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Biomedical subjects

P A Toro

Publications and source records attributed to P A Toro.

At least 19 recordsLinked to original sources
PubMed2000

Let's ask the homeless people themselves: a needs assessment based on a probability sample of adults.

A probability sample of 301 homeless adults from Buffalo, NY, was followed over 6 months to document the utilization of a variety of community services, examine services desired, and identify factors associated with service utilization, preference, and satisfaction. The following needs were all rated as at least equally important as the need for affordable housing: safety, education, transportation, medical/dental treatment, and job training/placement (most of these needs were also rated as difficult to obtain). Needs for formal mental health and substance abuse services were rated as relatively unimportant and easy to obtain, and for those who actually used them, respondents were often dissatisfied with them. Of 16 predictor variables examined in multivariate analyses, several showed consistent relationships with subsequent service use, preference, and satisfaction. Younger adults, persons of color, those with dependent children, and persons having fewer social supports reported less service utilization, less satisfaction with services received, different perceived needs for particular services, and/or greater difficulty obtaining services.

Adult↗
PubMed1999

Mental disorder among homeless and poor people: a comparison of assessment methods.

This study assessed mental disorders among 144 homeless and poor adults using four different methods: (a) history of psychiatric hospitalization, (b) structured clinical interview, (c) self-report symptom checklist, and (d) interviewer ratings. These four methods yielded divergent estimates of mental illness, ranging from 3-70%. Correlations assessing the degree of overlap among the measures were generally modest in magnitude. The results suggest that the variation in rates of mental illness across existing studies is due to methodological differences and that, with the exception of the structured interview, the various methods fail to adequately distinguish mental disorder from substance abuse.

Adult↗
PubMed1999

Giving and receiving help: interpersonal transactions in mutual-help meetings and psychosocial adjustment of members.

The helping transactions that occur in group meetings have been theorized to be important therapeutic mechanisms within mutual-help (or self-help) groups. Hypothesized links between giving and receiving help and psychosocial adjustment were examined in a mutual-help group for individuals with serious mental illness (GROW). Participants' adjustment was assessed at two time points and helping behaviors were measured with observational coding of weekly group interactions during the period between assessments. Frequencies of helping behaviors were used to predict Time 2 adjustment after controlling for initial adjustment. Consistent with the helper therapy principle, giving help to others predicted improvements in psychosocial adjustment; giving advice was a unique predictor. Total amount of help received was not associated with adjustment, but receiving help that provided cognitive reframing was associated with better social adjustment. A predicted interaction suggested that receiving help was related to better functioning when members experienced high levels of group integration.

Adaptation, Psychological↗
PubMed1998

Homeless and matched housed adolescents: a comparative study of psychopathology.

Compared a probability sample of 118 homeless adolescents (ages 12-17) from 6 shelters from throughout the 7-county Detroit metropolitan area to a matched sample of 118 housed adolescents using the Diagnostic Interview Schedule for Children (DISC), which yields diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R; American Psychiatric Association, 1987) criteria, and the Brief Symptom Inventory (BSI). Adolescents in the housed comparison group were matched on age, sex, race, and neighborhood characteristics. Analyses, including ones controlling for a set of 10 risk and resilience factors, indicated that the homeless showed more disruptive behavior disorders and alcohol abuse or dependence on the DISC and greater levels of symptomatology on the BSI. There were no significant group differences on drug abuse or affective disorders, and psychotic disorders were rare in both groups. This pattern of findings is not entirely consistent with popular stereotypes about homeless youth nor with many existing studies (which have often failed to include an appropriate comparison group).

Adolescent↗
PubMed1997

Evaluating an intervention for homeless persons: results of a field experiment.

An intensive case management intervention for homeless persons was evaluated by random assignment of 202 cases (involving 213 adults and 70 children) to the intervention or a control group. Full follow-up data (4 interviews: at baseline and at 6-, 12-, and 18-month follow-ups) were available on 98 cases (105 adults and 37 children). The follow-up rates for the 2 groups were not significantly different. Based on 13 repeated measures analyses, there were 3 statistically significant linear time effects (indicating overall change across the follow-up period) and 3 linear Time x Condition interactions (indicating differential change over time for intervention vs. control participants). Regardless of condition, adult participants improved in terms of their experience of homelessness, as well as on physical health symptoms and stressful life events. Condition x Time interactions indicating positive intervention impact were observed on the quality of housing environments, stressful life events, and interviewer ratings of psychopathology.

Adolescent↗
PubMed1995

Distinguishing homelessness from poverty: a comparative study.

To separate the characteristics of the homeless from those of the housed poor, 144 adults were randomly sampled from several sites, yielding 3 groups: the currently homeless (n = 59), the previously (but not currently) homeless (n = 31), and the never-homeless poor (n = 54). The homeless were significantly less likely to be receiving public benefits, were more likely to have a DSM-III (Diagnostic and Statistical Manual of Mental Disorders [3rd ed.; American Psychiatric Association, 1980]) diagnosis of substance abuse, showed higher levels of self-rated psychological distress and were more likely to be victims of recent domestic violence and to have been physically abused as children. The homeless did not differ from the comparison groups on DSM-III diagnosis of severe mental illness (schizophrenia or major affective disorder). physical health symptoms, and social support and social networks.

Adult↗
PubMed1992

Beliefs, attitudes, and knowledge about homelessness: a survey of the general public.

Obtained measures of policy-related beliefs, attitudes, and knowledge about homelessness through a telephone survey of a representative sample of 240 persons conducted over nearly a full year in a medium-size northeastern metropolitan area. The study's data were compared to a national poll and to a local study documenting the actual characteristics of homeless persons. The results suggest that citizens are both supportive of and well informed about homelessness. For instance, 58% were willing to pay more taxes to help homeless persons and the mean estimate for the extent of mental illness among the homeless was within the range of estimates found in the local interview study. Few respondent background characteristics predicted belief, attitude, and knowledge variables. The main exceptions were gender and age. Women and younger respondents thought homelessness a more serious problem, saw fewer personal deficits among homeless persons, and perceived employment as more critical in the cause and solution of the problem.

Ill-Housed Persons↗
PubMed1991

Expansion strategies of a mutual help organization.

Described a study of the expansion strategies of a successful self- and mutual help organization for persons with mental illness. Resource mobilization and behavior-setting theories were used as conceptual frameworks to guide the investigation. Collaborative methods and a grounded theory approach were used. Archives, reports of contacts outside of the organization, and naturalistic observations were data sources. Of particular interest are the processes used by the organization to mobilize internal and external resources and to start new mutual help groups. Results suggest that the organization mobilizes resources from a variety of sources, displays flexibility in securing resources and defining organizational roles, and creates underpopulated settings to encourage individual involvement. The strategies appear to avoid overtaxing resource pools, reduce role ambiguity, and encourage pluralistic participation. Discussion includes several potential explanations for the successful growth of the organization.

Community Mental Health Services↗
PubMed1991

Charting uncharted terrain: a behavioral observation system for mutual help groups.

Describes the development of a behavioral observation system for mutual help meetings and presents evidence supporting its reliability, validity, and utility. The MHOS-BIC (Mutual Help Observation System-Behavioral Interaction Codes) was used by 10 observers to record the sequential flow of group interaction in 527 meetings. Psychometric analyses indicate that the system performed consistently with measurement objectives. Mean kappas for each of the 12 coding categories ranged from .62 to .87; the system demonstrated sensitivity to setting and time differences; and a predictable pattern of correlations was found among BIC categories and conceptually related participant and observer ratings. Studies using the BIC to address substantive questions about mutual help are reviewed, providing further evidence for its validity and utility. An empirical description of mutual help is presented using BIC data, and the promises and limitations of the system are discussed.

Affective Symptoms↗
PubMed1991

Homelessness in the United States. An ecological perspective.

This article presents an ecological perspective on homelessness that emphasizes the context in which homeless people live and the complex interactions between personal, social, economic, and service system resources that affect their well-being. The ecological perspective encourages researchers and program developers to assess the problems of homelessness at multiple levels of analysis, to view homelessness as a result of contextual factors that interact with individual and family vulnerabilities, and to assess carefully the social contexts in which researchers and program developers operate. Four ecological principles are described as a heuristic for research, intervention, and policy development. The implications of an ecological perspective for psychologists who wish to get involved in dealing with homelessness are discussed.

Adaptation, Psychological↗
PubMed1990

Evaluating professionally operated and self-help programs for the seriously mentally ill.

Reviewed a study by Bond et al. (1990) that evaluates assertive community treatment (ACT), an intensive community-based program for the seriously mentally ill. Such programs have been developed at a rapid pace in recent years but lack extensive research support. This randomized study supports the effectiveness of ACT and is a significant contribution to the mixed findings from the existing literature. However, its methodological flaws include (a) differential dropout from the ACT and comparison groups, (b) a relatively short follow-up period (12 months), and (c) limitations of the ACT intervention which prevents rehospitalization but lacks impact in other domains (e.g., social relationships, housing stability, employment). Self-help programs, poorly represented by the comparison group in this research, may offer the sorts of societal niches required by the mentally ill. Further research, giving such programs a "fair shake" against professionally controlled programs, is sorely needed.

Assertiveness↗
PubMed1990

A comparison of children with and without learning disabilities on social problem-solving skill, school behavior, and family background.

The study compared 86 children with learning disabilities (LD) with 86 matched children without learning disabilities (NLD) on three domains of variables: social problem-solving skill, teacher-rated school behavior and competence, and family background. The children with LD and the NLD group differed on variables in all three domains. More specifically, the children with LD were able to generate fewer alternatives for solving social problem situations, showed less tolerance for frustration and less adaptive assertiveness, and had more overall classroom behavior problems and less personal and social competence in a variety of areas as rated by teachers. Children having LD also showed more family background difficulties (e.g., lack of educational stimulation at home, economic difficulties). The findings suggest the need for greater attention to social and behavioral remediation for children with LD and greater involvement of their families, in addition to the cognitive and academic remediation emphasized in existing curricula for children with LD.

Child↗
PubMed1989

Economic predictors of mental health service utilization: a time-series analysis.

This research was designed to understand the relationships between economic indicators and mental health service utilization. Six monthly and three quarterly time-series analyses were done to assess the time-dependent association between three state-level economic indices and two measures of mental health service utilization. Consistent with the existing literature, increases in manufacturing employment were inversely related to both first admissions in state hospitals and case openings in community outpatient facilities. Labor force participation was also inversely related to first admissions to state hospitals. No relationship was found between service employment and either of the mental health service use indices. The specific findings suggest that two processes may be operating in the relationship of labor force participation and manufacturing employment with mental health service utilization. Some of the findings suggest a "crisis" process, in which service use increases rapidly following an economic stressor, whereas other findings suggest a more insidious process, in which economic stressors slowly weaken the mental health of the community and eventually lead to increased mental health service use. These results can be used to better inform social policy and preventive interventions by highlighting the human costs of changes in economic well-being. The need for more ecological research is discussed.

Adaptation, Psychological↗
PubMed1989

Natural and professional help: a process analysis.

Differences in the helping interactions formed by mental health professionals, divorce lawyers, and mutual help group leaders were examined. Fourteen members of each of these three helper groups (N = 42) met independently with a coached client presenting marital difficulties. Using ratings of ability to ameliorate the personal and emotional problems presented, the 42 helpers were divided (using a median split) into successful and less successful outcome groups. The responses of each of the pairs were coded using the Hill Counselor Verbal Response Category System. The sequence of client-helper responses were examined using log-linear analysis as they varied by type of helper and outcome. Results indicated that successful helpers (regardless of type of helper) tended to use directives (e.g., guidance and approval-reassurance) differently from less successful helpers. Successful helpers used directives following client emotional expression and not following factual description. In addition, clear differences in helper responses by helper type and outcome were found. Each helper type had unique patterns of responses that differentiated successful from less successful outcomes. Client responses were found to vary across helper type even when given the same helper preceding response. Results are discussed with respect to the unique goals of each helping relationship and the different shaping process involved in each.

Adult↗
PubMed1986

A comparison of natural and professional help.

The study investigated the process and effectiveness of three natural and professional groups who commonly provide help to persons experiencing the important critical life event of marital disruption. Subjects were 42 helpers: 14 mental health professionals, 14 divorce lawyers, and 14 leaders of mutual help groups. Analyses, based on variables derived from coded audiotapes of simulated helping interactions and from ratings of helper effectiveness, indicated many similarities between mental health professionals and mutual help leaders but considerable differences between these two groups and divorce lawyers. Lawyers did more talking overall, showed greater proportions of information giving and closed questions, and were more effective in the legal/financial domain. Additional analyses indicated that all helpers showed fewer information-gathering behaviors and more information- and advice-giving behaviors as the helping interaction progressed.

Adaptation, Psychological↗
PubMed1985

Effects of community placement on chronic mental patients.

Patients judged ready for release from a state mental hospital were interviewed to determine their levels of depression and psychosocial functioning. This interview was repeated for 31 of the patients 8 weeks after their release and simultaneously repeated for 31 similar patients who remained in the hospital. In comparison with the matched controls, released patients became less depressed, less socially isolated, and less irritable. No differential improvement was found in their self-image. These findings, controlled for certain potential biases in a quasi-experimental design, identify some specific benefits of community placement for chronic mental patients.

Adult↗