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Biomedical subjects

J V Vaccaro

Publications and source records attributed to J V Vaccaro.

12 recordsLinked to original sources
PubMed1998

Skills training versus psychosocial occupational therapy for persons with persistent schizophrenia.

OBJECTIVE: The authors compared the community functioning of outpatients with persistent forms of schizophrenia after treatment with psychosocial occupational therapy or social skills training, with the latter conducted by paraprofessionals. METHOD: Eighty outpatients with persistent forms of schizophrenia were randomly assigned to receive either psychosocial occupational therapy or skills training for 12 hours weekly for 6 months, followed by 18 months of follow-up with case management in the community. Antipsychotic medication was prescribed through "doctor's choice" by psychiatrists who were blind to the psychosocial treatment assignments. RESULTS: Patients who received skills training showed significantly greater independent living skills during a 2-year follow-up of everyday community functioning. CONCLUSIONS: Skills training can be effectively conducted by paraprofessionals, with durability and generalization of the skills greater than that achieved by occupational therapists who provide their patients with psychosocial occupational therapy.

Activities of Daily Living↗
PubMed1995

An experimental evaluation of residential and nonresidential treatment for dually diagnosed homeless adults.

Homeless adults with both a serious mental illness and substance dependence (N = 276) were randomly assigned to: (1) a social model residential program providing integrated mental health and substance abuse treatment; (2) a community-based nonresidential program using the same social model approach; or (3) a control group receiving no intervention but free to access other community services. Interventions were designed to provide 3 months of intensive treatment, followed by 3 months of nonresidential maintenance. Subjects completed baseline interviews prior to randomization and reinterviews 3, 6, and 9 months later. Results showed that, while substance use, mental health, and housing outcomes improved from baseline, subjects assigned to treatment conditions differed little from control subjects. Examination of the relationship between length of treatment exposure and outcomes suggested that residential treatment had positive effects on outcomes at 3 months, but that these effects were eroded by 6 months.

Adult↗
PubMed1993

Community-based care of individuals with schizophrenia. Combining psychosocial and pharmacologic therapies.

The treatment and rehabilitation of individuals with schizophrenia has undergone rapid change during the past decade. We now accept that individuals with this illness are able to regain a modest degree of social and occupational functioning if optimal care is provided. To design and implement such care, we believe that the treatment setting and system, as well as the content of the treatment, are key to success. Treatment systems should ensure that care is provided continuously and without interruption across service settings and should employ a comprehensive array of interventions. The comprehensive array of interventions should be arranged in a user friendly format so that patients and their families can access care that is appropriate to their contemporary needs. This set of available services includes pharmacotherapy linked with psychosocial interventions including clinical case management, social skills training, vocational rehabilitation, and family support and treatment.

Ambulatory Care↗
PubMed1992

Effectively treating stimulant-abusing schizophrenics: mission impossible?

The development of effective treatment programs for dual diagnosis patients is in its initial stages, hampered by a variety of clinical, theoretical, administrative, and even sociopolitical obstacles. These patients are difficult to engage and treat effectively using standard systems of care. The Dual Diagnosis Treatment Program at the Brentwood VA Hospital integrates treatment for both stimulant abuse and chronic psychosis within one comprehensive program, emphasizing continuous treatment teams, optimal pharmacological management, behavior-shaping strategies, skills-training techniques, and assertive case management. The combination of these treatment approaches within one program appears to have helped some patients in our preliminary, one-year experience. Future publications will describe results from controlled outcome comparisons of DDTP with customary VA care.

Adult↗
PubMed1987

A profile of community mental health center psychiatrists: results of a national survey.

A national survey of community mental health center psychiatrists was designed to assess the extent to which they experience professional burnout. 214 psychiatrists responded to the survey. The largest single group of respondents (23.4%) was attracted to community mental health primarily by normative values (e.g., "serving the indigent"). The critical variable which has or would cause most of the respondents to leave their community mental health center is conflict over the psychiatrist's role and/or value. Despite problems encountered by many, 78.5% of respondents expressed a greater than 50% overall satisfaction in their work at Community Mental Health Centers. 34.1% of respondents have practiced in a community mental health center for more than 10 years. 31.7% of respondents spend half-time or less of their working time in a community mental health center, raising questions about possible limitations in psychiatrist roles. Thirty-one of respondents spend more than three quarters of their community mental health center time evaluating and treating patients, raising questions as to whether community mental health center psychiatrists are utilized in oversight roles appropriate to their levels of expertise.

Burnout, Professional↗
PubMed1987

Burnout among CMHC psychiatrists and the struggle to survive.

Comments gathered in a national survey of community mental health center (CMHC) psychiatrists indicate that many suffer from burnout. Of the 96 respondents who provided comments, 46 expressed dissatisfaction with their work in CMHCs, 14 expressed satisfaction, and seven had mixed feelings. Factors contributing to the respondents' dissatisfaction included a lack of administrative support and validation, low pay, responsibility without authority, and pressure to sign documents related to patients unknown to them. Factors contributing to their satisfaction were having a variety of tasks, being valued for having uniquely comprehensive experience, being supported in the clinical oversight role, being in charge of CMHC operations, and working in a CMHC affiliated with an academic center or the medical community. The authors believe that CMHCs must redress the issues contributing to burnout among CMHC psychiatrists if they are to retain psychiatrists and provide quality patient care.

Burnout, Professional↗
PubMedDate not supplied

Mental health parity.

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Health Care Costs↗