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Browsing by Author "Kukla, Marina"
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Item An Investigation of Employment Hope as a Key Factor Influencing Perceptions of Subjective Recovery among Adults with Serious Mental Illness Seeking Community Work(MDPI, 2024-03-19) Kukla, Marina; McGuire, Alan B.; Weber, Kenneth C.; Hatfield, Jessi; Henry, Nancy; Kulesza, Eric; Rollins, Angela L.; Psychology, School of ScienceIntroduction: Employment is an important contributor to recovery in people with serious mental illness (SMI), yet studies have not explored how subjective elements of employment hope contribute to perceptions of global recovery in this population. Methods: The current study examined the relationship between employment hope and subjective recovery in 276 unemployed adults with SMI participating in a multi-site clinical trial of a cognitive behavioral group intervention tailored toward work and combined with vocational rehabilitation. Participants had diagnoses of schizophrenia spectrum, bipolar, depressive, and posttraumatic stress disorders, and were receiving services at three Veterans Affairs healthcare facilities in the United States. Data were collected at study baseline. Linear regression analysis examined the relationship between employment hope (Short Employment Hope Scale; EHS-14) and subjective recovery (Recovery Assessment Scale; RAS) after controlling for psychiatric symptom severity and mental-health-related burden on daily life. Results: After accounting for covariates, employment hope significantly contributed to the regression model explaining subjective recovery. The overall model of predictor variables explained 52.5% of the variance in recovery. The results further explore the relationships between EHS-14 and RAS subscales. Conclusions: The findings suggest that employment hope is a key intervention target to bolster subjective recovery in this vulnerable population.Item Barriers and Facilitators to Work Success for Veterans in Supported Employment: A Nationwide Provider Survey(APA, 2016-04) Kukla, Marina; McGuire, Alan B.; Salyers, Michelle P.; Department of Psychology, School of Sciencebjective: Veterans with mental illness are at serious risk of poor work outcomes and career stagnation. Supported employment (SE) is an evidence-based model of vocational services that assists persons with mental illness to obtain competitive employment. The purpose of this study was to gain a rich understanding of barriers and facilitators related to competitive work success from the perspective of a nationwide sample of U.S. Department of Veterans Affairs (VA) SE staff, supervisors, and managers. Methods: This study utilized a mixed-methods approach in which 114 VA SE personnel completed an online questionnaire consisting of a survey of work barriers and facilitators; open-ended questions elicited additional factors affecting work success. Descriptive statistics characterized factors affecting work success, and an emergent, open-coding approach identified qualitative themes describing other key elements influencing employment. Results: The most prominent work facilitators were perceived veteran motivation, job match, the assistance of SE services, and veteran self-confidence. The highest rated barriers were psychological stress and a range of health-related problems. Qualitative findings revealed additional areas affecting work success, notably, the availability of resources, the capacity of frontline staff to form strong relationships with veterans and employers, the ability of staff to adapt and meet the multifaceted demands of the SE job, and the need for additional staff and supervisor training. The impact of employer stigma was also emphasized. Conclusions: An array of elements influencing work success at the level of the veteran, staff, SE program, and employer was recognized, suggesting several implications for VA services.Item A Brief Peer Support Intervention for Veterans with Chronic Musculoskeletal Pain: A Pilot Study of Feasibility and Effectiveness(Wiley, 2015-01) Matthias, Marianne S.; McGuire, Alan B.; Kukla, Marina; Daggy, Joanne; Myers, Laura J.; Bair, Matthew J.; Department of Communication Studies, School of Liberal ArtsObjective The aim of this study was to pilot test a peer support intervention, involving peer delivery of pain self-management strategies, for veterans with chronic musculoskeletal pain. Design Pretest/posttest with 4-month intervention period. Methods Ten peer coaches were each assigned 2 patients (N = 20 patients). All had chronic musculoskeletal pain. Guided by a study manual, peer coach–patient pairs were instructed to talk biweekly for 4 months. Pain was the primary outcome and was assessed with the PEG, a three-item version of the Brief Pain Inventory, and the PROMIS Pain Interference Questionnaire. Several secondary outcomes were also assessed. To assess change in outcomes, a linear mixed model with a random effect for peer coaches was applied. Results Nine peer coaches and 17 patients completed the study. All were male veterans. Patients' pain improved at 4 months compared with baseline but did not reach statistical significance (PEG: P = 0.33, ICC [intra-class correlation] = 0.28, Cohen's d = −0.25; PROMIS: P = 0.17, d = −0.35). Of secondary outcomes, self-efficacy (P = 0.16, ICC = 0.56, d = 0.60) and pain centrality (P = 0.06, ICC = 0.32, d = −0.62) showed greatest improvement, with moderate effect sizes. Conclusions This study suggests that peers can effectively deliver pain self-management strategies to other veterans with pain. Although this was a pilot study with a relatively short intervention period, patients improved on several outcomes.Item The Comparative Effectiveness of a Model of Job Development versus Treatment as Usual(2018) Carlson, Linda; Smith, Galen; Rapp, Charles A.; Mariscal, E. Susana; Holter, Mark C.; Ko, Eunjeong; Kukla, Marina; Fukui, Sadaaki; School of Social WorkJob development is critical to assisting people with serious disabilities to obtain jobs, but little is known about the actual methods that make job development effective. Using a post-only quasi-experimental design, this study examined the effects of the Conceptual Selling® method on the number of job development contacts and number of job placements. By controlling for employment specialists' characteristics (age, length of time in current position, years of human service experience, and years of business experience), the authors determined that the employment specialists trained in the Conceptual Selling® method had more job development contacts per employer, leading to more effective job placements for employers contacted, than the control group.Item Comparing the Costs and Acceptability of Three Fidelity Assessment Methods for Assertive Community Treatment(Springer, 2017-09) Rollins, Angela L.; Kukla, Marina; Salyers, Michelle P.; McGrew, John H.; Flanagan, Mindy E.; Leslie, Doug L.; Hunt, Marcia G.; Department of Psychology, School of ScienceSuccessful implementation of evidence-based practices requires valid, yet practical fidelity monitoring. This study compared the costs and acceptability of three fidelity assessment methods: on-site, phone, and expert-scored self-report. Thirty-two randomly selected VA mental health intensive case management teams completed all fidelity assessments using a standardized scale and provided feedback on each. Personnel and travel costs across the three methods were compared for statistical differences. Both phone and expert-scored self-report methods demonstrated significantly lower costs than on-site assessments, even when excluding travel costs. However, participants preferred on-site assessments. Remote fidelity assessments hold promise in monitoring large scale program fidelity with limited resources.Item Comparison of Assertive Community Treatment Fidelity Assessment Methods: Reliability and Validity(Springer, 2016-03) Rollins, Angela L.; McGrew, John H.; Kukla, Marina; McGuire, Alan B.; Flanagan, Mindy E.; Hunt, Marcia G.; Leslie, Doug L.; Collins, Linda A.; Wright-Berryman, Jennifer L.; Hicks, Lia J.; Salyers, Michelle P.; Department of Psychology, School of ScienceAssertive community treatment is known for improving consumer outcomes, but is difficult to implement. On-site fidelity measurement can help ensure model adherence, but is costly in large systems. This study compared reliability and validity of three methods of fidelity assessment (on-site, phone-administered, and expert-scored self-report) using a stratified random sample of 32 mental health intensive case management teams from the Department of Veterans Affairs. Overall, phone, and to a lesser extent, expert-scored self-report fidelity assessments compared favorably to on-site methods in inter-rater reliability and concurrent validity. If used appropriately, these alternative protocols hold promise in monitoring large-scale program fidelity with limited resources.Item Consumer and Relationship Factors Associated with Shared Decision-Making in Mental Health Consultations(2014-12) Matthias, Marianne S.; Fukui, Sadaaki; Kukla, Marina; Eliacin, Johanne; Bonfils, Kelsey A.; Firmin, Ruth; Oles, Sylwia; Adams, Erin L.; Collins, Linda A.; Salyers, Michelle P.; Department of Psychology, IU School of ScienceObjective: This study explored the association between shared decision making and consumers’ illness management skills and consumer-provider relationships. Methods: Medication management appointments for 79 consumers were audio recorded. Independent coders rated overall shared decision making, minimum level of shared decision making, and consumer-provider agreement for 63 clients whose visit included a treatment decision. Mental health diagnoses, medication adherence, patient activation, illness management, working alliance, and length of consumer-provider relationships were also assessed. Correlation analyses were used to determine relationships among measures. Results: Overall shared decision making was not associated with any variables. Minimum levels of shared decision making were associated with higher scores on the bond subscale of the Working Alliance Inventory, indicating a higher degree of liking and trust, and with better medication adherence. Agreement was associated with shorter consumer-provider relationships. Conclusions: Consumer-provider relationships and shared decision making might have a more nuanced association than originally thought.Item Correlates of attendance in mental health services for individuals with psychotic disorders: A critical review(Taylor & Francis, 2016) Bonfils, Kelsey A.; Bouchard, Lauren; Kukla, Marina; Miller, Alex P.; McGuire, Alan B.; Department of Psychology, School of ScienceLow attendance to mental health care results in loss of time, money, and treatment gains. No prior review in this area has taken into account the quality of studies or varying definitions of attendance. The current review provides a critical evaluation of variables associated with attendance in consumers with psychotic symptoms participating in outpatient mental health services, with a focus on study quality and operationalization of attendance. EMBASE, MEDLINE, PsycINFO, CINAHL, and the Cochrane Library were searched for empirical articles relevant to attendance to mental health services by individuals diagnosed with a psychotic disorder. Eligible articles were rated for quality by two coauthors; high-quality articles were reviewed in-depth. Twenty-eight articles were eligible; 11 articles qualified for in-depth review. Four attendance outcome types were identified, including the prediction of dropout, time engaged, categorical attendance, and continuous attendance. Ongoing substance use during treatment was consistently associated with lower attendance in high-quality articles. More high-quality research using systematically defined outcome types is needed to identify reliable associations with attendance. Commonly tested variables such as demographics show little utility in predicting attendance. Future research in this area should expand upon current findings focusing on clinically and theoretically relevant variables.Item Correlates of Attendance in Psychiatric Services: A Critical Review(Office of the Vice Chancellor for Research, 2013-04-05) Bonfils, Kelsey A.; McGuire, Alan B.; Bouchard, Lauren M.; Kukla, MarinaAttendance and dropout are concerning problems in the mental health field. With dropout rates averaging around 50%, mental health agencies lose money and resources invested in missed appointments and under-attended groups, providers lose valuable time, and consumers do not receive recommended levels of services. While there is research on consumer, provider, and agency factors that affect attendance, it has not been integrated and reviewed in the context of community services for those with psychotic disorders. The authors conducted a critical review of literature examining correlates of attendance in community services provided to samples with psychotic disorders as the most prominent diagnostic category. Twenty-two studies were identified that met inclusion criteria. Over 100 unique correlates of attendance were tested; the authors categorized these into eight content areas: demographics, current functioning, history (psychiatric/functional), neurocognitive functioning, services/treatment, social functioning, self-stigma/insight, and symptoms/psychopathology. Correlates were also sorted according to how often they were examined and how many times they were found to be significantly related to consumer attendance. The category containing the most unique correlates was symptoms/psychopathology. Demographic correlates were researched the most, with three unique correlates examined in over ten studies (age, sex, and living situation). Of these demographic correlates, all but two were found significant 25% of the time or less, and none exceeded 40%. Alternatively, some correlates have been investigated few times, but with promising results and theoretical connections to attendance, such as baseline illness severity, which has been found significant in 75% of analyses. There is evidence that researchers are examining correlates for which there is little empirical evidence of a connection to attendance. This may lead to missed opportunities to maximize attendance, use of services, and resources. Implications for future research in the area are discussed.Item Evaluation of a peer coach-led intervention to improve pain symptoms (ECLIPSE): Rationale, study design, methods, and sample characteristics(Elsevier, 2019) Matthias, Marianne S.; Daggy, Joanne; Adams, Jasma; Menen, Tetla; McCalley, Stephanie; Kukla, Marina; McGuire, Alan B.; Ofner, Susan; Pierce, Emilee; Kempf, Carol; Heisler, Michele; Bair, Matthew J.; Communication Studies, School of Liberal ArtsChronic pain is prevalent, costly, and a leading cause of disability. Pain self-management (i.e., employing self-management strategies including behavioral modifications) is an effective, evidence-based treatment. However, implementation and delivery of a pain self-management model is challenging because of time and resources. Peer supported pain self-management offers a promising approach to implementing pain self-management programs using fewer clinical resources. Evaluation of a Peer Coach-Led Intervention for the Improvement of Pain Symptoms (ECLIPSE) is a randomized controlled trial testing effectiveness of peer coach-delivered pain self-management intervention versus controls receiving a class on pain and pain self-management. ECLIPSE is a Hybrid Type 1 study testing effectiveness while examining implementation factors. ECLIPSE enrolled 215 veterans randomly assigned to the peer coaching (N = 120) or control (N = 95) arm. The peer coaching intervention lasts 6 months, with patient-peer coach pairs instructed to talk twice per month. Coaches attend initial training, are provided a detailed training manual, and attend monthly booster sessions. Outcomes are assessed at baseline, 6 months, and 9 months. The primary outcome is overall pain (intensity and interference), measured by the Brief Pain Inventory (BPI). Secondary outcomes are self-efficacy, social support, pain catastrophizing, patient activation, health-related quality of life, and health care utilization. To maximize implementation potential of pain self-management, innovative delivery methods are needed that do not require additional resources from healthcare teams. A novel and promising approach is a peer-coaching model, in which patients who are successfully managing their pain offer information, ongoing support, and advice to other patients with pain.