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PubMedDate not supplied

Evaluation of community services.

Implementation and expansion of community-based psychiatric services was followed by a wide range of positive and negative effects. Differences seem due to scale and speed of implementation, to proper coordination with closing down mental hospitals, but also to differences in goals and expectations as well as methods applied to reach them. An analysis of empirical evaluation studies reveals a series of conceptual and methodological difficulties. Operational research has been limited so far by the scarcity of controlled studies and especially of multicenter coordinated research. The same is true for evaluation using external criteria, for instance evaluation of utilization data, of unintentional side-effects etc. The preventive effects of community psychiatry are practically not evaluated on the levels of primary and secondary prevention. On the other hand, important studies have been made on the transfer of care from mental hospitals to alternative care, especially in nursing and boarding homes; its results reveal an important deficit of adequate care for those who have been deinstitutionalized but without profiting from the community mental health movement. The conclusions concern the reorientation of goals for community psychiatry, the priorities of care in times of limited resources, and the specifications for evaluative research in the future.

Community Mental Health Services↗
PubMedDate not supplied

Uses of a psychiatric case register. Evaluation studies.

The Groningen case register, modelled after the Camberwell register, was initiated with a point prevalence count on the 31st of December 1973, and accumulates since data on contacts with psychiatric services of all people in a small town in the north of the Netherlands, with a population of 43,783 inhabitants. It has been running smoothly for the past twelve years with increasing interest and involvement on the part of the field workers and policy makers. Examples are given of the use of the register in evaluating new services, patterns of care, continuity of care and deinstitutionalization, in which it has proved its value as a tool for evaluation.

Continuity of Patient Care↗
PubMed1986

Maladaptive behavior merits fair treatment: a response to Seltzer and Krauss.

This response is a reaction to a study by Seltzer and Krauss (1984), in which dichotomous measurement of the behavior-problem variable gave rise to some potentially misleading implications about community-placement planning. Some difficulties in measuring this complex variable were reviewed and a more functional behavior assessment advocated. The problem of maladaptive behavior as an obstacle to deinstitutionalization has not yet been resolved.

Deinstitutionalization↗
PubMed1987

From institution to foster care: impact on nutritional status.

Eighty-two clients who were transferred from a residential institution to foster-care homes were provided nutrition services as part of their Individual Program Plans. Findings of the nutrition assessment and intervention were analyzed to document the impact of deinstitutionalization and nutrition services. Nutrition-related problems identified were closely associated to the medical problems. More than half of the clients were diagnosed as having seizures and cerebral palsy and were, therefore, at high nutritional risk because of feeding problems and anticonvulsant-induced malnutrition. Forty-three of the 47 clients who were reassessed showed positive changes in height, weight, triceps skinfold thickness, dietary adequacy, and/or biochemical indices.

Adolescent↗
PubMedDate not supplied

Group home failures in juvenile justice: the next step.

The author demonstrates that young people who fail in open group homes for status offenders often receive the secure placements that deinstitutionalization was designed to avoid, and that funding regulations may encourage group homes to avoid working with the most difficult youths.

Adolescent↗
PubMed1985

Outcome after discharge from a psychiatric hospital. A retrospective study evaluating demographic factors as predictors of risk of readmission.

The deinstitutionalization process has confronted psychiatry with the challenge of maintaining patients in the community. This problem is reflected in the ever-increasing rates of readmission to psychiatric hospitals. The ability to predict patients at risk of readmission would aid in improving services by enabling attention to be focused on vulnerable groups. Past psychiatric history has been shown to be the most consistent predictor of readmission. This study verifies this finding among coloured patients discharged from Valkenberg Hospital, Cape Town.

Deinstitutionalization↗
PubMed1985

Severely disturbed adolescents in community care.

The purpose of this research was to study key concepts related to deinstitutionalization and community facilities for emotionally disturbed adolescents. This study was conducted in two phases: In Phase I, a statewide survey was mailed to all licensed group-care providers; in Phase II, field research methods were used to collect data on five small residential facilities, each serving between four and sixteen residents. An average of 35 hours was spent observing in each facility and a total of 53 interviews were conducted with staff, residents, and administrators. Survey results indicate that a total of 125 licensed group-care agencies in Massachusetts serve 4081 residents of all ages and disabilities in residential programs. At least sixty of these facilities accept adolescents, and seventy-four of them have state approval as residential schools for youngsters with special educational needs. Findings from the field research phase indicate that small group-care facilities place an emphasis on treatment and therapeutic intervention. The therapeutic activities in five facilities share similar features, and a classification scheme based on these similarities is offered. Other findings indicate that small residential facilities are not necessarily community-based, and that living in a small facility does not ensure integration into the community. A four-point scale is presented to measure the range of possible community-oriented activities. Four origins of decision-making about community activities are noted. Other findings indicate that the facilities are characterized by a high degree of staff/resident interaction, and that they possess some characteristics of total institutions, mediatory institutions, and families; the results suggest that these facilities are a new type of social setting with no direct correlation to other types of institutions.

Adolescent↗
PubMed1980

Conference report. Patient re-entry into the community.

The National Assoication of Private Psychiatric Hospitals, in cooperation with 19 other national health-related associations, held a conference last June in Washington, D.C., on the issues involved in patient re-entry into the community. Representatives of the legal and medical professions, the insurance industry, allied health and mental health organizations, and federal, state, and local officials discussed the complex legal, social, and treatment problems that have resulted from the national movement of deinstitutionalization. As a start toward solving those problems, most of the speakers mentioned the need for partnerships among state, local, federal, and private providers, between the hospitals and community-based facilties, and among all mental health professionals. Several speakers emphasized the need for an effective advocacy system for the mentally ill and the need for mental health professionals to learn to use the political system in order to secure benefits for patients re-entering the community.

Chronic Disease↗
PubMed1983

Determinants of community placement of institutionalized mentally retarded persons.

A systematic examination of the decision process used when deinstitutionalizing mentally retarded persons was undertaken to determine what criteria, if any, institutional review teams employed when making placement recommendations. A multivariate analysis of variance and a discriminant analysis revealed that demographic and Adaptive Behavior Scale (ABS) measures varied significantly with placement recommendations for skill development homes, group homes, small intermediate facilities, and large intermediate facilities. In general, higher functioning residents were placed in less restrictive settings. Specific differences among residents placed in skill development homes and group homes were examined. Implications for preparing institutionalized residents for community placement were drawn and directions for future research outlined.

Adaptation, Psychological↗
PubMed1982

Comparison of family-care and group homes as alternatives to institutions.

Two residential alternatives, family-care and group homes, for deinstitutionalized mentally retarded adults were compared. Residents in both settings displayed essentially no improvement in self-care skills. Individuals placed in family-care homes were significantly more likely to improve their maladaptive behavior. Individuals in group homes were more likely to improve in community living skills. Residents of both settings were equally likely to have friends, maintain ongoing contact with family, and make use of community resources. A differential use of family-care and group homes was suggested.

Activities of Daily Living↗
PubMed1982

Comparison of community adjustment of older vs. younger mentally retarded adults.

The relationship between age and community adjustment was studied in a sample of 153 deinstitutionalized mentally retarded adults. Those aged 18 to 54 were compared with those aged 55 and older with respect to IQ, rate of recidivism, community adjustment, and residential environment. Results showed that although the two groups were comparable in IQ and recidivism rate, the older subjects lived in less autonomous residences in the community and functioned at a lower level. Alternative explanations for these results were offered, and policy implications were presented.

Adolescent↗
PubMed1981

Community integration of mentally retarded adults: community placement and program success.

The extent of community and program success of 166 mentally retarded clients placed into a community-based program was evaluated over a 9-year period. Twenty predictor variables measuring institutional factors, client characteristics, training variables, and community characteristics were related to community or program success. Successful community placement was associated with sensorimotor and work skills, appropriate social-emotional behavior, gender, and family acceptance of community placement and involvement with the interdisciplinary team process. Program success was associated with language and psychomotor skills, education received prior to community placement, community and institution size, and family involvement. Sixteen percent of the clients were reinstitutionalized into either the state mental retardation facility or a mental health facility. Factors associated with successful placement and program progression were discussed as was a model for future deinstitutionalization research.

Adult↗
PubMed1981

Living in the community.

The movement to deinstitutionalize and normalize the lives of mentally retarded individuals has led to significant changes in where people live and how programs are administered. In this literature review findings about the relationship between "successful" programs and size, staff to resident ratio, cost, client characteristics, program type, community support, family involvement, and peer relationships were selectively highlighted. Specific recommendations, originally presented to the President's Committee on Mental Retardation, were made for future program development and evaluation.

Community Mental Health Services↗
PubMed1980

National survey of community residential facilities: a profile of facilities and residents in 1977.

In 1977, a national mail survey of all community residential facilities (CRFs) for mentally retarded persons throughout the United States was conducted by the staff of the Developmental Disabilities Project on Residential Services and Community Adjustment at the University of Minnesota. The results of 4,427 participating facilities were summarized in this report. Demographic information on facility size, location, ownership, and reimbursement rates was presented as well as general characteristics about the residents and their movement trends. The impact of the deinstitutionalization movement for mentally retarded persons was substantially verified by the results of this survey: between 1973 and 1977, the number of CRFs doubled. Wide variations in facility size and the extent to which states use community living arrangements to serve mentally retarded people were two notable trends confirmed by the survey results.

Adolescent↗
PubMed1980

Quality of life for the mentally disabled.

Case illustrations are given to suggest the complexity of the effects on the quality of life of developments in psychotropic medicines, deinstitutionalization, and patients' rights. Community services often do not provide the mentally disabled with the benefits predicted for such programs. Whether the net effect of the revolutionary extrusion of the mentally disabled from public hospitals will be beneficial remains for history to judge.

Adult↗
PubMed1995

Psychodynamic psychiatry and the treatment of psychosis in the French community.

The author reviews the development of psychodynamic psychiatry in France, comparing and contrasting it with trends in the United States. In particular, he describes the role of dynamic psychiatry in the treatment of psychotic patients. He traces the movement from institutional treatment toward deinstitutionalization and treatment in the community, culminating in the official adoption in France of catchment area psychiatry. He also notes the emergence and influence of antipsychiatry. He concludes that although psychodynamic psychiatry has experienced a decline resulting from both external (economic) and internal (theoretical) influences, this perspective continues to improve the understanding and treatment of psychotic patients, whether they are treated in the institution or in the community.

Community Mental Health Services↗
PubMed1995

Medical sociology and the study of severe mental illness: reflections on past accomplishments and directions for future research.

Over the past 40 years, the mental health care system has been radically transformed from one focused on institutionalized care to one centered on treatment in community settings. While medical sociology has played a prominent role in the study of psychiatric hospitalization and the deinstitutionalization process, the systematic exploration of the sociological dimensions of community-based mental health care is only just beginning. This essay reflects on past disciplinary contributions and explores some important empirical and theoretical directions in the field of mental illness research that could benefit from more extensive sociological analysis. The central argument is that the shift to a community-based mental health system has increased the need for the sociological perspective and that medical sociologists, in particular, have the theoretical and analytical perspective essential for developing a more complete understanding of the current conditions impacting the lives of people with severe mental disorders. Drawing on recent work in medical sociology, we illustrate some important topical areas at the center of controversies over treatment, social change, and public policy regarding severe mental illness. We conclude with a discussion of the barriers to this type of sociological research and suggestions for ways medical sociologists might contribute to the study of severe mental disorders in the future.

Deinstitutionalization↗