Client retention in residential drug treatment for Latinos

Client drop out from treatment is of great concern to the substance abuse field. Completion rates across modalities vary from low to moderate, not ideal since length of stay has been positively and consistently associated with better client outcomes. The study explored whether client characteristics shown to be related to retention were associated with treatment completion and treatment duration for a sample of 164 Latino substance users who entered a culturally focused residential program. In-person client interviews were conducted within a week of program admission. Logistic regression analysis was used to examine research questions. Clients most likely to drop out had self-reported co-occurring psychiatric diagnoses; they were 81% less likely to complete the program, suggesting that clients with mental health problems have a more difficult time remaining in residential treatment. Clients using drugs in the three months prior to entry were three and a half times more likely to be in the shorter stay group, and clients who lived in institutions prior to program entry were three times more likely to be in the longer-stay group. Factors contributing to drop out for this Latino sample were similar to those identified in the literature for non-Latino samples. Methods for addressing the needs of clients with co-occurring disorders are discussed.     

Diagnostic sequence of cocaine use disorder in relation to other mental health conditions among college students

Abstract

Objective: Cocaine use is increasing. Comorbidities and diagnostic sequencing are needed among college students to inform treatment of cocaine use disorder (CUD). Method: Using electronic medical records from the psychiatric clinic at the student health care center of a large, public university from 2005 to 2015, patients diagnosed with CUD were identified. Their top mental health conditions were identified and assessed to see whether the first diagnosis of these conditions was made (1) before, (2) at the same time as, or (3) after the first diagnosis of CUD. Results: Among the 50 CUD patients, their most common mental health comorbidities were alcohol use disorder, anxiety, depression, and cannabis use disorder. Anxiety and depression were likely to be diagnosed before CUD; alcohol and cannabis use disorders were likely to be diagnosed concurrently with CUD. Conclusion: Diagnostic sequencing can be used to inform screening, workup, and treatment for patients with CUD.     

Psychiatric Rehospitalization of Children and Adolescents: Implications for Social Work Intervention

This study explored factors associated with the psychiatric rehospitalization of children and adolescents. A retrospective archival review was conducted on 403 children and adolescents admitted into an inpatient psychiatric hospital. Results indicated that 16% were readmitted in the same year. Children and adolescents who had a prior history of psychiatric rehospitalization, lived in a residential treatment facility, and had a diagnosis of oppositional/defiant or conduct disorder were more likely to be rehospitalized. Psychosocial factors must be considered in predicting and preventing psychiatric rehospitalization. Clinical social workers should include therapeutic foster care as an option for aftercare placements of youth exhibiting externalizing behaviors and/or with a history of multiple restrictive care placements.     

Cytochrome P450 testing for better psychiatric care

Genotyping for CYP2D6 and CYP2C19 variations is emerging as a potentially useful clinical tool to help mental health professionals prescribe psychiatric medications for their patients. Cytochrome P450 testing uses a blood sample to determine an individual's required dosage of identified drugs that are metabolized by the two enzymes. To provide care for patients and families, nurses should be able to demonstrate identified essential nursing competencies related to genetics and genomics, which include an understanding of cytochrome P450 testing. As patient advocates, nurses are expected to understand how to identify patients most likely to benefit from CYP2D6 and CYP2C19 testing, how to ensure informed consent for such testing, and how to educate patients about testing and test results.     

Homeward bound. Broadening student experience with home visits

1. Because of patients are rapidly discharged after medication stabilization or crisis resolution, tertiary care in the home is emerging as an integral part of current psychiatric care. Students miss a valuable opportunity to participate in psychosocial rehabilitation if the clinical rotation is limited to an inpatient setting. 2. Guiding the client toward mental stabilization is the process of psychiatric care; outcomes are most apparent in the home. 3. Nursing is moving into psychiatric case management and continues to provide home care as a traditional role. Student home visits promote awareness of nursing responsibilities to families beyond the institution.     

Report on the cost-benefit/effectiveness of treatment at the Johns Hopkins Center for Pathological Gambling

It is mandatory that programs, particularly social programs, generate evidence of efficacy, safety, and cost-effectiveness of the treatment of illness. Thus a study was conducted to determine the cost-effectiveness of treatment of pathological gamblers at the Johns Hopkins Center for Pathological Gambling. This Center provides two types of treatment programs: an intensive residential program, and an out-patient program. Although abstinence is but one measure of the success of these programs, they have demonstrated an 80 percent and 90 percent abstention rate respectively, measured at an average of six months after completion of treatment for the residential programs and after six months while in treatment in the out-patient program. Similar high success rates were obtained for the stabilization, maintenance, and/or restoration of families, initiation and maintenance of restitution, indictments saved by restitution or other plans, and return to employment. Data from the Johns Hopkins Center for Pathological Gambling, indicates the benefit to cost ratio of treatment in excess of 20:1. Pathological gambling not only ranks amongst the most expensive illnesses afflicting society, but also is the least expensive to treat and the most cureable when treated. Without public education, and awareness, and without dollars for treatment and research, untreated pathological gambling will far surpass the costs of other catastrophic illnesses as the latter remain the focus of our health care expenditures while the former is ignored.     

Benefits of psychosocial rehabilitation programming in a treatment mall

Psychiatric patients need educational interventions that help them recover and increase their ability to live and work independently following discharge from the hospital. The psychosocial rehabilitation treatment mall model is designed to meet this educational need. Treatment malls are a new approach to psychosocial rehabilitaion for patients in state psychiatric hospitals. Treatment malls provide psychoeducation and skill-building activities in a centralized, school-like setting for participants from all patient care units. It differs from traditional strategies that use decentralized one-on-one or unit-based models. Treatment malls provide a self-directed learning experience that meets the person-centered needs of participants. Evidence is increasing that this psychosocial educational model can provide lasting benefits for psychiatric patients, including symptom management, reduced psychiatric hospital readmission rates, and improved quality of life.     

Ethnicity, Marginalisation and Mental Illness in Hawaii

This study examines the characteristics, treatment and care of severely and persistently mentally ill patients at Hawaii's largest public sector psychiatric facility, Hawaii State Hospital. The implications of this information are then discussed, in terms of treatment and care. Consistent with previous studies, the 88 patients included in this study were most often male, less than 40 years of age, with a high school education or less, and hospitalized under a penal code. More remarkable variations were revealed, however, when patients were grouped according to ethnicity and racial origin. For example, patients from marginalised groups had a significantly higher likelihood of violence than patients from more politically, economically and socially powerful groups in Hawaii. The findings of this research challenge health care providers in general, and nurses in particular, to combine social advocacy with clinical expertise to ensure that patients receive effective and complete treatment and care.     

Logs as adjuncts to therapy for adolescents in a residential psychiatric program

As part of a 3-year ethnography of an adolescent residential psychiatric program, staff, patients, and occasionally family members were observed communicating using written logs. Using participant observation and opportunistic interviewing, and reading the logs, the researcher was able to determine the advantages, disadvantages, and direct value of the logs to patients and staff. Logs, when used judiciously after patient assessment, demonstrated patient responsiveness to treatment and promoted patient-centered care. Writing in logs increased patients' identification of thoughts and feelings, mirrored their developmental state, and demonstrated staff members' skills in communication. They are an invaluable adjunct to therapy for certain adolescent patients.     

Evaluation of a Goal Attainment Program using the Goal Attainment Scale for Psychiatric In-patients in vocational rehabilitation

The purpose of this study is to evaluate the newly developed clinical protocol "Goal Attainment Program" to assist psychiatric in-patients in Hong Kong to formulate realistic life goals, with a view to shortening their length of stay and motivating them to join in work rehabilitation. The Goal Attainment Scale for Psychiatric In-patients was validated and used to evaluate the change in life goals after attending the four-session Goal Attainment Program. The validated 10-item version of the Goal Attainment Scale for Psychiatric In-patients (GASPI-10) was found to have good inter-rater reliability (rho_{I} ranged from 0.64 to 0.88,p < 0.01; N = 26) and internal consistency (alpha of rater 1 = 0.92, rater 2 = 0.87, N = 26). Twenty-five chronic psychiatric in-patients of Castle Peak Hospital in Hong Kong completed the Goal Attainment Program and were assessed using a pre and post-test quasi-experimental design. The T-score computation of GASPI-10 indicated that 92% of patients showed improvement in goal attainment. Some 92% of patients stated that they were willing to leave hospital, and 72% of participants planned to seek paid employment upon discharge after completion of the program. The overall results of this study verified the effectiveness of the Goal Attainment Program in instilling hope in chronic patients with schizophrenia and the use of the Goal Attainment Scale in documenting patients' progress.     

Predicting program success for adult offenders with serious mental illness in a court ordered diversion program

ABSTRACT

Individuals with mental illnesses are disproportionately involved with the criminal justice system and are now being diverted from jails to community-based supervision. This study examines secondary data from a state hospital, mental health diversion program. Logistic regression was used to examine risk factors that best predicted successful program completion. Results indicate that non-whites are more likely to complete. Participants in supervised housing, ever been re-hospitalized, diagnosed with a depressive or psychotic disorder or who had their probation revoked were less likely to complete. Findings indicate practitioners should provide a holistic and individually oriented treatment approach for success.     

Experience in developing a Transitional Employment Program (TEP) for the psychiatric patients in an acute general hospital in Hong Kong

This paper describes the application of a transitional employment program (TEP) for psychiatric patients in Hong Kong. The TEP and its values in psychiatric rehabilitation are introduced. The differences between TEP and Supported Employment (SE) were also highlighted. A TEP for psychiatric patients in an acute general hospital is outlined. Interviews of employer and trainees showed that, apart from increasing income, qualitative changes in the trainees were observed such as increased self-confidence, improved assertive and social skills, and increased work tolerance. Ongoing objective measurement should be conducted to demonstrate its effectiveness. TEP could be considered as a feasible alternative of vocational rehabilitation for patients with mental illness.     

High incidence of disability pension with a psychiatric diagnosis in western Sweden. A population-based study from 1980 to 1998

Regional differences in Sweden in the prevalence of disability pension with a psychiatric diagnosis are unexplained, in spite of the significant impact on the population's health, rehabilitation systems, and the health care system. The purpose of this study was to describe the pattern of disability pensions with a psychiatric diagnosis and to analyze the impact of age and gender. We examined the incidence rates in one urban and one semi-rural region and compared these to national rates. The study sample was drawn from employed persons between 16-64 years of age who, because of their sickness insurance coverage, would be eligible to access disability pensions should it be necessary. Analysis of annual incidences and standardized morbidity ratios were made for 1980, 1985, 1990, 1995, and 1998. Data on disability pension cases were collected from the National Social Insurance registers. In the urban region we found that the proportion of men and women clearly outnumbered the national average: approximately twice the number of persons between 16-64 years of age with a psychiatric diagnosis were receiving a disability pension. In the semi-rural region there were fewer men overall on disability pensions with psychiatric disorders, but in 1980, 1985, and 1995 women clearly outnumbered men. Access to psychiatric care, unemployment, alcohol dependence, and previous sickness absence are suggested as possible factors that might affect the rates of disability pension in different geographical settings.     

The Worker Role Interview: a powerful tool in Icelandic work rehabilitation

A pilot-study using the Worker Role Interview (WRI) was conducted to gather information from clients attending a work- rehabilitation program in an Icelandic psychiatric center. The work rehabilitation program traditionally used a performance-capacity-oriented assessment (PCA) to evaluate work readiness. Clients scoring 90% or higher on the PCA were considered able to re-enter the job market. However, scoring over 90% did not result in automatic return to work for the majority of clients. As a result, many questions were proposed about the effectiveness of the PCA to predict client ability to re-enter the work force. A pilot study using the Worker Role Interview was conducted with an aim to gain insight into what barriers prevented clients from entering the work force. Ten clients scoring 90% or over on the PCA were interviewed using the WRI. Qualitative methods were used to analyze the data. Results from the WRI indicated that clients failed to join the work force due to a number of psychosocial factors, such as lack of personal causation and self-efficacy combined with environmental factors. The WRI provided clients with an opportunity to express their attitudes and opinions towards work. Information gained through the WRI also gave new direction in goal setting for the work rehabilitation program and validated the need to expand occupational therapy services.     

The status of older adolescents at exit from out-of-home care.

Administrative data and case record reviews were used to assess the exit status of a sample of older youths leaving out-of-home care in one midwestern state. Results show that most left without a job or a high school diploma, and that many left with neither. The most common living arrangement at the time of exit was with relatives, some through planned reunification and some through unplanned reunification. The majority of the youths exited out-of-home care in unplanned ways. The number of placements and the completion of high school predicted employment status. High school completion was associated with age and a history of inpatient psychiatric care, running away, and mental retardation. Implications for independent living programs for older youths are discussed.     

Teaching hospitalized patients with serious, persistent mental illness.

1. Although patient teaching is an important nursing function, minimal research was found related to education of patients with schizophrenia. Teaching psychiatric patients about illness, treatment, and rehabilitation has not received the same attention in psychiatric nursing as it has in other nursing specialties. 2. Eighty percent of the patients who participated in patient education classes would recommend the program to others. Treatment teams reported that some patients asked more questions about their treatment and became more active in ward groups following the classes. 3. The use of nurses as patient educators facilitates professional nursing practice and effectively ensures that patients' general physical health and psychiatric education needs are systematically addressed.     

Home visiting program impacts on reducing homelessness among young mothers

In the current study, we aimed to determine the effects of Healthy Families Massachusetts (HFM), a statewide home visiting program, on young mothers’ experiences with homelessness during enrollment and after program completion. Data were drawn from a longitudinal, randomized control trial evaluation of HFM. Data collection occurred across 5 time points between 2008 and 2015 from a sample of 704 participants. The current analyses were restricted to a subsample of mothers (n?=?443) with Time 5 data (74 months post-enrollment; 59.1% program, 40.9% control), which was representative of the Time 1 sample. We used data from maternal phone interviews to assess program effects on experiences with homelessness. Young mothers who participated in HFM were less likely to experience homelessness when their children were preschool-age or older than mothers in the control group. During program participation, the number of home visits was negatively associated with concurrent homelessness when children were infants or toddlers.     

Brief admission program. An alliance of inpatient care and outpatient case management

1. Brief planned and crisis admissions to an inpatient psychiatric unit are presented as a component supportive of outpatient care and case management for chronically mentally ill patients. 2. Typical patients admitted to this inpatient short-term program are those experiencing a life stress or temporary crisis; chronically mentally ill patients who cycle and experience exacerbations of their illness; and those who need to make the transition from an acute inpatient unit to community living. 3. The Brief Admission Program treats the individual's response to and the consequences of a lifelong illness and enables the patient to return to his previous level of functioning and continue necessary outpatient treatment.     

Stereotypies as behavioral indices in mental patients

Stereotypies, defined here as monotonous and undirected behaviors (e.g., walking in place, foot swinging) were observed in inpatients at an intensive-treatment psychiatric center. Stereotypies were found to be especially sensitive to situations; the most stressful contexts produced the most stereotypies. In situations that seemingly made patients anxious, stereotypies were repetitive and typically took the form of incipient flight movements. In contexts where patients were apparently bored, their stereotypies were dominantly nonrepetitive and somewhat playful, suggesting a function of increasing arousal. Frequencies of stereotypies did not distinguish most diagnostic types (e.g., schizophrenia, organic brain damage) from each other. But stereotypies seemed to be markedly less characteristic of patients diagnosed as situation adjustment types, by far the most benign diagnosis of pathology represented in this sample. Overall, stereotypies showed promise as practical and reliable indices to be used as adjuncts to traditional measures of pathology.