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Biomedical subjects

G R Bond

Publications and source records attributed to G R Bond.

At least 19 recordsLinked to original sources
PubMed1998

Job terminations among persons with severe mental illness participating in supported employment.

For persons with psychiatric disabilities, maintaining a job is often more difficult than acquiring a job. A large proportion of jobs end unsatisfactorily. This study explored job terminations among 63 persons with severe mental illness who participated in competitive jobs through supported employment programs. More than half of the job terminations were unsatisfactory, defined as the client quitting without having other job plans or being fired. Baseline ratings of demographic and clinical characteristics, preemployment skills training, and early ratings of job satisfaction and work environment did not predict unsatisfactory terminations. Clients with better work histories were less likely to experience unsatisfactory terminations. In addition, unsatisfactory terminations were associated retrospectively with multiple problems on the job that were related to interpersonal functioning, mental illness, dissatisfaction with jobs, quality of work, medical illnesses, dependability, and substance abuse. These results suggest that supported employment programs need to address job maintenance with interventions that identify and address different types of difficulties as they arise on the job.

Adult↗
PubMed1998

Program fidelity in assertive community treatment: development and use of a measure.

Assertive community treatment (ACT) is a complex community-based service approach to helping people with severe mental disorders live successfully in the community. Effective replication of the model and research on critical elements require explicit criteria and measurement. A measure of program fidelity to ACT and the results of its application to fifty diverse programs are presented.

Community Mental Health Services↗
PubMed1998

Transferring clients from intensive case management: impact on client functioning.

The effects of transferring clients from assertive community treatment to a less intensive (step-down) case management program were examined. Service use decreased significantly after transfer to the step-down program, and no negative effects of transfer on hospital use or client functioning were evident. Critical elements for successful step-down are suggested and discussed.

Adult↗
PubMed1998

Methodological issues in assertive community treatment studies.

Recent evaluations of ACT programs have produced equivocal findings, often leading to the invocation of methodological problems as responsible for the lack of positive results. This paper discusses issues of theory and methodology as they pertain to improving research of ACT, with particular attention paid to issues of sampling, process evaluation, measurement, and data analysis.

Bias↗
PubMed1998

Models of community care for severe mental illness: a review of research on case management.

We describe different models of community care for persons with severe mental illness and review the research literature on case management, including the results of 75 studies. Most research has been conducted on the assertive community treatment (ACT) or intensive case management (ICM) models. Controlled research on ACT and ICM indicates that these models reduce time in the hospital and improve housing stability, especially among patients who are high service users. ACT and ICM appear to have moderate effects on improving symptomatology and quality of life. Most studies suggest little effect of ACT and ICM on social functioning, arrests and time spent in jail, or vocational functioning. Studies on reducing or withdrawing ACT or ICM services suggest some deterioration in gains. Research on other models of community care is inconclusive. We discuss the implications of the findings in terms of the need for specialization of ACT or ICM teams to address social and vocational functioning and substance abuse. We suggest directions for future research on models of community care, including evaluating implementation fidelity, exploring patient predictors of improvement, and evaluating the role of the helping alliance in mediating outcome.

Activities of Daily Living↗
PubMed1998

Review of integrated mental health and substance abuse treatment for patients with dual disorders.

Patients with severe mental disorders such as schizophrenia and co-occurring substance use disorders traditionally received treatments for their two disorders from two different sets of clinicians in parallel treatment systems. Dissatisfaction with this clinical tradition led to the development of integrated treatment models in which the same clinicians or teams of clinicians provide substance abuse treatment and mental health treatment in a coordinated fashion. We reviewed 36 research studies on the effectiveness of integrated treatment for dually diagnosed patients. Studies of adding dual-disorders groups to traditional services, studies of intensive integrated treatments in controlled settings, and studies of demonstration projects have thus far yielded disappointing results. On the other hand, 10 recent studies of comprehensive, integrated outpatient treatment programs provide encouraging evidence of the programs' potential to engage dually diagnosed patients in services and to help them reduce substance abuse and attain remission. Outcomes related to hospital use, psychiatric symptoms, and other domains are less consistent. Several program features appear to be associated with effectiveness: assertive outreach, case management, and a longitudinal, stage-wise, motivational approach to substance abuse treatment. Given the magnitude and severity of the problem of dual disorders, more controlled research on integrated treatment is needed.

Case Management↗
PubMed1997

Estimated use of a pediatric emergency department observation unit.

STUDY OBJECTIVE: To estimate the use of a pediatric ED observation unit, including the number of anticipated admissions per 10,000 pediatric ED visits per year and the distribution of those admissions by age group, by month, and by time of day. METHODS: Hospital and ED computer records on all ED patients younger than 18 years who were seen during a 2-year period were abstracted for diagnostic, demographic, and time-flow data. We retrospectively reviewed the charts of patients admitted to the hospital and discharged within 24 hours to determine whether discharge in less than 24 hours could have been anticipated and whether the patient could have been cared for in a pediatric ED observation unit. To refine the estimate, we also reviewed the ICD-9 discharge diagnoses of patients who were not admitted to the hospital but spent more than 6 hours in the pediatric ED. RESULTS: Of 29,667 pediatric ED visits in a 2-year period, 2,940 (10%) resulted in admission. Of 626 patients discharged in less than 24 hours, only 410 met the anticipation and pediatric ED observation unit level of care criteria. Patients younger than 4 years represented 43% of potential observation unit patients; those aged 16 and 17 years represented 15%. Potential use of an observation unit varied throughout the year. Admission occurred between 3 and 11:59 PM in 60% of the patients. Only 20% of the 176 patients who were not admitted to the hospital but spent more than 6 hours in the pediatric ED were estimated to be candidates for a pediatric ED observation unit. CONCLUSION: On the basis of these data, approximately 150 patients per 10,000 each year who visit the University of Virginia pediatric ED would be likely to use an observation unit. Staffing and facility use would be seasonally uneven and would be required during the busiest part of the day. Furthermore, even in a pediatric ED large enough to admit 365 pediatric ED observation unit patients each year, random daily variation in demand means that a single bed would be inadequate 25% of the time and empty 37% of the time. Optimal use of even a single-bed pediatric ED observation unit would not occur until pediatric ED census exceeded 30,000 to 40,000 visits annually.

Adolescent↗
PubMed1997

The association between program characteristics and service delivery in assertive community treatment.

The authors describe the relationship between service intensity and staffing, organizational, client, and site characteristics in 19 programs based on the Thresholds Bridge adaptation of the assertive community treatment (ACT) model. Pearson correlations were examined between 14 program characteristics and intensity of ACT services. Several staffing and organizational attributes were related to service intensity: larger team size, shared caseloads, greater supervisor involvement in direct client services, and assignment of primary responsibility for the client to the team. The potential facilitating relationship between several aspects of team operation and intensive services is discussed as are implications for local implementation of ACT.

Community Mental Health Services↗
PubMed1997

Implementing assertive community treatment programs in rural settings.

The authors present a controlled evaluation of a rural adaptation of the assertive community treatment (ACT) model for clients with serious and persistent mental illness (SPMI). Four community mental health settings adopted an ACT model, while a fifth site blended ACT principles with those of the Rhinelander model, another approach to case management for persons with SPMI. A broad array of client and system outcomes were evaluated at 6, 12, and 24 months into the intervention. Twelve-month findings alerted us to potential problems in implementing the treatment model in study year 1; the implementation was qualitatively evaluated and weaknesses were addressed at the beginning of the second treatment year. Small, positive findings at 24 months suggested that the mid-study course correction may have had an impact. We present these findings along with descriptive data on the challenges of implementing complex services models. We give particular attention to describing implementation barriers to mental health services provision that are uniquely rural.

Adult↗
PubMed1997

Work and nonvocational domains of functioning in persons with severe mental illness: a longitudinal analysis.

In this study we sought to understand the relationship between obtaining competitive employment and changes in nonvocational domains of functioning (symptoms, substance abuse, hospitalizations, self-esteem, quality of life) in persons with severe mental illness. A group of 143 unemployed patients participating in a study of vocational rehabilitation programs were assessed in nonvocational areas of functioning at baseline and 6, 12, and 18 months later. Statistical analyses examined the relationship between work status at the follow-up assessments and nonvocational functioning, controlling for baseline levels of nonvocational variables. Patients who were working at follow-up tended to have lower symptoms (particularly thought disorder and affect on the Brief Psychiatric Rating Scale), higher Global Assessment Scores, better self-esteem, and more satisfaction with their finances and vocational services than unemployed patients. Employment is associated with better functioning in a range of different nonvocational domains, even after controlling for baseline levels of functioning.

Activities of Daily Living↗
PubMed1997

An update on supported employment for people with severe mental illness.

OBJECTIVE: This review examines the effectiveness of supported employment for people with severe mental illness. METHODS: A comprehensive search was made for quantitative studies, primarily in the published literature. RESULTS: Seven descriptive studies, three surveys, one quasi-experimental study, and six experimental studies were found. All studies suggested significant gains in obtaining employment for persons enrolled in supported employment programs. In experimental studies, a mean of 58 percent of clients in supported employment programs achieved competitive employment, compared with 21 percent for control subjects, who typically received traditional vocational services. Employment outcomes relating to time employed and employment earnings also favored clients in supported employment over control subjects. No evidence was found that supported employment led to stress levels precipitating higher rehospitalization rates. Two features of many supported employment programs have the most empirical support: integration of mental health and vocational services within a single service team and the avoidance of preplacement training. Two other widely held principles-ongoing support and attention to client preferences-have not been systematically evaluated. CONCLUSIONS: Supported employment appears to be a promising approach for people with severe mental illness, but more studies are needed, with close attention to program implementation and long-term follow-up.

Employment↗
PubMed1996

Meta-analytic evaluation of skills training research for individuals with severe mental illness.

A meta-analysis of 68 studies examined the effectiveness of skills training for individuals with severe mental illness and the influence of such factors as methodological rigor, choice of outcome measures, and service settings. The methodological quality of these studies was generally very good. Skills training was found to be moderately to strongly effective in increasing skill acquisition and reducing psychiatric symptoms. However, effect size varied by type of outcome measure, with situationally specific measures yielding larger effects than measures of skill usage and role functioning. Studies rarely examined whether acquired skills were used outside the training setting. Surprisingly, most studies were confined to inpatient settings, and most focused exclusively on social skills. Implications are discussed for future research.

Humans↗
PubMed1996

Job preferences of clients with severe psychiatric disorders participating in supported employment programs.

OBJECTIVE: The job preferences of adults with severe mental illness who were participating in supported employment programs were examined. METHODS: Data were collected on job preferences, attainment of competitive employment, job satisfaction, and job tenure of 135 adults who participated in two supported employment programs in New Hampshire. Data obtained at baseline and at six-month follow-up were analyzed. RESULTS: When the clients entered the supported employment programs, 81 percent expressed job preferences, and their preferences tended to be realistic and stable. People who obtained employment in preferred areas were more satisfied with their jobs and remained in their jobs twice as long as those who worked in nonpreferred areas. Clients were more likely to develop a new job preference or to change their preference if they participated in a program that emphasized rapid job search than if they participated in a prevocational skills training program. They were also more likely to develop a preference or change their preference if they obtained a competitive job. CONCLUSIONS: Helping people with severe mental illness obtain competitive jobs that correspond with their explicit job preferences increases job satisfaction and tenure. Job preferences are more likely to develop or change through searching for a job or working at a job than through prevocational training.

Adult↗
PubMed1996

Hepatitis, rash and eosinophilia following trichloroethylene exposure: a case report and speculation on mechanistic similarity to halothane induced hepatitis.

CASE REPORT: A previously healthy 30-year-old male began work as a degreaser. The solvent used in the degreasing operation was trichloroethylene. Over the next month he experienced symptoms of weakness, dizziness, decreased appetite, nausea, abdominal pain, diarrhea, fever, chills, dry skin, red rash with bumps, peeling face, and itching. At that time he had marked liver enzyme elevation without evidence of cholestasis. CBC was remarkable for a significant number of atypical lymphocytes. Two weeks later his liver enzymes showed a marked reduction in ALT from a peak of 1250 IU to 717 IU. Tests for Hepatitis A, B, and C, CMV, HIV1 were all negative. The night following his first day back at work he had a recurrence of a red, diffuse rash without any consumption of alcohol. The rash caused tremendous itching. Over the next few days off work the rash continued and peeled. Physical examination one week after re-exposure was remarkable for diffuse, erythematous rash; some peeling skin and pitting edema to the knees. ALT was 517 IU/L. White blood cell count was 10,100/mm3 with 27% eosinophilia. CONCLUSION: This patient had possibly experienced sensitization to trichloroethylene, or more likely, to one of its metabolites. Similar symptoms attributed to trichloroethylene have been reported in only a few other patients. Patch testing with trichloroethylene and its metabolites may better clarify a causal relationship in future patients. If an immune mechanism is involved it may be similar to one postulated for halothane induced hepatitis.

Adult↗
PubMed1995

Critical ingredients of assertive community treatment: judgments of the experts.

Twenty experts on assertive community treatment (ACT) rated the importance of 73 program elements, also indicating ideal model specifications (e.g., minimum time commitment for psychiatrist) when appropriate. Interexpert agreement on ratings of importance was high (intraclass r = .94), although there was less agreement for some areas--for example, team structure (intraclass r = .70). Survey responses suggested several areas of increasing emphasis (e.g., vocational and addictions specialists) and of decreasing emphasis (e.g., the avoidance of office visits). Two subgroups of experts were identified--those who advocated large multidisciplinary teams (100 or more clients) and day and evening shifts, and those who advocated smaller, often generalist, teams (approximately 50 clients). Experts also reported ideal staffing for an ACT team. The most frequently identified disciplines were psychiatrist, nurse, and social worker. Implications for mental health policy--for example, quality assurance and program standards--are discussed.

Assertiveness↗
PubMed1995

Assertive outreach for frequent users of psychiatric hospitals: a meta-analysis.

A meta-analysis was conducted on nine studies of an assertive outreach model for frequent users of psychiatric hospitals. Four studies used experimental or quasi-experimental designs and five used pre-post designs. Findings at one-year follow-up were examined for retention in community mental health services, psychiatric inpatient days, quality of life, and client level of functioning. Eighty-four percent of assertive outreach clients were still receiving mental health services after one year, compared to 54% of controls. In two thirds of the programs, the mean annual rate of inpatient days declined by 50% or more. The overall experimental effect size for quality of life was negligible, although changes over time for assertive outreach clients were more encouraging. Similarly, improvement in level of functioning was found for assertive outreach clients. The study examining experimental differences in level of functioning obtained a nonsignificant moderate effect.

Chicago↗
PubMed1995

Home use of syrup of ipecac is associated with a reduction in pediatric emergency department visits.

STUDY OBJECTIVE: To determine whether home use of syrup of ipecac is safe and effective in reducing pediatric emergency department visits. DESIGN: Retrospective, multicenter comparison based on secondary use of a large database. PARTICIPANTS: Children younger than 6 years after acute, accidental ingestion of a pharmaceutical product. INTERVENTIONS: 1990 Data corresponding to the study patients from seven regional poison centers were obtained from the American Association of Poison Control Centers. Poison center management choices (particularly use of syrup of ipecac for home decontamination) and characteristics (distribution of pharmaceutical ingestions managed, work volume per staff, staff experience, and training of decision-making director) were analyzed for their impact on the decision to refer a patient to a health care facility or to manage the patient at home. Statistical techniques included weighted least-squares regression analysis using logistic transformation of dependent variables and the forward selection procedure. Adverse patient outcome was defined as moderate effect, major effect, or death (American Association of Poison Control Centers coding criteria). RESULTS: In all, 55,436 children were included in the analysis (range, 3,839 to 12,691 per poison center). The distribution of medications ingested was similar among centers. Increased home use of syrup of ipecac, decreased frequency of ingestion of "high-risk" drugs, and increased staff experience were associated with decreased referral to a health care facility (P < .0001 for each variable). The forward selection procedure determined that syrup of ipecac use explained 45% of the variation in the poison center referral rates. The percentage of drugs defined as high-risk accounted for an additional 31%, and staff experience accounted for another 10% of the variation. Outcome of patients was excellent. No child died. Two home-managed patients had a major effect, and 26 had a moderate effect. CONCLUSION: Centers that recommended home use of syrup of ipecac more frequently were able to manage childhood poisoning more cost-effectively, without a decrease in safety. Although increased home management was strongly associated with syrup of ipecac use, the reason for this relationship cannot be determined from the data. Management by experienced professionals also contributed to cost-effectiveness.

Child, Preschool↗