Many people with substance use disorders experience significant sleep disturbances that impact their pursuit of short- and long-term recovery goals, and overall health. Consistent rest and sleep routines contribute to effective functioning in daily life activities, overall health and wellness for people in early and long-term recovery. Despite the benefits, sleep and rest is not addressed by behavioral healthcare professionals in treatment settings. This manuscript illustrates how occupational therapists and social workers can collaborate to use sleep assessments to guide treatment. Addressing rest and sleep preparation and participation using a person-centered approach can have a profound impact on early and long-term recovery, quality of life for people with substance use challenges.
Gardner, J., Swarbrick, M., & Kitzinger, R.(2022). Sleep is something, not nothing: An interprofessional approach to sleep assessment and treatment to support substance use recovery. Journal of Social Work Practice in Addictions. DOI: 10.1080/1533256X.2022.2159643
“The need for behavioral health care prevention, treatment, and recovery supports, including crisis alternatives, has grown and is now receiving federal support through enhanced funding. When a person experiences severe emotional distress, crisis alternatives are a viable option instead of inpatient hospitalization to address the distress and restore balance. Peer respite programs are voluntary, short-term, crisis alternatives for people experiencing mental distress. Models have evolved in response to funding and regulatory requirements, yet research is limited. The current article describes a unique peer-led program, Wellness Respite, in operation for 7 years, including data from recent satisfaction surveys and the role of nurses in the program. Implications of a home-like, short-term crisis alternative and the role of the nurse are emphasized. [Journal of Psychosocial Nursing and Mental Health Services, 60(11), 26–32.]”
Smullen Thieling, AM., Swarbrick, M., Brice, B., Nemec, P. A welcoming space to manage Crisis: “Wellness Respite”. Journal of Psychosocial Nursing and Mental Health Services. Published online 2022:1-7. doi:10.3928/02793695-20220428-04.
Jordan, A., Nich, C., Swarbrick,M., Babuscio, T., Wyatt, J., O’Connell, M., Guy, K., Blackman, K., Anderson, R., Reis, G., Ocasio, L., Crespo, M., Bellamy, C. (2022). Breaking Through Social Determinants of Health: Results from Imani Breakthrough, a Community Developed Substance Use Program for Black and Latinx People. Journal of Substance Abuse Treatment.
Swarbrick, M., Nemec, P., Spagnolo, A., Gould Fogerite, S., Lundquist, MC., Zechner, M., & Townsend, M., (accepted, 5/2022). Self-care for all during the pandemic. American Journal of Psychiatric Rehabilitation.
Treitler P., Enich M., Hillis, M., & Swarbrick M. A qualitative study of participant experiences working with peer health navigators after release from state prison (PS-20220310). Psychiatric Services.
Swarbrick, M., Kuebler, C., DiGioia-Laird, V., Estes, A., Treitler, P, Moosvi, K., & Nemec, P. (accepted). Co-Production: Journey to Wellness Guide. Journal of Psychosocial Nursing and Mental Health Services.
Swarbrick, M., Spagnolo, A., Castellano, C., Vogel, M., Valovcin, D. (accepted). Reciprocal peer support wellness (RPS-W) model: A model for virtual peer support. American Journal of Psychiatric Rehabilitation.
“Background: Individuals with psychiatric diagnoses who are unemployed or underemployed are likely to disproportionately experience financial hardship and, in turn, lower life satisfaction (LS). Understanding the mechanisms though which financial hardship affects LS is essential to inform effective economic empowerment interventions for this population.
Aim: To examine if subjective financial hardship (SFH) mediates the relationship between objective financial hardship (OFH) and LS, and whether hope, and its agency and pathways components, further mediate the effect of SFH on LS among individuals with psychiatric diagnoses seeking employment.
Methods: We conducted structured interviews with participants (N = 215) of two peer-run employment programs using indicators of OFH and SFH and standardized scales for hope (overall hope, hope agency, and hope pathways) and LS. Three structural equation models were employed to test measurement models for OFH and SFH, and mediational relationships. Covariates included gender, age, psychiatric diagnosis, race/ethnicity, education, income, employment status, SSI/SSDI receipt, and site.
Results: Confirmatory factor analysis (CFA) for items measuring OFH and SFH supported two separate hypothesized factors. OFH had a strong and significant total effect on SFH [standardized beta (B) = 0.68] and LS (B = 0.49), and a weak-to-moderate effect on hope (B = –0.31). SFH alone mediated up to 94% of the effect of OFH on LS (indirect effect B = –0.46, p < 0.01). The effect of SFH on LS through hope was small (indirect effect B = –0.09, p < 0.05), primarily through hope agency (indirect effect B = –0.13, p < 0.01) and not hope pathways. Black and Hispanic ethno-racial identification seemed to buffer the effect of financial hardship on hope and LS. Individuals identifying as Black reported significantly higher overall hope (B = 0.41–0.47) and higher LS (B = 0.29–0.46), net of the effect of OFH and SFH.
Conclusion: SFH is a strong mediator of the relationship between OFH and LS in our study of unemployed and underemployed individuals with psychiatric diagnoses. Hope, and particularly its agency component, further mediate a modest but significant proportion of the association between SFH and LS. Economic empowerment interventions for this population should address objective and subjective financial stressors, foster a sense of agency, and consider the diverse effects of financial hardship across ethno-racial groups.”
Jiménez-Solomon, O., Primrose, R., Moon, I., Wall, M., Galfalvy, H., Méndez-Bustos, P., Cruz, AG., Swarbrick, M., Laing, T., Vite, L., Kelley, M., Jennings, E. and Lewis-Fernández, R. (2022). Financial hardship, hope, and life satisfaction among un/underemployed individuals with psychiatric diagnoses: A mediation analysis. Front. Psychiatry 13:867421. doi: 10.3389/fpsyt.2022.867421
Cook, J.A., Steigman, P.J., Swarbrick, M., Burke-Miller, J.K., Laing, T., Vite, L., Jonikas, J.A., Brown, I. (2022). Outcomes of peer-provided individual placement and support services in a mental health peer-run vocational program. Psychiatric Services https://doi.org/10.1176/appi.ps.20220134.
Fieldwork is an integral portion of occupational therapy education that ensures students have the
opportunity to develop basic competencies in real world practice settings. The national shortage of
fieldwork placements, particularly in the area of mental health, in combination with the COVID-19
pandemic, have led to the adoption of increasingly innovative fieldwork models. This retrospective,
qualitative study investigates occupational therapy assistant students’ experiences of completing a
faculty-led (i.e. where faculty served as the primary fieldwork educator) and virtual (i.e., where services were offered in a virtual environment) Level I fieldwork with a community-based peer led behavioral health agency. Twenty-three students completed a confidential survey describing their experiences in Fall 2020. A secondary analysis of students’ responses was performed using principles of thematic analysis, which yielded results centered on four themes: knowledge, skills, attitudes, and structure. Subcategories highlighted growth across multiple areas including knowledge of occupational therapy’s role in mental health, interpersonal skills, and use of technology and other resources. Students’ preconceived notions of individuals with mental illness were challenged and many reported increased confidence in their abilities to work with these individuals. Both positive and constructive feedback were provided regarding the overall virtual fieldwork experience. The faculty-led virtual fieldwork model was viable in supporting occupational therapy assistant students’ skills to engage people with mental health and substance use challenges in a community setting. The potential use of this model is discussed in light of the anticipated increase of behavioral health problems for many across the lifespan post-COVID-19 pandemic.
Benaroya, T. L., Swarbrick, M., Zechner, M., Murphy, A. A., & Cimmino, M. (2022). Faculty-led virtual level 1 community fieldwork during the COVID-19 pandemic. Journal of Occupational Therapy Education, 6 (2). DOI: 10.26681/jote.2022.060217
Brazeau, C. M. L. R., Ayyala, M. S., Chen, P.-H., & Swarbrick, M. (2022). Virtual faculty development peer programmes support physician well-being. ASME Medical Education, 56 (5). https://doi.org/10.1111/medu.14748
A constellation of factors detrimentally affects Black mental health at individual and community levels. Issues such as racism, trauma, and a lack of culturally relevant services prevent access to timely, high-quality mental health treatment. These negative experiences, exacerbated by the current impacts of the COVID-19 pandemic, contribute to the increased prevalence of mental health conditions in Black communities. The authors call for a Wellness First approach to dismantle the status quo and to mobilize collective action among individuals, providers, organizations, funders, and policy makers to create equitable opportunities that promote healing and prevent further trauma in Black communities.
Brandow, C., & Swarbrick, M. (2021). Improving black mental health: A collective call to action. Psychiatric Services. Advance online publication. https://doi.org/10.1176/appi.ps.202000894
“Objective: Little is known about the employment experiences of people with preexisting behavioral health conditions during the coronavirus disease of 2019 (COVID-19) pandemic, despite the recognized importance of work for this group. Method: Two hundred and seventy two adults with behavioral health conditions, recruited through statewide mental health networks in NJ and NY, completed an online survey in April–May 2020. Multivariable analysis examined the effects of sleep and dietary changes, COVID-19 exposure, anxiety (Generalized Anxiety Disorder-2), and depressive symptoms (Patient Health Questionnaire-2) on employment status and job changes. Respondents’ open-ended descriptions of pandemic-related changes in employment were analyzed using the constant comparative method. Results: Two-thirds (65%) were employed, only 4% became unemployed, and 29% reported changes in their jobs as a result of the pandemic. In logistic regression analysis controlling for age, race, education and gender, workers were more likely than nonworkers to report altered eating and sleeping habits, but not greater anxiety or depression. However, those whose jobs changed were more likely to report COVID-19 exposure, altered sleep patterns, clinically significant anxiety symptoms, and both anxiety and depressive symptoms compared to those whose jobs had not changed. Qualitative analysis revealed work’s positive impact (pride in job performance, using new skills, feeling safer working from home) and its negative effects (lifestyle disruption, worry about job security, isolation from coworkers). Conclusions and Implications for Practice: This is the first study to suggest the important role that work played for people with preexisting behavioral health disorders during the pandemic, with both positive and negative influences, and important implications for services and supports. (PsycInfo Database Record (c) 2022 APA, all rights reserved)”
Cook, J. A., Swarbrick, M., Boss, K. A., Steigman, P. J., Nemec, P., Jonikas, J. A., Brice, G.H., & Aranda, F. (2022). The importance of employment to workers with preexisting behavioral health disorders during the COVID-19 pandemic. Psychiatric Rehabilitation Journal, 45(1), 11-17. https://doi.org/10.1037/prj0000499
“Objective: This project aimed to develop a synthesized framework of multidimensional wellness for people aging with serious mental health conditions (SMHC) using existing frameworks to serve as a guide for policy and interventions to address the unique needs, experiences, and strengths of the population. Method: A concept analysis compared a widely used wellness approach (Swarbrick, 1997) for people with SMHC and one for older adults (Fullen, 2019) to synthesize into a practical framework for people aging with SMHC. Results: Nine dimensions were proposed for conceptualizing the wellness of this population including: (a) Developmental, (b) Intellectual/Cognitive, (c) Physical, (d) Emotional, (e) Social, (f) Occupational, (g) Spiritual, (h) Environmental, and (i) Financial. Practical suggestions for implementation are identified. Conclusions and Implication for Practice: People aging with SMHC require rehabilitation services that address their unique perspectives, strengths, and challenges. The proposed adapted wellness framework offers a guide to comprehensively address well-being in people aging with SMHC. Placing the model in the context of external factors of resources and supports available, and the impact of societal perspectives about each dimension, further delineates a holistic model of wellness that considers well-being and successful living. This model can offer structure and practical application for services, and consideration of future needs of people aging with SMHC to support psychiatric rehabilitation services, as well as offer strategies to encourage positive aging and recovery. Future work should explore the impact of multidecade experiences of mental health conditions and the mental health system to better support individual recovery. (PsycInfo Database Record (c) 2022 APA, all rights reserved)”
Zechner, M., Swarbrick, M., Fullen, M., Barret, N., Santos-Tuano- S., Pratt CW. (2022). Multi-dimensional wellness for people who are aging with mental health conditions: A proposed framework. Journal of Psychiatric Rehabilitation. Advance online publication. https://doi.org/10.1037/prj0000510.
“This content analysis of open-ended survey responses compares and contrasts perceptions on supervision from supervisors with experience providing direct peer support services (PS) and supervisors without experience providing direct peer support services (NPS).A 16-item online survey was distributed via the National Association of Peer Supporters (N.A.P.S.) listserv and through peer networks and peer run organizations. Responses from 837 respondents, across 46 US states, were analyzed. Four open ended questions assessed supervisors’ perceptions on differences supervising peer support workers (PSW) as compared to other staff, important qualities of PSW supervisors, roles when supervising a PSW, and concerns about PSWs in the organization. Among NPS and PS, three major differences in themes emerged: the knowledge required of supervisors, understanding of the role of the PSW, and supervisors’ beliefs regarding PSW competencies. PS have a more nuanced understanding of the peer support worker role and the impact of lived experience in the role.”
Foglesong, D., Spagnolo, A. B., Cronise, R., Forbes, J., Swarbrick, M., Edwards, J. P., & Pratt, C. (2021). Perceptions of supervisors of Peer Support Workers (PSW) in behavioral health: Results from a national survey. Community Mental Health Journal, 1–7. Advance online publication. https://doi.org/10.1007/s10597-021-00837-2.
“Background: Smoking continues to be a major health concern among persons with mental illnesses.
Aims: This pilot study compared smoking outcomes between wellness-coaching for smoking cessation and a control group.
Methods: Thirty-one individuals were enrolled in an educational group on smoking cessation and 23 completed an eight-session manualized education. Following this educational group, 11 of 23 participants were randomly assigned to wellness coaching for four months and 12 to a control condition. ANCOVAs were used to compare group differences in smoking outcomes.
Results: Fagerström Nicotine Dependence Index (FTND) score of the participants who received the wellness coaching intervention decreased significantly as compared to the control group, indicating a lower level of nicotine dependence. The outcomes of average number of cigarettes smoked daily and breath carbon monoxide level showed tendencies towards reductions for wellness coaching, although not statistically significant compared to the control condition.
Conclusions: Suggestions are shared about the feasibility of wellness coaching as well as barriers and challenges learned in implementing such an intervention to assist individuals with mental illnesses in quitting or reducing smoking.”
Gao, N., Solomon, P, Clay, Z., & Swarbrick, M. (2021). Pilot study of Wellness Coaching for smoking cessation among individuals with mental illnesses. Journal of Mental Health, 1-7. DOI: 10.1080/09638237.2021.1922630
“The purpose of this study was to explore sleep habits and routines in individuals (N = 52) with mental and/or substance-use disorders attending community wellness centers. Outcome measures included Pittsburgh Sleep Quality Index (PSQI), a researcher developed survey to analyze habits and routines and its effect on sleep, and semi-structured interviews. Results showed 78.6% of participants had poor sleep as per PSQI. Facilitators of sleep included turning off lights, listening to music, and taking a bath/shower, while barriers included taking a nap, smoking, and using the phone. The findings can guide assessment and intervention for sleep preparation and participation.”
Gardner, G., Swarbrick, M., Dennis, S., Franklin,M., Pricken, M., & Palmer, K. (2021) Sleep habits and routines of individuals diagnosed with mental and/or substance-use disorders. Occupational Therapy in Mental Health. doi: 10.1080/0164212X.2021.1877592
“People with behavioral health disorders may be particularly vulnerable to the impact of the COVID-19 pandemic, yet little is known about how they are faring. A mixed-methods, anonymous needs assessment was conducted to understand changes in the lives of adults with mental health and substance use disorders since the pandemic onset. A cross-sectional, online survey was completed by 272 adults in April and May 2020, recruited from statewide networks of community programs in New Jersey and New York. Measures included the Patient Health Questionnaire-2 and the Generalized Anxiety Disorder-2 to screen for depressive and anxiety disorders. Also assessed was the pandemic’s impact on sleep and dietary patterns, exposure to COVID-19 infection, and access to health care and medications. Finally, respondents were asked to describe in their own words any changes in their lives since the pandemic began. Over one-third (35.1%) screened positive for generalized anxiety disorder and over one-quarter (29.6%) screened positive for major depressive disorder. The majority reported pandemic-related changes in eating and sleeping patterns and exposure to COVID-19 infection. Multivariable logistic regression analysis found that many changes attributed to the pandemic were positively and significantly associated with screening positive for anxiety and depressive disorders. Qualitative analysis confirmed these findings and identified participants’ resilience stemming from social support, emotion management, and self-care. These results can inform the design of services that assist this population to bolster self-management skills and reestablish daily habits to improve their lives during and following the pandemic.”
Jonikas, J. A., Cook, J. A., Swarbrick, M., Nemec, P., Steigman, P. J., Boss, K. A., & Brice Jr, G. H. (2021). The impact of the COVID-19 pandemic on the mental health and daily life of adults with behavioral health disorders. Translational Behavioral Medicine, 11(5), 1162-1171. https://doi.org/10.1093/tbm/ibab013
McGrellis, K., Swarbrick, M., Cummings, C., Wilson, B., & Gill, K. (2021). Development of a Nurtured Heart Approach® Questionnaire. Journal of Psychosocial Nursing and Mental Health Services, Advance online publication. https://doi.org/10.3928/02793695-20210818-03.
“Caregivers are a source of support for family members with disabilities. However, caregivers are at risk for caregiver burden, which can erode self-care skills and lead to poor physical and mental health outcomes. Caregiver Wellness Self-Care, developed to address that risk, is a 5-week group program in which participants learn about strategies that cultivate their inner resources, while connecting with others for support. Wellness, self-care, mindfulness, and yoga-based information and practices are taught in the sessions and included in participant handouts. Self-reflection and planning activities with facilitated discussions further support awareness and personal transformation. Designed by and for people providing care to an adult family member with a mental health disorder and a developmental/intellectual disability, the program was piloted three times. The current article describes the development of the program through caregiver involvement, participant and facilitator feedback, and implications for future efforts to build caregiver wellness self-care skills. Implications for nurses are highlighted. [Journal of Psychosocial Nursing and Mental Health Services, 59(5), 25-32.].”
Swarbrick M, Fogerite SG, Spagnolo AB, Nemec PB. (2021). Caregivers of people with disabilities: A program to enhance wellness self-care. Journal of Psychosocial Nursing and Mental Health Services. Jan 13:1-8. doi: 10.3928/02793695-20210107-04.
“Many people with serious mental illnesses live in poverty, which can worsen mental and overall health. The authors suggest strategies to improve health outcomes through behavioral health services and supports that directly target financial wellness while reducing dependence on public benefits. Although some services focus on financial education, this effort is likely insufficient for addressing poverty and its accompanying financial hopelessness. A social-ecological approach with the core goal of financial wellness may improve outcomes. Financial wellness is a social justice issue that must be elevated to a high-priority area of intervention in behavioral health services.”
Brandow, C. L., Swarbrick, M., & Nemec, P. B. (2020). Rethinking the causes and consequences of financial wellness for people with serious mental illnesses. Psychiatric Services. (71) 1. DOI: 10.1176/appi.ps.201900323
“Employment has the potential to contribute to positive health outcomes for people with serious mental illnesses; however, its flipside, long-term unemployment, is a social determinant that has not been consistently recognized for its negative effects. Therefore, in this column, the authors examined how the widely accepted notion that unemployment is extremely deleterious to health is largely overlooked. Clinical risk factors related to long-term unemployment are identified as well as the inadequate response to them within mental health systems of care. Practical individual- and systems-level strategies to rectify this oversight are outlined.”
Marrone, J., & Swarbrick, M. (2020). Long-term unemployment: A social determinant under addressed within community behavioral health programs. Psychiatric Services. https://doi.org/10.1176/appi.ps.201900522
“This pre posttest study explored feasibility of a mobility program for nine community dwelling adults living with mental disorders. Using mixed methodology, outcome measures included phenomenological pre and post semi-structured interviews, surveys and subscales of Impact of Autonomy and Participation Questionnaire (IPAQ). The IPAQ confidence factor showed statistical significance (p = .034). The majority of participants either maintained or increased trip frequency, participation, knowledge of health problems and transportation, and either maintained or decreased isolation. Qualitative post program themes included increased comfort and self-esteem, as well as confidence and awareness. Results indicate feasibility of the program to be used for this population.”
Mulry, C., Gardner, J., Swarbrick, M., Maltempi, O., Ramirez, M., DiMaiuta, A., & Wollny, K. (2020) Feasibility of the Let’s Go Mobility Program for community dwelling adults with mental disorders. Occupational Therapy in Mental Health, 36(4), 307-329, doi: 10.1080/0164212X.2020.1825151
“Individuals served by behavioral health programs experience risk factors that threaten health and longevity. Health behavior changes may be supported through environmental modifications known as nudges. The current review (a) examines the potential value of nudges for helping individuals receiving services from behavioral health programs, and (b) offers physical and social environment strategies to support positive health behaviors. The authors discuss literature related to nudges and environmental influences on health behaviors. The research related to nudges supports the potential value of this framework for nurses in behavioral health settings, who are in a strong position to help address health and wellness concerns disproportionately experienced by individuals in behavioral health programs. [Journal of Psychosocial Nursing and Mental Health Services, 59(1), 21-28.].”
Nemec, PB., Swarbrick, M., Spagnolo, A. & Brandow, CL. (2020). Nudges to support health and wellness for individuals served by behavioral health programs. Journal of Psychosocial Nursing and Mental Health Services. 1; 59(1):21-28. doi: 10.3928/02793695-20201015-03.
“Background: Despite national calls to develop gender-specific interventions for women with opioid use disorder (OUD) with co-occurring trauma and post-traumatic stress disorder (PTSD) symptoms, there remains a dearth of research on what modalities or treatment components would be most feasible for this population. This study interviewed women with OUD receiving medication assisted treatment and addiction treatment providers to explore (a) experiences of barriers to receiving trauma treatment, and (b) both the perceptions and desired design of a prospective technology-delivered, trauma-informed treatment for women with OUD.
Methods: Women with lifetime OUD (n = 11) and providers (n = 5) at two community substance use clinics completed semi-structured interviews. Interviews were transcribed, coded, and analyzed in NVivo v11 using a grounded theory approach. Women also completed a demographic form and clinical measures.
Results: Clients were primarily women with children reporting histories of multiple trauma exposures, high PTSD symptoms, and polysubstance use. Two themes emerged among clients and one among providers regarding barriers to trauma treatment. Regarding the feasibility and desired attributes of a technology-based intervention, six themes emerged among clients and providers, respectively.
Conclusions: Themes suggest a high interest by clients and providers for a technology-delivered, trauma informed treatment available by smartphone. Utilizing technology as an adjunct to care, without reducing face-to-face therapy, was important to both clients and providers.”
Saraiya, T. C., Swarbrick, M., Franklin, L., Kass, S., Campbell, A. N. C., & Hien, D. A. (2020). Perspectives on trauma and the design of a technology-based trauma-informed intervention for women receiving medications for addiction treatment in community-based settings. Journal of substance abuse treatment, 112, 92–101. https://doi.org/10.1016/j.jsat.2020.01.011
“Background: An extensive literature exists describing treatment interventions and recovery from eating disorders (EDs); however, this body of knowledge is largely symptom-based and from a clinical perspective and thus limited in capturing perspectives and values of individuals with lived experience of an ED. In this study, we performed a systematic review to coproduce a conceptual framework for personal recovery from an ED based on primary qualitative data available in published literature.
Methods: A systematic review and qualitative meta-synthesis approach was used. Twenty studies focusing on ED recovery from the perspective of individuals with lived experience were included. The studies were searched for themes describing the components of personal recovery. All themes were analyzed and compared to the established connectedness; hope and optimism about the future; identity; meaning in life; and empowerment (CHIME) and Substance Abuse and Mental Health Services Administration (SAMHSA) frameworks of recovery, which are applicable to all mental disorders. Themes were labeled and organized into a framework outlining key components of the ED personal recovery process.
Results: Supportive relationships, hope, identity, meaning and purpose, empowerment, and self-compassion emerged as the central components of the recovery process. Symptom recovery and its relationship to the personal recovery process are also significant.
Discussion: Individuals with lived experience of EDs noted six essential elements in the personal ED recovery process. This framework is aligned with several of the key components of the CHIME and SAMHSA frameworks of recovery, incorporating person-centered elements of the recovery process. Future research should validate these constructs and develop instruments (or tools) that integrate the lived experiences into a measurement of recovery from an ED.”
Wetzler, S., Hackmann, C., Peryer,G., Clayman, K., Friedman, D., Saffran, K., Silver, J., Swarbrick, M., Magill, E., van Furth, EF., Pike, KM (2020). A framework to conceptualize personal recovery from eating disorders: A systematic review and qualitative meta-synthesis of perspectives from individuals with lived experience. International Journal of Eating Disorders. 1-16. https://doi.org/10.1002/eat.23260
“Family caregivers of persons with Alzheimer’s disease and related dementias (CADRD) provide significant support to their family members but often experience challenges and stress that impact their quality of life. Peer supporters can be an important resource to help alleviate stress associated with caregiving, yet few published studies have examined peer supporters for CADRD. This retrospective cohort study examined data collected from a peer support helpline for CADRD in a middle Atlantic state. Four years of data were reviewed to examine trends across time. Data analysis indicated that the most often reported issues by CADRD callers were related to their own emotional well-being. Results demonstrated that peer supporters have potential to address practical, physical, social, and emotional needs of caregivers who reach out. Nurses are well-positioned to partner with peer support specialists to best address the practical and emotional support needs and self-care challenges faced by CADRD. [Journal of Psychosocial Nursing and Mental Health Services, 58(10), 13–16.]”
Zechner, M., Lundquist, MC., Swarbrick, M., Wey, M. (2020). Care2Caregivers: A retrospective examination of needs addressed and services provided by a peer support helpline. Journal of Psychosocial Nursing and Mental Health Services. 58(10):13-16. https://doi.org/10.3928/02793695-20200817-04
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/10.1891/2168-66220.127.116.111
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: Peer wellness coaching is workforce innovation that empowers individuals with mental and substance use disorders to achieve recovery. This article briefly describes how this approach can help peer providers develop self-care skills to improve job tenure and promote satisfaction. Promising results of this new approach are presented. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Brice, G. H., Swarbrick, M. A., & Gill, K. J. (2014). Promoting wellness of peer providers through coaching. Journal of Psychosocial Nursing and Mental Health Services, 52(1), 41–45. https://doi.org/10.3928/02793695-20130930-03
ABSTRACT: BACKGROUND: Individual Placement and Support (IPS) is an evidence-based vocational rehabilitation intervention for people with severe mental illness. IPS emphasizes client choice, rapid job finding, competitive employment, team-oriented approaches, benefits counseling, and ongoing supports. OBJECTIVE: This paper summarizes 20 years of research on IPS, describes studies in the field now, and proposes priorities for future research. METHODS: To identify published and unpublished IPS research studies, we conducted an electronic search of qualitative and quantitative IPS studies, findings from recent reviews, and sought expert recommendation. RESULTS: Past research indicates that IPS supported employment is the most effective and cost-effective approach for helping people with psychiatric disabilities find and maintain competitive employment. Employment improves clinical, social, and economic outcomes. Current studies on IPS address several research gaps: IPS modification, generalizability, program settings, international dissemination, cultural awareness, and supportive technology. Looking forward, the field needs studies that report long-term outcomes, financing mechanisms, cost offsets, and standardized supported education models. CONCLUSIONS: While IPS is one of the most extensively studied of all vocational models, significant literature gaps remain.
Luciano, A., Drake, R. E., Bond, G. R., Becker, D. R., Carpenter-Song, E., Lord, S., Swarbrick, M., Swanson, S. J. (2014). Evidence-based supported employment for people with severe mental illness: Past, current, and future research. Journal of Vocational Rehabilitation, 40(1), 1–13. https://doi.org/10.3233/JVR-130666
ABSTRACT: Recovery-oriented service systems explicitly value including people with lived experiences of a mental and substance use diagnosis in the design, delivery, and evaluation of those services. Including first-person accounts as part of the education and training of service providers “demonstrates” recovery is possible, promotes empathy, offers insights into the lives of service users, and models a person-centered, person-first approach. More important, it serves as a visual and experiential example of the collegial relationships required for services that are truly recovery-oriented. This column provides recommendations for carefully planning in-person personal narratives as an effective teaching tool. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Legere, L., Nemec, P. B., & Swarbrick, M. (2013). Personal narrative as a teaching tool. Psychiatric Rehabilitation Journal, 36(4), 319–321. https://doi.org/10.1037/prj0000030
ABSTRACT: People with lived experience of mental illness have become leaders of an influential movement to help the mental health system embrace the notion of whole health and wellness in the areas of advocacy, policy, and care delivery. Wellness-oriented peer approaches delivered by peer-support whole-health specialists and wellness coaches can play an important role in integrated care models. This column examines the wellness definitions and peer models and some specific benefits and tensions between the peer-oriented wellness approach and the medical model. These models can work in unison to improve health and wellness among people with mental and substance use disorders.
Swarbrick, M. A. (2013). Integrated care: wellness-oriented peer approaches: a key ingredient for integrated care. Psychiatric Services, 64(8), 723–726. https://doi.org/10.1176/appi.ps.201300144
ABSTRACT: Nurses can play an important role in community-based health screenings, which are a practical resource to empower people living with mental and substance use disorders to make positive lifestyle changes. The experiences, struggles, and strengths of screening participants provides insights for nurses to engage people in health and wellness dialogues.
Swarbrick, M. A., Cook, J., Razzano, L., Yudof, J., Cohn, J., Fitzgerald, C., … Yost, C. (2013). Health screening dialogues. Journal of Psychosocial Nursing and Mental Health Services, 51(12), 22–28. https://doi.org/10.3928/02793695-20130930-02
Swarbrick, M., & Fitzgerald, C. (2012). The Million HeartsTM initiative: why psychosocial nurses should care. Journal of Psychosocial Nursing and Mental Health Services, 50(5), 10–11. https://doi.org/10.3928/02793695-20120410-05
ABSTRACT: This project assessed the effectiveness of group provision of four modules of illness management and recovery (IMR): recovery strategies, building social support, coping with problems and symptoms, and reducing relapse. Sixty-six adults (ages 20–68) diagnosed with severe mental illness recruited from consumer-run self-help centers in New Jersey participated in four IMR modules over 16 weekly sessions. The data from 36 of those individuals who attended five or more IMR sessions were used in this analysis. Presenters (six mental health professionals and three peer providers) who were closely matched in age, education, and experience were trained to cofacilitate weekly groups using the selected IMR modules. Assessment included self-reports and interviews (IMR Rating Scale, symptoms, two measures of social support, and two measures of coping skills). IMR participants showed improvement compared with a wait list control on the IMR Rating Scale, while the wait list control group showed improvement compared with IMR participants on the Norbeck Social Support Questionnaire. Overall, participants showed improvement on the IMR Rating Scale, the Perceived Social Support scale, and the Brief Symptom Inventory. Selected IMR modules provided in a group setting can foster positive change for participants. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Pratt, C. W., Lu, W., Swarbrick, M., & Murphy, A. (2011). Selective provision of illness management and recovery modules. American Journal of Psychiatric Rehabilitation, 14(4), 245–258. https://doi.org/10.1080/15487768.2011.622133
ABSTRACT: Although not strictly “education and training,” promoting staff wellness is an important component in hiring, supervising, and evaluating psychiatric rehabilitation practitioners. Certainly, a “well” staff member is likely to have reduced absenteeism, but also is likely to be a more efficient worker and a more effective learner. Given the emphasis on wellness in psychiatric rehabilitation today, spurred on by the fact that people with a major mental illness have dramatically shortened life spans, a “well” workforce also provides a model of health for people using services and will be informed about wellness strategies from personal experience. We recognize the need to focus on this area as a result of our first-hand knowledge of practitioners. Organizational culture has the potential to influence staff wellness for better or worse. Human resources policies, benefits packages, and information resources available to staff need to provide the knowledge and practical help that staff need to set and achieve personal wellness goals. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Swarbrick, M., D’Antonio, D., & Nemec, P. B. (2011). Promoting staff wellness. Psychiatric Rehabilitation Journal, 34(4), 334–336. https://doi.org/10.2975/34.4.2011.334.336
ABSTRACT: Objective: The purpose of the present study was to investigate and describe from the participants’ perspectives the factors and processes influencing their choice as to whether to use prescribed psychiatric medication. Methods: Thematic content analysis of data was obtained from semi-structured interviews with 19 individuals diagnosed with mental illnesses. Results: Central themes related to using psychiatric medication were negative side effects, feeling like a “guinea pig,” stigma, and struggling with the decision to continue or not to continue to take medication. The consequences of this decision were also considered. Conclusions and Implications for Practice: Our findings support the notion that “non-adherence” related to psychiatric medication is not simply a “problem” but rather a complex issue requiring personalized attention. To further examine the potential usefulness of psychiatric medication, it is important that medication be perceived as personally relevant and that medication issues be discussed within the context of an ongoing authentic dialogue between medication prescriber and user. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Swarbrick, M., & Roe, D. (2011). Experiences and motives relative to psychiatric medication choice. Psychiatric Rehabilitation Journal, 35(1), 45–50. https://doi.org/10.2975/35.1.2011.45.50
ABSTRACT: Studies indicate that asset development programs such as Individual Development Accounts (IDAs) can enhance the economic security of low-income populations; however, only a handful of asset development programs have been implemented specifically to serve people with psychiatric disabilities, and larger programs have not collected disability-specific information. The purpose of this article is to increase our knowledge about the use of IDAs to enhance self-determination and recovery for people with psychiatric disabilities. Sources used: Background information about IDAs is presented followed by case studies of two IDA programs that serve people with psychiatric disabilities. The use of IDA programs in enhancing self-determination among people with psychiatric disabilities is discussed, along with barriers and future directions.
Burke-Miller, J. K., Swarbrick, M. A., Carter, T. M., Jonikas, J. A., Zipple, A. M., Fraser, V. V., & Cook, J. A. (2010). Promoting self-determination and financial security through innovative asset building approaches. Psychiatric Rehabilitation Journal, 34(2), 104–112. https://doi.org/10.2975/34.2.2010.104.112
ABSTRACT: This article provides an overview of the national actions by key groups on recovery from psychiatric disability and how a shift is needed to transform health care service delivery in mental health. Fundamental components of recovery are outlined, and examples are provided from the literature in nursing and related disciplines that reflect similar research and evidence-based practice interventions. It is recommended that professional nursing include consumers as active participants in the design of evidence-based practices in all settings.
Caldwell, B. A., Sclafani, M., Swarbrick, M., & Piren, K. (2010). Psychiatric nursing practice and the recovery model of care. Journal of Psychosocial Nursing and Mental Health Services, 48(7), 42–48. https://doi.org/10.3928/02793695-20100504-03
Swarbrick, M., & Moosvi, K. V. (2010). Wellness: A practice for our lives and work. Journal of Psychosocial Nursing and Mental Health Services, 48(7), 2–3. https://doi.org/10.3928/02793695-20100602-99
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.