Chyrell Bellamy

A clinical trial of peer-based culturally responsive person-centered care for psychosis for African Americans and Latinos.

Background Providing culturally competent and person-centered care is at the forefront of changing practices in behavioral health. Significant health disparities remain between people of color and whites in terms of care received in the mental health system. Peer services, or support provided by others who have experience in the behavioral health system, is a promising new avenue for helping those with behavioral health concerns move forward in their lives. Purpose We describe a model of peer-based culturally competent person-centered care and treatment planning, informed by longstanding research on recovery from serious mental illness used in a randomized clinical trial conducted at two community mental health centers. Methods Participants all were Latino or African American with a current or past diagnosis within the psychotic disorders spectrum as this population is often underserved with limited access to culturally responsive, person-centered services. Study interventions were carried out in both an English-speaking and a Spanish-speaking outpatient program at each study center. Interventions included connecting individuals to their communities of choice and providing assistance in preparing for treatment planning meetings, all delivered by peer-service providers. Three points of evaluation, at baseline, 6 and 18 months, explored the impact of the interventions on areas such as community engagement, satisfaction with treatment, symptom distress, ethnic identity, personal empowerment, and quality of life. Conclusions Lessons learned from implementation include making cultural modifications, the need for a longer engagement period with participants, and the tension between maintaining strict interventions while addressing the individual needs of participants in line with person-centered principles. The study is one of the first to rigorously test peer-supported interventions in implementing person-centered care within the context of public mental health systems. Clinical Trials 2010; 7: 368—379. http://ctj.sagepub.com

Citizenship, Community, and Recovery: A Group- and Peer-Based Intervention for Persons With Co-Occurring Disorders and Criminal Justice Histories

Group interventions for persons with co-occurring disorders of serious mental illness (SMI) and alcohol or other substance use disorders may positively affect participants’ substance use, criminal justice contacts, and transition to community supports and community living. We report on a group intervention with wraparound peer support that, in earlier research, has shown promise regarding these domains. We provide a detailed description and discussion of the intervention, including case vignettes. We also discuss future research on this intervention and offer recommendations for additional research in this area and with this target population.

Enabling or Engaging? The Role of Recovery Support Services in Addiction Recovery

Recovery capital—the quantity and quality of internal and external resources to initiate and maintain recovery—is explored with suggestions for how recovery support services (RSS) (nontraditional, and often nonprofessional support) can be utilized within a context of comprehensive addiction services. This article includes a brief history of RSS, conceptual and operational definitions of RSS, a framework for evaluating RSS, along with a review of recent empirical evidence that suggests that rather than enabling continued addiction, recovery supports are effective at engaging people into care, especially those who have little recovery capital, and/or who otherwise would likely have little to no “access to recovery.”

An Analysis of Groups in Consumer-Centered Programs

This study used a mixed methods approach to describe and analyze data from groups observed in two types of mental health consumer-centered programs, namely consumer-run drop-in centers and clubhouses. An overview of consumer-centered programs is presented, followed by a report of the study which includes a description of the groups in the sample and data on the effects of group process and group leader characteristics on group functioning. Results indicate that, for the most part, the groups were task oriented (e.g., planning events or discussing issues about the center). Psychoeducation and recovery were also frequent topics in the group meetings. In terms of group participation, consumers took on various assignments, served as facilitators, assumed tasks and roles, shared experiences, and provided support to other group participants. A major finding is that group leaders displayed both good and poor leadership behaviors. The good leadership behaviors were often efforts to respond to problematic responses of members and poor leadership behaviors often elicited such responses. The qualitative analysis provided examples of how these behaviors affected the group sessions. This pilot study, by identifying some of the group conditions present in such groups, should lead to new studies that are based on specific hypotheses concerning the relationships that exist among group conditions, interventions to improve such conditions, and outcomes for participants.

An update on the growing evidence base for peer support

Purpose As peer support services have become increasingly used in mental health settings as a recovery-oriented practice, so has the body of published research on this approach to care. The purpose of this paper is to provide an update on the current evidence base for peer support for adults with mental illness in two domains: mental health and recovery, and physical health and wellness. Design/methodology/approach To provide a robust, non-redundant, and up-to-date review, first the authors searched for meta-analyses and systematic reviews. Second, the authors found individual studies not included in any of the reviews. Findings Peer services are generally equally effective to services provided by non-peer paraprofessionals on traditional clinical outcomes. Although some studies found peer services to be effective at reducing hospitalization rates and symptom severity, as a whole, the current evidence base is confounded by heterogeneity in programmatic characteristics and methodological shortcomings. On the other hand, the evidence is stronger for peer support services having more of a positive impact on levels of hope, empowerment, and quality of life. Research limitations/implications In addition to the need for further high-quality research on peer support in mental and physical health domains, the authors also question whether measures of hope, empowerment, and integration into the community are more relevant to recovery than traditional clinical outcomes. Originality/value This paper provides an original, robust, and up-to-date review of the evidence for peer services.

Subjective Experiences of Clients in a Voluntary Money Management Program

A large proportion of people diagnosed with mental illnesses have difficulty managing their money, and therefore many psychiatric treatments involve providing money management assistance. However, little is known about the subjective experience of having a money manager, and extant literature is restricted to people forced to work with a representative payee or conservator. In this study, fifteen people were interviewed about their experience receiving a voluntary money management intervention designed to minimize substance use. Clients emphasized the importance of trusting the money manager, financial mindfulness (an enhanced awareness of the financial transactions in clients’ day-to-day lives), agency over their own affairs, and addiction. In contrast to evaluations of people assigned representative payees or conservators, there was little mention of feeling coerced. These findings suggest that money management programs can address client concerns by building trust, relating budgeting to clients’ day-to-day lives, and encouraging clients’ control over their own affairs.

Giving Back and Getting Something Back: The Role of Mutual-Aid Groups for Individuals in Recovery From Incarceration, Addiction, and Mental Illness

Mutual-aid groups for people in recovery from mental illness, addictions, and former incarceration are virtually nonexistent. This article provides a review of the literature on mutual-aid groups for people who have previous incarceration histories and a review of groups for people with mental illness and multiple concerns (i.e., co-occurring diagnoses). Next, we present the “Whats Up?” group, a component of the Citizenship Community Enhancement Project, as an example of a mutual-aid group that was developed to better address these multiple concerns. The “Whats Up?” group was designed as a mutual-aid component for individuals living with mental illness and/or co-occurring substance abuse concerns who also have a history of previous involvement with the criminal justice system. Experiences of participants highlight ways in which the “Whats Up?” group provided opportunities for its members to not only “give back” but to “get something back” from the sharing of experiences and feedback offered from their peers.

Barriers and Facilitators of Healthcare for People with Mental Illness: Why Integrated Patient Centered Healthcare Is Necessary

Understanding barriers and facilitators of healthcare for people with mental illness is essential for healthcare and mental healthcare organizations moving towards patient centered care. This paper presents findings of a measure on barriers and facilitators of healthcare completed by 204 patients being served at a co-located wellness center (primary healthcare clinic) located in an urban mental health center. The top 10 results show important findings for planning healthcare services that are responsive to the needs of people with mental illness. Basic structural issues as a result of poverty are extremely important (transportation, housing, payment) as well as difficulty with public healthcare that often involves long wait-times for appointments and at the doctors office and hours that might not be convenient. Healthcare services that want to meet the needs of people with mental illness need to address these issues. What facilitates healthcare is not just removing the barriers to receiving healthcare services but instead involves more interpersonal aspects of healthcare such as liking your provider, being able to talk with your provider, feeling your provider cares about you and listens to you. Structural supports such as also being in mental health services, having systems for remembering appointments, and/or having appointment times that are convenient also facilitate seeking healthcare. Facilitating healthcare seeking also seems to involve a sense of agency—looking forward to taking charge of your health and feeling capable of following healthcare provider instructions. Healthcare systems for people with mental illness need to support these facilitators to give care-seekers the support they need. Key points are provided on how organizations and staff can work more effectively in implementing patient centered care.

Principles for Recovery-Oriented Inpatient Care

This chapter defines and distinguishes between two related concepts of “recovery” in relation to serious mental illnesses and the provision of “recovery-oriented care.” With this distinction in place, the chapter then outlines four key principles for applying the principles of recovery-oriented care to inpatient psychiatry. This first principle is that it is the person’s own recovery, reframing the aim of inpatient care to preparing the person to manage his or her condition and life following discharge. The second principle that follows from this is that Recovery-oriented care needs to be person/family-centered and culturally responsive to be relevant to the person’s life. Given the high prevalence of trauma among persons with mental illness and the potentially traumatic nature of hospitalization itself, the third principle is that inpatient staff should anticipate, and welcome, trauma survivors through the provision of a safe, respectful, and collaborative environment. Finally, principle four is that the interdisciplinary team needs to be expanded to include the person him or herself, his or her identified family members, and the community-based providers who have worked with the person in the past and/or will work with the person following discharge. In closing, the respective role of each of these team members within the context of recovery-oriented inpatient care is described.

Video conferencing technology in research on schizophrenia: a qualitative study of site research staff.

The objective of this study was to advance knowledge of the experience of multisite research staff with video conferencing mental health data collection among study participants with schizophrenia. An end-of-study focus group was conducted with all (N = 19) study coordinators of a multisite randomized trial of pharmacotherapy for schizophrenia to characterize the experiences of coordinators overseeing semistructured assessments via video conferencing technology (VCT). Researchers conducted an audiotaped voluntary focus group. Investigators independently coded a transcript of the focus group, followed by discussions to reach consensus on key themes. Three key themes emerged, involving issues associated with (a) the technology itself, (b) the technology in the context of clinical care and research, and (c) the feasibility of using VCT for study assessments, including coordinators’ perceptions of participants’ experience of VCT. Additional themes were that (a) interviewer skills appeared to moderate the impact of VCT, (b) research participants with serious psychiatric disorders who participated in VCT assessments appeared, overall, to be more amenable to the technology than research coordinators anticipated, and (c) because VCT will be adapted in a wide range of settings, staffing and resource needs should be considered in planning for and adopting VCT for psychiatric research or clinical assessment. This study adds contextual detail and emphasis to the existing literature on the use of VCT in research and factors regarding the effective deployment of the technology in research.