Community Support Programs Research Articles

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

Subjective quality of life in the planning and evaluation of programs

This paper attempts to develop a more thorough understanding of the different components of subjective quality of life (SQL). Based on that understanding and other theoretical considerations, the utility of SQL measures in evaluation and planning is discussed. It is concluded that the use of SQL measures in evaluation will mostly be limited to community support programs for chronic mental patients. Contrary to prior research focus, the potential of SQL measures seems to lie in its contribution to need assessment, when considered together with objective social indicators. Life-domains scales are most relevant for the purposes discussed above.

Medical problems of chronic patients in a community support program.

A study of a group of chronic mentally ill patients from an intensive community support program revealed that 53 percent of the subjects had undiagnosed medical problems and 36 percent had known medical problems requiring initiation of or a change in treatment. These high percentages may be explained by the severity of the subjects' psychiatric problems, the questionable quality of their past physical care, and the difficulties chronic patients have in appropriately seeking and using either physical or mental outpatient health care. The author asserts that community support programs must provide continuing assistance with physical health care and offers suggestions for better addressing the problem.

Rehabilitation of the Cancer Patient

Today, patients who have a diagnosis of cancer often face the same concerns as persons who have other types of chronic illnesses. The effects of the disease, the treatment, or both, may leave patients with residual impairments that necessitate sometimes prolonged periods of rehabilitation. Rehabilitation may be preventive, restorative, supportive, or palliative, depending on the type and stage of the disease and characteristics of the patient. Rehabilitation is most effectively planned and carried out by a team composed of various disciplines, as appropriate, but always with the patient and family as the central members of the team. Patients need to be well-informed about the illness and treatment from an early stage and assisted in learning methods to deal with problems they may face in areas such as coping, independent functioning, sexual functioning, employment, and financial pressures. The physician can provide the most effective care to the patient by being familiar with and involving the wide range of rehabilitation services, community support programs, and necessary resources. Through these services, patients can be helped to lead productive and satisfying lives.

The Model-Guided Method for Monitoring Program Implementation

Advocating for the use of model-derived specifications in the monitoring of program implementation, this article presents the model-guided method. The method provides a test of the adequacy of a program's implementation, and its application to the evaluation of a community support program for the chronically mentally ill is presented. A procedure for field testing the reliability and validity of a monitoring instrument is outlined, and recommendations for using the model-guided method in other field applications are offered.

An empirical analysis of services delivered in a model community support program.

An empirical analysis of services delivered in a model community support program.

Living with the mentally ill: factors affecting household complaints.

Data provided by case managers in community support programs are used to analyze the problems of families providing shelter to mentally ill relatives. Factors affecting complaints in 345 family households are contrasted with factors leading to complaints in a subsample of 622 other residential alternatives. Behavioral problems are the best predictors of complaints from all households regardless of type, but some causal factors identified are unique to family residences, notably failure to perform household chores and infrequently socializing with friends. Active and passive rule violations, encompassing both do's and don'ts, are more important than clinical history and social background in understanding complaints.

A rehabilitation response to the call for asylum.

Recently, the Schizophrenia Bulletin published an article on the concept of "asylum" for the mentally ill (Wasow 1986). This concept of asylum, while based on a desire to protect people with psychiatric disabilities is too vague to be useful and is politically dangerous. As a response to currently inadequate community service systems, it fails to take into account the empirical evidence of effectiveness of community support and rehabilitation programs and ignores the larger social responsibility to provide stable housing, employment, and other necessities to these individuals. Finally, it conflicts with the desires of psychiatrically disabled persons themselves. There is a need for aggressive development of community support and rehabilitation services, greater attention to the stated desires of mental health consumers, and continuing research into program effectiveness.

Patterns of case management activity in an intensive community support program: the first year.

Changes in activity patterns of 12 case managers over the first year of an intensive community support program are described and a method and format for the collection and analysis of time budget data in case management are presented. During the first six months of the program case managers recorded the predominant activity for each 15 minute period throughout the day. Mean values of proportional time were 35.3% for direct services, 40.3% for indirect services, and 24.4% for nonclinical services. The relatively high (64.7%) combination of indirect and nonclinical services deserves careful consideration in program cost analysis.

Descriptive Evaluations of Community Support Programs

(1986). Descriptive Evaluations of Community Support Programs. International Journal of Mental Health: Vol. 15, The Future of the Mentally Ill in Society, pp. 26-43.

Organizational analysis of three community support program models.

Little attention has been paid to the organizational and administrative characteristics of effective community support programs for the chronic mentally ill. The authors analyzed three successful support programs in Wisconsin that employ three different models of service delivery: one provides services through caseworkers who carry specialized caseloads, another through local nonprofessionals who work with a centrally located program coordinator, and the third through a team of various mental health workers. Each program has tailored its organizational process to suit the types of clients it sees, the size of its catchment area, and the availability of other professional resources. The interrelated strengths and weaknesses of each model are discussed.

Community support systems for the homeless mentally ill.

AbstractThe seriously mentally ill, homeless or not, require a broad range of housing, mental health, and social welfare supports. This chapter suggests how the framework of the federal Community Support Program for the chronically mentally ill can be adapted to assure comprehensive care for the homeless among them.

Chronic medical problems in the chronic mentally ill.

The findings of our study support previous reports documenting a high rate of chronic medical illness among the chronic mentally ill. More than 42 percent of CSP clients were reported to have at least one chronic medical problem severe enough to limit functioning. This finding was not attributable to age. The data indicate that different psychiatric groups have different needs that must be considered when planning possible interventions. The medical problems associated with OBS and retardation are so much a part of these syndromes that prevention efforts would have to focus on the psychiatric disorder itself. However, the high rate of illness from medication side effects might be prevented by more careful treatment regimens (8). The clients categorized as having other nonpsychotic disorders are the most puzzling. Research needs to be done on the link between limiting medical conditions and a "career" as a chronic mental patient (7). Longitudinal data are required to understand the complex interaction between limiting medical conditions and less severe psychiatnic disorders that result in outcomes as disabling as those associated with psychoses. Other studies have offered recommendations to help assure that the chronic mentally ill receive adequate medical care (1-4). Psychiatrists need to become adept at caring for physical illness, and primary care physicians need to acquire skill in caring for the mentally ill. Service systems like the community support program that link medical and mental health care are essential in moving toward those goals. To increase efforts toward primary prevention, we need a betten understanding of the interrelationship between physical and psychiatnic illnesses. However, efforts geared toward primary prevention will probably require a far better understanding of the part physical illness plays in persons' becoming or remaining mentally ill.

Functional Adaptation to the Job Market: Incorporating Specialized Skills of Music Therapy in a Comprehensive Mental Health Center

Journal Article Functional Adaptation to the Job Market: Incorporating Specialized Skills of Music Therapy in a Comprehensive Mental Health Center Get access Jerrilyn S. Herd, RMT-BC Jerrilyn S. Herd, RMT-BC coordinator of a Community Support Program 2Four County Counseling Center, Logansport, Indiana Search for other works by this author on: Oxford Academic PubMed Google Scholar Music Therapy Perspectives, Volume 3, Issue 1, Spring 1986, Pages 50–52, https://doi.org/10.1093/mtp/3.1.50 Published: 01 March 1986

The current status of the community support program: A personal assessment.

The current status of the community support program: A personal assessment.

Psychiatric deinstitutionalization: the possibilities and the reality.

There is a substantial research data base which indicates that the majority of the chronically mentally ill can function outside of institutional settings. A number of community support programs have been implemented and positively evaluated. However, despite this evidence, large-scale deinstitutionalization of these patients has not occurred. Instead, patients have been relocated to new institutional placements such as nursing homes and single-room only hotels (SRO's). The role of Medicaid and Supplemental Security Income (SSI) in mental health care appears to have contributed to limited placement options. In addition, deinstitutionalization has created ambiguity around the degree of dependence and social role status of these patients. Recommendations are made to provide the deinstitutionalized mentally ill with a viable social role using existing financial resources.

Correlates of acting-out behaviors among young adult chronic patients.

The authors studied how the abuse of alcohol and other drugs and the failure to take prescribed medications are related to behavior problems shown by young adult mentally ill persons at home and in the community. The study was based on information provided by case managers for 1,471 clients in the community support program (CSP) sponsored by the National Institute of Mental Health. The study found that alcohol abuse was strongly related to acting out among young CSP clients, but that drug abuse affected their behavior even more adversely. Failure to comply with prescribed medication regimens accounted for a considerable share of the behavior problems exhibited by the young clients, particularly acting out in the community. Age was found to have an attenuating effect on behavior problems. The authors emphasize the need to devise programs to meet the needs of young chronic mentally ill persons.

The long-term treatment of young schizophrenics in a community support program.

AbstractThe clinical research unit from which the Training in Community Living model came is now investigating long‐term use of the model in the treatment of young adults with schizophrenic disorders.

Rural community support programs: the experience in three Wisconsin counties.

AbstractCommunity support programs in rural areas are conceptually similar to the programs in urban areas, although the details must be adapted to fit the strengths and limitations of the rural setting.

Characteristics of dropouts, remainers, and refusers at a psychosocial rehabilitation program for the chronically mentally disabled.

Thirty-eight chronically mentally disabled patients who were invited to join a newly established, vocationally oriented, day treatment program in Raleigh, North Carolina, served as subjects. We attempted to determine whether demographic and psychosocial characteristics significantly differed among groups of clients who dropped out of, remained in, or refused membership in this community-support program. A variety of demographic, expectancy, psychological, and psychosocial measures were administered to each subject. Most significant was the finding that the subjects' perceived level of help and support from friends was a significant determinant of the level of program participation. Those subjects who refused to participate (refusers) perceived themselves as receiving proportionately less support than did members of the other two groups (dropouts and remainers).