published_or_final_version / Social Work / Master / Master of Social Work

Research in community management of the severely mentally ill has been scarce. Two primary components of community care in particular need evaluation, residential arrangements and styles of "case management." The purpose of this study was to evaluate the interaction of two types of residential arrangements (single- and double-occupancy) and two types of case management ("assertive" and "limited") in a 2 X 2 design. Participants were individuals with a severe mental illness served by CMHS, Inc. Individuals were matched on DSM-III-R diagnoses and sex: 8 had roommates and received assertive case management, 5 had roommates and limited case management, 5 lived alone and received assertive case management, and 5 lived alone with limited case management. Data were obtained from three independent sources: (1) each client was interviewed using the Denver Community Mental Health Questionnaire (DCMHQ) and the Inventory of Socially Supportive Behaviors (ISSB) on four separate occasions over three consecutive months; (2) frequency of client contact with family members over the same time interval was tracked by case managers; and (3) concurrent attendance in day treatment sessions, diagnosis, number of previous hospitalizations, and approximate number of months of previous hospitalization were obtained from community mental health center records. DCMHQ scores for acute symptoms and interpersonal conflict were combined into an index called problems, while ISSB scores measured social support received. Monthly follow-ups for three consecutive months were used to obtain stable estimates of problems and support. Significant positive correlations were found between family involvement and problems, family involvement and residential arrangements, social support and problems, group attendance percentage and age, problems and social support, and a marginal relationship between residence and social support. Statistically significant negative correlations were found between case management and problems, social support and number of previous hospitalizations, group attendance percentage and problems, and residence and age. In multiple regression involving all predictors, the variables other than roommating and case management, (i.e., average family involvement, number of previous hospitalizations, program attendance, and age, considered together) predicted both problems reported and support received, while as second and third steps in the regression analysis case management and residence did not significantly predict problems or social support. In other words, once chronicity (i.e., number of previous hospitalizations), family contact, age, and group attendance were controlled, case management and residence both vanished as predictors. Future studies should consider these factors, and other aspects of the natural context, when evaluating community interventions for the mentally ill in a more controlled experimental design. With respect to developing new research for community adjustment, recommendations for more controlled studies were made and two new community intervention procedures were described. / Department of Psychological Science

No description available.

This thesis is based on a research project that explored the deinstitutionalisation and eventual closure of a large residential facility for people with an intellectual disability. The thesis is focused on family experiences of deinstitutionalisation in order to understand how families interacted with this major process of social change, and pays specific attention to the role of adult siblings within this context. Unstructured interviews were held with thirty-five families who had family members with an intellectual disability who were being resettled from an institution to alternative disability support services. Families were interviewed at three specific phases during the deinstitutionalisation process: prior to the resettlement of their family member; 1-3 months following resettlement; and one year after resettlement. In keeping with the constructivist paradigm that underpinned this qualitative study, repeated contact with families enabled me to develop some insights into how families made decisions relevant to their family members� transitions from the institutional environment. The study findings highlight the complexity and heterogeneity of families. While families who participated in this study were found to have shared a similar journey toward institutionalisation, their responses and reactions to deinstitutionalisation and the decision-making associated with such a process were more diverse. My analysis presents the notion that taking a constructivist approach to theorising can facilitate an understanding of how families are influenced in their decision-making with regards to the resettlement of a family member with an intellectual disability. That is, we may be able to gain greater understanding of families� perceptions of their family members who have an intellectual disability and, subsequently, the decisions that families make regarding the care of that person by exploring the meanings they assign to their world. Ascertaining how families come to construct their understandings of disability is, in my view, critical to responding appropriately to families� needs within the context of disability support and service provision.

Thesis (Ph. D.)--Open University.

Thesis (Ph.D.)--University of Melbourne, School of Nursing and Social Work, 2009. / Typescript. Includes bibliographical references (p. 316-328)

During the last 50 years, there has been a transfer of care for individuals living with mental disorders from predominately institutional settings to predominately community settings. The purpose of this research was to document the closure of Brandon Mental Health Centre (BMHC) and to look at long-term outcomes for discharged individuals. These objectives were met by interviewing key people involved in the closure and through analysis of administrative data. To support individuals after BMHC closed, new services were developed in four priority areas: adult inpatient and crisis response services, adult rehabilitation and consumer support services, psychogeriatric services, and child and adolescent services. Visits to a general practitioner for a mental disorder by individuals discharged from BMHC decreased significantly over the follow-up period while visits to a psychiatrist increased significantly. Mortality rates, physician visits, and hospital admissions were higher in former BMHC residents than in a matched cohort.

No description available.

During the last 50 years, there has been a transfer of care for individuals living with mental disorders from predominately institutional settings to predominately community settings. The purpose of this research was to document the closure of Brandon Mental Health Centre (BMHC) and to look at long-term outcomes for discharged individuals. These objectives were met by interviewing key people involved in the closure and through analysis of administrative data. To support individuals after BMHC closed, new services were developed in four priority areas: adult inpatient and crisis response services, adult rehabilitation and consumer support services, psychogeriatric services, and child and adolescent services. Visits to a general practitioner for a mental disorder by individuals discharged from BMHC decreased significantly over the follow-up period while visits to a psychiatrist increased significantly. Mortality rates, physician visits, and hospital admissions were higher in former BMHC residents than in a matched cohort.

This thesis is based on a research project that explored the deinstitutionalisation and eventual closure of a large residential facility for people with an intellectual disability. The thesis is focused on family experiences of deinstitutionalisation in order to understand how families interacted with this major process of social change, and pays specific attention to the role of adult siblings within this context. Unstructured interviews were held with thirty-five families who had family members with an intellectual disability who were being resettled from an institution to alternative disability support services. Families were interviewed at three specific phases during the deinstitutionalisation process: prior to the resettlement of their family member; 1-3 months following resettlement; and one year after resettlement. In keeping with the constructivist paradigm that underpinned this qualitative study, repeated contact with families enabled me to develop some insights into how families made decisions relevant to their family members� transitions from the institutional environment. The study findings highlight the complexity and heterogeneity of families. While families who participated in this study were found to have shared a similar journey toward institutionalisation, their responses and reactions to deinstitutionalisation and the decision-making associated with such a process were more diverse. My analysis presents the notion that taking a constructivist approach to theorising can facilitate an understanding of how families are influenced in their decision-making with regards to the resettlement of a family member with an intellectual disability. That is, we may be able to gain greater understanding of families� perceptions of their family members who have an intellectual disability and, subsequently, the decisions that families make regarding the care of that person by exploring the meanings they assign to their world. Ascertaining how families come to construct their understandings of disability is, in my view, critical to responding appropriately to families� needs within the context of disability support and service provision.