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Biomedical subjects

D Bybee

Publications and source records attributed to D Bybee.

17 recordsLinked to original sources
PubMed2001

Life circumstances of mothers with serious mental illnesses.

Individuals with a severe mental illness now have greater opportunities to pursue normal adult roles, including parenting. The research reported involved 379 women carrying out parenting responsibilities, recruited from the public mental health system in an urban area. The sample displayed great heterogeneity in educational levels, number of children, number of fathers for their children, and family living arrangements, except that most women were very poor. These women faced many significant stresses: living alone with their children, significant child behavior problems, and financial worries. Still, most of the women endorsed the significance of motherhood in their lives. Inattention by most mental health providers to parenting issues leaves many important needs unmet and is likely to have adverse consequences for these women and their children. Implications for psychosocial rehabilitation practice are discussed.

Adolescent↗
PubMed2001

Follow-up client satisfaction in a supported education program.

Satisfaction data have recently returned to popularity, as an outcome measure in managed behavioral healthcare systems. However, there are few examples of management uses of such data. We collected data 12 months after participants had completed a supported education program, concerning their retrospective satisfaction and the barriers, needs, and personal difficulties currently experienced in their attempts to pursue post-secondary education or training. Data on follow-up supportive contacts were also obtained. Results supported participants' continuing satisfaction, and identified particular information items which were endorsed as most helpful. However, the data indicated that personal difficulties presented obstacles to many and that a majority of participants had current needs for financial aid, tutoring, job placements, support groups, and transportation. Following completion of the supported education program, many participants had continuing contacts in support of their educational plans. The amount of contact was generally low, however. In the future, supported education programs need to build in mechanisms to ensure students receive ongoing support for education, since this support was found to positively and significantly affect individuals' enrolling in college or training.

Adolescent↗
PubMed2001

Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women.

OBJECTIVES: This study examined whether lesbians are at increased risk for certain cancers as a result of an accumulation of behavioral risk factors and difficulties in accessing health care. METHODS: Prevalence estimates of behavioral risk factors (nulliparity, obesity, smoking, and alcohol use), cancer screening behaviors, and self-reported breast cancer histories derived from 7 independently conducted surveys of lesbians/bisexual women (n = 11,876) were compared with national estimates for women. RESULTS: In comparison with adjusted estimates for the US female population, lesbians/bisexual women exhibited greater prevalence rates of obesity, alcohol use, and tobacco use and lower rates of parity and birth control pill use. These women were also less likely to have health insurance coverage or to have had a recent pelvic examination or mammogram. Self-reported histories of breast cancer, however, did not differ from adjusted US female population estimates. CONCLUSIONS: Lesbians and bisexual women differ from heterosexual women in patterns of health risk. These women would be expected to be at especially greater risk for chronic diseases linked to smoking and obesity.

Adolescent↗
PubMed2000

Mothers with serious mental illness.

Mental health services have generally ignored the parenting needs of women with serious mental illness. This chapter identifies the parenting risks and strengths that these women display, as well as the opportunities available to psychologists to play a key role in improving mother and child outcomes.

Female↗
PubMed2000

Integrating vocational services on case management teams: outcomes from a research demonstration project.

Recent innovations to improve employment rates among persons with psychiatric disabilities include "hybrid case management/employment services." Project WINS was a research/demonstration project which integrated specialized vocational services into case management teams. In this report, client outcomes of WINS involvement are evaluated, using a quasiexperimental, longitudinal design. On almost all the work-related variables, participants in the immediate and delayed treatment conditions displayed better outcomes than those in the control condition, as did individuals receiving moderate or substantial service versus no/ minimal services. To address possible selection bias due to the quasiexperimental nature of the design, further analyses used baseline differences across conditions and participation levels as covariates. Results of multivariate analyses showed some anomalous findings regarding significant positive effects for the delayed, but not the immediate treatment condition versus the no-treatment control group. However, in similar analyses involving participation level as the independent variable, a moderate or substantial amount of service increased the odds of working by almost five times and also positively affected three other work-related variables. While limitations of this quasiexperimental design are noted, the results appear promising enough to support replications of WINS.

Adult↗
PubMed2000

Characteristics predicting successful outcomes of participants with severe mental illness in supported education.

OBJECTIVE: The study sought to identify characteristics of participants in a supported education program that were related to a successful outcome. Supported education programs provide rehabilitation and support services to help people attain postsecondary education. METHODS: A total of 147 persons who completed such a program were interviewed six or 12 months later, or at both times, to determine whether they were involved in productive activity, which was defined as engaging in either college or vocational education or in paid employment. Variables examined as predictors of productive activity were demographic characteristics; education and work background; social support; self-perceptions related to self-esteem, empowerment, quality of life, and school self-efficacy; and illness-related variables, including diagnosis, symptoms, and length of illness. RESULTS: Multivariate logistic regression identified the strongest predictor as productive activity at baseline. Marital status was the only significant demographic variable in the model; single participants were less likely to be engaged in productive activity. For participants who reported more frequent contact with their social network, the likelihood of engagement in productive activity was higher, and for those who reported more encouragement for education from their network, the likelihood was lower. A lower level of adjustment in the financial domain decreased the likelihood of productive activity, and a higher level of problems with housework increased the likelihood. No illness-related variable or self-perception was a significant predictor. CONCLUSIONS: Factors related to a successful outcome from a supported education program for persons with severe mental illness are also likely to be important factors for nondisabled populations. Among those with mental illness, social support is a key factor in attaining educational and vocational goals.

Adolescent↗
PubMed1999

Analysis of postdischarge change in a dual diagnosis population.

Many individuals with serious mental illnesses have co-occurring drug and alcohol problems. The research reported in this article examined an integrated inpatient mental illness-chemical dependency program and compared it with standard inpatient psychiatric treatment for two groups: those demonstrating high change from baseline to two-months postdischarge and those with negative or no change. Univariate analyses revealed significant differences in the change groups on baseline personal-clinical characteristics and on aspects of their social and physical environments. The results have implications for improving mental health practice by better predicting patients who will optimally benefit from inpatient treatment.

Adult↗
PubMed1999

Measuring coping strategies in an educational intervention for individuals with psychiatric disabilities.

Coping is a critical theoretical concept believed to be a mediator for successful outcomes produced through a variety of different social work interventions. This article describes an approach used to measure coping with stressors and was designed specifically for an intervention, the Michigan Supported Education Research Project, aimed at providing support for people with psychiatric disabilities to pursue college or vocational education. Hypothetical scenarios were developed that matched the content of material covered in the program. Open-ended responses were elicited from program participants as part of an in-person interview. Key findings included a participation effect on the number of positive coping strategies of participants and a significant relationship among some coping strategies and later outcomes. Implications for social work practice and research are identified.

Adaptation, Psychological↗
PubMed1998

Effectiveness of supported education for individuals with psychiatric disabilities: results from an experimental study.

In recent years post-secondary education has been recognized as a viable option in the psychosocial rehabilitation of individuals with mental illness. This study reports the first evidence of effectiveness of a supported education demonstration project which used an experimental design to compare the effects of different model types. A total of 397 participants were assigned to one of three conditions: group, classroom, and individual (control). At graduation from the program significant differences in program participation rates were found; group members participated most, followed by classroom participants, then those assigned to the individual condition. Also, immediate, intermediate, and long term outcomes were examined. On four immediate outcomes (motivation, satisfaction, enjoyment, and learning) significant participation effects were found (high participants scoring highest, followed by moderate participants, and then non-participants). On two intermediate outcome (empowerment and school efficacy) condition differences were found (classroom scoring highest followed by group, then individual). Although no condition differences were found on behavioral outcomes, the percentage of individuals enrolled in school or vocational education was more than twice that reported at baseline. Overall, the results demonstrated success in engaging participants, affecting self-perceptions, and increasing enrollment in post-secondary education.

Adolescent↗
PubMed1998

The long-term effects of battering on women's health.

We examined the effects of intimate violence on the physical and psychological health of women over time. Changes in levels of physical and psychological abuse, injuries, physical health symptoms, anxiety, and depression were assessed three times: immediately after exit from a domestic violence program and at 81/2- and 141/2-month follow-ups. Analyses showed a significant decline in abuse, physical health symptoms, anxiety, and depression over time. Longitudinal structural equation modeling demonstrated that ongoing abuse was significantly related to increased physical and psychological health problems from one time period to the next, even when prior levels of physical and psychological health were controlled. Within each time interval, the effects of abuse on physical symptoms appeared to be mediated through anxiety and depression; although this relationship was replicated at several time points, the mediation was not verified across time, probably because measurement intervals were too long to reflect the underlying causal sequence. Although injuries were the direct result of abuse, injuries showed no significant effect on physical symptoms, anxiety, or depression. Implications for intervention and future research are discussed.

Adult↗
PubMed1997

Emergency medical services for rape victims: detecting the cracks in service delivery.

Rape victims have many emergency medical needs, yet there has been very little research examining whether victims are receiving desired assistance. In this study, 147 rape victim advocates were interviewed about their most recent case in which a victim has sought treatment in an emergency room (ER). The results of this study indicated that there is some inconsistency in which services victims receive and that many women did not obtain the resources they wanted. Some forms of assistance were not provided to victims due to lack of resources in their communities (e.g., follow-up medical care). Other services were not offered due to problems in the implementation of available services (e.g., the morning-after pill [ethinyl estradiol-norgestrel] to prevent pregnancy). This research also examined how characteristics of the hospitals, the assaults themselves, and the victims impacted whether women would receive desired help. These findings indicated that women who were treated in hospitals affiliated with the Catholic church; those who were raped by their friends, dating partners, or husbands; those who experienced multiple forms of forced penetration (vaginal rape and anal rape, oral rape, or rape by an object); women of Color; and victims who did not present a sympathetic demeanor in the ER were less likely to receive several forms of assistance, such as treatment of physical injuries, arranging follow-up medical care, information and treatment for sexually transmitted diseases, information on the risk of pregnancy, the morning-after pill, and information on the physical and psychological health effects of sexual assault. Victims who were taken to hospitals that had coordinated response teams (e.g., Sexual Assault Response Teams) to work with survivors were more likely to receive some forms of treatment (e.g., information on the physical and psychological health effects of sexual assault). Implications for future research and policy initiatives in women's health are discussed.

Adolescent↗
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

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↗
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↗
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↗
PubMedDate not supplied

An analysis of allegations of sexual abuse in a multi-victim day-care center case.

Sexual abuse in day-care centers is a phenomenon of increasing concern, both in terms of its prevalence and its serious effects on child victims. Legal intervention in this area is problematic because criminal investigations are usually beset with difficulties: Characteristics of children and of the abuse situation affect disclosure rates and credibility. Research on children as witnesses is amassing; however, so far, little systematic analysis has been conducted on multi-victim child sexual abuse cases. The present study concerns a case of sexual abuse in a day-care center with over 100 alleged victims. Criteria derived from Statement Validity Analysis (SVA) protocols were applied to aggregate record review data to assess the veritability of the abuse allegations. Individual children's abuse disclosures were also analyzed, vis-à-vis characteristics of the children (age, gender, recency of attendance) and of the investigation (agency doing the interview, number of interviews, use of anatomically detailed dolls). The use of SVA criteria supported the veritability of allegations in this day-care abuse case. Even acknowledging the limitations of archival data collected for other purposes, the aggregate data analysis reflected consistency, logical structure, and spontaneity; however, little evidence of accommodation was found. Multivariate comparison of disclosing and nondisclosing children found an unexpected inverse relationship of disclosure with age, as well as positive associations with number of interviews and use of dolls. Alternative interpretations of these results are discussed.

Age Factors↗