Matthew Johnsen

Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness

OBJECTIVES This study evaluated the hypothesis that greater integration and coordination between agencies within service systems is associated with greater accessibility of services and improved client housing outcomes. METHODS As part of the Access to Community Care and Effective Services and Supports program, data were obtained on baseline client characteristics, service use, and 3-month and 12-month outcomes from 1832 clients seen at 18 sites during the first year of program operation. Data on interorganizational relationships were obtained from structured interviews with key informants from relevant organizations in each community (n = 32-82 at each site). RESULTS Complete follow-up data were obtained from 1340 clients (73%). After control for baseline characteristics, service system integration was associated with superior housing outcomes at 12 months, and this relationship was mediated through greater access to housing agencies. CONCLUSIONS Service system integration is related to improved access to housing services and better housing outcomes among homeless people with mental illness.

In search of the missing linkages: continuity of care in U.S. jails

Persons with symptoms of acute mental illnesses present problems for jail management. Jails have a constitutional duty to provide psychiatric services to all persons in need of such care. However, mental health resources are frequently insufficient to meet the many needs of persons with mental illnesses in jails, and are often inaccessible to those released to the community. This study focuses on the experiences of a cohort of detainees (n = 379) with mental illnesses who have been incarcerated in seven U.S. jails. Data gathered include criminal and demographic characteristics, mental health services received by the detainees in jail, discharge planning activities by jail staff, and community-based outcomes after release. This is primarily a descriptive study depicting typical experiences and processes related to detainees with mental illnesses. The goal is to provide information to support more detailed studies on the effectiveness of mental health-criminal justice linkages.

Case Management Models for Persons Who Are Homeless and Mentally Ill: The ACCESS Demonstration Project

Persons who are homeless and mentally illpresent unique challenges to service providers and humanservice systems. In vivo case management approaches suchas assertive community treatment (ACT) have shown promise in engaging this population. This paperexplores case management models employed within theACCESS program, a five year, 18-site demonstrationprogram enriching services for homeless persons with serious mental illness. We describe theimplementation of case management with ACCESS programsand determine the extent of variation across sites usinga measure of fidelity to ACT. While programs reported using four models, much similarity was foundamong programs on multiple dimensions.

Evaluating performance and change in mental health systems serving children and youth: An interorganizational network approach

Planning for the delivery of community mental health services has evolved from models of services within individual agencies to community-wide systems of care, but development of methodologies for assessing system performance has lagged behind. This article presents one approach to systemlevel assessment by viewing children’s mental health systems as an interorganizational network. Data are presented on two county-based child mental health systems in North Carolina that participated in the Robert Wood Johnson Foundation Mental Health Services Program for Youth. Site-specific data on client referrals, fund exchanges, and information flows were collected at two time points (1991 and 1993) to measure the cohesiveness and concentration of the service system using network k-core analyses. In addition, stakeholder ratings of service adequacy, quality, availability, coordination, and overall demonstration project goal attainment were obtained at both time periods. Findings indicate that the rural system was outperforming the urban system at the time of the first survey, but the urban system caught up over the study interval. There was high agreement between the network and stakeholder ratings of system performance at both time periods. The method of data collection and analysis used in this study provides tools that can be used in a variety of settings to assess service system growth and development.

An Empirical Assessment of Rural Community Support Networks for Individuals with Severe Mental Disorders

The community support network has beenwell-established as a requirement for communitytreatment of individuals with severe mental disorders.This network generally consists of a multidisciplinaryset of organizations that interrelate in some mannerwith individuals in the community. The question ofcoordination within this network has been muchdiscussed; however little published research hasempirically examined the types and extent of coordinationamong network organizations. In particular, littleattention has been given to community support networksin rural communities. In each of seven rural counties, information was obtained on interactions amongorganizations in the community support network. Thesenetworks were analyzed to yield information on networkdensity and centralization. Using measures of centrality, the most central organizations ineach network were identified. Exchanges of informationwere the most common type of interaction amongorganizations in each network. Client referrals occurred less frequently, and sharing of resources wasan even rarer phenomenon. Network analysis of communitysupport networks provides an objective perspective onthe structure of community support networks. An understanding of exchange among organizationswithin these networks is of value to administrators,clinicians, and planners interested in achieving greatereffectiveness, as well as to patients, their families, and advocacy groups concerned with access andquality of care.

A study of a structured exercise program with members of an ICCD Certified Clubhouse: program design, benefits, and implications for feasibility.

Individuals with serious mental illness (SMI) have significantly greater risk of comorbid health problems and premature death, and there is need for interventions that can improve physical fitness and overall health. Accordingly, a study was conducted which evaluated the effectiveness of a structured physical exercise program that was developed as part of a wellness project in an ICCD Certified Clubhouse. Seventeen clubhouse members completed a 16-week program with evidence of significant improvement in aerobic capacity and perceived mental health as well as positive trends in perceived improvements in physical and social functioning. Qualitative data indicated satisfaction with the program by all participants, especially the value of group support, while also highlighting the need for greater attention to nutrition as part of a future program. Moreover, the study found that a structured exercise program can be successfully provided to members of an ICCD Certified Clubhouse.

Structure and change in child mental health service delivery networks

This article presents an empirical approach which views mental health service systems as interorganizational networks. Data are reported on two county-based child mental health systems in North Carolina that participated in the Robert Wood Johnson Foundation (RWJF) Mental Health Services Program for Youth. Analyses are based on a structural equivalence approach which groups organizations on the basis of similarity in their patterns of interaction. Site-specific data were collected at two time points (1991 and 1993) to measure the social network structure of these service systems including their density, fragmentation, and centralization. Findings indicate that two interesting changes occurred in these systems of care. First, each system moved in a direction consistent with the goals of the RWJF demonstration program, in that they were better organized by the end of the demonstration. Second, while the two systems started at very different levels of system development, one site made significantly larger gains, such that the systems converged over time toward moderately high levels of system organization at the end of the demonstration. Implications for further research are discussed.

Using the Referral Decision Scale to Screen Mentally Ill Jail Detainees: Validity and Implementation Issues

The prevalence of serious mental illnesses in jail populations is significantly greater than in the general population. Identifying individuals who warrant psychiatric evaluations is important and benefits correctional staff as well as detainees. One widely used screening instrument intended for this task is the Referral Decision Scale (RDS). This paper reviews the development and validation of the RDS. Using data from a multisite study which assessed postrelease outcomes for detainees with mental illness, various types of validity are addressed. The results confirm that the RDS has some inherent characteristics that seriously limit its practical application as a screening instrument for use by correctional staff.

Different Paths to Justice: The ADA, Employment, and Administrative Enforcement by the EEOC and FEPAs

Under Title I of the ADA, individuals who believe they have been subjected to disability-based employment discrimination may file an administrative charge. This article looks at who files charges; over what issues, and with what outcomes in both Equal Employment Opportunity Commission (EEOC) field offices, and state and local fair employment practice agencies (FEPAs). The data for the article are computerized records of all ADA charges filed through March 31, 1998. The data indicate that individuals who rely on a FEPA to investigate their charge have a greater likelihood of obtaining a beneficial outcome than individuals who rely on the EEOC, but proportionately more individuals receiving a beneficial outcome are likely to receive monetary benefits from the EEOC than from a FEPA. Further, those who receive beneficial outcomes will probably receive greater monetary benefits from charges investigated by the EEOC than from those investigated by a FEPA.

What Does Competitive Employment Mean? A Secondary Analysis of Employment Approaches in the Massachusetts Employment Intervention Demonstration Project

Significant unemployment among adults with serious mental illness (SMI) is a well-documented problem. Estimates suggest that as many as 85% of adults with SMI are unemployed at any one time (Anthony & Blanch, 1987; Milazzo-Sayre, Henderson & Manderscheid, 1997; Rogers, Walsh, Masotta & Danley, 1991). Recent years have seen advances in the development and dissemination of a variety of supported employment services for adults with disabilities. When people with SMI are enrolled in services with a specific employment focus, they achieve employment outcomes (e.g. job placement rates, job tenure) superior to those achieved by people receiving standard mental health services such as day treatment (Bond et al., 2001; Cook, 2003). Supported employment is now considered an “evidenced-based” practice (Bond et al., 2001). Although supported employment approaches vary, evidence-based services share common principles, including (1) prioritizing client preferences for type and timing of work; (2) providing in-vivo and follow-along supports as long as needed; (3) viewing work attempts as part of a learning opportunity; (4) having a commitment to “competitive” employment as an attainable goal; and (5) not relying on pre-vocational training, day treatment or sheltered workshops (Bond et al., 2001; Mowbray, Leff, Warren, McCrohan et al., 1997; Ridgeway & Rapp, 1998).