Sandra E. Herman

Pathways to Family Empowerment: Effects of Family-Centered Delivery of Early Intervention Services

This study explores how the method of delivery for early intervention services impacts perceptions of empowerment among families. Analysis of data collected from 270 randomly sampled families participating in the State of Michigans Early On (Part H of the Individuals with Disabilities Education Act) program suggests two paths by which empowerment is effected. Along one path, implementation of program components via a family-centered framework appears to help increase empowerment. An alternative path models how family-centered delivery may help to build a familys support network. This is related to reduced stress and increased empowerment. Findings support programs emphasizing family-centered methods of service delivery.

Longitudinal effects of integrated treatment on alcohol use for persons with serious mental illness and substance use disorders

A randomized experimental design was used to assign participants to an integrated mental health and substance use treatment program or to standard hospital treatment. A multilevel, nonlinear model was used to estimate hospital treatment effects on days of alcohol use for persons with serious mental illness and substance use disorders over 18 months. The integrated treatment program had a significant effect on the rate of alcohol use at 2 months postdischarge, reducing the rate of use by 54%. Motivation for sobriety at hospital discharge, posttreatment self-help attendance, and social support for sobriety were also found to reduce the rate of use during the follow-up period. Implications for mental health treatment and aftercare support are discussed.

Methods of ensuring high follow-up rates: Lessons from a longitudinal study of dual diagnosed participants

Despite growing research interest in co-occurring psychiatric and substance misuse disorders, relatively few longitudinal studies have been conducted with dual diagnosis populations. Many of the longitudinal studies that have been done have experienced excessive attrition. Thus, investigators have noted that one of the primary difficulties of conducting longitudinal studies with this population is successfully minimizing attrition during follow-up. This study, conducted in 1991 1993, describes retention and tracking methods employed in a longitudinal study of 485 dual diagnosis participants. Follow-up interview completion rates at the 2-, 6-, 10-, 14-, and 18-month interviews were 86.7, 85.6, 85.1, 84.5, and 88.4%, respectively. Several case studies are provided that document some of the challenges facing project staff and successful strategies for handling them. A notable finding from this study was that participants reported that the relationship established with the interviewer was more important than material incentives in preventing study attrition.

Perceptions of services and resources as mediators of depression among parents of children with developmental disabilities

Path analysis was used to test the effects of resource perceptions and respite use in a theoretical model of parental adaptation to children with disabilities The amount and quality of respite indirectly affected parental depression via parents perceptions of the adequacy of baby sitting and the time the parent had for herself or himself. Both quality and respite use were related to the helpfulness of the parents social network. The strongest predictor of depression was the parents perception of time resources, which was influenced by the amount of care the child required, the adequacy of money, and baby sitting resources.

Client typology based on functioning level assessments: utility for service planning and monitoring.

Cluster analysis was used to develop a six-group typology based on level of functioning data from 2,447 clients with serious mental illness served by the Michigan public mental health system. The groups are described in terms of level of functioning in 16 domains, global functioning, diagnosis, demographic characteristics and services used. A group of older, poor functioning clients with high health needs was identified. A second group of highly dysfunctional clients with few health needs was also found. Two groups of young adult “chronic” clients were found: one with extensive substance abuse problems and one with moderate substance abuse problems and extreme levels of suicidal and aggressive behavior. Two groups of relatively good functioning clients were also identified: one with some problems in many areas and a second with functional problems in a number of life areas and pronounced symptoms of depression and demoralization. The results point to the utility of cluster analysis as a mechanism to organize and identify patterns within the rich array of information provided by multidimensional level of functioning assessments. The uses of empirically derived client types in planning and monitoring mental health services are discussed.

Treatment for mental illness and substance abuse in a public psychiatric hospital. Successful Strategies and Challenging Problems

Although the literature on dual diagnosis has grown considerably over the last several years, report describing inpatient treatment models are less common. We describe some of the major treatment concerns in the dural diagnosis literature, such as using 12-step self-help programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), dealing with different stages of treatment, and developing a program with integrated substance abuse and psychiatric treatment. The practical application of these treatment issues is featured by showing how they are incorporated into an innovative inpatient dual diagnosis treatment program at a public psychiatric hospital. Finally, the treatment program is described in detail regarding administrative issues, staff training, daily treatment schedules, and patient demographics.

Immediate outcomes of substance use treatment within a state psychiatric hospital

Outcomes of an integrated inpatient treatment program for persons with serious mental illness and substance use disorders are examined in relationship to five stages of treatment—stabilization, engagement, persuasion/awareness, active treatment, and relapse prevention. The study used a randomized design with participants assigned to an integrated mental health and substance abuse treatment program or standard psychiatric hospital treatment. At discharge, participants in the integrated treatment program indicated more active engagement in treatment and greater awareness of mental health issues, substance use issues, and the 12-step program than those who received standard hospital treatment. Participants in the integrated treatment program also saw their treatment as being more effective and had more motivation to stay healthy and sober. The integrated treatment program was not equally effective at each treatment stage with all participants. The implications of the program’s success overall and at each treatment stage are discussed.

Parents' perspectives on quality in family support programs.

Support services for families who have a member with developmental disabilities are a growing component of many state mental health systems. Family empowerment is a key principle of these programs, but parents and the staff who work with them are often challenged in their efforts to have parents participate in policy development, program management, and evaluation of programs. The use of nominal group techniques is described as a means of identifying factors parents believe characterize quality family support programs. Parents’ identified factors are then compared with factors from a theoretical framework for quality. Parents stressed access to information, adherence to empowerment philosophy, and the importance of interpersonal relationships with staff. Parents placed less emphasis on factors generally found in accreditation criteria.

Exploring the diversity of dual diagnosis: Utility of cluster analysis for program planning

This study demonstrates the utility of using cluster analysis to explore the heterogeneity of dual diagnosis populations so as to facilitate planning and implementation of individualized treatment programs. A sample of 467 persons admitted to a state psychiatric hospital with DSM-III-R psychiatric diagnoses and substance abuse problems were interviewed on the Addiction Severity Index (ASI) and other measures to assess psychological, social, and community functioning. Scores on seven ASI severity ratings (medical, employment, alcohol, drug, legal, family, and psychiatric functioning) were used to group patients into seven homogeneous subgroups using cluster analysis: best functioning, unhealthy alcohol abuse, functioning alcohol abuse, drug abuse, functioning polyabuse, criminal polyabuse, and unhealthy polyabuse. Cluster reliability and validity were demonstrated using split-half tests as well as cross-sectional and longitudinal analyses. Results illustrate the extreme heterogeneity of dual diagnosis and are suggestive of how individualized treatment programs can be matched to the particular needs of patients with dual diagnoses.

Social climate differences in a large psychiatric hospital: staff and client observations

Most of the research on social climate in psychiatric hospitals has addressed differences in client/staff perceptions, while neglecting the differences in social climate across types of wards. However, the literature on setting heterogeneity has also suggested that it might be important to examine differences between types of wards within a psychiatric institution since different setting subclassifications have been identified in other settings (Luke, Rappaport, & Seidman, 1991). This research is important to evaluate the treatment milieu and identify aspects of the ward treatment that may require changes in order to function more effectively. Using the Ward Atmosphere Scale (WAS) (Moos, 1989) we surveyed both clients (n = 130) and staff (n = 113) on three types of wards, specialized, extended care, and acute care, within a large urban state psychiatric hospital. Although, clients perceived differences between extended care and acute units, staff did not. Staff, however, reported differences between specialized and extended care wards on all subscales except Anger and Aggression. These findings suggest that perceptions of social climate within this psychiatric hospital are different for acute and extended care treatment settings, and that staff and clients perceive these settings differently. Although prior studies have documented that staff and clients differ on their perceptions of the ward social climate, the present results highlight the need to consider ward type in social climate studies.