Self-help Agencies Research Articles

English

In spite of being the principal producers of food, women and child girls are often suffer from malnutrition and hunger. Most of the discussions regarding their food insecurity have focused so far on the intra-household access and distribution of food. This article analyzes the broader spectrum of gender dimensions of inter and intra-household entitlement to food. This study conducted in the far-western region of Nepal, which is established as a resource poor region, shows the institutions such as patrilinearity, patriarchal inheritance law, patrilocality and early marriage, the cultural norms, discriminatory food distributional practices, caste and ethnicity still function among some categories women in terms of land ownerships, share tenancy, acquiring sufficient and nutritious food, wage and employment, and credit, resulting their entitlement failure. At a time, this article discusses how new initiatives such as market, women’s self-help agencies, Government’s new policy and NGOs have been playing crucial role to change in the institutions that resulted into women’s capability enhancement.

Self-stigma and empowerment in combined-CMHA and consumer-run services: two controlled trials.

Self-help agencies (SHAs) are consumer-operated service organizations managed as participatory democracies involving members in all management tasks. Hierarchically organized board- and staff-run consumer-operated service programs (BSR-COSPs) are consumer managed, but they afford members less decision-making power. This study considered the relative effectiveness of SHAs and BSR-COSPs working jointly with community mental health agencies (CMHAs) and the role of organizational empowerment in reducing self-stigma. Clients seeking CMHA services were assigned in separate randomized controlled trials to a trial of combined SHA and CMHA services versus regular CMHA services (N=505) or to a trial of combined BSR-COSP and CMHA services versus regular CMHA services (N=139). Self-stigma, organizational empowerment, and self-efficacy were assessed at baseline and eight months with the Attitudes Toward Persons With Mental Illness Scale, the Organizationally Mediated Empowerment Scale, and the Self-Efficacy Scale. Outcomes were evaluated with fully recursive path analysis models. SHA-CMHA participants experienced greater positive change in self-stigma than CMHA-only participants, a result attributable to participation in the combined condition (b=1.20, p=.016) and increased organizational empowerment (b=.27, p=.003). BSR-COSP-CMHA participants experienced greater negative change in self-stigma than CMHA-only participants, a result attributable to participation in the combined service (b=-4.73, p=.031). In the SHA-CMHA trial, participants showed positive change in self-efficacy, whereas the change among BSR-COSP-CMHA participants was negative. Differential organizational empowerment efforts in the SHA and BSR-COSP appeared to account for the differing outcomes. Members experienced reduced self-stigma and increases in self-efficacy when they were engaged in responsible roles.

Are All Consumer-Operated Programs Empowering Self-Help Agencies?

The literature on consumer-operated-service programs (COSPs) distinguishes two organizational types based on their leadership styles: the self-help agency (SHA)–participant democracy and the board–staff-run COSP. This study considers whether the characteristics of these two organizational leadership styles are recognized by members and whether these characteristics are associated with membership degree of empowerment. Two-hundred and fifty new entrants to five COSP drop-in centers rated the programs' leadership style using the COPES System Maintenance Scale and assessed their own empowerment on four empowerment measures. ANOVA with Bonferroni post-hoc tests were used to evaluate differences between settings; MANCOVA to assess differences in member empowerment. COSP system maintenance differences distinguished the two organizational types (p < .000). SHA–participant democracy members scored significantly better than board–staff-run program members on three of the four empowerment measures. SHA–participant democracies, with a lower focus on system maintenance, and an emphasis on power sharing between staff and non-staff members, appeared to more effectively use organizational decision-making processes to empower their members.

Self-Help and Community Mental Health Agency Outcomes: A Recovery-Focused Randomized Controlled Trial

Self-Help and Community Mental Health Agency Outcomes: A Recovery-Focused Randomized Controlled Trial

Self-Help and Community Mental Health Agency Outcomes: A Recovery-Focused Randomized Controlled Trial

Self-help agencies (SHAs) are consumer-operated service organizations managed as participatory democracies. Members are involved in all aspects of organizational management, because a premise of SHAs is that organizationally empowered individuals become more empowered in their own lives, which promotes recovery. The study sought to determine the effectiveness of combined SHA and community mental health agency (CMHA) services in assisting recovery for persons with serious mental illness. A weighted sample of new clients seeking CMHA services was randomly assigned to regular CMHA services or to combined SHA-CMHA services at five proximally located pairs of SHA drop-in centers and county CMHAs. Member-clients (N=505) were assessed at baseline and at one, three, and eight months on five recovery-focused outcome measures: personal empowerment, self-efficacy, social integration, hope, and psychological functioning. Scales had high levels of reliability and independently established validity. Outcomes were evaluated with a repeated-measures multivariate analysis of covariance. Overall results indicated that combined SHA-CMHA services were significantly better able to promote recovery of client-members than CMHA services alone. The sample with combined services showed greater improvements in personal empowerment (F=3.99, df=3 and 491, p<.008), self-efficacy (F=11.20, df=3 and 491, p<.001), and independent social integration (F=12.13, df=3 and 491, p<.001). Hopelessness (F=4.36, df=3 and 491, p<.005) and symptoms (F=4.49, df=3 and 491, p<.004) dissipated more quickly and to a greater extent in the combined condition than in the CMHA-only condition. Member-empowering SHAs run as participatory democracies in combination with CMHA services produced more positive recovery-focused results than CMHA services alone.

Goal Achievement and the Accountability of Consumer-Run Organizations

This study explores how consumer-run organizations (CROs) can maintain independence while meeting the accountability needs of funding agencies. The importance of both funding agency needs for accountability and CRO needs for independence are discussed. A goal-tracking process is proposed as a potential strategy for balancing the potentially conflicting needs of accountability and independence. To demonstrate the utility of the goal tracking approach, this study analyzes goal tracking documentation in 3 years of quarterly reports from 21 CROs (also known as consumer drop-in centers and self-help agencies). Results detail the different goals of CROs. A 68% goal achievement rate suggests general organizational competence. Furthermore, CRO operations appear to be relatively cost-efficient, with an average of $11.51 spent per person per day. The analysis of quarterly reports leads to a discussion of several insights that may be useful to CROs, funding agencies, researchers, and mental health professionals.

Involvement With the Criminal Justice System Among New Clients at Outpatient Mental Health Agencies

This study assessed involvement with the criminal justice system among new clients of community mental health centers and self-help agencies in order to determine the characteristics and service needs of this population. Such information has implications for improving the care available for persons with mental illness who have been involved with the criminal justice system. Interview assessments and criminal records were obtained for 673 new clients of 21 outpatient mental health agencies. Descriptive statistics, chi square tests, and multivariate analysis of variance were used to describe these new help-seekers and their involvement with the criminal justice system. A total of 303 study participants (45 percent) had at least one contact with the criminal justice system before arriving at the agency, with an approximately equal percentage at community mental health centers and self-help agencies. The mean+/-SD number of contacts with the criminal justice system was 7.81+/-9.12. A total of 240 individuals (36 percent) had at least one criminal conviction, including 128 (19 percent) with a felony conviction. Common charges and convictions included petty theft, assault and battery, felony theft, narcotics offenses, and misdemeanor drug offenses. Clients who had been involved with the criminal justice system were more likely to be homeless, to have drug dependence, to have greater psychological disability, and to have less personal empowerment than other clients. The population overlap between the mental health system and criminal justice system and the multiple problems facing criminally involved clients argues for greater collaboration between the two systems and a comprehensive package of services to meet the multiple needs of this population. The equal distribution of these individuals and similar offense patterns at both types of agencies necessitates further consideration of the role that nontraditional service providers have in serving individuals with a history of involvement with the criminal justice system.

Predictors of Hope Among Members of Mental Health Self-Help Agencies

Hope is a key construct for successful community adjustment among those with severe mental illnesses, particularly given the strengths-based recovery model increasingly prevalent in mental health services and in social work. Consumer-run mental health self-help agencies (SHAs) are well suited to fostering hope via their supportive program environments. This study examines factors associated with hope among members of four self-help agencies via a two-stage least squares regression model (N =310). Findings provide evidence of both individual and program-level associations with hope. These findings mirror social work ethical values of focusing on consumer strengths and self-determination, which are primary goals of SHAs.

African-Americans and comprehensive service use.

This study examined African-Americans' use of comprehensive mental health services. 248 long-term users of self-help agencies (SHAs) were interviewed about their use of 37 different mental health services from various providers in a six-month period. Multiple regression analysis showed that the homeless and African-Americans were the high users in our sample. A subsequent MANOVA procedure suggested that this may be the result of African-Americans' increased use of SHAs. While African-Americans are low service users in traditional studies focusing on a narrow list of services and providers, this research argues for including SHAs in future studies of African-American service use.

Community membership and social networks in mental health self-help agencies.

This article explores community membership among self-help agency (SHA) participants. It is suggested that SHAs foster the enhancement of peer-oriented social networks, leading to the experience of shared community. Social network analysis was used to examine the structure of support mechanisms, and to assess levels of community membership through peer inclusion. Results indicate that both individual and organizational characteristics play roles in predicting peer presence in social networks. Organizational empowerment is a key factor, with the SHA emerging as a promising locus for peer support development through enhanced social networks. Implications for the organization of consumer-based services are discussed.

Substance use and mental disorder diagnostic profiles in a sample of long-term self-help agency users.

This study examined the prevalence of substance use and mental disorder profiles in a sample of mental health self-help attendees. Findings demonstrate that the rates of these disorders are equivalent to or exceed those found in clinical and community samples. Implications for the role that self-help agencies play in the lives of vulnerable individuals, as well as the justification for increased funding from drug and alcohol treatment sources, are discussed.

Determinants of client outcomes in self-help agencies.

This study assessed the relationship between the outcomes of clients of client-run self-help agencies and attendance at the agency, satisfaction with the agency, psychological disability, and organizationally mediated empowerment, that is, the provision of opportunities for clients to meaningfully participate in decisions about their care and the care of others in the agency. The outcomes assessed were independent social functioning, assisted social functioning, and personal empowerment. A total of 255 long-term users of four self-help agencies were interviewed at baseline and six months later. Univariate descriptive analyses as well as t tests describing changes in outcomes were conducted. The relationship of each of the four determinants to the three outcomes, after controlling for baseline status on the given outcome and other covariates, was assessed with structural modeling using Amos software. On average, personal empowerment among the clients of the self-help agencies increased, independent social functioning remained the same, and assisted social functioning decreased during the six-month follow-up period. Multivariate analyses showed a positive association between organizationally mediated empowerment and all three outcomes. The significant ingredient promoting positive outcomes for clients of self-help agencies appears to be the provision of opportunities for clients to meaningfully participate in decisions about their care and the care of others in the organization.

Goal advancement among mental health self-help agency members.

Goal advancement is critical to mental health clients' reintegration into the community. This research considers factors likely to contribute to goal advancement among members of four consumer-run mental health self-help agencies (SHAs) who responded to questions about their goals at baseline and six-month follow-up. Type of goals, demographics, psychiatric disability, agency characteristics, and members' attitudes toward professionals were used to predict goal advancement. Surprisingly, faith in the psychiatrist as the source of responsibility for treatment decisions was associated with goal advancement. This is contrary to SHA ideology, which emphasizes peer-driven help. Other findings are also discussed.

Factors in decisions to seek help from self-help and co-located community mental health agencies.

This study examined 673 new users of co-located mental health self-help agencies run by consumers and community mental health agencies to evaluate the relative importance of predisposing, enabling, and need factors in site selection. Although need dominated help site choice, clients' attitudes toward the helpfulness of mental health treatment and their fears of coerced or inadequate care played an important role in setting choice, a choice indicative of a more complex motivational dynamic in help seeking.

Measuring Clients' Satisfaction With Self-Help Agencies

Clients' satisfaction with their involvement in treatment decisions has been largely overlooked in the formulation of satisfaction measures. The authors describe the development of a scale that assesses clients' satisfaction with services and with their involvement in treatment decisions. Long-term users of four client-operated mental health self-help agencies were interviewed at baseline (N=310) and six months (N=248) using the 11-item Self-Help Agency Satisfaction Scale (SHASS). The scale was developed on the basis of consumers' input about their satisfaction with services and their involvement in treatment decisions. To explore the relationship between satisfaction as measured by the SHASS and outcomes, the six-month interview included four outcome measures-independent and assisted social functioning, symptom severity, and a sense of personal empowerment. Internal consistency, stability, and discriminant validity were evaluated. Factor analyses confirmed that the SHASS has two subscales, one assessing service satisfaction and the other assessing satisfaction with involvement in treatment decisions. The scale and its subscales showed high internal consistency, moderate stability, and discriminant validity. The SHASS subscales showed modest associations with two of four outcome measures-assisted and independent social functioning. The SHASS is a brief instrument that can be used to measure clients' satisfaction with their involvement in treatment in mental health self-help agencies.

Social Work in Mental Health

Contents Social Work in Mental Health: Trends and Issues* Recovery and Empowerment for People with Psychiatric Disabilities * Community Care and the Origins of Psychiatric Social Work * Strategies for Helping Young Adults with Severe Mental Disorders * Social Networks and Psychological Disability Among Housed and Homeless Users of Self-Help Agencies * Discharge Planning and Community Housing in Ontario * Working Collaboratively with Families * The Universality of Self-Help Program of American Origin: Narcotics Anonymous in Israel * The Ethics of Informed Consent: A Critical Variable in the Self-Determination of Health and Mental Health Clients * Revamping Mental Health Care in Israel: From the Netanyahu Commission to National Health Insurance Law * Index

Social Networks and Psychological Disability Among Housed and Homeless Users of Self-Help Agencies

SUMMARY We look at the effects of psychological disability on social networks and support of homeless and non-homeless individuals. We analyze a survey of 310 long-term users of client-run mental health agencies. Psychological disability is negatively associated with network characteristics for housed individuals, but not for the homeless. There is a positive relationship between psychological distress and network size for the homeless who receive SSI while homeless individuals who do not receive SSI show a negative, non-significant association. We suggest the financial resources of SSI enable network members to become expressively involved with homeless individuals with relatively more psychological disturbance.

Program environments of self-help agencies for persons with mental disabilities.

Leaders of self-help agencies (SHAs) aspire to develop program environments that are different from community mental health agencies (CMHAs). This article addresses two questions. Do consumers' perceptions of SHAs approximate the characteristics leaders think ought to typify such agencies? Do SHA and CMHA consumers differ in their program perceptions? Using the Community-Oriented Program Environment Scale, leader expectations of ideal SHA environments were obtained from a national survey of 189 consumer-run agency heads, perceptions of actual environments from interviews with 310 SHA consumers, and perceptions of CMHAs from questionnaire responses of 779 consumers in 54 programs. SHA reality conforms to ideology in offering opportunities for consumers to experience involvement, support, and autonomy in the receipt of needed service. While showing only modest differences from CMHAs on relationship and treatment characteristics, SHA consumers differ in their perceived control over program rules, a fact previously found significant in promoting positive outcomes.

Measuring empowerment in client-run self-help agencies.

"Empowerment" connotes a process of gaining control over one's life and influencing the organizational and societal structures in which one lives. This study defines and validates three measures: the Personal Empowerment Scale, the Organizational Empowerment Scale, and the Extra-Organizational Empowerment Scale. Measurement efforts are based on observational work, baseline interviews (N = 310), and six month follow-ups (N = 241) in four client-run self-help agencies (SHAs) for persons with severe mental disabilities. All three study scales demonstrated strong internal consistency and stability. They were sensitive to user changes over time and have construct validity.

Empowerment and Self-help Agency Practice for People with Mental Disabilities

During the past 15 years, there has been tremendous growth in the number of self-help groups and agencies for mental health clients. This article examines the self-help perspective in relation to problems with traditional mental health services and the need for client-run services. Self-help agencies see their goal as empowerment on an individual, organizational, and societal level. They strive to accomplish this by helping members obtain needed resources and develop coping skills; providing means of enhancing members' self-concept and lessening the stigma of perceived mental disability; giving members control in the agencies' governance, administration, and service delivery; and furthering member involvement in social policy-making. The goal of this article is not to endorse the self-help perspective but to use it as the basis for raising research questions that will further the mental health practitioner's understanding of this service modality.