Mercedes Hernandez

Hope and Burden among Latino Families of Adults with Schizophrenia

This study examined hope and family burden among Latino families of individuals with schizophrenia. The sample consisted of 54 family members, one family member per outpatient adult recruited from public mental health programs in a diverse urban community. Hierarchical linear regression analyses were used to test the hypothesis that the family members increased hope for the patients future would be associated with decreased family burden beyond effects explained by the patients length of illness and severity of symptoms. Results supported the study hypothesis. Family hope for the patients future was associated with four of five types of family burden. Findings point to the prominent role of hope as a source of resilience for Latino families dealing with severe mental illness of a loved one.

Perceptions of Subjective Burden Among Latino Families Caring for a Loved One with Schizophrenia

The purpose of this study was to explore perceptions of subjective burden among Latino family members providing care for a loved one with schizophrenia. Data were collected from outpatient community mental health centers and featured 64 Latino family members who were primarily Spanish speaking and of Mexican origin. We used qualitative methods to examine subjective burden based on an open section of the Family Burden Interview Schedule. Five salient themes emerged capturing family members’ subjective burden experience: (a) interpersonal family relationships, (b) emotional and physical health, (c) loss of role expectations, (d) religion and spirituality, and (e) stigma. Overall, findings illustrated that families perceived numerous challenges in their caregiving. Implications for research and practice among Latino family members are discussed.

Serving Latino Families Caring for a Person with Serious Mental Illness

What do mental health practitioners need to know about providing culturally relevant services for Latino families dealing with severe mental illness in a loved one? In this chapter, we will review salient sociocultural issues that practitioners and program managers need to consider in the design and delivery of quality care for Latino families with a member diagnosed with schizophrenia and other related disorders. We will examine pertinent research and practice areas on: the caregiving ideology characteristic of Latino families, cultural issues that affect Latino family participation in services, family involvement in services in the early stages of the illness, and psychoeducational approaches with Latino families. We will draw from our experience in the development of a culturally based psychoeducational intervention for Spanish-speaking families and discuss the applicability of a cultural exchange framework for increasing the cultural fit between family and provider cultures. Finally, the practice implications of an approach that prospectively takes into account the cultural strengths and resources that families bring into treatment are addressed.

Recovery From Schizophrenia in Community-Based Psychosocial Rehabilitation Settings Rates and Predictors

Objective: We assessed the rate of recovery from schizophrenia in community-based psychosocial rehabilitation and whether psychosocial attributes predicted the achievement of recovery beyond demographic and clinical characteristics. Methods: We used data from 246 individuals with schizophrenia spectrum disorder collected at baseline and at 6 and 12 months after admission to psychosocial rehabilitation. Results: The proportion of participants who showed recovery during either 6-month period and the full 1-year period was 19.86% and 7.53%, respectively. Although predictors of recovery for the 1-year period could not be reliably estimated due to its low rate, higher levels of intrinsic motivation and more positive family relationships at baseline predicted recovery for either 6-month period after controlling for initial functioning capacity. Conclusions: One in five individuals with schizophrenia who engage in intensive community-based psychosocial rehabilitation can achieve periods of recovery during treatment. Psychosocial attributes at the start of treatment are important contributors to subsequent recovery.

Families and medication use and adherence among Latinos with schizophrenia

Abstract Background: Medication nonadherence among Latinos with schizophrenia represents a significant treatment obstacle. Although some studies have examined patient and family perceptions of adherence, few have examined these perceptions together. However, such knowledge can provide a deeper understanding of how family processes may contribute to or impede adherence among underserved groups such as Latinos. Aims: This study explored perceptions of medication and adherence among Latinos with schizophrenia and key family members. Method: Purposive sampling was used to collect data from 34 participants: 14 patients with schizophrenia receiving community-based mental health services in an urban public setting and 20 key family members. Informed by grounded theory, semistructured interviews were analyzed by bilingual–bicultural team members. Results: Salient themes emerged indicating facilitators of and obstacles to medication use. Specifically, challenges centered on medication side effects, autonomy and choice, and illness insight, whereas facilitators focused on family support and holistic views of treatment and empowerment. Conclusions: Because the majority of Spanish-speaking Latinos with schizophrenia live with family, it is important to examine family factors that may influence medication use. Findings suggest that patient and family perceptions of medication should be examined as part of the treatment process, particularly regarding issues of autonomy and choice.

Remission of symptoms in community-based psychosocial rehabilitation services for individuals with schizophrenia.

OBJECTIVE The aims of this study were to determine the prevalence of remission in individuals with schizophrenia at baseline and 6 months after admission to community-based psychosocial rehabilitation and whether baseline intrapersonal and environmental resources predicted remission at 6 months, controlling for relevant demographic and clinical variables. METHOD The sample featured 187 individuals with schizophrenia spectrum disorder. To determine remission status, consensus-based criteria proposed by the Remission in Schizophrenia Working Group were adapted to identify predictors of remission outcomes, direct binary logistic regression analysis was performed. RESULTS Findings indicated that 34.57% and 55.61% of the sample was in remission at baseline and 6 months, respectively. Remission at 6 months was predicted by shorter length of illness and being in remission at admission. CONCLUSIONS Remission of schizophrenia is an achievable outcome in community psychosocial rehabilitation settings. Clinical characteristics exerted a significantly stronger influence on remission outcomes compared with psychosocial factors.

Lessons Learned in Clinical Research Recruitment of Immigrants and Minority Group Members with First-Episode Psychosis

Recruitment of immigrants and racial and ethnic minorities with first-episode psychosis (FEP) for research studies presents numerous challenges. We describe methods used to recruit 43 U.S. Latinos with FEP and their family caregivers (n = 41) participating in a study to reduce duration of untreated psychosis. A key challenge was that patients were not continuing treatment at an outpatient clinic, as initially expected. To facilitate identification of patients prior to outpatient care, we collaborated with clinic and hospital administrators. Many patients and families were grappling with the aftermath of a hospitalization or adjusting to a diagnosis of a serious mental illness. A considerable amount of time was devoted to addressing participants’ concerns and when possible, facilitating needed services. Our experience underscores the importance of establishing long-term relationships through multiple contacts with patients, families, and stakeholders to address recruitment barriers among underserved groups with FEP.

The family caregiving context among adults with disabilities: A review of the research on developmental disabilities, serious mental illness, and traumatic brain injury

ABSTRACT A majority of adults with serious disabilities are cared for in the home by family members. Guided by an ecological framework, this article presents the findings of a literature review of research on family caregiving and family support for adults with disabilities. This review included 33 research studies published between 2000 and 2015 focused on three disabilities: Developmental disabilities, serious mental illnesses, and traumatic brain injury. A synthesis of the findings underscores the critical role that family caregivers occupy in addressing the needs of their loved one with a disability; however, the needs of the caregiver are insufficiently met by existing service approaches. A better understanding of the unique needs and strengths of the family support context of caregivers and care recipients is needed, giving greater attention to ethnic, racial, and cultural considerations in future research.