Background:Accurately counting Americans with mental health conditions is essential to support program development and appropriate resource allocations, which are often based on prevalence data. Multiple federal surveys use the Washington Group Short Set (WG-SS) questions to identify people with disabilities, including those with mental health conditions. However, the WG-SS questions miss many people with mental illnesses, under-representing this population in US federal survey data. Hence, we sought to explore the degree to which people with serious mental illness are missed. Methods:We used data from the 2020 National Survey on Health and Disability to assess the rates that respondents with self-reported serious mental illness (SMI) conditions, i.e., major depression, bipolar disorder, schizophrenia, and schizoaffective disorder (n=263), were missed as disabled by the WG-SS questions. Results:Using the three WG-SS questions suggested by the Washington Group to capture people with mental illnesses, 66.2%, 88.6%, and 96.6% of respondents with SMI were characterized as non-disabled; 58.2% were characterized as non-disabled across the three questions combined. Discussion:Previous research demonstrated that the WG-SS questions missed almost 60% of respondents with any mental illness. However, the Washington Group states that its question set better captures people with more severe disabilities, so this study focused only on respondents with serious mental illnesses and only on questions that the Washington Group suggests capture people with psychosocial disabilities. Conclusion:Results indicate that the WG-SS questions miss large percentages of even those with the most severe mental illnesses, who therefore may be substantially undercounted in US federal surveys using these questions. In turn, public mental health programs may be substantially underfunded.

Loneliness is recognized as a significant public health concern, affecting quality of life and health outcomes, including cancer-related outcomes. Thus, it is essential to understand the prevalence and risk factors for loneliness in people with cancer. Through an exploratory analysis of secondary data from the Health Information National Trends Survey, we investigated the prevalence and correlates of loneliness among adult cancer survivors (N = 1,234). An estimated 35.9% of participants experienced moderate to severe loneliness. In a series of multiple logistic regression models, we identified differences in sociodemographic, cancer-related factors, non-cancer comorbidities, social isolation, social support, and social media use behaviors in the odds of reporting moderate-severe loneliness. In our fully adjusted model, years since cancer diagnosis, fair-poor overall health, moderate-high psychological distress, and having children living in the household were all positively and independently associated with moderate-severe loneliness. In this same model, being married and reporting some types of social support were negatively associated with moderate-severe loneliness. This study underscores the multifaceted nature of loneliness among cancer survivors, revealing a complex interplay of demographic, health-related, and social factors.

Objective: Promoting leisure participation requires a collaborative approach that emphasizes personal interests, strengths, and motivations. The purpose of this article was to test the effectiveness of the Independence through Community Access and Navigation (ICAN) intervention on community participation, recreation participation, and positive emotions among individuals with schizophrenia spectrum disorders. Using motivational interviewing and an individualized placements and support framework, the ICAN intervention focuses on working with participants to identify and participate in personally meaningful leisure activities by connecting with personal motivations and mainstream community opportunities. Method: This randomized controlled trial was conducted with 74 participants diagnosed with schizophrenia with assessments conducted at baseline and posttreatment. Intervention effects were examined with repeated-measures analysis of variance (ANOVA). Multiple regression analysis was also performed using a change score as an outcome variable and baseline negative symptoms score, condition, and interaction as predictors. Results: There was no significant main effect of ICAN on positive emotions, recreation participation, or community participation; however, among those in the experimental group, those with impairments in motivation and pleasure experienced improvements in community participation. Conclusions and Implications for Practice: For individuals experiencing greater negative symptoms, a supported leisure intervention may be an effective strategy to explore personal motivations and increase leisure participation. Future research should test the intervention effectiveness specifically targeting a larger sample of individuals with more severe negative symptoms.

The profession of recreational therapy first established professional membership organizations in the 1940s and 1950s. The most recent national professional membership organization was developed in 1984, when the American Therapeutic Recreation Association (ATRA) was formed. The National Academy of Recreational Therapists (NART) was established in 2011 as an honor society to recognize the most accomplished practitioners and educators in recreational therapy and to provide a clearinghouse for the exchange of ideas that would ultimately lead to the advancement of the recreational therapy profession. Efforts to establish NART began in 2009 when David Austin and Ray West drafted a conceptualization of the academy and its operations, as well as proposed a set of by-laws. A steering committee was subsequently established to review and approve by-laws for NART and to establish the Founding Fellows of NART. The central purpose of the Academy was the advancement of recreational therapy by recognition, education, research, scholarly activity, advocacy, and the provision of advice to decision makers. Since its inception NART has established and funded a Future Scholars Fund to support outstanding graduate students considering pursuing a terminal degree, as well as the Marcia Carter Scholarly Manuscript Award for the best annual publication in the Therapeutic Recreation Journal. Over its first 10 years, NART made revisions to its bylaws to refine criteria and categories for Fellows, and by 2021 there were 77 elected Fellows. The invited paper summarizes the first 10 years and considers a number of original goals that remain to be realized to support and advance this honor society.

Distance education (DE) today is a growing phenomenon in American colleges and universities, almost exclusively in the form of online courses. With the rapid development of DE, it has become a burgeoning force within college and university therapeutic recreation/recreational therapy (TR/RT) programs, at a time that there has been a decline in TR/RT professional preparation programs. DE is certainly a timely and important topic for the TR/RT profession. Yet, the development of DE in TR/RT has been largely neglected in the literature of TR/RT. Within this article, the evolution of DE in TR/RT is traced, and ramifications resulting from the developments of DE in TR/RT are considered.

Recreational therapists typically read about moral treatment in their introductory textbooks, which indicate that recreational therapy (RT) has its roots in moral treatment. Recreational therapists, however, are typically not provided the opportunity to gain an understanding of how moral treatment developed and the basics that underlie its practice. Nor are they aware that many principles taken from moral treatment are being applied within the practices of those in the recreational therapist profession today. This article describes the beginnings of moral treatment, how it influenced psychiatric care in the United States, its demise, and, most importantly, what it has brought to the practice of contemporary RT.

Various characteristics and circumstances lead older adults in the community to transition into long-term care homes (LTCHs). Family caregivers often provide support, resources, and encouragement to older adults during the transition into a LTCH. Therefore, this study aimed to explore family caregiver perceptions of older adults' sub-acute rehabilitation experiences that may associate with older adults' transitions into LTCHs. A descriptive survey resulted in understanding circumstances that led to older adults' transitions into the LTCH, and older adults with sub-acute rehabilitation experiences were positively associated with being more independently able to integrate into the LTCH. Future research directions and practical implications for healthcare professionals are further discussed.

Research suggests that leisure is as an effective coping strategy for depression. The foundational theory of lei-sure coping assumes that leisure coping can be benefi-cial in three ways: mood enhancement, diversion, and companionship. While theorists asserted that the above three strategies are universal, research suggests that the personality trait of extraversion is associated with leisure behavior and may affect the effectiveness of leisure cop-ing strategies. The current study aimed to examine the role of extraversion in the relationship between leisure coping and depressive symptoms. A total of 155 adults with depression (59 males and 96 females) were recruit-ed from four different depression-related venues and responded to an online survey. The results of multiple regression analyses found that extraversion did not affect the relationship of leisure palliative coping and mood en-hancement; however, it significantly moderated the rela-tionship between leisure companionship and depressive symptoms. While a significant negative association be-tween leisure companionship and depressive symptoms was found among extroverts, no significant relationship was observed among introverts. The results suggest that the personality trait of extraversion matters to leisure coping and should be considered to better facilitate rec-reational therapy interventions.

This study documents the perceptions of recreational therapy students who took part in an international faculty-led study abroad experience for 3 weeks in Serbia, Romania, and Croatia. Students volunteered in institutions, schools, and a camp for individuals with disabilities as well as taking part in cultural experiences. Participant video journals were recorded pre-trip, during the trip, and shortly after returning from studying abroad to garner student perspectives. Using a general qualitative approach, responses were transcribed verbatim, coded, and then arranged in over-arching themes. Pre-trip themes focused on looking forward to the experience coupled with anxiety. During the trip perceptions included, a positive impact from working in programs with clients who have disabilities as well as developing relationships with peers in the program cohort. Upon return and reflection, students expressed a perceived overall growth professionally and personally from the trip, a positive experience, life-long relationships that were firmly established, a gratefulness for the experience, and finally, helpful suggestions for future improvements.

There is a high prevalence of loneliness among adults with serious mental illness (SMI) with most research focusing on stable contributing factors. This study sought to identify the role of dispositional loneliness and internalized stigma, as well as the momentary feelings of acceptance on experiential loneliness among adults with SMI. Data were collected using ecological momentary assessment via smart phones, and 89 adults with a SMI were included. Hierarchical linear modeling was used to identify the role of dispositional and experience factors in experiential loneliness. Findings indicated that (a) dispositional internalized stigma, (b) being at home, (c) being alone and, (d) a cross-level interaction between dispositional loneliness and feelings of acceptance best fit the data. The relationship of acceptance to experiential loneliness was strongest among the most lonely. Supporting people with SMI to develop social connections contributing to their relational value may enhance feelings of acceptance and reduce loneliness.

Objective: Engagement in arts and cultural activities is valued and yields positive outcomes but may be understudied in populations with serious mental illness (SMI). Our aims are to evaluate the extent to which individuals with SMI deem participation areas related to arts and culture (e.g., going to a theater) to be important, and if important, how often they are being done and if it is enough in comparison to a nonSMI sample. Methods: We conducted analyses using a sample of 1,120 individuals with SMI from nine research studies between 2008 and 2016 and a sample of 300 individuals without SMI that were part of the Truven Health Analytics PULSE survey. All participants completed a survey containing questions related community participation. Analyses were conducted using independent samples t tests, followed by analysis of variances, and chi-square tests. Results: The results indicate that adults with SMI are as, or more interested in arts and cultural activities as adults in the general population, but do not participate in those areas as much as they would like in comparison. We also found that, as with the general population, participation in these areas is positively associated with quality of life and to a lesser degree, recovery. Conclusions and Implications for Practice: Engagement in arts and culture activities may be an overlooked compared to other areas of participation, such as employment. Psychiatric rehabilitation practitioners may need to pay greater attention to areas related to art appreciation, rather than just art production.

Objective: Severe loneliness infrequently occurs in the general population but has very significant impacts on health and quality of life. This study examined the extent to which severe loneliness is experienced by adults with serious mental illnesses (SMIs) relative to adults in the general population and its possible implications for psychiatric rehabilitation services. Method: Data were gathered from samples of individuals with SMI (N = 231) and a general community sample of adults (N = 300) using the University of California, Los Angeles Loneliness Scale. Results: The results indicate that loneliness was much greater among those with SMI than the general adult population sample (Cohen's d = 1.220) and approximately 41% of the participants with SMI were "severely lonely" versus 7.3% of the non-SMI adult sample. Conclusions and Implications for Practice: Severe loneliness is extremely common among individuals with SMI. Psychiatric rehabilitation services that focus on socialization and mattering are needed to address this significant public health issue. Impact and Implications The present study found that disproportionately many people with serious mental illnesses reported severe levels of loneliness. Loneliness should be considered as an intervention target in psychiatric rehabilitation services. To accomplish that, funders and policy makers should prioritize addressing loneliness as a critical outcome of mental health services.

BACKGROUND:People with serious mental illnesses (SMI) have higher levels of loneliness than the general population. Furthermore, people with SMI tend to be less satisfied with their housing and tend to move more frequently.AIM:This study aims to examine relationships between housing variables (whom they live with, duration of residence, and satisfaction) and loneliness among individuals with SMI.METHODS:Data were collected from 188 adults with SMI in greater Philadelphia area. Classification and Regression Trees (CART) were used to examine whether whom they live with, duration of residence, and housing satisfaction were associated with loneliness.RESULTS:Housing satisfaction was found to be the most prominent predictor of loneliness. Those who were unsatisfied with their overall housing conditions always had the highest level of loneliness, regardless of other factors. Even if they were satisfied with their housing conditions, their loneliness was higher if they had just moved to the new residence. Participants had lower loneliness the longer they lived in a residence and had the lowest loneliness levels after about three years.CONCLUSION:Housing is associated with loneliness among people with SMI. Psychiatric service providers should increase support to factors contributing to housing satisfaction and duration of residence, including active engagement in the community.

Mental health services and interventions have increasingly focused on the importance of community participation and mobility for people with serious mental illnesses (SMI). This study examined the role that visits to community mental health centers (CMHCs) may play in increasing community mobility of people with SMI. Eighty-nine adults with SMI receiving services at three CMHCS were tracked with GPS-enabled phones over a 13-day period. Findings revealed that participants visited more destinations on days they went to a CMHC compared to days they did not. They also spent more time out of the home and traveled greater distances. Results suggest that the benefits of visiting a mental health center appear to go beyond treatment outcomes, but also point to the possibility that obligations, whether to a clinic appointment or possibly vocational, educational, leisure, faith, or social commitments, may be an important stepping stone to more mobility and intentional, sustained community participation.

[Correction Notice: An Erratum for this article was reported online in Psychiatric Rehabilitation Journal on May 20 2021 (see record 2021-48272-001). In the original article, the following acknowledgments were missing from the author note: : "The contents of this article were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; Grant 901F0065-02-00; Mark S. Salzer, principal investigator). However, the contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and endorsement by the federal government should not be assumed. The authors are grateful to Kevin Frech, Stephany Wilson, Alison Weigl, Jared Pryor, David Glogoza and Katie Pizziketti for their assistance with data collection and analysis and to Alex Fechner for providing his implementation of the ST-DBSCAN algorithm in RapidMiner." All versions of the original article have been corrected.] Objective: The purpose of this study was to determine if environmental novelty was associated with neurocognitive function among adults with serious mental illness. Method: Participants were recruited from community mental health centers (n = 117), and received a Global Positioning System (GPS) enabled cellular phone for 13 days. Data were also collected on cognitive function and recent participation in community-based activities. Independent samples t-tests were conducted to identify differences in neurocognitive function between participants who predominantly stayed in their homes ("homebodies") versus those who ventured more often from their homes ("venturers"). Analyses were also undertaken to identify if the nature of community participation activities mediated the relationship of neurocognitive function to group membership. Results: Overall, 74% of GPS signals were from participants' home residence. Homebodies demonstrated significantly poorer cognitive function than venturers, and this relationship was not mediated by a number of unique destinations or breadth of community participation activities. Conclusions and Implications for Practice: This study identified a subset of adults with serious mental illnesses who left their homes infrequently and who demonstrate significantly poorer cognitive function than those who left their homes more frequently. Spending extensive amounts of time in an unchanging environment may be a contributing factor to poor cognitive function, and a potential area for intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Equine-assisted therapy (EAT) is an increasingly popular intervention for people with various disabilities and diagnoses. However, a lack of evidence-based protocols has hampered efforts to provide standardization of treatment. The Galloping Towards Success (GTS) protocol was designed specifically for clients with moderate to severe autism spectrum disorder (ASD) and is described in this paper. The 15-week manualized EAT protocol was previously tested across multiple sites in Serbia and the U.S. (Dawson et al., 2022) demonstrating the protocol’s preliminary effectiveness in increasing social skills in 9 out of 10 individuals with moderate to severe ASD. This manuscript aims to provide professionals with information regarding the GTS 15-week protocol, including an introductory overview, description of participants, assessment, planning weekly intervention activities, evaluation procedures, documentation, limitations, and author comments. This protocol will help create consistency in facilitation among Certified Therapeutic Recreation Specialists (CTRS ) who use equine-assisted therapy to treat adolescents and young adults with moderate to severe ASD while equipping researchers with the means to conduct future evidence-based research in the area of equine-assisted therapies.

The field of recreational therapy has well-established methods of scientific collaboration within the United States yet historically there is a scarcity of International Research Collaborations (IRC). IRC could provide many benefits to the field as well as encourage the pollination of new ideas and philosophies to other continents and cultures. The purpose of this paper is to present an IRC framework and to describe the steps that would bring successful IRC to the field of recreational therapy.

Adolescent and young adults with a diagnosed autism spectrum disorder (ASD) in the severe to moderate functioning range were recruited for this study in Serbia and the United States (U.S.). A total of ten participants, five from each respective country, participated in a 15- week equine-assisted therapy (EAT) intervention that utilized ground-based learning through a manualized program approach. The purpose of the study was to test the effects of a manualized 15-week EAT intervention on the social functioning of individuals with severe to moderate ASD across two cultures using a single subject research design. Nine out of 10 participants displayed improved social functioning over the course of the 15- week EAT intervention in both cultures.

Residential medical specialty camps provide short-term psychosocial benefits to youth with health conditions during summer camp, yet extinguishing effects are commonly seen in followup data as campers return to home and school settings (Dawson, 2017; Knapp et al., 2015; Moola et al., 2014; Plante et al., 2001). Innovative year-round support approaches are needed to enhance existing residential medical camps to improve long-term psychosocial outcomes associated with the months following the summer experience (Dawson, 2017; Dawson et al., 2018). This study is a qualitative analysis of an online mentoring support program designed as a follow-up approach in the months after residential summer camp experience has ended. The mentoring support program matched adolescent campers with a physical disability to an adult mentor having a similar disability and was structured through an online support curriculum facilitated by a recreational therapist. Qualitative analysis yielded two major themes from mentors and mentees (a) mentor as a disability life coach providing psychosocial support and expanding life expectations, and (b) barriers and facilitators to the mentee-mentor relationship. Discussion centers on insights for further developing this mentoring support program as an adjunct to traditional medical specialty camps.

The COVID-19 pandemic provided a unique opportunity to develop and test distance-based interventions. Based upon the Competence Enhancement Model, ConnectionsRx is a distance-based intervention designed to support emerging adults with serious mental illnesses to identify and increase participation in the community. Using a case study approach, the purpose of this study was to explore the feasibility, acceptability, and preliminary outcomes of ConnectionsRx. The case study details the APIE process, highlighting the individualized, client-driven nature of the intervention. Preliminary outcomes suggest the intervention has the potential to improve well-being through increased social and community participation. This study lays the groundwork for future research, which should explore the effectiveness of the intervention using more robust research methods.