Papers by Jennifer I. Manuel
The journal of behavioral health services & research, Jan 9, 2016
This study examined gender differences in perceived unmet treatment needs among persons with and ... more This study examined gender differences in perceived unmet treatment needs among persons with and without co-occurring substance use disorders and serious mental health conditions. Data were drawn from the 2008-2013 National Survey on Drug Use and Health (unweighted N = 37,187) to test the hypothesis that the relationships between diagnosis and perceived unmet treatment needs differ as a function of gender. Compared to individuals with a substance use disorder or severe mental illness, those with co-occurring disorders were more likely to report perceived unmet needs for substance abuse and mental health treatment. Gender significantly moderated the relationship between diagnosis and unmet needs, suggesting that men with co-occurring disorders might be more adversely affected. Findings highlight the need for better understanding of gender-diagnosis differences with respect to unmet needs for substance abuse and mental health care.
HIV/AIDS - Research and Palliative Care, 2015
High rates of smoking among persons living with HIV (PLWH) may reduce the effectiveness of HIV tr... more High rates of smoking among persons living with HIV (PLWH) may reduce the effectiveness of HIV treatment and contribute to significant morbidity and mortality. Factors associated with smoking in PLWH include mental health comorbidity, alcohol and drug use, health-related quality of life, smoking among social networks and supports, and lack of access to care. PLWH smokers are at a higher risk of numerous HIV-associated infections and non-HIV related morbidity, including a decreased response to antiretroviral treatment, impaired immune functioning, reduced cognitive functioning, decreased lung functioning, and cardiovascular disease. Seventeen smoking cessation interventions were identified, of which seven were randomized controlled trials. The most effective studies combined behavioral and pharmacotherapy treatments that incorporated comprehensive assessments, multiple sessions, and cognitive-behavioral and motivational strategies. Smoking cessation interventions that are tailored to the unique needs of diverse samples and incorporate strategies to reduce the risk of relapse are essential to advancing health outcomes in PLWH.
International Encyclopedia of Public Health, 2008
Violence and Victims, 2006
This study tests the feasibility, safety, and short-term preliminary effects of a relapse prevent... more This study tests the feasibility, safety, and short-term preliminary effects of a relapse prevention and relationship safety (RPRS) intervention in reducing drug use and the experience of intimate partner violence (IPV) among women on methadone. For this randomized controlled trial, 34 women who met IPV and drug use criteria were randomly assigned to either the RPRS condition (n = 16) or a one-session informational control (IC) condition (n = 18). RPRS participants were more likely than IC participants to report a decrease in minor physical or sexual IPV (OR = 7.1, p = .05), minor psychological IPV (OR = 5.3, p = .03) and severe psychological IPV (OR = 6.07, p = .03) at the 3-month follow-up. Data suggest that RPRS participants were also more likely than IC participants to report a decrease in any drug use at 3 months (OR = 3.3, p = .08). This study provides preliminary evidence that the RPRS intervention is effective in reducing IPV and drug use among women on methadone.
Journal of Social Work Education, 2008
Little is known ahout evidence-based practice (EBP) in social service agencies beyond studies of ... more Little is known ahout evidence-based practice (EBP) in social service agencies beyond studies of researcher, practitioner, and educator opinions. The Bringing Evidence for Social Work Trairüng (BEST) Project involved 16 participants from 3 social service agencies. The experiential training, delivered by 2 doctoral students, focused on a team-identified practice issue and followed the EBP process of motivation, question formulation, search, evaluation, and application planning. Posttrairiing focus group data were analyzed. Results suggest that university researchers who based in schools of social work can successfully collaborate with agencies to support the process of identifying, evaluating, and discussing the application of research evidence in practice. University-agency training partnerships should be considered as 1 of many potential strategies for advancing EBP in social work.
Administration and Policy in Mental Health and Mental Health Services Research, 2014
This study examined trends in general hospital discharges and dispositions involving episodes of ... more This study examined trends in general hospital discharges and dispositions involving episodes of severe mental illness (SMI) with and without co-occurring substance use disorders. We analyzed data from the National Hospital Discharge Survey from 1979 through 2008. Discharges involving SMI and co-occurring substance use disorders (COD) were associated with shorter lengths of stay and had a greater likelihood of being discharged routinely or home and reduced likelihood of being transferred to a short-or longterm facility. Although COD discharges had a greater odds of leaving against medical advice than SMI discharges, this effect was not significant over time. A greater understanding of hospital discharge planning practices is needed to ensure that patients are linked to appropriate aftercare services.
Journal of Religion & Spirituality in Social Work: Social Thought, 2015
ABSTRACT In this article we present the findings from a survey of Master of Social Work (MSW) stu... more ABSTRACT In this article we present the findings from a survey of Master of Social Work (MSW) students regarding their attitudes toward religion in social work practice and their feelings of competence when working with clients who are Muslim. Our findings indicated that some students are uncomfortable working with Muslim groups. Interestingly, those students who are minority and non-Christian appear to identify with other oppressed groups and expressed attitudes of greater comfort and tolerance than their White and Christian counterparts. This suggests a need for a more comprehensive view of multicultural practice in social work education perhaps with a focus on cultural humility.
Psychiatric Services, 2012
This article describes the creation, validation, and use of an assertive community treatment (ACT... more This article describes the creation, validation, and use of an assertive community treatment (ACT) Transition Readiness Scale (TRS) to identify clients who may be ready to transition from ACT services. Scale development was prompted by concerns over long stays on ACT teams and the resulting impact on access. Data were extracted from a centralized clinical reporting system for all 1,365 persons enrolled for at least 12 months as of August 2008 in the 42 ACT teams in New York City, including 382 clients of eight of those ACT teams. Data in seven domains deemed relevant to transition readiness were used to calculate readiness scores for each client. An algorithm assigned clients to one of three categories: consider for transition, readiness unclear, and not ready. Via the TRS algorithm, of the 1,365 clients, 192 (14%) were assigned to the consider-for-transition group, 382 (28%) to the unclear group, and 791 (58%) to the not ready group. Clinicians on the eight ACT teams categorized 15% of their current clients in the consider-for-transition group, whereas the TRS algorithm classified 18% in this category. Overall, the TRS agreed with the category assigned by ACT team clinicians in 69% of cases. The TRS may provide ACT teams and program administrators with a tool to identify clients who may be ready to transition to less intensive services, thereby opening scarce slots. Because ACT cases are complex, data summaries can offer useful syntheses of information, particularly when data from several assessments are used to summarize a client's trajectory.
Psychiatric Services, 2012
Demographic and clinical factors associated with starting clozapine and other antipsychotics were... more Demographic and clinical factors associated with starting clozapine and other antipsychotics were examined. New York State Medicaid claims from 2008 to 2009 identified individuals with a schizophrenia spectrum disorder, continuous Medicaid eligibility during the study, and at least one clinic service and antipsychotic fill. The sample included individuals who initiated an antipsychotic without any fills for the same medication in the prior 90 days (N=7,035). Only 144 patients (2%) started on clozapine. They were more likely to be younger, white males who had received services in a state-operated facility, with more hospital admissions and higher total psychiatric costs. African Americans and Hispanics were less likely than whites to start on clozapine. Individuals with substance use disorders were less likely than those without them to start on clozapine. Clozapine was rarely prescribed, and problematic disparities were found. Quality improvement efforts are needed to ensure that patients are offered this effective treatment when appropriate.
Psychiatric Services, 2011
People experiencing a first episode of psychosis frequently have co-occurring substance use disor... more People experiencing a first episode of psychosis frequently have co-occurring substance use disorders, usually involving alcohol and cannabis, which put them at risk for prolonged psychosis, psychotic relapse, and other adverse outcomes. Yet few studies of first-episode psychosis have addressed the course of substance use disorders and the response to specialized substance abuse treatments. The authors searched MEDLINE, PsycINFO, and other medical databases for English-language articles published between 1990 and 2009. Included studies addressed two research questions. First, do some clients become abstinent after a first episode of psychosis without specialized substance abuse treatments? Second, for clients who continue to use substances after a first episode of psychosis, does the addition of specialized substance abuse treatment enhance outcomes? Nine studies without specialized substance abuse treatment and five with specialized substance abuse treatment assessed the course of substance use (primarily cannabis and alcohol) after a first episode of psychosis. Many clients (approximately half) became abstinent or significantly reduced their alcohol and drug use after a first episode of psychosis. The few available studies of specialized substance abuse treatments did not find better rates of abstinence or reduction. Experience, education, treatment, or other factors led many clients to curtail their substance use disorders after a first episode of psychosis. Specialized interventions for others need to be developed and tested.
Social Science & Medicine, 2012
Limited research has examined the associations of stress, social support, and depression among mo... more Limited research has examined the associations of stress, social support, and depression among mothers with young children over time. Longitudinal studies are needed to identify risk and protective factors for maternal depression given that depression can be cyclical and may affect women through the early years of their children's development. This study examined the relationships among stress, social support, and depressive symptoms in a national sample of low-income urban American women with young children. A secondary data analysis of the Fragile Families and Child Wellbeing Study, a national longitudinal panel study of nearly 5000 births across 20 cities with populations of 200,000 or more in the United States, was conducted. The analytic sample included all mothers (N = 3675) who completed assessments at baseline through year 5 of the study between 1998 and 2005. Multivariate models using generalized estimating equations were used to estimate the probability of being depressed as a function of stress-related risk factors, social support factors, and sociodemographic variables. The rate of depression each year ranged from 15% to 21%. The results suggest that stress related to economic hardship, parenting, and poor physical health increases the risk of depression among low-income urban mothers with young children. Instrumental and partner support were found to be potential protective factors in reducing the negative effects of stress, but only to a certain degree. Future efforts are needed to strengthen social support and mitigate chronic stressors that contribute to mental health problems in low-income communities.
Psychiatric Services, 2013
OBJECTIVE This study compared rates of arrest and incarceration, psychiatric hospitalization, hom... more OBJECTIVE This study compared rates of arrest and incarceration, psychiatric hospitalization, homelessness, and discharge from assertive community treatment (ACT) programs for forensic and nonforensic clients in New York State and explored associated risk factors. METHODS Data were extracted from the New York State Office of Mental Health's Web-based outcome reporting system. ACT clients admitted between July 1, 2003, and June 30, 2007 (N=4,756), were divided into three groups by their forensic status at enrollment: recent (involvement in the past six months), remote (forensic involvement was more than six months prior), and no history. Client characteristics as of ACT enrollment and outcomes at one, two, and three years were compared over time. RESULTS Clients with forensic histories had a significantly higher ongoing risk of arrest or incarceration, and those with recent criminal justice involvement had a higher risk of homelessness and early discharge from ACT. Psychiatric hospitalization rates did not differ significantly across groups. Rates of all adverse outcomes were highest in the first year for all ACT clients, especially for those with a recent forensic history, and rates of psychiatric hospitalization, homelessness, and discharge declined over time for all clients. For all ACT clients, homelessness and problematic substance abuse at enrollment were significant risk factors for arrest or incarceration and for homelessness on three-year follow-up. CONCLUSIONS Clients with recent forensic histories were vulnerable to an array of adverse outcomes, particularly during their first year of ACT. This finding highlights the need for additional strategies to improve forensic and other outcomes for this high-risk population.
Research on Social Work Practice, 2009
The implementation of evidence-based practice (EBP) as a professional model of practice for socia... more The implementation of evidence-based practice (EBP) as a professional model of practice for social work has been suggested as one approach to support informed clinical decision making. However, different barriers and processes have been identified that impact the use of EBP at individual, organizational, and systemic levels. This article describes results from a project that sought to enhance practitioner use of EBP by using a supportive strategy including training and technical assistance through a partnership between university-based researchers and three social work agencies. Results compare similarities and differences across each of the three agencies in terms of barriers and promoters at the team, organizational, and system levels. Results suggest that comprehensive multilevel interventions are needed to support the use of EBP in social work organizations and that further research is needed to test explicit partnership components. Findings suggest that a multilevel approach has the greatest potential to support implementation of EBP in social agencies.
Journal of the American Psychiatric Nurses Association, 2011
This study analyzed data from a randomized trial to examine the impact on medication adherence of... more This study analyzed data from a randomized trial to examine the impact on medication adherence of integrated treatment delivered via assertive community treatment (ACT) versus standard clinical case management (SCCM). Data from the original study included 198 study participants with co-occurring psychotic and substance use disorders who were randomly assigned to receive integrated treatment via ACT or SCCM and were followed for 3 years. We applied mixed-effects logistic regression to estimate group (ACT vs. SCCM) by time effects on a self-report measure of medication adherence. Adherence was dichotomized as 20% or more missed medication days ("poor adherence") versus less than 20% missed medication days ("adequate adherence"). Participants who were assigned to ACT reported significant improvement in medication adherence compared with those assigned to SCCM. Integrated treatment delivered via ACT may benefit persons with co-occurring psychotic and substance use disorders who are poorly adherent to medications.
Journal of Evidence-Based Social Work, 2013
Responding to the call for evidence-based practice (EBP) in social work, the authors conducted a ... more Responding to the call for evidence-based practice (EBP) in social work, the authors conducted a multiphase exploratory study to test the acceptability of a training-based collaborative agency-university partnership strategy supporting EBP. The Bringing Evidence for Social Work Training (BEST) study includes an agency training component consisting of 10 modules designed to support the implementation of EBP in social agencies. Qualitative data from post-training participant focus groups were analyzed in order to describe practitioner perceptions of the 10 training modules and trainer experiences of implementation. Based on the findings from this study the authors suggest that the BEST training was generally acceptable to agency team members, but not sufficient to sustain the use of EBP in practice.
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Papers by Jennifer I. Manuel