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Biomedical subjects

J R Greenley

Publications and source records attributed to J R Greenley.

At least 19 recordsLinked to original sources
PubMed1997

Sociodemographic characteristics of severely mentally ill clients in rural and urban counties.

Sociodemographic differences between rural and urban clients with severe mental illness (SMI) are explored using approaches which extend research in this area beyond limitations found in the few existing studies. Sixteen hundred adult clients from 18 Wisconsin counties are classified according to the degree of rurality of their counties of residence, using two definitions: a dichotomous metropolitan-non-metropolitan grouping and population density. There are significant differences between rural and urban clients for age, gender, and marital status, but not education or income. Young (18-35 years), unmarried males are more likely to live in more densely populated counties. Older (65 and older) women who are currently or previously married are more likely to live in less densely populated counties.

Adolescent↗
PubMed1997

Rural-urban differences in psychiatric status and functioning among clients with severe mental illness.

Studies of clients with severe mental illness (SMI) typically focus on individuals in larger urban areas. Less is known about clients in rural and smaller urban areas. Here we compare the psychiatric status, home and community activities of daily living, and social and vocational functioning of 1600 adult clients with SMI from 18 small-city and rural Wisconsin counties. Rural clients are less likely to have a diagnosis of schizophrenia or organic brain syndrome; have higher levels of general pathology, including more belligerent, bizarre, nervous, and depressive behaviors; and engage in fewer vocational activities than urban clients.

Activities of Daily Living↗
PubMed1997

Factors associated with subjective burden in siblings of adults with severe mental illness.

Experiences of subjective burden were analyzed in a sample of 164 siblings of persons with serious mental illness. Findings indicated that the well sibling's experience of burden was consistently related to the symptomatology of the ill sibling. In addition, those who viewed the ill sibling's behavior as outside his or control exhibited lower levels of subjective burden than did those who viewed the behavior as within the sibling's control. Implications for research and clinical intervention are discussed.

Activities of Daily Living↗
PubMed1997

Measuring quality of life: a new and practical survey instrument.

Despite increasing recognition of the importance of measuring the quality of life (QOL) of people with severe mental illness, such assessments are seldom carried out because of the lack of an efficient, easy-to-use, and valid measurement instrument. To facilitate the gathering of QOL information from clients in evaluation, program improvement, or other efforts, the authors present a new short (24-item) self-administered questionnaire called the Quality of Life Questionnaire (QLQ). The questionnaire assesses subjective QOL in seven areas. Evidence for the reliability and validity of the QLQ is based on data gathered from 971 clients with serious mental illness who were receiving publicly funded mental health services at the time of the study. The results of a confirmatory factor analysis using a random split-half procedure indicated that a seven-factor solution fit the data well. Scores on the QLQ also correlated significantly with the client's functioning and satisfaction with services, providing support for the validity of the QLQ. The advantages of the QLQ over existing measures include low-cost administration and some superior psychometric properties.

Adult↗
PubMed1997

Evaluations of organizational effectiveness in mental health programs.

We present a conceptual framework derived from organizational theory for understanding the evaluation of the effectiveness of mental health services. We postulate that organizations are deemed "successful" by their constituents when they conform to institutional demands and expectations that are both internally and externally generated. We empirically assess institutional conformity by examining evaluations of effectiveness by 269 mental health providers in 29 different mental health programs. Specialist programs responded to institutional demands by targeting services to those considered most in need: clients with severe mental illnesses. The formal structure and program philosophy of these programs clearly reflected this emphasis; consequently, levels of goal incongruence were low and evaluations of effectiveness were high. Generalist programs continued to provide care to diverse client groups, had more professionals, offered traditional services (such as psychotherapy), and exhibited higher levels of goal incongruence; these factors resulted in lower evaluations of effectiveness. This research is important because it demonstrates that organizational processes of institutional conformity (program objectives meet the demands of external constituents) and goal congruence (program objectives meet with expectations of internal constituents) are critical to positive evaluations of effectiveness. With the current institutional demand for effective, efficient services, it is critical that researchers have a conceptual framework for analyzing those factors which influence evaluations of effectiveness.

Chi-Square Distribution↗
PubMed1996

Characteristics of persons with severe mental illness and substance abuse in rural areas.

A cross-sectional study of 1,551 clients receiving care in ten community-based rural mental health care systems assessed problem behaviors and psychiatric symptoms among three groups of severely mentally ill clients: those with a current substance abuse problem, those with a history of substance abuse but no current problem, and those with no history of substance abuse problems. Clients with a current substance abuse problem were younger than clients who had no history of such problems and had more symptoms of anger, more trouble with the law, and more suicidal threats than clients in the other two groups.

Adolescent↗
PubMed1995

Organization, management, and client effects on staff burnout.

Employee burnout is perceived to be a serious problem in human service organizations serving persons with severe mental illness. There has been considerable investigation of burnout and many of its possible causes, but little investigation of the role of client severity in relationship to burnout. Furthermore, theoretical models linking environmental context, organization structure, and management processes to burnout have seldom been proposed or examined. Building on our previous work, we employ a theoretical framework that conceptualizes environmental context, organization structure, management processes, client severity and staff characteristics as influencing work satisfaction and burnout. We examine this in a survey of 311 staff in 42 community mental health service organizations. Controlling for individual staff characteristics, results suggest that organization structure, culture, and management process are important to work environment and in turn to satisfaction and subsequently to burnout. Contrary to the literature, client severity was not associated with burnout nor to work dissatisfaction.

Burnout, Professional↗
PubMed1994

Contributions of persons with serious mental illness to their families.

OBJECTIVE: This study investigated the contributions that persons with serious mental illness make to their families according to both clients and family respondents. METHODS: The sample consisted of 725 clients with serious mental illness and 725 family respondents living in rural counties or counties with small urban areas in Wisconsin. Clients were in contact with family respondents at least three times a year; 23.7 percent of them lived with the respondent. Clients returned a questionnaire, and family respondents completed a telephone interview; both rated the amount of help the client gave in eight areas such as household chores, shopping, and companionship. RESULTS: Overall, the clients, especially those who lived with their families, provided substantial help. For the total sample, clients were most likely to contribute by providing companionship; family respondents reported that 59 percent of clients gave such help. For clients who lived with respondents, between 50 and 80 percent helped by doing household chores, shopping, listening to problems, providing companionship, and providing news about family and friends, according to family respondents. CONCLUSIONS: Many persons with severe mental illness play positive roles in their families. Recognition of clients' contributions by providers, researchers, and clients and families themselves could help reduce stigma and expand community opportunities for persons with severe mental illness.

Activities of Daily Living↗
PubMed1993

Aging parents of adults with disabilities: the gratifications and frustrations of later-life caregiving.

Using a stress process model, we investigated the impact of later-life caregiving on 105 mothers of adult children with mental illness and 208 mothers of adult children with mental retardation. As hypothesized, mothers of persons with mental illness reported higher levels of frustrations and lower levels of gratifications. Whereas the adult child's behavior problems were the strongest predictor of maternal gratifications, the adult child's diagnosis was the strongest predictor of maternal frustrations once all other factors were controlled. In addition, the size of the mother's social network, the family social climate, and the child's participation in an out-of-home program were associated with the effect of caregiver stress.

Adult↗
PubMed1992

Validity of case manager reports of clients' functioning in the community: independent living, income, employment, family contact, and problem behaviors.

Validity of case manager reports of client functioning in the community was assessed by examining the correspondence between case manager reports and client reports of several widely-used indicators of client well-being, including independent living, income, employment, family contact, and problem behaviors. Effects of how well case managers knew their clients and of using telephone interviews vs. self-administered questionnaires to gather case manager data were also investigated. Data were gathered from 6 case managers and 55 of their seriously mentally ill clients in a rural Wisconsin Community Support Program. Indicators of independent living and employment displayed reasonably good agreement and support the use of case manager reports in research. Indicators of income and problem behaviors produced lower levels of client-case manager agreement at least in part because client reports proved an inadequate criterion for these measures.

Activities of Daily Living↗
PubMed1992

Neglected organization and management issues in mental health systems development.

Fragmented and often uncoordinated public services for the more severely mentally ill are often characteristic of the current U.S. mental health system. The creation of local mental health authorities has been promoted as part of a solution, as has happened in Wisconsin at the county level and is championed in the ongoing Robert Wood Johnson Foundation funded innovative service sites for severely mentally ill adults. There are indications that these innovative mental health authorities will fall short of fulfilling their promise. Basic principles from the management and organizations literature are used to identify several organization and management issues that may have been neglected. These include resource management, attention to system goals, monitoring and feedback, and the promotion of desirable interorganizational cultures.

Humans↗
PubMed1991

Evaluation of a comprehensive program for youth with severe emotional disorders: an analysis of family experiences and satisfaction.

An innovative pilot program of comprehensive services to youth with severe emotional disorders was evaluated by means of a self-administered questionnaire survey of family members. Results indicate that the program increased use of noninstitutional outpatient services, improved access to services, and enhanced family satisfaction and involvement with treatment planning and implementation.

Adolescent↗
PubMed1987

Seeking help for psychologic problems. A replication and extension.

Patterns of seeking help for psychologic problems were investigated using interview and medical record data in a representative community sample and a sample of mental health clinic users from the same eligible population. In multivariate analyses, users of psychiatric services, compared with nonusers, were significantly younger, more likely to be separated or divorced, more psychologically distressed, and physically symptomatic. They were also more likely to use a large multispecialty clinic, compared with satellite clinics, and less likely to have membership in the prepaid medical plan established by the multispecialty clinic. Users had a greater reported propensity to seek help for anxiety and were more likely to know other mental health services users. Confiding social support was not significantly associated with use of mental health services, controlling for psychologic symptoms. Substantial social selection in seeking help was evident at both high and low levels of psychologic distress. Mental health users, compared with nonusers, reported more of most types of symptoms studied, except withdrawal, obsessive-compulsive symptoms, and alcohol consumption. Particular social characteristics and symptoms were associated with seeking help in general and other characteristics were more specifically linked to choice of a particular provider.

Adult↗
PubMed1986

Social control and expressed emotion.

Research shows a higher risk of relapse among schizophrenics in high "expressed emotion" families. In this paper, the measure called "expressed emotion" is conceptualized as an indicator of family attempts to socially control the schizophrenic person's behavior in a particular way. This social control conceptualization is supported by a review of the type of information in the measure. Hypotheses following from this view are examined to assess the construct validity of the measure conceptualized as a type of social control. First, attempts at control are hypothesized to be ways anxious and fearful families try to cope. Second, the family's recognition of the schizophrenic's problem as mental illness is hypothesized to reduce the fearful and anxious family's likelihood of an intense interpersonal social control coping response. This type of social control of involuntary illness behaviors would be abandoned as unjust and unlikely to be effective. Data from the pioneering 1972 study by Brown, Birley, and Wing (Br. J. Psychiatry 121:241-258) provide support for these hypotheses and thus provide support for this social control conceptualization.

Anxiety↗
PubMed1986

Organizational analysis of three community support program models.

Little attention has been paid to the organizational and administrative characteristics of effective community support programs for the chronic mentally ill. The authors analyzed three successful support programs in Wisconsin that employ three different models of service delivery: one provides services through caseworkers who carry specialized caseloads, another through local nonprofessionals who work with a centrally located program coordinator, and the third through a team of various mental health workers. Each program has tailored its organizational process to suit the types of clients it sees, the size of its catchment area, and the availability of other professional resources. The interrelated strengths and weaknesses of each model are discussed.

Chronic Disease↗
PubMed1984

Social factors, mental illness, and psychiatric care: recent advances from a sociological perspective.

The author reviews advances in the sociological perspective on mental health over the past four years. He examines research on such topics as community acceptance of the mentally ill, arrest rates among former psychiatric inpatients, and the effect of social factors on the type of mental health treatment received. Other research areas surveyed include the influence of social factors on service utilization and on life stress and psychological distress, sex differences in psychological problems, and the relationship between organization of service delivery systems and patient outcome.

Age Factors↗
PubMed1984

Differences in the direct costs of public and private acute inpatient psychiatric services.

This exploratory study examined differences in the direct costs of acute inpatient psychiatric services in seven public county-operated specialty hospital units and six private community general hospital units in Wisconsin. There were no significant or substantial differences in measures of severity of patients between the public and private systems. Direct costs per stay and per day were significantly lower in the private units, although charges may have been higher in the private units. These differences in costs appear to be the result of private units having a significantly higher average daily census, more goal emphasis for cost containment, and more psychiatrist influence on how the unit was run. Our findings suggest that mental health system managers examine opportunities for achieving economies of scale and that they set and manage goals for efficiency.

Cost Control↗