Community Mental Health Center Clients Research Articles

Use of a Mental Health Center Collaborative Care Team to Improve Diabetes Care and Outcomes for Patients With Psychosis.

This study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness (compared with usual care) of a collaborative care model to treat community mental health center (CMHC) patients with psychosis and poorly controlled diabetes. Stakeholder input was used to adapt a primary care-based collaborative care intervention for CMHC settings. Thirty-five adult CMHC clients with type II diabetes and hemoglobin A1c (HbA1c) >8% or blood pressure >140/90 were randomized to receive either collaborative care or usual care. Change in HbA1c was evaluated between baseline and three months. Paired t tests were used for within-group comparisons. After three months, intervention participants had a statistically significant mean decrease in HbA1c of 1.1% (p=.049). There was no significant change in HbA1c in the usual-care group. This pilot demonstrates the feasibility and acceptability of implementing collaborative care in CMHC settings and its preliminary effectiveness in improving glycemic control in a high-risk population.

Randomized controlled trial of an internet cognitive behavioral skills-based program for auditory hallucinations in persons with psychosis.

Despite strong evidence supporting the effectiveness of cognitive-behavioral therapy for psychosis (CBTp), most clinicians in the United States have received little or no training in the approach and access remains very low, indicating a potential role for technology in increasing access to this intervention. Coping With Voices (CWV) is a 10-session, interactive, Web-based CBTp skills program that was developed to meet this need, and was shown to be feasible and associated with reduced severity of auditory hallucinations in a previous pilot study. To more rigorously evaluate this program, a randomized controlled trial was conducted comparing the efficacy of CWV to usual care (UC). The trial was conducted with a sample of 37 community mental health center clients with schizophrenia and moderate-to-severe auditory hallucinations, with assessments conducted at baseline, posttreatment, and 3-month follow-up. Engagement in and satisfaction with the CWV program were high. Both the CWV and UC groups improved comparably in severity of auditory hallucinations and other symptoms over the treatment and at follow-up. However, participants in the CWV program showed significantly greater increases in social functioning and in knowledge about CBTp. The results suggest that the CWV program has promise for increasing access to CBTp, and associated benefits in the management of distressing psychotic symptoms and improving social functioning. (PsycINFO Database Record

Longitudinal Course of Clients With Co-occurring Schizophrenia-Spectrum and Substance Use Disorders in Urban Mental Health Centers: A 7-Year Prospective Study.

A previous longitudinal study in rural New Hampshire showed that community mental health center clients with co-occurring schizophrenia-spectrum and substance use disorders (SZ/SUD) improved steadily and substantially over 10 years. The current study examined 7 years of prospective clinical and functional outcomes among inner-city Connecticut (CT) community mental health center clients with SZ/SUD. Participants were 150 adults with SZ/SUD, selected for high service needs, in 2 inner-city mental health centers in CT. Initially, all received integrated mental health and substance abuse treatments for at least the first 3 years as part of a clinical trial. Assessments at baseline and yearly over 7 years measured progress toward 6 target clinical and functional outcomes: absence of psychiatric symptoms, remission of substance abuse, independent housing, competitive employment, social contact with non-users of substances, and life satisfaction. The CT SZ/SUD participants improved significantly on 5 of the 6 main outcomes: absence of psychiatric symptoms (45%-70%), remission of substance use disorders (8%-61%), independent housing (33%-47%), competitive employment (14%-28%), and life satisfaction (35%-53%). Only social contact with nonusers of substances was unimproved (14%-17%). Many urban community mental health center clients with SZ/SUD and access to integrated treatment improve significantly on clinical, vocational, residential, and life satisfaction outcomes over time, similar to clients with SZ/SUD in rural areas. Thus, the long-term course for people with SZ/SUD is variable but often quite positive.

Peer-delivered wellness recovery services: From evidence to widespread implementation.

Reviewing the evidence for peer-delivered services, writing in 2004 in this journal, researcher Phyllis Solomon commented on the “high level of evidence” for peer-provided services, including four randomized studies and three quasi-experimental design studies using a variety of meaningful outcome measures (Solomon, 2004). The past two decades have witnessed a number of important studies of these models and services that meet these evidence criteria. For example, Paulson and his colleagues randomly assigned community mental health center clients to a peer-staffed Assertive Community Treatment (ACT)1 team, an ACT team staffed by non-peers, or services as usual (Clarke et al., 2000; Herinckx, Kinney, Clarke, & Paulson, 1997; Paulson et al. 1999). Results revealed no differences between the two ACT teams in participants’ symptom severity or any clinical or social outcome for the first two years of service delivery. However, both ACT teams had significantly greater treatment retention than usual care. In another study, clients of a community mental health center were randomly assigned to peerrun intensive case management (ICM) versus non-consumer-run ICM teams (Solomon & Draine, 1995a, 1995b). At two years, clients of both teams had equivalent symptoms, quality of life, and a variety of clinical and social outcomes. Service delivery patterns differed, however, in that the consumer case management team provided more face-to-face services and services outside of an office setting than did the non-consumer team.

Public-Academic Partnerships: Tools for Mental Health Agencies to Evaluate Research Protocols

Research involving community mental health center clients, resources, or both can affect clinical care, administrative processes, and costs. To help agencies identify and quantify these effects, a stakeholder group examined and discussed a range of protocols and then developed questionnaires and rating scales for agency use. The purpose of these materials is to make explicit the risks, costs, and benefits of a research protocol so an agency can make informed decisions about protocol approval and implementation. The goal of this work was to promote the conduct of appropriate research in community mental health settings while reducing risks to the agency and its clientele.

A pilot examination of social context and everyday physical activity among adults receiving Community Mental Health Services

Community mental health center (CMHC) clients include a variety of people with moderate to severe mental illnesses who also report a number of physical health problems. Physical activity (PA) has been identified as one intervention to improve health among this population; however, little is known about the role of social context in PA. The purpose of this study was to examine the role of social context in everyday PA among CMHC clients. Data were collected from CMHC clients in two cultures using accelerometery and experience sampling methods. Data were analyzed using hierarchical linear modeling. Independence in housing nor culture was significantly associated with levels of PA. Being alone was significantly negatively related to PA level. Social isolation appears to be negatively related to PA at the level of everyday life. Physical activity interventions with this population should consider including social components as a part of PA.

Psychometric properties of the Trauma Assessment for Adults

The Trauma Assessment for Adults (TAA) was developed to facilitate the assessment of exposure to traumatic events that could result in posttraumatic stress disorder (PTSD). The TAA inquires about numerous potentially traumatic events that an individual may have experienced. Although the TAA has been used extensively for clinical and research purposes, its psychometric properties have never been formally evaluated. The objective of the present investigation was to evaluate the psychometric properties of this frequently used measure. The studies reported here describe the performance of the TAA in two samples-college undergraduates (N=142) and community mental health center clients (N=67). Among undergraduates, 1-week temporal stability was evaluated and, in both samples, item- and scale-level convergence of the TAA with an established trauma exposure measure was assessed. Convergence of the TAA with clinically related constructs was also evaluated. The TAA exhibited adequate temporal stability (r=.80) and satisfactory item-level convergence with existing measures of trauma history among college students. In the clinical sample, the TAA again converged well with an established measure of trauma exposure (r=.65). It was not as strongly predictive, in either sample, of trauma-related distress relative to an alternate trauma exposure measure. Although it performs satisfactorily, the TAA does not appear to be superior to other existing measures of trauma exposure.

Subjective distress from stressful events and high-risk behaviors as predictors of PTSD symptom severity in clients with severe mental illness

Survey data collected from 257 community mental health center clients tested direct and indirect relationships among subjective distress associated with stressful/traumatic events and high-risk behaviors, substance abuse, and posttraumatic stress disorder (PTSD) symptoms. Structural equation modeling (SEM) revealed substantial direct effects of subjective distress associated with lifetime physical and sexual abuse on PTSD symptom severity. Subjective distress related to high-risk behaviors (e.g., suicide attempts) mediated subjective distress and PTSD symptom severity. Subjective distress from physical and sexual abuse was also strongly related to problem drinking. Adding gender to the model revealed greater subjective distress from physical and sexual abuse for women and greater drinking problems for men. Otherwise, gender had little effect on the model overall.

Ethics In Community Care Making the Case for Ethics Consults in Community Mental Health Centers

Practitioners in community mental health center (CMHC) settings face an environment of vast and ever-increasing ethical complexities, in which there are both emergent dilemmas and ongoing ethical tensions created through competing treatment paradigms. CMHCs clients are a highly vulnerable population due to lower socio-economic status, possibly compromised mental functioning, and societal stigmatization. While many healthcare institutions serving vulnerable individuals offer access to clinical ethics consultations, consults are not routinely available at CMHCs. In this article, we explore the need for ethics consults in CMHCs, propose possible benefits and costs of ethics consultations, and offer suggestions for incorporating consults at CMHCs.

Ethnic Match and Treatment Outcomes for Child and Adolescent Mental Health Center Clients

This study investigated the effects of client ethnicity and client‐counselor ethnic match on treatment outcomes (i.e., GAF‐difference [from the Global Assessment of Functioning Axis V rating of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, American Psychiatric Association, 1994] and client visitation) of 1,946 child and adolescent community mental health center clients. After controlling for 7 other variables, no differences were observed after adjustment among client ethnicities, age groups, or ethnic match on the GAF‐difference dependent measure. Ethnically matched African American child and adolescent clients had fewer mental health visits than did their nonmatched counterparts. Implications of these findings are discussed.

What is a Case Manager? The Perspective of Persons with Borderline Personality Disorder

BACKGROUND: Case management services have expanded to include persons with diagnoses other than schizophrenia. Attention has been directed toward persons with chronic, nonpsychotic disorders—in particular, persons with personality disorders. However, to date, the nature and effects of case management for persons with personality disorders are relatively unknown. OBJECTIVES: The purpose of this study was to explore case management services from the perspective of community mental health center clients with borderline personality disorder. By providing descriptions and interpretations of the day-to-day experience of having a case manager, the benefits and limitations of this service delivery model for persons with borderline personality disorder are revealed. STUDY DESIGN: An interpretive, phenomenological research approach was used. RESULTS: Based on the interview data, the following three themes were identified and explicated through the words of the clients: (1) “My case manager treats me like a person,” (2) “My case manager is more than a case manager,” and (3) “My case manager has stuck with me for years.” CONCLUSIONS: The results suggest that person-centered, comprehensive, and continuous services from a single caregiver are the core of case management services for persons with borderline personality disorder. Participants perceived their case managers as respectful, resourceful, and reliable. Further work is needed to determine how these practices can be more widely disseminated in mental health care for persons with borderline personality disorder.

Effectiveness of an empirically based treatment for panic disorder delivered in a service clinic setting: 1-year follow-up.

The transportability of cognitive-behavioral therapy (CBT) for panic disorder to a community mental health center (CMHC) setting at 1-year follow-up was examined by comparing CMHC treatment outcome data with results obtained in controlled efficacy studies. Participants were 81 CMHC clients with a primary diagnosis of panic disorder with or without agoraphobia who completed CBT for panic disorder. Despite differences in settings, clients, and treatment providers, both the magnitude of change from pretreatment to follow-up and the maintenance of change from posttreatment to follow-up in the CMHC sample were comparable with the parallel findings in the efficacy studies. At follow-up, 89% of the CMHC clients were panic free and a substantial proportion of the sample successfully discontinued benzodiazepine use.

The Effect of Geriatric Day Treatment on a Measure of Depression

ABSTRACT A pre-test, treatment, post-test design was used to study the effect of day treatment on a measure of depression and a measure of global functioning in a group of elderly community mental health center clients in a rural area. Results were analyzed using a t-test, showing statistically significant differences for before and after treatment groups, and were compared with the results of similar Studies in the literature.

Group therapy for people with borderline personality disorder: interventions associated with positive outcomes.

Group psychotherapy is becoming a more prevalent treatment option for people with borderline personality disorder. Various types of group approaches have been discussed; however, data about specific interventions and their relationship to outcomes for subgroups of people with borderline personality disorder are lacking. The purpose of this study was to explicate the interventions used in a successful group therapy program developed for community mental health center clients with borderline personality disorder. Two independent raters used the Hill Counselor Verbal Response Category System-Revised to describe and categorize the therapists' verbal responses. Coding of eight videotaped sessions indicated that the therapists' level and type of verbal activity did not change over time. The most frequently utilized interventions across sessions were providing information and seeking information. These responses are indicative of a moderate and high degree of structure. The results suggest that clinicians must consider the unique needs of serious and persistently ill people with borderline personality disorder and plan group interventions accordingly.

Minimizing the negative impact of a planned hazardous waste facility on the surrounding communities

A follow-up community survey (n=83) of residents living near a planned hazardous waste facility revealed that the majority of residents maintained considerable concerns over a four year period. They were worried about their health and safety, distrustful of the facility operator, and anticipated limited community benefits. Demoralization, a measure of nonspecific psychological distress, remained disturbingly high, with 41% of those interviewed scoring above the mean of community mental health center clients. One of the two communities studied had lower perceptions of risk than the other, suggesting that expectations of compensation may influence risk perception. Improved communication is needed between local residents and government agency and private industry personnel to address perceptions of danger and distrust. Primary prevention strategies are discussed to improve communication and monitor the health status of residents most at risk of developing physical and psychological problems.

The effect of client choice of therapist on therapy outcome

This study compared the therapeutic progress of three randomly assigned groups (n = 14 in each group) of community mental health center clients: (a) clients who viewed a slide/sound presentation about all available therapists and chose their own therapist; (b) clients who viewed the presentation and were assigned to a therapist by the center's clinical director; (c) clients who were assigned to a therapist by the clinical director without seeing the presentation. There were no significant differences among the three groups in their initial reaction to the clinic, number of therapy sessions, type of termination, severity of presenting problems, General Well-Being Schedule scores, Current Adjustment Rating Scale scores, or therapist's satisfaction with therapy. Further analysis revealed that three out of four clients had improved significantly as a result of therapy. It was concluded that in the absence of research evidence demonstrating the efficacy of client choice on therapy outcome, support for the notion of client choice must be based solely on social, ethical, and legal considerations.

Client perception of role in psychotropic drug management.

A cross-sectional exploratory survey of 46 community mental health center clients was conducted to determine if client perception of the role of medication consumer was congruent with the prescribed role. Analysis of findings suggested that the subjects functioned as passive rather than active participants in drug management. The majority of subjects were unable to remember basic information about their psychotropic medication regimens.

Social congruence and empathy in paraprofessional and professional mental health workers.

The use of indigenous nonprofessionals as mental health workers has become an increasingly widespread practice. A frequently cited rationale for such useage is that nonwhite, nonmiddle-class clients, frequently a majority in community clinics, are likely to relate more readily to helpers of similar socioeconomic or cultural background. This study examines the empirical basis for this rationale by interviewing 102 community mental health center clients. Three attitude measures (perceived social congruence, perceived understanding, and perceived helpfulness) are utilized to assess Ss'perception of both paraprofessional and professional mental health personnel. Although Ss' were accurate in their judgments of social congruence, the expected correlations of social congruence with perceived empathy and helpfulness did not occur.