American journal of psychiatric rehabilitation最新文献

A pilot study of Veterans with serious mental illness assessed fidelity and preliminary outcomes of peer specialist (PS)-delivered Cognitive-Behavioral Social Skills Training (CBSST). A single-arm, baseline-post pilot involved 4 PSs and 12 Veterans, split between two sites. Five functioning and symptom measures were administered before and after the 12-week intervention. Half of all sessions were rated on a standardized fidelity measure. Four outcomes (symptoms, hope, defeatist attitudes, skill learning) showed statistically significant improvement. Effect sizes and fidelity ratings matched previous trials with the training, and the fidelity ratings exceeded the threshold for competence. Although more research is needed, PSs could improve services for serious mental illness by delivering structured interventions.

Procedures to determine when people receiving disability payments are incapable of managing their money recently have been re-examined by the Social Security Administration. Understanding the time-course of financial capability is necessary because people who are judged capable of managing their funds at one point may go on to need supports in the future, and those judged incapable and assigned a fiduciary will need re-evaluation so they have the most possible autonomy over their funds management. The financial capability of 132 individuals was examined during acute treatment and twenty-four weeks later. The extent to which baseline variables predicted future capability were examined. More participants were assessed as financially incapable at baseline (n=72) than at the twenty-four-week follow-up (n=43). Most participants had stable capability across assessment periods (n=35 remained incapable; n=52 remained capable), however a substantial minority (n=37) moved from incapable to capable. People who transitioned from incapable to capable had greater net reductions in psychiatric distress ratings and days of alcohol use from baseline to follow-up, compared to people who remained incapable. In multivariate analyses, incapability at follow-up was predicted by having been rated incapable at baseline, drug use at baseline, and having a psychotic disorder. The high baseline rate of incapability determinations suggests that admission into intensive psychiatric programs may be a good time to assess an individual's financial capability. However, these findings also suggest the importance of periodically reassessing beneficiaries' capability because high proportions rated incapable were rated to be capable twenty-four weeks later.

This qualitative study examines the delivery of person-centered care in Medicaid-funded supportive housing for adults with serious mental illness. While much work has been done to promote the uptake of a person-centered approach in healthcare, less is known about how this approach functions in homeless services and supportive housing where many individuals with mental health issues receive rehabilitative services. A total of 84 semi-structured interviews were collected from a purposeful sample of 35 frontline providers. Transcripts were analyzed inductively using Boytazis' thematic analysis. Three principle themes characterize the dilemmas experienced by street-level workers in these programs: (1) Putting the "consumer first" vs. achieving maximum billing; (2) Doing the "real work" vs. paperwork; and (3) Juggling clinical supervision vs. administrative oversight. In order to meet the demands of Medicaid, as well as the expectation for person-centered care delivery, providers enacted several discretionary strategies at the street-level: (1) Staying late and taking work home; (2) Padding the numbers; (3) Offering service recipients small choices; (4) Redirecting small talk to get to billable goal talk; and (5) Keeping consumers home. Findings highlight tensions between the accountability-focused fee-for-service model and the prioritization of consumer choice and individualization of services in person-centered care delivery.