Joseph Guada

The Relationships Among Perceived Criticism, Family Contact, and Consumer Clinical and Psychosocial Functioning for African-American Consumers with Schizophrenia

This study examined whether Perceived Criticism (PC) was related to community functioning in a sample of African-American consumers with schizophrenia. The study tested assumptions from the Expressed Emotion literature that were based primarily on samples of white consumers. The study found that PC affected psychiatric symptomatology but not psychosocial functioning. Greater family contact was strongly related to better psychosocial functioning. Findings suggested that the nature and impact of contact between consumer and family for this sample of African-Americans appears different from what has been found in white, middle-class samples.

An Exploratory Factor Analysis of the Burden Assessment Scale with a Sample of African-American Families

It remains unclear if the factor structures of commonly used caregiver burden scales normed on white samples are similar with samples from different ethnic communities. Our study tests the factor structure of the Burden Assessment Scale (BAS) using Exploratory Factor Analysis (EFA) with data from low-income, African American families caring for a family member with schizophrenia. The EFA solution included a 2 factor structure of subjective burden and objective burden with strong loadings demonstrating a clear differentiation between the factors. Our results suggest that low income, African American families appear to experience caregiving burden as one major or broad component in their lives similar to other areas that demand ongoing coping and adaptation. Likewise, the factor structure found with this sample as compared to the factor structure found with white samples suggests differences in the perception of and/or the reporting of burden. Study limitations as well as implications for practice are provided.

Individual and Contextual-Level Factors Associated with Continuity of Care for Adults with Schizophrenia

This retrospective cohort study examined rates of conformance to continuity of care treatment guidelines and factors associated with conformance for persons with schizophrenia. Subjects were 8,621 adult Ohio Medicaid recipients, aged 18–64, treated for schizophrenia in 2004. Information on individual-level (demographic and clinical characteristics) and contextual-level variables (county socio-demographic, economic, and health care resources) were abstracted from Medicaid claim files and the Area Resource File. Outcome measures captured four dimensions of continuity of care: (1) regularity of care; (2) transitions; (3) care coordination, and (4) treatment engagement. Multilevel modeling was used to assess the association between individual and contextual-level variables and the four continuity of care measures. The results indicated that conformance rates for continuity of care for adults with schizophrenia are below recommended guidelines and that variations in continuity of care are associated with both individual and contextual-level factors. Efforts to improve continuity of care should target high risk patient groups (racial/ethnic minorities, the dually diagnosed, and younger adults with early onset psychosis), as well as community-level risk factors (provider supply and geographic barriers of rural counties) that impede access to care.

How Family Factors Impact Psychosocial Functioning for African American Consumers with Schizophrenia

There is a critical need to test how family contextual factors impact outpatient consumer functioning in schizophrenia. This is the first study of two companion studies reported here that tests family factors’ influence on consumer functioning. Ninety-three low income inner-city African American consumer-family dyads were tested to see the possible impact of family factors, based on the EE and family caregiver burden literatures, on consumer psychosocial functioning (work, social, and independent living). The results supported a model wherein greater amounts of family contact had a significant relationship with better consumer psychosocial functioning. Additionally, family dysfunction had a direct negative relationship to consumer psychosocial functioning while family pressures and resources had an indirect negative relationship to consumer psychosocial functioning. Results are in marked contrast to what impacted consumer clinical functioning for the same sample. The findings appear to confirm that family factors differently impact the domains of clinical and psychosocial functioning. These findings are new for understanding the contextual factors that impact consumer functioning, especially psychosocial functioning.

The Importance of Consumer Perceived Criticism on Clinical Outcomes for Outpatient African Americans with Schizophrenia

This is the second of two studies that tests the impact of family factors on consumer functioning. This study tests the impact of the consumer’s perception of being criticized by the family (consumer perceived criticism) on the consumer’s clinical functioning. It likewise, concurrently tests the impact that other family factors have on perceived criticism. The sample was ninety-three consumer-family dyads. Results showed that none of the family factors directly contributed to level of perceived criticism, but more consumer perceived criticism was significantly related to higher levels of psychiatric symptoms. The findings suggest that an important component of treatment for symptom stabilization for African American consumers involves perceptions of the family being critical toward the consumer. The finding confirms for a sample of poor outpatient African American consumers what was found in previous research with African Americans. Results are in marked contrast to what impacted consumer psychosocial functioning in the companion study, suggesting that clinical and psychosocial functioning domains are distinct, particularly for African American consumers. This should be reflected in the interventions that are developed for African American consumers and their families.

Adult day services: A service platform for delivering mental health care

Objectives: The purpose of this study was to understand the degree to which mental health services targeting anxiety and depression disorders are offered by adult day services (ADS) centers in the US. In addition, researchers wanted to determine whether staffing and organizational characteristics are associated with the provision of medication management, individual counseling, and group counseling for participants with anxiety or depression. Method: Data were drawn from the MetLife National Study of ADS. Hierarchical logistic regression analyses were conducted to determine which staffing and organizational factors were associated with the provision of services to treat anxiety and depression. Results: Approximately, three in four adult day programs provided medication management for the treatment of anxiety and depression while 38% provided individual counseling and almost 30% group counseling. Programs offering medication management were more likely to have more registered nurse (RN) service hours available per shift and higher costs. Programs that provided individual and group counseling for participants with anxiety or depression were more likely to have more hours of RN and social work services available and a lower percentage of participants who pay privately for services. Conclusion: The results suggest that ADS are well positioned to act as a platform for delivering mental health care to older persons with anxiety or depression.

Assessing the Family Functioning of Inner-City African-American Families Living With Schizophrenia With the McMaster Family Assessment Device

Historically, the mental health literature focused on the deficits of families, particularly for those families with a family member with schizophrenia. The purpose of the present study is to assess the family functioning of a group of inner-city African-American families who have a family member living with schizophrenia. This study analyzes potential clinical problems for these families using a commonly used family functioning device—the McMaster Family Assessment Device (MFAD). The families showed no clinical problems on five of the seven sub-scales. The study provides preliminary quantitative evidence that social work research and practice models should avoid a deficit-oriented model when assessing and intervening with similar families.

Culturally Competent Practice with African American Juvenile Sex Offenders

African American juveniles adjudicated for sexual offenses may struggle with the mistrust of both the judicial and treatment systems. Unlike general mental health services, juvenile sex offender treatment is often mandated by the court or child welfare services, thus these youths and their families must engage in the treatment process. Without clinicians and services that can acknowledge and respond to a minority youth’s experience in a sensitive, culturally competent manner, there could be significant resistance to treatment. Traditional treatment approaches fail to prioritize issues involving cultural competence. This article addresses the unique challenges of African American juvenile sex offenders and makes recommendations for creating culturally competent practice for these youth and their families.

The Aftercare Support Program: An Emerging Group Intervention for Transition-Aged Youth

The unique challenges faced by transition-aged youth have received considerable attention in the literature, but few developments for aftercare support interventions have followed. The Aftercare Support Program (ASP) is a group-based intervention designed for such youth. ASP was developed as a zero budget, low-intensity intervention delivered by volunteers from a local college/university and youth-serving agencies to encourage transition-aged youth to pursue postsecondary education and vocational training by utilizing existing community resources and services. The underlying theoretical concepts are derived from solution-focused brief therapy and a strengths-perspective in social work. Case vignettes, including feedback from participants and lessons learned are offered, along with implications for the ASP model and other aftercare support models for transition-aged youth at a time when public and private funds for such programs are limited.

The Unique Coping Strategies of African American Families With a Loved One With Schizophrenia: The Use of the Family Crisis Oriented Personal Evaluation Scale

This study assesses how a sample of African American families with a loved one with schizophrenia cope using a commonly used family coping scale (F-COPES). The scales overall performance and psychometric properties were tested to highlight how such families cope. The results demonstrated that families used proactive verses passive ways of coping. An exploratory factor analysis also demonstrated several unique ways in which this sample coped that were not included in the original subscales of the scale. The utility of using a family coping scale such as the F-COPES for practice and research with similar populations is reviewed.