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Biomedical subjects

J Draine

Publications and source records attributed to J Draine.

At least 19 recordsLinked to original sources

Self-help groups for families of persons with mental illness: perceived benefits of helpfulness.

Self-help groups have become important resources for families of persons with mental illness. The present study was an attempt to understand the factors perceived by group members as helpful using Yalom's factors in clarifying the dynamics of groups. Members (N = 202) of the Alliance for the Mentally Ill of Pennsylvania (AMI of PA), an association of self-help groups for families of the mentally ill, were recruited and responded to a self-administered questionnaire. Hierarchical block multiple regression indicated that those AMI members who felt information provision and gaining support and self-understanding from the group process was helpful and were longer term participants in their group were more likely to perceive benefit from belonging to the group. The findings may provide the basis for evaluating and improving self-help group effectiveness and contribute to understanding process factors within a self-help group which members find beneficial. Implications for how these groups can attract and maintain members are discussed.

Adult

Using clinical and criminal involvement factors to explain homelessness among clients of a psychiatric probation and parole service.

This study sought to examine the rate of homelessness and the extent to which lifetime homelessness was associated with clinical factors, such as diagnosis and treatment history; or criminal factors, such as criminal behavior and arrest history, among psychiatric probationers and parolees. Nearly half of the clients screened had experienced homelessness in their lifetime. In a logistic regression model to explain lifetime homelessness, significant factors were younger age, less education, a greater number of lifetime arrests, a schizophrenia diagnosis, and reporting both an alcohol and drug problem. Implications for service delivery with this population are discussed.

Adult

Describing and evaluating jail diversion services for persons with serious mental illness.

Despite efforts over the last 30 years to promote diversion from jail for individuals with serious mental illness who have engaged in criminal behavior, few jail diversion programs have been adequately studied. To guide development of jail diversion services and encourage empirical research on their effectiveness, the authors describe the overall concept of jail diversion and the basic operations of such a program. They also outline research issues in evaluating the effectiveness of jail diversion programs, including problems encountered in randomized field trials and quasiexperimental designs. Implications of jail diversion services for mental health professionals include learning how to collaborate with law enforcement personnel, sufficiently integrating mental health and substance abuse services into the criminal justice system despite segregated funding streams, and ensuring that clients who are intensively monitored are also provided with adequate treatment to avoid jail recidivism.

Commitment of Persons with Psychiatric Disorders

Explaining lifetime criminal arrests among clients of a psychiatric probation and parole service.

This study examines the extent to which sociodemographic characteristics, clinical characteristics, substance abuse problems, and the array of lifetime criminal behavior may explain lifetime arrests among offenders supervised by the psychiatric probation and parole service. Three hundred twenty-five clients with new cases at a psychiatric probation and parole service in a large urban center were screened for major psychiatric disorders. They were also interviewed for socio-demographic characteristics, mental health treatment history, criminal behavior, and arrest history. Hierarchical block multiple regression analysis tested a model explaining lifetime arrests. After controlling for age and other demographic variables, the number of lifetime psychiatric hospitalizations and lifetime occurrences of mania diagnosis significantly explained lifetime arrests. The total model explained about 10 percent of the variance in lifetime arrests after controlling for opportunity variables, which explained 45 percent. The explanatory power of lifetime hospitalizations and mania support the contention that symptoms, rather than diagnosis, may be the most important clinical factor in explaining criminal arrest among persons with mental illness. Implications for psychiatric services include the development of effective jail diversion programs.

Adult

Consumers as providers in psychiatric rehabilitation.

Issues that arise in employing consumers as providers in psychiatric rehabilitation programs include readiness of the sponsoring agency, consumer disclosure, and adjustments in employment practices. Psychiatric rehabilitation agencies are obligated to seriously consider employing consumers, since they frequently ask the same of the other organizations.

Attitude to Health

Increased contact with community mental health resources as a potential benefit of family education.

OBJECTIVE: This study examined the hypothesis that families of adults with severe mental illness who participate in either a group family education workshop or individual family consultation will try to seek more assistance from community services than those in a control group assigned to a waiting list. METHODS: A total of 225 family members who agreed to participate in the study were randomly assigned to one of three conditions: a ten-week group workshop, individual family consultation, or a waiting list (control group). Family members were interviewed about the extent of their contact with mental health professionals, providers, and community resources at baseline, termination of the interventions, and at six months after termination. RESULTS: No differences were found between conditions in the extent of family members' contact with three types of services: conventional, psychosocial, and ancillary mental health services. CONCLUSIONS: Neither of the educational interventions produced any change in behaviors of families seeking advice and assistance on behalf of their ill relative from the three types of services examined. Modifications in the interventions may be worthwhile. Increasing family members' contacts with community resources on behalf of their ill relative may increase the benefits of the intervention to the family as well as to the ill relative.

Adult

Conceptualizing services research on outpatient commitment.

Issues affecting the research of outcomes of involuntary outpatient commitment (OC) of persons with serious mental illness are explored. These issues include the reliance on hospital recidivism as a primary measure of outcome, the role of family members and coercion in the process of outpatient commitment, and the conceptualization and design of studies. A conceptual framework that attempts to incorporate responses to these issues is proposed. Continued research on OC should build on conceptual models that include family role and burden, services delivered, an accounting for varied coercive mechanisms, and client-level outcomes. Rehospitalization should be conceptualized as an intermediate variable between OC and client-level outcomes rather than as an ultimate outcome.

Ambulatory Care

Applying research on family education about mental illness to development of a relatives' group consultation model.

Results from a random field trial of family education interventions were applied to create a new model of family education programs. This paper reviews the family education literature, the random field trial results, and the pre-piloting of an adapted service model called group consultation. The new model emphasizes a more interactive approach to the conventional group workshop model as opposed to adherence to a pre-planned curriculum. Pre-pilot group participants were all past members of group workshops. In a process evaluation these group members were questioned about their reactions to the new group format and its usefulness.

Family Health

Effectiveness of two models of brief family education: retention of gains by family members of adults with serious mental illness.

The retention of benefits from two models of family education was compared with maturational effects in an untreated control group. The three-month interventions showed an initial effect for self-efficacy regarding a mentally ill relative that did not significantly diminish during the following six months. However, no significant differences on this measure were found between the treated groups and the untreated controls. Ways of refining the interventions and measures so as to improve gains and retain them over time are discussed.

Adaptation, Psychological

Examination of grief among family members of individuals with serious and persistent mental illness.

Many family members experience a profound sense of loss when a relative becomes mentally ill. The adjustment to this loss is similar to grief as a response to death. The extent of this grief may be explained by personal characteristics of family members, the severity of the illness, and the extent of social support available. A family member's emotional response to a relative's mental illness may be exacerbated by increases in both objective and subjective burden. While grief among families with a seriously mentally ill relative is the emotional response to reflecting on the loss of an emotionally healthy relative, burden reflects the present state of responsibility for the ill relative, expressed in both subjective and objective terms. In this study, family member characteristics, social support, objective burden and subjective burden contributed to explaining expressed grief among 225 family members of seriously mentally ill individuals. Mental health and family support professionals are encouraged to recognize the grief response in family members with a mentally ill relative.

Caregivers

Perspectives concerning consumers as case managers.

Consumer and non-consumer case managers participating in a randomized trial of consumer case management were interviewed regarding their perceptions of consumer and non-consumer case managers, their work and their clients. Consumer case managers were concerned about how they were accepted by other mental health professionals. The consumer team maintained less collateral contact with other professionals and more interpersonal contact with clients than the non-consumer team. Consumer case managers did not show any greater signs of stress, diminished self esteem, or burnout than non-consumer case managers.

Burnout, Professional

Case manager alliance with clients in an older cohort.

It was hypothesized that members of an older cohort of seriously mentally ill community mental health clients would develop stronger alliances with intensive case managers. Eighty-six clients participating in a study of case management services completed a measure of working alliance and structured interviews. It was found that older cohort clients, those age 45 or older, showed much stronger alliances with their case managers than younger clients.

Adult

Impact of brief family psychoeducation on self-efficacy.

One hundred eighty-three relatives of people with serious mental illnesses were randomly assigned to receive individualized consultation or group psychoeducation or were placed on a 9-month wait list. Analysis of variance and multiple regression revealed that the individualized consultation increased the family members' sense of self-efficacy regarding mentally ill relatives. Group psychoeducation was helpful in increasing self-efficacy of family members who had never participated in a support or advocacy group for relatives of psychiatrically disabled individuals.

Adult

Consumer case management and attitudes concerning family relations among persons with mental illness.

Data from 91 clients participating in a clinical trial of consumer case management services were analyzed to determine if there is a relationship between client satisfaction with family relations and the amount of community treatment services, including case management. It was found that clients' greater face to face contact with case managers was related to less satisfaction with family relations after one year of service. The analysis provides some support for the hypothesis that case managers may be serving some of the functions that have traditionally been served by the families of mentally ill clients. Another conclusion that could be supported by this analysis is that the degree of intensity of case management services has an impact on family relations.

Adult

The working alliance and consumer case management.

The Working Alliance Inventory was used to measure the strength of the therapeutic relationship between seriously mentally disabled case management clients and their case managers in a randomized trial of consumer-provided case management services. It was found that while there was no difference in the strength of the alliance between the consumer and nonconsumer teams of case managers, there were positive relationships between alliance and some outcomes, including quality of life, symptomatology, attitudes toward medication compliance, and satisfaction with mental health treatment.

Assertiveness

The efficacy of a consumer case management team: 2-year outcomes of a randomized trial.

This article reports the results of a randomized trial of a team of case managers who are mental health consumers compared to a team of nonconsumer. Using a repeated measures MANOVA design, consumer case managers were found to be as effective as a team of nonconsumer case managers in maintaining the stability of severely mentally disabled clients served over a 2-year period. Implications for the employment of consumers in mental health services and the vocational capacity of persons with mental illness are discussed.

Administrative Personnel

Subjective burden among family members of mentally ill adults: relation to stress, coping, and adaptation.

Among 225 family members participating in a study of psychoeducational interventions, 39% of the variance in subjective burden was explained by the severity of stressors related to the relative's illness and by mediators related to social support and coping capabilities. Interventions directed toward improving self-efficacy and coping strategies may be important mediators of subjective burden.

Adaptation, Psychological