Donald M. Linhorst

A Review of the Use and Potential of Focus Groups in Social Work Research

Over the last 15 years, social scientists increasingly have used focus groups as a method for collecting qualitative data. With focus groups, a moderator uses the group process with a small number of participants to stimulate discussion and obtain information on the beliefs, attitudes, or motivations of participants on a specific topic. Based upon a review of a sample of social work articles, researchers used focus groups to study a wide range of topics, with diverse and vulnerable populations, and in combination with other qualitative or quantitative methods. Although focus groups have limitations, they have the potential to be an important qualitative data collection method to capture information about the variety of issues and populations dealt with by the social work profession. In addition, social work researchers have the potential to further develop focus groups as a qualitative research method.

Involving People with Severe Mental Illness in Evaluation and Performance Improvement

This article argues for the increased involvement of people with severe mental illness and consumers of other health and mental health services in evaluation and performance improvement in the organizations from which they receive services. Among other reasons, consumers can bring a different perspective to the selection of areas to evaluate, such involvement is consistent with some models of program evaluation, and the process of participation itself can be empowering to consumers. Based on a review of the literature and the experiences of a public psychiatric hospital in involving consumers in evaluation and performance improvement, the authors exemplify how mental health consumers can participate in each stage of the evaluation process, ranging from the initial stage of posing evaluation questions to the final stage of acting on evaluation findings. Next, challenges to consumer involvement are described. Guidelines are then offered for involving consumers of health and mental health services in evaluation and performance improvement.

Conditions for Empowering People with Severe Mental Illness

We contend that people with severe mental illness can be empowered though participation in decision making when certain conditions are met. Applying the work of Joel Handler, we identify seven conditions that must be present for meaningful participation to occur. Some conditions are internal to the person, such as having controlled psychiatric symptoms and decision‐making skills, while others are a function of the mental health system. We apply the conditions to an analysis of empowerment at a public psychiatric hospital. We conclude with the roles of mental health clinicians, administrators, and policy makers in creating conditions for empowerment.

Assaultive Behavior in State Psychiatric Hospitals Differences Between Forensic and Nonforensic Patients

Forensic patients are occupying an increasingly large number of beds in state psychiatric hospitals. The presence of these mentally ill offenders has raised concerns about the risk they present to nonforensic patients. This study compared the rate of assaults and factors associated with assaultive behavior among 308 nonforensic patients and two groups of forensic patients including 469 patients found not guilty by reason of insanity and 76 pretrial patients. Consistent with other studies, nonforensic patients had higher rates of assaults than either group of forensic patients. However, being a forensic patient did not affect the odds of assault when controlling for the effects of demographic and clinical variables in a multivariate logistic regression analysis. Factors associated with assaults in each of the three patient groups were identified using multivariate analyses. Implications are presented for treatment of assaultive behavior, mixing of forensic and nonforensic patients within state hospitals, forensic release policies, and future research.

Recidivism among Offenders with Developmental Disabilities Participating in a Case Management Program.

This study examined recidivism, defined as arrests, among 252 clients who were accepted into a case management program for offenders with developmental disabilities. Overall, 40% of clients were arrested while participating in the program, and 34% were arrested within 6 months after case closure. The crimes for which clients were arrested tended to be minor: 21% were for probation or parole violations not associated with new criminal acts, 39% were for misdemeanors, 27% were nonviolent felonies, and 12% were for felonies against persons. Clients who completed the program (N=115) were less likely to be arrested after case closure than those who dropped out of the program (N=112), 25 and 43%, respectively. Other factors associated with arrests after case closure included having a developmental disability other than mental retardation, living in an urban area, being referred to the program by a criminal justice agency or through a private referral rather than a social service agency, and being arrested while in the program. Implications are discussed for service provision and evaluation of programs that work with offenders with developmental disabilities.

Factors Associated with Mental Health Court Nonparticipation and Negative Termination

Mental health court outcomes research shows moderate success in reducing criminal recidivism. Far less research concentrates on defendants who do not choose to participate or are negatively terminated. Eight years of data from a suburban Midwestern mental health court indicate that substance abuse history and having multiple psychiatric diagnoses increased the odds of nonparticipation, while a bipolar diagnosis, the other category of diagnosis, and referral source, decreased the odds. For those negatively terminated, being male, racial minority status, having multiple diagnoses, a charge of stealing, and committing a new crime while under Municipal Mental Health Court supervision increased the odds of negative termination. A substance abuse history, increased mental health court attendance, receiving disability income, and psychiatric medication prescription decreased the odds of negative termination. Implications for policy, practice, and future research are discussed, including better engagement strategies for participation and treatment.

Implementing the Essential Elements of a Mental Health Court: The Experiences of a Large Multijurisdictional Suburban County

Mental health courts developed in the USA in the late 1990s as one means to reduce the involvement of people with mental illness in the criminal justice system. In response to the growth in number of mental health courts, the Council of State Governments led an initiative to identify essential elements of mental health courts to guide their development and implementation. This paper applies these essential elements to a municipal mental health court in a multijurisdictional, suburban county. While this court met most essential elements, they faced a number of challenges. The primary ones included not being able to advance from hearing municipal cases only to state misdemeanor and felonies, not having the resources to expand program capacity for municipal cases, and participants not being able to always access needed mental health treatment, rehabilitation, and support services. The paper concludes with implications for behavioral health administrators and direct service staff in implementing the essential elements of mental health courts.Mental health courts developed in the USA in the late 1990s as one means to reduce the involvement of people with mental illness in the criminal justice system. In response to the growth in number of mental health courts, the Council of State Governments led an initiative to identify essential elements of mental health courts to guide their development and implementation. This paper applies these essential elements to a municipal mental health court in a multijurisdictional, suburban county. While this court met most essential elements, they faced a number of challenges. The primary ones included not being able to advance from hearing municipal cases only to state misdemeanor and felonies, not having the resources to expand program capacity for municipal cases, and participants not being able to always access needed mental health treatment, rehabilitation, and support services. The paper concludes with implications for behavioral health administrators and direct service staff in implementing the essential elements of mental health courts.

Implementing psychosocial rehabilitation in long-term inpatient psychiatric facilities

Using the focus group methodology, data were gathered from the initial experiences of Missouri’s four long-term psychiatric facilities with psychosocial rehabilitation (PSR). Significant implementation factors include the establishment of a firm PSR philosophical base; extensive staff training in PSR values, technologies, and the skills necessary to implement the technologies; support for staff as their roles change with the adoption of PSR; adaptation of PSR for use with forensic clients; use of community resources while clients are still inpatients; maintenance of PSR values and skills learned after clients are released into the community; and the establishment of a program evaluation system that assesses both outcome and process. Clients residing in long-term, public psychiatric facilities also can receive substantial benefits from this approach to service delivery.Using the focus group methodology, data were gathered from the initial experiences of Missouri’s four long-term psychiatric facilities with psychosocial rehabilitation (PSR). Significant implementation factors include the establishment of a firm PSR philosophical base; extensive staff training in PSR values, technologies, and the skills necessary to implement the technologies; support for staff as their roles change with the adoption of PSR; adaptation of PSR for use with forensic clients; use of community resources while clients are still inpatients; maintenance of PSR values and skills learned after clients are released into the community; and the establishment of a program evaluation system that assesses both outcome and process. Clients residing in long-term, public psychiatric facilities also can receive substantial benefits from this approach to service delivery.

Development and implementation of a program for offenders with developmental disabilities.

The need for a comprehensive range of services for persons with mental retardation and other developmental disabilities who enter the criminal justice system has been well-established. However, such services are unavailable to most offenders with developmental disabilities. Here we describe the services of one agency devoted to this population. Established in 1990, this agency has provided education and training to over 1,500 professionals, answered over 1,000 information and referral questions, and provided direct services to over 600 offenders with developmental disabilities. Recommendations for developing and implementing similar programs are offered. Areas addressed include assessing need, funding, composition of boards of directors, program philosophy, selection of program services, staffing, the referral process, and program evaluation.

The Impact of Insanity Acquittees on Missouri's Public Mental Health System

Even though state departments of mental health have primary responsibility for the care, custody, and treatment of insanity acquittees, the impact of insanity acquittees on the public mental health system is generally lacking in policy discussions and as a topic for policy research. This issue has received increased attention in Missouri, where insanity acquittees now occupy half of the long-term public psychiatric hospital beds. This article examines the presence of Missouris insanity acquittees on the states public mental health system and includes the impact on goals, fiscal costs, inpatient and community psychiatric services, and inpatient treatment staff. As states consider managed care and other cost containment measures, it remains to be seen if the high costs associated with extensive use of hospitalization of insanity acquittees to promote public safety will influence policy changes to more community-based insanity acquittee systems.