The Program Environment Scale: assessing client perceptions of community-based programs for the severely mentally ill.

The Program Environment Scale (PES) was developed for use with clients of community-based programs for the severely mentally ill. It is intended to fill the gap in available tools for assessing clients' perceptions of program functioning as it affects their "quality of life" in a program. Formal pretests were conducted with 121 clients at 12 randomly selected programs near Washington, DC. The final field test used a revised form (29 domains; 129 items) with 221 clients in 22 programs selected randomly throughout the U.S., including Clubhouse, day treatment, psychosocial rehabilitation, and social club programs. Twenty-three subscales met at least five of eight psychometric criteria for internal consistency and discriminant validity. A 24th subscale was retained because of its substantive importance. Successful subscales cover program atmosphere and interactions (program cares about me, energy level, friendliness, openness, staff-client and client-client respect, reasonable rules, availability of positive physical contact, protection from bad touch, staff investment in their jobs, and confidentiality), client empowerment/staff-client equality (program and treatment empowerment, egalitarian space use), and service components (support for paid work, work importance, emergency access, family activities, housing, public benefits, community activities, medications, substance abuse, and continuity). Subscale validity is indicated by associations of specific service offerings with scores on scales measuring client perceptions of those services, and by an ability to differentiate among program models (i.e., Clubhouses, day treatment programs, and psychosocial rehabilitation programs look different from each other). Subscale scores were not influenced by client characteristics (gender, race, age, diagnosis, number of hospitalizations, length of time in program). The final scale has 97 items and takes about 25 minutes to complete. The PES succeeds in measuring different aspects of programs as clients perceive them. In the programs we visited, directors felt the PES covers the important things they want to know about how clients perceive their program. The PES should become a useful tool both for researchers interested in how client responses to programs may influence their therapeutic outcomes, and for practitioners interested in improving their clients' program experiences and/or increasing convergence of staff and client views of their program.

Youth at risk: definitions and implications for service delivery.

The literature on adolescent risk is reviewed, a model of risk that emphasizes risk antecedents and markers is proposed, and an overview is presented of an emergency service delivery strategy that integrates services, emphasizes interagency coordination, and addresses the full range of service needs for youth at risk. Highlights of programs currently in operation are described.

Critical factors in counting the homeless: an invited commentary.

Several factors affect Wright and Devine's efforts to estimate the size of the homeless population. The most critical ones are the purpose of the estimate, implicit or explicit definitions of homelessness used in the estimate, and the time period covered by the data sets used in the calculations.

Public costs and policy implications of teenage childbearing.

PIP: Teenage pregnancies end in an increasing number of abortions, a declining number of placements in adoptive homes, and an increasing number of children born to unmarried teens with large public expenditures for welfare and medical care. A study estimated that the public cost of a family started by a 1st birth to a teenager in 1979 would amount to $18,710; and all such families would cost $8.3 billion to taxpayers. Children of teenage parents face poorer infant health, lower academic achievement, greater risk of socioemotional problems, and a greater probability of becoming teen parents themselves. A recent New York City study indicated that 86% of homeless families were female-headed households, 83% received public assistance, and the likelihood of their genesis from a teenage birth was high. Over the past 10-15 years US culture has become more sexualized; as a result 7 million males and 5 million females are sexually active among 26 million young people aged 13-19, and fewer than 9% of them are married according to 1981 data. By 1979, 1/3 of white and 1/2 of black unmarried 16-year old girls had experienced sexual intercourse. Only 1/3 of sexually active teenagers use contraception consistently, and only 1/2 of them used any contraception at 1st intercourse. 20% of teen pregnancies occur within 1 month of 1st intercourse and 50% occur within the 1st 6 months. Fewer than 10% of teenagers receive a comprehensive sex or family life education course in high school. Cost-effective primary prevention activities focus on delay or abstention from sexual activity, or make contraceptives available. Expensive secondary prevention programs influence teenager's decision about whether to abort, carry the pregnancy to term, or place the baby up for adoption; they attempt to prevent various negative consequences of teenage pregnancy, including low birth weight, out-of-wedlock parenting, and educational and employment disadvantages.^ieng

Estimating the public costs of teenage childbearing.

A formula for making national, state and local estimates of the cost to the public of teenage childbearing is derived from a review of 12 studies. The formula is then applied to U.S. data. The calculations yield a single-year cost for 1985 of $16.65 billion paid through three programs--Aid to Families with Dependent Children, food stamps and Medicaid--for women who first gave birth as teenagers. The calculations also show that the public will pay an average of $13,902 over the next 20 years for the family begun by each first birth to a teenager in 1985 and $5.16 billion over the same period for the families of all teenagers experiencing a first birth in 1985. If all teenage births were delayed until the mother was 20 or older, the potential savings to the public would be $5,560 for each birth delayed and $2.06 billion for the entire cohort of teenagers who would otherwise have had a first birth in 1985.

PIP: Estimates of public outlays for teenage childbearing often afftract a great deal of attention in the US media, at both the national and the local level. Such estimates are time-consuming but not difficult to calculate, and enough is known about how to make them that such figures should become readily available to policy-makers and program-planners throughout the USA. A formula for making national, state and local estimates of the cost to the public of teenage childbearing is derived from a review of 12 studies. The formula is then applied to US data. The calculations yield a single-year cost for 1985 of US$16.65 billion paid through 3 programs--Aid to Families with Dependent Children, food stamps and Medicaid--for women who 1st gave birth as teenagers. The calculations also show that the public will pay an average of US$13,902 over the next 20 years for the family begun by each 1st birth to a teenager in 1985 and US$5.16 billion over the same period for the families of all teenagers experienceing a 1st birth in 1985. If all teenage births were delayed until the mother was 20 or older, the potential savings to the public would be US$5560 for each birth delayed and $2.06 billion for the entire cohort of teenagers who would otherwise have had a 1st birth in 1985.

Adult day care: substitute or supplement?

In 1972 there were fewer than 10 nonpsychiatric adult day care centers in the United States; by late 1982 there were 1,000 or more. This development of programs as an alternative to nursing home and hospital care of impaired adults has been haphazard. Complications from surveys, field visits, and regulatory agencies reveal a lack of elements for systematic evaluation of the real costs and benefits. Future policies must also recognize that adult day care has become a new service without significantly diminishing institutional use.

Primary CNS tumors presenting as cerebellopontine angle tumors.

Adult patients with posterior fossa tumors arising from the cerebellum and brainstem are reported. In each case the tumor presented as a cerebellopontine angle tumor and not as an intra-axial tumor. Tumors of CNS origin are uncommon in the posterior fossa in adults, but they may be seen by the otologist if the presenting symptoms are audiologic or vestibular. Computed tomography scanning will not always distinguish these lesions from the much more common extraaxial neurinoma, meningioma, or cholesteatoma. The progression of symptoms is more rapid in these patients, and other associated neurologic deficits are more common. The auditory brainstem response may demonstrate characteristic abnormalities in these patients. The differential diagnosis of these tumors in adults is discussed and the recent literature reviewed.

Prevalence and consequences of drug abuse among U.S. military personnel: 1980.

A worldwide survey of nonmedical drug use among U.S. military personnel was conducted in 1980. A stratified multistage probability sample was drawn and a questionnaire administered by staff of Burt Associates, Inc. The results show that 27% of the military personnel reported they had used some type of drug or drugs nonmedically in the past 30 d; 36% reported such use within the past year. Prevalence rates are presented for each of nine drug categories. Nonmedical drug use is limited primarily to junior enlisted personnel. The overwhelming majority of nonmedical drug use in the military is occasional or experimental in nature. From these results obtained, it is estimated that 3% of Department of Defense (DOD) junior enlisted personnel were physiologically drug dependent and a total of 4% were physiologically or psychologically drug dependent at some time during the preceding 12 months. The proportions of junior enlisted personnel reporting consequences of drug use and work impairment because of drug use are also presented. There is no general pattern of nonmedical use being more prevalent among military personnel than comparable civilians.

Follow-up of former clients of a large multimodality drug treatment program.

A follow-up study was conducted of a sample of 360 former clients of the Narcotics Treatment Administration program in Washington, D.C. Ninety-five percent of the persons sampled were located, and interviews were successfully completed with 81 percent of the total sample. Interviews were conducted 1 to 3 years following treatment. Findings indicate that a general decrease in drug use has occurred between the period immediately preceding treatment and time of the interview. Improvements were also realized in arrests and in employment and other prosocial activities.

Cultural myths and supports for rape.

This article describes the "rape myth" and tests hypotheses derived from social psychological and feminist theory that acceptance of rape myths can be predicted from attitudes such as sex role stereotyping, adversarial sexual beliefs, sexual conservatism, and acceptance of interpersonal violence. Personality characteristics, background characteristics, and personal exposure to rape, rape victims, and rapists are other factors used in predictions. Results from regression analysis of interview data indicate that the higher the sex role stereotyping, adversarial sexual beliefs, and acceptance of interpersonal violence, the greater a respondent's acceptance of rape myths. In addition, younger and better educated people reveal less stereotypic, adversarial, and proviolence attitudes and less rape myth acceptance. Discussion focuses on the implications of these results for understanding and changing this cultural orientation toward sexual assault.

Final results of the Nashville Comprehensive Emergency Services project.

This demonstration program was originally described in CHILD WELFARE's March 1974 issue. This summary of its results in coordinating the wide variety of services provided for neglected and abused children in a metropolitan area indicates that objectives were met, at a substantial reduction in costs.

Components of "authority" as determinants of compliance.

This study investigated factors affecting compliance, to orders from a formal authority. The design created a two-level status hierarchy in which subjects occupied identical low-status positions and responded to demands from a simulated high-status leader. Four components of authority-normativity,coervice power, collective justification, and success-failure-were manipulated as independent variables. Another component, the endorsement accorded the leader, was included in the design as a measured variable. Results indicated that compliance increased significantly when coervice power was high (rather than low), when justification was collective (rather than partisan), and when demands were normative (rather than counternormative). Contary ti the theoretical expectation, endorsement did not affect compliance by low-status members. The findings show that the normative aspect of legitimacy serves as a compliance-gaining base even when stripped of enforcing sanctions and under-lying goals and that the distinction between normativity and endorsement is valid for research on social power.