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Research Interests: Sociology and Citizenship
... need to explore the importance of fun, play, and pleasure's role in recovery (Davidson, Shahar, Lawless, Sells, & Tondora, 200613. Davidson, L., Shahar, G., Lawless, MS, Sells, D. and Tondora, J. 2006. ...... more
... need to explore the importance of fun, play, and pleasure's role in recovery (Davidson, Shahar, Lawless, Sells, & Tondora, 200613. Davidson, L., Shahar, G., Lawless, MS, Sells, D. and Tondora, J. 2006. ... Davidson, L., Shahar, G., Lawless, MS, Sells, D. and Tondora, J. 2006. ...
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Several instruments have been developed by clinicians and academics to assess clinical recovery. Based on their life narratives, measurement tools have also been developed and validated through participatory research programs by persons... more
Several instruments have been developed by clinicians and academics to assess clinical recovery. Based on their life narratives, measurement tools have also been developed and validated through participatory research programs by persons living with mental health problems or illnesses to assess personal recovery. The main objective of this project is to explore possible correlations between clinical recovery, personal recovery, and citizenship by using patient-reported outcome measures. All study participants are currently being treated and monitored after having been diagnosed either with (a) psychotic disorders or (b) anxiety and mood disorders. They have completed questionnaires for clinical evaluation purposes (clinical recovery) will further complete the Recovery Assessment Scale and Citizenship Measure (personal-civic recovery composite index). Descriptive and statistical analyses will be performed to determine internal consistency for each of the subscales, and assess converge...
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Objectives. We sought to understand interpersonal and systems-level factors relevant to delivering health care to emergency department (ED) patients who are homeless. Methods. We conducted semistructured interviews with emergency medicine... more
Objectives. We sought to understand interpersonal and systems-level factors relevant to delivering health care to emergency department (ED) patients who are homeless. Methods. We conducted semistructured interviews with emergency medicine residents from 2 residency programs, 1 in New York City and 1 in a medium-sized northeastern city, from February to September 2012. A team of researchers reviewed transcripts independently and coded text segments using a grounded theory approach. They reconciled differences in code interpretations and generated themes inductively. Data collection and analysis occurred iteratively, and interviews continued until theoretical saturation was achieved. Results. From 23 interviews, 3 key themes emerged: (1) use of pattern recognition in identifying and treating patients who are homeless, (2) variations from standard ED care for patients who are homeless, and (3) tensions in navigating the boundaries of ED social care. Conclusions. Our study revealed prac...
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Research Interests: Sociology and Citizenship
In order to help states establish best practice standards for mental health outreach and engagement teams for persons who are homeless, this study aimed to identify key functional elements needed to effectively address the multiple needs... more
In order to help states establish best practice standards for mental health outreach and engagement teams for persons who are homeless, this study aimed to identify key functional elements needed to effectively address the multiple needs of these persons. A statewide survey across six representative outreach programs was initiated in Connecticut. Focus groups with staff and clients, interviews with program administrators, shadowing of outreach workers on their rounds, and review of relevant written materials were conducted. Four main functional themes regarding optimal outreach work-constructive outreach team characteristics; availability of a wide range of services and resources for clients; navigation of multiple service systems; and favorable work demands and training opportunities-were identified through thematic analysis. The article concludes with recommendations for incorporating these four essential functional elements into mental health outreach and engagement practice to e...
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Violence is a serious public health problem in the United States, and a common risk factor for many forms of violence is the perpetrator's motivation to achieve personal justice for past wrongs and injustices. Using a fictional... more
Violence is a serious public health problem in the United States, and a common risk factor for many forms of violence is the perpetrator's motivation to achieve personal justice for past wrongs and injustices. Using a fictional transgression scenario to stimulate revenge feelings, we studied the preliminary efficacy of an intervention designed to mitigate revenge desires among victims of perceived injustice. The intervention consisted of a guided role-play of key figures in the justice system (e.g., victim, prosecutor, defendant, judge, etc.) in an imaginary mock trial of the offender. Study participants' revenge desires toward the perpetrator decreased significantly immediately after the intervention and at a 2-week follow-up interview. Benevolence toward the offender increased immediately postintervention and at a 2-week follow-up interview. These results suggest that the intervention has promise to decrease revenge desires in people who have been victimized, and it potent...
Research Interests: Psychology and Medicine
In a 2000 editorial in The Journal , Rowe and Baranoski[1][1] introduced the concept of citizenship as a theoretical framework for developing programatic and policy initiatives aimed at the community integration of persons with mental... more
In a 2000 editorial in The Journal , Rowe and Baranoski[1][1] introduced the concept of citizenship as a theoretical framework for developing programatic and policy initiatives aimed at the community integration of persons with mental illness and criminal justice histories. Rowe and colleagues
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The killing of 26 students and teachers in Newtown, Connecticut last year was committed by a young man, Adam Lanza, who took his own life before police could apprehend him. Investigative news reports and articles have stated that Lanza... more
The killing of 26 students and teachers in Newtown, Connecticut last year was committed by a young man, Adam Lanza, who took his own life before police could apprehend him. Investigative news reports and articles have stated that Lanza had received a diagnosis of Asperger's syndrome with sensory
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Recovery as a process through which people reclaim their lives even while continuing to experience symptoms of mental illness has at times been misunderstood or misinterpreted, including being used as an excuse for cutting needed services... more
Recovery as a process through which people reclaim their lives even while continuing to experience symptoms of mental illness has at times been misunderstood or misinterpreted, including being used as an excuse for cutting needed services and supports in the guise of allowing people to pursue their own personal "recovery journeys." In delivering a message of hope to individuals and fostering initiatives to counter the debilitating impact of clinical pessimism, recovery literature has also, at times, paid less attention to the material, social, cultural, political and economic contexts in which people pursue recovery. The importance of these contexts are implied in a 1961 American Report on Mental Illness and Health that argued that people with mental illnesses should be able to live their lives "in the normal manner" in their home communities. We argue for a disability model that provides people with necessary supports and services to make individual recovery pos...
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Citizenship is an approach to supporting the social inclusion and participation in society of people with mental illnesses. It is receiving greater attention in community mental health discourse and literature in parallel with increased... more
Citizenship is an approach to supporting the social inclusion and participation in society of people with mental illnesses. It is receiving greater attention in community mental health discourse and literature in parallel with increased awareness of social determinants of health and concern over the continued marginalization of persons with mental illness in the United States. In this article, we review the definition and principles of our citizenship framework with attention to social participation and access to resources as well as rights and responsibilities that society confers on its members. We then discuss our citizenship research at both individual and social-environmental levels, including previous, current, and planned efforts. We also discuss the role of community psychology and psychologists in advancing citizenship and other themes relevant to a citizenship perspective on mental health care and persons with mental illness.
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Chronic homelessness is an enduring condition experienced by more than 75,000 individual adults in the USA. An individual is considered chronically homeless if they have a disabling condition and has been residing on the street or in... more
Chronic homelessness is an enduring condition experienced by more than 75,000 individual adults in the USA. An individual is considered chronically homeless if they have a disabling condition and has been residing on the street or in emergency shelters continuously for 12 months or on at least four separate occasions in 3 years. Qualifying disabilities include substance use disorders, serious mental illness, developmental disability, post-traumatic stress disorder, brain injury-induced cognitive impairments, and chronic physical disability or illness. Chronic homelessness is a significant challenge to address, as it is not generally the result of one illness, one missed rent payment, or one period of unemployment. Rather, it is often the result of interactions between societal factors, such as limited availability of affordable housing and personal vulnerabilities, making the task of exiting homelessness especially complex. Individuals experiencing chronic homelessness face many obstacles related to recovery and housing. These can include difficulty navigating complex service systems, low income, barriers to accessing affordable housing, limited educational attainment, an unstable job market, and chronic and untreated medical, mental health, and substance use issues. Given that chronic homelessness is defined, in part, by the presence of a disabling condition, it is crucial to identify mechanisms for supporting recovery from homelessness and its co-existing complications. A growing literature supports the notion that interventions providing permanent supportive housing (PSH) without sobriety or treatment requirements are effective in helping individuals who have experienced chronic homelessness achieve housing stability. Housing First is an evidencebased model of permanent housing with consumer-driven support services with promising outcomes including housing retention, improved quality of life, and decreased emergency service
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The theoretical framework of citizenship is increasingly being used in mental health settings to inform practice. This exploratory qualitative study describes in more detail the acts of citizenship embedded in the everyday practices of... more
The theoretical framework of citizenship is increasingly being used in mental health settings to inform practice. This exploratory qualitative study describes in more detail the acts of citizenship embedded in the everyday practices of mental health workers that promote the social inclusion of people in their care. Acts make a claim for justice when one's rights and responsibilities of citizenship are denied. Semistructured interviews were conducted with 12 participants, seven mental health clinicians and five peer support workers, recruited from a mental health facility in Connecticut, USA. Two themes are presented, breaking the rules and the right thing to do, a rights-based practice that fosters inclusion for service users. Results suggest that staff undertake hidden acts of citizenship to promote inclusion and rights of service users by responsibly subverting the rules and norms of the organization. Changes to organizational practices to make visible such inclusionary acts a...
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Research Interests: Psychology, Psychometrics, Schizophrenia, Borderline Personality Disorder, Treatment Outcome, and 15 moreMedicine, Quebec, Humans, Major Depressive Disorder, Female, Male, Panic Disorder, Obsessive Compulsive Disorder, Mental Disorders, Clinical Sciences, Middle Aged, Questionnaires, Reproducibility of Results, Psychiatric Status Rating Scales, and Patient Outcome Assessment
Contexte: Plusieurs écrits scientifiques suggèrent que la participation de personnes en rétablissement en tant que partenaires de recherche représente une valeur scientifique et sociale ajoutée à la recherche en toxicomanie. Toutefois,... more
Contexte: Plusieurs écrits scientifiques suggèrent que la participation de personnes en rétablissement en tant que partenaires de recherche représente une valeur scientifique et sociale ajoutée à la recherche en toxicomanie. Toutefois, peu de recherches ont évalué systématiquement les retombées d'une telle participation sur les personnes concernées et selon ces personnes. Objectif: Cet article décrit diverses modalités et degrés de participation possibles en recherche. Les effets de leur participation sont discutés par des personnes qui furent activement parties prenantes au sein de deux projets. Elles furent rencontrées lors de groupes de discussion visant à dégager ce qu'elles pensent que la participation active en recherche peut leur apporter et ce qu'elles pensent qu'elles peuvent apporter à une dynamique de recherche, notamment à titre de pairs-assistants recherche. Résultats: La participation active en recherche favorise une certaine émancipation de la pauvreté...
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The objectives were to examine how emergency medicine (EM) residents learn to care for patients in the emergency department (ED) who are homeless and how providing care for patients who are homeless influences... more
The objectives were to examine how emergency medicine (EM) residents learn to care for patients in the emergency department (ED) who are homeless and how providing care for patients who are homeless influences residents' education and professional development as emergency physicians. We conducted in-depth, one-on-one interviews with EM residents from two programs. A random sample of residents stratified by training year was selected from each site. Interviews were digitally recorded and professionally transcribed. A team of researchers with diverse content-relevant expertise reviewed transcripts independently and applied codes to text segments using a grounded theory approach. The team met regularly to reconcile differences in code interpretations. Data collection and analysis occurred iteratively, and interviews continued until theoretical saturation was achieved. Three recurring themes emerged from 23 resident interviews. First, residents learn unique aspects of EM by caring for patients who are homeless. This learning encompasses both specific knowledge and skills (e.g., disease processes infrequently seen in other populations) and professional development as an emergency physician (e.g., the core value of service in EM). Second, residents learn how to care for patients who are homeless through experience and informal teaching rather than through a formal curriculum. Residents noted little formal curricular time dedicated to homelessness and instead learned during clinical shifts through personal experience and by observing more senior physicians. One unique method of learning was through stories of "misses," in which patients who were homeless had bad outcomes. Third, caring for patients who are homeless affects residents emotionally in complex, multifaceted ways. Emotions were dominated by feelings of frustration. This frustration was often related to feelings of futility in truly helping homeless patients, particularly for patients who were frequent visitors to the ED and who had concomitant alcohol dependence. Caring for ED patients who are homeless is an important part of EM residency training. Our findings suggest the need for increased formal curricular time dedicated to the unique medical and social challenges inherent in treating patients who are homeless, as well as enhanced support and resources to improve the ability of residents to care for this vulnerable population. Future research is needed to determine if such interventions improve EM resident education and, ultimately, result in improved care for ED patients who are homeless.
Research Interests: Emergency Medicine, Qualitative Research, Frustration, Medicine, Learning, and 13 moreCurriculum, Humans, New York City, Female, Male, Physicians, Connecticut, Clinical Sciences, Public health systems and services research, Clinical Competence, Homeless Persons, internship and residency, and Interviews as topic
The article published in this issue of Surgical Oncology by Dr. Itzhak Brook, a physician who became a cancer patient, is a powerful example of a courageous personal narrative. In it, he relates his experience of relapsed head and neck... more
The article published in this issue of Surgical Oncology by Dr. Itzhak Brook, a physician who became a cancer patient, is a powerful example of a courageous personal narrative. In it, he relates his experience of relapsed head and neck cancer that required repeated painful interventions and major life adjustments [1]. Surgical Oncology has chosen to publish a moving, balanced account of illness containing references to events and attitudes that oncologists should never allow to occur. Ignorance, failure to admit and correct mistakes, and arrogance or indifference cannot be part of cancer care, and Dr. Brook’s article offers us material for deep reflection on devotion, warmth, and compassion belonging at the core of our profession [1]. Dr. Brook’s story is that of many cancer patients: an initial diagnosis of a small cancer with good prognostic factors, accompanied by the reassurance that it will likely not recur after removal, an effort to return to normalcy under the illusion of being cured, followed by relapse, further interventions, complications, and additional interventions with short and long-term sequelae. During such a process, the patient struggles to maintain hope and keep searching for the best care while, at the same time remaining alert to possible mistakes or other reasons to question the care he receives, assuming that he, or a family member, is able to speak to his doctors about questionable procedures or treatment plans. The patient, while struggling to maintain hope and alertness, must often confront depression that may be the consequence of cancer-related distress or social isolation, but may also derive from the side effects of many anticancer drugs and treatment modalities, such as anaemia or thyroid dysfunction. Finally, the patient realizes that life will no longer be the same for him. Given his internal and external resources and support, he may also come to the conclusion that, although he would never have wished cancer upon himself, there is still the possibility of reinventing his life. Cancer has been described as an illness of the entire family, as it deeply affects the relational dynamics among its members [2]. Cancer patients often perceive
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Research Interests: Psychology, Human Rights, Focus Groups, Medicine, Community Based Participatory Research, and 15 moreSocial behavior, Humans, Concept Formation, Female, Male, Cluster Analysis, Social Adjustment, Self Concept, Adult, Public health systems and services research, Psychiatric Services, Consumer Participation, Psychiatric, Social Behavior, and Life Change Events
Research Interests: Psychology, Communication, Mental Health, Public Health, Medicine, and 15 moreSelf Help Groups, Humans, Female, Male, Patient Satisfaction, Mental Disorders, Interpersonal Relations, Social Environment, Peer group, Middle Aged, Severe Mental Illness, Questionnaires, Adult, Psychiatric Services, and Severity of Illness Index
... that match the cultural experiences and traditions of clients and that increase both the ... one's belief systems, assumptions, and modes of problem solving, decision making, and conflict resolution (Ibrahim, 1991). ... CULTURAL... more
... that match the cultural experiences and traditions of clients and that increase both the ... one's belief systems, assumptions, and modes of problem solving, decision making, and conflict resolution (Ibrahim, 1991). ... CULTURAL COMPETENCE AND MENTAL HEALTH OUTREACH ...
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The prevalence of mental illness among homeless persons points to the importance of providing mental health training to emergency shelter staff. The authors report on their own work and argue that such training offers the potential to... more
The prevalence of mental illness among homeless persons points to the importance of providing mental health training to emergency shelter staff. The authors report on their own work and argue that such training offers the potential to significantly improve shelter staff's ability to respond to the needs of shelter residents with mental illness, and to the behavioral problems some of
Research Interests: Program Evaluation, Psychology, Psychiatry, Mental Health, Medicine, and 12 moreCrisis Intervention, Humans, Mental Disorders, Case Management, Connecticut, Clinical Sciences, Community Mental Health, Prevalence, Competency Based Education, Homeless Persons, Inservice training, and interprofessional relations
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Purpose – The purpose of this paper is to update the Global Model of Public Mental Health (GMPMH) in light of the WHO QualityRights project. Design/methodology/approach – Being able to refer to international conventions and human rights... more
Purpose – The purpose of this paper is to update the Global Model of Public Mental Health (GMPMH) in light of the WHO QualityRights project. Design/methodology/approach – Being able to refer to international conventions and human rights standards is a key component of a genuine global approach that is supportive of individuals and communities in their quest for recovery and full citizenship. The GMPMH was inspired by the ecological approach in health promotion programs, adding to that approach the individuals as agents of mental health policies and legislation transformation. The GMPMH integrates recovery- and citizenship-oriented psychiatric practices through the Ottawa Charter for Health Promotion (WHO, 1986). Findings – Updating the GMPMH through the WHO QualityRights Toolkit highlights the need for a new form of governance body, namely the Civic Forum, which is inclusive of local communities and persons in recovery. People with mental health disabilities, intellectual disabiliti...
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To the Editor: In their article on the relatively limited changes that have followed the 1999 Institute of Medicine (IOM) report To Err Is Human, Drs Leape and Berwick correctly argue that complexity, professional fragmentation,... more
To the Editor: In their article on the relatively limited changes that have followed the 1999 Institute of Medicine (IOM) report To Err Is Human, Drs Leape and Berwick correctly argue that complexity, professional fragmentation, individualism, and hierarchical authority structures, along with vague accountability and lack of hospital or health plan leadership, create barriers to team work and individual accountability, prerequisites for a culture of safety in medicine. We wish to draw attention to the critical role that specialty societies can play in advancing patient safety. Specialty societies are ideally positioned to explore how patient safety concepts play out in their individual fields and engage their members in addressing the problem of medical errors. Although many aspects of patient safety are common across diseases, errors and adverse events have important specialty-specific dimensions. For example, in clinical oncology, there may be issues related to errors around the severity, pain, and uncertainty of the patient’s condition; the tension inherent in patient-physician communication about cancer; the complexity of cancer diagnosis and treatment; and the toxicity of many cancer therapies, coupled with the prominent role of experimental treatments. The 2005 Annual International Meeting of the American Society of Clinical Oncology offered an educational session on “Medical errors in oncology: patients’ and physicians’ attitudes and management strategies.” A narrative lecture by a journalist and patient with breast cancer was followed by the presentation of ongoing empirical research on patients’ and physicians’ attitudes regarding error disclosure. Physicians’ emotional reactions to errors committed or observed were discussed, along with the ethical implications of medical errors in oncology, focusing on team errors, errors in clinical trials, improper communication, and individual and institutional arrogance. By understanding the problem of medical errors within their specific context, specialty societies can contribute to changing the culture of medicine and to developing effective strategies for reducing errors. How to communicate with patients when harmful errors occur may also be best addressed within each specialty. Silence spoils the trust necessary to the patient-physician relationship and it negatively affects the physician’s inner life and moral integrity. Persisting cultural differences in truth-telling with patients who have cancer add to the complexity of medical errors in oncology. Research should also focus on crosscultural analysis of attitudes and practices of disclosure.
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Citizenship is a theoretical framework regarding social inclusion and community participation of people with mental illnesses. It is defined by a person's connection to rights, responsibilities, roles, resources, and relationships.... more
Citizenship is a theoretical framework regarding social inclusion and community participation of people with mental illnesses. It is defined by a person's connection to rights, responsibilities, roles, resources, and relationships. The application of this framework in public mental health settings is in its early stages. This study was an exploration of mental health providers' views of the potential contribution of this framework. Eight focus groups were conducted with 77 providers on teams in a large mental health center. A 12-item brief version of a 46-item measure of citizenship was a starting point for discussion of the relevance of the framework and citizenship supports in public mental health care. Two themes were presented: social, including relatedness, stigma, and meaningful choices, and clinical, including client empowerment and barriers to citizenship work in clinical settings. These themes are discussed in relation to the introduction of citizenship-oriented pra...
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Recovery capital—the quantity and quality of internal and external resources to initiate and maintain recovery—is explored with suggestions for how recovery support services (RSS) (nontraditional, and often nonprofessional support) can be... more
Recovery capital—the quantity and quality of internal and external resources to initiate and maintain recovery—is explored with suggestions for how recovery support services (RSS) (nontraditional, and often nonprofessional support) can be utilized within a context of comprehensive addiction services. This article includes a brief history of RSS, conceptual and operational definitions of RSS, a framework for evaluating RSS, along with
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The Patient Protection and Affordable Care Act, signed into law by President Obama in March 2010, contains elements of two seemingly contradictory positions: health care as a commodity and as a right. The commodity argument posits that... more
The Patient Protection and Affordable Care Act, signed into law by President Obama in March 2010, contains elements of two seemingly contradictory positions: health care as a commodity and as a right. The commodity argument posits that the marketplace should govern demand, supply, and costs of care. The law's establishment of state insurance exchanges reflects this position. The argument that health care is a right posits that it is a need, not a choice, and that government should regulate care standards that may be compromised as insurers attempt to minimize costs. The law's requirement for coverage of mental and substance use disorders reflects this position. This Open Forum examines these arguments in light of current state fiscal crises and impending reforms. Despite the federal government's interest in expanding prevention and treatment of mental illness, states may demonstrate varying levels of commitment, based in part on their perception of health care as a right or a commodity. The federal government should outline clear performance standards, with minimum services specified to maximize state commitments to services.