Biomedical subjects
Publications and source records attributed to P P Freddolino.
This article reports a successful field test of a client-driven model of support and advocacy for people labeled mentally ill, which has some similarities to case management models. Refinements of the model to address the unique service needs of similar clients who are also homeless are then articulated. Implications for service delivery are discussed.
Although group homes for adults labeled mentally ill have been the focus of significant attention in deinstitutionalization discussions, substantive research on their operation has been lacking. The present study addresses past limitations by focusing on a well-defined sample of small group homes, with higher staffing levels and in-home treatment provided. Thirty homes were randomly selected; all home residents (N = 253) were studied. Data were collected from case managers, residents, and home staff to assess residents' functioning, services and treatments provided, and the environment of the home. The findings were examined in terms of adequacy and appropriateness of care provided in the home, using accepted guidelines. The results indicated that there are aspects of a homelike environment, emotional support from staff, and skill-development activities within the home. However, an institutional focus still seems prevalent, along with limited rehabilitation and socialization activities. Residents expressed high levels of satisfaction, which may reflect their dislike of the group home alternative, e.g., the state hospital. Policy implications are discussed vis-a-vis current efforts to move away from group homes toward supported housing initiatives.
In this article the authors report on the self-perceived needs of 40 homeless people who are coping with psychiatric problems. These people were among 207 with psychiatric problems participating in an innovative advocacy project based outside the formal mental health system. Compared with domiciled participants, the homeless participants had more accentuated and somewhat different major daily living needs in the areas of income and benefits, housing, legal services, employment, and health care. On the basis of these findings, the authors draw implications for social work practice with homeless people coping with psychiatric problems.
Traditional rights protection and advocacy systems in the mental health field have focused primarily on the use of legal processes to protect patients in inpatient settings. This paper describes a study of an advocacy model designed to help frequent users of mental health services adjust more successfully to community living. Clients who were offered advocacy services related to self-identified problems and needs were compared with a control group who were not offered the services. During the study period clients who received the advocacy services were hospitalized significantly fewer days than the control group with no increase in psychiatric symptoms, but the differences between the two groups disappeared after advocacy services were terminated. The authors compare the advocacy intervention to case management and discuss the potential role of advocacy services in mental health systems.
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The classification of clients in terms of psychiatric diagnosis or level of functioning is a logical prerequisite to the conduct of quality of care assessments in mental health care. This article reports on efforts to create a typology of mentally ill group home residents based on a variety of measures of functioning. Subjects for the study come from a probability sample of 253 group home residents in Michigan. A three group typology, derived through cluster analytic procedures, is presented along with-evidence supporting its validity. Implications of the typology for program evaluators and service system planners are briefly addressed.
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