Adult Service Users Research Articles

Music festival drug checking: evaluation of an Australian pilot program

BackgroundThis paper explores the feasibility of delivering a music festival-based drug checking service in Australia, evaluating service design and stakeholder acceptability.MethodsQuestionnaire and interview data were collected from adult service users and key stakeholders. A mixed methods approach was used to analyse the data on implementation, impact and acceptability.ResultsThe trial service tested 170 substances with more than 230 patrons (including individuals who attended in groups). Adult service users had an average age of 21 years. Voluntary participation in the evaluation resulted in 158 participants completing the pre-service questionnaire, most of whom also completed the post-service (147 participants). Eleven in-depth qualitative interviews were conducted with patrons in the weeks following the drug checking. Concordance between what the patron expected the drug to be and drug checking results occurred in 88 per cent (n = 139) of the sample. Evaluation results show that the experience of testing and the accompanying harm reduction brief interventions positively impacted on patrons’ self-reported drug harm reduction knowledge, trust of health providers and stated drug use intentions. The service was received positively by service users.ConclusionThis is the first independent evaluation of a pilot drug checking service in Australia. Consideration of operational feasibility and self-reported behavioural change suggests that the program was successful, although communication about the interpretation of drug checking results could be improved. Future studies should develop strategies for follow-up and consider the applicability of behavioural change theory.

45 INTERPROFESSIONAL EDUCATION AND COLLABORATIVE PRACTICE IN FRAIL OLDER PERSONS’ CARE

Abstract Background Frail older adults present with complex care needs. Inter-Professional Education (IPE) is a means of creating a practice-ready workforce to improve patient safety and healthcare outcomes. A Steering Group was established comprised of acute and community clinicians, members of the Health Service Executive, service user, students and members of all Schools in the College of Medicine and Health in an Irish University (Medicine, Nursing and Midwifery, Pharmacy, Public Health, Clinical Therapies and Dentistry) to evaluate the effectiveness of IPE. A workshop dedicated to the management of frail older adults occurred for multidisciplinary healthcare students as part of a suite of three IPE workshops. Methods The validated ‘Interprofessional Collaborative Competencies Attainment Survey’ (ICCAS) evaluated student views of IPE pre- & post-workshop. This workshop involved a case-based study and facilitated discussion with involvement of frail older adult service users. One service user was in a rehabilitation unit post hospital admission, the other was living well at home. Their participation occurred using an online platform, supported by a consultant geriatrician in the rehabilitation unit and a relative for the home-based service user. Results Student scores on the six subscales of the ICCAS (communication, collaboration, roles and responsibilities, collaborative patient-centred approach, conflict management and team functioning) were compared. Scores in all categories achieved statistically significant increases after completion of the IPE workshop. The greatest positive change was observed in collaborative patient-centred approach with pre-workshop scores increasing from a mean of 2.61 to 4.25 (p<0.05). Conclusion This initiative explored the inclusion of a frail older adult workshop in the higher education setting. Older adults had an opportunity to share their lived experiences. Evaluation of this IPE initiative will inform future IPE activities to be incorporated into undergraduate education programmes. Similar IPE models can be replicated nationally to enable and enhance team-based working and integrated care.

Community employment, facility-based work, and day activities for working age people with intellectual and developmental disability

BACKGROUND: Individuals with Intellectual and Developmental Disability (IDD) participate in a variety of day/employment activities including community-based activities and work and facility-based activities and work. These different activities have important implications for community inclusion and economic independence. OBJECTIVE: The purpose of this study is to use the National Core Indicators-In person Survey (NCI-IPS) to explore the prevalence of day/employment activities for adult service users with IDD and to determine what personal and environmental factors are related to each type of activity. METHODS: The data analyzed in this study come from the 2018-19 National Core Indicators (NCI), a survey of adult services users with IDD in the U.S. We used descriptive statistics and multinominal logistic regression to explore how the various covariates differentially relate to the four day/employment activity types. RESULTS: A variety of personal and environmental characteristics were associated with each type of activity. Characteristics related to equity (e.g., race and gender) and support needs (e.g., mental health) were associated with less community-based work. CONCLUSIONS: This study was the first, to our knowledge, to describe the complexity of day/employment activities individuals with IDD experience in terms of prevalence and overlap. Further, this study provides evidence that certain profiles are leading to different experiences and that services do impact service users employment opportunities.

What factors influence engagement with primary mental health care services? A qualitative study of service user perspectives in rural communities of Mexico

BackgroundLow engagement with mental health treatment, including a lack of help-seeking and low subsequent attendance to treatment, are important challenges to the provision of mental healthcare. In settings with high levels of poverty, such as rural Mexican communities, low engagement may be aggravated by the limited availability of mental health services and existing barriers to access these services. This qualitative study was conducted to investigate factors that influenced engagement to a primary care mental health service programme in Chiapas, Mexico. MethodsWe conducted 30 semi-structured interviews with adult service users diagnosed with depression or anxiety who had received mental health services at 10 primary care clinics in rural communities in Mexico. Interviews were analysed through the framework analysis approach to understand service user perspectives on factors influencing: (a) help-seeking, and (b) subsequent treatment attendance. ResultsLack of attribution of symptoms to a mental illness, the perception that symptoms could be managed without treatment, and stigma hindered help-seeking. Perceived need for care, prompted by strong feelings of desperation and severe somatic symptoms, along with advice from trusted sources about the availability of relevant services at the primary health care clinics, were key incentives for service users to make their first contact with the clinics. An ongoing desire for symptom alleviation and satisfaction with services (e.g. due to the positive impact of treatment) improved subsequent attendance, while feeling that treatment was no longer necessary and structural barriers led to non-attendance. ConclusionsStrategies to enhance understandings between service users and health care providers are necessary to improve the extent to which the needs and preferences of service users are met by healthcare services. Further improvements in the mental health of communities are likely to require interventions outside the health setting that tackle social risk factors affecting mental health.

Proceedings of the 17th Annual International INEBRIA Conference

Proceedings of the 17th Annual International INEBRIA Conference

The service user experience of SlowMo therapy: A co-produced thematic analysis of service users' subjective experience.

SlowMo is the first blended digital therapy for paranoia, showing significant small-moderate reductions in paranoia in a recent large-scale randomized controlled trial (RCT). This study explored the subjective service-user experience of the SlowMo therapy content and design; the experience of the blended therapy approach, including the triangle of the therapeutic alliance; and the experience of the digital aspects of the intervention. Qualitative co-produced sub-study of an RCT. Participants were 22 adult service users with schizophrenia-spectrum psychosis and persistent distressing paranoia, who completed at least one SlowMo therapy session and a 24-week follow-up, at one of 3sites in Oxford, London, and Sussex, UK. They were interviewed by peer researchers, using a topic guide co-produced by the Patient and Public Involvement (PPI) team. The transcribed data were analysed thematically. Multiple coding and triangulation, and lay peer researcher validation were used to reach a consensus on the final theme structure. Six core themes were identified: (i) starting the SlowMo journey; (ii) the central role of the supportive therapist; (iii) slowing things down; (iv) value and learning from social connections; (v) approaches and challenges of technology; and (vi) improvements in paranoia and well-being. For these service users, slowing down for a moment was helpful, and integrated into thinking over time. Learning from social connections reflected reduced isolation, and enhanced learning through videos, vignettes, and peers. The central role of the supportive therapist and the triangle of alliance between service user, therapist, and digital platform were effective in promoting positive therapeutic outcomes.

An acute change? Does treatment within a therapeutic community for personality disorders affect local acute service use

Purpose The intensive 18-month treatment in the personality disorder (PD) therapeutic community (TC) is felt to offer improvement in many aspects of patients’ lives. This study aims to understand if the use of acute services was also affected via a service evaluation project. Design/methodology/approach The authors collected data from electronic records on the use of local services in the two years before, during and the two years after treatment in the TC. Specifically, the authors counted inpatient bed days, Emergency department (ED) presentations and days under home treatment team and liaison psychiatry; the authors used ANOVA to analyse the data. Findings The study included 25 adult service users, 17 female and 8 male, with an average age of 40. Whilst there were reductions in the use of inpatient beds and ED presentations, on analysis, these were not found statistically significant. The small size of the study is a limitation and may limit the generalisability of the findings. The study concludes there may be reductions in acute psychiatric service use during and after treatment in the TC. The findings were not statistically significant; the authors suggest larger multi-centre studies may be able to demonstrate statistical significance. Originality/value PD patients have a relatively high use of acute psychiatric services compared to other patient groups. The authors are not aware of any similar studies in the published literature.

Social workers and refugee service users (re)constructing their relationships in a hostile political climate

Summary This article explores the relationship between social workers and adult Eritrean refugee service users in the context of a hostile political climate and restrictive state policies. It examines the implications of politics and policies on the formation of this relationship based on findings from a qualitative study conducted in Israel and Germany. Semi-structured in-depth interviews were conducted with 38 participants – 16 Eritrean refugees and 22 social workers who work with refugees. Findings Despite different political, social and organizational contexts, especially in the asylum policies towards Eritrean refugees, our thematic analysis yielded two main themes common to both countries: First, changing relationship structures, in particular moving away from a ‘traditional’ conceptualization of the social work relationship towards ‘informal’ practices. These included modifications of the setting, of professional boundaries and of the therapeutic language. Second, shifting power relations, characterized by a friend-like dynamic, which enabled more egalitarian relations, and a parent–child dynamic, which included increased power imbalances and dependency. Implications An increased understanding of the role of restrictive policies, everyday racism and exclusionary political discourse in the reconstruction of the user-worker relationship dynamics could inform social work education and practice. Beyond the refugee arena, establishing informal relationship structures could help to reduce power differentials, increase trust-building and improve therapeutic outcomes with refugees and other service users. The possible risks of informal relations, such as misunderstandings or worker burnout, are also discussed.

Assessment of the quality of Primary Health Care in Fortaleza, Brazil, from the perspective of adult service users in 2019.

Primary Health Care (PHC) is the "front door" and keystone of Brazil's public health system, meaning that the evaluation of the quality of primary care services is of utmost importance. Using the Primary Care Assessment Tool (PCAT), this study evaluated the performance of public PHC services in Fortaleza from the view of adult service users. We conducted a cross-sectional study of 233 adult service users from 19 primary care centers (PCCs) between June and December 2019, collecting data on the sociodemographic and epidemiological characteristics of users and structural features of PCCs. The association between user and PCC characteristics and primary care attribute scores was measured by multilevel logistic regression. Most participants were women, aged between 30 and 59 years, brown, house owners, had completed high school, did not own health insurance, and belonged to families with at least 4 members. The lowest and highest-scoring attributes were "first contact accessibility" and "first contact utilization" (2.8 and 8.1, respectively). The overall essential and general scores were 6.0 and 5.7, respectively. Having complete health teams, more community health workers, and a family and community medicine residency program had a positive effect on the general score (p<0.05). Overall, the public services analyzed in Fortaleza received a low performance rating from the adult service users.

Pre-discharge factors associated with early readmission to psychiatric inpatient services within 90 days

AimsThe aim of this study was to identify pre-discharge risk factors associated with early inpatient readmission in general adult service users, with a particular focus on modifiable factors. We hypothesised that stability prior to discharge would reduce readmission to inpatient services within 90 days.BackgroundEarly readmission to inpatient psychiatric services is a poor outcome for service users, staff and the healthcare system. A variety of clinical, demographic and system factors, mostly non-modifiable, have been investigated previously. The identification of pre-discharge and particularly modifiable factors associated with readmission would give an opportunity for intervention and changes in policy.Method272 medical records of all admissions within an 8 month period to a NHS inner city psychiatric inpatient service were reviewed to identify factors associated with readmission within 90 days of discharge. The data were analysed by simple comparison, calculation of odds ratios and logistic regression.Result26% of service users were readmitted to the mental health trust within 90 days of discharge. Incidents (OR = 3.86; 95% CI 1.39–10.75) and psychotropic medication change in the week before discharge (OR = 2.94; 95% CI 1.43–6.03) were significantly associated with readmission, as were the number of previous admissions, and comorbid substance misuse. Successful overnight leave was found to be significantly protective against readmission (OR = 0.29; 95% CI 0.11–0.72).ConclusionThe ability to predict those at high risk for readmission means they can be targeted for interventions and it can also help develop best practice around inpatient care and the discharge process. The novel findings in this study of pre-discharge modifiable risk factors such as stability and successful overnight leave could have significant implications in discharge planning policy.

Suicide: can we identify and manage those at risk more effectively?

AimsThis study aimed to conduct longitudinal analysis of suicide reviews for mental health service users in Ayrshire to improve local practice and outcomes. Traditional risk factors – middle-age, male and alcohol misuse – were hypothesised to convey greater risk of completing suicide.BackgroundSuicide is an important public health issue in Scotland, with potentially devastating impacts. Practice and policy may lag behind emerging evidence. Mental health problems are associated with an increased suicide risk, and care provided to those who take their own lives is reviewed to identify recommendations and learning points to improve practice and outcomes. However, these reviews and their conclusions are often considered individually, when studying them collectively over time it is necessary to characterise common themes and highlight factors that could be addressed to reduce suicide. Moreover, national averages can obscure local patterns.MethodAccess to reviews of suicides for mental health service users in Ayrshire was granted by the Adverse Event Review Group. Relevant data were extracted for the 35 General Adult service users completing suicide between 2013 and 2015, including details of the act, demographics and clinical factors, and analysed for trends. Those with and without emotional instability as a primary diagnosis or significant problem were dichotomised to facilitate identification of statistically significant factors specific to these symptoms.ResultThere were 35 completed suicides including three inpatients. Suicide was most common in the 25-29 and 45-54 age ranges, and over 68.6% were male. Hanging accounted for 60.0% of deaths, and self-poisoning for 8.6%. Up to 62.9% of patients did not appear to have ongoing scheduled appointments on a regular basis. Diagnoses were difficult to identify – 48.6% had no clear primary diagnosis specified in the reviews, and features of depressive, anxiety, psychotic, substance misuse and personality disorders frequently overlapped and co-occurred. 22.9% had problems with emotional instability; their median age was 14 years younger, and 87.5% were female.ConclusionSmall sample size precluded detailed analysis. The traditional risk profile remains relevant. However, almost 25% of those completing suicide were younger females with emotional instability, despite frequent contact with services. Given the challenges in predicting suicide, we should continue to consider how best to prevent this tragic outcome in all service users, especially in younger females with emotional instability; middle-aged males who misuse alcohol, and those with ill-defined diffuse psychological difficulties who do not fit into discrete categories or are reviewed infrequently.

Optimising response rates in a national postal survey evaluating community mental health care: four interventions trialled

Background The Community Mental Health Survey (CMHS) is a valuable resource of information on experiences of mental health care in England; however, response rates are declining. Aim To increase the overall response rate and response rate of young adult service users. Methods Four interventions were trialled in a randomised controlled study design alongside the 2017 CMHS. The questionnaire and information letters were modified based on an established framework for influencing behaviour. The modified materials plus a pre-notification card were tested to increase the overall response rate, identified by one-sided z-tests between the intervention and control groups. An information flyer was modified to target service users age 18 to 35, tested using multilevel logistic regression. Results The overall response rate significantly increased with the modified information letters compared to the control (29.1% vs. 25.1%; p = 0.007). The targeted information flyer did not increase responses from younger service users; though the combination of modified information letters and questionnaire did (24.6% vs. 15.8%; p = 0.01). Conclusions Modifying information letters based on the easy, attractive, social and timely (EAST) framework can increase response rate in postal surveys evaluating community mental health care. Modified letters combined with a modified questionnaire can increase the response from younger service users.

Therapist art making as a means of helping service users with anxiety problems

ABSTRACT Background Therapist art making in individual sessions with adult service users has received little attention in the art therapy literature. Similarly, art therapy’s efficacy with anxiety problems has not been established. Context NHS Criminal Justice Community Mental Health Team, long term weekly individual art therapy. Outcomes Service User reported marked reduction in anxiety, CJCMHT observed significant reduction in anxiety and increased social functioning leading to discharge from forensic services. Conclusions Therapist art making helped reduce anxiety by increasing trust. The ambiguity of the artwork challenged black and white ways of relating to self and others. Therapist artmaking functioned as a non-verbal form of psychoeducation. Three styles of therapist art making can be described, all of which are characterised by improvisation: Alongside the Service User; Jointly with the Service User; Under the gaze of the Service User. Implications for research Art making can be helpful in 1:1 therapy with adult service users because it magnifies the art therapist’s ostensive (i.e. non-verbal) communications and increases trust. Making art alongside service users provides a unique way to engage with complex psychological and interpersonal material. It is the ambiguity of therapist artwork that seems particularly helpful, and it should be considered as a promising way to address black and white thinking in common mental health problems like anxiety and depression. Plain-language summary This paper describes the benefits of therapist art making in individual sessions with an adult user of mental health services. Lived Experience feedback is used to show how therapist art making helped reduce severe anxiety and improve social functioning. The paper describes the clinical reasoning for three art-based interventions; how they built and maintained trust, meaning and hope for both therapist and Lived Experience Author. The paper suggests that the ambiguity of therapist artwork can be thought about in terms of the presenting problem, particularly to reframe black and white ways of relating to self and others.

A retrospective study examining the adverse effect of childhood abuse among adult psychiatric service users in Britain.

The long-term effects of childhood abuse have been well studied though the effects of abuse of specific types in adult psychiatric service users are less known. This study aimed to assess the association between childhood abuse and the development of harmful social and behavioural outcomes among adult psychiatric service users. Adult psychiatric service users were accessed from secondary mental health services in South London. A retrospective analysis was conducted of a randomly selected sample of 342 mental health records. Chi-square tests and logistic regression models were used to examine associations between childhood abuse - sexual abuse, physical abuse and psychological/emotional abuse - and health and behavioural outcomes. This study identified that 109 (31.8%) psychiatric service users had some history of childhood abuse and more often presented with high-risk or severe behaviours. Sexual abuse in childhood was linked with social isolation related to loss of friends (odds ratio (OR)=2.68, P<0.01), risky behaviours such as binge drinking (OR=2.15, P<0.05) and self-harming (OR=2.86, P<0.01), while childhood physical abuse was associated with drug abuse in adulthood (OR=1.88, P<0.05). Revictimization (adult domestic violence) also impacted on service users' quality of life in terms of loss of housing (OR=2.21, P<0.05) and loss of friends/family contact (OR=2.73, P<0.01). These findings suggest childhood abuse may play an important role in shaping risk and vulnerability for mental health problems across a lifespan. In acute mental health services, the incorporation of a trauma-informed nursing care model is necessary to generate a shift in culture in the delivery of care.

Chemical restraint: A qualitative synthesis review of adult service user and staff experiences in mental health settings.

With an imperative to reduce or eliminate the use of coercive practices in mental health care it is important to understand the experience of service users and staff. This review aimed to synthesize qualitative studies, published between 1996 and 2020, reporting on mental health service users' and staff's experiences of chemical restraint. The databases PsycINFO, CINAHL, MEDLINE, Embase, Emcare, Web of Science, and Scopus were searched. Three analytic themes were identified from 17 included articles, synthesizing the experiences of service users and staff. These were "Unjustified versusjustified," "Violence versus necessity," and "Reflecting back: Positives and negatives." Service users viewed chemical restraint as an unjustified response to "behaviors of concern" and experienced it as a violent act with negative outcomes, although some saw it as necessary in retrospect and preferred it to other forms of coercion. Staff generally viewed it as a justified response to "behaviors of concern" and experienced it as appropriate within the constraints of staff numbers and limited alternatives. These findings identify nuances not apparent in the literature, which has generally conflated all forms of coercive practices.

Older Adult Peer Support Specialists' Age-Related Contributions to an Integrated Medical and Psychiatric Self-Management Intervention: Qualitative Study of Text Message Exchanges.

BackgroundMiddle-aged and older adults with mental health conditions have a high likelihood of experiencing comorbid physical health conditions, premature nursing home admissions, and early death compared with the general population of adults aged 50 years or above. An emerging workforce of peer support specialists aged 50 years or above or “older adult peer support specialists” is increasingly using technology to deliver peer support services to address both the mental health and physical health needs of middle-aged and older adults with a diagnosis of a serious mental illness.ObjectiveThis exploratory qualitative study examined older adult peer support specialists’ text message exchanges with middle-aged and older adults with a diagnosis of a serious mental illness and their nonmanualized age-related contributions to a standardized integrated medical and psychiatric self-management intervention.MethodsOlder adult peer support specialists exchanged text messages with middle-aged and older adults with a diagnosis of a serious mental illness as part of a 12-week standardized integrated medical and psychiatric self-management smartphone intervention. Text message exchanges between older adult peer support specialists (n=3) and people with serious mental illnesses (n=8) were examined (mean age 68.8 years, SD 4.9 years). A total of 356 text messages were sent between older adult peer support specialists and service users with a diagnosis of a serious mental illness. Older adult peer support specialists sent text messages to older participants’ smartphones between 8 AM and 10 PM on weekdays and weekends.ResultsFive themes emerged from text message exchanges related to older adult peer support specialists’ age-related contributions to integrated self-management, including (1) using technology to simultaneously manage mental health and physical health issues; (2) realizing new coping skills in late life; (3) sharing roles as parents and grandparents; (4) wisdom; and (5) sharing lived experience of difficulties with normal age-related changes (emerging).ConclusionsOlder adult peer support specialists’ lived experience of aging successfully with a mental health challenge may offer an age-related form of peer support that may have implications for promoting successful aging in older adults with a serious mental illness.

"Surviving out of the Ashes" - An exploration of young adult service users' perspectives of mental health recovery.

INTRODUCTION: Within their emerging adult role, young people will embark on employment, form intimate relationships and live independently. This indicates that how recovery is experienced and actualized in young adulthood may be different from other age groups. To explore young adult service user's perspectives of mental health recovery in Northern Ireland. Semi-structured individual qualitative interviews were analysed using a Gadamerian-based hermeneutic method and interpreted using a novel theoretical framework. The sample comprised 25 participants with an average age of 28years. Five key themes evolved: Services: A Losing Battle Straight Away; From your Foundations to a Step in the Dark; Let Go of the Pain not the Experience; Surviving Out of the Ashes Recovery; and Needs to be More than a Word. The main findings were that recovery involved the reclaiming of their active and purposeful life force. It is suggested that young adults have developed an explanatory model of "use that stuff you wanna bury" to transform an illness narrative to a wellness strategy. This research has implications for mental health nursing so the process of mental health recovery is not presented as a clinical pathway, but a personalized strategy of individual wellness.

Internet use and online behaviour of adults with intellectual disability: support workers’ perceptions, training and online risk mediation

The aim of this study was to examine support workers’ perceptions of the benefits and risks of Internet access by adult service users with intellectual disability and their online activities and behaviours. It also aimed to explore support workers’ training needs and mediation strategies implemented to prevent and address online risks. A cross-sectional survey design was conducted including 135 Spanish support workers participating in the study. Findings show that support workers perceive the Internet as an unsafe environment, emphasising online risks over benefits for people with intellectual disability. Support workers reported undesirable online behaviours (e.g. cyberbullying) experienced and engaged in by service users. Although support workers declared the use of active mediation strategies to prevent online risks, they lacked training on Internet safety. Training programs should be designed and implemented by service providers to provide their support workers with strategies to promote the safe use of the Internet. Points of interest People with intellectual disabilities' access to the Internet is increasing, and while this has brought about many opportunities for them, it has also raised some concerns among family and support workers. This article discusses Internet-related issues experienced by adults with intellectual disability from the perspective of their support workers. According to support workers, the Internet is more risky than beneficial for adults with intellectual disability and they report some undesirable online behaviours experienced and/or perpetrated by their service users (e.g. cyberbullying, online threatening, requesting personal information). In addition, support workers report a lack of training on Internet safety and a limited use of strategies that help to prevent and address online risks. The perceptions of risk may result in overprotection. More training programs should be implemented to promote the meaningful but safe use of the Internet by adults with intellectual disability.

Understanding the Wellbeing Effects of a Community Music Program for People With Disabilities: A Mixed Methods, Person-Centered Study.

People with disabilities face inequalities in mental wellbeing, for which social exclusion is a contributing factor. Musical activities offer a promising but complex intervention, making impacts on a population with highly varied characteristics and needs challenging to capture. This paper reports on a mixed methods, person-centered study investigating a community music intervention for such a population. Three groups of adult service users with varied disabilities (either physical, learning, or both), took part in weekly music workshops in different locations. Music staff, housing and resource center staff, as well as participants and members of their families, took part in semi-structured interviews. A quantitative measure administered by service staff was used to rate service users’ social development. Two lay researchers, both individuals with a disability contributed to all aspects of the study. Interviews were analyzed through thematic analysis. Improvements in individuals’ self-expression, confidence, mood, and social skills were consistent with previous findings. Differences in effect between centers included: Group 1, some of whom had previous experience of workshops, showed an improvement in musical skills; Group 2 showed a mixed response, some participated with enthusiasm but others chose art activities over music workshops; Group 3 had lasting positive impact, this group had very limited opportunities for music due to their rural location. Quantitative analysis showed significant increase over all groups in communication, interaction with others, and joint attention. The intervention was beneficial for participants in separate locations in similar ways, but also highlighted that context and prior experience mediated effects in distinct ways. The lay researchers enhanced the qualitative analysis by emphasizing (1) the importance of recognizing participants’ self-expression in non-verbal modes of communication and (2) the importance of having music staff with a disability to provide a positive role model. This paper proposes that mixed methods person-centered research is the most suitable approach to capture and understand the multiple and varied effects of this complex intervention for a diverse group of participants.

Improving quality of life assessments for high-need adult Medicaid service users with mental health conditions.

There is a lack of consensus on how to evaluate health and social service programs for people with mental health (MH) conditions. Having service users be the primary decision makers in selecting outcome measures can inform a meaningful evaluation strategy. We sought to identify the quality of life (QoL) survey preferences of high-need adult service users with MH conditions. A systematic review identified generic, self-reported QoL surveys with evidence of validity in MH populations of interest. An advisory panel selected the most promising surveys to assess the success of programs like Medicaid for MH service users. Three groups of high-need, adult service users with MH conditions and one group of direct care staff ranked the surveys from the advisory panel, and generated and ranked characteristics that were desirable or undesirable in a QoL survey. Twenty-two surveys met the inclusion criteria. Of the six surveys selected by the advisory panel, groups of service users and direct care staff most preferred the Warwick-Edinburg Mental Well-being Scale (WEMWBS). The WEMWBS best embodied the features prioritized by the groups: to have a user-friendly format and positive focus, to be clearly worded and brief, and to avoid presumptive or unrealistic items. Service user groups appreciated survey topics most amenable to self-report, such as satisfaction with relationships. Using QoL surveys that service users prefer can reduce the chance that deteriorating QoL is going unchecked, and increase the chance that decisions based on survey findings are meaningful to service users.