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Biomedical subjects

C T Mowbray

Publications and source records attributed to C T Mowbray.

At least 37 records · Page 2Linked to original sources
PubMed1996

Consumers as community support providers: issues created by role innovation.

Using data from a CSP-funded research demonstration project designed to expand vocational services offered by case management teams serving people with serious mental illness, this paper examines the issues created by employing consumers as peer support specialists for the project. Roles and benefits of these positions are analyzed. Challenges experienced by specialists created by serving peers, the structure of the position, the mental health system and the community, and personal issues are analyzed using data from focus groups and the project's management information system. Implications for consumer role definition, supports for role effectiveness, and the structuring of these types of positions are discussed.

Adult↗
PubMed1996

Correlates of functioning in a population with dual diagnoses: an examination of diagnosis and problem history.

This study examines the relationship between diagnosis and life functioning using the Addiction Severity Index (ASI) with 467 hospitalized individuals with mental illness and substance abuse problems. Persons diagnosed with schizophrenia were the best functioning group across most of the ASI domains except employment and psychiatric functioning. More robust relationships were found between problem history (i.e., prior symptomatology or treatment) and current functioning. Respondents with histories of drug treatment, prior experience of anxiety and depression, self-injurious behavior, or violence control problems experienced more severe medical, drug, alcohol, psychiatric, legal, and family/social problems at the time of hospitalization. Violence control problems were related to drug use and criminal involvement, whereas self-injurious behavior was more often related to alcohol use and psychiatric distress. These findings suggest that problem history may be a stronger predictor of treatment need at the time of hospital entry than are more commonly used indexes, such as diagnosis.

Adult↗
PubMed1996

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.

Cluster Analysis↗
PubMed1996

Characteristics of participants in a supported education program for adults with psychiatric disabilities.

OBJECTIVE: Supported education programs provide assistance, preparation, and support to individuals with psychiatric disabilities who desire to pursue postsecondary education. To determine the extent to which "typical" clients with severe mental illness can participate in a supported education program, the study examined characteristics of participants in a large supported education program. METHODS: Baseline interviews with participants in a supported education program in the metropolitan Detroit area gathered demographic data, as well as information about school, work, and psychiatric history; social adjustment and support; psychiatric symptoms; and self-perceptions in the areas of school efficacy and self-esteem. Cluster analysis used five variables (sex, age, educational attainment, work background, and symptoms) to produce a client typology. RESULTS: Five clusters emerged: well-functioning young men, young aspiring women, young dependent men, well-functioning but unemployed participants, and distressed unemployed participants. The clusters also differed on a large number of variables not used in the cluster analysis. However, members of all clusters had similar rates of program participation and first-semester attendance. Overall, the supported education participants were younger, better educated, and higher functioning than subjects in general samples of persons with severe mental illness. Although many participants had significant problems with symptoms, social adjustment, and substance abuse, they were able to remain active program participants. CONCLUSIONS: The results indicate that supported education is a feasible alternative for many individuals to meet goals for educational advancement, personal development, and better jobs.

Adolescent↗
PubMed1995

Motherhood for women with serious mental illness: pregnancy, childbirth, and the postpartum period.

Although women with serious mental illness have normal fertility rates, the literature points to multiple risk factors and a paucity of emotional and economic support during the initial phases of parenthood. Since most research has focused on child outcomes, the extent and nature of parenting problems experienced by these mothers are not adequately understood. An emphasis on the context of parenting and the meaning of pregnancy and childbearing to these mothers is called for and implications for research and clinical practice are discussed.

Child↗
PubMed1995

A strengths perspective: an ethnographic study of homeless women with children.

Homeless women with children have been one of the fastest growing homeless subpopulations during the past decade. However, research in this area has paid scant attention to the needs of these homeless families. The ethnographic study of homeless women with children described in this article captures the prevailing strengths of this population. The women's strengths were identified in seeking housing, caring for children, and remaining connected to social contacts to keep their families together. The authors suggest that ethnography provides guideposts for social workers as they search for practice models.

Adolescent↗
PubMed1994

Project WINS: integrating vocational services on mental health case management teams.

In an effort to expand employment opportunities available to psychiatric consumers, a research demonstration project was developed to incorporate vocational services into case management teams. Following psychiatric rehabilitation principles, Project WINS employs professionals as Vocational Specialists and consumers as Peer Support Specialists to work with clients and their case managers. This report describes the characteristics of clients eligible for WINS services, the implementation of the program, and the impact of WINS on clients and on the mental health and vocational systems. It also describes the challenges and barriers this innovative service is confronting.

Adult↗
PubMed1994

Short versus longer term effectiveness of an outreach program for the homeless mentally ill.

Presents 12-month follow-up results from an outreach/linkage intervention with persons who are homeless and mentally ill, contrasting these with results obtained at 4 months. Both sets reflect the success of the program in placing individuals in independent housing. However, longer term data provide useful information regarding client movement patterns and increased tenure in nonhomeless living arrangements beyond the termination of specialized services. Analyses of 12-month residential outcomes identified four variables as significant predictors: recruitment source, project service duration, CMH service duration, and client age. In contrast to 4-month predictors, variables reflecting baseline client functioning were no longer significantly related to outcome, suggesting that the positive effects of the intervention may take longer to achieve with some clients. Discussion focuses on the implications of these effectiveness results for future research designs and measures as well as the utility and limitations of preexperimental approaches for evaluating innovative service models when implementation and efficacy experiences are lacking.

Adult↗
PubMed1994

Physical health, mental health, and substance abuse problems of shelter users.

This article summarizes physical health, mental health, and substance abuse problems of users of four of Detroit's largest homeless shelters. Shelter users with mental illness or substance abuse problems were compared with those without these problems. Alcohol abusers were significantly more likely to have low blood pressure, symptoms of liver disease, and a tuberculosis treatment history. No health differences were found for those with or without a history of psychiatric hospitalization. Contrary to expectations, few gender differences were found. Aside from the obvious need for low-income housing, comprehensive and integrated treatment approaches from health care, mental health, and substance abuse agencies are needed to help homeless individuals. Social workers need to become more directly involved in service and policy issues for this vulnerable population.

Adolescent↗
PubMed1994

Resources and supports for mothers with severe mental illness.

Over the past 20 years, community mental health services have enabled individuals with severe mental illness (SMI) to spend more time in the community and to have greater opportunities to face normal developmental life tasks. Currently, women with SMI appear to be as likely to have children as women in the general population. Although these mothers tend to be single parents, often live in inadequate housing, have small social networks, and lack social and emotional supports, they have received little treatment attention. This article presents a systematic review of literature published in the past decade that describes interventions for mothers with SMI. These interventions are critiqued, and implications for future interventions are drawn using a psychiatric rehabilitation framework.

Adult↗
PubMed1993

Describing the homeless mentally ill: cluster analysis results.

Presented descriptive data on a group of homeless, mentally ill individuals (N = 108) served by a two-site demonstration project, funded by NIMH. Comparing results with those from other studies of this population produced some differences and some similarities. Cluster analysis techniques were applied to the data, producing a 4-group solution. Data validating the cluster solution are presented. It is suggested that the cluster results provide a more meaningful and useful method of understanding the descriptive data. Results suggest that while the population of individuals served as homeless and mentally ill is quite heterogeneous, many have well-developed functioning skills--only one cluster, making up 35.2% of the sample, fits the stereotype of the aggressive, psychotic individual with skill deficits in many areas. Further discussion is presented concerning the implications of the cluster analysis results for demonstrating contextual effects and thus better interpreting research results from other studies and assisting in future services planning.

Adult↗
PubMed1993

Consumer-operated drop-in centers: evaluation of operations and impact.

Research on self-help for consumers of psychiatric services has focused on the operation of voluntary groups and largely ignored service programs operated by consumers. This evaluation study focused on six consumer-operated drop-in centers, each established for at least two years. These centers served a combined total of 1,445 consumers and were funded as demonstration projects by the Michigan Department of Mental Health. Structured interviews of consumer-users of these centers indicated that the program was meeting its funding intents of serving people with serious mental illness and of creating an environment promoting social support and shared problem solving. Levels of satisfaction were uniformly high; there were few differences across centers. Issues that emerged for future policy and research considerations included funding constraints, enhancing accessibility (particularly for women and people needing frequent hospitalization), variable levels of support from catchment area community mental health agencies, and determining the long-term benefits of drop-in center participation.

Community Mental Health Centers↗
PubMed1992

An analysis of treatment services provided in group homes for adults labeled mentally ill.

Although group homes for adults labeled mentally ill have been the focus of significant attention in deinstitutionalization discussions, substantive research on their operation has been lacking. The present study addresses past limitations by focusing on a well-defined sample of small group homes, with higher staffing levels and in-home treatment provided. Thirty homes were randomly selected; all home residents (N = 253) were studied. Data were collected from case managers, residents, and home staff to assess residents' functioning, services and treatments provided, and the environment of the home. The findings were examined in terms of adequacy and appropriateness of care provided in the home, using accepted guidelines. The results indicated that there are aspects of a homelike environment, emotional support from staff, and skill-development activities within the home. However, an institutional focus still seems prevalent, along with limited rehabilitation and socialization activities. Residents expressed high levels of satisfaction, which may reflect their dislike of the group home alternative, e.g., the state hospital. Policy implications are discussed vis-a-vis current efforts to move away from group homes toward supported housing initiatives.

Activities of Daily Living↗
PubMed1991

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.

Catchment Area, Health↗
PubMed1991

Characteristics of seriously mentally ill adults in a public mental health system.

To aid in planning mental health services, the state of Michigan collected sociodemographic and clinical information on a sample of 2,447 mental health system clientele in both hospital and community settings. Hospitalized patients were found to have poorer functioning and higher levels of disability than clients treated in community settings. Younger patients were more likely to be male, to exhibit more self-destructive behaviors, and to be more aggressive and demoralized. Older patients were more likely to be women, to have a high degree of physical health care needs, and to possess poor skills in self-care and community living. The heterogeneous nature of the population and the presence of complicating problems not traditionally served by mental health systems, such as medical illness and substance abuse, point to a need for interagency planning to address the needs of seriously mentally ill adults.

Activities of Daily Living↗
PubMed1990

Serving the chronic mentally ill in state and community hospitals.

Acute psychiatric admissions to three state and three community hospitals from the same geographic areas were examined in terms of patient characteristics, services, and costs. Overall, patients in state hospitals were more likely than patients in community hospitals to be admitted involuntarily, to have bizarre or assaultive behaviors as a precipitating cause of admission, to have recent community mental health involvement, to be referred by family or friends, to be living in dependent care at admission, and to have police initiated admissions; differences on other variables such as prior psychiatric hospitalizations, or in-hospital behaviors were not significant. The length of stay was longer for state hospital patients who were also more likely to be discharged to an independent living situation. While actual costs per inpatient day were greater for community hospitals, the costs of treating patients in state hospitals, after reimbursements, were greater on both an inpatient day and episode basis. The average savings per inpatient day of treating all patients in community hospitals versus the hospitals they were in at the time of the study would be $7.38 per day. The conservative average cost savings per episode would be $440. This data suggests that it may be less expensive to the state to treat patients in community hospitals.

Adult↗
PubMed1990

Community treatment for the seriously mentally ill: is this community psychology?

Reviewed the study by Bond et al. (1990) on assertive community treatment (ACT) for the seriously mentally ill and raised questions as to why community psychologists have not been more involved in this research area. The relevance of ACT to community psychology was described in 6 areas: ecological approach, advocacy orientation, promotion of competence, prevention of psychopathology, integration of services, and systems theory. Three other areas were identified as critical for ACT and as domains in which community psychologists could provide future expertise: empowerment, research design, and community context effects. Community psychologists were challenged to reach out to the seriously mentally ill and demonstrate the relevance of this discipline to all disenfranchised persons.

Assertiveness↗