The parish clergy as a mental health resource

Summary This paper presents observations on the assets and liabilities of the parish clergy as a mental health resource within the community. These observations are drawn from a ten-year program of continuing education for cleargy in mental health, which focuses on daily pastoral experience. The parish setting is similar in many respects to the service area of a community mental health center. The clergy's assets often include availability, experience, tradition, and the special significance of the religious leader. Inadequate training in mental health skills and the complex demands of parish life are among the problems confronting the clergy in this area. On the whole, the pastoral role offers a unique and highly useful opportunity for positive psychological intervention.The work described in this paper has been supported in part by National Institute of Mental Health grant no. MH-11929-01 and by grants from the Cleveland Foundation and the Grant Foundation, Inc., and the Cuyahoga County Board of Mental Health and Mental Retardation.     

Project ABLE

This paper describes a proposed model for the management of Army soldiers rendered ineffective due to inadequate skills in coping with life stress. The history of Army mental health programs is reviewed to establish the rationale for program development. The proposed treatment methods and staffing are discussed. The application of this peacetime treaetment model in the management of combat psychiatric casualties is presented. Emphasis is placed on the role of the Army occupational therapist as a professional skilled in the use of task-directed behavior to enhance daily living skills.     

Pastoral consultation through a community Mental Health Center

Conclusion Pastoral consultation through a mental health center in Kansas has been a beneficial experience for participating clergymen and the mental health center staff. This consultation has provided interested clergymen an opportunity to learn effective ways of serving parishioners through the church. The clergymen and mental health center staff have also begun to realize the mental health implications of religious resources, as well as ways in which ministers and the mental health center staff can effectively work together in serving troubled individuals within the local community. Pastoral consultation may become a means through which other community mental health centers and local clergymen can form meaningful professional relationships. The continuance of a pastoral consultation program over a longer period of time is needed to determine its possibilities and liabilities for assistingA report of one aspect of a special study project on Community Clergy and Mental Health, made possible by a grant from W. Clement Stone to the Menninger Foundation.     

TEACHING MONEY MANAGEMENT SKILLS TO PSYCHIATRIC OUTPATIENTS

Poor money management skills were found to be a common problem in an outpatient population of psychiatric clients attending a VA Community Living Center facility. A course in Money Management offered by the occupational therapist which aims to improve skills and functioning in surveying assets, budgeting, using banks, and other practical skills necessary for independent financial functioning, is described.     

Cognitive Behavioral Principles Within Group Mentoring: A Randomized Pilot Study

This study evaluated the effectiveness of a group mentoring program that included components of empirically supported mentoring and cognitive behavioral techniques for children served at a community mental health center. Eighty-six 8- to 12-year-old children were randomly assigned to either group mentoring or a wait-list control group. Group mentoring significantly increased children's reported social problem-solving skills and decreased parent-reported child externalizing and internalizing behavior problems after controlling for other concurrent mental health services. Attrition from the group mentoring program was notably low (7%) for children. The integration of a cognitive behavioral group mentoring program into children's existing community mental health services may result in additional reductions in externalizing and internalizing behavior problems.     

Factors influencing placement recommendations for hospitalized individuals with chronic mental illness

This study was undertaken to identify factors that may preclude a patient's discharge from a community mental health center and result in the patient being labeled "unplaceable." Placement recommendations differed between the state hospital staff and a mental health professional employed by the center to evaluate 28 patients. A measure designed to assist in the assessment of patients' competencies suggested the professionals' recommendations were more related to patients' skills in areas associated with community living than were those of the state hospital staff. Follow-up indicated that 15 patients discharged according to the professionals' recommendations maintained community tenure. Use of a more psychometrically sound and comprehensive assessment concerning discharge and placement may improve likelihood of success.     

The Role of the Occupational Therapist as a Community Consultant

Concern for health development has been in the forefront of occupational therapy practice and training for many years. However, consultation in this area to community agencies and grass roots programs is a relatively new endeavor for occupational therapists. This article describes community consultation in a demonstration project emphasizing the concept of preventive mental health. Steps in establishing the consultation role are discussed using the theoretical constructs of systems consultation. Discussion of the educational objectives for field training in community mental health, community experience during the field training, and the supervisory and communication networks essential to such a program are presented as a model in developing the role of the occupational therapist as a community consultant.     

The Independent Living Skills Evaluation

With the recent trend of occupational therapy moving into the community, a need has arisen for assessment and treatment procedures to assist chronic mentally disabled individuals to cope successfully with environmental demands. This article describes a semisupervised apartment living program which provides training in the skills necessary for independent community living. The development of an evaluation tool is described which assesses clients' levels of living skills. This evaluation tool, the Independent Living Skills Evaluation (I.L.S.E.), comprehensively evaluates skills necessary for independent community living in the areas of household maintenance, personal and health care, community resources, communication and problem solving, and vocational and personal growth. Information on the administration and use of the I.L.S.E is included. The I.L.S.E. is used as an intial assessment to provide a basis for establishing objectives and treatment methods, to measure and document client progress, to determine client readiness for discharge, and to measure program effectiveness.     

Threats of violence in group-oriented day treatment

Threats of violence in a group-oriented day treatment program are examined regarding the patient's motivation to make threats, and what occurs among patients and staff that fosters threats. Effects of threats on other patients, the program, and therapists are considered. Management of the threatening patient, the group, and staff reactions are described. Safety of group members is a sine qua non for the groups to function effectively.     

The Test–Retest Reliability and Predictive Validity of a Battery of Newly Developed Occupational Performance Assessments

The Canadian Occupational Performance Measure was used as a tool to compare goals for intervention identified by seven clients living in a long-term residential program and diagnosed with schizophrenia, with their goals as identified by the occupational therapist. In-depth interviews were conducted in conjunction with the use of the Canadian Occupational Performance Measure. Data analysis revealed an overarching theme that described the clients' concerns as, “I want to accomplish goals outside of the residence program.” During the analysis, however, the data revealed that the occupational therapist primarily focused her attention on goals to be achieved within the residence program, emphasizing programming and symptom management as each client's priorities for intervention, rather than community involvement. The findings reveal how data from the Canadian Occupational Performance Measure was used to reveal client/therapist disconnect in goal setting and the need to continue to examine client-centered practices in mental health settings.     

The Association Between Therapeutic Alliance and Treatment Outcomes in a Group Triple P Intervention

A growing literature has examined the association between therapeutic alliance and treatment outcomes in child therapy. Few studies, however, have specifically investigated the role of therapeutic alliance within evidence-based parenting programs for children with externalizing behavioural difficulties. The current study prospectively collected measures of therapeutic alliance for 117 families completing a Triple P parenting program in a community children’s mental health center. Higher levels of mother and father rated therapeutic alliance were associated with greater gains in parenting skills and parental sense of competence. Parental rated therapeutic alliance was also associated with greater improvements in child conduct problems for mothers, but not fathers. However, therapist ratings of therapeutic alliance had limited associations with treatment improvement. The implications of the findings for clinical practice are discussed.     

A program for increasing manual signing by a nonvocal adult within the daily environment

An instructional program was implemented to increase an adult's repertoire of manual signlanguage skills. The participant was a 39-year-old male with mental retardation who had never demonstrated vocal speech. The program used modified incidental teaching strategies consisting of modeling, verbal prompts, physical guidance, positive reinforcement, and naturally occurring reinforcers within the participant's daily environment. The teaching program was implemented by eight direct care personnel who interacted with the participant and five other residents in a community living arrangement (CLA) on a daily basis. Results indicated that the participant learned to independently use manual signing during structured interactions and that the independent levels of responding were maintained for the duration of this study. Results are discussed regarding the potential benefits of teaching manual signs to nonvocal individuals.     

Community reintegrating former child soldiers in Northern Uganda: A qualitative study on the road to recovery

This study aimed to profile the qualities of a holistic community reintegration program for former child soldiers (FCS) in the Lira region of Northern Uganda. Informants were a convenience sample of 37 FCS (age range 17 to 34, mean age 23.86, SD = 4.715 years; females = 29.73%). FCS completed semi-structured interviews on their current living situations and existing resources. This was aimed at assessing how they were transitioning back into the community and identifying gaps in resources. About 24% of FCS reported feeling unwelcome in their communities, suggesting a need for additional support and resources through the community integration models. Thematic analysis of the data suggests that the FCS would benefit from a holistic community reintegration program with the following qualities: psychosocial support, workforce development training, and job placement. FCS emphasised the need for skills training and employment opportunities over health and wellness; suggesting that mental health support and health care are not sufficient alone for them to successfully reintegrate into the community. FCS community integration policies and practices should prioritise holistic approaches.     

Mental health literacy: empowering the community to take action for better mental health

For major physical diseases, it is widely accepted that members of the public will benefit by knowing what actions they can take for prevention, early intervention, and treatment. However, this type of public knowledge about mental disorders (mental health literacy) has received much less attention. There is evidence from surveys in several countries for deficiencies in (a) the public's knowledge of how to prevent mental disorders, (b) recognition of when a disorder is developing, (c) knowledge of help-seeking options and treatments available, (d) knowledge of effective self-help strategies for milder problems, and (e) first aid skills to support others affected by mental health problems. Nevertheless, there is evidence that a range of interventions can improve mental health literacy, including whole-of-community campaigns, interventions in educational settings, Mental Health First Aid training, and information websites. There is also evidence for historical improvements in mental health literacy in some countries. Increasing the community's mental health literacy needs to be a focus for national policy and population monitoring so that the whole community is empowered to take action for better mental health.     

Employers' Perceptions of Occupational Therapy in Community Mental Health

ABSTRACT

This paper explores the nature of occupational therapy practice from the perspective of community mental health agency directors currently employing occupational therapists. Directors were interviewed using a semi-structured format. Retrospective content analysis produced a systematic detailed summary of six major and eight minor themes separating into process themes or how the occupational therapist practised, and content themes, or what the occupational therapist practised. The process themes included a holistic approach, client centredness, and a practical, outcome oriented focus. The content themes included the use of activity, focus on individual functioning, and specific vocational and living skill training. In addition, some directors identified inadequacies including insufficient medical background and the need for education in community practice. Themes were compared against two additional data sources; expert occupational therapists and current literature in occupational therapy in mental health. There was agreement on the major themes. Implications of these results are discussed.     

Perceived Occupational Concerns and Sensory Processing Patterns of Mothers in a Temporary Assistance for Needy Families (TANF)-to-Work Program

In this study, the authors examine the perceived occupational concerns, typical daily routines, and sensory processing of mothers in a mandatory Temporary Assistance for Needy Families return to work program. Participants were five female members of a transitional work program for single parents with mental illness. The Canadian Occupational Performance Measure and the Adult Sensory Profile were administered. The study found that the most frequently identified occupational problems were leisure and self-care. All participants scored as having at least one atypical sensory processing pattern. Future research should investigate the efficacy of an occupational therapy intervention on this population's return to employment.     

Dialectical behavior therapy group skills training in a community mental health setting: a pilot study

Effective and affordable therapies are needed for treating people with severe and persistent mental illness in a community mental health setting. In this pilot study, we evaluated the effectiveness of a modified dialectical behavior therapy (DBT) protocol for improving symptoms and functioning in a cohort of persons with severe and persistent mental illness. We provided six months of weekly DBT skills training in a group setting. Depression symptoms decreased significantly after treatment. There was a wide range of number of sessions attended, with a minority of the participants completing the full course of treatment. Increased attendance was correlated with improvements in depression symptoms, overall symptoms, quality of life, and community functioning. The study findings suggest that the group skills training component of DBT can be successfully implemented in a community mental health center and that further research to determine its efficacy in comparison to other treatments is warranted.     

Housing First and Photovoice: Transforming Lives,Communities, and Systems

This article presents findings from a community‐based participatory evaluation of a Housing First program on the Island of O'ahu. In this study, clients in a Housing First program used Photovoice to evaluate the program and to advocate for progressive housing policies. Written together by members of the Housing First Photovoice group, this collaborative article describes the outcomes from both the Housing First program and the Photovoice project and demonstrates the ways in which participatory program evaluations can interact with client‐driven programs like Housing First to produce a cumulative, transformative impact. Findings suggest that community psychologists hoping to re‐engage with community mental health systems through enacting transformative change should consider taking a community‐based participatory approach to program evaluation because increased client voice in community mental health programs and their evaluations can have far‐reaching, transformative impacts for research, practice, and policy.     

Outcomes of a Therapeutic Gardening Program in a Mental Health Recovery Center

This study evaluated outcomes of a therapeutic gardening project in a community mental health center. The authors worked with 20 adults with severe mental illnesses, to plan, build, and care for raised-bed gardens. Targets for recovery-oriented outcomes related to personal responsibility, emotional and physical well-being, and socialization, were established in advance. Achievement of outcomes was measured using quantitative and qualitative methodology. Results indicated that the program supported recovery. Participants demonstrated significant improvement in mood and markedly higher levels of involvement and spontaneity, when engaged in gardening. Positive changes in diet and social interaction were also reported.     

Designing a behavioral program for a barrio in Tegucigalpa, Honduras

Health in Housing initiated a behavioral program of education and skills training for children and adults in a community of 30,000 persons living in substandard conditions in Tegucigalpa, Honduras. To measure achievement in the long-range project, 21 families of Flor del Campo participated in a preliminary three-part survey of their (a) health, (b) housing and the environment, and (c) family history. Doctors, designers, and educators worked with Honduran personnel in the first survey. Following functional analyses of the home and surrounding environment and the physical status of the individuals living there, procedures provide the family with treatment and training for home and environment improvement. Graphic, verbal, and numerical data, incorporated into a master computerized system, record events of each family member: training programs experienced, health care delivery courses taken, medical treatments, growth of children, literacy changes, educational courses completed, kinds and amounts of foods eaten, household and building materials purchased. Ongoing functional analysis and a long-range evaluation are made of the progress of each participating individual in a family. Teams revisit each house to observe and record any changes in the physical and environmental facility and the health and life-styles, and to report any indications of new health problems or recurrences.