Wellness Institute

ABSTRACT: Developed in collaboration with WHO Department of Mental Health and Substance Abuse, this study (conducted in India, the UK, and the USA) integrated feedback from mental health service users into the development of the chapter on mental, behavioural, and neurodevelopmental disorders for ICD-11. The ICD-11 will be used for health reporting from January, 2022. As a reporting standard and diagnostic classification system, ICD-11 will be highly influential by informing policy, clinical practice, and research that affect mental health service users. We report here the first study to systematically seek and collate service user perspectives on a major classification and diagnostic guideline. Focus groups were used to collect feedback on five diagnoses: depressive episode, generalised anxiety disorder, schizophrenia, bipolar type 1 disorder, and personality disorder. Participants were given the official draft diagnostic guidelines and a parallel lay translation. Data were then thematically analysed, forming the basis of co-produced recommendations for WHO, which included features that could be added or revised to better reflect lived experience and changes to language that was confusing or objectionable to service users. The findings indicated that an accessible lay language version of the ICD-11 could be beneficial for service users and their supporters. 

Hackmann, C., Balhara, Y. P. S., Clayman, K., Nemec, P.B., Notley, C., Pike, K., Reed, G.M. Sharan, P., Rana, M.S., Silver, J., Swarbrick, M., Zeilig, H., & Shakespeare, T. (2019). Perspectives on the INternational CLassification of Diseases, 11th Revision (ICD-11); an international qualitative study to Understand and improve mental health Diagnosis using expertise by Experience: INCLUDE Study. The Lancet Psychiatry. DOI: 10.1016/s2215-0366(19)30093-8 

ABSTRACT: OBJECTIVE: Adults with serious mental illnesses have a lower life expectancy attributable to many factors including metabolic disorders and cancer. Access to cancer screening has been shown to decrease morbidity and increase chances of survival. This study examined access to cancer screening services among individuals with serious mental illnesses served by a community behavioral health care agency partial hospitalization program at four locations. METHOD: A self-administered paper-and-pencil survey was provided to adults attending partial hospitalization programs. The survey consisted of open- and closed-ended questions about utilization, access to, and barriers to cervical, breast, and colorectal cancer screenings. RESULTS: Surveys were completed by 136 individuals. Participant screening rates were above national rates for cervical and breast cancer but lower for colorectal cancer. The main cited barrier to receiving the screening tests was lack of physician recommendations. CONCLUSIONS: Psychiatric nurses are ideally suited to communicate with this population and other behavioral health care professions about the importance of these screenings. Communication should also advocate for improved education and increased support for cancer screenings to address this health care disparity.

Rockson L, Swarbrick, M, Pratt C. (2019). Cancer screening in behavioral health care programs. American Psychiatric Nurses Assoc.:1078390319877227. doi: 10.1177/1078390319877227

Swarbrick, M., Bohan, MC., Gitlitz, R., & Hillis, M (2019). Peer health navigators support individuals with an opioid uuse disorder transitioning from prison. Drug and Alcohol Dependence, 203(1), 88-91.

ABSTRACT: This qualitative study explored peer specialists’ contributions to a healthy lifestyle intervention for obese/overweight individuals with serious mental illness (SMI) living in supportive housing. Intervention participants, peer specialists, and supervisors were interviewed and a grounded model emerged from the data identifying essential interpersonal attributes of the peer specialist-participant relationship. Peer specialists’ disclosure of their own experiences making health behaviors changes was critical for building participants’ motivation and ability to try lifestyle changes. Findings can inform peer specialist training and practice standards and facilitate the expansion of peer-delivered interventions to improve the physical health of people with SMI.

Bochicchio, L., Stefancic, A., Gurdak, K., Swarbrick, M., Cabassa, L. (2018). We’re all in this together”: Peer-specialist contributions to a healthy lifestyle intervention for people with serious mental illness. Administration and Policy in Mental Health and Mental Health Services Research. doi:10.1007/s10488-018-0914-6.

ABSTRACT: This study explored the sensory preferences of adults with mental health disorders who attend peer-led community wellness centers in the northeastern United States. Participants (N = 55) completed a demographic survey and the Adolescent/Adult Sensory Profile. The participants scored significantly higher in the quadrants of low registration (p = .042), sensory sensitivity (p = .039), and sensation avoiding (p = .010). Individuals diagnosed with bipolar disorder I scored significantly higher in the quadrants of sensory sensitivity (p = .039) and sensation avoiding (p = .021). These findings enhance the understanding of sensory preferences among community dwelling individuals diagnosed with a mental health disorder attending peer-led community wellness centers. This information can help healthcare professionals, including mental health care practitioners and peer providers, better support individuals who have sensory regulation challenges.

Gardner, J., Swarbrick, M., Kearns, D., Suero, L., Harder, P., Moscoe, E., Rutledge, J. (2018). Exploring sensory preferences among community-dwelling individuals living with mental health disorders. American Journal of Psychiatric Rehabilitation, 21(3), 381-398. https://www.muse.jhu.edu/article/759940.

ABSTRACT: National behavioral health care efforts have opened opportunities to reignite occupational therapy mental health practice and research. The profession’s person-centered and occupation-based practice fits well with the growing needs of people with serious mental illness (SMI) served in community-based settings. The nine articles in this special issue provide a growing body of evidence to support the effectiveness of occupational therapy interventions for adults with SMI to enhance health management skills and promote independence in living a balanced and satisfying life. However, much more high-level research is required to explicitly investigate the contributions of occupational therapy in all areas of occupation for adults with SMI and to broaden the available evidence base to inform occupational therapy practice.

Swarbrick, M., & Noyes, S. (2018), Guest Editorial: Effectiveness of occupational therapy services in mental health practice. American Journal of Occupational Therapy, 72 (1-4). DOI: 10.5014/ajot.2018.725001

ABSTRACT: Individuals with major mental disorders could benefit from low cost, functional ways to support healthy lifestyles. Walking is a popular, preferred, accessible, and safe physical activity for many people. Walking is free, requiring no specialized equipment or membership fee, and is important to support engagement in other daily living activities. The current study explores the benefits of walking and strategies for promoting walking among community-dwelling individuals with major mental disorders. Key issues include strengthening engagement, tracking progress, and sustaining participation to achieve goals related to walking. The authors propose ways that nurses can support increased walking behavior for improved health and well-being in this population. [Journal of Psychosocial Nursing and Mental Health Services, 56(3), 25-32.].

Swarbrick, M., Nemec, PB, Brandow, CL, Spagnolo, A. (2018). Strategies to promote walking among community-dwelling individuals with major mental disorders. Journal of Psychosocial Nursing and Mental Health Services, Mar 1;56(3):25-32. doi: 10.3928/02793695-20171205-0

ABSTRACT: Music is a meaningful occupation; a summary of current literature and the authors’ experiences regarding health and wellness benefits and potential for music as a therapeutic medium in occupational therapy practice is presented. An interview and a summary of the authors’ experiences illustrate the role for music and its benefits for occupational therapy. These benefits are described through three themes which emerged: (a) music as a means of increasing group cohesion toward common goals, (b) music as a means of increasing socialization, and (c) music as a meaningful occupation can empower individuals to enhance and embrace wellness and recovery.

Cohn, J., Kowalski, K. Z., & Swarbrick, M. (2017). Music as a therapeutic medium for occupational egagement: Implications for occupational therapy. Occupational Therapy in Mental Health, 0(0), 1–11. https://doi.org/10.1080/0164212X.2016.1248311

ABSTRACT: Individuals living with mental health disorders served by the public mental health system often face comorbid medical conditions that affect their quality of life and lifespan. The effect of physical limitations on the engagement in daily activities among individuals living with mental health disorders has not been extensively researched. Adults attending community wellness centers (N = 53) in a northeastern United State were included in a descriptive study exploring the impact of physical limitations on daily activities. The activities most frequently affected were: walking or moving around, sleeping, and finding a job. The physical limitations affecting these three activities were lack of energy and pain. Health care professionals, including mental health nurses and occupational therapy practitioners, are in an ideal position to collaborate by evaluating and offering treatment interventions that address physical limitations to positively affect occupational functioning and recovery. [Journal of Psychosocial Nursing and Mental Health Services, 55(10), 45-51.].

Gardner, J., Swarbrick, M., Ackerman, A., Church, T., Rios, V., Valente, L., & Rutledge, J. (2017). Effects of physical limitations on daily activities among adults with mental health disorders: Opportunities for nursing and occupational therapy interventions. Journal of Psychosocial Nursing and Mental Health Services 55(10), 45-51. doi:10.3928/02793695-20170818-05

ABSTRACT: To date, whether individuals with mental illness use high energy drinks (HED) to offset their symptoms, or whether their use began after diagnosis or psychoactive drugs were prescribed is unknown. Their degree of knowledge regarding their symptoms, diagnosis, or what strategies they have used to feel better is also undetermined. A search of the literature yielded no studies about these areas or domains. The current article provides background information on caffeine and HED, with or without alcohol, and the use patterns of consumers of mental health services, as well as their attitudes and knowledge. Participants in the Network for Psychiatric Nursing Researchers, who were consumers, influenced the current study group to expand their thinking about how to address the unknown areas. Their related work and publication are described. [Journal of Psychosocial Nursing and Mental Health Services, 55(4), 37-43.].

Smoyak, S. A., Swarbrick, M., Nowik, K., Ancheta, A., & Lombardo, A. (2017). Consumers of mental health services: Their knowledge, attitudes, and practices about high energy drinks and drugs. Journal of Psychosocial Nursing & Mental Health Services, 55(4), 37–43. https://doi.org/10.3928/02793695-20170330-06.

ABSTRACT: BACKGROUND: The Individual Placement and Support (IPS) Learning Community was established in 2002 to increase access to Individual Placement and Support (IPS) supported employment. In 2008, learning community leaders launched the Family Advocacy Project to advance the role of families in providing education and advocacy for IPS. OBJECTIVE: This paper describes the perspective of the Family Advocacy Project leaders in understanding the sustainment of IPS services. METHODS: Representatives from ten family teams were interviewed by phone using a structured protocol. RESULTS: Most of the state family advocacy teams were part of the National Alliance on Mental Illness and included people other than family members. Education and advocacy were reported as the main goals of the teams. Facilitators and barriers to advocacy were described. CONCLUSION: The state family advocacy teams though small in numbers place a clear focus on advocacy and education activities that may impact the sustainment of IPS.

Swarbrick, M., Wilson, L., Becker, D., Swanson, S., Reese, S., & Bond, G. (2017). The role of the family advocacy team in sustaining supported employment. Journal of Vocational Rehabilitation, 47(1), 13-17. doi:10.3233/JVR-170879.

ABSTRACT: Objective: As part of a study of health status among 457 adults with diagnostically heterogeneous serious mental illnesses served by the public mental health system in four U.S. states, we assessed predictors of current cigarette smoking. Methods: We examined bivariate relationships between smoking status and risks for drug and alcohol use disorders, residential setting, parental status, and employment. Finally, we used multivariable logistic regression to predict current smoking, controlling for significant confounds. Results: Of the total sample, 44% of participants reported that they currently smoked and most (62%) were moderately to severely nicotine-dependent. Those at high risk for drug use disorders were more than three times as likely and those at high risk for alcohol use disorders were more than twice as likely to smoke, compared to their counterparts with little or no drug or alcohol use disorder risk. Controlling for all other model variables including drug and alcohol disorder risk, current smokers were less likely to be parents and more likely to reside in supervised settings than nonsmokers. Younger people and those without a college degree were more likely to smoke, controlling for all other model variables. Conclusions: Given the high degree of comorbidity of smoking, alcohol disorders, and drug use disorders, the authors highlight the need for integrated interventions that address these issues simultaneously.

Swarbrick, M., 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. https://doi.org/10.1080/15504263.2017.1296603

ABSTRACT: Objective: This study examined the prevalence and correlates of co-occurring obesity and diabetes among community mental health program members. Methods: Medical screenings of 457 adults with serious mental illnesses were conducted by researchers and peer wellness specialists in four U.S. states. Body mass index was measured directly. Diabetes was assessed via glycosylated hemoglobin and interview self-report. Multivariable logistic regression analysis examined associations with known predictors. Results: In the sample, 59% were obese, 25% had diabetes, and 19% had both conditions. When gender, diagnosis, and site were controlled, co-occurring diabetes and obesity was almost three times as likely among African Americans (OR=2.93) as among participants from other racial groups and half as likely among smokers as among nonsmokers (OR=.58). Older persons and those with poorer self-rated physical health also were more likely to have these co-occurring conditions. Conclusions: Results support the need for culturally competent treatment and for smoking cessation options with sensitivity to the potential for weight gain.

Cook, J. A., Razzano, L., Jonikas, J. A., Swarbrick, M., Steigman, P. J., Hamilton, M. M., … Santos, A. B. (2016). Correlates of Co-Occurring Diabetes and Obesity Among Community Mental Health Program Members With Serious Mental Illnesses. Psychiatric Services, 67(11), 1269–1271. https://doi.org/10.1176/appi.ps.201500219

ABSTRACT: Objective: This paper evaluates a pilot multidisciplinary intervention intended to increase health-promoting behaviors and reduce the negative effects of metabolic syndrome disorders among persons with serious mental illnesses. Exercise, nutritional counseling, health literacy education, and peer wellness coaching were provided by allied health professionals and students. Method: Participants with serious mental illnesses were recruited from partial hospitalization and supported housing programs. Initially, there were 77 participants, with 64 completing the study measures. A single-group, pre-post design was used. They participated in an 8-week program (3 hr each week). Individuals set their own personal health goals and received the interprofessional set of allied health interventions. Body weight, body mass index (BMI), blood pressure, and several measures of physical strength and flexibility were collected. Paired t tests evaluate the statistical significance of possible changes. Results: Average blood pressure decreased. Waist circumference decreased. Participants improved on measures of strength and flexibility as measured by the functional reach test, the half sit-up test, and the sit-to-stand test. Participants reported increased readiness to exercise and make dietary changes. Conclusions and Implications for Practice: Significant improvements in metabolic syndrome risk factors, physical strength, and flexibility were found. Next steps include a longer intervention likely to further reduce metabolic syndrome risk factors. Future studies should include a comparison intervention group and a follow-up to see if gains are maintained. The study highlights the potential utility of psychiatric rehabilitation providers collaborating with other allied health practitioners to promote overall health. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Gill, K. J., Zechner, M., Zambo Anderson, E., Swarbrick, M., & Murphy, A. (2016). Wellness for life: A pilot of an interprofessional intervention to address metabolic syndrome in adults with serious mental illnesses. Psychiatric Rehabilitation Journal, 39(2), 147–153. https://doi.org/10.1037/prj0000172

ABSTRACT: Objective: People with psychiatric disabilities experience substantial economic exclusion, which hinders their ability to achieve recovery and wellness. The purpose of this article is to describe a framework for a peer-supported economic empowerment intervention grounded in empirical literature and designed to enhance financial wellness. Method: The authors followed a 3-step process, including (a) an environmental scan of scientific literature, (b) a critical review of relevant conceptual frameworks, and (c) the design of an intervention logic framework based on (a) and (b), the programmatic experience of the authors, and input from peer providers. Results: We identified 6 peer provider functions to support individuals with psychiatric disabilities to overcome economic inclusion barriers, achieve financial wellness goals, and lessen the psychosocial impact of poverty and dependency. These include (a) engaging individuals in culturally meaningful conversations about life dreams and financial goals, (b) inspiring individuals to reframe self-defeating narratives by sharing personal stories, (c) facilitating a financial wellness action plan, (d) coaching to develop essential financial skills, (e) supporting navigation and utilization of financial and asset-building services, and (f) fostering mutual emotional and social support to achieve financial wellness goals. Conclusions and Implications for Practice: Financial wellness requires capabilities that depend on gaining access to financial and asset-building supports, and not merely developing financial skills. The proposed framework outlines new roles and competencies for peer providers to help individuals build essential financial capabilities, and address social determinants of mental health and disability. Research is currently underway to pilot-test and refine peer-supported economic empowerment strategies. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Jiménez-Solomon, O. G., Méndez-Bustos, P., Swarbrick, M., Díaz, S., Silva, S., Kelley, M., … Lewis-Fernández, R. (2016). Peer-supported economic empowerment: A financial wellness intervention framework for people with psychiatric disabilities. Psychiatric Rehabilitation Journal, 39(3), 222–233. https://doi.org/10.1037/prj0000210

ABSTRACT: Persons with a serious mental illness have more physical health problems and shorter life expectancy compared to the general population, in part due to modifiable at-risk health behaviors like obesity. This study provides a systematic review and meta-analysis of the available evidence on the efficacy of weight management interventions when compared to treatment as usual. Fourteen studies were included in the meta-analysis, analyzing data from a total of 1779 participants. Across all studies, an effect in favor of the intervention groups, with a reduction in mean absolute weight of −2.01 kg, compared to control groups (95% CI: −2.93 kg to −1.10 kg, p < 0.001) over a period ranging from 3 months to 12 months. Subgroup meta-analyses indicate programs that incorporate individual sessions and are implemented at the onset of illness may have the greatest impact on weight management for this population. Despite the statistically significant findings of mean weight change in the intervention groups compared to controls, the reported weight loss only equates to a 2% change from the initial body weight. This falls short of the clinically significant target of 5% weight loss in order to reduce related health complications. The current research was not consistent in capturing data on other metrics that could supplement mean weight loss in assessing positive health outcomes. Due the current health epidemic faced by this population, it is imperative for future research to include adequate follow-up periods, provide protocols, and employ better control methods. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Olker, S. J., Parrott, J. S., Swarbrick, M. A., & Spagnolo, A. B. (2016). Weight management interventions in adults with a serious mental illness: A meta-analytic review. American Journal of Psychiatric Rehabilitation, 19(4), 370–393. https://doi.org/10.1080/15487768.2016.1231643

ABSTRACT: Growing evidence suggests health disparities exist in services for individuals with mental disorders served by the public mental health system. The current study assessed the use of cancer screening services among New Jersey residents in publicly funded mental health programs. Self-administered written surveys were completed by 148 adults using peer-led community wellness centers throughout New Jersey. Information was collected on (a) the use of breast, cervical, and colorectal cancer screening services; (b) barriers to receiving preventive services; and (c) perceptions of overall health. More males than females participated in the study, with equal participation among White and African American individuals. Schizophrenia spectrum disorders were the most common self-reported psychiatric condition. Colorectal cancers had lower screening levels compared to those of the general population. Physicians not advising patients to complete tests emerged as a main cause of low screening rates. Wellness initiatives designed by peers collaborating with health care providers may improve adherence to preventive cancer screening measures. [Journal of Psychosocial Nursing and Mental Health Services, 54(3), 36–40.]

Rockson, L. E., Swarbrick, M., & Pratt, C. (2016). Cancer screening among peer-led community wellness center enrollees. Journal of Psychosocial Nursing and Mental Health Services, 54(3), 36–40. https://doi.org/10.3928/02793695-20160219-06

Rogers, S. & Swarbrick, M. (2016). Peer-delivered services: Current trends and innovations. Psychiatric Rehabilitation Journal, 39(3), 193-196. http://dx.doi.org/10.1037/prj0000223

ABSTRACT: Objective: People receiving publicly funded behavioral health services for severe mental disorders have shorter lifespans and significantly impaired health-related quality of life compared to the general population. The aim of this article was to explore how peer wellness coaching (PWC), a manualized approach to pursue specific physical wellness goals, impacted goal attainment and overall health related quality of life. Method: Deidentified archival program evaluation data were examined to explore whether peer delivered wellness coaching had an impact on 33 service recipients with regard to goal attainment and health-related quality of life. Participants were served by 1 of 12 wellness coach trainees from a transformation transfer initiative grant who had been trained in the manualized approach. Results: Coaching participants and their coaches reported significant progress toward the attainment of individually chosen goals, 2 to 4 weeks after establishing their goals. After 8 to 10 weeks of peer delivered wellness coaching, improvements were evident in the self-report of physical health, general health, and perceived health. These improvements were sustained 90 days later. Conclusions and Implications for Practice: PWC is potentially a promising practice for helping people choose and pursue individual goals and facilitating positive health and wellness changes. Rigorous controlled research with larger samples is needed to evaluate the benefits of peer delivered wellness coaching. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Swarbrick, M., Gill, K. J., & Pratt, C. W. (2016). Impact of peer delivered wellness coaching. Psychiatric Rehabilitation Journal, 39(3), 234–238. https://doi.org/10.1037/prj0000187

Swarbrick, M., & Nemec, P. B. (2016). Supporting the health and wellness of individuals with psychiatric disabilities. Rehabilitation Research, Policy, and Education, 30(3), 321–333. https://doi.org/10.1891/2168-6653.30.3.321

ABSTRACT: Objective: This article provides examples of the development, implementation, and funding of peer-delivered health and wellness services in three states. Health and wellness services are critical to addressing the health disparities facing people living with mental health and substance use disorders served by the public behavioral health care system. Methods: Information was compiled from the authors’ experiences as champions in three states (Georgia, Michigan, and New Jersey) and the National Association of State Mental Health Program Directors, as well as documents from and discussions with local state and national sources. Results: Key issues for the implementation and expansion of peer-delivered health and wellness services include defining the model to be disseminated, providing training to prepare the peer workforce, accessing funding for implementation, and establishing clear expectations to sustain the services and maintain quality over time. Conclusions and Implications for Practice: Peer-delivered health and wellness services can help address the health disparities facing people who are living with mental health and substance use disorders through a variety of innovative models tailored to local needs and circumstances. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Swarbrick, M., Tunner, T. P., Miller, D. W., Werner, P., & Tiegreen, W. W. (2016). Promoting health and wellness through peer-delivered services: Three innovative state examples. Psychiatric Rehabilitation Journal, 39(3), 204–210. https://doi.org/10.1037/prj0000205

ABSTRACT: Physical health screenings were conducted by researchers and peer wellness specialists for adults attending publicly-funded community mental health programs. A total of 457 adults with serious mental illnesses attended health fairs in 4 U.S. states and were screened for 8 common medical co-morbidities and health risk factors. Also assessed were self-reported health competencies, medical conditions, and health service utilization. Compared to non-institutionalized U.S. adults, markedly higher proportions screened positive for obesity (60%), hypertension (32%), diabetes (14%), smoking (44%), nicotine dependence (62%), alcohol abuse (17%), drug abuse (11%), and coronary heart disease (10%). A lower proportion screened positive for hyperlipidemia (7%). Multivariable random regression analysis found significant pre- to post-screening increases in participants’ self-rated abilities for health practices, competence for health maintenance, and health locus of control. Screening identified 82 instances of undiagnosed diabetes, hypertension or hyperlipidemia, and 76 instances where these disorders were treated but uncontrolled. These results are discussed in the context of how this global public health approach holds promise for furthering the goal of integrating health and mental health care.

Cook, J. A., Razzano, L. A., Swarbrick, M., Jonikas, J. A., Yost, C., Burke, L., … 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. https://doi.org/10.1371/journal.pone.0123552

ABSTRACT: Topic: This column describes the experience of prejudice and discrimination that some mental health service users encounter in their interactions with service providers and organizations. Purpose: The intent of this column is to highlight potential action steps to address the negative beliefs and attitudes of service providers that contribute to prejudice and discrimination. Sources Used: This description draws from published material and the authors’ experience. Conclusions and Implications for Practice: If the most effective approaches to reduce public prejudice and discrimination toward people diagnosed with a mental illness are education and contact, then those methods may be useful methods to help mental health service providers view and engage persons served from a strengths-based recovery and wellness orientation. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Nemec, P., Swarbrick, M., & Legere, L. (2015). Prejudice and discrimination from mental health service providers. Psychiatric Rehabilitation Journal, 38(2), 203-206. http://dx.doi.org/10.1037/prj0000148

ABSTRACT: Objective: Training the mental health workforce to provide health promotion and support to people using their services to manage comorbid conditions is essential if full integration of physical and mental health is to become a reality. We document how a training model was explicitly designed to extend curricula beyond the classroom in order to increase the frequency and quality of physical health interventions. We also show how implementation was supported by a strong project structure and a facilitative administration. Method: This article was informed by the workforce development literature, process observations, and key informant interviews. Results: Passive dissemination cannot change practice. Buy-in and commitment from agency leaders facilitates collaboration between consultant-trainers and trainees. Organizations with strong implementation structures help ensure training uptake. Conclusions and Implications for Practice: When contracting with trainers, ensure that they understand the need for and are willing to commit to sustainability. Additionally, organizations will benefit by using lessons from implementation science when approaching workforce. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Davis, K., Swarbrick, M., Krzos, I. M., Ruppert, S., & O’Neill, S. (2015). Health literacy training: A model for effective implementation and sustainability. Psychiatric Rehabilitation Journal, 38(4), 377–379. https://doi.org/10.1037/prj0000166

ABSTRACT: Regardless of an individual’s mental health status, habits are difficult to establish and/or eliminate. Given the importance of good habits to overall health and wellness, nurses and other mental health service providers need to understand the force of habits (positive and negative), factors that make habit change difficult, and approaches that are likely to facilitate building and maintaining good habits. The current article provides a cursory overview of several factors (i.e., motivation, will-power, and rewards) that impact habit formation. Relevant theories and research are presented. Habit formation can be fostered through a careful analysis of current behaviors, specific and measurable short-term goals or objectives, and a detailed action plan.

Nemec, P. B., Swarbrick, M. A., & Merlo, D. M. (2015). The force of habit: Creating and sustaining a wellness lifestyle. Journal of Psychosocial Nursing and Mental Health Services, 53(9), 24–30. https://doi.org/10.3928/02793695-20150821-01

ABSTRACT: Background: This study examined the prevalence and treatment of 17 co-occurring physical health conditions among adults with serious mental health disorders, and factors associated with prevalence of the 5 most common medical co-morbidities. Methods: Data were collected from 457 adults attending publicly funded mental health programs who participated in community health screenings held in 4 U.S. states. Face-to-face interviews included standardized items from the National Health Interview Survey and the National Health and Nutrition Examination Survey. Ordinary least squares regression analysis examined associations between prevalence of the 5 most common co-morbid conditions and respondents’ demographic, clinical, attitudinal, and health insurance statuses. Results: Compared to the U.S. population, prevalence was significantly higher for 14 out of 17 medical conditions assessed. The 5 most common were hyperlipidemia (45%), hypertension (44%), asthma (28%), arthritis (22%), and diabetes (21%). Controlling for age, study site, and Medicaid status, racial/ethnic minorities were almost twice as likely as Caucasians to be diagnosed with hypertension and diabetes; women were almost twice as likely as men to be diagnosed with diabetes; and people with schizophrenia were around half as likely as those with other disorders to be diagnosed with hypertension and arthritis. Age was positively related to all conditions except asthma. Treatment prevalence was below 70% for approximately half of ongoing conditions. Conclusions: These results suggest a high level of medical vulnerability and need for coordination of health and mental health services in this population. Associations with age, minority status, and gender point to the need for targeted health care strategies.

Razzano, L. A., Cook, J. A., Yost, C., Jonikas, J. A., Swarbrick, M. A., Carter, T. M., & Santos, A. (2015). Factors associated with co-occurring medical conditions among adults with serious mental disorders. Schizophrenia Research, 161(2–3), 458–464. https://doi.org/10.1016/j.schres.2014.11.021

ABSTRACT: People who are served by the public mental health system often live with chronic medical conditions, exhibit many risk factors for metabolic syndrome, and experience high rates of early mortality. This research project assessed the recency of screenings and perceptions of overall health of 148 people served by the public mental health system and attending peer-run, self-help centers in New Jersey. The results underscore existing health risks and the need to assess, educate, and empower people served by the public mental health systems to regularly access screenings and self-monitor health measures, including weight and blood pressure.

Swarbrick, M., Rockson, L., Pratt, C., Yudof, J., & Nemec, P. (2015). Perceptions of overall health and recency of screenings. American Journal of Psychiatric Rehabilitation, 18(1), 5–18. https://doi.org/10.1080/15487768.2015.1001703

ABSTRACT: In an effort to identify the tasks, knowledge and skills of peer specialists, a formal analysis of the nature and complexity of their role was sponsored by the Veterans Administration in New Jersey. Using a content validity method of role delineationr, the study was executed by faculty of the University of Medicine and Dentistry of New Jersey(UMDNJ), Department of Psychiatric Rehabilitation and Counseling Professions. Engaging the input of two groups of subject matter experts, peer specialists and their supervisors, 85 specific job tasks and skills were identified and categorized into eight broad domains: outreach, peer support activities, counseling skills, skill development, professional documentation and communication, crisis intervention, knowledge of resources, and continued professional role/competency development. The findings have significant implications for the curriculum development of educational programs, remuneration, as well as the status of staff in these roles. This report includes an overview of the study method, reports of the ratings for specific tasks and competencies, and suggestions for the development of academic courses based on the findings of the role delineation study.

Gill, K. J., Burns-Lynch, W., Murphy, A. A., & Swarbrick, M. (2009). Delineation of the job role. Journal of Rehabilitation, 75(3), 23–31.

ABSTRACT: A variety of chronic, co-morbid medical conditions are worsening the quality of life for persons with serious mental illness. The poor overall health of these individuals is interfering with the pursuit and maintenance of rehabilitation goals. Also, very troubling are the facts about their premature mortality, about 25 years earlier than their peers who do not have mental illness. This paper provides an overview of the problems in this area and a discussion of the variety of contributing factors that are negatively influencing the health of persons with serious mental illness. An introduction is provided to the variety of innovations and strategies that are being implemented in an attempt to address the extreme disparities in both care and outcomes. Most of these interventions focus on improving accessibility, coordination of services, and the integration of psychiatric care with other health care and health promotion strategies. The summary and conclusion offer policy, practice, and workforce development recommendations.

Gill, K. J., Murphy, A. A., Spagnolo, A. B., Swarbrick, M., & Zechner, M. R. (2009). Co-morbid psychiatric and medical disorders: Challenges and strategies. The Journal of Rehabilitation, 75(3), 32+. https://link.gale.com/apps/doc/A205906600/HRCA?u=anon~3c685d22&sid=googleScholar&xid=6510ba25

ABSTRACT: Objective: Despite the piling evidence supporting the effectiveness of psychiatric medication, research has consistently shown that only about half of those administered treatment actually take it as prescribed. The purpose of the present study was to explore why and how people with a serious mental illness (SMI) choose to stop taking prescribed medication. Method: Seven persons with SMI who had been prescribed and had used medication in the past, but had not taken medication for at least a year, participated in semi-structured interviews, which were recorded and later transcribed. Qualitative analysis provided a foundation for sketching a hypothesized five-stage model of the process involved in choosing to stop medication. Results: This study revealed the subjective experience of taking medication, dilemmas it evokes, and the struggle to develop a personal perspective, plan and choice with regard to medication use. Conclusions: Implications of these findings are discussed, emphasizing the importance of the “doctor-patient” relationship context.

Roe, D., Goldblatt, H., Baloush-Klienman, V., Swarbrick, M., & Davidson, L. (2009). Why and how people decide to stop taking prescribed psychiatric medication: Exploring the subjective process of choice. Psychiatric Rehabilitation Journal, 33(1), 38–46. https://doi.org/10.2975/33.1.2009.38.46

ABSTRACT: Consumer-operated self-help centers were designed to provide social environments that promote participant empowerment and satisfaction. This exploratory, descriptive study examined how variance in empowerment and satisfaction scores could be explained by participants’ perceptions of the social environment factors (relationship, personal growth, and systems maintenance and change) and quantity of participation. Participants (N = 144) involved in consumer-operated self-help centers completed a four-part, 161-item survey designed to capture perceptions of satisfaction, empowerment, social environment factors, quantity of center participation, and demographic data. Significant relationships were found between participant satisfaction and the three social environment factors. Findings also indicated that participant empowerment was related to quantity of self-help center involvement. From these exploratory analyses, recommendations are made on how to improve consumer-run self-help center operations.

Swarbrick, M., Schmidt LT, & Pratt CW. (2009). Consumer-operated self-help centers: environment, empowerment, and satisfaction. Journal of Psychosocial Nursing & Mental Health Services, 47(7), 40–47. https://doi.org/10.3928/02793695-20090527-03

Swarbrick, M. (2009). Collaborative Support Programs of New Jersey. Occupational Therapy in Mental Health, 25(3–4), 224–238. https://doi.org/10.1080/01642120903083952

Swarbrick, M. (2009). Designing a study to examine peer-operated self-help centers. Occupational Therapy in Mental Health, 25(3–4), 252–299. https://doi.org/10.1080/01642120903083978

Swarbrick, M. (2009). Does Supportive Housing Impact Quality of Life? Occupational Therapy in Mental Health, 25(3–4), 352–366. https://doi.org/10.1080/01642120903084133

Swarbrick, M. (2009). Historical perspective – From institution to community. Occupational Therapy in Mental Health, 25(3–4), 201–223. https://doi.org/10.1080/01642120903083945

Swarbrick, M., Bates, F., & Roberts, M. (2009). Peer Employment Support (PES): A Model Created Through Collaboration Between a Peer-Operated Service and University. Occupational Therapy in Mental Health, 25(3–4), 325–334. https://doi.org/10.1080/01642120903084075

Swarbrick, M., & Ellis, J. (2009). Peer-operated self-help centers. Occupational Therapy in Mental Health, 25(3–4), 239–251. https://doi.org/10.1080/01642120903083960

Swarbrick, M., Roe, D., Yudof, J., & Zisman, Y. (2009). Participant perceptions of a peer wellness and recovery education program. Occupational Therapy in Mental Health, 25(3–4), 312–324. https://doi.org/10.1080/01642120903084059

Swarbrick, M., & Stahl, P. (2009). Wellness and recovery through asset building services. Occupational Therapy in Mental Health, 25(3-4), 335–342. https://doi.org/10.1080/01642120903084091

Swarbrick, M., & Yudof, J. (2009). Words of wellness. Occupational Therapy in Mental Health, 25(3-4), 367–412. https://doi.org/10.1080/01642120903084158.

ABSTRACT: This paper reviews the current need for training and education in the pursuit of optimal health for mental health consumers. Recommendations for building the capacity of consumers and the mental and medical health-care systems to support the self-directed recovery of health by persons living with mental illness are made.

Swarbrick, P., Hutchinson, D. S., & Gill, K. (2008). The Quest for Optimal Health: Can Education and Training Cure What Ails Us? International Journal of Mental Health, 37(2), 69–88. http://www.jstor.org/stable/41345252

ABSTRACT: Despite the well-documented effectiveness of psychiatric medication, studies reveal that it is used by only approximately half of those for whom it is prescribed. Whereas large-scale studies have focused primarily on the consequences of not taking medication as prescribed, a number of recent qualitative studies have tried to understand the phenomenon from the perspective of consumers. Findings have revealed that nonadherence may not always reflect psychopathology or a lack of insight, but rather a personal choice directed toward engaging in activities that provide meaning and purpose. In this article, we review the literature on medication use, emphasizing the importance of the practitioner-consumer relationship. We also present a recovery-oriented perspective to understand consumers’ choices regarding medication use and discuss practical guidelines for psychiatric nurses.

Roe, D., & Swarbrick, M. (2007). A recovery-oriented approach to psychiatric medication: guidelines for nurses. Journal of Psychosocial Nursing and Mental Health Services, 45(2), 35–40.

ABSTRACT: Consumer-operated services (COS) are viewed as a legitimate alternative for mental health consumers living in the community. This article provides an overview of, outlines a consumer-operated self-help center model that has evolved in New Jersey, and illustrates how it has become a viable component of the mental health system. The goal is to inspire psychiatric rehabilitation practitioners to create COS alternatives as part of their state-run services transformation efforts.

Swarbrick, M (2007). Consumer-operated self-help centers. Psychiatric Rehabilitation Journal, 31(1), 76-79. https://doi.org/10.2975/31.1.2007.76.79.

Swarbrick, M. & JR, G. H. B. (2006). Sharing the message of hope, wellness, and recovery with consumers psychiatric hospitals. American Journal of Psychiatric Rehabilitation, 9(2), 101-109. https://doi.org/10.1080/15487760600876196

ABSTRACT: There is a significant paradigm in the field of public mental health practice that encompasses a wellness approach. This paper will present a wellness approach by comparing it to the traditional medical model. A personal application of the wellness approach will be discussed.

Swarbrick, M. (2006a). A wellness approach. Psychiatric Rehabilitation Journal, 29(4), 311-314. https://doi.org/10.2975/29.2006.311.314

ABSTRACT: This program represents an innovative approach to traditional money-management services. This asset-building, financial self-management service model has the potential to positively affect recovery, self-sufficiency, and community integration for people with mental illnesses. It is hoped this program will be replicated by other providers in a way that may effect systems change.

Swarbrick, Margaret. (2006). Asset-building, financial self-management service model: piecing together consumer financial independence. Journal Of Psychosocial Nursing And Mental Health Services, 44(10), 22-26.

ABSTRACT: As the public mental health service delivery system has shifted incrementally from being primarily institutional to being primarily community-based, a growing cohort of persons diagnosed with mental illness has created a consumer-operated service (s) (COS) model designed to address social and emotional needs and empower participants (Carling, 1995; Van Tosh & del Vecchio, 2000; Van Tosh, Ralph, & Campbell, 2000). Although professionals may and do participate, COS are mostly planned, operated, and evaluated by and for mental health consumers. COS, funded through state legislatures and private foundations, complement and provide an alternative to traditional mental health services. In contrast to traditional modalities that often mandate specific services and label consumers by their diagnoses, COS offer a menu of service options to address individual desires, needs, and resources. Occupational therapy values and practices place practitioners in an ideal situation to work with this promising practice model. The history, core principles and values, and research on the COS model will be presented. Roles and possibilities for occupational therapists and occupational therapy assistants to collaborate to create and support COS will be outlined. Occupational therapists and occupational therapy assistants will be provided with information about COS and will be encouraged to examine the possibilities in terms of how they can become involved locally with consumer groups to develop, implement, and evaluate COS.

Swarbrick P, & Pratt C. (2006). Consumer-operated self-help services: Roles and opportunities for occupational therapists and occupational therapy assistants. OT Practice, 11(5), CE-2p.

Swarbrick, M. (2004). A cognitive behavioral treatment program: Practical considerations. American Journal of Psychiatric Rehabilitation, 7(2), 193–199. https://doi.org/10.1080/15487760490476228

Nolan C, & Swarbrick P. (2002). Supportive housing occupational therapy home management program. Mental Health Special Interest Section Quarterly, 25(2), 1–3.

Swarbrick, M., & Burkhardt, A. (2000). The spiritual domain of health. Mental Health Special Interest Section Quarterly, 23(1), 1–4.

Swarbrick, M., & Duffy, M. (2000). A consumer run self-help program model. Mental Health Special Interest Section Quarterly, 23(1), 1–4.

ABSTRACT: This paper examines the relationships between women, traumatic brain injury (TBI), alcohol dependency, and childhood sexual abuse. Alcohol use has increasingly been implicated as a direct cause of TBI occurrence. Because most TBI rehabilitation programs have been developed tor a male population, however, the unique relationship between women with TBI and alcohol dependency has largely been unexamined. Women with alcohol-related difficulties are highly likely to report histories of childhood sexual abuse and adult revictimization experiences. The experience of childhood sexual abuse, commonly found in the histories of women with alcohol problems, may predispose women to the occurrence of head injuries sustained through alcohol-related motor vehicle accidents and/or physical violence perpetrated by chemically dependent partners. This paper explores the psychosocial factors that may lead to head injury in women with alcohol and abuse histories. Suggestions for occupational therapy practice that address the psychosocial sequelae commonly resulting from the concomitant effeels of alcohol abuse, childhood victimization, and neurologic impairment in Women are offered.

Gutman S., & Swarbrick P. (1999). The multiple linkages between childhood sexual abuse, adult alcoholism, and traumatic brain injury in women. Occupational Therapy in Mental Health, 14(3), 33–65. https://doi.org/10.1300/J004v14n03_03

Swarbrick, M (1997). A wellness model for clients. Mental Health Special Interest Section Quarterly, 20(1), 1–4.