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Biomedical subjects

Steven P Segal

Publications and source records attributed to Steven P Segal.

8 recordsLinked to original sources
PubMed2003

African-Americans and comprehensive service use.

This study examined African-Americans' use of comprehensive mental health services. 248 long-term users of self-help agencies (SHAs) were interviewed about their use of 37 different mental health services from various providers in a six-month period. Multiple regression analysis showed that the homeless and African-Americans were the high users in our sample. A subsequent MANOVA procedure suggested that this may be the result of African-Americans' increased use of SHAs. While African-Americans are low service users in traditional studies focusing on a narrow list of services and providers, this research argues for including SHAs in future studies of African-American service use.

Black or African American↗
PubMed2003

Community membership and social networks in mental health self-help agencies.

This article explores community membership among self-help agency (SHA) participants. It is suggested that SHAs foster the enhancement of peer-oriented social networks, leading to the experience of shared community. Social network analysis was used to examine the structure of support mechanisms, and to assess levels of community membership through peer inclusion. Results indicate that both individual and organizational characteristics play roles in predicting peer presence in social networks. Organizational empowerment is a key factor, with the SHA emerging as a promising locus for peer support development through enhanced social networks. Implications for the organization of consumer-based services are discussed.

Adult↗
PubMed2002

Determinants of client outcomes in self-help agencies.

OBJECTIVE: This study assessed the relationship between the outcomes of clients of client-run self-help agencies and attendance at the agency, satisfaction with the agency, psychological disability, and organizationally mediated empowerment, that is, the provision of opportunities for clients to meaningfully participate in decisions about their care and the care of others in the agency. The outcomes assessed were independent social functioning, assisted social functioning, and personal empowerment. METHODS: A total of 255 long-term users of four self-help agencies were interviewed at baseline and six months later. Univariate descriptive analyses as well as t tests describing changes in outcomes were conducted. The relationship of each of the four determinants to the three outcomes, after controlling for baseline status on the given outcome and other covariates, was assessed with structural modeling using Amos software. RESULTS: On average, personal empowerment among the clients of the self-help agencies increased, independent social functioning remained the same, and assisted social functioning decreased during the six-month follow-up period. Multivariate analyses showed a positive association between organizationally mediated empowerment and all three outcomes. CONCLUSIONS: The significant ingredient promoting positive outcomes for clients of self-help agencies appears to be the provision of opportunities for clients to meaningfully participate in decisions about their care and the care of others in the organization.

Adult↗
PubMed2002

Characteristics of new clients at self-help and community mental health agencies in geographic proximity.

OBJECTIVE: Self-help agencies are funded as adjuncts of, referral sources for, or alternatives to community mental health agencies. Little is known about how these two types of organization in geographic proximity interact, whom they attract as prospective clients, and what their clients bring to the service situation. The authors compared the characteristics and past service use of new enrollees of self-help agencies and community mental health agencies serving the same geographic area. METHODS: Interview assessments were conducted with 673 new users at ten pairs of self-help and community mental health agencies serving the same geographic areas. Client characteristics were evaluated with multivariate analysis of variance and chi square tests. RESULTS: Clients of community mental health agencies had more acute symptoms, lower levels of social functioning, and more life stressors in the previous 30 days than clients of self-help agencies. The self-help agency cohort evidenced greater self-esteem, locus of control, and hope about the future. Clients of self-help agencies had received more services from facilities other than self-help or community mental health agencies in the previous six months, and clients of self-help agencies who were not African American had more long-term mental health service histories. CONCLUSIONS: Although self-help and community mental health agencies both provide services to people with major mental disorders, community mental health agencies deliver primarily acute treatment-focused services, whereas self-help agencies provide services aimed at fostering socialization, mutual support, empowerment, and autonomy.

Adult↗
PubMed2002

Involuntary return to a psychiatric emergency service within twelve months.

OBJECTIVE: Under managed care, there is pressure to shorten hospital stays. Yet, previous investigations have shown longer hospitalizations following a psychiatric emergency service (PES) evaluation reduce recidivism. This study examines the relationship between post-PES hospitalization, patient characteristics and involuntary PES return within 12 months. It is done in a context where average duration of post-PES hospitalizations are 6 days, approximately 1/4 the duration of previous studies reporting positive effects of such hospitalization. METHOD: Structured observations of PES evaluations of 417 patients were completed at 7 California county general hospitals. Follow-ups were conducted at 12 months after initial evaluation. Study objectives are evaluated using multivariate modeling. RESULTS: Subsequent to the initial evaluation, 121 of the 417 patients (29.0%) were involuntarily returned to the PES. The likelihood of involuntary return was increased by a psychotic diagnosis and the seriousness of initial clinical presentations on the TRIAD dangerousness criterion measure. Having insurance also increased the likelihood of involuntary return. CONCLUSIONS: As the patient's initial PES condition was found to be the best predictor of involuntary return and duration of post-PES hospitalization seemed to lose its prophylactic effect, it seems we have gone too far in reducing lengths of inpatient stays. We may have lost sight of the crucial role of this setting in stopping the revolving door and insuring appropriate care.

Adult↗
PubMed2002

Goal advancement among mental health self-help agency members.

OBJECTIVE: Goal advancement is critical to mental health clients' reintegration into the community. This research considers factors likely to contribute to goal advancement among members of four consumer-run mental health self-help agencies (SHAs) who responded to questions about their goals at baseline and six-month follow-up. METHOD: Type of goals, demographics, psychiatric disability, agency characteristics, and members' attitudes toward professionals were used to predict goal advancement. RESULTS/DISCUSSION: Surprisingly, faith in the psychiatrist as the source of responsibility for treatment decisions was associated with goal advancement. This is contrary to SHA ideology, which emphasizes peer-driven help. Other findings are also discussed.

Adolescent↗