Community support services and functioning of the seriously mentally ill.

A cohort of 729 chronically mentally ill patients receiving community support services (CSS) were followed over a nine-month period. Receiving needed community support services was shown to predict change in client functioning as measured by the Global Assessment Scale (GAS) even after the initial values on the GAS, as well as demographic, psychiatric, residential and medication maintenance variables were considered. Adequacy of social support from family, friends and others also contributed to predicting change in global functioning of the CSS patients.

Social support and quality of life of community support clients.

Two aspects of social support, availability and adequacy, were assessed for 729 severely mentally ill adults enrolled in seven state-supported Community Support Services (CSS) programs as part of repeated questionnaire surveys nine months apart. Perceived quality of life interviews with the clients were also conducted at both times. These interviews included the Bradburn Positive and Negative Affect Scales and the Satisfaction with Life Domains Scale (SLDS). Availability of social support was significantly correlated with positive affect over time, but not with negative affect at either point. Inadequacy of social support was significantly related to negative affect at both assessments. Both availability and adequacy of social support were significantly related to the SLDS at each time. Change in satisfaction with life domains was found to be related to both availability and, to a lesser degree, with adequacy of social support.

A participatory approach to the evaluation design of a case management program for the long-term mentally ill.

Resistance by clinical staff is a problem frequently encountered in the course of implementing an evaluation. This paper examines the process of developing a comprehensive evaluation for a case management program for the long-term mentally ill in Metropolitan Toronto. A participatory approach was used in the design and implementation of this evaluation. Parties involved included Ministry of Health officials, hospital administrators, outside consultants, the case manager co-ordinator, case managers, and the evaluators. The goal was to elicit both understanding and support from these key actors. The advantages of this approach are highlighted, as are the limitations and problems encountered.

Role of the family in case management of the mentally ill.

This article provides a systematic discussion and assessment of the actual and potential contributions that families of the chronic mentally ill can make to the case management of their patient-relatives. It examines family members' involvement with six major case management functions including assessment, linkage, monitoring, assistance with daily problems, crisis intervention, and advocacy. For each function, the authors consider the potential of family members to make a contribution, specific activities that are more appropriately assumed by professional staff, and any limitations or caveats about family members' involvement with the given case management activity. The article points out that family members are clearly quite capable of making significant contributions in almost all aspects of managing their patient-relatives and that their potential contributions are too frequently ignored or underused by professionals. The authors recommend that professionals give greater acknowledgment to the case management efforts of family members, work to integrate the contributions of these natural helpers with formal case management systems, and provide family members with the encouragement and support they need to enhance their caring contributions.

The New York State community support system: a profile of clients.

In 1979 the New York State Office of Mental Health contracted with the authors and their colleagues for an independent evaluation of its community support services (CSS) program for the chronically mentally ill in the four upstate mental health regions. As a first step in their program evaluation, the authors present initial findings from a 1981 survey of 844 clients sampled from seven selected CSS program sites. The demographic characteristics, clinical characteristics, and levels of functioning of the CSS client sample are discussed and compared with similar data collected by the National Institute of Mental Health (NIMH) in a 1980 survey of chronically disabled adults in its national community support program (CSP). The authors also present a profile of the services received by the CSS clients and, whenever possible, they compare these services with those received by the NIMH CSP clients.

A comparative analysis of the young adult chronic patient in New York State's community support system.

Using data from a 1981 survey of 844 clients in seven selected programs of New York State's community support system, the authors assess the relationship of client age to a wide range of individual characteristics. They are particularly concerned with whether the young adult chronic patients in their study (those aged 18 to 34) share the same negative characteristics increasingly applied to young chronic patients in the literature, and whether these characteristics also apply to older patients. Their results indicate that while the 18- to 34-year-old patients in their study did exhibit many of the problematic characteristics associated with young chronic patients, these characteristics applied to a relatively small minority of the young patients as well as to many of the older patients. In addition, the results highlight several significant strengths of young patients that have received little attention. The authors conclude by discussing the important clinical and programmatic implications of their findings.

Reinstitutionalization of mentally retarded persons successfully placed into family-care and group homes.

The characteristics of clients currently living successfully in the community but previously reinstitutionalized were compared with those of clients who had remained continuously in the community since their initial placement from an institution. Results showed that, overall, returnees could be discriminated from nonreturnees primarily by their higher level of maladaptive behavior. Separate comparisons of these two groups among family-care and group-home residents, however, did not consistently identify the same differentiating factors. Results indicate that although reinstitutionalized clients can be placed back into the community, their success in remaining there may depend upon characteristics of the setting into which they are placed.

Comparison of family-care and group homes as alternatives to institutions.

Two residential alternatives, family-care and group homes, for deinstitutionalized mentally retarded adults were compared. Residents in both settings displayed essentially no improvement in self-care skills. Individuals placed in family-care homes were significantly more likely to improve their maladaptive behavior. Individuals in group homes were more likely to improve in community living skills. Residents of both settings were equally likely to have friends, maintain ongoing contact with family, and make use of community resources. A differential use of family-care and group homes was suggested.

Improving the quality of community care for the chronically mentally disabled: the role of case management.

This article draws upon an extensive case management literature in order to integrate a number of key concepts and findings that must be considered by those responsible for the planning, administration, and provision of effective community care to the chronically mentally disabled. A discussion of the reasons for the current popularity of the case management concept within human services is followed by a detailed presentation of the objectives, ideology, functions, and structural elements that characterize case management systems. A series of practical problems and issues that must be addressed to effectively implement a case management system are then identified and analyzed. Finally, a set of recommendations for those developing case management systems is offered, and a number of important unanswered research questions about the delivery and impact of case management services are identified.

Quality of life in the evaluation of community support systems.

As a result of the authors' experience in conducting an evaluation of the community support system (CSS) program in New York State, they have identified five reasons for focusing on quality of life (QOL) as a desired outcome for programs for the chronically ill. These reasons are presented and problems in QOL evaluative research are discussed. Psychological indicators are distinguished from social indicators of QOL, and two methods of operationalizing perceived QOL, the psychological well-being and life domains methods, are examined. A conceptual model is presented and the results of an exploratory study of the QOL of 118 chronic psychiatric patients receiving CSS services are presented.

Social-environmental factors as predictors of adjustment of deinstitutionalized mentally retarded adults.

Mentally retarded adults (N = 338) placed from five state institutions were studied 2 to 4 years, after they were placed in either foster family care or community residences. Factors of the social environment that were most predictive of individual adjustment were determined. Adjustment was defined as behavior in five areas of functioning: self-care, behavior control, community-living skills, use of community resources, and social support. Multiple regression analysis revealed that social environmental factors and other characteristics of community settings played an important role in individuals' adjustment. Important features of the social environment were similar across both settings.

A review of training programs for providers of foster family care to mentally retarded persons.

The training needs of foster care providers serving mentally retarded persons have been acknowledged for some time. This review of specific training programs demonstrates that a variety of excellent materials and strategies for meeting these needs are now available. A number of important tasks remain. First, existing training programs need to be implemented more widely. Second, new programs and training materials need to be developed to address needs not adequately met by existing programs. Finally, there is a need to conduct systematic evaluations of care provider training on a more regular basis. The results of these evaluations must then be used to guide refinements in future training efforts. This is an essential step if these programs are to be effective in meeting their goal of improving the quality of care offered to mentally retarded persons by foster family care providers.