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Biomedical subjects

J M Jerrell

Publications and source records attributed to J M Jerrell.

At least 19 recordsLinked to original sources
PubMed2000

Issues and outcomes in integrated treatment programs for dual disorders.

In an integrated, dual disorder treatment program delivered at two sites, the authors address numerous barriers to delivering services to dually diagnosed consumers and employ a set of multidimensional indicators to assess outcome. Consumers who received services through the well-implemented, integrated services program for 12 months were functioning better in the community. There was a cost shifting from mental health to drug and alcohol services, as well as a one-third increase in the total costs of care by the end of the first year of treatment. Program implementation issues are described and the clinical management implications for more effectively serving dually diagnosed consumers through integrated treatment programs are discussed.

Adolescent↗
PubMed1999

Impact of robustness of program implementation on outcomes of clients in dual diagnosis programs.

Three types of treatment-behavioral skills training, a 12-step recovery model, and intensive case management-provided to 132 clients at four facilities were identified as being robustly or not robustly implemented, depending on whether core elements of these treatments were emphasized. Outcomes and costs of services to clients were examined over 18 months. Clients receiving robustly implemented behavioral skills training had significantly higher psychosocial functioning and lower costs for supportive services than those receiving nonrobustly implemented training. Clients receiving robustly implemented case management also exhibited significantly higher psychosocial functioning and lower costs for intensive services than those in the nonrobust intervention. To be effective, dual diagnosis programs should better manage the robustness of implementation of planned interventions.

Adolescent↗
PubMed1998

Utilization management analysis for children's mental health services.

Efficient identification of high-cost child and adolescent consumers of public mental health services using existing utilization and cost data is illustrated, along with analyses that profile these high-cost consumers and demonstrate the effect on total service cost per client of providing case management. The results indicate that providing high levels of case management services is not correlated with reductions in total service costs and that there is a need in the service system for using high-cost case management review techniques to control service utilization and lower costs.

Adolescent↗
PubMed1998

Qualitative analysis of three case management programs.

Most investigations of case management service programs for people with severe mental illness lack detail about the specialized interventions employed, their key differences, and the changes they undergo over time. Qualitative data are presented which describe and compare three service approaches, and their relationship to quantitative outcomes from a cost-effectiveness study of the three models. The organization and functioning of the PACT Adaptation Model were most conductive to enhancing client psychosocial functioning and significantly reducing intensive mental health service costs. Outcomes for the Clinical Team and Intensive Broker Models were less consonant with the qualitative findings.

Adult↗
PubMed1998

Effect of ethnic matching of young clients and mental health staff.

The results of an analysis of factors affecting service use among children and adolescents suggest that those served by an ethnically matched therapist stay in outpatient treatment longer and use less day treatment service, a more intensive level of care. These findings support efforts to increase the number and type of ethnic staff delivering children's mental health services and to expand the types of culturally competent services available to children with mental health problems and their families.

Adolescent↗
PubMed1997

Dual diagnosis care for severe and persistent disorders. A comparison of three methods.

People with severe and persistent mental illnesses frequently suffer from addictive disorders as well. Managed care plans and at-risk providers who care for people with these conditions must understand, authorize, and provide evidence-based and cost-effective care. The authors of this article evaluated three specialized interventions for treating people with co-occurring severe mental illness and substance abuse. Treatment of both disorders was found to be essential. In addition, a behavioral skills training was found to improve outcomes and reduce total healthcare costs when compared with intensive case management and 12-Step recovery interventions. Supplemental supportive services further increase the overall value of care. Implications for managed care and at-risk providers are discussed.

Alcoholics Anonymous↗
PubMed1996

Analysis of three interventions for substance abuse treatment of severely mentally ill people.

Severely mentally ill people with co-occurring substance abuse disorders are difficult to treat and the course of their psychiatric treatment is worsened by substance abuse. Despite increased attention to the problem, few studies of specialized treatment are reported in the literature and most lack detail about the specialized interventions employed. Qualitative data, gathered as part of a larger study of the cost-effectiveness of three substance abuse interventions for severely mentally ill people, are presented which describe the interventions, their implementation in four community mental health centers over 18 months of the study, and their relationship to the quantitative outcomes. Illustrated is the difficulty of implementing innovative programs and the need for vigilance concerning program fidelity.

Activities of Daily Living↗
PubMed1996

Toward cost-effective care for persons with dual diagnoses.

Implementing services that control costs and improve client functioning for persons with both severe psychiatric and substance disorders is paramount in a managed care environment. In this clinical trial, standard mental health care augmented by the behavioral skills intervention was more effective than two other approaches (case management and modified 12-step recovery) in interventions with persons with dual diagnoses across indicators of psychosocial adjustment, psychiatric and substance abuse symptoms, and mental health service costs. These findings reinforce the need to address mental health and substance disorders concomitantly; to provide skill-building interventions as the primary ingredient of active treatment to address various instrumental, coping, and social skill deficits that clients with dual diagnoses have; and to monitor the effectiveness of the services and client progress every six months on multiple adjustment and symptomatology dimensions.

Behavior Therapy↗
PubMed1996

The utility of dual diagnosis services for consumers from nonwhite ethnic groups.

Differences in psychosocial functioning, symptoms, service use, and costs for 40 nonwhite consumers of mental health services and 92 white consumers were compared at baseline and six months in a controlled clinical trial of three dual diagnosis interventions. At six months nonwhite consumers had lower psychosocial functioning than white consumers as measured by self-report and clinicians' ratings. Nonwhite consumers received significantly less supportive treatment than white consumers. Qualitative data from staff interviews indicated that nonwhite consumers had inadequate community and family supports due to a variety of problems. Although the nonwhite consumers had outcomes similar to those of white consumers, the complex needs of the nonwhite consumers warrant additional staff resources and culturally sensitive services in dual diagnosis treatment programs.

Adolescent↗
PubMed1996

Estimating the cost impact of three dual diagnosis treatment programs.

Specialized intervention programs for people with concurrent severe mental illness and substance abuse reduce the total costs of care. Compared to baseline, cost savings of over 40% were achieved by 18 months, primarily due to significant reductions in the use of acute and subacute mental health services and despite an increase in outpatient mental health services. There also was an observable impact on cost reductions in medical and criminal justice services without an increase in family costs over the same time period.

Adolescent↗
PubMed1995

Emergency care avoidance: ethnic matching and participation in minority-serving programs.

Using data from a county level mental health service system, relationships were examined between ethnic matching, program involvement and emergency service use. When clients were matched with an ethnically similar clinician who was also proficient in their preferred language, they had fewer emergency service visits than did clients who were unmatched on the basis of ethnicity and language. Equally if not more significant than ethnicity or language matching was the client's program and the proportion of minority clients it served. Clients in programs serving a relatively large proportion of minority clients had fewer emergency service visits than those in programs serving a smaller proportion of minority clients. More research is needed to document the impact of matching along with greater attention to minority oriented programs.

Adolescent↗
PubMed1995

Comparative effectiveness of three approaches to serving people with severe mental illness and substance abuse disorders.

This study examines the rationale for and relative effectiveness of three intervention models for treating people with severe mental illness and substance abuse disorders: Twelve Step recovery, behavioral skills training, and intensive case management. Using clinical trial methods, 132 dually diagnosed clients were assigned to three service approaches. Changes in client psychosocial outcomes, and psychiatric and substance abuse symptomatology were tracked over a 24-month period. Differential effectiveness was evident, with clients in the behavioral skills group demonstrating the most positive and significant differences in psychosocial functioning and symptomatology, compared with the Twelve Step recovery approach. However, the case management intervention also resulted in several positive and important differences compared with the Twelve Step recovery approach. We also found significant changes over time, not only at 6 months but increasingly positive changes in psychosocial functioning at 12 and 18 months as well. These results underscore the need for clinical trials to further examine the relative cost effectiveness of treatment approaches for dually disordered clients and to incorporate means of assessing subgroup differences so that the interventions being tested can be further refined and targeted to a broad set of needs among the dually diagnosed.

Adolescent↗
PubMed1995

Evaluating changes in symptoms and functioning of dually diagnosed clients in specialized treatment.

OBJECTIVE: The authors outline a minimal set of outcome indicators to assess the effects of specialized treatment for people with severe mental illness and substance use disorders and report on use of these indicators in a longitudinal study of such treatments. METHODS: A total of 147 clients with dual disorders participated in a controlled clinical trial of three interventions--behavioral skills training, case management, and 12-step recovery--in a county mental health program. The clients were assessed every six months over a two-year period using multidimensional self-report and observer-rated outcome measures encompassing psychosocial functioning, psychiatric and substance abuse symptoms, and service utilization. RESULTS: Client self-reports showed changes in psychosocial functioning, especially increased functioning in residential stability and work, and reductions in alcohol and drug symptoms and usage. Data on service utilization showed decreased use of acute and subacute mental health services and increased use of outpatient and case management services over time. Ratings by trained observers of psychiatric symptoms and psychosocial functioning improved dramatically. CONCLUSIONS: A minimal set of outcome indicators for clinical trials and demonstrations of interventions for clients with dual disorders should include client self-reports of social adjustment, life satisfaction, psychiatric and substance abuse symptoms, and current substance use; interviewers' ratings of psychosocial functioning and psychiatric symptoms; data on utilization of mental health treatment and support services; and data on clients' personal income, use of medical services, and contact with the criminal justice system.

Adolescent↗
PubMed1995

Toward managed care for persons with severe mental illness: implications from a cost-effectiveness study.

Over the past two decades various models of community-based care for persons with severe mental illness have been developed. This study, which represents the first comparison of the most successful care approach (Program of Assertive Community Treatment or PACT adaptation model) with other, less intensive approaches (clinical team and intensive broker models) in a community service system, indicates that client outcomes were more positive in the PACT adaptation model in terms of enhanced psychosocial functioning and reduced acute and subacute care costs. The PACT model was not significantly more expensive in terms of the costs of providing supportive services compared with the clinical team approach and the intensive broker model of care.

Chronic Disease↗
PubMed1994

Cost-effectiveness of substance disorder interventions for people with severe mental illness.

This study examines the cost effectiveness of three intervention strategies for people with severe mental illness who are dually diagnosed clients in terms of service use and costs. The interventions represent three primary approaches to treating these disorders: 12-step recovery, case management, and behavioral skills training. Interim findings from the study indicate that all three approaches are reducing acute and subacute service use and increasing involvement with outpatient and case management treatments. However, both the case management and behavioral skills approaches reduce costs more than the 12-step recovery approach, although not to a statistically significant degree in the data collected thus far. Overall, the societal costs for these clients are reduced by 43% without increasing the burden on client families or on the criminal justice system.

Adaptation, Psychological↗
PubMed1992

Costs and use of public mental health services by ethnicity.

This paper used data obtained from Santa Clara County, California, to study the costs and use of public mental health services among ethnic populations (Asians, Blacks, Hispanics, and Whites). The study had access to 12,436 unduplicated users of services. The study found Whites had the highest per capita costs, while Asians incurred the lowest. However, after controlling for other demographic characteristics, Asians incurred higher costs than Whites. This reversal of Whites and Asians occurred because cost distributions are more skewed for Whites than Asians. Asians had the highest median costs and Hispanics the lowest. The top 5% of users incurred about 50% of the total public mental health costs.

Adolescent↗