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PubMed1993

Development and evaluation of drop-in centers operated by mental health consumers.

As part of a statewide initiative begun in 1989 to promote consumer involvement, the Pennsylvania Office of Mental Health initially funded the development of nine consumer-operated drop-in centers. This paper describes some of the programs and services developed by the centers and presents results of a survey of consumers' use of and satisfaction with services. During the six-month survey period, a total of 478 consumers used services; average daily attendance at each center was 28. Most centers had one paid position supplemented by heavy use of volunteers. Most projects had collaborative relationships with a few providers who maintained a low profile in daily operations. Although consumers were highly satisfied with the drop-in centers, they desired improvements in the number of paid staff, hours of operation, management, and transportation.

Ambulatory Care↗
PubMed1993

Clozapine use by state programs: public mental health systems respond to a new medication.

The authors present data from a national survey of state departments of mental health showing that two years after reaching the U.S. market, clozapine is available to only a small fraction of the patients whom it might benefit. The primary continuing hurdle for the public sector, where most schizophrenic patients get their care, is funding. Several arguments support the use of clozapine in state mental health systems: it is the most effective or only effective medication for many patients, it can decrease the enormous costs of schizophrenia and related disorders, and access to the medication has become an important issue for advocacy groups and other mental health activists. Two years of experience with clozapine in the Texas mental health system have shown that availability of clozapine in the community is a vital factor for successful use of the drug in hospitals. The authors discuss ways to encourage outpatient clozapine programs that are critical to successful treatment in both the hospital and the community.

Chronic Disease↗
PubMed1995

A state management planning system for addressing high levels of use of inpatient psychiatric services.

Research on psychiatric hospital admissions shows that a small group of patients use a disproportionate amount of inpatient services. In the late 1980s Washington State developed initiatives to target outpatient community mental health services to mentally ill persons with high rates of inpatient psychiatric service use. Services to the targeted group are provided by regional support networks under contract with the state. Diverse funding sources were consolidated to give the regional authorities flexibility to tailor funding to local needs, and new appropriations were tied to the region's commitment to increase capacity for community mental health services. To support those initiatives, the state developed a specialized client-focused database to identify individuals with high rates of hospital utilization, provide information to regional authorities about use of hospital services by those individuals, and assess whether they were receiving outpatient services. Analyses of statewide data showed wide variation among regions in hospital use and delivery of community services.

Community Mental Health Services↗
PubMed1985

The community health care center: current status and future directions.

This paper presents an assessment of The Robert Wood Johnson Foundation's Municipal Health Services Program, a demonstration in five major cities of neighborhood-based health care delivery for inner-city residents, started in 1978 and supported until 1984. The program was successful in achieving higher levels of clinic utilization, as well as in integrating preventive and therapeutic services; it was less successful in reducing the dependence of inner-city residents on hospital-based ambulatory services. Although the neighborhood centers provided care at substantially lower cost than that of other public facilities, they remained dependent on outside financial support. The viability of the community health care centers at the end of the grant period is discussed, in terms of the changes that have affected the health delivery system in the seven years since the program was started, and in terms of expected changes over the next few years that will affect their future usefulness and stability. A series of alternatives that might provide for the health care needs of the indigent are also discussed.

Community Health Centers↗
PubMed1994

Elders' out-of-pocket payment for community-based long-term care.

This research describes characteristics of community living elders aged 71 and older with long-term care (LTC) needs who pay out-of-pocket for community-based LTC. Community living elders with higher incomes, more friends and non-child relatives outside the home, and greater ADL or IADL needs are more likely to purchase LTC than those without these characteristics. Also the lack of sufficient numbers of children outside the home to provide assistance tended to result in the use of out-of-pocket paid services. Paying for LTC is not associated with the extent of disability experienced. This study clarifies the characteristics of those in need who currently pay out-of-pocket for community LTC as a basis for examining the inadequacies of current LTC financing.

Activities of Daily Living↗
PubMed2002

Seniors connect: a partnership for training between health care and public libraries.

Kaleida Health Libraries, in partnership with the Buffalo and Erie County Public Library, presented "Seniors Connect: A Health Information Project." The program was funded by the Community Foundation for Greater Buffalo and the Kaleida Health Foundation. The purpose of the project was to teach African-American and Hispanic senior citizens or their caregivers residing in the city of Buffalo how to search the Internet to find quality, accurate, understandable health information. Attendees were taught to distinguish quality information from inaccurate, misleading, and fraudulent material. A total of fourteen training sessions were offered. The Seniors Connect program was initiated with health fair at each branch library, conducted by Kaleida Health staff, to provide an opportunity for participants to learn about health care services available in their community; observe demonstrations of health information searches on the Internet; learn about new treatment modalities for diseases such as diabetes, high cholesterol, thyroid abnormalities, and hypertension; and interact with area health care providers and library staff. The sessions were highly rated by attendees and many participants expressed their gratitude for a program geared specifically toward seniors.

Black or African American↗
PubMed1994

Involving stakeholders in health services research: developing Alberta's resident classification system for long-term care facilities.

Little attention has been directed in Canada to identifying stakeholders at the administrative policy level to whom relevant health services research information can be targeted. This article describes a case study in which key stakeholders (long-term care facility owners, operators, and care providers) were explicitly defined not only as targets of original research information to inform administrative public policy but also as collaborators in the research process and dissemination of results. The research involved development of a classification system to measure resident care requirements in the province's nursing homes and auxiliary hospitals. The classification system formed the basis of a new government administrative policy for allocating public funds to these facilities based on levels of care. The authors describe the rationale for involving stakeholders in the research process, the role of stakeholders as collaborators, and lessons learned from the Alberta experience. Examples are presented of how stakeholders can contribute to the health services research process and outcome: by providing experiential knowledge related to the research outcome, anticipating and overcoming potential problems with policy implementation, facilitating policy-oriented learning across stakeholder groups, assisting in the transfer of research information to wider stakeholder audiences, and promoting acceptance for policy change.

Aged↗
PubMed1996

Use of social indicators in assessment of local community alcohol and other drug dependence treatment needs within Chicago.

The State Systems Development Program of the US Center for Substance Abuse Treatment supports needs assessment studies conducted through state authorities. This article reports results of a social indicator study funded through this program of alcohol and other drug dependence (AODD) treatment needs specific to communities in Chicago, Illinois. Purposes of study analyses were: identify theoretical factors underlying a large set of social indicators, determine degree to which resultant factor scale scores predict community resident admissions to publicly-funded AODD treatment, and explore usefulness of factor scale scores in grouping communities into planning regions. Cautions and limitations in interpretation of results are discussed.

Chicago↗