Lindy Fox

Psychometric evaluation of trauma and posttraumatic stress disorder assessments in persons with severe mental illness

Interrater reliability, internal consistency, test-retest reliability, and convergent validity were examined for the Trauma History Questionnaire (THQ), the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (CAPS), and the PTSD Checklist (PCL) in 30 clients with severe mental illnesses. Interrater reliability for the THQ and CAPS was high, as was internal consistency of CAPS and PCL subscales. The test-retest reliability of the THQ was moderate to high for different traumas. PTSD diagnoses on the CAPS and PCL showed moderate test-retest reliability. Lower levels of test-retest reliability for PTSD diagnoses were related to psychosis diagnoses and symptoms. However, when more stringent criteria for PTSD were used on the CAPS, it had excellent test-retest reliability across all clients. CAPS and PCL diagnoses of PTSD showed moderate convergent validity. The results support the reliability of trauma and PTSD assessments in clients with severe mental illness.

The role of self-help programs in the rehabilitation of persons with severe mental illness and substance use disorders

Substance abuse treatment programs in the United States frequently incorporate self-help approaches, but little is known about the use of self-help groups by individuals with dual disorders. This paper brings together several current studies on the role of self-help programs in treating substance use disorders among individuals with severe mental illness. These studies indicate that only a minority of individuals with dual disorders become closely linked to self-help. Psychiatric diagnosis and possibly social skills are correlates of participation. Dually disordered consumers often experience the use of 12-step philosophy and jargon by mental health professionals as alienating and unempathic. The authors propose suggestions for incorporating self-help approaches into the comprehensive community care of individuals with dual disorders.

The challenge of implementing and sustaining integrated dual disorders treatment programs.

Integrated dual disorders treatment programs for people with severe mental illness and co-occurring substance use disorder have been implemented in a variety of community mental health center sites across the U.S. and in several other countries over the past 15 years. Consumers who receive services from programs that offer integrated dual diagnosis treatments that are faithful to evidence-based principles achieve significant improvements in their outcomes. Unfortunately, not all programs that attempt implementation are successful, and the quality of high-fidelity programs sometimes erodes over time. This article outlines implementation strategies that have been used by successful programs. As a general rule, success is achieved by involving all major participants (consumers, family members, clinicians, program leaders, and state or county mental health authorities) in the process and attending to the three phases of change: motivating, enacting, and sustaining implementation.

A Family Intervention Program for Dual Disorders

Objective: To provide a rationale for working with families of clients with psychiatric and substance use disorder, and to describe a new program, family intervention for dual disorders (FIDD). Method: We developed and manualized the FIDD program, which includes both single-family and multiple-family group formats. We trained several clinicians at a local mental health center in the model and conducted a small pilot study. Results: Clinicians were able to implement the program, and to successfully engage families in treatment. Most clients demonstrated significant improvements in substance abuse over one to two years of treatment. Conclusions: The FIDD program is feasible and appears to promote collaboration between families and professionals, thereby improving the course of dual disorders. Controlled research is underway to evaluate the effects of the FIDD program on client and family outcomes.

Family intervention for co-occurring substance use and severe psychiatric disorders: participant characteristics and correlates of initial engagement and more extended exposure in a randomized controlled trial.

Clients with severe mental illness and substance use disorder (i.e., dual disorders) frequently have contact with family members, who may provide valuable emotional and material support, but have limited skills and knowledge to promote recovery. Furthermore, high levels of family conflict and stress are related to higher rates of relapse. The present study was a two-site randomized controlled trial comparing a comprehensive, behaviorally-based family intervention for dual disorders program (FIDD) to a shorter-term family psychoeducational program (FPE). The modal family was a single male son in his early 30s diagnosed with both alcohol and drug problems and a schizophrenia-spectrum disorder participating with his middle-aged mother, with whom he lived. Initial engagement rates following consent to participate in the study and the family intervention programs were moderately high for both programs (88% and 84%, respectively), but rates of longer term retention and exposure to the core elements of each treatment model were lower (61% and 55%, respectively). Characteristics of the relatives were the strongest predictors of successful initial engagement in the family programs with the most important predictor being relatives who reported higher levels of benefit related to the relationship with the client. Subsequent successful exposure to the family treatment models was more strongly associated with client factors, including less severity of drug abuse and male client gender. The results suggest that attention to issues of motivating relatives to participate in family intervention, and more focused efforts to address the disruptive effects of drug abuse on the family could improve rates of engagement and retention in family programs for dual disorders.

Response to “consumers as service providers: The promise and challenge”

As this art icle describes, several issues are raised when consumers of men ta l hea l th services are employed to provide the same services. New and innovat ive programs are beginning to employ this special group of people, and these efforts are b reak ing ground for others to follow. By developing the role of the consumer as provider, the programs are s t re tching conventional roles, relat ionships, and boundar ies in the men ta l hea l th system, as well as combat ing the roots of st igma. Programs tha t employ consumers to work with other men ta l hea l th professionals as par t of a t r e a t m e n t t e am for persons wi th men ta l i l lnesses follow wha t has a l ready been done in the field of substance abuse. The composition of t r e a tmen t teams varies from program to p rogram (i.e., different mixes of social workers, case managers , nurses, employment specialists, and psychiatrists), but, as in the substance abuse field, these programs are consistently f inding tha t consumers can be helpful members of t r e a t m e n t teams. Role definit ion for the consumer on a t r e a t m e n t t eam is one critical issue. We believe tha t consumers can assume the same roles as any other staff and should receive equal pay, benefits, and status. They are also ent i t led and obligated to the same t r a in ing requi red of other t eam members .

FAMILY PSYCHOEDUCATION WITH PATIENTS WHO HAVE CO-OCCURRING SUBSTANCE USE DISORDERS AND SEVERE MENTAL ILLNESS

been empirically demonstrated through the provision of regulated and quality training followed by their supervised application to clinical practice, and ascertaining limits, establishing indicators, evaluating the quality of their application and their effects, thereby obtaining essential information for their future dissemination in clinical practice. Results: the preliminary results from the mental health services of the Murcia Region are presented. The low application in clinical practice is confirmed, particularly in mental health centres, with therapy/family per year ratios ranging between 0-8. The benefits obtained where strategies have been applied are similar to experimental studies. The greatest shortcomings identified were connecting with the family and the absence of re-call sessions. The current organisation of services and overburdened staff and the need for changes on the part of professionals towards a therapy model that takes setting into account, are underlined as the greatest obstacles for their implementation. Conclusions: Additional measures are necessary, such as specific funding and professional incentives.

Family Intervention for Severe Mental Illness and Substance Use Disorder

Alcohol and drug use disorders (including both abuse and dependence) are a major problem that plagues the lives of many persons with severe mental illness (SMI) such as schizophrenia or bipolar disorder. Epidemiological research has repeatedly shown that individuals with SMI are at increased risk to develop substance use disorders (Cuffel, 1996; Regier et al., 1990). Surveys of the prevalence of substance abuse among the SMI population indicate that on average between 40 and 60 percent of clients have a disorder over their lifetime, and 25 to 40 percent have a current substance use disorder (Mueser et al., 1995a).