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Biomedical subjects

J M Jerrell

Publications and source records attributed to J M Jerrell.

34 records · Page 2Linked to original sources
PubMed1992

In-home treatment of families with seriously disturbed adolescents in crisis.

This article describes an innovative Adolescent In-Home Treatment Program that was designed as a hospital alternative for families with adolescents in serious crises. Using multiple-impact, in-home, and in-office techniques, a mental health team systemically intervenes with families to assist them in resolving this major developmental event. Since the program's inception, over 160 high-risk adolescents have completed the 90-day course of treatment. Preliminary data gathered from an early group of families and clinicians suggest the potential of significant improvements in family and adolescent functioning, and the attainment of clinical goals among the majority of families served.

Adolescent↗
PubMed1991

Ethnic populations in public mental health: services choice and level of use.

BACKGROUND: Barriers to access and use of mental health care by Asians, Blacks, and Hispanic Americans have been a source of concern for many years. Limitations in our knowledge base persist regarding patterns of use in public sector programs of certain services. Using a sample of almost 27,000 persons, this study examined access and level of use by ethnic minority groups of emergency services, inpatient care, individual outpatient visit, and case management. METHODS: Data from the management information systems of San Francisco and Santa Clara counties were analyzed for fiscal year 1987/1988. Multivariate models were evaluated at two stages, reflecting whether or not a service had been used, and if used, the level of use. RESULTS: Asians and Hispanics used less emergency and inpatient but more outpatient care than did Whites; Blacks used more emergency and less outpatient care. CONCLUSIONS: Ethnicity continues to play a role in understanding the utilization of mental health services. Regarding emergency and inpatient care, Asian and Hispanic patterns of use appear relatively favorable, whereas the patterns of Blacks continue to be problematic.

Black or African American↗
PubMed1989

Cost-effectiveness of intensive clinical and case management compared with an existing system of care.

Using controlled experimental methods, this investigation compares treatment outcomes and costs of an intensive clinical and case management program with those of an existing system of care for severely mentally ill clients. The results indicate that after 24 months the treatment group did not improve significantly in psychosocial adjustment and reported life satisfaction, although intermediate changes were apparent. The experimental treatment program did not cost significantly more than the comparison condition, and both groups demonstrated a cost reallocation away from 24-hour and emergency care toward outpatient and case management service. Policy implications and limitations regarding generalizability are discussed.

Cost-Benefit Analysis↗
PubMed1987

Selecting the proper management strategy.

Formulating and implementing corporate strategy to guide the planning and operations of mental health centers is related to some degree to the center's initial scale of operations and its funding context. The results of a longitudinal study of centers in 15 states indicate that these aspects of a center's context favor a specific array of management strategies: the extent to which centers are diversifying their service operations, the percent of change in direct government and nongovernment revenue, and an emphasis on developing interagency ties and on reducing costs represent major strategy options which differentiate mental health centers.

Community Mental Health Centers↗
PubMed1986

Evaluation in a down-loaded mental health system.

Speculation that policy and funding shifts in the nation's mental health system would negatively impact program evaluation services in community mental health centers (CMHC) is substantiated. Performance of program evaluation activities was investigated in 71 CMHCs in 15 states over a two-year period. Twenty-five percent of the centers reported cutbacks, including staff attrition and diminished funding devoted to evaluation functions. The majority of centers reported no changes, but many directors representing these centers also indicated that they had never fully developed a capacity for performing evaluations and would cease to devote attention to these activities without available funding. In some centers evaluation functions are being transferred to clinical administrators; integrated into quality assurance activities; performed "as needed' by external consultants; or ignored altogether. Many centers are developing or enhancing a computerized information system to improve internal efficiency and to meet state accountability requirements. The professional issues raised to these trends as well as their implications for federal and state policy are discussed.

Community Mental Health Centers↗
PubMed1985

How community mental health centers deal with cutbacks and competition.

The results of a survey of 71 directors of community mental health centers in 15 states in 1982 and 1983 indicate that CMHCs made major changes in their services, staffing, sources of revenue, administration, and organization to cope with shrinking budgets, increased state regulation, impending prospective payment systems, and accelerating competition from private for-profit health care providers. Services offered by the CMHCs became less comprehensive and more oriented toward chronic and severely ill patients in 1982 and 1983, and entrepreneurial principles were employed to increase efficiency and attract new sources of revenue. These strategies have been successful, but the authors believe more long-range planning is necessary if CMHCs are to retain their distinctive place in the health care system.

Community Mental Health Centers↗
PubMed1984

Policy shifts and organizational adaptation: a review of current developments.

Changes in the operations and structure of local mental health centers are occurring in response to policy and funding shifts at the state and federal levels. Clinical and administrative staffing changes reflect both cutbacks in funding for traditional outpatient and inpatient services, as well as increases in partial care, community, residential and case management services. Centers are diversifying their funding sources, especially through increased revenues from Medicare-Medicaid sources. Governing boards remain active in center policy making, with few changes in their composition. Current adaptation strategies focus mainly on enhancing efficiency, reviewing service costs, expanding services to more viable markets, and improving business practices. These actions and strategies are compared to findings from previous studies, and their implications are discussed.

Ambulatory Care↗
PubMed1984

Staffing patterns in rural health services for children and adolescents.

This paper reviews several current human resources issues in delivering mental health services to children and adolescents, focusing primarily on the lack of systematic data regarding staff involved in these programs. Data from twenty counties in rural western Pennsylvania are then presented demonstrating the personal, educational, employment, and caseload characteristics of this group of staff, as well as their primary job functions and areas of job satisfaction. Professional staff were likely to have terminal master's degrees and to work primarily in outpatient services, whereas bachelor's-level staff were more likely to perform "generalist" functions, often without adequate supervision and clinical training. Paraprofessional staff were most numerous in community residential settings and performed a variety of functions. The implications of these findings for services development and staff training are discussed.

Adolescent↗
PubMed1983

Work satisfaction among rural mental health staff.

Previous studies demonstrating low levels of work satisfaction among mental health staff have failed to investigate specific correlates such as employment status, educational and caseload characteristics or to consider differences in a rural organizational context. Responses on 11 work satisfaction items were compared on 16 work and educational characteristics for 47 clinical staff in rural mental health facilities. The correlates of work satisfaction identified are compared to previous job satisfaction studies, and profiles of least and most satisfied staff are discussed.

Adult↗
PubMed1982

Evaluating a management and organization development effort in mental health agencies.

Although the use of management and organization development techniques in health and human service settings is increasing, there are few systematic studies of their effects. Those which do exist are problematic in many respects. An 18-month program incorporating both management and organization development is described along with the results of its evaluation, which were positive and well-utilized. A discussion of the methods employed, the problems encountered, and the outcomes obtained illustrates that these evaluation efforts are needed and can be useful to program evaluators involved in planned-change efforts.

Analysis of Variance↗
PubMed1982

Evaluating employee assistance programs. A review of methods, outcomes, and future directions.

Renewed interest in assisting troubled employees has led to an upsurge in the development of employee assistance programs, coupled with demands for demonstrable effectiveness. This review examines the nature and scope of these programs, their administrative and methodological context, and the types and outcomes of evaluation studies conducted thus far. Proposals for improving future investigations through a number of different approaches and strategies are then made.

Evaluation Studies as Topic↗
PubMedDate not supplied

The reliability and validity of the SAS-SMI.

The reliability and validity of the SAS-SMI (Social Adjustment Scale for the Severely Mentally Ill) were assessed in three samples of 670 persons with severe mental illness from a public mental health system. The SAS-SMI retained comparable factor structures (Social, Family, Work, Residential Stability, Romantic Interest, and Personal Well-being) to its predecessor, the SAS-II, and yielded high item-to-scale internal consistency correlations, good interrater reliability, and comparable convergent and divergent validity. The SAS-SMI's performance across these dimensions makes it a potentially valuable tool in mental health services research investigations. Limitations and suggestions for further development are discussed.

Adolescent↗
PubMedDate not supplied

Ethnic differences in the treatment of dual mental and substance disorders. A preliminary analysis.

Differences between white and ethnic client psychosocial functioning, psychiatric and substance abuse symptomatology, and service utilization costs from a longitudinal clinical trial examining the relative cost effectiveness of three specialized interventions for dual disorders are compared within the study sample and to the existing literature. Ethnic clients comprised 30% of the treated sample, had lower psychosocial functioning scores (rated and self-reported), and received less supportive treatment services during the first 6 months of the intervention program; however, their overall outcomes were equivalent to those of white clients at 6 months. There were no functioning or symptom outcome differences across the three treatment groups, but the 12-step group had the highest intensive and supportive service costs over time, and also the greatest reductions in intensive service costs after 6 months. Clinical issues are described and the clinical implications for more effectively serving dually diagnosed ethnic clients are outlined.

Adolescent↗
PubMedDate not supplied

Gender differences in the assessment of specialized treatments for substance abuse among people with severe mental illness.

A recent study examined the relative cost-effectiveness of three specialized interventions for treating people with both severe mental illness and substance abuse disorders: behavioral skills training, intensive case management, and 12-Step recovery. This article reports the changes in client psychosocial outcomes, psychiatric and substance abuse symptomatology, and service utilization and costs for the 31 women involved in the study, and compares these results to similar data on the men in the study sample and to the existing literature. Also presented are the most salient clinical impressions of the treating staff of issues affecting the course of treatment and outcomes for these women. Similarities were found in treated prevalence, service utilization, and related clinical issues in women with dual disorders compared to those reported in the existing psychiatric or substance abuse literature. Compared to men in the same sample, the women had higher functioning scores, more psychiatric symptomatology, and greater reductions in 24-hour acute or subacute treatment services used during the first six months of the specialized intervention programs. These results provide some insight into ways of serving dually diagnosed women more effectively in community-based treatment programs and of investigating these services more fruitfully.

Adult↗
PubMedDate not supplied

Social work practice in rural mental health systems.

A precise understanding of the role of the social worker in rural mental health services is necessary to ensure the adequate training of workers destined for this setting. The authors have conducted a survey of mental health staff in one rural area, examining the interrelationships among such factors as education, perceived levels of knowledge, and clinical functions.

Analysis of Variance↗