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Biomedical subjects

D A Bigelow

Publications and source records attributed to D A Bigelow.

15 recordsLinked to original sources
PubMed1992

The multi-service network: reaching the unserved multi-problem individual.

A small number of multi-problem, service-resistant individuals in every metropolitan community consume extraordinary amounts of human service at great cost to publicly-funded agencies with less than satisfactory benefit to the individual. This paper describes an innovative collaboration among mental health, alcohol/drug treatment, corrections, forensic, and social and housing agencies to provide more effective services at less cost. The theory of action was that (1) inter-agency communication and (2) external controls developed by core service agencies increase the efficacy of treatment and reduce the cost of caring for multi-problem clients. Agencies refer clients to the Multi-Service Network who are then screened for problematic multi-agency involvement. Case conferences result in individual service plans. Three illustrative cases are described and the results of two evaluative studies summarized. Cost of care for clients appears to have been reduced. Agencies appear to have benefited from improved information and communication. Clients' behavior was stabilized by external controls and more adequate attention to their needs.

Activities of Daily Living↗
PubMed1992

The involvement of schizophrenic insanity acquittees in the mental health and criminal justice systems.

This article described the mental health and criminal justice involvement of a large group of schizophrenic insanity acquittees and the program designed to manage and treat these individuals. Most insanity acquittees in our system are chronically mentally ill individuals who fit well into the psychosocial rehabilitation models that have developed over the past 15 years. In addition, the use of conditional release and monitored care in the community appears to be the most realistic approach to this group of individuals who show a high degree of involvement with the mental health and criminal justice service systems. This research has continued implications for the development of outpatient civil commitment and for the attempt to give people as much liberty as they are capable of handling while being realistic about their capacities to survive in the community.

Adolescent↗
PubMed1991

Quality of life of community mental health program clients: validating a measure.

A quality of life theory is proposed as a framework for conceptualizing and evaluating mental health services. Quality of life consists of fulfilling needs, meeting social expectations, and accessing opportunities by using abilities. Abilities are impaired by mental illness. Mental health services moderate social demands, supplement opportunities, and restore abilities. A 263 item questionnaire was developed to assess the impact of mental health services on clients' quality of life. A 24 site study including 1,154 pre-tests, 758 post-tests, and 190 interviews with randomly selected community residents was conducted. Evidence for the reliability and validity of the questionnaire are presented. The instrument discriminates among four known client groups, client and community samples, communities with known quality of life differences, and pre- versus post-treatment samples of clients. The convergence between client's retrospective impressions of improvement and measured pre-post improvement is discussed.

Adolescent↗
PubMed1991

Effectiveness of a case management program.

Legislation of a case management service provided an opportunity to conduct a natural experiment exploring questions about implementation and effectiveness of case management services. A sample of 21 case managed and 21 comparison clients was interviewed using a protocol adapted from the Quality of Life Questionnaire (Fixed Response Alternative version). Results indicate that case managed clients received more services and had fewer unmet service needs. Quality of life was greater for case managed clients, hospital utilization was reduced, and a possible relationship among services, quality of life, and hospital utilization was identified.

Activities of Daily Living↗
PubMed1991

Implementation and effectiveness of a bed reduction project.

A legislative mandate to shift a cohort of patients from the state hospital into intensive community treatment created an opportunity to explore questions about the impact of intensive community treatment on hospital utilization and quality of life. Information on prior and subsequent hospital utilization was taken from the state client information system. Information on community services and quality of life was obtained by interviewing clients in their homes, interviewing others who knew the clients, and by making direct observations of the clients' circumstances. Twenty-five of the intensively served clients were interviewed two to three months after discharge, as were 17 comparable clients who did not receive the intensive services. Clients did, in fact, receive more and better community services, their quality of life was better, and hospital utilization was dramatically reduced for both the targeted clients and the entire county catchment area.

Activities of Daily Living↗
PubMed1991

Monitored conditional release of persons found not guilty by reason of insanity.

This article reviews the recent literature documenting changes that have taken place in the management and treatment of insanity defense acquittees with the development of conditional release and monitored community treatment. The review demonstrates that conditional release is particularly important as a means of balancing the protection of society with the treatment of insanity defense acquittees in the least restrictive environment. The review also highlights the development of community programs based on treatment models for the chronically mentally ill. In addition, monitored community treatment programs appear cost-effective when compared with hospital-based programs. These factors point to the development in the 1990s of program standards for the release of insanity defense acquittees.

Civil Rights↗
PubMed1989

State data systems and research opportunities.

State mental health data bases offer a wealth of information to systems researchers, but discriminating choices among data elements, methods of access, and research paradigms are critical.

Community Mental Health Services↗
PubMed1989

Comparative costs and impacts of Canadian and American payment systems for mental health services.

In attempts to contain mental health costs, administrators are increasingly using incentives, competition, and accounting strategies and are creating more complicated financing systems. Yet the costs of these strategies and their impacts on the efficacy and efficiency of mental health services have yet to be studied. The authors compare mental health payment systems in British Columbia and Oregon. In the Canadian system, the patient is isolated from payment, sources of revenue are consolidated at the provincial level, only one payment mechanism per service type is used, health care documentation is oriented more to clinical needs than to reimbursement, and more discretion is delegated to providers. As a result, Canadian overhead costs are substantially less than those in the U.S. Patients have universal access to medical services in the Canadian system, and providers in hospitals, agencies, and individual practices have high incomes with low overhead costs.

British Columbia↗
PubMed1988

Characteristics of state hospital patients who are hard to place.

As a result of deinstitutionalization, acute care beds in state hospitals have become blocked by patients who lack access to appropriate community placements but who have derived maximum benefit from hospital care. To help plan community services for these patients, this study identified and described patients at an Oregon state hospital who were hospitalized longer than therapeutically necessary because no community facility could treat them. A total of 146 patients were identified during a three-month period, and 81 were described; 65 percent were men, 70 percent were schizophrenic, and 90 percent presented a risk to themselves or others. The patients exhibited few strengths, and one-third had a substance abuse problem, at least one counter-therapeutic attitude, or a need for medical monitoring. The authors describe how new community residential facilities can meet the needs of these difficult patients.

Adult↗
PubMed1975

The impact of therapeutic effectiveness data on community mental health center management: the systems evaluation project.

A major assumption of C.M.H. evaluation is that data fed back to center managers have an impact on the management, resulting in optimization of programs. This is the empirical question addressed in this paper. A study of the influences bearing on management decisions, the process of decision making, and the effects of introducing evaluation data into that process is described. The concepts, procedures, and instruments are set out as possible models for further investigation of the complex but fundamental question. The data presented are consistent with the hypotheses about the detailed influences of systems evaluation project evaluation data.

Colorado↗