Nursing facility compliance with administration and documentation of PASRR screens appears problematic. Nevertheless, there do not appear to be excessively high numbers of residents with serious mental illness, suggesting that state PASRR programs may contribute positively to the identification of people with serious mental illness. However, many nursing facility residents have some type of psychiatric illness, and PASRR legislation does not appear to have enhanced their ability to gain access to mental health services beyond standard psychiatric consultation and medication therapy.
Psychosocial rehabilitation (PSR) encompasses a diverse array of skill-building and environmental support services for individuals with serious mental illness. The current study gleaned information from state Department of Mental Heath (DMH) databases and interviews with program directors to describe general characteristics and services of 22 out of 24 PSR programs in one New England state. Results underscored the relative predominance of services targeting social rehabilitation rather than vocational, educational, or residential rehabilitation. In addition, density of service provision across agencies was unrelated to enrollment or daily attendance statistics. Furthermore, low validity coefficients between mandated reporting statistics and information collected via interviews were found, suggesting the need to develop more valid and reliable reporting systems. Finally, four areas of concern were highlighted: substantial discrepancies between average membership enrollment and daily attendance, low percentages of peer-managed activities, predominance of services in traditional clinical settings, and lack of attention to multicultural issues.
While randomized clinical trials (RCTs) have helped to establish Individual Placement and Support (IPS) programs as an evidence-based practice, it is important to evaluate whether "real world" IPS programs can be implemented with fidelity and achieve outcomes comparable to programs evaluated in RCTs. The current evaluation examined retrospectively employment outcomes for go participants from an IPS-model Services for Employment and Education (SEE) program in Massachusetts over a 4.5-year period. Evaluators accessed demographic, functioning, and employment data from three sources--SEE program records/database, clinical records, and the Massachusetts Department of Mental Health Client Tracking system. Results indicate that the SEE program maintained high IPS fidelity and achieved employment outcomes comparable or superior to other SE and IPS model programs described in the literature.
Supported employment (SE) is considered an "evidence-based" practice for people with serious mental illness. We examined inpatient hospitalizations and emergency service visits among clients in a SE program based on the Individual Placement and Support (IPS) model in comparison to a propensity score matched group of clients who did not participate in IPS. A significant interaction showed that only IPS/SE clients who were also high in regular mental health services had fewer hospitalizations and emergency service visits than matched controls. The interaction effect was moderate, even when we controlled for client functioning. These findings provide support for the integration of mental health and vocational rehabilitation services, a key feature of evidence-based SE services.
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