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Biomedical subjects

J R Greenley

Publications and source records attributed to J R Greenley.

At least 19 recordsLinked to original sources
PubMed1992

Validity of case manager reports of clients' functioning in the community: independent living, income, employment, family contact, and problem behaviors.

Validity of case manager reports of client functioning in the community was assessed by examining the correspondence between case manager reports and client reports of several widely-used indicators of client well-being, including independent living, income, employment, family contact, and problem behaviors. Effects of how well case managers knew their clients and of using telephone interviews vs. self-administered questionnaires to gather case manager data were also investigated. Data were gathered from 6 case managers and 55 of their seriously mentally ill clients in a rural Wisconsin Community Support Program. Indicators of independent living and employment displayed reasonably good agreement and support the use of case manager reports in research. Indicators of income and problem behaviors produced lower levels of client-case manager agreement at least in part because client reports proved an inadequate criterion for these measures.

Activities of Daily Living↗
PubMed1992

Neglected organization and management issues in mental health systems development.

Fragmented and often uncoordinated public services for the more severely mentally ill are often characteristic of the current U.S. mental health system. The creation of local mental health authorities has been promoted as part of a solution, as has happened in Wisconsin at the county level and is championed in the ongoing Robert Wood Johnson Foundation funded innovative service sites for severely mentally ill adults. There are indications that these innovative mental health authorities will fall short of fulfilling their promise. Basic principles from the management and organizations literature are used to identify several organization and management issues that may have been neglected. These include resource management, attention to system goals, monitoring and feedback, and the promotion of desirable interorganizational cultures.

Humans↗
PubMed1991

Evaluation of a comprehensive program for youth with severe emotional disorders: an analysis of family experiences and satisfaction.

An innovative pilot program of comprehensive services to youth with severe emotional disorders was evaluated by means of a self-administered questionnaire survey of family members. Results indicate that the program increased use of noninstitutional outpatient services, improved access to services, and enhanced family satisfaction and involvement with treatment planning and implementation.

Adolescent↗
PubMed1987

Seeking help for psychologic problems. A replication and extension.

Patterns of seeking help for psychologic problems were investigated using interview and medical record data in a representative community sample and a sample of mental health clinic users from the same eligible population. In multivariate analyses, users of psychiatric services, compared with nonusers, were significantly younger, more likely to be separated or divorced, more psychologically distressed, and physically symptomatic. They were also more likely to use a large multispecialty clinic, compared with satellite clinics, and less likely to have membership in the prepaid medical plan established by the multispecialty clinic. Users had a greater reported propensity to seek help for anxiety and were more likely to know other mental health services users. Confiding social support was not significantly associated with use of mental health services, controlling for psychologic symptoms. Substantial social selection in seeking help was evident at both high and low levels of psychologic distress. Mental health users, compared with nonusers, reported more of most types of symptoms studied, except withdrawal, obsessive-compulsive symptoms, and alcohol consumption. Particular social characteristics and symptoms were associated with seeking help in general and other characteristics were more specifically linked to choice of a particular provider.

Adult↗
PubMed1986

Social control and expressed emotion.

Research shows a higher risk of relapse among schizophrenics in high "expressed emotion" families. In this paper, the measure called "expressed emotion" is conceptualized as an indicator of family attempts to socially control the schizophrenic person's behavior in a particular way. This social control conceptualization is supported by a review of the type of information in the measure. Hypotheses following from this view are examined to assess the construct validity of the measure conceptualized as a type of social control. First, attempts at control are hypothesized to be ways anxious and fearful families try to cope. Second, the family's recognition of the schizophrenic's problem as mental illness is hypothesized to reduce the fearful and anxious family's likelihood of an intense interpersonal social control coping response. This type of social control of involuntary illness behaviors would be abandoned as unjust and unlikely to be effective. Data from the pioneering 1972 study by Brown, Birley, and Wing (Br. J. Psychiatry 121:241-258) provide support for these hypotheses and thus provide support for this social control conceptualization.

Anxiety↗
PubMed1986

Organizational analysis of three community support program models.

Little attention has been paid to the organizational and administrative characteristics of effective community support programs for the chronic mentally ill. The authors analyzed three successful support programs in Wisconsin that employ three different models of service delivery: one provides services through caseworkers who carry specialized caseloads, another through local nonprofessionals who work with a centrally located program coordinator, and the third through a team of various mental health workers. Each program has tailored its organizational process to suit the types of clients it sees, the size of its catchment area, and the availability of other professional resources. The interrelated strengths and weaknesses of each model are discussed.

Chronic Disease↗
PubMed1984

Social factors, mental illness, and psychiatric care: recent advances from a sociological perspective.

The author reviews advances in the sociological perspective on mental health over the past four years. He examines research on such topics as community acceptance of the mentally ill, arrest rates among former psychiatric inpatients, and the effect of social factors on the type of mental health treatment received. Other research areas surveyed include the influence of social factors on service utilization and on life stress and psychological distress, sex differences in psychological problems, and the relationship between organization of service delivery systems and patient outcome.

Age Factors↗
PubMed1984

Differences in the direct costs of public and private acute inpatient psychiatric services.

This exploratory study examined differences in the direct costs of acute inpatient psychiatric services in seven public county-operated specialty hospital units and six private community general hospital units in Wisconsin. There were no significant or substantial differences in measures of severity of patients between the public and private systems. Direct costs per stay and per day were significantly lower in the private units, although charges may have been higher in the private units. These differences in costs appear to be the result of private units having a significantly higher average daily census, more goal emphasis for cost containment, and more psychiatrist influence on how the unit was run. Our findings suggest that mental health system managers examine opportunities for achieving economies of scale and that they set and manage goals for efficiency.

Cost Control↗
PubMed1983

Management, cost, and quality of acute inpatient psychiatric services.

A common objective of health services is to provide high quality care at the least cost, yet some services achieve these objectives better than others. Moreover, there are questions about relationships between cost and quality: do higher expenditures usually result in higher quality, or, conversely, is it possible to provide higher quality of care at expenditure levels that may be lower than other institutions? This paper reports on a study of 13 acute inpatient psychiatric units in which a range of quality and direct cost outcomes was found. Some units had higher quality and lower direct costs than the others. Some had higher quality and higher direct cost, some had lower direct costs and lower quality as well, while another group had lower quality and higher direct costs. Differences in costs and quality were found to be related more to management than to patient, staff, environmental, or institutional characteristics of these units. The findings of this study suggest that proactive management that focuses on organizational outcomes, that makes consequences of operation visible, and that promotes mutual coordination will achieve higher quality and efficient performance.

Costs and Cost Analysis↗
PubMed1975

A race riot's effect on psychological symptoms.

Certain individually stressful events have been observed to increase the psychological distress of persons affected; reduced psychological distress following other events has been attributed to collective processes, including increased group cohesion. These possibilities are investigated by contrasting reported symptom levels of 938 adults interviewed before, during, and after a racial riot. White suburbanites interviewed after the riot and urban black women interviewed during the riot report significantly fewer psychological symptoms. Hypotheses of seasonal symptom changes, sampling biases, and the absence of symptom changes among relatively unimpaired respondents are rejected, suggesting that reductions in symptom level are associated with the riot. Serious methodological problems are raised by our finding that such events may significantly affect not only rates but also patterns of reported psychological symptoms obtained through epidemiological studies.

Black or African American↗