Community Residential Services Research Articles

Community residential program policies, services, and treatment orientations influence patients' participation in treatment

The study sought to identify community residential program characteristics that predict patients' participation in treatment and to examine the association between these characteristics, participation, and outcomes at discharge from treatment. A sample of 2,790 patients with substance abuse disorders was assessed at entry into and discharge from 87 community residential facilities (CRFs). The CRFs were assessed using a survey that obtained information about program size and staffing, policies and services, and treatment orientation. High expectations for patients' functioning, clear policies, structured programming, a high proportion of staff in recovery from substance abuse problems, and more emphasis on psychosocial treatment were associated with patients' participation in program services and activities. Higher expectations for functioning and a strong treatment orientation enhanced participation more among better functioning patients; program support and structure enhanced participation more among impaired patients. Participation in treatment independently predicted outcomes at discharge even after both patient and program characteristics were controlled. These findings show that community residential program policies, services, and treatment orientations play a key role in influencing patients' engagement in treatment, which, in turn, improves patients' outcomes at discharge.

Adaptive Behaviour Gains in Ordinary Housing for People with Intellectual Disabilities

Fifty‐one residents of 14 staffed houses for people with intellectual disabilities were assessed using the Adaptive Behavior Scale (ABS) at the beginning, middle and end of a two year period. Changes in ABS score were calculated to ascertain whether residents experienced continued development once the immediate period following resettlement from institutional services was past. Although some individuals changed little and some lost skills, ABS scores were found to increase significantly over time, particularly among the least able residents. This latter finding prompted further investigations. Conversion to percentile ranks was undertaken to provide a better basis for comparison between individuals as the raw scores cannot be interpreted as an equal interval scale. Unreliability of measurement provided a further reason for caution. Changes in percentile rank scores were relatively modest when compared to the level of unreliability. Moreover, the consistency of change found for individuals across both years of the study period was unconvincing, with the number of times change was in the same direction being only similar to that which would be predicted by chance. Overall, the study demonstrates the difficulties encountered in trying to establish whether improvements in personal competence are ongoing in community residential services for people with intellectual disabilities.

A Home of Your Own: Moving from Community Residential Services to Supported Living for People with Learning Disabilities in the North West

The replacement of long‐stay hospitals by Care in the Community provides an opportunity to reflect on the quality of people's lives in the community and use of resources. New ways of assisting people with learning disabilities to live in their own homes are emerging. These ‘supported living’ arrangements do not offer a model but rather some guiding principles for finding out how people want to live, and the design, development and co‐ordination of informal and formal supports. The conditions working for and against developing supported living as a mainstream option are reviewed, and what is being learnt about person‐centred planning; supporting people with complex needs; managing costs and service effectiveness; and the enabling role of purchasers.

Ideologies of care in community residential services: what do caregivers believe?

Ideologies of care, or systems of beliefs about the importance of particular goals and activities, help guide how care is provided. One currently pervasive ideology of care is that of normalization. In this paper, the ideologies of care of both house managers and direct care staff in group homes are contrasted. Results indicate that the ideology of direct care staff is less differentiated than that of the house managers. In addition, house managers are more likely to subscribe to a normalization ideology and less likely to subscribe to a family orientation ideology than are direct care staff. Ideological differences between house managers and direct care staff are only partially explained by differences in the demographic composition of the two groups.

Living under the Strategy: Do Outcomes for Users of Welsh Community Residential Services Live up to the All Wales Strategy's Underlying Principles?

The results of a two‐year study which assessed quality of life outcomes for residents of fourteen small‐scale staffed houses in Wales are discussed in the context of the principles which underlie the All Wales Strategy for the Development of Services for Mentally Handicapped People. Housing quality and location, levels of community participation, individualisation and autonomy were generally found to be reasonably high. In contrast, levels of social participation and support for resident involvement in activity were typically low. Furthermore, it was found that people with more substantial disabilities tended to fair worse than others. These results are compared with outcomes reported for users of earlier ‘demonstration’ projects and brief suggestions for service development are made.

Community residential services and community tenure.

Community residential services and community tenure.

Enrolling En Groups

I am a Senior Enrolled Nurse working with North West Surrey Health Authority in community residential services with people with learning difficulties.

The community residential treatment service: developing a continuum of prosthetic environments for the chronically disabled.

Among the many issues regarding the care of chronic mental patients, none is more pressing than the need for administrative and clinical models designed to organize and systematize the efforts of diverse community service providers. This paper describes the functioning of the Community Residential Treatment Service of the South Beach Psychiatric Center, a large-scale project of a state facility created to respond to this tissue. By blending sophisticated clinical and administrative technology, programs operated by the state, voluntary, and proprietary health care sectors have been integrated to form a balanced service delivery system. This system provides a broad continuum of inpatient and outpatient residential settings developed in accordance with social learning principles. The components of the system, with the Community Residential Treatment Service as the major integrative force, are linked together by detailed contracts as well as common behavioral clinical and behavioral administrative language. The treatment successes f this system have been significant enough to suggest that a positive synergistic effect is generated by this programming combination.

A Typology of Community Residential Services: Report of theTask Force on Community Residential Services—1982, 90 pages, paperbound, $5. Available from Publication Sales, American Psychiatnic Press, Inc., 1400 K Street, N.W., Washington, D.C. 20005 (all orders of $35 or less must be prepaid). The publication was sent as part of the Hospital and Community Psychiatry Service supplementary mailing in March

<b>A Typology of Community Residential Services: Report of theTask Force on Community Residential Services</b>—1982, 90 pages, paperbound, $5. Available from Publication Sales, American Psychiatnic Press, Inc., 1400 K Street, N.W., Washington, D.C. 20005 (all orders of $35 or less must be prepaid). The publication was sent as part of the Hospital and Community Psychiatry Service supplementary mailing in March

Community Residential Services during the 1980s: Challenges and Future Trends

The author suggests new directions for community-based residential programs and points out major changes that may occur in the community residential service system during the 1980s. The need for mo...

Training Resident Advisors to Provide Community Residential Services: A University-Based Program

With deinstitutionalization comes the responsibility of providing quality residential settings for developmentally disabled clientele in need of continued supervision and training. Unfortunately, little effort has gone into training resident advisors (RAs) to work with residents in small community homes. This paper details the formulation of a curriculum development model for training RAs and presents data from a university-based training effort designed to evalute the model initially.

De‐institutionalization and the Intellectually Handicapped Part II: Developing Strategies to Improve the Transition Process

The process of enabling members of an organisation to work in harmony can be a difficult one. When the expectations of clients and their families must be acknowledged the situation becomes more complex still. Seminars and workshops can be used to increase the awareness of relevant issues. They provide opportunity to develop objectives. The proceedings and outcome of a seminar entitled ‘The Transition from Hostel Living to Community Residential Services’ are described. The seminar resulted in the practical application of concepts described in Bartnik, E. De‐institutionalization and the intellectually handicapped Part 1: The concept of transition. Australian Occupational Therapy Journal, 1981, 28(2), 63–69.

The cost of community residential services

AbstractThe convergence of growing demand for residential services and increasing requirements for fiscal accountability focus attention on facility costs and programmatic alternatives for cost‐effective services.

Better community residential services for the mentally handicapped.

The sociological study of institutions has developed considerably in the past two decades. It has moved from the case studies of mental hospitals (e.g. Stanton &amp; Schwartz, 1954; Belknap, 1956) and the graphic, speculative typology of Goffman (1961) to empirically based comparative studies of facilities for both the mentally ill and the mentally handicapped (Hewett et al. 1975; Wing &amp; Brown, 1970; Ullman, 1967; Wing &amp; Hailey, 1972; Morris, 1969; King et al. 1971; Raynes et al. 1977). All these studies have included among their goals the development of our understanding of the structure and functioning of these institutions so as to facilitate the planning, administration and evaluation of better residential services. Further, since the publication of Better Services for the Mentally Handicapped (DHSS, 1971), it is clear that in the United Kingdom the government supports the provision of a continuum of services for mentally handicapped persons. As part of that continuum there is a commitment to provide residential facilities in the community for those who need such services.