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.     

Life satisfaction in China and consumption and income inequalities

This research uses nationally representative data to study how economic resources and inequalities are associated with life satisfaction of Chinese residents. We construct economic resource and inequality measures from expenditure rather than from income, after confirming that expenditure inequality is a better measure in the Chinese context. We find that economic inequalities in general are negatively associated with life satisfaction, and that this association is larger for inequalities in the lower half of the distribution than those in the upper half of the distribution. We further explore the mechanisms under which inequality can be associated with life satisfaction, and find that aspiration is potentially one important channel.     

Wealth and inheritance in Britain from 1896 to the present

Personal wealth has grown since the 1970s twice as fast in real terms as national income. Has this rise in the wealth-income ratio led to a corresponding increase in the wealth being passed on from one generation to the next? Are we returning to the levels of inheritance found in the 19th century? The aim of this paper is to construct UK evidence on the extent of the transmission of wealth in the form of estates and gifts inter vivos. It takes a long-run view of inheritance, starting from 1896, when the modern Estate Duty was introduced, and exploits the extensive estate data published over the years. Construction of a long-run time series for more than a century is challenging, and there are important limitations. The resulting time-series demonstrates the major importance of inheritance in the UK before the First World War, when the total transmitted wealth represented some 20 per cent of net national income. In the inter-war period, the total was around 15 per cent, falling to some 10 per cent after the Second World War, and then falling further to below 5 per cent in the late 1970s. Since then, there has indeed been an upturn: a rise from 4.8 per cent in 1977 to 8.2 per cent in 2006. This increase was more or less in line with the increase in personal wealth, and has to be interpreted in the light of the changing net worth of the corporate and public sectors of the economy.     

From classes to copulas: wages,capital, and top incomes

Public debates about the rise in top income shares often focus on the growing dispersion in earnings, and the soaring pay for top executives and financial-sector employees. But can the change in the marginal distribution of earnings on its own explain the rise in top income shares? Are top executives replacing capital owners in the group of top-income earners, or are we rather witnessing a fusion of top capital and top earnings? This paper proposes an extension of the copula framework and uses it for exploring the changing composition of top incomes. It illustrates that changes in top income shares can easily be decomposed into respective changes in the marginal distributions of labour and capital income and the changing association between the two types of income. An application using tax record data from Norway shows that the association between top labour and capital incomes grew stronger between 1995 and 2005 in the top half of the wage and capital income distribution, though it declined for the top 1% of capital income receivers. A gender decomposition demonstrates that the association of wage and capital incomes at the top is particularly striking for men, whilst women are largely under-represented in the top halves of the two marginal distributions.     

Tracking of sport and exercise types from midlife to old age: a 20-year cohort study of British men

Background

Previous physical activity (PA) tracking studies have examined the stability of overall PA and/or PA types, but few have investigated how specific types of sport/exercise track over the life course. The aim of this study was to determine how specific sports/exercises in midlife track and predict future sport/exercise and PA in men transitioning to old age.

Methods

Seven thousand seven hundred thirty-five men (aged 40–59?years) recruited in 1978–80 were followed up after 12, 16 and 20?years. At each wave men self-reported participation in sport/exercise. Frequent sport/exercise participants (>?1/month) reported the types of sport/exercise they engaged in. Men also reported total PA, health status, lifestyle behaviours and socio-demographic characteristics. Stability of each sport/exercise was assessed using kappa statistics and intraclass correlation coefficients. Logistic regression estimated the odds of participating in sport/exercise and being active at 20-year follow up according to specific types of sport/exercise in midlife.

Results

Three thousand three hundred eighty-four men with complete data at all waves were included in analyses. Tracking of specific sports/exercises ranged from fair to substantial, with golf being the most common and most stable. Bowls was the most frequently adopted. Odds of participating in sport/exercise and being active in old age varied according to sport/exercise types in midlife. Golf and bowls in midlife were the strongest predictors of sport/exercise participation in old age. Golf, cricket and running/jogging in midlife were among the strongest predictors of being active in old age. Compared to participating in just one sport/exercise in midlife, sampling multiple sports/exercises was more strongly associated with sport/exercise participation and being active in old age.

Conclusion

The stability of sport/exercise participation from midlife to old age varies by type. Specific sports/exercises in midlife may be more likely to predict future PA than others. However, participating in a range of sports/exercises may be optimal for preserving PA into old age.

     

Influence of socioeconomic status on changes in body size and physical activity in ageing black South African women

Background

The increasing prevalence of obesity in sub-Saharan African women is not well understood, and black South African women in the region are particularly vulnerable. This study aimed to examine whether the relationship of socioeconomic status (SES) with changes in body mass index (BMI) and waist circumference (WC) is mediated by physical activity in ageing African women.

Methods

In a longitudinal analysis of the 518 caregivers associated with the Birth to Twenty Plus study, the role of SES associated with 10-year changes in BMI and WC was tested using structural equation modelling (SEM). The degree of mediation of moderate-vigorous physical activity (MVPA) and sitting time in this association was also assessed.

Results

The prevalence of obesity increased significantly from baseline to follow-up (p?<?0.0001). In the SEM models, baseline SES had a direct positive effect on changes in BMI (β, 95% CI, 0.02 (0.005 to 0.04), and a direct negative effect on changes in MVPA (β, 95% CI, ??3.81 (??6.92 to ??0.70). Baseline MVPA had a direct negative effect (β, 95% CI, ??0.002 (??0.003 to ??0.0003) and indirect positive effect via change in MVPA (β, 95% CI, 0.01 (0.0001 to 0.001) on change in WC.

Conclusions

Our study demonstrates the role and interaction of sociodemographic and behavioural predictors of obesity, and suggests a multifaceted approach to management of the crisis in communities of ageing urban African women.

     

The Effects of Merit-Based Scholarships on Educational Outcomes

This paper analyzes the effect of a statewide merit-based scholarship program on educational outcomes in Arizona. It tests whether Arizona’s Instrument to Measure Standards (AIMS) scholarship has an effect on a comprehensive set of educational outcomes such as the number of applicants, student admissions, first-year first-time enrollment, ACT scores of entering freshman, retention rates, as well as on the level of tuition and fees at the three schools targeted by the program; Arizona State University, University of Arizona and Northern Arizona University. Both difference-in-differences estimation as well as synthetic control methods shows that AIMS has an economically and statistically significant effect enrollment. Enrollment effects are greatest among African American and Hispanic students and are significant for both men and women. While point estimates suggest that AIMS also lead to increases in tuition and fees, these results are not robust to placebo tests.     

Parent–Child Positive Touch: Gender,Age, and Task Differences

This study examined gender, age, and task differences in positive touch and physical proximity during mother–child and father–child conversations. Sixty-five Spanish mothers and fathers and their 4- (M = 53.50 months, SD = 3.54) and 6-year-old (M = 77.07 months, SD = 3.94) children participated in this study. Positive touch was examined during a play-related storytelling task and a reminiscence task (conversation about past emotions). Fathers touched their children positively more frequently during the play-related storytelling task than did mothers. Both mothers and fathers were in closer proximity to their 6-year-olds than their 4-year-olds. Mothers and fathers touched their children positively more frequently when reminiscing than when playing. Finally, 6-year-olds remained closer to their parents than did 4-year-olds. Implications of these findings for future research on children’s socioemotional development are discussed.     

Identifying Mental Disorder from the Faces of Women with Borderline Personality Disorder

Although appearance-based cues can help to diagnose physical illness, visual manifestations of mental disorder may be more elusive. Here, we investigated whether individuals could distinguish women with a serious mental disorder (borderline personality disorder) from demographically- and IQ-matched non-psychiatric controls. Participants rated mentally ill targets as more likely to have a mental disorder from photos more accurately than chance, despite not believing that such judgments were possible. The configuration of facial cues played an important role in these judgments, as interfering with the spatial relationships between facial features reduced participants’ accuracy to chance guessing. Further investigation showed similar results when participants rated the targets for specific mental disorders (borderline personality disorder, major depressive disorder) and rated the mentally ill targets as more depressed, angry, anxious, disgusted, emotionally unstable, distressed, and less happy. Moreover, the depression ratings significantly correlated with the targets’ actual depressive symptoms. Thus, individuals may be able to infer aspects of mental disorder from minimal facial cues.     

Speaking Out: Youth Led Research as a Methodology Used with Homeless Youth

Participatory action research is well documented with marginalized groups, but less is known about participatory action research with homeless youth. The use of youth led research as a methodology was examined among a population of homeless youth. Peer researchers (n = 10) reported on their experience utilizing youth led research methodology. Results indicate that youth led research is a promising methodology for use among homeless youth. Participants reported that the approach positively impacted the quality and quantity of data that could be collected from participants. Further, peer researchers reported individual benefits of feeling that participating in the project mattered, that people listened to them and that they had a voice.