Insight in schizophrenia tends to be assessed as the degree to which one possesses specific knowledge. It therefore often fails to account for the fact that awareness of illness is an inextricable part of a personal narrative and may be incoherent or incomplete for many different narrative reasons. Accordingly, we have developed a means of eliciting narratives of illness: the Indiana Psychiatric Illness Interview, and a method for rating the coherence of those narratives: the Narrative Coherence Rating Scale. In this article we describe these methods and present data on their reliability and validity in a study of the illness narratives of 33 outpatients with schizophrenia or schizoaffective disorder. Results suggest our measures possess sufficient internal consistency and good to excellent interrater reliability. Additionally, as predicted, our measures of narrative coherence were significantly correlated with traditional measures of insight and with measures of cognitive impairment and hopelessness gathered earlier.

The PAM-13 is a useful tool for understanding health behaviours in MS. The findings of this study support further clinical consideration and investigation into developing interventions to increase patient activation and improve health outcomes in MS.

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Persons with schizophrenia are widely recognized to experience potent feelings of hopelessness, helplessness, and a fragile sense of well-being. Although these subjective experiences have been linked to positive symptoms, little is known about their relationship to neurocognition. Accordingly, this study examined the relationship of self-reports of hope, self-efficacy, and well-being to measures of neurocognition, symptoms, and coping among 49 persons with schizophrenia or schizoaffective disorder. Results suggest that poorer executive function, verbal memory, and a greater reliance on escape avoidance as a coping mechanism predicted significantly higher levels of hope and well being with multiple regressions accounting for 34% and 20% of the variance (p < .0001), respectively. Self-efficacy predicted lower levels of positive symptoms and greater preference for escape avoidance as a coping mechanism with a multiple repression accounting for 9% of the variance (p < .05). Results may suggest that higher levels of neurocognitive impairment and an avoidant coping style may shield some with schizophrenia from painful subjective experiences. Theoretical and practical implications for rehabilitation are discussed.

Identifying variables associated with patient activation in the multiple sclerosis population could serve to facilitate better multiple sclerosis self-management behaviors. Using a cross-sectional survey design, 199 participants were recruited from a multiple sclerosis center in the Southeastern United States. Depression, multiple sclerosis quality of life, and multiple Sclerosis self-efficacy were all significantly correlated with patient activation. Results of a hierarchical regression indicated that patient activation was significantly related to educational attainment, depression, and self-efficacy but not to quality of life. The results suggest several possible targets for intervention to increase patient activation, including health literacy, depression symptoms, and self-efficacy for multiple sclerosis disease management.

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Although some evidence suggests that providing treatment via service coordination teams is related to improved outcomes among youth in a system of care, the aspects of team structure that contribute to treatment effectiveness are not well understood.This study draws on team membership and attendance data to identify and describe the structure of service coordination teams in the Dawn Project, a system-of-care initiative in Indianapolis, Indiana.This analysis examines three dimensions of team structure—size, form, and role composition—as well as the effect of these dimensions on the young people's program disposition.The results suggest that service coordination teams are most likely to be effective in achieving the team's treatment goals when they consist of four to eight members and include the youth and multiple family members. More generally,the findings underline the importance of considering team structure as an important force in shaping the effectiveness of service coordination programs and the potential utility of social network methods for studying these effects.The implications for management of service coordination teams and for future research on service coordination teams are discussed.ERIC R. WRIGHT, PhD, is an associate professor in the School of Public and Environmental Affairs at Indiana University—Purdue University Indianapolis (IUPUI), and director of health policy at the Center for Urban Policy and the Environment. His current interests include health policy, HIV/AIDS prevention, and mental health and social services for adults and children with serious mental health challenges. LISA A. RUSSELL, PhD, is associate director of research for ETR Associates. Her current interests include child maltreatment, domestic violence, and mental health. JEFFREY A. ANDERSON, PhD, is the director of the Center for Urban and Multicultural Education and an associate professor and area coordinator for special education programs in the School of Education at IUPUI. His current research interests include creating models of school-based interagency collaboration to improve prevention and early intervention of emotional and behavioral challenges in students. HAROLD E. KOOREMAN, MA, currently conducts research in health policy and wraparound services for children at the Center for Urban Policy and the Environment. DUSTIN E. WRIGHT, MS, conducts research in health policy, mental health services for adults and children with serious mental illness, and HIV/AIDS prevention at the Center for Urban Policy and the Environment. Address: Eric R. Wright, School of Public and Environmental Affairs, Indiana University—Purdue University Indianapolis (IUPUI), BS 4059, 801 W. Michigan St., Indianapolis, IN 46202; e-mail: ewright@iupui.edu

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