making in three local human service delivery nonprofits, focusing on the level (local versus national) of the actors making decisions as well as the degree of horizontal or vertical coordination among decision makers. The findings show that the decision-making context affects nonprofit structure and operations and suggest that providers may have to make significant trade-offs as they seek to restructure in response to policy changes such as devolution.     

Military EAPs:

A review of recent developments and future trends in military family services is of interest since the military is the largest single employer in the United States, providing health, mental health, recreational and social services to an estimated 13.2 million persons or over 5% of the national population. Rapid program development is taking place in the military, focused on services to the total family for the purpose of supporting the well-being of active duty personnel. This paper examines several issues related to the growing opportunities for social workers in military family services, including potential values conflicts, needs assessments, relations between military and civilian service providers, and avoiding culture shock.     

Managing physical and mental health conditions: Consumer perspectives on integrated care

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses (SMI) manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness, and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.     

Engaging Experts: Expanding Participation and Enhancing Research in Chinese Eldercare Institutions

Due to the myriad factors straining China’s traditional family-based eldercare system, today unprecedented numbers of older adults are turning to institutions for caregiving needs. As researchers and policy makers organize conferences, analyze trends, and allocate resources, the subjective experiences of elders themselves are often forgotten or ignored. While providers recognize that institutionalized elders are at an increased risk for mental health issues, most cite personnel and resource shortages as insurmountable barriers to provision. Using examples from ethnographic research in Chinese eldercare institutions, this article examines the link between participation and mental health for contemporary Chinese elders and makes a case for expanding the role of elders in research in order to improve both the experience and understanding of institutional eldercare.     

Alzheimer's Disease:

Alzheimer's disease and other dementias are increasingly being recognized as important problems for older persons and their caregivers, but these disorders are rarely discussed in the context of elder abuse and neglect. This paper reviews information on the prevalence and clinical characteristics of Alzheimer's and other dementias and on the unique stresses experienced by Alzheimer's caregivers. Patients with Alzheimer's are often misdiagnosed and not accurately identified within medical and social service systems, and the special problems faced by caregivers and patients are not sufficiently addressed. Recommendations that would make clinicians and policy makers more responsive to Alzheimer's patients and their families are discussed.     

An Employment Project as a Route to Social Inclusion for People with Learning Difficulties?

Government policy to reduce social exclusion focuses on increasing employment opportunities and incentives, especially for disadvantaged groups. This paper discusses the findings of an evaluation of a project in the North West of England for people with learning difficulties, which sought to create opportunities for paid and/or integrated employment. The findings suggest that this goal can be undermined by many factors such as the isolation of social care services from employers and the disinclination of service organisations to include users, carers and staff in the development of new service approaches. Social welfare policies also mitigate against this aim, by failing to enable providers to translate the rhetoric of social inclusion into a reality. We discuss some of the obstacles preventing people with learning difficulties from inclusion into mainstream employment, by considering their impact upon the achievements of the North West project.     

Subjective distress from trauma in older clients with severe mental illness

There is little research on older persons with severe mental illness (SMI) who have experienced trauma. We conducted an exploratory study with 174 community mental health clients with SMI who were 50 years of age or older (range 50–87; mean age 58) to examine the relationship between subjective distress related to six common traumas and post-traumatic stress symptoms while controlling for gender and other key psychiatric symptoms. With regression analysis, we found that of the six common traumas, only distress from unexpected loss of a loved one was significant. That factor accounted for the most variance in post-traumatic stress symptoms than all other factors in the model including gender, psychiatric symptoms of SMI, and other trauma. Gender and symptoms of psychosis were also significant in the model. Unexpected losses, particularly in older persons with SMI, can cause considerable emotional distress and could be related to post-traumatic stress symptoms. Practitioners should be vigilant in regularly screening older people with SMI for recent loss of loved ones and be prepared to address their distress with grief/bereavement counseling.     

Disentangling system contact and services: A key pathway to evidence-based children's policy

There is often a disconnect between the best available research and the policy decisions governing the functioning of large child-serving systems. This paper argues that this is, in part, due to conflating system contact with actual service provision. When outcomes are understood in terms of contacts as compared to services, this can lead to inappropriate or inadequate policy responses. Empirical data on contact and services for four large child-serving systems (child welfare, education, juvenile court, and mental health) are presented to illustrate this dilemma. Multi-sector services and need for collaboration are also briefly reviewed. Recommendations are made for improving data infrastructure and research to help bridge the gap between what policy makers see and actual system functioning. This is presented as a key step on the path to achieving evidence-based policy to support children's well-being.     

Translating collaborative models of mental health care for older adults: using Iowa's experience to inform national efforts

The Patient Protection and Affordable Care Act supports the translation of collaborative models of mental health care, but how the act will affect older adults remains unclear. The authors examined a sample of older Medicare beneficiaries and evaluated how individual characteristics, local service supplies, and other contextual features corresponded with the identification of older persons with psychiatric diagnoses and their access to specialty mental health care providers. Older adults presented a variety of psychiatric disorders, and their access and use of specialty mental health care related to age; sex; diagnosis; supply of mental health, health, and long-term care providers; and whether an older person lived in a rural area. Translation of collaborative models should consider a range of psychiatric conditions, adjust for varying local provider supplies, and consider the challenges in establishing collaborative care within rural areas.     

Age Segregation and the Quality of Life of the Elderly People in Studio Apartments

ABSTRACT

The paper attempts to ascertain the impact of age-segregation on the quality of life of elderly people who are living in studio apartments in Singapore. After a review of the relevant literature and statistical analysis of a survey data for 390 elderly respondents in studio apartments, it was found that age-segregation have a deleterious impact on the quality of life of the elderly people. Furthermore, it was found that the perception of the elderly in relation to factors that are most significant to their quality of life is at variance with that of the policy makers. This implies that there is a need for policy makers and service providers to review their existing policies, products and services so as to be more effective in providing housing options for the rapidly aging population of Singapore.     

Nonprofit's Use of Awards to Improve and Demonstrate Performance: Valuable Discipline or Burdensome Formalities?

Arrangements to certify that an organization's management systems meet standards of good practice are an increasingly prominent feature in the environment of public and private nonprofits. This paper reports an exploratory study of the issues that this phenomenon presents to managers and policy makers, drawing on the limited literature, and five case studies covering two different schemes. The main conclusions are that nonprofits can and do use these awards in very different ways, and hence the outcomes are diverse. These findings run counter both to the rational system assumptions on which such arrangements are based, and to the general thrust of institutional theory with its emphasis on isomorphism. Some implications for decision makers and future research are outlined.     

Single Mothers,Work(fare), and Managed Precariousness

Welfare-to-work initiatives represent a trenchant example of the expansion of the rules and norms of global capitalism and welfare residualism. A study of the everyday experiences of women who parent alone, this article is a case analysis of the residual welfare state as it functions according to the gendered and racialized logic of the market. I examine lone mothers' experiences of the design, delivery, and enforcement of workfare in Ontario, Canada. Specific attention is given to the operation of random and limiting employment-preparation programs; ambiguous and complex regulations; capricious and punitive service delivery; and managed precariousness. I conclude with a discussion of the ways in which women cope and resist, and a challenge to social service providers and policy makers.     

‘The Bad People Go and Speak to Her’: Young People’s Choice and Agency when Accessing Mental Health Support in School

Concerns about the mental health and well‐being of children and young people have been articulated in health and education policy fields as a call for closer working between schools and providers of mental health support services. Drawing from a Scottish study, this article explores issues of access, when mental health initiatives are sited in formal educational settings. In particular, it focuses on the implications for the agency of children and young people seeking support from those services when and how they choose. The study argues that over‐reliance on teachers as the main referral route to service influences what is deemed to be a problem, who is thought to need support and how the interventions are viewed by the children and young people. Alternative approaches are discussed, which offer opportunities for children and young people to explore the available services and make their own choices about their level of engagement.