Over the years, Thresholds has studied most facets of rehabilitation, including treatment of people with mental illnesses in jail, innovative living situations, access to services, the effects of medication, and vocational services. Following is a sampling of past research studies.

Diversified Placement Approach / Individual
Placement and Support Study
This NIMH and NIDRR funded vocational project is a collaborative effort between Thresholds and Indiana University-Purdue University Indianapolis. Dr. Gary Bond of IUPUI is the Principal Investigator. The aim of this study is to compare work outcomes and cost effectiveness of two important and popular employment models for persons with severe mental illness. One vocational model, the Diversified Placement Approach (DPA), has evolved at Thresholds over 30 years and includes: work readiness training, group placement, agency-run businesses, and individual placement in the community. The other, Individual Placement and Support (IPS), developed by Dartmouth Psychiatric Research Center in New Hampshire, supports rapid job search and direct vocational placement.
u8232 This study is currently in the data analysis phase. Several papers from this study will be submitted for publication including a comparison of the two models in terms of:

• Effectiveness and cost-effectiveness
• Attrition rates
• Workplace social networks
• Other factors in employment success

Employer Survey
The Thresholds Vocational Programs appreciates working with community businesses and wants to continue providing quality employees that meet the employer's expectations. To assist us in our ongoing efforts to meet quality standards, employers were mailed a survey on which they could rate their satisfaction with employee referral / placement services in the areas of general arrangements, employee quality and support from Thresholds. The survey also asked several open-ended questions such as what is the most important reason employers choose to work with Thresholds and its members, how can we improve our services to meet the needs of employers and if our staff have provided support to the business with regard to education about mental illness or stigma-related issues (and what was the most helpful).

Jail Project Outcomes
Jail Project Qualitative Study: For more information see the following article: Jail Linkage Assertive Community Treatment Services for Individuals with Mental Illnesses (McCoy, Roberts, Hanrahan, Clay & Luchins). Published in the Psychiatric Rehabilitation Journal,  http://www.bu.edu/prj, Winter, 2004.

Stigma
The article, Mental Illness Stigma: Problem of Public Health or Social Injustice? (Corrigan, Watson, Davis & Byrne) was submitted to Social Work in 2004. Acceptance of publication is pending. Below you can find the abstract to the paper.

Public health approaches that try to decrease the stigma of mental illness largely rely on education based on the medical model. These include the idea that as treatments improve and symptoms / disabilities diminish, prejudicial attitudes held by the public will naturally diminish. Unfortunately, anti-stigma programs solely reflecting the medical perspective may have unintended consequences. They may result in the public viewing mental illness as a condition from which people do not recover. Genetic explanations might increase perceptions that consumers cannot control their behavior. These programs might suggest the harm caused by stigma has greater impact on the mental health system rather than the person with mental illness. They might foster pity rather than parity. Stigma as a social justice issue is reviewed as a model that augments the public health perspective on mental illness stigma. Based on sociological research, the social justice perspective notes that many of the lost opportunities experienced by people with mental illness result not from actual difference and defects, but those implied by stereotypes about mental illness. Exaggerated notions of group difference result in less power for people with mental illness. Framing stigma as a social injustice expands our understanding of the phenomena as well as broadens the approach to erasing stigma. The paper concludes with recommendations as to how the two approaches might be better integrated.

Grais Apartments Studies
Thresholds Dual Diagnosis Residential Treatment: Grais Apartments Program 18-Month Results (Tim Devitt & Sheila O'Neill). Published in Mental Health Weekly, Vol.11, #40. October, 2001. Outcomes for this study show that residents' diagnoses reveal that most clients (37 of the 40 in the sample) have co-morbid diagnoses of substance dependence in addition to major mental illness 923 with schizophrenia, 5 with schizoaffective disorders, 4 with bipolar disorders, two with major depression, and three with personality disorders). Three residents are diagnosed with schizophrenia and alcohol abuse disorders. To determine changes over time for each resident, three evidence-based practice outcome tools were administered over an 18-month period for 40 of the original 44 residents (of the four not included, one resident died and three others voluntarily withdrew). The tools used are the Stage of Substance Abuse Treatment Scale, the Clinician Alcohol use Scale, and the Clinician Drug Use Scale. Each scale is standardized, and statistically reliable and valid (see Toolkit for Evaluating Substance Abuse in Persons with Mental Illness, Mueser, et al., 1995).

Integrated Residential Treatment for Persons with Severe and Persistent Mental Illness: Lessons in Recovery (Davis), submitted in June of 2004 to the Journal of Psychoactive Drugs.

CBT Therapy & ACT
(Smythe, Rollins, Mayes & Harding)

Evaluating the implementation and usefulness of Cognitive Behavioral Therapy for consumers receiving ACT services.

Family Accessibility to Services Survey
Thresholds wanted to expand the support services it offers to families of those living with a severe and persistent mental illness. To start the process of getting families more involved we first learned that for a multitude of reasons, many families do not participate in their loved ones recovery nor seek support services for themselves. To learn more about why this is, we wanted to ask the following questions: Do barriers to services exist for families? If so, what specifically are they? And finally, what can we do about them? To answer these questions, we created a survey designed to collect the perspectives from the families themselves regarding accessibility issues. We utilized a pre-existing "family" database which was created as a means to distribute information to families, such as the Thresholds Family Support Newsletter. We mailed approximately 1,700 surveys to family members. One survey, along with a return envelope, was sent per household. After a 3-week period, 139 surveys were completed and returned. Research staff entered the survey responses into a SPSS database in which no identifiers were included to ensure anonymity. We coded responses to the open-ended questions based on similar themes and then grouped them into the appropriate barrier category.

Submitted for publication in the Psychiatric Rehabilitation Journal. At the May, 2004 IAPSRS conference, our poster presentation highlighted the survey and outcomes. This presentation will also be held at the National NAMI conference in Washington, D.C., October, 2004

Prison Outreach
All too often, people with severe mental illness (SMI) have negative contact with the criminal justice system. A recent survey by the National Alliance for the Mentally Ill indicated that 44% of people with SMI had been arrested over their lifetime, and 29% had been arrested the past year. Likewise, individuals with SMI are over represented in correctional facilities at alarming rates, with estimates of the prevalence of SMI ranging from 7-15%. Much of the time, if mental health services are even offered within the correctional setting, planning for quality post-release services in the community is insufficient and individuals end up repeating the cycle of homelessness, incarceration, or hospitalization. This comprehensive, innovative project seeks to address the gaps between correctional facilities and mental health providers at both the individual service and systems level, over a two-year period. The study encompasses a range of activities to address this problem:

• Encourage mental health providers to engage these individuals in evidence-based treatment using performance-based incentives
• Use technology to begin the engagement process BEFORE individuals are released from prison so that the transition to the community is more productive
• Train mental health providers, parole and probation officers, corrections staff, and other community stakeholders (e.g., homeless shelters, consumer and family groups) about evidence-based treatments for this population
• Conduct program evaluation and research to track critical outcomes and identify program elements predictive of positive outcomes
• Involve consumers, family members, and corrections experts as consultants and advocates in producing public policy changes affecting this population

Wellness Management and Recovery (WMR) pilot
WMR is a structured approach to helping adults with severe mental illness (SMI) manage their illnesses more independently. WMR provides a set of specific techniques to educate consumers about their illness, medications, coping skills and relapse prevention techniques using cognitive-behavioral and motivational interventions. WMR ha s been shown to be effective in improving medication adherence, reducing symptom severity, and reducing relapse and hospitalization rates [1] and is considered one of the six evidence-based practices for the SMI population [2, 3]. The ACT Center of Indiana has been working with Thresholds to help them implement and evaluate WMR. For the pilot, the ACT Center trainers for WMR, one clinical psychologist and one trained peer specialist, provided individualized consultation and two trainings to Thresholds. Training consists of a 2-day intensive workshop, followed by phone consultation with Susan Gingerich, a national expert in WMR. To date, Thresholds has approximately 15 staff from 9 Thresholds programs providing WMR services.

Relapse Prevention Studies
A Qualitative study analyzing strategies, skills & supports people with co-occurring disorders use to stay sober (Davis, O'Neill with Drake & others). Why is it that some people with co-occurring mental illness and substance use disorders are able to stop abusing substances and others continue to struggle? This qualitative study, which will rely on data from focus group discussions and individual interviews with persons in later stages of recovery, hopes to provide much-needed insight into the motivations, support, and strategies that help some people stop using drugs and/or alcohol. The long-run findings from this study may help develop standardized recovery skill-building approaches that can help persons move into and maintain the recovery stages of substance abuse treatment.

• Collaboration on a series of relapse prevention projects with Bob Drake affiliated with Dartmouth College (http://www.dartmouth.edu/~psych/) & Community Connections in Washington D.C. (O'Neill, MISA group & Thresholds Research Department).
• Relapse Interviews: Open-ended qualitative interviews with individuals who have relapsed. The goal of this study is to better understand the relapse process, from the distant and often covert, precursors of relapse to the more immediate precursors of relapse.
• Relapse Intervention Form Analysis: This qualitative (content analysis) study of clinical forms used to help members understand their relapse. Researchers will seek to determine the most frequent internal (emotional states, thoughts, etc.) and external conditions (receiving money, being with friends who use, etc.) which precipitate relapses.

J&J Supported Employment Project
J&J project and NIMH/SAMHSA grant are intended to increase employment rates among persons with MI by implementing EBP SE. We are making recommendations for state standards regarding SE, as well as policies and funding arrangements to support SE, particularly as related to interagency collaboration (i.e., DRS & DMH). We are developing an implementation protocol that identifies evaluation tools and technical assistance requirements at both the organizational and clinical levels.