Community Support Programs Research Articles

Long term strategies for system change: The US community support programme (CSP)

In this section of the JMH the editors solicit information and comments on mental health issues from around the world.

Observations from the program on chronic mental illness.

The Robert Wood Johnson Foundation (RWJF) Program on Chronic Mental Illness has come to an end. Launched in December 1986, it was the foundation’s first multisite national venture into mental health care. The program sought to establish improved systems of care for persons with serious and long-term mental disorders in nine major cities across the country. Now, almost six years later, the grant period has ended, and it is time to take stock. The nine demonstration programs are still intact, with more than 250 staff in place at the sites. Throughout the program’s lifetime it received $22.5 million in RWJF grant funds, $9 million in foundation loan funds to stimulate housing development, and 1,200 Section 8 housing certificates, issued by the U.S. Department of Housing and Urban Development (HUD). One view of the impact of this program is offered by Howard Goldman and his colleagues, based on a formal evaluation funded by RWJF and a consortium of federal agencies.’ But there is another view of the program’s impact: the subjective impressions of the national program office staff and the staff at the nine demonstration sites. This perspective has been enriched by RWJF’s style of grant management, which is to fund a partnership between the national program office (typically in a university) and the demonstration sites. Instead of awarding the grant and coming back later to assess the results, RWJF requires that each demonstration site develop its program in collaboration with the national program staff. The national office maintains constant contact with the sites to monitor progress and solve immediate problems and carries out numerous site visits, with special conferences among the sites and other direct contact as needed. This management style affords the national program staff an intimate view of the demonstration sites and an opportunity to compare them as they face common situations.

Operating a Member-Employing Therapeutic Business as Part of an Alternative Mental Health Center

The promises of deinstitutionalization have not been kept for unemployed chronically mentally ill people. This article describes an innovative community support program--a nonprofit therapeutic member-run business. Rainbow Services provides opportunities for adults with chronic mental health problems to learn marketable job skills and necessary social skills through participation in various work settings. On-site job training, vocational education, socialization, and job counseling are offered. Thirteen years of business success demonstrate that chronically mentally ill people can function productively in the community. The features of the business are related to beliefs and values familiar to early settlement house workers and social activists and support social work's claim to leadership in working with this population.

Treatment Cost and Rehospitalization Rate in Schizophrenic Outpatients With a History of Substance Abuse

Retrospective self-report data from 60 chronic schizophrenic outpatients in a community support program (CSP) were used to study the relationship between a history of substance abuse and rate of psychiatric rehospitalization and outpatient treatment cost. The sample showed a significant overall reduction in days spent in a psychiatric hospital or jail and in outpatient treatment expenses during the first year in the CSP. Although subjects with recent symptoms of substance abuse (N = 27) showed consistently smaller reductions than subjects with no history of substance abuse (N = 17) or subjects with no recent substance abuse symptoms (N = 16), the only significant difference between the groups was in the total number of days spent in an institution. However, the findings suggest that treatment of patients with concurrent substance abuse and schizophrenia is disproportionately more costly than that of patients without dual diagnoses.

A Comprehensive Clinical Vocational Assessment: The PACT Approach

The purpose of this paper is to present an “Integrated Clinical Behavioral Assessment Approach” for use with persons with severe and persistent mental illness. This approach has been viewed as effective in facilitating successful competitive vocational outcomes within a model community support program.

The Client Interaction Scale. A method for assessing community support programs for persons with chronic mental illness.

The Client Interaction Scale (CIS) is a brief assessment tool for measuring client integration into the client-to-client interactive milieu in Community Support Programs (CSPs) for persons with chronic mental illness. Using a sample of 95 clients from three different CSPs, the scale shows excellent inter-item reliability. A factor analysis indicates that it measures the clients' level of integration on unique affective and instrumental dimensions. The scale also discriminates among environments known to differ on their interactive qualities. Its application to the evaluation of CSPs and other program environments is discussed.

When Case Managers Manage the Seriously Mentally Ill: A Role-Contingency Approach

Although case management is crucial to the delivery of mental health services to the seriously mentally ill, there is little understanding of what case managers actually do. The conventional view of the case manager role as an organizational linchpin is narrow and neglects the reciprocal and processual nature of the case manager role. In an effort to go beyond these limitations, a role-contingency approach is offered that assumes case managers perform a variety of therapeutic, interventive, and integrative functions for their clients along with the organizational-linchpin function. The frequency that each function is performed is dependent on service system, organizational, and client contingencies. Data from a study of 49 case managers in eight, countywide care systems in a northwestern state system based on the Community Support Program model provide support for the role-contingency approach. Additionally, the data show that the role most frequently performed by case managers is that of therapist/crisi...

A comparison of the affective well‐being of young and middle‐aged unemployed men matched for length of unemployment

A sample of young unemployed men (mean age: 21.7 years) was compared with a sample of middle-aged unemployed men (mean age: 47.8 years) on a range of psychological and demographic/background variables. The groups were fortuitously matched for length of unemployment, with the average duration of current unemployment being 20.0 months for the young group and 17.9 months for the middle-aged group. The middle-aged group displayed poorer mental health, less life satisfaction and greater work involvement than the young group but the groups did not differ in self-esteem. For the young group the best predictor of well-being was perceived adequacy of social support and for the middle-aged group the best predictor was participation in leisure activities involving other people. It was concluded that the poorer mental health displayed by middle-aged unemployed men is not explained by the fact that they have, in general, been unemployed for longer than their young counterparts. In both groups, the best predictor of affective well-being was a measure (albeit a different measure) of social support. These conclusions can only be regarded as tentative, however, because of the small sample sizes. Implications of these findings for community support programmes for both young and middle-aged unemployed groups are discussed.

More hospital or more community?

A historical prospective study of urban chronic psychiatric patients participating in a state-sponsored Community Support Program (CSP) was conducted. The cohort was tracked over a three year demonstration period of community based treatments. The study showed that community treatments had strong protective effects against early rehospitalization. Study results are consistent with previous experimental work in regard to service costs, but also demonstrate increased survival time in the community for the case management group. Such extended survival times are necessary for patients to build community supports.

Utilization patterns of community support program clients in New York State.

The results of this study point up several significant features of the CSS program as it currently operates in New York State. First, once enrolled in the CSS program, clients usually receive services on an ongoing basis and are not simply being carried on the program rolls. Second, when planning for expansion of services, service providers should consider the fact that clients tend to enroll in and use services in a single agency even when multiple agencies are providing CSS-funded services. This was ascertained by examining the extent to which the same clients were served by multiple agencies in a geographic area. Third, the predominance of case management as the service most likely to be used by clients receiving only one service suggests that integration with local-and state-operated outpatient services is important in ensuring that CSS clients receive appropriate, comprehensive services.

Defining and measuring stabilization of patients during 4 years of intensive community support.

The first 4 years of an intensive community support program were evaluated in terms of key variables of patient stabilization. Patients (N = 196) had previously demonstrated an inability to manage themselves without repeated and/or lengthy hospitalizations. During program participation, there were significant reductions in hospital days and events (80%), jail incarcerations and charges, billings per patient, and stressful events. Patients reported increased satisfaction both with their lives and the program. The results support the value of continued multidimensional and multimethod examinations of patient stabilization.

Families of the seriously mentally ill and their satisfaction with services.

Family members of seriously mentally ill persons were interviewed to determine their satisfaction with services received through a countywide service system based on the community support program (CSP) model developed by the National Institute of Mental Health. Interviews with 56 family members indicated that a majority were dissatisfied with various aspects of the service system. Multiple regression analysis revealed that significant contributors to family satisfaction were sex of respondent, type of relationship to family member, age at onset of illness, and time since onset of illness. Interaction with a case manager, specifically interaction involving emotional support for families, was the strongest factor explaining family satisfaction. That finding confirms the central role of the case manager in the delivery of CSP services.

Characteristics of community support program clients in 1980 and 1984.

Results from a survey of 1,053 clients enrolled in the community support program in 1984 were compared with data on 1,471 clients enrolled in 1980. In 1984 the percentages of males and blacks treated was larger than in 1980, and clients made increased use of private homes and apartments and relied less on supported living arrangements. Both the percentage of clients receiving federal income supports and clients' median income as a percentage of the national median declined between 1980 and 1984. Fewer clients with schizophrenia and more clients with affective disorders were treated in 1984 than in 1980, probably due to implementation of DSM-III. Nationwide, the number of clients in the program grew from 4,288 in 1980 to more than 350,000 in 1984. The preponderance of schizophrenia, unemployment, and history of hospitalization in the 1984 cohort suggests the program is meeting its goal of treating the most severely mentally disabled.

Beyond ‘coverage’

Full integration of projects and programmes for rural water supply and sanitation has yet to take place in most developing countries, thus contributing to a situation in which long‐term success in the sector has been difficult to demonstrate. It is suggested that full integration in individual countries will require reorientation of project planning procedures, and the development of a community support programme (CSP) to provide backup to communities after project completion. Ultimately, full integration of projects and programmes is an iterative process, requiring the evaluation of past efforts in the field. Experience in the International Drinking Water Supply and Sanitation Decade (1981–90) has demonstrated that coverage alone — as the de facto indicator of success — is not sufficient (particularly in rural areas). The 1990s represent a fresh chance to modify indicators for success, and to go beyond coverage by integrating projects and programmes for rural water supply and sanitation.

Evaluating the effectiveness of countywide mental health care systems.

This study evaluates the effectiveness of eight (four urban and four rural) Community Support Program (CSP) delivery systems located in a state in the northwest United States. Data were collected from 364 respondents: 156 service organization directors, 49 case managers, 77 family members, and 82 seriously mentally ill clients. Four measures of effectiveness were used: comprehensiveness (number of key services for the seriously mentally ill available), coverage (proportion of persons served who needed services), quality of services on a six-point scale, and services coordination (six-item scale). The four performance measures were found to significantly differentiate the eight counties. In five of six cases the measures were positively intercorrelated thereby confirming CSP claims that the key services are an integrated set and that it is feasible to provide a full range of services without sacrificing quality or hindering coordination.

A Respite Residential Service for Geographically Dispersed Outpatients—Community Support Program, Bristol Bay Area Health Corporation, Dillingham, Alaska

Back to table of contents Previous article Next article ArticleNo AccessA Respite Residential Service for Geographically Dispersed Outpatients—Community Support Program, Bristol Bay Area Health Corporation, Dillingham, AlaskaCecilie A. MartinCecilie A. MartinSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.39.11.1196AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "A Respite Residential Service for Geographically Dispersed Outpatients—Community Support Program, Bristol Bay Area Health Corporation, Dillingham, Alaska." Psychiatric Services, 39(11), pp. 1196–1197 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByNone Volume 39Issue 11 November 1988Pages 1196-1197 Metrics PDF download History Published online 1 April 2006 Published in print 1 November 1988

Reducing treatment costs in a community support program.

they have indicated that the CSP model may be a cost-effective alternative to traditional modalities. For example, Hoult and Reynolds (1 1) found that a CSP-type program in Australia cost 2 1 percent less than traditional hospitalization and aftercare. Despite these findings, policymakers and legislators have understandably continued to question the high costs of CSPs. They have frequently asked whether the programs are effective in reducing costly hospitalizations and whether they are sufficiently cost-effective to warrant replication or expansion. To answer these and other questions related to costs and recidivism, we conducted a retrospective study of the records of the intensive community support and treatment program (ICSTP) of the Highline West Seattle Mental Health Center.

What Do We Really Know About Community Support Programs? Strategies for Better Monitoring

Studies have shown that community support programs are more effective in treating the chronic mentally ill than traditional forms of aftercare. Yet an analysis of 33 controlled studies of community support programs reveals that almost no systematic empirical knowledge exists about their actual implementation, including the kinds of treatment they deliver, how they can be replicated, or what ingredients account for their success. As a result, dissemination of the community support program model has been slower than expected. Developing effective community support programs requires making a commitment to evaluating programs as they are implemented, identifying program variables to monitor, devising methods for monitoring the variables chosen, and drawing from and building on existing literature about program evaluation. Strategies and models for monitoring implementation of community support programs are described.

The Organization of Mental Health Services: Societal and Community Systems.

Organizations and Mental Health - W Richard Scott and Bruce L Black PART ONE: THE SOCIETAL ORGANIZATION OF MENTAL HEALTH SERVICES Theoretical Perspectives Institutional and Organizational Rationalization in the Mental Health System - John W Meyer Systems Within Systems - W Richard Scott The Mental Health Sector Conceptualizing Mental Health Delivery Systems - Jerald Hage Organizational Theory Applied Data Sources Origins, Uses, Limitations The Origins of American Psychiatric Epidemiology - Gerald N Grob Mental Health Systems Research - Philip J Leaf Adequacy of Available Organizational and Systems Data PART TWO: THE COMMUNITY ORGANIZATION OF MENTAL HEALTH SERVICES Issues in Conceptualizing Community Systems Community Mental Health Centers as Human Service Orgnizations - Yeheskel Hasenfeld Interorganizational or Interprofessional Relationships - Richard H Hall A Case of Mistaken Identity? Interorganizational Models and Methods Models of Local Mental Health Delivery Systems - Oscar Grusky et al Interorganizational Networks in Mental Health Systems - Joseph P Morrissey, Mark Tausig, and Michael L Lindsey Assessing Community Support Programs for the Chronically Mentally Ill PART THREE: LINKING SOCIETAL AND COMMUNITY SYSTEMS Institutional Context and Strategy - Bruce L Black A Framework for the Analysis of Mental Health Policy Linked Systems - Thomas D'Aunno and Richard H Price Drug Abuse and Mental Health Services

Coping with Negative Symptoms: Implications for Services in Developing and Developed Countries

Chronic mental illness, especially schizophrenia, can lead to long-term disability, largely consequent upon the negative symptoms that persist. More than half of all patients with schizophrenia will suffer from residual disability. Depressing though this is, it is encouraging to note that in half of all patients, the mental symptoms decrease over time, and the patients are able to achieve some semblance of a normal life sometimes even a complete cure. A variety of factors seem to be implicated in the extent to which patients remain with deficits. Although genetics may play a part, it is recognized that social factors and periods of institutionalization may cause negative symptoms. This has important implications for rehabilitation and the prevention of relapse. It is especially important that community support programs and long-term rehabilitation efforts help to remedy or compensate for deficits in social skills. Even where institutionalization is uncommon, there are other psychosocial factors that produce the same effects. In many developing countries, a person is ostracized and stigmatized following an episode of ' 'madness, ' ' even if all symptoms have disappeared and the patient' s behavior has returned to normal. Expectations with regard to the person's role in society, a lack of trust in his judgment, and a generally negative attitude by others in the community can cause the former