<h4></h4> <p>Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.</p> <h4></h4> <p>Dr. Chiverton is Dean and Professor, and Vice President, Strong Health-Nursing, Dr. Lindley is Associate Professor of Clinical Nursing and Director of Research and Development for the Center of Nursing Entrepreneurship, Ms. Tortoretti is Assistant Professor of Clinical Nursing and CEO of the Center of Nursing Entrepreneurship, and Dr. Plum is Adjunct Associate Professor of Clinical Nursing, School of Nursing, University of Rochester, Rochester, New York. Dr. Plum is also Director, Office of Mental Health, Monroe County Department of Human Services, Rochester, New York.</p> <p>The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support. </p> <p>The authors acknowledge Eva Bellis, BSN, RN, CCM, and Marlene Downs, BSN, RN, CCM, for their many contributions to the success of this program.</p> <p>Address correspondence to Patricia Chiverton, EdD, RN, FNAP, Dean and Professor, School of Nursing, University of Rochester, 601 Elmwood Avenue, Box SON, Rochester, NY 14642; e-mail: <a href="mailto:Patricia_Chiverton@URMC.Rochester.edu">Patricia_Chiverton@URMC.Rochester.edu</a>.</p>

One promising approach to meeting the needs of families of the mentally ill is through the use of support groups. The organization, format, and evaluation of a support group for families of the chronically mentally ill is described. The program was designed to provide support and guidance, increase understanding of mental illness and its impact on the family, and encourage family members to become more active in the treatment process. Preliminary findings suggest that families gained a more realistic understanding of mental illness and recognized the important role they play in providing support to the patient. At follow-up, participants' social networks had grown and many were more active and involved in the treatment process.

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How do youth from various community groups designated as having a serious emotional disturbance (SED) recover over time? We conducted an evaluation of a Substance Abuse and Mental Health Services Administration System of Care grant initiative for Monroe County, New York, to answer this and other questions. We looked at outcome differences over time using the Behavioral and Emotional Ratings Scale’s (2nd ed.) overall strength scores among youth living in four geographical places at the start of services: high-income urban, low-income urban, suburban, and rural. Minorities (be they nonwhite or white) within each group, except suburban, had the higher probability of being designated as having SED. We found recovery disparities among white urban youth and their nonurban counterparts, and among nonwhite suburban and high-income urban youth and their low-income urban and rural counterparts. Applied implications include the following: (a) Continue the restructuring of mental health and juvenile justice agencies to become more culturally competent, (b) create a social marketing campaign to address the stigma surrounding mental illness, (c) build coalitions to publicize risk factors to mental health and their prevention, (d) restructure schools away from the prevailing eurocentric model of education, and (e) create a labor hour exchange for the repair and upgrade of housing and other infrastructure.

To what extent might race and where one lives at service start in Monroe County, New York, influence three dimensions of caregiver strain among those caring for a youth designated as having serious emotional disturbance? We used the Caregiver Strain Questionnaire to measure our outcomes: subjective internalizing strain—negative feelings of guilt and worry associated with having a child with behavioral and emotional problems; subjective externalizing strain—negative feelings about the child such as anger or embarrassment; and objective strain—interruption of personal time, lost work time, and/or financial strain in four geographical areas (place of residence) defined by ZIP code. These places included Low Income Urban (median ZIP code household income less than $39,000), High Income Urban (median ZIP code household income greater than or equal to $39,000), Suburban, and Rural. We found that place at service start and time predicted caregiver strain levels (though time was the only predictor for externalizing strain), controlling for several factors. Race had no detectable influence. Supports can be individualized to a greater extent to address specific factors influencing the type of strain experienced by a caregiver. Providers might begin by identifying caregiver strain by type and intensity as well as identifying the specific circumstances leading to feelings and concerns associated with each type of caregiver strain.