Predicting work outcomes and service use in supported employment services for persons with psychiatric disabilities.

New funding policies make it timely to identify correlates of effectiveness and effciency in supported employment (SE) programs for persons with psychiatric disabilities. In a statewide sample of SE participants with serious mental illness, individual clinical characteristics were unrelated to competitive work or hours of services consumed. However, amounts of SE provider time devoted to travel, training, and nonemployment advocacy were independently related to the likelihood of obtaining competitive work. These results suggest that SE providers should pursue an individualized, participant-driven model of services that includes active efforts to remove logistical barriers to community employment.

Decisions and justifications by community mental health providers about hypothetical ethical dilemmas.

OBJECTIVE: Community-based treatment of persons with serious mental illness requires providers to become involved in clients' personal lives to a greater degree than does hospital-based treatment. The study examined attendant ethical dilemmas, especially for staff who lack professional training or work in rural communities. METHODS: A total of 95 staff members from five community mental health centers read 14 vignettes describing ambiguous ethical dilemmas involving professional role boundaries or client confidentiality. Twenty-seven staff members were from rural agencies, and 68 from urban-suburban agencies; 60 were direct care staff, and 35 were supervisory. Participants were asked to make and justify a more conservative or a less conservative decision in response to each dilemma. RESULTS: Years of experience as a mental health provider and previous ethics training correlated positively with staff having experienced more situations similar to those in the vignettes; however, these variables were not related to the decision made or the type of ethical justification for it. When the analysis controlled for experience and previous ethics training, staff made fewer conservative decisions in boundary dilemmas than in confidentiality dilemmas. Compared with nonrural providers, rural providers had experienced more boundary dilemmas and made fewer conservative decisions in response to them. CONCLUSIONS: Boundary problems occur frequently in community-based services, especially in rural settings, and may or may not be handled conservatively. With the expansion of case management and other in vivo services, better understanding of ethical risks and informal practices will help improve services and provide appropriate training and supervision of staff.

A behavior setting assessment for community programs and residences.

Using the concept of person-environment fit to determine the effectiveness of residential and program placements for chronic psychiatric clients requires systematic and concrete information about these community environments in addition to information about the clients themselves. The conceptual and empirical development of the Behavior Setting Assessment (BSA), a measure based on Barker's behavior setting theory, is described. Use of the BSA with 28 residences (117 settings) and 11 programs (176 settings) from two community support systems demonstrated that all 293 settings assessed could be described and analyzed in terms of differences in their demands for self-care skills, food preparation and consumption, verbal/cognitive responses, and solitary or group activities. The BSA is an efficient measure for obtaining specific, concrete information about the behavioral demands of important community environments.

Program maturity and cost analysis in the evaluation of primary prevention programs.

Primary prevention has been growing as a major initiative in mental health, and to avoid overpromising its benefits, primary prevention programs must be evaluated in a systematic and effective fashion. Information on the developmental maturity and the direct costs of a program is very useful in assessing its merit, even if definitive findings on incidence reduction are not available for many years. This paper outlines the steps by which information on a program's developmental maturity and direct costs can be obtained, and discusses the implications of these steps for primary prevention policy.

Individual differences and task structure in the performance of a behavior setting: an experimental evaluation of Barker's Manning Theory.

Barker's theory of "undermanning" has attracted interest for its potential applications to a variety of problems in community psychology, although to date little attention has been given to mediating factors such as individual differences and the organizational structure of the setting task. The present study crossed two levels each of manning, task structure, and manipulated "competence" over 56 independent replications of a laboratory-based behavior setting. Direct observations of subject behavior confirmed that participants in undermanned settings worked harder, held more different positions, performed more difficult and more important jobs, and spent more time in the task-related areas of the setting, than did subjects in over-manned groups. However, interactions with the task and competence factors attenuated several of the manning effects, and undermanning's hypothesized influences on the subjective experiences of setting occupants were not found.

Study of behavioral factors associated with psychiatric rehospitalization.

Archival data from daily logs maintained at a private proprietary home were tracked from four to 29 weeks prior to psychiatric rehospitalization for ten deinstitutionalized adult females and ten nonhospitalized controls. Three raters coded behavioral incidents into ten categories. The rehospitalized women had significantly more incidents than did the controls, including more affective disturbances (depression, anxiety, anger, and interpersonal concerns) and more attempts to secure psychiatric rehospitalization. The rehospitalized groups also exhibited symptomatic behavior for a greater number of weeks than did the control group, suggesting that the symptom pattern was probably detectable long before rehospitalization was necessary. Peaks in incidence frequency often occurred several weeks prior to rehospitalization.