Impact of COVID-19 Pandemic
The importance of employment to workers with preexisting behavioral health disorders during the COVID-19 pandemic
Little is known about the employment experiences of people with preexisting behavioral health conditions during the coronavirus disease of 2019 (COVID-19) pandemic, despite the recognized importance of work for this group. A mixed-methods, anonymous needs assessment was conducted to understand changes in the lives and employment of adults with mental health and substance use disorders since the pandemic onset. Two hundred and seventy-two adults with behavioral health conditions, recruited through statewide mental health networks in NJ and NY, completed an online survey in April-May 2020. Two-thirds (65%) were employed, only 4% became unemployed, and 29% reported changes in their jobs as a result of the pandemic. In logistic regression analysis controlling for age, race, education and gender, workers were more likely than nonworkers to report altered eating and sleeping habits, but not greater anxiety or depression. However, those whose jobs changed were more likely to report COVID-19 exposure, altered sleep patterns, clinically significant anxiety symptoms, and both anxiety and depressive symptoms compared to those whose jobs had not changed. Qualitative analysis revealed work’s positive impact (pride in job performance, using new skills, feeling safer working from home) and its negative effects (lifestyle disruption, worry about job security, isolation from coworkers).
Cook, J. A., Swarbrick, M., Boss, K. A., Steigman, P. J., Nemec, P., Jonikas, J. A., Brice, G. H., Jr., & Aranda, F. (2021). The importance of employment to workers with preexisting behavioral health disorders during the COVID-19 pandemic. Psychiatric Rehabilitation Journal. Advance online publication: doi.apa.org/fulltext/2021-94364-001.html
The impact of the COVID-19 pandemic on the mental health and daily life of adults with behavioral health disorders
People with behavioral health disorders may be particularly vulnerable to the impact of the COVID-19 pandemic, yet little is known about how they are faring. A mixed-methods, anonymous needs assessment was conducted to understand changes in the lives of adults with mental health and substance use disorders since the pandemic onset. A cross-sectional, online survey was completed by 272 adults in April and May 2020, recruited from statewide networks of community programs in New Jersey and New York. Over one-third (35.1%) screened positive for generalized anxiety disorder and over one-quarter (29.6%) screened positive for major depressive disorder. The majority reported pandemic-related changes in eating and sleeping patterns and exposure to COVID-19 infection. Multivariable logistic regression analysis found that many changes attributed to the pandemic were positively and significantly associated with screening positive for anxiety and depressive disorders. Qualitative analysis confirmed these findings and identified participants’ resilience stemming from social support, emotion management, and self-care.
Jonikas, J. A., Cook, J. A., Swarbrick, M., Nemec, P., Steigman, P. J., Boss, K. A., & Brice Jr, G. H. (2021). The impact of the COVID-19 pandemic on the mental health and daily life of adults with behavioral health disorders. Translational behavioral medicine, 11(5), 1162-1171.
The importance of psychiatric rehabilitation services during and after the COVID-19 pandemic
This editorial makes the case that psychiatric rehabilitation services and mental health peer support are needed to help people in recovery over the long-term, as they seek to rebuild healthy and satisfying lives following the COVID-19 pandemic. Also discussed is the vital role of the federal agency, the National Institute for Disability, Independent Living, and Rehabilitation Research, in funding the development and evaluation of interventions that improve health, function, community participation, and quality of life for individuals with disabilities, including psychiatric disabilities. Continued funding for these research and development projects will be critical as we help people to restart their lives after the current pandemic.
Cook, J. A., & Jonikas, J. A. (2020). The Importance of Psychiatric Rehabilitation Services During and After the COVID-19 Pandemic. Psychiatric Services, 71(9), 883-884.
Integrated Health and Mental Health
Registry-managed care coordination and education for patients with co-occurring diabetes and serious mental illness
This observational cohort study included 179 patients with serious mental illness and diabetes mellitus type 2 at a behavioral health home in Chicago. The intervention employed a care coordinator who used a diabetes registry to integrate services; patients also received personalized diabetes self-management education. Outcomes included glucose, lipid, and blood pressure levels as assessed by glycosylated hemoglobin, low-density lipoprotein, triglycerides, and systolic/diastolic values from electronic medical records and completion of specialty visits confirmed with optometrists and podiatrists. Interrupted time-series segmented random-effects regression models tested for level changes in the eight study quarters following intervention implementation compared with eight pre-implementation study quarters, controlling for clinic site and pre-implementation secular trends.
Significant declines were found in levels of glucose, lipids, and blood pressure postimplementation. In addition, completed optometry referrals increased by 44% and completed podiatry referrals increased by 60%.
Cook, J. A., Jonikas, J. A., Steigman, P. J., Glover, C. M., Burke-Miller, J. K., Weidenaar, J., ... & Santos, C. J. (2021). Registry-Managed Care Coordination and Education for Patients With Co-occurring Diabetes and Serious Mental Illness. Psychiatric Services, appi-ps.
Serious mental illness, other mental health disorders, and outpatient health care as predictors of 30-day readmissions following medical hospitalization
Prior research has not addressed whether both serious mental illness (SMI) and other mental health (OMH) disorders affect the likelihood of 30-day readmissions after medical hospitalizations, or whether post-discharge use of outpatient medical, mental health, and pharmacy services is associated with readmission likelihood. Using the Truven Health Analytics MarketScan® Medicaid Multi-State Database, we studied 43,817 Medicaid beneﬁciaries, age 18–64, following discharge from medical hospitalizations in 2011. Logistic regression models compared all-cause, 30-day readmissions among those with SMI, OMH, and no psychiatric diagnosis, and examined associations of 30-day outpatient service use with 30-day readmissions. Thirty-day readmission rates were 15.9% (SMI), 13.8% (OMH), and 11.7% (no mental illness). In multivariable analysis, compared to patients without mental illness, odds of readmission were greater for those with SMI (aOR = 1.43, 95%CI:1.32–1.51) and OMH (aOR = 1.21, 95%CI:1.12–1.30), and lower among those using outpatient mental health services (aOR = 0.50, 95%CI: 0.44–0.56). The adult Medicaid population disproportionately includes patients with SMI and OMH disorders, both of which were found to be associated with 30-day hospital readmissions. Receiving outpatient mental health services after hospital discharge may be protective against readmission following medical hospitalizations.
Cook, J. A., Burke-Miller, J. K., Razzano, L. A., Steigman, P. J., Jonikas, J. A., & Santos, A. (2021). Serious mental illness, other mental health disorders, and outpatient health care as predictors of 30-day readmissions following medical hospitalization. General Hospital Psychiatry. https://doi.org/10.1016/j.genhosppsych.2021.02.004
Whole Health Action Management: A randomized controlled trial of a peer-led health promotion intervention
Adults in mental health recovery have high rates of general medical comorbidity and encounter challenges in dealing with multiple health conditions. Chronic illness self-management programs may help them more effectively cope with co-morbid illnesses, especially when instructors are certified peer specialists. Our study assessed the longitudinal effectiveness of a peer-delivered health promotion program. called Whole Health Action Management (WHAM). Longitudinal analysis indicated that compared with control participants, WHAM participants demonstrated significantly greater improvement over time in patient activation for health care. Intervention participants also demonstrated greater improvement in their self-assessed general health, overall hopefulness, and paid employment. Reactions to the WHAM program were positive, with 97% reporting being very or somewhat satisfied, and almost two-thirds (63%) reporting that their health was better than before they joined the program.
Cook, J. A., Jonikas, J. A., Burke-Miller, J. K., Hamilton, M., Powell, I. G., Tucker, S. J., ... & Powers, D. L. (2020). Whole Health Action Management: A Randomized Controlled Trial of a Peer-Led Health Promotion Intervention. Psychiatric Services, https://doi.org/10.1176/appi.ps.202000012
Factors associated with 30-day readmissions following medical hospitalizations among Medicaid beneficiaries with schizophrenia, bipolar disorder, and major depressive disorder
While evidence suggests that adults with serious mental illness have an elevated rate of 30-day readmissions after medical hospitalizations, most studies are of patients who are privately insured or Medicare beneficiaries, and little is known about the differential experiences of people with schizophrenia, bipolar disorder, and major depression. We used the Truven Health Analytics MarketScan® Medicaid Multi-State Database to study 43,817 Medicaid enrollees from 11 states, age 18-64, who had medical hospitalizations. In a multivariable analysis, compared to those without mental health diagnoses, people with schizophrenia had the highest odds of 30-day readmission, followed by those with bipolar disorder and those with major depressive disorder. Readmissions also were more likely among those with substance use disorders, males, those with Medicaid eligibility due to disability, patients with longer index hospitalizations, and those with 2 or more medical co-morbidities. This is the first large-scale study to demonstrate the elevated risk of hospital readmission among low-income, working-age adults diagnosed with schizophrenia.
Cook, J. A., Burke-Miller, J. K., Jonikas, J. A., Aranda, F., & Santos, A. (2020). Factors associated with 30-day readmissions following medical hospitalizations among Medicaid beneficiaries with schizophrenia, bipolar disorder, and major depressive disorder. Psychiatry Research, 113168, https://doi.org/10.1016/j.psychres.2020.113168.
Prevalence, comorbidity, and correlates of psychiatric and substance use disorders and associations with HIV risk behaviors in a multisite cohort of women living with HIV
This study used the World Health Organization’s Composite International Diagnostic Interview to determine the prevalence, co-morbidity, and correlates of lifetime and 12-month behavioral health disorders in a multisite cohort of 1027 women living with HIV in the United States. Most (82.6%) had one or more lifetime disorders including 34.2% with mood disorders, 61.6% with anxiety disorders, and 58.3% with substance use disorders. Over half (53.9%) had at least one 12-month disorder, including 22.1% with mood disorders, 45.4% with anxiety disorders, and 11.1% with substance use disorders. Behavioral health disorder onset preceded HIV diagnosis by an average of 19 years. In multivariable models, likelihood of disorders was associated with women’s race/ethnicity, employment status, and income. Women with 12-month behavioral health disorders were significantly more likely than their counterparts to engage in subsequent sexual and substance use HIV risk behaviors.The authors discuss the complex physical and behavioral health needs of women living with HIV.
Cook, J.A., Burke-Miller, J.K., Steigman, P., Schwartz, R.M., Hessol, N.A., Milam, J., Merenstein, D.J., Anastos, K., Golub, E.T., & Cohen, M.H. (2018). Prevalence, Comorbidity, and Correlates of Psychiatric and Substance Use Disorders and Associations with HIV Risk Behaviors in a Multisite Cohort of Women Living with HIV. AIDS and Behavior. Advance Online Publication: https://doi.org/10.1007/s10461-018-2051-3.
Correlates of current smoking among adults served by the public mental health system
This study examines the relationship between nicotine dependence and risk of drug and alcohol use disorder, as well as their association to employment, parental, and residential status among 457 adults served by the public mental health system. Slightly less than half (44%) of study participants indicated that they currently smoke, and more than half of those individuals (62%) reported that they were moderately to severely dependent on nicotine. Individuals at high risk for drug use disorders were more than 3 times as likely to smoke as study participants who had little to no risk. Participants at increased risk for alcohol use disorders were more than twice as likely to smoke compared to those who had little to no risk. In addition, current smokers were more likely to live in supervised residential settings, and less likely to have children than nonsmokers. Individuals who were more likely to smoke tended to be younger and less likely to have a college degree. Given the strong association between smoking and drug and alcohol use disorders, this study suggests that integrated interventions that address all of these issues simultaneously may be more successful than traditional treatment options.
Swarbrick, M. A., Cook, J. A., Razzano, L. A., Jonikas, J. A., Gao, N., Williams, J., & Yudof, J. (2017). Correlates of current smoking among adults served by the public mental health system. Journal of Dual Diagnosis, 13(2), 82-90.
Perceived and post-traumatic stress are associated with decreased learning, memory, and fluency in HIV-infected women
This article summarizes the relationship between psychological risk factors and learning and memory impairments among women living with HIV. Between 2009 and 2013, 646 HIV-positive women and 300 HIV-negative women underwent neuropsychological testing. While both groups of women had similar rates of psychological risk factors, women who were HIV-positive showed cognitive decline as it related to stress and post-traumatic stress disorder (PTSD). This conclusion suggests that treatment for stress and PTSD may support improved learning and cognitive functioning among women living with HIV.
Rubin, L.H., Cook, J.A., Springer, G., Weber, K.M., Cohen, M.H., Martin, E.M., Valcour, V.G., Benning, L., Alden, C., Milam, J., Anastos, K., Young, M.A., Gustafson, D.R., Sundermann, E.E., & Maki, P.M. (2017). Perceived and post-traumatic stress are associated with decreased learning, memory, and fluency in HIV-infected women. AIDS., (31)17, 2393-2401.
Using the Center for Epidemiologic Studies Depression Scale to assess depression in women with HIV and women at risk for HIV: Are somatic items invariant?
Women living with HIV are at increased risk of experiencing depression. However, since some symptoms of HIV may be similar to symptoms of depression, it is important to identify a screening tool that accurately identifies signs of depression, rather than symptoms associated with HIV/AIDS. This study assesses the effectiveness of the Center for Epidemiologic Studies Depression Scale (CES-D) in determining whether women living with HIV have depression. Data for this study were obtained from 1,870 women who completed the CES-D during a study visit for the multisite Women’s Interagency HIV Study. Findings suggest that the CES-D can determine symptoms of depression in women living with HIV as accurately as it can identify these symptoms in women who are HIV-negative.
Adams, L. M., Wilson, T. E., Merenstein, D., Milam, J., Cohen, J., Golub, E. T., Adedimeji, A., & Cook, J. A. (2017). Using the Center for Epidemiologic Studies Depression Scale to assess depression in women with HIV and women at risk for HIV: Are somatic items invariant? Psychological Assessment, Advance Online Publication, dx.doi.org/10.1037/pas0000456.
Correlates of co-occurring diabetes and obesity among community mental health program members with serious mental illnesses
This article summarizes the prevalence of co-occurring diabetes and obesity among 457 adults in mental health recovery who attended health fairs in four U.S. states. In comparison to the general population, 31% of adults with diabetes were obese or morbidly obese, whereas in this study group 78% of the participants with diabetes were obese or morbidly obese. These exponentially higher numbers support the need for integrated health care that would facilitate early screening for both conditions. Offering self-management education in tandem with weight reduction interventions also could reduce the impact of these co-occurring conditions.
Cook, J.A., Razzano, L., Jonikas, J.A., Swarbrick, M.A., Steigman, P.J., Hamilton, M.M. Carter, T.M., & Santos, A.B. (2016). Correlates of Co-Occurring Diabetes and Obesity among Community Mental Health Program Members with Serious Mental Illnesses. Psychiatric Services in Advance (doi.org/10.1176/appi.ps.201500219).
Abstinence and use of community-based cessation treatment after a motivational intervention among smokers with severe mental illness
This article examines predictors of 128 people in mental health recovery abstaining from smoking after a motivational intervention. At 6-month follow-up, researchers found that smoking cessation treatment was the strongest predictor of abstinence from smoking. Other significant predictors were respondents’ education and their stage of change post intervention. The research concludes that cessation treatment, as well as pharmacotherapy, are important clinical goals for people in recovery from mental illness. It also suggests that further research is needed to develop models for accessible cessation treatment and motivation and retention in these treatment programs.
Ferron, J. C., Devitt, T., McHugo, G. J., Jonikas, J. A., Cook, J. A., & Brunette, M. F. (2016). Abstinence and use of community-based cessation treatment after a motivational intervention among smokers with severe mental illness. Community Mental Health Journal, 52(4), 446-456.
Health risks and changes in self-efficacy following community health screening
This article summarizes the outcomes of 457 adults with mental illnesses who attended health fairs in 4 U.S. states and were screened for 8 common medical co-morbidities and health risk factors. Compared to non-institutionalized U.S. adults, markedly higher proportions screened positive for obesity, hypertension, diabetes, smoking, nicotine dependence, alcohol abuse, drug abuse, and coronary heart disease. As a result of attending the health fair, results suggest significant increases in participants’ self-rated abilities for health practices, competence for health maintenance, and health locus of control.
Cook, J.A., Razzano, L.A., Swarbrick, M.A., Jonikas, J.A., Yost, C., Burke, L., Steigman, P.K., Santos, A. (2015). Health risks and changes in self-efficacy following community health screening of adults with serious mental illnesses. PLoS ONE, 10(4): e0123552. doi:10.1371/journal.pone.012355.
Associations between gender and obesity among adults with mental illnesses in a community health screening study
The prevalence of obesity and its associations with gender and other demographics, clinical factors, and medical co-morbidities were examined among 457 adults attending public mental health programs in 4 U.S. states. Interaction effects were found between gender and diabetes, hypertension, tobacco smoking, education, race, and age. The high prevalence of obesity among women, coupled with interactions between gender and other factors, suggest that targeted approaches are needed to promote optimal physical health among women in mental health recovery.
Jonikas, J.A., Cook, J.A., Razzano, L.A., Steigman, P.J., Hamilton, M.M., Swarbrick, M.A., Santos, A. (2015). Associations between gender and obesity among adults with mental illnesses in a community health screening study. Community Mental Health Journal. [Epub ahead of print].
A pilot study of Nutrition and Exercise for Wellness and Recovery (NEW-R)
A pilot study was conducted to examine the efficacy of Nutrition and Exercise for Wellness and Recovery (NEW-R), a weight loss intervention for individuals in mental health recovery. Eighteen participants were recruited and enrolled in the 8-week intervention. On average, participants lost three pounds at immediate post-intervention and an average of 10 pounds at the 6-month follow-up. In addition, participants demonstrated a statistically significant increase in knowledge about nutrition, physical activity, and weight management.
Brown, C., Goetz, J., Bledsoe, C., Cook, J.A., Jonikas, J.A. (2015). A pilot study of Nutrition and Exercise for Wellness and Recovery (NEW-R): A weight loss program for individuals with serious mental illness. Psychiatric Rehabilitation Journal, 38(4), 371-373.
Factors associated with co-occurring medical conditions among adults with serious mental disorders
This study examined the prevalence and treatment of 17 co-occurring physical health conditions and prevalence of the 5 most common medical co-morbidities among 457adults with mental illnesses, who participated in community health screenings held in 4 U.S. states. The results of this multi-site study confirm the high rate of health and mental health co-morbidity found in prior research, with 87% of this sample reporting at least one, 82% two or more, and 69% three or more co-occurring medical conditions.
Razzano, L.A., Cook, J.A., Yost, C., Jonikas, J.A., Swarbrick, M.A. et al., (2014). Factors associated with co-occurring medical conditions among adults with serious mental disorders. Schizophrenia Research, 161(2-3), 458-464.
Do HIV-positive women receive depression treatment that meets best practice guidelines
This article focuses on whether psychotherapeutic and psychopharmacological treatment of women living with HIV and depression were consistent with current medical standards detailed in the best practices literature, and examined predictors of care that met these current standards. This research was conducted with 1,352 women living with HIV who were participating in the multisite Women’s Interagency HIV Study. The study found that women who received adequate depression treatment were more likely to see a consistent primary care provider, pay out-of-pocket for health care, and have poorer role functioning. Women who were African American and/or Latina were less likely to receive depression treatment that met best practice standards. The results suggest that increasing health care provider continuity, focusing on the concerns of African American and Latina women, and conducting outreach to women with reduced role functioning could promote better depression treatment for women living with HIV.
Cook, J. A., Burke-Miller, J. K., Grey, D. D., Coccohoba, J., Liu, C., Schwartz, R., Golub, E.T, Anastos, K., Steigman, P.J., & Cohen, M.H. (2014). Do HIV-positive women receive depression treatment that meets best practice guidelines? AIDS and Behavior, 18(6), 1094-1102.
Health screening dialogues
This article looks at the important role that mental health peers play in health screenings for members of community mental health programs. Health screenings help to empower members of community mental health programs to explore health risks related to obesity, hypertension, diabetes, high cholesterol, substance use, nicotine dependence, and heart disease. A total of 457 adults with mental illnesses from 4 states attended health screenings. Highlighted are the experiences shared by the peer health fair staff and screening participants.
Swarbrick, M., Cook, J.A., Razzano, L.A., Yost, C., Cohn, J., Redman, E., Carter, T., Yudof, J., Fitzferald, C. (2013). Health screening dialogues. Journal of Psychosocial Nursing and Mental Health Services, 51(12), 22-28.
Carbon monoxide feedback in a motivational decision support system for nicotine dependence
The purpose of this study was to examine the effectiveness of the use of carbon monoxide monitors with a motivational intervention for smoking cessation among 124 smokers with diagnoses of schizophrenia or mood disorders. While participants who received the intervention were more likely to have increased knowledge about the impact of carbon monoxide, there was no difference between groups in initiating cessation.
Brunette, M.F., Ferron, J.C., Devitt, T., Cook, J.A. et al. (2013). Carbon monoxide feedback in a motivational decision support system for nicotine dependence among smokers with severe mental illness. Journal of Substance Abuse Treatment, 45(4), 319-324.
Do symptoms and cognitive problems affect the use and efficacy of a web-based decision support system?
This study examined outcomes of a web-based motivational decision support system for smoking cessation. A total of 128 smokers with mental illnesses used the web site and were assessed at baseline and at a 2-month follow-up. Results indicated that 32% of smokers initiated one or more of the recommended treatments, and 51% demonstrated some kind of smoking cessation behavior after using the website. When controlling for cigarette use, symptoms, cognition, and other potential predictors, regression analysis showed that being older, having a diagnosis of a schizophrenia spectrum disorder, and cognitive impairment were associated with a greater amount of time spent in the motivation section.
Ferron, J.C., Brunette, M.F., McGurk, S., Xie, H., Frounfelker, R., Cook, J.A., Jonikas, J.A., McHugo, G. (2012). Do symptoms and cognitive problems affect the use and efficacy of a web-based decision support system for smokers with serious mental illness? Journal of Dual Diagnosis, 8(4), 315-325.
Implications of the Feldenkrais Method of Somatic Education for training college students to be transformational leaders
This study explored the Feldenkrais Method as a tool for developing transformational leadership. 138 undergraduates at a large state university participated in a single-session, 35-minute Feldenkrais Awareness through Movement lesson via: 1) in-person instruction, 2) video/audiotape, or 3) audiotape only. We tested for changes in levels of body awareness, stress, and self-perceived empathic and communicative leadership capacities using standardized scales administered pre- and post-intervention. Significant increases were found in body awareness and self-assessed leadership capacities and significant decreases in stress between pre-and post-test. Body awareness and leadership increased significantly regardless of instructional modality, while stress reduction occurred for the in-person intervention.
Fonow, M.M., Cook, J.A., Goldsand, R., & Burke-Miller, J.K.(2017). Implications of the Feldenkrais Method of somatic education for training college students to be transformational leaders. Journal of Education and Social Policy, 4(3), 1-18.
Using the Feldenkrais Method of Somatic Education to enhance mindfulness, body awareness, and empathetic leadership perceptions among college students
This study examines the potential of the Feldenkrais Method of somatic education through body movement as a tool to enhance mindfulness, awareness of the body, and leadership capacities among college students. The intervention included 21 students who attended 75-minute Feldenkrais group sessions twice a week for a total of 32 sessions. Standardized scales were administered at study baseline, midterm, and end of term. These assessments were supplemented by twice-weekly student journals that recorded changes in bodily sensations and perceptions. Over the semester, students evidenced significantly greater mindfulness, body awareness, and a domain of transformational leadership measuring empathy, controlling for their level of stress at the time of final exams. The authors conclude that not all approaches to developing transformational leadership need be exclusively cognitive, and argue that somatic education may be an additional important ingredient. They note that a holistic approach to leadership education requires a better understanding of how body awareness develops more mindful leaders with the empathy to build complex interpersonal relationships that serve as a foundation for societal change.
Fonow, M. M., Cook, J. A., Goldsand, R. S., & Burke-Miller, J. K. (2016). Using the Feldenkrais method of somatic education to enhance mindfulness, body awareness, and empathetic leadership perceptions among college students. Journal of Leadership Education, 15(3), 125-136.
Impact of Wellness Recovery Action Planning on service utilization and need
The purpose of this study was to assess the impact of Wellness Recovery Action Planning (WRAP), a mental wellness self-management intervention, on the use of and need for mental health services. Results indicated that, compared with controls who received a nutrition and wellness education program, WRAP participants reported significantly greater reduction over time in service utilization and service need. Participants in both groups improved significantly over time in symptoms and recovery outcomes.
Cook, J.A., Jonikas, J.A., Hamilton, M.M., Goldrick, V., Steigman, P.J., Grey, D.D., Burke, L., Carter, T.M., Razzano, L.A., Copeland, M.E. (2013). Impact of Wellness Recovery Action Planning on service utilization and need in a randomized controlled trial. Psychiatric Rehabilitation Journal, 36(4), 250-257.
Improving propensity for patient self-advocacy through Wellness Recovery Action Planning
This study reports findings from a randomized controlled trial comparing propensity for patient self-advocacy among those who received Wellness Recovery Action Planning (WRAP) and those who received services as usual. In a multivariable analysis, at immediate post-intervention and 6-month follow-up, WRAP participants were significantly more likely than controls to report engaging in self-advocacy with their service providers.
Jonikas, J.A., Copeland, M.E., Razzano, L.A…Cook, J.A. (2013). Improving propensity for patient self-advocacy through Wellness Recovery Action Planning: results of a randomized controlled trial. Community Mental Health Journal, 49(3), 260-269.
Impact of Wellness Recovery Action Planning on depression, anxiety, and recovery
The purpose of this study was to test the effectiveness of the Wellness Recovery Action Planning (WRAP) self-management intervention in reducing depression and anxiety, and increasing self-perceived recovery, among 519 adults in recovery in six Ohio communities. Results show that WRAP intervention participants reported significant improvements over time in self-reported depression and anxiety symptoms, recovery, personal confidence, and goal orientation.
Cook, J.A., Copeland, M.E., Floyd, C.B. et al. (2012). Impact of Wellness Recovery Action Planning on depression, anxiety, and recovery: Results of a randomized controlled trial. Psychiatric Services, 63(6), 541-547.
Results of a randomized controlled trial of mental illness self-management using WRAP
The purpose of this study was to determine the efficacy of a peer-led illness self-management intervention called Wellness Recovery Action Planning (WRAP). Results suggest that compared to the services-as-usual group, participants who received WRAP showed significant improvements over time in psychiatric symptoms, hopefulness, and quality of life.
Cook, J.A., Copeland, M.E., Jonikas, J.A., Hamilton, M.M., Razzano, L.A. et al. (2012). Results of a randomized controlled trial of mental illness self-management using Wellness Recovery Action Planning. Schizophrenia Bulletin, 38(4), 881-891.
Psychiatric symptoms may moderate the effects of mental illness self-management
This purpose of this article is to examine how psychiatric symptoms moderate the effects of a peer-led self-management intervention called Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES). A total of 428 participants from 8 Tennessee communities were randomly assigned to receive BRIDGES or services as usual. Intent-to-treat analysis using mixed-effects random regression found significant interaction effects between study condition and three moderating symptom profiles. Empowerment was greater for the intervention participants with high levels of depressive symptoms, anxiety symptoms, and general symptom distress than for the experimental participants with low symptom levels and the control subjects with high or low levels of symptoms.
Steigman, P, Pickett, S.A., Diehl, S., Fox, A. Cook, J.A. (2014). Psychiatric symptoms moderate the effects of mental illness self-management in a randomized controlled trial. Journal of Nervous and Mental Disease, 202(3), 193-199.
Empowerment and self-advocacy outcomes in a randomized study of peer-led education
This study examined the effectiveness of the Building Recovery of Individual Dreams and Goals (BRIDGES) peer-led education intervention in empowering recipients of mental health services to become better advocates for their own care. A total of 428 adults were randomly assigned to BRIDGES (intervention condition) or a services-as-usual wait list (control condition). Findings suggest that BRIDGES may enhance participants’ feelings of empowerment in mental health service settings, and increases their ability to become more actively involved in their own mental health care.
Pickett, S.A., Diehl, S., Steigman, P., Fox, A., Cook, J.A. (2012). Consumer empowerment and self-advocacy outcomes in a randomized study of peer-led education. Community Mental Health Journal, 48(4), 420-430.
RCT of peer-led recovery education using Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES)
The purpose of this study was to test the efficacy of a peer-led, mental health education intervention called Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES). A total of 428 individuals in mental health recovery from 8 Tennessee communities participated in this randomized controlled trial. Compared to controls, intervention participants reported significantly greater improvement in self-perceived recovery, personal confidence, tolerable symptoms, and hopefulness.
Cook, J.A., Steigman, P., Pickett, S.A., Diehl, S. et al., (2012). Randomized controlled trial of peer-led recovery education using Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES). Schizophrenia Research, 136(1-3), 36-42.
Self-Direction and Mental Health Recovery
Mental health self-directed care financing: Efficacy in improving outcomes and controlling costs for adults with serious mental illness
Self-directed care allows individuals with disabilities and elderly persons to control public funds to purchase goods and services that help them remain outside institutional settings. This study examined effects on outcomes, service costs, and user satisfaction among adults with serious mental illness. Public mental health system clients were randomly assigned to self-directed care (N=114) versus services as usual (N=102) and assessed at baseline and 12 and 24 months. Compared with the control group, self-directed care participants had significantly greater improvement over time in recovery, self-esteem, coping mastery, autonomy support, somatic symptoms, employment, and education. No between-group differences were found in total per-person service costs in years 1 and 2 or both years combined. However, self-directed care participants were more likely than control group participants to have zero costs for six of 12 individual services and to have lower costs for four. The most frequent nontraditional purchases were for transportation (21%), communication (17%), medical care (15%), residential (14%), and health and wellness needs (11%). Client satisfaction with mental health services was significantly higher among intervention participants, compared with control participants, at both follow-ups.
Cook, J.A., Shore, S., Burke-Miller, J.K., Jonikas, J.A. Hamilton, M., Ruckdeschel, B. et al. (2019). Psychiatric Services, 70(3), 191-201.
Intersectional policy analysis of self-directed mental health care in Canada
This article examined the potential for self-directed care (SDC) financing in the Canadian mental health system. This involved conducting an intersectional policy analysis framework using the multi-strand method to analyze the potential impact of SDC in Canada. The methodology included a panel of 16 stakeholders that met 4 times. Analysis results suggests that the SDC model has the potential to increase: 1) peer involvement in implementing SDC; 2) use of indigenous community supports; 3) the ability to purchase material goods among economically-disenfranchised persons; and 4) access to ethnically diverse service providers in the private sector. The panel also concluded that participants could experience the benefits of SDC unevenly due to geographical (e.g., paucity of service options in some communities) and cultural (e.g., lack of recovery capital in some communities) reasons. The information gleaned from this analysis has the potential to help create a Canadian-specific mental health self-directed care model.
Cook, J. A., Morrow, M., & Battersby, L. (2017). Intersectional policy analysis of self-directed mental health care in Canada. Psychiatric Rehabilitation Journal. APA Online first http://dx.doi.org/10.1037/prj0000266.
Outcomes of programs serving mothers with psychiatric disabilities and their young children: A multi-site case file abstraction study
This multisite study uses case file abstraction to examine the first year outcomes of 104 mothers in mental health recovery receiving parenting services and integrated clinical and psychiatric rehabilitation services. The study found a significant increase in employment and independent living for women participating in these programs. There also was a significant decrease in the proportion of mothers who engaged in substance abuse during this time frame. However, there was no reduction in the number of women who were psychiatrically hospitalized during the first year of the program. The study also found that 22% of mothers were reunited with one or more children. Results suggest that integrated programs for mothers living with mental illnesses can improve the clinical and rehabilitation outcomes for these women and their preschool age children, while supporting family reunification and reducing custody loss.
Cook. J. A., Steigman, P. J., & Jonikas, J. A. (2014). Outcomes of programs serving mothers with psychiatric disabilities and their young children: A multisite case file abstraction study. Psychiatric Rehabilitation Journal, 37(3), 232-241.
Participatory action research to establish self-directed care for mental health recovery in Texas
This article describes the collaboration between a University research center and the Texas state mental health authority to design and evaluate a unique “money follows the person” model called self-directed care (SDC). SDC programs give participants control over public funds to purchase services and supports for their own recovery. The story of this effort and the program that resulted are described, along with quantitative and qualitative data from the project’s start-up phase.
Cook, J.A., Shore, S.E., Burke-Miller, J.A., Jonikas, J.A., Ferrara, M., Colegrove, S., et al. (2010). Participatory action research to establish self-directed care for mental health recovery in Texas. Psychiatric Rehabilitation Journal, 34(2), 137-144.
A self-directed care model for mental health recovery
This pilot study summarizes the implications of Self-directed care programs (SDC). Data were examined for 106 individuals. Results indicate that compared with the year before enrollment, in the year after enrollment, participants spent significantly less time in psychiatric inpatient and criminal justice settings and showed significantly better functioning.
Cook, J.A. Russell, C., Grey, D.D. & Jonikas, J.A. (2008). A self-directed care model for mental health recovery. Psychiatric Services,
Employment and Asset Development
Long-term effects of evidence-based supported employment on earnings and on SSI and SSDI participation among individuals with psychiatric disabilities
This article summarizes the long-term results of the Employment Intervention Demonstration Program (EIDP), matching supported employment services data with Social Security Administration data for program participants with psychiatric disabilities. Supported employment recipients were almost three times as likely as those not receiving the service to earn income over the 13-year follow-up period. Supported employment participants were 13 times as likely as those not receiving the service to terminate or suspend their public disability benefits due to working due the 13-year follow-up period.
Judith A. Cook, Ph.D., Jane K. Burke-Miller, Ph.D., Emily Roessel, M.P.P. (2015). Long-Term Effects of Evidence-Based Supported Employment on Earnings and on SSI and SSDI Participation among Individuals with Psychiatric Disabilities. American Journal of Psychiatry in Advance (doi: 10.1176/appi.ajp.2016.15101359).
Reasons for job separations in a cohort of workers with psychiatric disabilities
This study explored the effects of adverse working conditions, job satisfaction, wages, worker characteristics, and local labor markets in explaining voluntary job separations (quits) among employed workers with psychiatric disabilities. Stepped multivariable logistic regression analysis suggests that 59% of all job separations were voluntary while 41% were involuntary, including firings (17%), temporary job endings (14%), and layoffs (10%). Workers were more likely to quit positions at which they were employed for 20 hours/week or less, those with which they were dissatisfied, low-wage jobs, non-temporary positions, and jobs in construction. Voluntary separation was less likely for older workers, among racially and ethnically diverse workers, and those residing in regions with lower unemployment rates.
Cook, J.A., Burke, J.K. (2015). Reasons for job separations in a cohort of workers with psychiatric disabilities. Journal of Rehabilitation Research and Development, 52(4), 371-384.
Best practice supported employment outcomes for transition age youth and young adults
The purpose of this analysis is to examine the role of Supported Employment in achieving employment outcomes for youth (ages 18-24) and young adults (ages 25-30), compared to outcomes for older adults. Results showed that adults had lower proportions of any employment or competitive employment than youth or young adults.
Burke-Miller, J.K., Razzano, L.A., Grey, D.D., Blyler, C.R., Cook, J.A. (2012). Best practice supported employment outcomes for transition age youth and young adults. Psychiatric Rehabilitation Journal, 35(3), 171-179.
Promoting self-determination and financial security through innovative asset building approaches
The purpose of this article is to increase knowledge about the use of Individual Development Accounts (IDAs) to enhance self-determination and recovery for people with psychiatric disabilities. The success of IDA participants along with collaborative efforts demonstrates the value of creating opportunities for persons with disabilities to garner assets to break the cycle of poverty and enhance self-determination.
Burke-Miller, J.K., Swarbrick, P., Carter, T.M., Jonikas, J.A., Zipple, A., Fraser, V., Cook, J.A. (2010). Promoting self-determination and financial security through innovative asset building approaches. Psychiatric Rehabilitation Journal, 34(2), 104-112.
The Employment Intervention Demonstration Program: Findings and policy implications
This article summarizes the published results of the Employment Intervention Demonstration Program (EIDP), a federally-funded, multi-site study examining the effectiveness of supported employment programs for 1,273 unemployed individuals with psychiatric disabilities in the U.S. Findings confirm the effectiveness of supported employment across different models, program locations, and participant populations. For most EIDP participants, work did not serve as a springboard to financial self-sufficiency, but instead as a route to membership into a social stratum of society referred to as the “working poor.”
Cook, J.A., Blyler, C.R., Leff, H.S., McFarlane, W.R., Goldberg, R.W., Gold, P.B., Mueser, K.T., Razzano, L.A. (2008). The Employment Intervention Demonstration Program: findings and policy implications. Psychiatric Rehabilitation Journal, 31(4), 291-295.
Effects of co-occurring disorders on employment outcomes in a multi-site randomized study of supported employment
This article explores the effects of co-occurring disorders on work outcomes at seven sites among 1,273 individuals in mental health recovery receiving supported employment services. The results suggest that those with a chronic or acute medical condition were more likely to achieve competitive employment than those with other or no co-morbidities.
Cook, J.A., Razzano, L.A., Burke-Miller, J.K. et al. (2007). Effects of co-occurring disorders on employment outcomes in a multi-site randomized study of supported employment for people with severe mental illness. Journal of Rehabilitation Research and Development, 44(6), 837–850.