Sarah Conover - Academia.edu (original) (raw)
Papers by Sarah Conover
Global Implementation Research and Applications
Frontiers in Health Services
Global Mental Health, 2017
The purpose of this paper is to describe the development and initial accomplishments of a trainin... more The purpose of this paper is to describe the development and initial accomplishments of a training program of young leaders in community mental health research as part of a Latin American initiative known as RedeAmericas. RedeAmericas was one of five regional ‘Hubs’ funded by the National Institute of Mental Health (NIMH) to improve community mental health care and build mental health research capacity in low- and middle-income countries. It included investigators in six Latin American cities – Santiago, Chile; Medellín, Colombia; Rio de Janeiro, Brazil; and Córdoba, Neuquén, and Buenos Aires in Argentina – working together with a team affiliated with the Global Mental Health program at Columbia University in New York City. One component of RedeAmericas was a capacity-building effort that included an Awardee program for early career researchers in the mental health field. We review the aims of this component, how it developed, and what was learned that would be useful for future cap...
Frontiers in Health Services
BackgroundIn 2005, Chile became the first country in Latin America to guarantee universal free ac... more BackgroundIn 2005, Chile became the first country in Latin America to guarantee universal free access for the diagnosis and treatment of schizophrenia. A cluster randomized control trial utilizing the Dynamic Adaptation Process framework is underway to adapt and test the OnTrack coordinated specialty care model to provide recovery-oriented, person-centered care by a multidisciplinary team for individuals with first episode psychosis (FEP) in Chile.MethodsA qualitative formative research study was conducted to inform the initial adaptation of the OnTrack Chile (OTCH) program. We conducted key informant interviews (n = 17) with various stakeholders (policymakers; directors/managers of community mental health centers; mental health professionals) and focus group discussions (n = 6) with individuals with FEP and caregivers (n = 35 focus group participants total). Data was analyzed using thematic analysis, organized by participants' perspectives on the benefits, barriers, and recomme...
Administration and Policy in Mental Health and Mental Health Services Research
Critical Time Intervention (CTI) is designed to reduce the risk of homelessness and other adverse... more Critical Time Intervention (CTI) is designed to reduce the risk of homelessness and other adverse outcomes by providing support to individuals during challenging life course transitions. While several narrative reviews suggest the benefit of CTI, the evidence on the model’s effectiveness has not been systematically reviewed. This article systematically reviews studies of CTI applied to a variety of populations and transition types. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis for protocols (PRISMA-P) guidelines, we reviewed 13 eligible experimental and quasi-experimental studies. Findings were summarized by individual outcome domains, including housing, service engagement use, hospitalization or emergency services, mental health, substance use, family and social support, and quality of life. CTI had a consistent positive impact on two primary outcomes—reduced homelessness and increased service engagement use—among different populations and contexts...
The Journal of Forensic Psychiatry & Psychology, 2019
Community Mental Health Journal, 1990
In this paper, we review problems of epidemiologic method in surveys that reported on mental illn... more In this paper, we review problems of epidemiologic method in surveys that reported on mental illness in homeless adults in the United States in the 1980s (Arce, et al., 1983; Vergare & Arce, 1986; Bassuk, et al., 1984; Bassuk, et ah, 1986; Crystal, et ah, 1986; Fischer, et ah, 1986; Koegel, et al., 1988; Kroll, et ah, 1986; Morse & Calsyn, 1986; Rossi, et al., 1987; Roth & Bean, 1986; Snow, et al., 1986; Struening, 1986; Susser, et al., 1989a). These surveys can be construed, in epidemiologic terms, as ~'case surveys" of homelessness, since most gathered data on homeless persons without selecting a second group specifically for comparison. Surveys included in our review meet two minimal criteria:
The British Journal of Psychiatry, 1995
Background We examined whether acute transient psychoses can be distinguished from schizophrenia ... more Background We examined whether acute transient psychoses can be distinguished from schizophrenia and the affective disorders. Method We studied 46 cases of nonaffective acute psychosis in the Chandigarh Acute Psychosis Study. With respect to separation from schizophrenia, we examined the distribution of duration of the episode. With respect to separation from affective disorders, we assessed the frequency of affective symptoms. Results Duration was bimodal, suggesting the presence of two distinct conditions of short and long duration. Affective symptoms were minimal, suggesting that these were not atypical affective syndromes. Conclusions Acute transient psychoses conform neither with schizophrenia of brief duration nor with atypical affective psychosis, and thus require separate classification as proposed in the ICD–10.
AIDS and Behavior, 2002
... 120 Diaz, Vlahov, Edwards, Conover, and Monterroso Table II. ... The authors would like to th... more ... 120 Diaz, Vlahov, Edwards, Conover, and Monterroso Table II. ... The authors would like to thank the outreach workers and interviewers (Yvonne Cuevas, Mercedes Kullian, Diedra Harris, and Mark Vega), whose dedication helped make this a successful project. ...
The British Journal of …, 1995
Background. We examined whether acute transient psychoses can be distinguished from schizophrenia... more Background. We examined whether acute transient psychoses can be distinguished from schizophrenia and the affective disorders. Method. We studied 46 cases of nonaffective acute psychosis in the Chandigarh Acute Psychosis Study. With respect to separation from schizophrenia,we examined the distribution of durationof the episode.With respectto separationfrom affective disorders, we assessed the frequency of affectivesymptoms. Results. Duration was bimodal, suggesting the presence of two distinct conditions of short and long duration. Affective symptoms were minimal, suggesting that these were not atypical affective syndromes. Conclusions. Acute transient psychoses conform neither with schizophrenia of brief duration nor with atypical affective psychosis, and thus require separate classification
Archives of General Psychiatry, 1989
Archives of General Psychiatry, 1998
Background: The spread of human immunodeficiency virus infection to impaired groups has intensifi... more Background: The spread of human immunodeficiency virus infection to impaired groups has intensified the challenge for its prevention; control of the epidemic now requires behavioral change among persons with limited ability to sustain attention and learn. In this randomized clinical trial, we tested an intervention to reduce sexual risk behaviors among homeless men with severe mental illness. Methods: Men were recruited from a psychiatric program in a homeless shelter. Of 116 eligible men, 97 (83.6%) participated. Most were African American and had a chronic psychotic disorder and a comorbid substance use disorder. Participantswereassignedtoa15-sessionexperimentalgroup intervention or to a 2-session control intervention and observed for 18 months. The 59 participants sexually active beforethetrialwerethemaintargetoftheintervention.Sexual risk behavior was the primary outcome. Results: Among the 59 sexually active men, follow-up data were obtained on 59 (100%) for the initial 6-month follow-up and on 56 (95%) for the remainder of the 18-month follow-up. The mean score on a sexual risk index for the experimental group was 3 times lower than for the control group (1.0 vs 3.1; P=.01) during the initial 6-month follow-up and 2 times lower during the remainder of the 18-month follow-up. Conclusions: This intervention successfully reduced sexual risk behaviors of homeless men with mental illness. The effect diminished over 18 months but did not disappear. Similar approaches may be effective in other impaired high-risk groups.
American Journal of …, 1995
The authors investigated sexual behaviors related to HIV transmission among homeless mentally ill... more The authors investigated sexual behaviors related to HIV transmission among homeless mentally ill men in a New York City shelter. A previous study of a similar population found HIV prevalence to be 19%. In standardized interviews with 122 men, data on sexual behaviors for the previous 6 months were collected. The frequency and nature of sexual episodes that may facilitate HIV transmission were examined. In addition, sexual risk behaviors among broadly defined diagnostic groups were compared. Of the 122 men, 65 (53%) had sex, 56 with women and 20 with men (11 who had sex with both women and men are counted in each group). The sexually active men, in most cases, had only occasional sex (once per month or less). The majority of sexually active men--29 (52%) of those who had sex with women and 12 (60%) of those who had sex with men--had sex without a condom and with nonmonogamous partners. Comorbid cocaine abuse or dependence was significantly associated with high-risk sexual behaviors. The majority of these men had sex occasionally or not at all. Nonetheless, because many of them had unprotected sex with nonmonogamous partners, the few sexual episodes may have carried an appreciable risk of HIV transmission. Moreover, men with a comorbid cocaine dependence may represent a group with an especially high risk for sexual HIV transmission. The authors propose that in this population, preventive interventions could modify the nature, if not the frequency, of sexual episodes.
American Journal of …, 1991
This study examined the relationship between childhood experience and homelessness in psychiatric... more This study examined the relationship between childhood experience and homelessness in psychiatric patients. Three large and diverse samples of homeless patients (N = 512) were compared with a sample of patients who had never been homeless (N = 271), with respect to childhood experience of foster care, group home placement, and running away. One of the homeless samples and the never homeless sample were drawn from patients admitted to a state mental hospital. In this state hospital population, risk ratios for lifetime prevalence of homelessness could be derived. In the three homeless samples, over 15% had a history of foster care, over 10% had a history of group home placement, and over 20% had a history of running away. These figures compared with 2%, 1%, and 5%, respectively, in the never homeless sample. In the state hospital, the lifetime prevalence of homelessness in patients with any one of these childhood experiences was about threefold that of other patients. A history of homelessness was reported by the great majority of state hospital patients who had had one of these childhood experiences. These childhood experiences were strongly associated with adult homelessness in these psychiatric patients. It might be possible to prevent homelessness in some cases by interventions aimed at patients with such childhood histories.
Archives of General …, 1989
Schizophrenia Research, 2010
Available evidence suggests that individuals with schizophrenia and other severe mental illnesses... more Available evidence suggests that individuals with schizophrenia and other severe mental illnesses are at increased risk for homelessness in contemporary societies with diverse cultures and socioeconomic conditions. Yet the prevention of homelessness among individuals with mental illness has rarely been a focus of global health programs. We propose that it should be. In any given society, the overall risk of homelessness will reflect broad societal factors such as income inequality, housing, migration, economic conditions, and family ties. We strongly advocate for addressing these societal causes of homelessness. We also believe, however, that we need to develop special programs in parallel to prevent homelessness among individuals with severe mental illness. We use historical examples to draw attention to ways in which individuals with mental illness have beenand still areexplicitly excluded from societies. We suggest that this social exclusion requires us to take special measures to protect the rights of individuals with mental illness, and to develop programs to ensure they have access to basic necessities including a home. The form these measures take will of necessity vary widely according to local conditions. We describe mental health initiatives in two middle-income countries (Brazil and Argentina) which illustrate different approaches, and allude more briefly to efforts being made in other countries including low-income countries. Finally, we consider some of the efforts that are already being made by various international groups to further this agenda within the global health movement.
Psychiatric Services, 1989
Because the problem of homelessness has generated such attention and controversy, findings from s... more Because the problem of homelessness has generated such attention and controversy, findings from studies of homeless populations are often received eagerly without appreciation of the significant biases inherent in surveys. Drawing on surveys of the homeless made in the 1980s, the authors review problems in sampling and in measurement of mental disorder. They suggest that within any one study researchers employ alternative sampling strategies and measures of mental disorder to facilitate comparison of results within and across studies.
We report on the inter-rater reliability of the Life Chart Schedule (LCS). The LCS is designed to... more We report on the inter-rater reliability of the Life Chart Schedule (LCS). The LCS is designed to assess the longterm course of schizophrenia in four key domains (symptoms, treatment, residence, and work) over two time periods (past two years, entire period of illness). The subjects were 27 consecutive admissions to a schizophrenia research unit. The LCS was filled out by pairs of raters, blinded to each others' ratings, using the same data (interview with subject and chart). Reliability was examined for 45 LCS ratings selected from all four domains and both time periods. Selected ratings pertained to the duration of specified experiences, the quality of these experiences, and the long-term time trend. The kappa statistic and the intra-class correlation coefficient (ICC) were used to determine inter-rater reliability for continuous and categorical ratings, respectively. LCS ratings proved reliable in all four key domains and both time periods. The reliability was fair to excellent for ratings of duration of experience (ICC ranged from 0.53 to 0.99), quality of experience (kappa ranged from 0.46 to 0.92) and long-term time trends (kappa ranged from 0.66 to 0.94). The LCS can be used to obtain reliable ratings of the long-term course of schizophrenia in multiple domains.
Global Implementation Research and Applications
Frontiers in Health Services
Global Mental Health, 2017
The purpose of this paper is to describe the development and initial accomplishments of a trainin... more The purpose of this paper is to describe the development and initial accomplishments of a training program of young leaders in community mental health research as part of a Latin American initiative known as RedeAmericas. RedeAmericas was one of five regional ‘Hubs’ funded by the National Institute of Mental Health (NIMH) to improve community mental health care and build mental health research capacity in low- and middle-income countries. It included investigators in six Latin American cities – Santiago, Chile; Medellín, Colombia; Rio de Janeiro, Brazil; and Córdoba, Neuquén, and Buenos Aires in Argentina – working together with a team affiliated with the Global Mental Health program at Columbia University in New York City. One component of RedeAmericas was a capacity-building effort that included an Awardee program for early career researchers in the mental health field. We review the aims of this component, how it developed, and what was learned that would be useful for future cap...
Frontiers in Health Services
BackgroundIn 2005, Chile became the first country in Latin America to guarantee universal free ac... more BackgroundIn 2005, Chile became the first country in Latin America to guarantee universal free access for the diagnosis and treatment of schizophrenia. A cluster randomized control trial utilizing the Dynamic Adaptation Process framework is underway to adapt and test the OnTrack coordinated specialty care model to provide recovery-oriented, person-centered care by a multidisciplinary team for individuals with first episode psychosis (FEP) in Chile.MethodsA qualitative formative research study was conducted to inform the initial adaptation of the OnTrack Chile (OTCH) program. We conducted key informant interviews (n = 17) with various stakeholders (policymakers; directors/managers of community mental health centers; mental health professionals) and focus group discussions (n = 6) with individuals with FEP and caregivers (n = 35 focus group participants total). Data was analyzed using thematic analysis, organized by participants' perspectives on the benefits, barriers, and recomme...
Administration and Policy in Mental Health and Mental Health Services Research
Critical Time Intervention (CTI) is designed to reduce the risk of homelessness and other adverse... more Critical Time Intervention (CTI) is designed to reduce the risk of homelessness and other adverse outcomes by providing support to individuals during challenging life course transitions. While several narrative reviews suggest the benefit of CTI, the evidence on the model’s effectiveness has not been systematically reviewed. This article systematically reviews studies of CTI applied to a variety of populations and transition types. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis for protocols (PRISMA-P) guidelines, we reviewed 13 eligible experimental and quasi-experimental studies. Findings were summarized by individual outcome domains, including housing, service engagement use, hospitalization or emergency services, mental health, substance use, family and social support, and quality of life. CTI had a consistent positive impact on two primary outcomes—reduced homelessness and increased service engagement use—among different populations and contexts...
The Journal of Forensic Psychiatry & Psychology, 2019
Community Mental Health Journal, 1990
In this paper, we review problems of epidemiologic method in surveys that reported on mental illn... more In this paper, we review problems of epidemiologic method in surveys that reported on mental illness in homeless adults in the United States in the 1980s (Arce, et al., 1983; Vergare & Arce, 1986; Bassuk, et al., 1984; Bassuk, et ah, 1986; Crystal, et ah, 1986; Fischer, et ah, 1986; Koegel, et al., 1988; Kroll, et ah, 1986; Morse & Calsyn, 1986; Rossi, et al., 1987; Roth & Bean, 1986; Snow, et al., 1986; Struening, 1986; Susser, et al., 1989a). These surveys can be construed, in epidemiologic terms, as ~'case surveys" of homelessness, since most gathered data on homeless persons without selecting a second group specifically for comparison. Surveys included in our review meet two minimal criteria:
The British Journal of Psychiatry, 1995
Background We examined whether acute transient psychoses can be distinguished from schizophrenia ... more Background We examined whether acute transient psychoses can be distinguished from schizophrenia and the affective disorders. Method We studied 46 cases of nonaffective acute psychosis in the Chandigarh Acute Psychosis Study. With respect to separation from schizophrenia, we examined the distribution of duration of the episode. With respect to separation from affective disorders, we assessed the frequency of affective symptoms. Results Duration was bimodal, suggesting the presence of two distinct conditions of short and long duration. Affective symptoms were minimal, suggesting that these were not atypical affective syndromes. Conclusions Acute transient psychoses conform neither with schizophrenia of brief duration nor with atypical affective psychosis, and thus require separate classification as proposed in the ICD–10.
AIDS and Behavior, 2002
... 120 Diaz, Vlahov, Edwards, Conover, and Monterroso Table II. ... The authors would like to th... more ... 120 Diaz, Vlahov, Edwards, Conover, and Monterroso Table II. ... The authors would like to thank the outreach workers and interviewers (Yvonne Cuevas, Mercedes Kullian, Diedra Harris, and Mark Vega), whose dedication helped make this a successful project. ...
The British Journal of …, 1995
Background. We examined whether acute transient psychoses can be distinguished from schizophrenia... more Background. We examined whether acute transient psychoses can be distinguished from schizophrenia and the affective disorders. Method. We studied 46 cases of nonaffective acute psychosis in the Chandigarh Acute Psychosis Study. With respect to separation from schizophrenia,we examined the distribution of durationof the episode.With respectto separationfrom affective disorders, we assessed the frequency of affectivesymptoms. Results. Duration was bimodal, suggesting the presence of two distinct conditions of short and long duration. Affective symptoms were minimal, suggesting that these were not atypical affective syndromes. Conclusions. Acute transient psychoses conform neither with schizophrenia of brief duration nor with atypical affective psychosis, and thus require separate classification
Archives of General Psychiatry, 1989
Archives of General Psychiatry, 1998
Background: The spread of human immunodeficiency virus infection to impaired groups has intensifi... more Background: The spread of human immunodeficiency virus infection to impaired groups has intensified the challenge for its prevention; control of the epidemic now requires behavioral change among persons with limited ability to sustain attention and learn. In this randomized clinical trial, we tested an intervention to reduce sexual risk behaviors among homeless men with severe mental illness. Methods: Men were recruited from a psychiatric program in a homeless shelter. Of 116 eligible men, 97 (83.6%) participated. Most were African American and had a chronic psychotic disorder and a comorbid substance use disorder. Participantswereassignedtoa15-sessionexperimentalgroup intervention or to a 2-session control intervention and observed for 18 months. The 59 participants sexually active beforethetrialwerethemaintargetoftheintervention.Sexual risk behavior was the primary outcome. Results: Among the 59 sexually active men, follow-up data were obtained on 59 (100%) for the initial 6-month follow-up and on 56 (95%) for the remainder of the 18-month follow-up. The mean score on a sexual risk index for the experimental group was 3 times lower than for the control group (1.0 vs 3.1; P=.01) during the initial 6-month follow-up and 2 times lower during the remainder of the 18-month follow-up. Conclusions: This intervention successfully reduced sexual risk behaviors of homeless men with mental illness. The effect diminished over 18 months but did not disappear. Similar approaches may be effective in other impaired high-risk groups.
American Journal of …, 1995
The authors investigated sexual behaviors related to HIV transmission among homeless mentally ill... more The authors investigated sexual behaviors related to HIV transmission among homeless mentally ill men in a New York City shelter. A previous study of a similar population found HIV prevalence to be 19%. In standardized interviews with 122 men, data on sexual behaviors for the previous 6 months were collected. The frequency and nature of sexual episodes that may facilitate HIV transmission were examined. In addition, sexual risk behaviors among broadly defined diagnostic groups were compared. Of the 122 men, 65 (53%) had sex, 56 with women and 20 with men (11 who had sex with both women and men are counted in each group). The sexually active men, in most cases, had only occasional sex (once per month or less). The majority of sexually active men--29 (52%) of those who had sex with women and 12 (60%) of those who had sex with men--had sex without a condom and with nonmonogamous partners. Comorbid cocaine abuse or dependence was significantly associated with high-risk sexual behaviors. The majority of these men had sex occasionally or not at all. Nonetheless, because many of them had unprotected sex with nonmonogamous partners, the few sexual episodes may have carried an appreciable risk of HIV transmission. Moreover, men with a comorbid cocaine dependence may represent a group with an especially high risk for sexual HIV transmission. The authors propose that in this population, preventive interventions could modify the nature, if not the frequency, of sexual episodes.
American Journal of …, 1991
This study examined the relationship between childhood experience and homelessness in psychiatric... more This study examined the relationship between childhood experience and homelessness in psychiatric patients. Three large and diverse samples of homeless patients (N = 512) were compared with a sample of patients who had never been homeless (N = 271), with respect to childhood experience of foster care, group home placement, and running away. One of the homeless samples and the never homeless sample were drawn from patients admitted to a state mental hospital. In this state hospital population, risk ratios for lifetime prevalence of homelessness could be derived. In the three homeless samples, over 15% had a history of foster care, over 10% had a history of group home placement, and over 20% had a history of running away. These figures compared with 2%, 1%, and 5%, respectively, in the never homeless sample. In the state hospital, the lifetime prevalence of homelessness in patients with any one of these childhood experiences was about threefold that of other patients. A history of homelessness was reported by the great majority of state hospital patients who had had one of these childhood experiences. These childhood experiences were strongly associated with adult homelessness in these psychiatric patients. It might be possible to prevent homelessness in some cases by interventions aimed at patients with such childhood histories.
Archives of General …, 1989
Schizophrenia Research, 2010
Available evidence suggests that individuals with schizophrenia and other severe mental illnesses... more Available evidence suggests that individuals with schizophrenia and other severe mental illnesses are at increased risk for homelessness in contemporary societies with diverse cultures and socioeconomic conditions. Yet the prevention of homelessness among individuals with mental illness has rarely been a focus of global health programs. We propose that it should be. In any given society, the overall risk of homelessness will reflect broad societal factors such as income inequality, housing, migration, economic conditions, and family ties. We strongly advocate for addressing these societal causes of homelessness. We also believe, however, that we need to develop special programs in parallel to prevent homelessness among individuals with severe mental illness. We use historical examples to draw attention to ways in which individuals with mental illness have beenand still areexplicitly excluded from societies. We suggest that this social exclusion requires us to take special measures to protect the rights of individuals with mental illness, and to develop programs to ensure they have access to basic necessities including a home. The form these measures take will of necessity vary widely according to local conditions. We describe mental health initiatives in two middle-income countries (Brazil and Argentina) which illustrate different approaches, and allude more briefly to efforts being made in other countries including low-income countries. Finally, we consider some of the efforts that are already being made by various international groups to further this agenda within the global health movement.
Psychiatric Services, 1989
Because the problem of homelessness has generated such attention and controversy, findings from s... more Because the problem of homelessness has generated such attention and controversy, findings from studies of homeless populations are often received eagerly without appreciation of the significant biases inherent in surveys. Drawing on surveys of the homeless made in the 1980s, the authors review problems in sampling and in measurement of mental disorder. They suggest that within any one study researchers employ alternative sampling strategies and measures of mental disorder to facilitate comparison of results within and across studies.
We report on the inter-rater reliability of the Life Chart Schedule (LCS). The LCS is designed to... more We report on the inter-rater reliability of the Life Chart Schedule (LCS). The LCS is designed to assess the longterm course of schizophrenia in four key domains (symptoms, treatment, residence, and work) over two time periods (past two years, entire period of illness). The subjects were 27 consecutive admissions to a schizophrenia research unit. The LCS was filled out by pairs of raters, blinded to each others' ratings, using the same data (interview with subject and chart). Reliability was examined for 45 LCS ratings selected from all four domains and both time periods. Selected ratings pertained to the duration of specified experiences, the quality of these experiences, and the long-term time trend. The kappa statistic and the intra-class correlation coefficient (ICC) were used to determine inter-rater reliability for continuous and categorical ratings, respectively. LCS ratings proved reliable in all four key domains and both time periods. The reliability was fair to excellent for ratings of duration of experience (ICC ranged from 0.53 to 0.99), quality of experience (kappa ranged from 0.46 to 0.92) and long-term time trends (kappa ranged from 0.66 to 0.94). The LCS can be used to obtain reliable ratings of the long-term course of schizophrenia in multiple domains.