Jonathan Delman

Community-Based, Acute Posttraumatic Stress Management: A Description and Evaluation of a Psychosocial-Intervention Continuum

&NA; Much of todays psychological trauma can be identified as resulting from sudden and seemingly random events, and particularly from events that involve the loss of human life. This article presents a perspective on how behavioral health providers may approach the design, development, and implementation of community‐based psychological trauma interventions. These interventions allow those community members most affected by the trauma to play a central role in the resolution of, and community adaptation to, traumatic losses. After a brief discussion of “critical incident stress debriefing”—a common form of psychological “first aid” that is sometimes used following traumatic events that affect a community—the article turns to the description of a community‐based trauma‐response program that provides a continuum‐of‐care model for the care and management of individual and group reactions to shared, traumatic events. A recent evaluation of that program, which was developed by the Community Services Program of the Trauma Center in Boston, is presented as an important first step toward determining the types of community‐based responses that show promise in our efforts to ameliorate the impact of traumatic events in communities nationwide and internationally.

Facilitators and Barriers to the Active Participation of Clients with Serious Mental Illnesses in Medication Decision Making: the Perceptions of Young Adult Clients

The active participation of young adults with serious mental illnesses (SMI) in making decisions about their psychotropic medications is beneficial to their care quality and overall health. Many however report not expressing treatment preferences to psychiatrists. Qualitative methods were used to interview 24 young adults with SMI about their experiences making medication decisions with their psychiatrists. An inductive analytic approach was taken to identifying conceptual themes in the transcripts. Respondents reported that the primary facilitators to active participation were the psychiatrist’s openness to the client’s perspective, the psychiatrist’s availability outside of office hours, the support of other mental health providers, and personal growth and self-confidence of the young adults. The primary barriers to active participation reported were the resistance of the psychiatrist, the lack of time for consultations, and limited client self-efficacy. Young adults with SMI can be active participants in making decisions about their psychiatric treatment.

Participatory action research and young adults with psychiatric disabilities

TOPIC Participatory Action Research (PAR) methods are increasingly being used to include people with psychiatric disabilities in the research production process. PAR places a strong emphasis on collaboration between academic researchers and the disadvantaged community, along with strategies for overcoming barriers to collaboration. PURPOSE The author describes key principles for engaging young adults with psychiatric disabilities as research associates in a participatory action research (PAR) project. SOURCES USED Over the past decade, the author developed substantial knowledge by leading or co-leading five (5) funded PAR projects with young adults with psychiatric disabilities and has integrated this experience with an analysis of relevant publications. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The key components for achieving successful PAR with young adult researchers align well with the literature on PAR with adults with psychiatric disabilities. Specific adaptations for transition age youth researchers include mentorship from more experienced researchers and the availability of specialized vocational supports.

Appealing Features of Vocational Support Services for Hispanic and non-Hispanic Transition Age Youth and Young Adults with Serious Mental Health Conditions

Transition age youth and young adults (TAYYAs) diagnosed with serious mental health conditions (SMHCs) are at greater risk of being unemployed compared to their peers without SMHCs. Job counseling and job placement services are the greatest predictor of competitive employment, yet we have limited knowledge about what TAYYAs believe they need to obtain gainful employment. In person, qualitative interviews were conducted with 57 non-Hispanic and Hispanic TAYYAs with SMHCs enrolled in three vocational support programs in MA (Vocational Rehabilitation, Individual Placement and Support; the Clubhouse Model as described by the International Center for Clubhouse Development). Six themes emerged from the data: three themes were identified as social capital (supportive relationships, readily available workplace supports, and vocational preparation), two themes related to human capital (effective educational supports and work experience), and one theme related to cultural capital (social skills training). Unique features (Spanish-speaking staff and/or familiar in Latino culture, familial-like staff support) were frequently noted by Hispanic TAYYAs.

Developing a community-based participatory research model to engage transition age youth using mental health service in research

We present a model for the development and conduct of a community-based participatory research project with transition age youth (TAY) mental health service users. Community-based participatory research frameworks can facilitate equitable partnerships and meaningful inclusion but have not been fully drawn upon in mental health research. The model included TAY as trained research associates involved in every aspect of the research process. We describe the development of the project, creation of the research team, training, the design and conduct of the study, and challenges faced. The methods developed successfully provided support for the meaningful participation of TAY in the project.

Developing a Community-Based Participatory Research Approach to Understanding of the Repeat Use of Psychiatric Emergency Services

Psychiatric emergency services (PES) remain a critical and under-examined component of the community mental health system. We describe how a unique community-academic partnership came together to examine repeat use of PES through the design and conduct of a qualitative study using a CBPR approach. The goals of the project were to: (1) develop a model of research which promoted the inclusion of people who use mental health services in the research process; and (2) design and conduct a study to examine the repeat use of PES through the inclusion of the perspectives and experiences of people who use these services.

Factors Supporting the Employment of Young Adult Peer Providers: Perspectives of Peers and Supervisors

Peer providers are a promising practice for transition-age youth community mental health treatment engagement and support, yet little is known about the experience of being a young adult peer provider or what helps to make an individual in this role successful. Utilizing a capital theory lens, this study uses data from focus groups (two with young adult peer providers and two with their supervisors) to examine facilitators of young adult peer provider success in community mental health treatment settings. Eight factors were identified as critical to young adult peer provider on-the-job success: persistence, job confidence, resilience, job training, skilled communications with colleagues, regular and individualized supervision, support from colleagues, and family support. Findings suggest that young adult peer providers may benefit immensely from an agency level focus on fostering social organizational capital as well as more individualized efforts to increase cultural, social, and psychological capital through training and supervision.

The BMC ACCESS Project: The Development of a Medically Enhanced Safe Haven Shelter

This paper describes the development and implementation of the Boston Medical Center (BMC) Advanced Clinical Capacity for Engagement, Safety, and Services Project. In October 2002, the BMC Division of Psychiatry became the first such entity to open a Safe Haven shelter for people who are chronically homeless, struggling with severe mental illness, and actively substance abusing. The low-demand Safe Haven model targets the most difficult to reach population and serves as a “portal of entry” to the mental health and addiction service systems. In this paper, the process by which this blended funded, multi-level collaboration, consisting of a medical center, state, city, local, and community-based consumer organizations, was created and is maintained, as well as the clinical model of care is described. Lessons learned from creating the Safe Haven Shelter and the development and implementation of the consumer-informed evaluation are discussed as well as implications for future work with this population.

Peer led Recovery Learning Communities: Expanding Social Integration Opportunities for People with the Lived Experience of Psychiatric Disability and Emotional Distress

Social integration is the development of mutually supportive relationships with other community members. For people with psychiatric disabilities (PD) social integration is a critical aspect of mental wellness and recovery. While people with PD generally want supportive friends, their social networks tend to be weak, often limited to treatment staff and close family. The barriers to social integration of people with PD are often high, and include public discrimination, lack of confidence, and insufficient financial resources. In the United States, community mental health providers have focused primarily on illness management and have not successfully helped clients integrate socially. To fill that gap, people with lived experience of psychiatric disability have for many years established networks of peer support, including peer-facilitated groups. With the aim of enhancing that approach, peers in Massachusetts developed the “Recovery Learning Community” model, a regional network of peer support and education operated and staffed by people with lived experience, are distinct from most other peer run programs in that they provide meetings and workshops in various community locations, not only in a single location. In this article, we describe conceptually and with examples the significant impact RLCs have on both the social integration of people with PD and the delivery of mental health services in United States and internationally.