ABSTRACT
OBJECTIVES: This study tested a psychiatric rehabilitation approach for organizing and delivering services to street-dwelling persons with severe mental illness. METHODS: Street-dwelling persons with severe mental illness were randomly assigned to the experimental program (called Choices) or to standard treatment in New York City. We assessed study participants at baseline and at 6-month intervals over 24 months, using measures of service use, quality of life, health, mental health, and social psychological status. The average deviation from baseline summary statistic was employed to assess change. RESULTS: Compared with persons in standard treatment (n = 77), members of the experimental group (n = 91) were more likely to attend a day program (53% vs 27%), had less difficulty in meeting their basic needs, spent less time on the streets (55% vs 28% reduction), and spent more time in community housing (21% vs 9% increase). They showed greater improvement in life satisfaction and experienced a greater reduction in psychiatric symptoms. CONCLUSIONS: With an appropriate service model, it is possible to engage disaffiliated populations, expand their use of human services, and improve their housing conditions, quality of life, and mental health status.
Subject(s)
Community Mental Health Services/organization & administration , Ill-Housed Persons/psychology , Mental Disorders/rehabilitation , Persons with Mental Disabilities/rehabilitation , Urban Health Services/organization & administration , Adult , Aged , Community-Institutional Relations , Female , Health Services Research , Humans , Interview, Psychological , Male , Mental Disorders/psychology , Mental Health , Middle Aged , Models, Organizational , Needs Assessment , New York City , Outcome Assessment, Health Care , Personal Satisfaction , Program Evaluation , Public Housing , Quality of LifeABSTRACT
The organization, financing, and delivery of publicly funded behavioral health services are undergoing massive changes nationwide. Managed care principles and practices are being implemented widely and are being relied on increasingly to meet the challenges of containing costs and improving service effectiveness. To meet these goals, comprehensive systems are under development for measuring and reporting outcomes experienced by individuals who received services and for assessing the impact of managed care strategies on the service delivery system. This article presents an example from the Prepaid Mental Health Program in New York State. It highlights the development, implementation, and early experiences with the plan's performance management system for public sector managed behavioral health, a basis for continuous quality improvement activities and information reporting products such as report cards. Policy, administrative, and financial implications are illuminated.
Subject(s)
Managed Care Programs/organization & administration , Mental Health Services/organization & administration , Prepaid Health Plans/organization & administration , Public Health Administration/standards , Total Quality Management/organization & administration , Humans , Information Services , Managed Care Programs/standards , Mental Health Services/standards , New York , Prepaid Health Plans/standards , Program Development , Program Evaluation , Quality Indicators, Health CareABSTRACT
In the early 1990s the National Institute of Mental Health sponsored projects in four cities that served a total of 896 homeless mentally ill adults. Each project tested the effectiveness of different housing, support, and rehabilitative services in reducing homelessness. Most homeless individuals resided in community housing after the intervention. The proportion in community housing varied between sites. A 47.5 percent increase in community housing was found for those in active treatment conditions. At final follow-up, 78 percent of participants in community housing were stably housed. The findings indicate that effective strategies are available for serving homeless individuals with severe mental illness.
Subject(s)
Ill-Housed Persons/legislation & jurisprudence , Mental Disorders/rehabilitation , Public Housing , Urban Population , Adult , Case Management/legislation & jurisprudence , Female , Follow-Up Studies , Ill-Housed Persons/psychology , Humans , Male , National Institute of Mental Health (U.S.) , Outcome and Process Assessment, Health Care , Patient Care Team/legislation & jurisprudence , United StatesABSTRACT
OBJECTIVE: The study examined whether employing mental health consumers as peer specialists in an intensive case management program can enhance outcomes for clients with serious mental illness. METHODS: A quasiexperimental, longitudinal, nonequivalent control group design was used to compare outcomes of clients assigned to three case management conditions: teams of case managers plus peer specialists, teams of case managers plus nonconsumer assistants, and case managers only. Outcomes were measured at baseline and at three six-month intervals. Repeated-measures analysis of variance was used to assess between-group differences. RESULTS: Complete data were available for 104 clients. Compared with clients in the other two groups, clients served by teams with peer specialists demonstrated greater gains in several areas of quality of life and overall reduction in the number of major life problems experienced. They also reported more frequent contact with their case managers and the largest gains of all three groups in the areas of self-image and outlook and social support. No differences in outcomes were found between clients served by teams with nonconsumer assistants and those served by case managers only. CONCLUSIONS: Integration of peer specialists into intensive case management programs appears to lead to enhanced quality of life for clients and more effective case management.