Characteristics predicting successful outcomes of participants with severe mental illness in supported education

Development of a Supported Education Program for Students with Severe Mental Disorders in India

BACKGROUND

The onset of severe mental disorders (SMDs) is during adolescence or young adulthood, which affects the well-being and the educational aspirations of the students. Models of supported education practiced in the West are not culturally suitable for Indian students or the Indian education system. This study aimed to develop a Supported Education Program (SEP) for students with SMDs to help them with academic reintegration in an Indian context.

METHODS AND MATERIAL

To develop the SEP, a realist review was done, followed by an in-depth interview with eight mental health professionals (MHP) and nine lecturers, using a validated interview script. After each interview, interim analysis and modifications were done to improve the rigor of the interview. After all interviews, the SEP was circulated for a second round of iteration for consensual validation by four mental health experts. The outcome of the entire process was the final version of SEP for students with SMDs.

RESULTS

The final SEP had two broad themes and 18 subthemes from the qualitative thematic analysis: theme 1 included issues and strategies relevant to the client or caregivers, and theme 2 was pertinent to the education system.

CONCLUSION

The SEP developed and validated for people with SMDs has distinctive components: one for the individual and caregiver and the other for the educational system.

Barriers to academic reintegration in students with severe mental disorders: Thematic analysis

BACKGROUND

Education provides a platform to persons to integrate into society for their livelihood. In countries like India, higher education is accorded a significant place in society and is an important pre-requisite for most professional and skilled occupations. However there are a number of illness related and psychosocial barriers to attaining educational goals, especially for persons with Severe Mental Disorders (SMDs'). The purpose of this qualitative study is to understand the bio-psychosocial barriers of students with severe mental disorders to academic reintegration.

METHODS

Qualitative in-depth interviews were conducted with Mental Health Professionals (MHP's) (n = 8), Lecturers (n = 9) and Students with SMD's (n = 14). The interviews were audio recorded, transcribed and coded into themes and sub-themes separately for each group manually. Triangulation of the themes derived data collected from the three groups were subject to thematic content analysis.

RESULTS

A total of five barriers (themes) to academic reintegration were derived from triangulated data: 1. Illness and its treatment-related barriers, 2. Individual related barriers, 3. Family-related barriers, 4. Academic-related barriers and 5. Social barriers.

CONCLUSION

It is important for mental health professionals and researcher in the field to understand the above barriers in order to plan and implement supported education programmes effectively and enable the students to attain their post-secondary educational goals.

Predictors of job satisfaction among individuals with disabilities: An analysis of South Korea's National Survey of employment for the disabled

This study aims to explore the influences of personal, vocational, and job environment related factors that are associated with job satisfaction of individuals with disabilities in South Korea. Data for wage-based working employees from a nationwide survey were obtained, which resulted in a total number of 417 participants. The six hypotheses and mediation effects of personal and work related environmental factors were tested using the structural equation modeling drawn from existing research evidence. Results revealed that (a) life satisfaction and job related environments directly influenced job satisfaction; (b) the relationship between personal experience and job satisfaction was mediated by life satisfaction for both mild/moderate and severe/profound disabilities group; and (c) the mediating role of job environment between vocational preparedness and job satisfaction was only observed for individuals with mild/moderate disabilities. Summary of findings and implications for future research and practices are discussed.

Postsecondary academic achievement and first-episode psychosis: A mixed-methods study

Background.

Postsecondary academic achievement as an area of functional recovery for young adults living with mental illness has received little research attention.

Purpose.

This study had three purposes: to compare rates of participation, performance, and satisfaction in postsecondary education between young adults with first-episode psychosis and closely matched young adults; to identify characteristics associated with academic participation; and to explore the processes associated with educational experiences.

Method.

One hundred young adults ages 18 to 30 participated in the study. Quantitative data on academic engagement, performance, and satisfaction, and qualitative data ( n = 52) on academic experiences were integrated through pattern analyzes.

Findings.

Young adults with psychosis were significantly less likely to be engaged in postsecondary education. No difference appeared for the extent of engagement, but performance and satisfaction were lower among participants with psychosis. Participants engaged in reflexive decision making to access postsecondary education and to maintain adequate academic performance. Strategies used by successful students with mental illness were identified.

Implications.

Assessment and intervention focused on educational needs and skills should become landmark practices for psychiatric rehabilitation practitioners, including occupational therapists.

The ICF-CY-based structural equation model of factors associated with participation in children with autism

OBJECTIVE

The aim of this study was to apply the International Classification of Functioning, Disability and Health - Child and Youth (ICF-CY) framework to identify the factors related to the participation of children with autism.

METHOD

A convenience sample included 162 preschool children with autism ages 36 to 72 months. The raters collected data using the ICF-CY-based questionnaire as an instrument to construct the structural equation modeling of factors associated with participation.

RESULTS

The internal structure of the model was acceptable, indicating that the observed variables would suffice in accounting for latent variables. The structural model showed that the performance of participation in children with autism was influenced by body functions and personal factors. All the variables accounted for 77% of the explained variance for activities and for participation by 71% of the children with autism.

CONCLUSION

These findings may provide critical information pertaining to predictive factors of participation for parents, educators, and professionals who work with children with autism.

Investigating the Relationship of Resilience to Academic Persistence in College Students With Mental Health Issues

In this study, the relationships between measures of inter- and intrapersonal resilience and mental health were examined with respect to academic persistence in college students with mental health issues. A sample of 121 undergraduate students with mental health issues was recruited from campus mental health offices offering college counseling, psychiatric support, and disability support at two midwestern universities. Hierarchal (or sequential) regression analysis examined whether the resilience and mental health measures contributed to explaining variance in the response variables of university cumulative grade point average and time to credits completed. The results indicated that intrapersonal resilience was more important and operated differently for students with the most psychological distress. Furthermore, there was a strong statistical correlation between the resilience factors and mental health. The results indicate that a resilience framework may assist college students with mental health issues to cope more effectively with the complexities of college learning and improve college retention.

A comparative study of campus experiences of college students with mental illnesses versus a general college sample

OBJECTIVE

Examine campus experiences and relationships of college students with mental illnesses compared to general student norms using the College Student Experiences Questionnaire to understand potential sources of distress and retention issues.

PARTICIPANTS

Responses were obtained from 449 former and current students with mental illnesses from more than 300 colleges and universities around the country.

METHODS

Participants completed an online survey available from July 2005 to July 2006.

RESULTS

Multivariate analysis of variance and t test results indicate that college students with mental illnesses report less engagement on campus and poorer relationships, and that these factors were associated with lower graduation rates. Students reporting they were treated differently "most of the time" because of a mental illness had the lowest levels of engagement and poorest relationships.

CONCLUSIONS

More attention is needed to developing interventions that enhance social functioning and engagement and address stigma on campus in order to reduce distress and enhance retention.

Relationships between occupational engagement and status of and satisfaction with sociodemographic factors in a group of people with schizophrenia

The present study is part of a larger project investigating occupational engagement and health in a group of people with schizophrenia. This study was aimed at extending this knowledge base with regard to occupational engagement and sociodemographic factors. Seventy-four outpatients participated in the study. The Profile of Occupational Engagement in People with Schizophrenia, the Lancashire Quality of Life Profile scale and a standardized questionnaire were used to gather data. Contrary to what was expected, occupational engagement was not associated with a certain type of schizophrenia, being younger or older, or gender. The results showed that a high level of occupational engagement was related to greater satisfaction with the participants' social and living situation, having a reliable alliance and a close friend, school-leaving age, living in a flat, and working or studying. Satisfaction with living independently, having had a recent experience of accomplishment, and working together explained 55% of the variance in occupational engagement. Occupational therapists should thus focus on and promote social engagement appropriate to the client's level of engagement, the client's opportunity and ability to work, his/her experience of accomplishment, and, most importantly, satisfaction with the home and living situation.

A collaboration of student nurse coaches and students with mental illnesses in a college preparation project

OBJECTIVE

With refined diagnostic tools, earlier recognition, new pharmacological and other treatment modalities, individuals living with mental illnesses are able to experience considerable recovery. Some individuals require support and guidance to build confidence and to manage in everyday situations. Previous to their illness, many had been functioning and able to meet their needs in most aspects of their lives, including academics, but, following illness, lacked confidence or skill to continue their education. This pilot program was designed to socialize students with a mental illness to life at college.

METHODS

To develop the pilot concept, college departments including nursing faculty and community mental health personnel collaborated together. Potential students attended informational sessions where those interested, applied for entry into the pilot. Each student was paired with a coach, a third year nursing student, with whom they established and evaluated goals geared towards registering independently in a college course the following semester.

RESULTS

Evaluation of the program was measured in terms of attendance, registration in a college course for the following semester or job readiness, and focus group evaluation sessions. By the end of the semester, 12 of the 13 students completed the program.

CONCLUSIONS

With support and guidance of their coaches, students gained confidence, developed a social support network and learned skills needed to be able to navigate the college system. This type of college preparation program is effective in assisting students with mental illness to access college courses and it is recommended that there be further similar programs offered as an orientation at the college level for students with mental illness in preparation for their registration and attendance at college. To minimize cost factors and gain administrative support, practitioners wishing to replicate this study would do well to consider sources of funding, as well as resource personal or volunteers in order to keep costs to a minimum.

Preference in random assignment: implications for the interpretation of randomized trials

Random assignment to a preferred experimental condition can increase service engagement and enhance outcomes, while assignment to a less-preferred condition can discourage service receipt and limit outcome attainment. We examined randomized trials for one prominent psychiatric rehabilitation intervention, supported employment, to gauge how often assignment preference might have complicated the interpretation of findings. Condition descriptions, and greater early attrition from services-as-usual comparison conditions, suggest that many study enrollees favored assignment to new rapid-job-placement supported employment, but no study took this possibility into account. Reviews of trials in other service fields are needed to determine whether this design problem is widespread.

Aspirations, ability, and support: consumers' perceptions of attending college

Research examines aspirations and plans for college, perceptions of social support and acceptance, and perceived intellectual and emotional capacity for college reported by 80 adults with coping with serious mental illness. The role of consumers' age, prior college experience, hospitalization history, and feelings of personal loss due to mental illness in accounting for their views about college is examined. In general, consumers expressed strong aspirations for college, provided a positive assessment of their intellectual abilities, and mixed feelings about their emotional capacity to attend college. Participants were generally very optimistic about the level of acceptance from faculty and students and support from family and friends if they were to attend college. Amount of personal loss expressed by consumers accounted for a significant amount of variance in their reported aspirations and perceived capacity for college beyond that of age, prior college experience, and number of recent psychiatric hospitalizations. Participants' perceptions of support and acceptance were not related to total number of reported hospitalizations, but were positively related to the number of hospitalizations reported in the past year.

Recovery principles and evidence-based practice: essential ingredients of service improvement

The two of the most commonly advocated service improvement proposals for adults with severe mental illnesses are to redesign services based on recovery principles and to increase the availability of services with strong research support. The two improvement strategies complement and inform each other much more than they conflict. To improve, the field needs the insights of people who have personally experienced severe mental illnesses and it needs the scientific process. Applied together, the two strategies can guide the development of an optimal service system: The kind of service system that most people would want for themselves or their family should they have the need.

Validation of the Chinese general self-efficacy scale among individuals with schizophrenia in Hong Kong

The concept of self-efficacy has recently produced considerable interest among mental illness researchers. Self-efficacy was found to be associated with the number of hospitalizations, social adjustment, rehabilitation outcome, and levels of positive symptoms among individuals with schizophrenia. Given its escalating importance in psychiatric rehabilitation, a scale to assess self-efficacy with established psychometric properties is urgently needed. Validated scales that measure self-efficacy of Chinese with severe mental illness are however extremely limited. The Chinese General Self-efficacy Scale (CGSS) was generic in design and had not been validated for use with people with mental illness. The purpose of this study is to examine psychometric properties of CGSS for use among persons with schizophrenia in Chinese societies. The content validity of items was endorsed by a panel of 8 rehabilitation professionals with 75% to 100% of agreement. The scale was tested in sample of 78 individuals with schizophrenia and found to have excellent internal consistency (0.92-0.93) and very good to excellent test re-test reliability (0.75-0.94). Exploratory factor analysis yielded a two-factor solution explaining 69.0% of variance which was different from overseas studies which showed the scale to be unidimensional. The scale was concluded to be reliable and valid to assess self-efficacy of Chinese with schizophrenia. Potential uses of this scale were suggested.

What can Community Support Programs Do to Promote Productivity?: Perspectives of Service Users

A major goal of community support programs is to help users of services lead meaningful, productive lives in the community. However, there is currently little evidence to support an understanding of how community support programs influence the productivity of service users, particularly from the perspective of consumers themselves. This qualitative study explored consumer perspectives on how community support programs promote productive activity. Data were obtained from in-depth interviews with a sample of 14 participants who received community support services, and analyzed using the constant comparative method involving unitizing, categorizing, and forming themes. The 4 themes that emerged from the data were: (a) the need for a specific focus on productivity within services, (b) the importance of consumer empowerment, (c) the need for learning opportunities, and (d) the value of supportive networks.