Papers by Kristin Serowik
Pain practice : the official journal of World Institute of Pain, 2021
OBJECTIVES Musculoskeletal disorders often lead to chronic pain in Veterans. Chronic pain puts su... more OBJECTIVES Musculoskeletal disorders often lead to chronic pain in Veterans. Chronic pain puts sufferers at risk for substance misuse, and early intervention is needed for both conditions. This pilot study tested the feasibility and acceptability of a Screening, Brief Intervention, and Referral to Treatment for Pain Management intervention (SBIRT-PM) to help engage Veterans seeking disability compensation for painful musculoskeletal disorders in multimodal pain treatment and to reduce risky substance use, when indicated. METHODS This pilot study enrolled 40 Veterans from 8 medical centers across New England in up to 4 sessions of telephone-based counseling using a motivational interviewing framework. Counseling provided education about, and facilitated engagement in, multimodal pain treatments. Study eligibility required Veterans be engaged in no more than 2 VA pain treatment modalities, and study participation involved a 12-week post-assessment and semi-structured interview about t...
The prevalence of substance use disorders is higher among medical inpatients than in the general ... more The prevalence of substance use disorders is higher among medical inpatients than in the general population, placing inpatient providers in a prime position to detect these patients and intervene. To assess provider detection rates of substance use disorders among medical inpatients and to identify patient characteristics associated with detection. Data drawn from a cluster randomized controlled trial that tested the effectiveness of three distinct implementation strategies for providers to screen patients for substance use disorders and deliver a brief intervention (Clinical Trials.gov: NCT01825057). A total of 1076 patients receiving care from 13 general medical inpatient units in a large teaching hospital participated in this study. Data sources included patient self-reported questionnaires, a diagnostic interview for substance use disorders, and patient medical records. Provider detection was determined by diagnoses documented in medical records. Provider detection rates were hi...
Journal of Health Psychology
A randomized controlled trial compared cognitive behavioral therapy (CBT) and diabetes education ... more A randomized controlled trial compared cognitive behavioral therapy (CBT) and diabetes education (ED) as an adjunctive treatment for diabetic peripheral neuropathic pain (DPNP). We examined change from baseline to 12- and 36-week follow-up in overall pain intensity (NRS), neuropathic pain intensity/quality, pain interference, and mental health functioning, among others. Although CBT participants demonstrated improvement in pain intensity NRS, there were no between-condition differences at either follow-up. CBT reduced neuropathic pain intensity at 12-weeks more than ED. At 36-weeks, CBT was superior to ED for improving pain interference and mental health functioning. Results provide evidence of benefit of CBT for DPNP. ClinicalTrials.gov Identifier: NCT00830011
The American Journal on Addictions
Cognitive Behaviour Therapy
Pain Medicine
Objective. Cognitive behavioral therapy for chronic pain (CBT-CP) has been identified as an evide... more Objective. Cognitive behavioral therapy for chronic pain (CBT-CP) has been identified as an evidence-based adjunct or alternative to opioid pain care. However, little is known about which patients participate in CBT-CP. This study examined predictors of enrollment in a noninferiority trial of in-person vs technology-based CBT-CP for patients with chronic back pain. Setting. A single Veterans Health Affairs (VHA) medical center. Subjects. Veterans with chronic back pain. Design and Methods. For eligible participants (N ¼ 290), individual factors (demographics, distance from a VHA medical center, pain intensity, receipt of opioid prescription, and recruitment method) collected at trial screening were examined to identify predictors of enrollment (i.e., signed consent form). Of those who enrolled, duration of participation in the treatment portion of the study was examined. Results. Among eligible patients, 54% declined enrollment due to lack of interest. Regression analyses revealed that patients not in receipt of an opioid were more likely to enroll. The probability of being in the trial long enough to receive a "dose" of treatment (3 visits or more) was 0.76 (0.04). Conclusions. Overall, enrollment rates were low. However, most patients who enrolled in the study (102 of 134 signed consent) were retained and received a treatment dose. Patients not receiving opioids were more likely to enroll, suggesting that patients who are prescribed opioids, an important group for treatment outreach, are likely underengaged. Identifying predictors of enrollment in CBT-CP may help increase recruitment efficiency and assist in targeting patients who may benefit but are not currently interested in treatment.
American Journal of Psychiatric Rehabilitation
A large proportion of people diagnosed with mental illness have difficulty managing their money, ... more A large proportion of people diagnosed with mental illness have difficulty managing their money, and therefore many psychiatric treatments involve providing money management assistance. However, little is known about the subjective experience of having a money manager, and extant literature is restricted to people forced to work with a representative payee or conservator. In this qualitative study, fifteen people were interviewed about their experience receiving a voluntary money management intervention designed to minimize substance use. Clients emphasized the importance of trusting the money manager, financial mindfulness (an enhanced awareness of the financial transactions in clients' day-to-day lives), agency over their own affairs, and addiction. In contrast to evaluations of people assigned representative payees and/or conservators, there was little mention of feeling coerced. These findings suggest that money management programs can address client concerns by building tru...
Computers in Human Behavior, 2014
Understanding Veterans' narrated experience as they navigate a web-based intervention is importan... more Understanding Veterans' narrated experience as they navigate a web-based intervention is important because it can inform the content, layout and format of these therapies. Using the ''Think Aloud'' method, twenty-five Veterans of military service expressed thoughts and reactions while navigating through a web-based Motivational Interviewing intervention. The intervention encouraged Veterans applying for Compensation for military-related psychiatric conditions to engage in work related activities. They then completed quantitative ratings of the site. Overall, the site was rated highly, and ratings were in the neutral range as to whether internet delivery of the material was preferable to in-person counseling. Comments revealed the complexity of adapting Motivational Interviewing for a web-based intervention. The intervention provided reflections and non-judgmental statements to Veterans accustomed to more directive statements, and receiving reflections from a computer-therapist evoked mixed responses. Veterans answered questions with intuitive formats quickly, and usually did not read directions concerning how to answer questions. Veterans felt frustrated by the lack of support throughout the Compensation process. They advocated for further development of this web-based intervention as a support for people awaiting their claim determination.
Psychiatric Services, 2014
This study&am... more This study's objective was to determine the efficacy of benefits counseling in a clinical trial. There has been concern that disability payments for psychiatric disorders reduce incentives for employment and rehabilitation. Benefits counseling, with education about opportunities to work and the financial implications of work on receipt of disability benefits, may counter these disincentives. This single-blind, six-month randomized clinical trial enrolled 84 veterans who had applied for service-connected compensation for a psychiatric condition. Veterans were randomly assigned to either four sessions of benefits counseling or of a control condition involving orientation to the U.S Department of Veterans Affairs health care system and services. Days of paid work and work-related activities were assessed at follow-up visits by using a timeline follow-back calendar. Veterans assigned to benefits counseling worked for pay for significantly more days than did veterans in the control group (effect size=.69, p<.05), reflecting an average of three more days of paid employment during the 28 days preceding the six-month follow-up. Benefits counseling was associated with increased use of mental health services, but this correlation did not mediate the effect of benefits counseling on working. Barriers to employment associated with disability payments are remediable with basic counseling. More research is needed to understand the active ingredient of this counseling and to strengthen the intervention.
Psychiatric Quarterly, 2013
Integrating information technology into healthcare has the potential to bring treatment to hard-t... more Integrating information technology into healthcare has the potential to bring treatment to hard-to-reach people. Individuals with serious mental illness (SMI), however, may derive limited benefit from these advances in care because of lack of computer ownership and experience. To date, conclusions about the computer skills and attitudes of adults with SMI have been based primarily on self-report. In the current study, 28 psychiatric outpatients with co-occurring cocaine use were interviewed about their computer use and opinions, and 25 were then directly observed using task analysis and think aloud methods as they navigated a multi-component health informational website. Participants reported low rates of computer ownership and use, and negative attitudes towards computers. Self-reported computer skills were higher than demonstrated in the task analysis. However, some participants spontaneously expressed more positive attitudes and greater computer self-efficacy after navigating the website. Implications for increasing access to computer-based health information are discussed.
Mental Health and Substance Use, 2013
It is approximated that 14% of prison inmates have severe mental illness (SMI; Fazel, S., &am... more It is approximated that 14% of prison inmates have severe mental illness (SMI; Fazel, S., & Danesh, J. (2002). Serious mental disorder in 23000 prisoners: A systematic review of 62 surveys. The Lancet, 359, 545–550) and 78% of mentally ill state prison inmates recidivate during their lifetime (James, D.J., & Glaze, L.E. (2006). Mental health problems of prison and jail
The Journal of Nervous and Mental Disease, 2013
The need for accurate and reliable information about income and resources available to individual... more The need for accurate and reliable information about income and resources available to individuals with psychiatric disabilities is critical for the assessment of need and evaluation of programs designed to alleviate financial hardship or affect finance allocation. Measurement of finances is ubiquitous in studies of economics, poverty, and social services. However, evidence has demonstrated that these measures often contain error. We compare the 1-week test-retest reliability of income and finance data from 24 adult psychiatric outpatients using assessment-as-usual (AAU) and a new instrument, the Timeline Historical Review of Income and Financial Transactions (THRIFT). Reliability estimates obtained with the THRIFT for Income (0.77), Expenses (0.91), and Debt (0.99) domains were significantly better than those obtained with AAU. Reliability estimates for Balance did not differ. THRIFT reduced measurement error and provided more reliable information than AAU for assessment of personal finances in psychiatric patients receiving Social Security benefits. The instrument also may be useful with other low-income groups.
The American Journal of Drug and Alcohol Abuse, 2009
Background/Objectives-It is unknown whether impulsivity is associated with risky sexual behavior ... more Background/Objectives-It is unknown whether impulsivity is associated with risky sexual behavior in dually diagnosed clients. Methods-Impulsivity in 51 sexually-active, dually diagnosed clients was assessed by the Barrett Impulsivity Scale, Delayed Discounting Questionnaire, and Wisconsin Card-Sorting Task, and a path analysis of relationship to self-reported risk behaviors was conducted. Results-Recent cocaine use was correlated with risky sexual behaviors and a preference for immediate over larger, delayed rewards trended towards a correlation. Conclusion and Scientific Significance-The association between impulsivity and risky sexual behavior among substance users appears to extend to the dually diagnosed. Implications for HIV prevention are discussed.
Community Mental Health Journal, Jun 14, 2013
How clients come to be assigned representative payees and/or conservators to manage their funds i... more How clients come to be assigned representative payees and/or conservators to manage their funds is not well understood. We compared clients assigned a payee during a clinical trial of a money management-based intervention to those not assigned payees and examined antecedents to payee assignment. One year after randomization, significantly more clients assigned to the advisor teller money manager (ATM) money management intervention were assigned payees than participants in the control condition (10 of 47 vs. 2 of 43; p = .02); those assigned payees had lower baseline GAF scores and participated more in study therapies. Several ATM clients were assigned payees after third parties paid more attention to clients' finances, and others after having negotiated storage of their funds with the ATM money manager during the study. Assignment of payees appears to be influenced by whether third parties critically attend to how clients' manage funds and by clients' receptiveness to having a payee.
American Journal of Psychiatric Rehabilitation
A large proportion of people diagnosed with mental illness have difficulty managing their money, ... more A large proportion of people diagnosed with mental illness have difficulty managing their money, and therefore many psychiatric treatments involve providing money management assistance. However, little is known about the subjective experience of having a money manager, and extant literature is restricted to people forced to work with a representative payee or conservator. In this qualitative study, fifteen people were interviewed about their experience receiving a voluntary money management intervention designed to minimize substance use. Clients emphasized the importance of trusting the money manager, financial mindfulness (an enhanced awareness of the financial transactions in clients' day-to-day lives), agency over their own affairs, and addiction. In contrast to evaluations of people assigned representative payees and/or conservators, there was little mention of feeling coerced. These findings suggest that money management programs can address client concerns by building tru...
Journal of mental health (Abingdon, England), 2014
Supported employment is an effective intervention for people with serious mental illnesses (SMI) ... more Supported employment is an effective intervention for people with serious mental illnesses (SMI) but is underutilized. Clients' desire to work might be heightened by programs that provide counseling about managing one's funds, since money management helps people become more aware of the advantages of having money. To analyze the thoughts of recently homeless or hospitalized persons with SMI concerning their personal finances and employment. We interviewed 49 people with SMI about their finances, reviewed transcripts and analyzed their baseline characteristics. Twenty of the 49 participants spontaneously expressed a desire to work in order to earn more money. Those who expressed a desire to work managed their money significantly better than those who did not. Discussion of finances, such as that fostered by money management programs, may promote engagement in vocational rehabilitation and working for pay.
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Papers by Kristin Serowik