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Measures and Predictors of Community-Based Employment and Earnings of Persons With Schizophrenia in a Multisite Study

OBJECTIVE Data from a national study of persons with schizophrenia-related disorders were examined to determine clinical factors and labor-market conditions related to employment outcomes. METHODS Data were obtained from the U.S. Schizophrenia Care and Assessment Program, a naturalistic study of more than 2,300 persons from organized care systems in six U.S. regions. Data were collected via surveys and from medical records and clinical assessments at baseline and for three years. Outcome measures included any community-based (nonsheltered) employment, 40 or more hours of work in the past month, employment at or above the federal minimum wage, days and hours of work, and earnings. Bivariate and multiple regression analyses of data from more than 7,000 assessments tested relationships between outcomes and sociodemographic, clinical, and local labor market characteristics. RESULTS The employment rate was 17.2%; only 57.1% of participants who worked reported 40 or more hours of past-month employment. The mean hourly wage was

Unmet Needs for Mental Health Services for Latino Older Adults: Perspectives from Consumers, Family Members, Advocates, and Service Providers

7.05, and mean monthly earnings were

From documenting to eliminating disparities in mental health care for Latinos.

494.20. Employment rates and number of hours worked were substantially below those found in household surveys or in baseline data from trials of employment programs but substantially higher than those found in a recent large clinical trial. Strong positive relationships were found between clinical factors and work outcomes, but evidence of a relationship between local unemployment rates and outcomes was weak. CONCLUSIONS Work attachment and earnings were substantially lower than in previous survey data, not very sensitive to labor market conditions, and strongly related to clinical status.

The Family Forum: Directions for the Implementation of Family Psychoeducation for Severe Mental Illness

This study qualitatively assessed the need for mental health services among Latino older adults in San Diego, California. The primary mental health issue was depression. Primary organizational barriers to accessing services were language and cultural barriers secondary to a lack of translators, dearth of information on available services, and scarcity of providers representative of the Latino community. Other challenges included a lack of transportation and housing, and the need for socialization and social support. Latino older adults experienced their unmet needs in ways associated with their cultural background and minority status. Age- and culturally-appropriate services are needed to overcome these barriers.

Culturally Based Intervention Development: The Case of Latino Families Dealing With Schizophrenia

The U.S. Surgeon Generals report Mental Health: Culture, Race and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services, 2001) identified significant disparities in mental health care for Latinos and recommended directions for future research and mental health services. We update that report by reviewing five groundbreaking research projects on the mental health of Latinos that were published since 2001. National studies of adults and children, longitudinal designs, and analyses of Latino subgroups characterize these investigations. Despite the increasing sophistication of disparities research, these landmark studies, as well as the research in the supplemental report, can be characterized as documenting disparities in care. We argue that the next wave of research should give greater attention to reducing and eliminating disparities. Accordingly, we apply Rogler and Cortess (1993) framework of pathways to care to the study of Latinos with schizophrenia. Specifically, we draw on research regarding the recognition of illness, social networks (families) and their association with the course of illness, and interventions. We illustrate examples at each pathway that have the potential to reduce disparities. We argue that implementing interventions synchronously across multiple pathways has considerable potential to reduce and eventually eliminate disparities in mental health care.

Intrinsic Motivation as a Mediator of Relationships Between Symptoms and Functioning Among Individuals With Schizophrenia Spectrum Disorders in a Diverse Urban Community

It is well documented that family psychoeducation decreases relapse rates of individuals with schizophrenia. Despite the evidence, surveys indicate that families have minimal contact with their relatives treatment team, let alone participate in the evidence-based practice of family psychoeducation. The Department of Veterans Affairs (VA) sponsored a conference, the Family Forum, to assess the state of the art regarding family psychoeducation and to form a consensus regarding the next steps to increase family involvement. The forum reached consensus on these issues: family psychoeducation treatment models should be optimized by efforts to identify the factors mediating their success in order to maximize dissemination; leadership support, training in family psychoeducation models for managers and clinicians, and adequate resources are necessary to successfully implement family psychoeducation; because family psychoeducation may not be appropriate, indicated, or acceptable for all families, additional complementary strategies are needed that involve families in the mental health care of the patient; and work is required to develop and validate instruments that appropriately assess the intervention process and consumer and family outcomes. A treatment heuristic for working with families of persons with severe mental illness is also offered and provides a match of interventions at varying levels of intensity, tailored to family and consumer needs and circumstances. The article describes opportunities for the research and clinical communities to expand the proportion of families served.

Cultural Values and Caregiver Preference for Mexican-American and Non-Latino White Elders

Objectives: This article describes the process of developing a culturally based family intervention for Spanish-speaking Latino families with a relative diagnosed with schizophrenia. Method: Our iterative intervention development process was guided by a cultural exchange framework and based on findings from an ethnographic study. We piloted this multifamily group 16-session intervention with 59 Latino families in a randomized control trial. Data were collected on family- and client-level outcomes, and poststudy focus groups were conducted with intervention participants. Results: Preliminary evidence indicates that the intervention is effective by increasing illness knowledge and reducing family burden. Conclusions: This work can provide a model for how to integrate cultural factors into psychosocial services and enhance interventions in real-world settings for culturally diverse populations.

The Relationship between Functional Capacity and Community Responsibilities in Middle-aged and Older Latinos of Mexican Origin with Chronic Psychosis

This study investigated intrinsic motivation as a mediator of the relationship between clinical symptoms and functioning. The mediation model was tested with a sample of 166 adults with schizophrenia spectrum disorders attending psychosocial rehabilitation programs in a diverse urban community. Ethnic minority status was examined as a moderator of the mediation model. Motivation was measured using items reflecting intrapsychic drive. Symptoms were assessed with the expanded Brief Psychiatric Rating Scale and functioning with the Role Functioning Scale. Motivation was a significant mediator of the relationship between functioning and all symptom scores; fully mediating the relationship between functioning and negative, disorganized, and global symptoms, and partially mediating the relationship between positive symptoms and functioning. Motivation scores between ethnic minority and nonminority individuals differed significantly (p < 0.05), but no moderation effect was indicated. The strong mediation effect schizophrenia of motivation on the symptoms-functioning relationship supports future work to translate findings into effective recovery-oriented services.

Selecting an Acculturation Measure for Use With Latino Older Adults

This study examined caregiver preferences in the event of hip fracture between Mexican-American and non-Latino White elders. The differential effects of ethnicity and a cultural factor were also examined to elucidate the role of culture on caregiver preference.Data came from a cross-sectional survey of 89 Mexican-American and 30 non-Latino White elders. Hierarchical binary logistic regression was used to examine the differential impact of ethnicity and a cultural factor on caregiver preference. Fewer Mexican-American elders than non-Latino White elders preferred to rely on a formal/professional helper, and a greater proportion of Mexican-Americans than non-Latino Whites would turn to informal caregivers when faced with care needs following a hip fracture. The cultural factor significantly mediated the ethnic effect on caregiver preference. The need for culturally-relevant services based on caregiver preference for long-term care is discussed in addressing health disparities for ethnically diverse elders.

Hope and Burden among Latino Families of Adults with Schizophrenia

The purpose of this study was to examine the relationship between scores on the UCSD Performance-based Skills Assessment (UPSA), a performance-based measure of functional capacity, and level of patient community responsibilities (i.e., work for pay; volunteer work; attend school; household duties) in a Latino sample. Participants were 58 middle-aged and older Latinos of Mexican origin (mean age=48.8 years) with a diagnosis of schizophrenia or schizoaffective disorder. We conducted an analysis of covariance (ANCOVA), controlling for age, symptoms of psychosis, and participant language, to determine if greater participation in community responsibilities was associated with higher functional capacity, as measured by the UPSA. Results indicated significant group differences in UPSA scores (F=5.11, df=2, 51; p=.009), with patients reporting only a single community responsibility having significantly higher UPSA scores than those reporting zero community responsibilities (p=.016) and those reporting two responsibilities scoring significantly higher than those reporting zero community responsibility (p=.008). There were no differences found between those reporting one and those reporting two community responsibilities (p=.256). In contrast, no group differences were observed on the Dementia Rating Scale, a global measure of cognitive functioning (F=2.14, df=2, 51; p=.128). These results provide initial support for the validity of the UPSA in Latino patients of Mexican origin, and suggest that improvement in functional capacity (i.e., UPSA scores) may be associated with increased capacity for greater community involvement in this population.