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.

Adverse childhood experiences (ACEs) are linked to increased mental health problems in children, but their association with mental health services utilization is not well known. This secondary analysis used 2016 National Survey of Children’s Health data from two samples: children aged 6-17-years-old with a mental or behavioral condition in need of treatment or counseling (N = 5,723); and a subsample of children who experienced at least one ACE (n = 3,812). Multiple logistic regression and latent class analysis (LCA) were performed to examine the association between ACEs and mental health services utilization. Multiple logistic regressions also examined the associations of parent/caretaker vulnerability, school-system, and medical-system factors on mental health services utilization for children with ACEs using the Gelberg-Andersen Behavioral Model for Vulnerable Populations and a Systems of Care approach as the framework for model building. Children with increased ACE scores did not have higher odds of utilizing mental health services compared to children at lower levels of or no ACEs. For children who experienced adversity, increased parent/caretaker vulnerability was associated with lower odds and the current receipt of special education services with increased odds of mental health services utilization in adjusted models. Strengths of this study included the large dataset and generalizability to the U.S. population. There were limitations to the measurement of ACEs and other key variables. The current study identified children who experienced adversity as an underserviced population for mental health services.

No description available.

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

Children with antisocial, aggressive and disruptive behaviours pose considerable concern to families, educators and the wider community. A major barrier to implementing effective interventions is treatment non-attendance and attrition. The dissertation examines treatment participation among children with conduct problems, and their families, referred to child and youth mental health services. First, a model of treatment engagement was proposed that included Structural strategies (clinic service operations, such as service accessibility) and Therapy Process strategies (aspects of the interaction between the clinician and the family of the referred child). Consistent with the model of engagement, parent-report and clinician-report measures were developed and evaluated in the local Queensland Child and Adolescent Mental Health Services. The next study explored and manipulated Structural aspects in a randomised control trial evaluating the impact of telephone reminder calls. Families of children with conduct problems, in comparison to children without conduct problems, were more likely to miss appointments and to drop out of treatment. The low rate of treatment attendance for conduct problem children was diminished among those assigned to the telephone reminder condition. In the final study, the impact of a clinician training program covering the proposed engagement model was evaluated. Utilising a multiple-staggered baseline design, the training impact on clinician behaviour (n = 30) and client outcomes (n = 221) was evaluated across three mental health services. The training program was associated with a significant increase in clinicians' appraisal and use of the engagement strategies based on clinician report and chart audit measures, but not on the parent report measure. In comparison to clients referred during a baseline period, clients referred after the clinician training program had significantly higher rates of treatment attendance and lower attrition. Greater improvement in mental health functioning was found for clients referred after the training intervention on the clinician rated measure, but not for the parent report of child psychopathology. The study was limited by the use of previously un-validated engagement measures, lack of follow-up for outcome measures, and non-random allocation to conditions. The staggering of interventions across clinics and the comparability of client groups, however, minimised potential confounding explanations. Overall the results show that targeting Structural and Therapy Process aspects can enhance engagement, reduce drop-out, and improve selected outcomes in the treatment of child conduct problems.

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>

The subject of drug and alcohol abuse on college campuses across the country is the concern of many college administrators. There exists a relatively high consumption pattern of drug and alcohol abuse among college students when compared to the general population. This pattern of alcohol abuse has remained stable despite the presence of substance abuse programs on campuses that are specifically targeted toward the student population. There exists little research on how these programs operate and how they address the problem of substance abuse on campuses. Most of the research that exists is of survey design. This study examined through a descriptive case study, the substance abuse programs in three public universities in Oregon. The study used descriptive case study to describe what components comprised the programs as well as how the programs functioned under the various organizational structures. Three organizational structures were identified. The first university's organizational structure was under the health center, both administratively and physically. The second university studied had part of the program under the counseling center and other components under the athletic department and the health center. The third university had what was termed as a de-centralized structure, with the treatment component under the health center, the prevention component under an academic department, and the peer education component under the health center. The various organizational structures were also examined for their influence on the respective program. The 1989 Drug-Free Schools and Campuses Act Amendment, required institutions of higher education receiving federal funds to have programs. The impact of the Act on both the program and the organizational structure of the program was also examined. The study demonstrated an impact of the legislation on the programs in the form of funding that made possible new services. The study also suggested an influence of the organizational structure on the programs in the form of the funding of new program components that changed the organizational structure. Implications for programming as well as research as a result of this study's findings are presented. Recommendations for program models are also presented. / Graduation date: 1994

Project (D. Min.)--Iliff School of Theology, 2006. / Includes abstract. Includes bibliographical references (leaves 121-123; 126-146).

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. 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. 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. 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. Although clients reported fewer needs than staff in psychiatric care, the reported needs were in the same areas. 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. 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.