Alexis D. Henry

Achieving the goal of evidence-based psychiatric rehabilitation practices for mothers with mental illnesses

There is a growing commitment to evidence-based practices in mental health. There is no well-articulated evidence base for interventions for mothers with mental illnesses. Parenthood is common among women with mental illnesses. Women themselves report motherhood is an important role. The risks of parental mental illness to children have been demonstrated; the challenges that motherhood brings to people with mental illnesses have been described. Because outcomes for both children and adults are multiply determined, there are many intervention opportunities. Recommendations for intervention are drawn from a focus group study and from the existing literature on parent training and support, exemplary programs for mothers with mental illnesses, and other evidence-based psychosocial interventions. The value of a psychiatric rehabilitation approach is highlighted. Challenges in documenting and testing interventions for mothers with mental illness include resource allocation and research innovation.

A qualitative study of programs for parents with serious mental illness and their children: building practice-based evidence

The rationale for the development of effective programs for parents with serious mental illness and their children is compelling. Using qualitative methods and a grounded theory approach with data obtained in site visits, seven existing programs for parents with mental illness and their children in the United States are described and compared across core components: target population, theory and assumptions, funding, community and agency contexts, essential services and intervention strategies, moderators, and outcomes. The diversity across programs is strongly complemented by shared characteristics, the identification of which provides the foundation for future testing and the development of an evidence base. Challenges in program implementation and sustainability are identified. Qualitative methods are useful, particularly when studying existing programs, in taking steps toward building the evidence base for effective programs for parents with serious mental illness and their children.

A Survey of Programs for Parents with Mental Illness and their Families: Identifying Common Elements to Build the Evidence Base

Little is known about the effectiveness of interventions for families living with parental mental illness. Existing interventions offer information about successfully implemented treatments, which may demonstrate effectiveness in research. In the current study, directors of programs for parents with mental illness and their families were interviewed. Qualitative analyses revealed noteworthy similarities with respect to target population; funding; community context; agency context; mission, theoretical orientation, and assumptions; locus of care and essential services; desired outcomes; and moderators. Program similarities were identified to provide parameters for research, and to contribute to the development of testable hypotheses. Family-centered, strengths-based approaches were identified across program directors as critical to intervention success.

Assessing Health Care Reform: Potential Effects on Insurance Coverage Among Persons With Disabilities

The changes enacted by the Patient Protection and Affordable Care Act are designed to substantially increase health insurance coverage. The authors analyze the health care reforms to assess the potential for increased insurance coverage among persons with disabilities. They estimate that approximately 2 million persons with disabilities will be newly insured; however, they also find a probable unintended consequence of the health care reforms: that some persons with disabilities will lose their current Medicaid coverage. The article outlines policy changes that would prevent this unintended consequence before full implementation of the changes in 2014.

Mobility Limitations Negatively Impact Work Outcomes among Medicaid Enrollees with Disabilities

IntroductionFear of losing health insurance is believed to be a significant work barrier for people with disabilities in the US. We examined the relationship of different types of daily activity limitations to work outcomes among adults with a variety of disabling conditions for whom the risk of losing health insurance has been removed by enrolling in a Medicaid buy-in (MBI) program.Methods1093 working-age adults with disabilities in the Massachusetts MBI program responded to the MassHealth Employment and Disability Survey, which provided data on the types of disabling conditions and activity limitations members experienced as well as three work outcomes––work status of members; annual earnings above substantial gainful activity of working members; and plans to work in the future of non-working members.ResultsAmong different types of activity limitations, mobility limitations were generally associated with poorer work outcomes, regardless of disabling condition. Across members in three disability groups––psychiatric; physical; and co-occurring psychiatric and physical––those reporting mobility limitations were significantly less likely to be working or, if non-working, to be planning work than those reporting no or other types of limitations. There was an exception to this pattern with respect earnings among working members. Overall, work outcomes among members with co-occurring psychiatric and physical disabilities were most consistently negatively impacted by mobility limitations.ConclusionsRehabilitation providers aiming to promote entry into the workforce need to be aware of the varied ways in which mobility limitations may create barriers for people with all types of disabilities.

A Generalizability Study of the Occupational Performance History Interview

In a previous project the Occupational Performance History Interview was developed and its reliability was studied. This paper reports the results of a study designed to examine the interviews reliability when used by therapists using one of two different frames of reference—model of human occupation and eclectic. Videotapes of 20 psychiatrically disabled subjects were rated by three registered occupational therapists within each frame of reference. Results indicated that the interview was only moderately stable under both conditions. Implications for further development of the interview are discussed.

Employer-recommended strategies to increase opportunities for people with disabilities

BACKGROUND: The employment rate among persons with disabilities is less than half the rate among persons without disabilities. Broad innovations are needed to reduce this disparity. OBJECTIVE: We examined employers’ perspective related to: a) challenges they face when hiring people with disabilities, b) advantages (i.e. the business case) to employing people with disabilities, and c) their recommendations for innovations in both the public disability employment services systems and their own hiring practices to increase employment of people with disabilities. METHODS: We conducted four focus groups with a total of 74 participants. Participants were purposively sampled among Massachusetts private and public sector employers. Qualitative methods were used to analyze the data. RESULTS: Employers identified stigma, uncertainties about applicant abilities, and the complexity of the public disability employment service system as hiring challenges, and increasing diversity, expanding talent and increasing brand loyalty as advantages to employing people with disabilities. Employers recommended establishing business-to-business networks and improving coordination across the disability employment service system to increase job opportunities for people with disabilities. CONCLUSIONS: Service system innovations and changes in employer hiring practices may increase employment among people with disabilities and have benefits to employers and companies, especially those looking to diversity their workforces.

Creating job opportunities for people with psychiatric disabilities at a university-based research center

The consumer empowerment movement has led to an increase in opportunities for people with psychiatric disabilities to take on roles in the development and delivery of mental health services. However, to date there has been less involvement of people with psychiatric disabilities in services research. In this paper, we describe our experiences creating employment opportunities for people with psychiatric disabilities in a university-based mental health services research center. Working with two local clubhouse programs we developed research assistant positions using both transitional and supported employment approaches. We describe the development of the jobs, employee characteristics, the orientation and training provided to new employees, job characteristics and typical responsibilities, supports and accommodations provided to employees, boundary issues we encountered, and the perspectives of employees on rewards and challenges of the jobs. We offer recommendations to mental health researchers wishing to create these types of opportunities for people with psychiatric disabilities.

Have Working-Age People with Disabilities Shared in the Gains of Massachusetts Health Reform?

The Massachusetts health reform, implemented in 2006 and 2007, reduced the uninsurance rate for working-age people with disabilities by nearly half. Enrollment in Medicaid and subsidized insurance accounted for most of the gain in insurance coverage. The reduction in uninsurance was greatest among younger adults. The reform also reduced cost-related problems obtaining care; however, cost remains an obstacle, particularly among young adults with disabilities. The Massachusetts outcomes demonstrate that insurance subsidies, Medicaid expansions for low-income adults, individual insurance mandates, and enrollment initiatives can lead to substantial reductions in uninsurance and cost-related problems obtaining care among working-age people with disabilities.

What Does Competitive Employment Mean? A Secondary Analysis of Employment Approaches in the Massachusetts Employment Intervention Demonstration Project

Significant unemployment among adults with serious mental illness (SMI) is a well-documented problem. Estimates suggest that as many as 85% of adults with SMI are unemployed at any one time (Anthony & Blanch, 1987; Milazzo-Sayre, Henderson & Manderscheid, 1997; Rogers, Walsh, Masotta & Danley, 1991). Recent years have seen advances in the development and dissemination of a variety of supported employment services for adults with disabilities. When people with SMI are enrolled in services with a specific employment focus, they achieve employment outcomes (e.g. job placement rates, job tenure) superior to those achieved by people receiving standard mental health services such as day treatment (Bond et al., 2001; Cook, 2003). Supported employment is now considered an “evidenced-based” practice (Bond et al., 2001). Although supported employment approaches vary, evidence-based services share common principles, including (1) prioritizing client preferences for type and timing of work; (2) providing in-vivo and follow-along supports as long as needed; (3) viewing work attempts as part of a learning opportunity; (4) having a commitment to “competitive” employment as an attainable goal; and (5) not relying on pre-vocational training, day treatment or sheltered workshops (Bond et al., 2001; Mowbray, Leff, Warren, McCrohan et al., 1997; Ridgeway & Rapp, 1998).