Bret Kloos

Understanding the experience of place: Expanding methods to conceptualize and measure community integration of persons with serious mental illness

Community integration research explores community contexts and factors that encourage or hinder individuals with serious mental illness (SMI) from actively participating in community life. This research agenda can be advanced by using mixed-methods that better document the relationships between contextual factors and individual experience. Two such methods were applied to a mixed-methods study of 40 adults with SMI living in independent housing in the Southeastern United States. Their contextualized experiences of community integration were measured by applying innovative participatory mapping and Geographic Information Systems (GIS) mapping techniques. Use of these methods in conjunction with one another facilitated the creation of activity spaces, which can measure geographic accessibility and help to represent an individuals experience of place and degree of mobility. The utility of these newly applied methods for better understanding community integration for persons with SMI is explored and implications for using these measures in research and practice are discussed.

Reconcilable Differences? Human Diversity, Cultural Relativity, and Sense of Community

Sense of community (SOC) is one of the most widely used and studied constructs in community psychology. As proposed by Sarason in (The Psychological sense of community: prospects for a community psychology, Jossey-Bass, San Francisco, 1974), SOC represents the strength of bonding among community members. It is a valuable component of community life, and it has been linked to positive mental health outcomes, citizen participation, and community connectedness. However, promotion of SOC can become problematic in community psychology praxis when it conflicts with other core values proposed to define the field, namely values of human diversity, cultural relativity, and heterogeneity of experience and perspective. Several commentators have noted that promotion of SOC can conflict with multicultural diversity because it tends to emphasize group member similarity and appears to be higher in homogeneous communities. In this paper, we introduce the idea of a community-diversity dialectic as part of praxis and research in community psychology. We argue that systematic consideration of cultural psychology perspectives can guide efforts to address a community-diversity dialectic and revise SOC formulations that ultimately will invigorate community research and action. We provide a working agenda for addressing this dialectic, proposing that systematic consideration of the creative tension between SOC and diversity can be beneficial to community psychology.

A Social Ecological Approach to Investigating Relationships Between Housing and Adaptive Functioning for Persons with Serious Mental Illness

This paper seeks to advance mental health—housing research regarding which factors of housing and neighborhood environments are critical for adaptive functioning, health, and recovery for persons with serious mental illness (SMI). Housing and neighborhood environments are particularly important for persons with SMI because of the prevalence of poor housing conditions among this population. Most mental health—housing research has been limited by a focus on problems in environments and functioning. The paper seeks to expand the mental health—housing research agenda to consider protective factors that promote community integration and adaptive functioning. We provide an account of how social ecology theory transformed a research program, from examining individual risk factors to investigating the functioning of persons in the contexts of their housing and neighborhood experiences. The resulting housing environment framework—physical aspects of housing and neighborhoods, social environment of neighborhoods, and interpersonal relationships tied to housing—allows for identification of opportunities for health promotion and facilitation of participation in community-based settings. This program of research draws upon several methods to understand the social experience of persons with SMI living in community settings—survey research, qualitative interviews, Geographic Information Systems, participatory research, and visual ethnography. In this paper, we present how social ecology theory was instrumental in the development of new housing environment measures, the selection of appropriate research methods, and framing research questions that are building a new empirical base of knowledge about promoting adaptive functioning, health, and recovery for persons with SMI living in community settings.

Homelessness, Mental Illness and Citizenship

Assertive mental health outreach to homeless persons, which operates under the premise that mental illness must be understood and treated within the individual’s social and economic environment, points towards the goals of community membership and ‘citizenship’—a connection to the rights, responsibilities, roles, and resources that society offers through public and social institutions and informal ‘associational life’—for homeless persons. We argue that the concept of citizenship is a useful framework for approaching these goals. We review the principles of assertive mental health outreach and relevant aspects of contemporary citizenship theory; present a case example of outreach leading to a ‘citizenship project’; and discuss the potential benefits and pitfalls of a citizenship framework, including strategies and recommendations for program administrators, researchers and policy makers.

Examining the Psychological Sense of Community for Individuals with Serious Mental Illness Residing in Supported Housing Environments

The psychological sense of community is an important aspect of community life; yet, it remains largely unexamined among individuals with serious mental illness (SMI). Sense of community represents the strength of bonding among community members; and this social phenomenon likely impacts the process by which individuals with SMI integrate into community life. The current study examined sense of community (SOC) for individuals with SMI by assessing the relationships between neighborhood experiences, unique factors related to SMI (e.g., mental illness diagnosis), and sense of community in the neighborhood. Participants were 402 residents of supported housing programs who used mental health services in South Carolina. Hierarchical linear regression was utilized to determine which components of community life helped to explain variability in sense of community. In total, 214 participants reported that it is very important for them to feel a sense of community in their neighborhoods. Neighbor relations, neighborhood safety, neighborhood satisfaction, neighborhood tolerance for mental illness, and housing site type emerged as significant explanatory variables of sense of community. These findings have implications for interventions aimed at enhancing SOC and community integration for individuals with SMI.

The prospect and purpose of locating community research and action in religious settings

Although the importance of working with people within their natural settingshas been advocated since the 1965 conference at Swampscott, communitypsychologists have had relatively little discourse about religious settings whencompared to the vast number of studies undertaken in other settings—schools, family environments, workplaces, and hospitals, to name a few.Only in recent years have some community psychologists begun to explore the potential benefits of working within religious and spiritual settings. Weassert that this omission has resulted in little work centered in the context ofreligious settings, and consequently may limit the scope of our theories andthe effectiveness of our interventions. In this article we argue that there issufficient evidence to conclude that locating research and interventionprojects in religious contexts can enrich the study and practice in the field.We consider first the history of the relationship between religion andpsychology in research and practice, and review community psychology’sdiscussion of religious settings over the past 25 years. We then discuss therelevance of these settings for community psychology by reviewing empiricalfindings within a conceptual framework of key constructs of communitypsychology. We argue that work in many religious settings is consistent withthe priorities associated with these constructs. Furthermore, collaborationwith religious organizations which share priorities with communitypsychology can help both community psychologists and participants of thesereligious settings achieve their goals.

A Little Goes a Long Way: The Impact of Distal Social Support on Community Integration and Recovery of Individuals with Psychiatric Disabilities

Although an extensive body of literature highlights the important role of social support for individuals with psychiatric disabilities, definitions of support tend to be restricted—focusing on intimate relationships such as friend and family networks and ignoring the role of casual relationships existing naturally in the community. This mixed-methods study of 300 consumers of mental health services in the Southeastern US aims to better understand the impact of community supports, termed distal supports, on community integration and recovery from mental illness. Qualitative content analysis, tests of group mean differences, and hierarchical linear regression analyses revealed the following: (1) participants primarily reported receiving tangible support (e.g., free medication/discounted goods) from distal supports rather than emotional support (e.g., displays of warmth/affection) or informational support (e.g., provision of advice); (2) women and older participants reported more distal supports than men or younger participants; and (3) distal supports played a unique role in predicting community integration and recovery even after accounting for the influence of traditional support networks. Results highlight the importance of considering diverse types of social support in naturally occurring settings when designing treatment plans and interventions aimed at encouraging community participation and adaptive functioning for individuals with psychiatric disabilities.

Trauma and adaptation in Severe Mental illness: The role of self-reported abuse and exposure to community violence

ABSTRACT The authors examined the role of self-reported physical and/or sexual abuse and recent exposure to community violence on three adaptation outcomes in Severe Mental Illness (SMI): psychotic symptoms, demoralization, and substance abuse. One hundred and nine (109) individuals with SMI were administered an extensive protocol that included the pertinent variables. Structural Equation Modeling analyses indicated that abuse predicted psychotic symptoms and demoralization, whereas exposure to community violence predicted substance abuse. These findings point to different possible trauma-adaptation configurations, and suggest that both past and present trauma complicates the adaptation of people with SMI.

The roles of clinical and nonclinical dimensions of recovery in promoting community activities for individuals with psychiatric disabilities.

OBJECTIVE The present study examines the relationships between theoretical domains of recovery as put forth by Whitley and Drake (Whitley, R., & Drake, R. [2010]. Recovery: A dimensional approach. Psychiatric Services, 61, 1248-1250). Specifically, it proposes that nonclinical components of recovery can mediate, or account for, the relationship between clinical recovery (e.g., less psychiatric distress) and more participation in community activities. METHOD Three hundred adults recruited from an outpatient community mental health population were interviewed once using self-report questionnaires about community experiences, social functioning, and psychiatric symptoms. Present analyses used the Recovery Assessment Scale, the Brief Symptom Inventory Global Severity Index, and a community activities measure designed for the study. RESULTS A series of linear regressions supported the model of nonclinical recovery as a mediator of the hypothesized relationship. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Findings hold implications for integrating the dimensions of recovery, as both components seem to promote community integration. Future research should further explore the relationships between all dimensions of recovery.

Mind Over Matter? The Role of Individual Perceptions in Understanding the Social Ecology of Housing Environments for Individuals with Psychiatric Disabilities

Abstract There is a disagreement in place-based research regarding whether objective indicators or individual perceptions of environments are better predictors of well-being. This study assessed environmental influences on well-being for 373 individuals with psychiatric disabilities living independently in 66 neighborhoods in the southeastern United States. Three questions were examined utilizing random effects models: (1) How much variance in personal and neighborhood well-being can be explained by neighborhood membership? (2) What is the relationship between participant perceptions of neighborhood quality and researcher ratings of neighborhood quality? and (3) What is the relative influence of individual perceptions, perceptions aggregated by neighborhood, and researcher ratings of neighborhood quality in predicting personal and neighborhood well-being? Results indicate that individual perceptions of neighborhood quality were more closely related to well-being than either aggregated perceptions or researcher ratings. Thus, participants’ perceptions of their neighborhoods were more important indicators of their well-being than objective ratings made by researchers. Findings have implications for measurement approaches and intervention design in placed-based research.