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Biomedical subjects

Larry Davidson

Publications and source records attributed to Larry Davidson.

At least 19 recordsLinked to original sources
PubMed2006

Peer support among adults with serious mental illness: a report from the field.

Peer support is based on the belief that people who have faced, endured, and overcome adversity can offer useful support, encouragement, hope, and perhaps mentorship to others facing similar situations. While this belief is well accepted for many conditions, such as addiction, trauma, or cancer, stigma and stereotypes about mental illness have impeded attempts on the part of people in recovery to offer such supports within the mental health system. Beginning in the early 1990s with programs that deployed people with mental illness to provide conventional services such as case management, opportunities for the provision and receipt of peer support within the mental health system have proliferated rapidly across the country as part of the emerging recovery movement. This article defines peer support as a form of mental health care and reviews data from 4 randomized controlled trials, which demonstrated few differences between the outcomes of conventional care when provided by peers versus non-peers. We then consider what, if any, unique contributions can be made by virtue of a person's history of serious mental illness and recovery and review beginning efforts to identify and evaluate these potential valued-added components of care. We conclude by suggesting that peer support is still early in its development as a form of mental health service provision and encourage further exploration and evaluation of this promising, if yet unproven, practice.

Adult↗
PubMed2006

Leading a horse to water: an action perspective on mental health policy.

Following publication of several landmark policy documents beginning in 1999, there are unprecedented opportunities for reforming mental health care to meet the needs of persons with mental illness. In this article, the authors suggest that transforming mental health requires dramatic changes in theory as well as in policy and practice, offering action theory as a corrective for a clinical psychology that has yet to view people as active agents shaping their own lives. A participatory approach to policy development and adoption of an action-oriented model of clinical practice provide examples of the shift, which results from treating people to enhancing their access to opportunities and offering them the in vivo supports they need to pursue meaningful lives even while disabled.

Adult↗
PubMed2006

Toward the implementation of mental health consumer provider services.

Encouraged by the New Freedom Commission, mental health systems such as the Veteran Administration (VA) are now becoming more recovery-oriented. Consumer providers (CPs)--those with serious mental illness who are further along in recovery who provide services to others with similar mental health problems--are viewed as a key part of this change. However, organizational change theories suggest that careful consideration of implementation issues is critical when disseminating new and sometimes controversial services into existing organizations. Therefore, to guide the dissemination of CP services, the literature on the effectiveness of CPs was reviewed, and interviews, focus groups, and a brief survey of 110 administrators, providers, and patients were conducted at three large VA clinics in Southern California. Questions focused on their perceptions of feasibility and acceptability of CP services. Using literature and study findings, an organizational change framework and other strategies to overcome potential implementation challenges of CP services are suggested.

Adult↗
PubMed2006

The top ten concerns about recovery encountered in mental health system transformation.

The notion of "recovery" has recently taken center stage in guiding mental health policy and practice. However, it is not yet clear what the term means and what is to be entailed in transforming the nation's mental health system to promote it. The authors discuss the various meanings of recovery as applied to mental illness and list the top ten concerns encountered in efforts to articulate and implement recovery-oriented care. These concerns include the following: recovery is old news, recovery-oriented care adds to the burden of already stretched providers, recovery involves cure, recovery happens to very few people, recovery represents an irresponsible fad, recovery happens only after and as a result of active treatment, recovery-oriented care is implemented only through the addition of new resources, recovery-oriented care is neither reimbursable nor evidence based, recovery-oriented care devalues the role of professional intervention, and recovery-oriented care increases providers' exposure to risk and liability. These concerns are addressed through discussion of the two over-arching challenges that they pose, namely the issues of resources and risk.

Health Resources↗
PubMed2006

The treatment relationship in peer-based and regular case management for clients with severe mental illness.

OBJECTIVE: This study compared the quality of treatment relationships and engagement in peer-based and regular case management. It also assessed the value of positive relationship qualities in predicting motivation for and use of community-based services for persons with severe mental illness. METHODS: One hundred thirty-seven adults with severe mental illness participated in a 2x2 prospective longitudinal randomized clinical trial with two levels of case management intervention (peer and regular) and two interviews (six and 12 months). Self-report questionnaires assessed treatment relationships, motivation, and service use, and providers rated participants' initial engagement and monthly attendance in treatment. RESULTS: Participants perceived higher positive regard, understanding, and acceptance from peer providers rather than from regular providers at six months only, with initially unengaged clients showing more contacts with case managers in the peer condition and decreasing contacts in the regular condition. Six-month positive regard and understanding positively predicted 12-month treatment motivation for psychiatric, alcohol, and drug use problems and attendance at Alcoholics and Narcotics Anonymous meetings. CONCLUSIONS: Early in treatment, peer providers may possess distinctive skills in communicating positive regard, understanding, and acceptance to clients and a facility for increasing treatment participation among the most disengaged, leading to greater motivation for further treatment and use of peer-based community services. Findings strongly suggest that peer providers serve a valued role in quickly forging therapeutic connections with persons typically considered to be among the most alienated from the health care service system.

Acute Disease↗
PubMed2006

Play, pleasure, and other positive life events: "non-specific" factors in recovery from mental illness?

As part of the emerging recovery paradigm, there is an increasing need for psychiatric treatment and rehabilitation to be strengths-based and to be driven by the desires and preferences of the person with mental illness. Yet if mental illness is a brain disease, it is not at all clear how these characteristics contribute to improvement in the person's condition or influence the course and outcome of the disorder. To avoid these aspects being relegated to the role of nonspecific factors, the field must develop an understanding of the role of strengths and interests in recovery. To contribute to this effort, we review the existing empirical research on the protective and stress-buffering effects of positive life events and qualitative data on the importance of play and pleasure in the lives of people with mental illness. We conclude by considering briefly the implications of this research for clinical practice.

Affect↗
PubMed2006

The social context of adolescent suicide attempts: interactive effects of parent, peer, and school social relations.

An ecological developmental model of adolescent suicidality was used to inform a hierarchical logistic regression analysis of longitudinal interactions between parent, peer, and school relations and suicide attempts. Reanalyzing data from the National Longitudinal Study of Adolescent Health, it was found that parent relations were the most consistent protective factor, and among boys with prior suicide attempts, school relations augmented the effects of parent relations when peer relations were low. Results indicated the need to understand suicidal behavior as a component of interactive social processes in the design of clinical interventions.

Adolescent↗
PubMed2006

The Recovery Knowledge Inventory: assessment of mental health staff knowledge and attitudes about recovery.

In order to assess knowledge of and attitudes toward recovery-oriented practices among providers of mental health and substance abuse treatment and rehabilitation services throughout the state of Connecticut, an instrument named the Recovery Knowledge Inventory (RKI) was developed and administered. The items that comprise the instrument are based on the emerging literature on recovery in psychiatric and substance use disorders, and assess four different domains of understanding, namely: 1) roles and responsibilities in recovery, 2) non-linearity of the recovery process, 3) the roles of self-definition and peers in recovery, and 4) expectations regarding recovery. This paper describes the instrument and its preliminary psychometric properties, and provides an example of its utility in assessing the training needs of staff who increasingly are being expected to deliver recovery-oriented care.

Attitude of Health Personnel↗
PubMed2005

Application of cultural constructs in the care of first generation Latino clients in a community mental health setting.

As the Latino population in the United States grows, it is imperative to attend to the appropriateness of the mental health care that is being provided to its members. Latinos experience many of the same behavioral health disorders as other ethnic and cultural groups in the United States, but underutilize services relative to many other groups. Such underutilization may be related to issues such as stigma, language, and acculturation level, all of which often create barriers to treatment. First generation Latinos (i.e., individuals born outside the United States) are especially vulnerable to adverse experiences when seeking and receiving treatment. This may be due in part to acculturation and language issues which may further contribute to future underutilization of services. A well established therapeutic alliance developed through the appropriate use of cultural constructs may help mitigate some of the barriers faced by some Latino groups, especially those who are first generation. This paper reviews several cultural constructs that have been highlighted in the Hispanic behavioral health literature and discusses their potential implications for clinical care. This paper offers a number of practical clinical guidelines for mental health professionals who work with Latino groups. These clinical recommendations are based on a synthesis of selected cultural constructs and the clinical experiences of the authors' work in a large community-based Hispanic mental health clinic.

Acculturation↗
PubMed2005

Concepts of recovery: competing or complementary?

PURPOSE OF REVIEW: Within the last 5 years, concepts of recovery have taken center stage in psychiatry as the overarching goal of mental health services. In the course of this shift towards recovery, clinicians and consumers (and many others) have struggled to make the concept of recovery both measurable and meaningful. The clinical concept of recovery has focused upon the remission of symptoms and restoration of functioning. A rehabilitation model of recovery has been a more subjective and consumer-oriented concept that focuses on the full lives that are lived within the context of enduring disability. RECENT FINDINGS: A review of the literature addressing the concepts of recovery over the last 2 years demonstrates that authors are rarely explicit about the perspective of recovery from which they are writing. Almost all of the representative papers, however, struggled with how best to define, measure and validate recovery in its broadest terms. Several authors reviewed the history of recovery and offered conceptual discussions of either their first-person experiences or implications for mental health practice. Other authors, regardless of their perspective on recovery, sought to more concretely define criteria for recovery, for the purposes of recovery measure development or more rigorous research of the concept. SUMMARY: As authors struggle to reconcile these often competing concepts of recovery, we suggest that both concepts are useful for different purposes and populations and that the synthesis of the two will offer a broader perspective on life with, after, or despite mental illness.

Journal Article↗
PubMed2005

From rhetoric to routine: assessing perceptions of recovery-oriented practices in a state mental health and addiction system.

The Recovery Self Assessment (RSA) was developed to gauge perceptions of the degree to which programs implement recovery-oriented practices. Nine hundred and sixty-seven directors, providers, persons in recovery, and significant others from 78 mental health and addiction programs completed the instrument. Factor analysis revealed five factors: Life Goals, Involvement, Diversity of Treatment Options, Choice, and Individually-Tailored Services. Agencies were rated highest on items related to helping people explore their interests and lowest on items regarding service user involvement in services. The RSA is a useful, self-reflective tool to identify strengths and areas for improvement as agencies strive to offer recovery-oriented care.

Choice Behavior↗
PubMed2004

Recovering the self in schizophrenia: an integrative review of qualitative studies.

In this paper we review qualitative research on recovery from schizophrenia and summarize how persons' daily activities and experiences reflect mechanisms of recovery of the self. We begin by describing examples of persons' daily activities, suggesting that they have in common a stance labeled by E. Corin (1990) as positive withdrawal, representing negotiation of distance from the social milieu. We note that positive withdrawal may foster the creation of larger life frames, representing broad mechanisms through which to reconsider and ultimately recover a durable sense of self. We suggest that these mechanisms are not specific to people with schizophrenia, and briefly discuss implications of these ideas for models of outpatient treatment.

Ambulatory Care↗
PubMed2004

The person in recovery from acute and severe psychosis: the role of dependency, self-criticism, and efficacy.

The role of 3 personality dimensions (i.e., dependency, self-criticism, and efficacy) in recovery from an acute and severe psychosis was examined. Conceptualizing psychosis as involving difficulties in establishing psychological boundaries, the authors hypothesized that dependency has a greater disruptive effect on recovery than self-criticism. Results of a reanalysis of longitudinal data (N = 76) of people with schizophrenia spectrum disorders during recovery from acute psychosis were consistent with this hypothesis: Dependency predicted depressive and negative symptoms, and, under low efficacy, perceived loss of independence and insight into the presence of the illness. These findings elucidate the central role of interpersonal relatedness as a foundation for self-definition in recovery from psychosis.

Acute Disease↗