Marsha Langer Ellison

Characteristics of mental health case management: results of a national survey

In the last several years, state mental health authorities throughout the United States have assigned a high priority to the funding, development, and operation of case management programs. Although the concept of case management has been in existence for over a decade, there is still confusion regarding the definition of case management and the identification of alternative case management approaches. Recognizing this confusion, the Center for Psychiatric Rehabilitation undertook a comprehensive study to determine the state of case management practice today. This article reports on the results of a national survey of case management programs and describes the characteristics of the programs themselves, the case managers, the clients they serve, and the systems within which they operate. Implications of these findings for a definition of case management are discussed.

Supporting the education goals of post-9/11 veterans with self-reported PTSD symptoms: A needs assessment.

PURPOSE The influx of young adult veterans with mental health challenges from recent wars combined with newly expanded veteran education benefits has highlighted the need for a supported education service within the Veterans Administration. However, it is unknown how such a service should be designed to best respond to these needs. This study undertook a qualitative needs assessment for education supports among veterans with post-9/11 service with self-reported PTSD symptoms. METHODS Focus groups were held with 31 veterans, 54% of whom were under age 30. Transcripts were analyzed and interpreted using a thematic approach and a Participatory Action Research team. RESULTS Findings indicate a need for age relevant services that assist with: education planning and access, counseling for the G.I. Bill, accommodations for PTSD symptoms, community and family re-integration, and outreach and support. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The veterans recommended that supported education be integrated with the delivery of mental health services, that services have varied intensity, and there be linkages between colleges and the Veterans Health Administration.

Adapting Supported Employment for Emerging Adults with Serious Mental Health Conditions

Effective services are needed to assist young people with serious mental health conditions to successfully transition to employment or education, especially among those with intensive adolescent mental health service utilization. To meet these needs, the Individual Placement and Support (IPS) model of supported employment was adapted and its feasibility was tested in a psychiatric treatment program for early-emerging adults. Participants were 17–20 years old (mean age = 18.5 years). Most were African American, under the custody of the state, with a primary mood disorder diagnosis. Adaptations to IPS included adding the following: near age peer mentors, a supported education component, and a career development focus. This open trial feasibility study tracked the model’s development, recruitment, and retention and tracked vocational and educational outcomes for 12 months. Model refinement resulted in the development of a separate educational specialist position, greater integration of the peer mentor with the vocational team, and further specification of the role of peer mentor. There was an 80% retention rate in the feasibility evaluation. Of the 35 participants, 49% started a job and/or enrolled in an education program over the 12-month period.

Between Adolescence and Adulthood: Rehabilitation Research to Improve Services for Youth and Young adults

University of Massachusetts Medical School Learning and Working During the Transition to Adulthood Rehabilitation Research and Training Center (Transitions RTC) ENRM Veterans Hospital, Bedford, MA In what ways are current evidencebased or informed services well suited for the needs of older adolescents or young adults (i.e., 16-30 year olds) with serious mental health conditions (SMHC)? In what ways would modifications improve their efficacy? These are the questions at the heart of this Special Issue. The papers published in this Special Issue describe examples of current efforts to modify and test the effectiveness of evidence-based interventions, originally designed for other age groups, on this population. Other papers investigate elements of services that may have particular importance for this age group e.g., social media. As Guest Editors, we hope this Special Issue serves to increase the evidence base, and to invite more research on youth and young adults of transition age.

Professionals and managers with severe mental illnesses: findings from a national survey.

This study explores the capacity of individuals with severe mental illness to be employed in managerial or professional jobs and the correlates of their vocational success. Using purposive sampling techniques, we identified a national sample of 347 individuals for a mail survey who had succeeded in obtaining and retaining mid to upper level managerial or professional positions. The majority worked full-time and held their job for more than 2 years. Their vocational success was operationalized based on 4 employment outcomes: employment status (full-time vs. part-time), job tenure, occupational rank, and annual income. Key factors that contributed to respondents’ vocational success were lesser severity of the illness as indicated by lack of lifetime receipt of disability benefits, capacity to manage ones own psychiatric condition, and higher education. Study findings point to the role of supported education and self-efficacy in promoting the employment outcomes among individuals with severe mental illnesses.

Empowering and Demedicalized Case Management Practices: Perspectives of Mental Health Consumer Leaders and Professionals

Abstract The principles of empowerment and demedicalization have been central to the formulations of rehabilitation and social service practices as well as case management, a core community support service provided to people with psychiatric disabilities. This study describes empowering and demedicalized practices in mental health case management. Semi-structured interviews were conducted with thirty leaders in the mental health consumer movement and five professionals. Twenty-five categories of such practices were developed and are presented. Findings have implications for both the nature of the interaction between case manager and client and for program structures, activities, and missions.

Explication and Definition of Mental Health Recovery: A Systematic Review

This review assessed the concordance of the literature on recovery with the definition and components of recovery developed by the Substance Abuse and Mental Health Services Administration (SAMHSA). Each SAMHSA identified recovery component was first explicated with synonyms and keywords and made mutually exclusive by authors. Inter-rater reliability was established on the coding of the presence of 17 recovery components and dimensions in 67 literature reviews on the recovery concept in mental health. The review indicated that concordance varied across SAMHSA components. The components of recovery with greatest concordance were: individualized/person centered, empowerment, purpose, and hope.

Unemployment and Co-occurring Disorders Among Homeless Veterans

Objective: To examine employment patterns from 2005 to 2008 among homeless veterans with co-occurring mental health and substance use disorders relative to national trends in veteran and non-veteran populations. Methods: Unemployment rates for homeless veterans (N = 328) with co-occurring disorders were compared to national veteran and non-veteran unemployment rates using Current Population Survey data. Results: From 2005 to 2008, unemployment among the homeless veteran sample with co-occurring disorders increased from 47% to 66%. While unemployment decreased for Current Population Survey comparison groups from 2006 to 2007, homeless veterans with co-occurring disorders experienced a 35.62% increase in unemployment. Conclusions: Homeless veterans with co-occurring disorders were disproportionately affected by the 2007 recession. This increase in unemployment, relative to comparison group data, indicates the need for more comprehensive and integrated vocational supports aimed at obtaining competitive employment upon program discharge. Future research should monitor the impact of economic fluctuations on placement and employment sustainability for homeless veterans with co-occurring disorders.

Design Features for Employment-Supportive Personal Assistance Services in Medicaid Programs

To support the employment of persons with disabilities, state Medicaid programs are allowed to offer personal assistance services (PAS) at work as well as at home. These employment-supportive personal assistance services (EPAS) can be used to help persons with disabilities obtain or retain employment. This article explores Medicaid-funded EPAS through examination of programs in seven states and analysis of results from PAS user focus groups and employer interviews. Medicaid policy recommendations include: link EPAS with existing PAS programs in Medicaid state plans or waivers, distinguish EPAS from job- or task-related assistance that is the responsibility of the employer, and specify explicit coverage for personal care services at home, at the work site, and for work-related transportation.

The integration of psychiatric rehabilitation services in behavioral health care structures: a state example.

This article describes a model for integrating psychiatric rehabilitation services in a managed behavioral health care structure. Psychiatric rehabilitation and managed care are two distinct developments in the provision of mental health services that have proceeded independently though they can have compatible methods and outcomes. Descriptive detail is provided about a state initiative in Iowa to provide psychiatric rehabilitation services to those with serious mental illness through the state-contracted managed behavioral health care corporation. The article describes factors leading to the programs implementation, service delivery structures, reimbursements, personnel requirements, and performance indicators. Evidence for supporting this innovation is provided through a case-controlled outcomes study of mental health service units used and their costs for participants and matched controls.