Search PubMed⌕ Search

Biomedical subjects

Michelle P Salyers

Publications and source records attributed to Michelle P Salyers.

9 recordsLinked to original sources
PubMed2006

The Illness Management and Recovery program: rationale, development, and preliminary findings.

The Illness Management and Recovery (IMR) program was developed based on a comprehensive review of research on teaching illness self-management strategies to clients with schizophrenia and other severe mental illnesses and "packaged" in a resource kit to facilitate dissemination. Despite growing dissemination of this program, it has not yet been empirically validated. This article describes the development and theoretical underpinnings of the IMR program and presents pilot data from the United States and Australia (N = 24, 88% schizophrenia or schizoaffective) on the effects of individual-based and group-based treatment over the 9-month program and over a 3-month follow-up. High satisfaction was reported by participants. Strong improvements over treatment and at follow-up were found in clients' self-reported effectiveness in coping with symptoms and clinicians' reports of global functioning and moderate improvements in knowledge about mental illness, distress related to symptoms, hope, and goal orientation. These findings support the feasibility and promise of the IMR program and point to the need for controlled research to rigorously evaluate its effects.

Adolescent↗
PubMed2004

How evidence-based practices contribute to community integration.

Since the groundbreaking work of the Robert Wood Johnson Conference in 1998 identifying six evidence-based practices (EBPs) for people with severe mental illness (SMI), the mental health field has moved in the direction of re-examination and redesign of service systems. Surprisingly, one area that has not been fully explicated is the role that EBPs play in promoting community integration. In this paper, we explain how community integration is a unifying concept providing direction and vision for community mental health for people with SMI. As one crucial aspect of the recovery process, community integration clarifies the link between EBPs and recovery. We propose an alternate view, grounded in the empirical literature, to the assertion by Anthony, Rogers, and Farkas [2003, Community Mental Health Journal, 39, 101-114] that "EBP research has rarely demonstrated a positive impact on recovery related outcomes."

Community Mental Health Centers↗
PubMed2004

Prediction of outcome from the Dartmouth assertive community treatment fidelity scale.

BACKGROUND: Assertive community treatment (ACT) is an intensive and comprehensive treatment for clients with severe mental illness (SMI) who do not readily benefit from clinic-based services. Monitoring the implementation of such programs is critical, because better-implemented programs have been found to be effective in improving client outcomes. OBJECTIVE: We tested the hypothesis that fidelity to the ACT model would be positively correlated with improved client outcomes, as measured by reduction in psychiatric hospital use. METHODS: A scale measuring fidelity of program implementation, the Dartmouth ACT Scale, was examined in 10 newly formed ACT teams. Using the team as the unit of measure, the mean reduction in state hospital days for a 1-year period before and after program admission was calculated. Mean effect size in reduction in hospital days was used as the outcome measure in a correlational design. RESULTS: Pre/post comparisons showed a 43 percent reduction in hospital days for 317 clients (t=8.61, P<.001). The Pearson correlation between DACTS fidelity and reduction of state hospital days was .49, P=.08, one-tailed. CONCLUSION: Several possible reasons are offered for why the study hypothesis was not confirmed. However, even if predictive validity of the Dartmouth ACT Scale is limited, it continues to be a useful tool for program monitoring and for providing corrective feedback.

Assertiveness↗
PubMed2004

Barriers to assessment and treatment of posttraumatic stress disorder and other trauma-related problems in people with severe mental illness: clinician perspectives.

We conducted a state-wide survey of 251 clinicians serving people with severe mental illness (SMI) in community support programs, to identify barriers to the diagnosis and treatment of PTSD and other trauma-related problems. Most clinicians did not feel competent to effectively treat these problems. Competence/confidence and belief in utility of intervention were positively related to the percentage of clients with whom trauma and PTSD had been discussed, documented in charts, and addressed directly in treatment. Clinicians need training that develops skills and knowledge as well as conveys the value of addressing PTSD and other trauma-related problems in people with SMI.

Adult↗
PubMed2004

Interpersonal trauma and posttraumatic stress disorder in patients with severe mental illness: demographic, clinical, and health correlates.

This study's purpose was to evaluate the prevalence and correlates of posttraumatic stress disorder (PTSD) in persons with severe mental illness. Standardized assessments of interpersonal trauma and PTSD were conducted in 782 patients with severe mental illness receiving services in one of five inpatient and outpatient treatment settings. Analyses examined the prevalence of PTSD and the demographic, clinical, and health correlates of PTSD diagnosis. The overall rate of current PTSD in the sample was 34.8 percent. For demographic characteristics, the prevalence of PTSD was higher in patients who were younger, white, homeless, and unemployed. For clinical and health variables, PTSD was more common in patients with major mood disorders (compared to schizophrenia or schizoaffective disorders), alcohol use disorder, more recent psychiatric hospitalizations, more health problems, more visits to doctors for health problems, and more nonpsychiatric hospitalizations over the past year. The results support prior research documenting the high rates of PTSD in patients with severe mental illness and suggest that PTSD may contribute to substance abuse, psychiatric and medical comorbidity, and psychiatric and health service utilization.

Adult↗
PubMed2004

A ten-year follow-up of a supported employment program.

OBJECTIVE: Supported employment has steadily increased in prominence as an evidence-based mental health practice, and research shows that the service significantly improves employment outcomes over one to two years. The objective of this study was to examine the outcomes of supported employment ten years after an initial demonstration project. METHODS: The study group consisted of 36 clients who had participated in a supported employment program at one of two mental health centers in 1990 or 1992. Clients were interviewed ten years after program completion about their employment history, facilitators to their employment, and their perceptions of how working affected areas of their lives. RESULTS: Seventy-five percent of the participants worked beyond the initial study period, with 33 percent who worked at least five years during the ten-year period. Current and recent jobs tended to be competitive and long term; the average job tenure was 32 months. However, few clients made the transition to full-time employment with health benefits. Clients reported that employment led to substantial benefits in diverse areas, such as improvements in self-esteem, hope, relationships, and control of substance abuse. CONCLUSIONS: On the basis of this small sample, supported employment seems to be more effective over the long term, with benefits lasting beyond the first one to two years.

Adult↗
PubMed2004

Development of the DPA Fidelity Scale: using fidelity to define an existing vocational model.

Psychiatric rehabilitation practices are often poorly defined, hindering implementation, research, and dissemination efforts. Documentation of adherence to a specific psychiatric rehabilitation approach is particularly important in conducting randomized controlled trials. This paper outlines steps taken to define and measure the Diversified Placement Approach (DPA), a well-regarded vocational program for people with severe mental illnesses. Details of scale development are described, and the scale's utility for model clarification and detection of experimental drift are discussed.

Documentation↗
PubMedDate not supplied

Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment.

Despite growing interest in assessment of program implementation, little is known about the best way to evaluate whether a particular program has implemented the intended service to a level that is minimally acceptable to a funding source, such as a state mental health authority. Such is the case for assertive community treatment (ACT), an evidence-based practice being widely disseminated. Using an exploratory, actuarial approach to defining program standards, this study applies different statistical criteria for determining whether or not a program meets ACT standards using the 28-item Dartmouth Assertive Community Treatment Scale. The sample consists of 51 ACT programs, 25 intensive case management programs, and 11 brokered case management programs which were compared to identify levels of fidelity that discriminated between programs, but were still attainable by the majority of ACT programs. A grading system based on mean total score for a reduced set of 21 items appeared to be most attainable, but still discriminated ACT programs from other forms of case management. Implications for setting and evaluating ACT program standards are discussed.

Case Management↗