Objectives Veterans with serious mental illness are at increased risk of obesity, sedentary lifestyle, and a host of related chronic diseases. Although evidence suggests that lifestyle interventions can help mental health consumers achieve modest weight loss, several studies have failed to show a benefit and most have concluded that significant challenges remain in delivering effective interventions. In 2006, the Veterans Health Administration introduced MOVE!, a weight management program that includes behaviorally based dietary and physical activity self-management support. This article describes modifications used to manualize MOVE! for veterans with serious mental illness and reports findings from a randomized controlled trial of the new intervention. Methods Between January 2007 and June 2009, overweight or obese veterans with serious mental illness were randomly assigned to a six-month trial of MOVE! (N=53), which includes both individual and group sessions, or to a control condition that offered basic information about diet and exercise every month (N=56). Weight and metabolic, attitudinal, behavioral, and functional variables were measured at baseline and six months, and weight was also measured monthly. Results Thirty participants in MOVE! and 41 participants in the control group completed the six-month assessment, and only seven lost 5% of their baseline weight; there was no effect of group assignment on weight loss. There were no significant group × time differences in any metabolic, dietary, physical activity, attitudinal, or functional measure. Conclusions Despite the negative findings of this study, research is crucial to identify lifestyle interventions and related supports and services to help veterans with mental illness reduce overweight and obesity.

The HARP program was associated with improved physical health- and mental health-related quality of life among individuals with serious mental illness and comorbid general medical conditions, suggesting the potential benefits of more widespread dissemination of peer-led disease self-management in this population.

This study investigated whether acoustic input, in the form of infant-directed speech, influenced infants' segmenting of action sequences. Thirty-two 7.5-to 1 1.5-monthold infants were familiarized with video sequences made up of short action clips. Narration coincided with portions of the action stream to package certain pairs of clips together. At test, packaged and nonpackaged pairs of actions were presented side by side in silence. Narration heard during familiarization influenced how infants viewed the action units, such that at test, infants older than 9.5 months (but not younger) looked longer at the nonpackaged than the packaged action sequences. The role of infant-directed speech as well as other types of acoustic input in assisting infants' processing of action is discussed.Both adults and infants seem capable of processing the dynamic flow of human activity into discrete events (Baldwin, Baird, Saylor, &Clark, 2001;Newtson, 1973). This skill is critical in interpreting and predicting the actions of others and is thus fundamental to all social interactions. Adults' and infants' abilities in this realm are remarkable, considering the numerous possibilities for segmenting any given action stream.For instance, imagine witnessing the following movements: An actor walks across the kitchen floor, grasps and releases a small towel on the counter beside the sink, turns the water on, touches a bar of soap, rubs her hands together under the water, turns the water off, then grasps and releases the towel again. How might one determine whether the first grasping of the towel is included in the hand-washing event? Knowledgeable observers might interpret the scene as moving a towel out of the way, and then washing hands. That is, they might view the towel grasp at the Correspondence should be addressed to Rebecca J. Brand,

Objectives People dually diagnosed with severe mental illness and substance use disorders are at markedly elevated risk for HIV, hepatitis B and hepatitis C, but generally do not receive basic recommended services. Several barriers impede receipt of services, including lack of programs offered by mental health providers, and client refusal of available services. Clients from ethnic minority groups are even less likely to accept recommended services. The intervention tested was designed to facilitate integrated infectious disease programming in mental health settings, and to increase acceptance of such services among clients. Methods A randomized clinical trial (n=236) compared enhanced treatment as usual (Control) to a brief intervention to deliver best practice services for blood-borne diseases in an urban, largely minority sample of dually diagnosed clients. This intervention included Screening, Testing for HIV and hepatitis, Immunization for hepatitis A and B, Risk-reduction counseling and medical treatment Referral and support (STIRR) at the site of mental health care. Results Clients randomized to STIRR had high levels (over 80%) of participation and acceptance of core services. They were more likely to be tested for HBV and HCV; immunized for hepatitis A and B; increase their hepatitis knowledge and to reduce their substance abuse. However, they showed no reduction in risk behavior, were no more likely to be referred to care (81 vs. 75%) and showed no increase in HIV knowledge. Intervention costs were $541 per client. Conclusions STIRR appears to be efficacious in providing a basic, best-practice package of interventions for dually diagnosed clients.

Objective Although dissatisfaction is a primary reason for disengagement from outpatient psychiatric care among consumers with serious mental illnesses, little is known about predictors of their satisfaction with medication management visits. The primary purpose of the present study was to explore how dimensions of consumer preferences for shared decision-making (i.e., preferences for obtaining knowledge about one’s mental illness, being offered and asked one’s opinion about treatment options, and involvement in treatment decisions) and the therapeutic relationship (i.e., positive collaboration and type of clinician input) were related to visit satisfaction. Methods Participants were 228 Veterans with serious mental illnesses who completed a 19-item self-report questionnaire assessing satisfaction with visits to prescribers (n=524 assessments) immediately after visits. In this correlational design, a 3-level mixed model with the restricted maximum likelihood estimation procedure was used to examine shared decision-making preferences and therapeutic alliance as predictors of visit satisfaction. Results Preferences for involvement in treatment decisions was the unique component of shared decision-making associated with satisfaction, such that the more consumers desired involvement, the less satisfied they were. Positive collaboration and prescriber input were associated with greater visit satisfaction. Conclusions and Implications for Practice When consumers with serious mental illnesses express preferences to be involved in shared decision-making, it may not be sufficient to only provide information and treatment options; prescribers should attend to consumers’ interest in involvement in actual treatment decisions. Assessment and tailoring of treatment approaches to consumer preferences for shared decision-making should occur within the context of a strong therapeutic relationship.

COVID-19 social distancing guidelines caused a rapid transition to telephone and video technologies for the delivery of mental health (MH) services. The study examined: (a) adoption of these technologies across the MH service continuum; (b) acceptance of these technologies; and (c) intention of providers to use these technologies following the pandemic based on a sample of 327 MH organizations from 22 states during May–August 2020. There was widespread use of technology, with greater than 69% of organizations reporting using telephone or video for most services. For all video services and just three telephone services, organizations reported significantly greater odds of intending to use technology to deliver services post-COVID-19. Use of video was seen as more desirable as compared to telephone. The overall perceived ease of use and usefulness for video-based services and certain telephone services provide a promising outlook for use of these services post the COVID-19 pandemic.

Objectives People dually diagnosed with severe mental illness and substance use disorders are at markedly elevated risk for HIV, hepatitis B and hepatitis C, but generally do not receive basic recommended services. Several barriers impede receipt of services, including lack of programs offered by mental health providers, and client refusal of available services. Clients from ethnic minority groups are even less likely to accept recommended services. The intervention tested was designed to facilitate integrated infectious disease programming in mental health settings, and to increase acceptance of such services among clients. Methods A randomized clinical trial (n=236) compared enhanced treatment as usual (Control) to a brief intervention to deliver best practice services for blood-borne diseases in an urban, largely minority sample of dually diagnosed clients. This intervention included Screening, Testing for HIV and hepatitis, Immunization for hepatitis A and B, Risk-reduction counseling and medical treatment Referral and support (STIRR) at the site of mental health care. Results Clients randomized to STIRR had high levels (over 80%) of participation and acceptance of core services. They were more likely to be tested for HBV and HCV; immunized for hepatitis A and B; increase their hepatitis knowledge and to reduce their substance abuse. However, they showed no reduction in risk behavior, were no more likely to be referred to care (81 vs. 75%) and showed no increase in HIV knowledge. Intervention costs were $541 per client. Conclusions STIRR appears to be efficacious in providing a basic, best-practice package of interventions for dually diagnosed clients.

Behavioral health homes, which provide onsite primary medical care in mental health clinics, face challenges in integrating information across multiple health records. This study tested whether a mobile personal health record application improved quality of medical care for individuals treated in these settings.