Steven P. Segal

Measuring empowerment in client-run self-help agencies

Abstract“Empowerment” connotes a process of gaining control over ones life and influencing the organizational and societal structures in which one lives. This study defines and validates three measures: the Personal Empowerment Scale, the Organizational Empowerment Scale, and the Extra-Organizational Empowerment Scale.Measurement efforts are based on observational work, baseline interviews (N=310), and six month follow-ups (N=241) in four client-run self-help agencies (SHAs) for persons with severe mental disabilities. All three study scales demonstrated strong internal consistency and stability. They were sensitive to user changes over time and have construct validity.

Falling Through the Cracks: Mental Disorder and Social Margin in a Young Vagrant Population

Twenty-two percent of a young vagrant population reported on in this study, and believed to be representative of similar groups in many American cities, have been hospitalized for psychological disorder. These young mentally disordered vagrants are the most marginal members of the vagrant subculture, lacking social margin (i.e. resources, relationships, and a credible identity) with their families, community services and their peers. Their critical lack of social margin is due to an incongruence of expectations between disordered vagrants and potential benefactors. This incongruence generates a situation in which apparently eligible clients fall or slip through cracks in the service system. Ultimately, these individuals will become the core of a new chronically disordered and dependent population housed, at best, in community-based sheltered living arrangements as they grow older.

Community Membership and Social Networks in Mental Health Self-Help Agencies

This article explores community membership among self-help agency (SHA) participants. It is suggested that SHAs foster the enhancement of peer-oriented social networks, leading to the experience of shared community. Social network analysis was used to examine the structure of support mechanisms, and to assess levels of community membership through peer inclusion. Results indicate that both individual and organizational characteristics play roles in predicting peer presence in social networks. Organizational empowerment is a key factor, with the SHA emerging as a promising locus for peer support development through enhanced social networks. Implications for the organization of consumer-based services are discussed.

Research on the Outcome of Social Work Therapeutic Interventions: A Review of the Literature

Questions associated with developing a therapeutic technology are considered. A review of the research concerning the outcome of social work treatment is presented with respect to two client populations. Diflerences in types of treatment employed with each population are considered. Finally, given the population and the type of therapeutic intervention, issues are raised and evaluations made about the adequacy of outcome research in the particular area of interest. THE standard review-of-outcome research (Eysenck, 1952, 1961, 1965) has tended to approach the literature methodologically-i.e., by considering various studies in terms of the validity of inferences that might be drawn on the basis of the results they present. Methodologically speaking, two points are pertinent to therapeutic interventions in social work (more specifically, with respect to the given types of therapeutic interventions with the specific client populations delineated below). The

Census tract predictors and the social integration of sheltered care residents

SummaryIt would appear that social-environmental circumstances surrounding the place of residence of patients discharged to sheltered care facilities are crucial to their adjustment to, and involvement in, community life. Census tract indicators of environmental circumstance were found to be strongly related to an individuals level of social integration. Mental health workers should carefully consider the immediate environmental situation in accepting a residence for the placement of discharged psychatric clients. Just as emphasis has been placed on the “therapeutic milieu” within the sheltered care facility, attention should be similarly directed to the attributes of the community immediately surrounding potential residential facilities.

Failure to Seek Health Care Among the Mentally Ill

This study describes failure to seek health care among 673 new adult clients seeking mental health services in the San Francisco Bay area. Overall, 49% (n = 328) reported a failure to seek health care they believed was needed in the past year. People with dual diagnosis, severe depression, chronic physical illness, fear of coercive treatment, private insurance, and no insurance were more likely to fail to seek health care. Greater use of private physicians decreased the odds of failure to seek health care. These findings highlight the need to target groups at risk for failure to seek health care and the need to design nonthreatening programs to improve health access for people with mental illness.

Civil commitment standards and patient mix in England/Wales, Italy, and the United States.

Although England/Wales, Italy, and the United States share a common policy of deinstitutionalization, their mental health systems differ considerably. Each country’s civil commitment standards define patient eligibility criteria along one of two primary dimensions-need for treatment or degree of dangerousness. These differential selection criteria result in mental health systems serving different subgroups of the total population. The criteria in England/Wales target older women; in the United States, younger men; and in Italy, a group balanced in age and sex. Implications for the current debate on civil commitment policies are considered.

An eleven-year evaluation of the effect of community treatment orders on changes in mental health service use

Many studies of compulsory community treatment have assessed their effect early on after the implementation of legislation. Although compulsory community treatment may not prevent readmission to hospital, there is evidence of an effect on length of stay before and after the intervention when compared to controls. This paper examines whether outcomes change as clinicians gain experience in the use of community treatment orders (CTOs). Cases and controls from three linked Western Australian databases were matched on age, sex, diagnosis and time of hospital discharge or community placement. We compared changes in bed-days and outpatient visits of CTO cases and controls using multivariate analyses to further control for confounders. We identified 2958 CTO cases and controls from November 1997 to December 2008 (total n = 5916). The average age was 37 years and 64% were male. Schizophrenia and other non-affective psychoses were the commonest diagnoses (73%). CTO placement was associated with a mean decrease of 5 bed-days from before the order when compared to controls (B = -5.23, s.e. = 1.60, t = -3.26, p < 0.001). There was an increase of 8 days in outpatient contacts (B = 8.31, s.e. = 1.17, t = 7.11, p < 0.001). There was little change in CTO use and outcomes over the 11 years. Compared to controls, CTOs may therefore reduce lengths of stay from before placement on the order. They also increase outpatient contacts. This study illustrates the importance of selecting an outcome that directly addresses the objective of the intervention.

Management style and institutional dependency in sheltered care

SummaryTwo styles of management utilized by operators of Californias alternative to the mental hospital — the community-based sheltered-care facility — have been identified. One style of management is characterized by a low-structure, laissez-faire approach that places the responsibility for decision making with the patient. The other style stresses structure and rule following, and leaves decision making to the operators of the facility. The authors examine patterns of client dependency in each type of facility. Residents in the highly structured environments manifest a distinct pattern of dependency while those in the environment emphasizing responsibility for ones own decision making do not.

Outcomes From Consumer-Operated and Community Mental Health Services: A Randomized Controlled Trial

OBJECTIVE Hierarchically organized board-and-staff-run consumer-operated service programs (COSPs) are viewed as organizations that promote recovery while working in concert with community mental health agencies (CMHAs). This studys objective was to determine the effectiveness of such combined services for people with serious mental illness. METHODS A board-and-staff-run consumer-operated drop-in center and colocated CMHA provided the context for the randomized clinical trial. In a weighted sample, 139 new clients seeking help from the CMHA were randomly assigned to agency-only service or to a combination of COSP and CMHA services. Client-members were assessed at baseline and eight months on a measure of symptom severity and on four recovery-focused outcome measures: personal empowerment, self-efficacy, independent social integration, and hopelessness. All scales used have high reliability and well-established validity. Differences in outcome by service condition were evaluated with multivariate analysis of covariance via dummy variable regression. Change scores on the five outcomes were the dependent variables. The covariates for the multivariate analysis included baseline status on each outcome measure and service condition between-group demographic differences. RESULTS Results indicated that significant changes in three recovery-focused outcomes were associated with service condition across time: social integration (p<.001), personal empowerment (p<.006), and self-efficacy (p<.001). All changes favored the CMHA-only condition. Neither symptomology nor hopelessness differed by service condition across time. CONCLUSIONS Hierarchically organized board-and-staff-run COSPs combined with CMHA service may be less helpful than CMHA service alone.