Helde Pereira MRes

Background. Medicaid funded long-term services and supports (LTSS) can provide crucial wraparound supports to adults with serious mental illness (SMI) that have been shown to improve overall health, enhance quality of life, and promote longer tenure in home-and-community settings. In the United States, access to LTSS is determined by level-of-care (LOC) assessments, which are typically homegrown instruments that vary by state. Currently, it is unclear whether LOC assessments address functional limitations commonly experienced by adults with SMI.

Method. To examine this, we first identified publicly available LOC assessments nationwide with clearly defined scoring strategies. Second, we utilized the Health of the Nation Outcomes Scale (HoNOS), an evidence-based, functional assessment for adults with SMI, to comparatively analyze the extent to which state LOC assessments addressed functional limitations associated with SMI.

Results. Assessments from five states met our criteria: Hawai’i, Arizona, Mississippi, Missouri and Tennessee. Problems with activities of daily living (ADLs) were the primary driver of LTSS LOC scores and were substantially overrepresented compared to the HoNOS. Furthermore, eight of the 12 HoNOS functional limitation domains were either drastically underrepresented or not represented in any state assessment.

Conclusion. This analysis suggests that LTSS LOC assessments do not adequately account for the full range of functional limitations commonly associated with SMI and may be systematically excluding high-need Medicaid recipients with SMI who do not have ADL challenges. To ensure parity for Medicaid recipients with SMI, we recommend state Medicaid programs consider implementing a uniform, evidence-based LOC assessment to determine LTSS eligibility for people with a primarily diagnosis of mental illness.

Keywords. Long-term services and supports, Home and community-based services, Level-of-care assessment, LTSS eligibility, Serious mental illness

The Measure of Experiential Aspects of Participation (MeEAP) has strong potential for use in mental health and community settings, such as Clubhouses, as it addresses subjective aspects of participation. Thus, this study analyzes the MeEAP’s psychometric properties and descriptively examines experiential aspects of participation among 206 Clubhouse members. Results indicated good model fit, high internal consistency, and associations with health-related quality of life. Members rated autonomy, belonging, challenge, engagement, mastery, and meaning in Clubhouses very highly. However, members with activity limitations reported lower experiential participation than those without, suggesting opportunities to improve Clubhouse engagement for members with concurrent nonpsychiatric disabilities.

Keywords. Participation measurement, community participation, quality of participation, serious mental illness, community mental health settings, Clubhouse

This study explored how mental health Clubhouses, an occupation-centered psychosocial rehabilitation model, supported wellness for members and staff during the COVID-19 pandemic through the lens of Maslow’s hierarchy of needs. Data from 15 participants in Hawaiʻi were collected over five sessions through a virtual Photovoice process and analyzed using the framework method and thematic analysis. Findings illustrate how occupation-centered approaches supported higher-level growth needs during a period of collective crisis and uncertainty. This underscores the value of coupling occupation-centered approaches, such as Clubhouse, with those that meet basic needs to support belonging, identity, and purpose among people with mental illness.

Keywords. Clubhouse, mental illness, Photovoice, hierarchy of needs, COVID-19 pandemic

Pereira, H., de Almeida, S. C., & Drummond, A. F. (2024). Occupations of users of a Brazilian mental health service during the COVID-19 pandemic. Journal of Occupational Science, 31(1), 149–162.

Abstract. The coronavirus disease 2019 (COVID-19) pandemic and its resulting health measures led to occupational disruption in several contexts of everyday life. This study aimed to investigate the occupations of users of a unique Brazilian mental health service during the pandemic. This qualitative case study utilized semi-structured interviews to examine the lived experiences of 14 individuals (11 male and 3 female) who were users of a Center of Convivência for mental health. The participants were primarily from low-income backgrounds and mostly identified as Black. Two categories emerged from the content analysis: occupations experienced in and through the Center of Convivência and at home. The center was one of the few places attended by users outside home. During the pandemic, users reduced their weekly attendance, choices, and modality for participating in workshops at the center. Also, they presented a home-restricted life before the pandemic, with limited social circulation, access to leisure and work opportunities. Thus, users had few changes in routine during the pandemic, and housework was their main occupation. Although users had no changes in the existing social limitations and occupational deprivation in the home environment, they experienced occupational disruptions in the Center of Convivência during the pandemic. [Available in Portuguese]