published_or_final_version / Social Work / Master / Master of Social Work

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Typescript (photocopy). / Digitized by Kansas Correctional Industries / Department: Regional and Community Planning.

Thesis. 1976. M.C.P.--Massachusetts Institute of Technology. Dept. of Urban Studies and Planning. / Microfiche copy available in Archives and Rotch. / Bibliography: leaves 120-122. / by Victor John Franckiewicz, Jr. / M.C.P.

Zion Lutheran Church in Portland has had contact with a number of neighborhood residents who have been released from mental institutions but who have had little community support. The Church has felt the need for some time to develop a residential program for former patients in the area they serve. The authors of this report agreed to conduct a needs assessment and to develop a program relative to the results of the assessment. A needs assessment identified the target population, attempted to determine what services they would use and how such services might best be delivered. The assessment was conducted in Northwest Portland because this is the general area which interests Zion Lutheran Church. It was designed to discern whether a residential program for released mental patients would be used in the area designated, and, if so, how such a program would best be formulated. However, it was also designed to allow respondents to express interest in other types of programs and services.

Portland Youth Advocates is a nonprofit organization in Portland, Oregon that since 1969 has supervised nearly a dozen innovative service programs for young people. One of these programs was a counseling and referral program that evolved in August 1970 and closed in September 1979. Although it used different names at various times, it was most often known as the Contact Center. Three of PYA's former programs are operating in 1981, having each incorporated separately since 1979. To address the problem of why the Contact Center was unable to continue as well, an ex post facto case study of the program is undertaken. To facilitate the study, the program's history is divided into five representative time periods. Four categories of sources are then consulted to indicate the program's performance in five fixed factors during each time period. Findings are initially presented for each factor in each time period. They are subsequently comprehensively analyzed from the viewpoint of two factors over time, a collective factor over time, and three special attitudes. A conclusion is then drawn regarding the Contact Center's demise. Data is sufficiently indicative as to suggest a reply to the problem. The Contact Center appears to have been a fairly well organized program that generally provided good service. Its difficulties seemed to derive from its increasingly troubled mediation with the external landscape--government officials, foundation executives, and other private human service agencies. Some of the disturbance the center encountered in this regard was a consequence of its acknowledged preference for clinical as opposed to political activity. But the evidence also implies that distinguishing attitudes assumed by program members may have exacerbated already tenuous relationships between the program and external entities. Because these attitudes roughly identify the Contact Center program with what is often called "alternative human service," the work concludes with a prescriptive essay regarding the perpetuation of such service. In this manner, the particular experience of the Contact Center inspires an informed contribution to the consideration of a national phenomenon in human service.

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Background: Dissemination of evidence-based mental health clinical practice guidelines had not been studied in Australia prior to the National General Practice Guideline Implementation Program. This naturalistic research reports ten national interventions designed to disseminate the NHMRC 1997 Clinical Practice Guideline Depression in Young People for GPs (GDIYP-GP) through 123 Divisions of General Practice. The guideline covered depression and suicide in young people aged 13 to 20 years. Aim: To evaluate a 'coordinated link agent' and 'enhanced packaged approach' for disseminating a national guideline by engaging 20 Divisions in using 5 dissemination models and to measure Divisions' capacities in performing unfunded local dissemination to GPs. Method: An Implementation Kit was the main national intervention, housing the guidelines and 5 models: Education by the Division; Education by an external provider; 3) Clinical Audit; 4) Segmented Formats and 5) Appraisal. Five studies are reported: 1) an organisational census on guideline-related practices in all topics; 2) a Case Study Database of 3 consecutive interviews of 51 participating Divisions; 3) a Guideline Appraisal study of 9 cohorts of doctors; 4) a Clinical Audit study of 54 doctors involving 1200 patients; and 5) a 'Segmented Formats' documentary analysis of Division communications on GDIYP-GP. Results: Prior dissemination by most Divisions was administrative mail outs rather than planned programs. In all, 70 instead of the pilot 20 organisations participated (57% of the sector) using 10,000 guidelines: 45 participated by 7 weeks and 71 by 35 weeks and the majority used multiple active strategies showing fidelity to the Kit. Education by the Division, Segmented Formats and Appraisal were the most adopted models. GDIYP-GP was acceptable and relevant to the majority of Divisions and to 9 samples of doctors. Conclusion: Divisions are one appropriate system through which evidence-based mental health guidelines can be disseminated to general practitioners. Uptake can be rapid using a flexible enhanced package approach with link-agent support. 3-6 months is needed for organisations to begin effective interventions. Divisions reorient their approach with guidance toward evidence-based dissemination but Division and practice barriers

Self neglect among older people refers to situations in which older individuals fail to adequately maintain their environment and to perform essential self care tasks. This concept has been variably addressed in the fields of biomedicine, adult protection, and suicide prevention, yet minimal research has been conducted on this topic in Australia. While the existing literature acknowledges that these situations can pose considerable challenges for professionals, no research has explored the actual experience of these dilemmas in professional practice. This thesis aims to address these gaps by critically exploring how self neglect among older people is understood in the Australian context, investigating the content of ethical dilemmas that arise in these situations, and examining how professionals resolve these ethical dilemmas. A two-part, qualitative methodology was used to address the research aims. In Part One, a five-month period of participant observation was conducted at a community-based organisation that had obtained funding to provide case management to people living in squalor. In Part Two, 18 semi-structured interviews were conducted with professionals who worked with situations of squalor and self neglect in the community. The results from both parts of the research were analysed using NVivo, a software program specifically designed to assist in the analysis of qualitative data. This research uncovered that, unlike the definition of self neglect used in the wider literature on this topic, participants clearly differentiated between personal neglect (self neglect) and environmental neglect (squalor and hoarding). Ethical dilemmas were common in these situations and fully understanding how professionals resolved these dilemmas required that both objective and relational approaches to ethics be used to analyse participant responses. In this way, a pluralistic approach to ethics emerged as the theory best suited to fully explore ethical decision-making in situations where older people were self neglecting or living in squalor. Decisions that resulted in good outcomes were found to be increasingly constrained by changes to services driven by neoliberalism and managerialism. Individual reflection and peer support emerged as important elements that helped professionals to cope with the ethical dilemmas and the practical constraints that were encountered in these situations.

<p>The general aim of the present thesis is to investigate needs of support and service in clients with long-term mental disabilities living in the community. A further aim is to study changes in these client needs during a 3.5-year follow-up. </p><p>A questionnaire, The Need of Support and Service Questionnaire (NSSQ), was developed to provide staffs in psychiatric care and social services with a brief instrument to assess how their clients live in the community and to identify their needs. </p><p>The results are based on 1,759 clients. The prevalence of clients in urban and rural areas was 6.4/1,000 and 4.5/1,000 inhabitants, respectively. The clients living in the urban setting were more frequently male, older, with a diagnosis of schizophrenia and needed more support in activities of daily living than rural clients. </p><p>Clients identified by staff in psychiatric care only were more often living with a partner, with children living at home and more often had a rehabilitation allowance than clients identified by social services staff. In clients assessed by both organizations similar needs at a group level were identified. However, agreements were lower at the individual level. </p><p>Although clients reported fewer needs than staff in psychiatric care, the reported needs were in the same areas.</p><p>A majority of the clients with unmet needs of service at baseline had their needs met at the 3.5-year follow-up. New unmet needs were also identified at the follow-up, however. The results demonstrate less improvement in clients with schizophrenia as compared with non-schizophrenic clients.</p><p>In conclusion, needs of support and service present a dynamic process and both psychiatric care and social services should critically evaluate assessments of these needs.</p>