Background/Objectives: Vulnerable populations, particularly those with mental illness, are at a significantly higher risk of developing chronic health comorbidities and facing barriers to regular healthcare, often resulting in a shorter lifespan than the average population. The purpose of this needs assessment of a rural population utilizing a local food bank and soup kitchen is to assess the health status of the population in relation to mental health and chronic illness, and to determine this population’s access and utilization of primary care services. The data collected in this assessment will identify potential needs for formal community partnerships and help develop recommendations to improve health status of this potentially vulnerable community. Design: This study consisted of a needs assessment involving an orally administered survey to a potentially vulnerable population evaluating socio-demographic factors, chronic illness, mental health diagnoses, and questions regarding primary care access and utilization using the Primary Care Assessment Tool (PCAT). Setting: The study took place at the Flagstaff Family Food Center (FFFC), a local food bank and soup kitchen in Northern Arizona. Data collection took place during the free dinner meal over two site visits. Participants: Clients utilizing the FFFC who are English speaking, 18 years of age and older, able to give informed consent. Results: Data collected shows that a large number of FFFC clientele would be classified as vulnerable, and several report mental illness and other chronic illness. One hundred percent of survey participants report having health insurance, yet two participants report not having a primary care provider (PCP) and using the emergency department for their healthcare needs. While the majority of clients report having easy access to their PCP, the ongoing care and coordination of services appears to be lacking. Conclusion: Based on this pilot needs assessment, there is a need for more formal partnerships between healthcare providers and organizations and the FFFC to ensure this vulnerable population receives adequate care for chronic disease management, mental illness and prevention. By providing connections at the FFFC where clients come to receive a free meal, some of the common barriers of stigma, transportation and system navigation may be eliminated.

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No description available.

There has been a recent and widespread interest in developing new methods of assisting the mental hospital patient in becoming a self-supporting member of society. A new concept, that of "the therapeutic community", has provided insight as to the significance of both physical surroundings and the staff interaction upon the patient's potential for return to the community. Many mental hospital patients become sufficiently free of symptoms to be able to leave hospital, but require further assistance before being able to do so. It is in this context that various kinds of transitional facilities are now being established. The present study examines one such facility, the "halfway house", and attempts by a comparative survey an "operational definition" of its distinguishing features. The several areas requiring descriptive data were assembled in a questionnaire, which was then sent to all centres which could be located from available references on the subject. Responses were received from twelve examples in the United States, to which are added two from British Columbia. A brief reference only is included for "hostels" which are of comparable character in Britain. The introductory chapter reviews the perspective of these institutions. This points up rehabilitation as a process that involves many elements, such as the removal of disabilities incurred as a result of being a mental hospital patient, the necessity of providing for gradual reintegration of the patient into the community, the development of new resources to help accomplish this goal, and the changing attitude developed by service personnel in both the large institution and the transitional facility, so that the patient will be able to receive the encouragement and assistance required. The core material, compiled from the questionnaire, is analyzed under the headings of (a) the new features of this social agency, (b) sponsorship and finance, (c) physical facilities, (d) the nature of staff and facilities, (e) eligibility (Chapter II). Dynamically, the "halfway house" is assessed as a therapeutic community, covering (a) staff functions, (b) the residents' progression, (d) special services, (e) discharge criteria (Chapter III). The conclusions are that the "halfway house" is a new type of social agency that has developed within the last decade. Although it has some similarities with boarding homes, it also retains some of the characteristics of mental hospitals with which it is usually linked. All but one of the examples stress the movement of individuals or clients into the community, and in order to accomplish this, a team of personnel has developed: the houseparent, social worker, and psychiatrist. The makeup of the team is analogous to the mental hospital treatment team of nurse, social worker, psychiatrist. Two elements remain unclear: (a) the policy with regard to eligibility or selection and discharge, and (b) the function of the houseparent. With regard to the former, such matters as high cost of service to the client or policy limiting who is accepted may limit the service. In some cases it is not clear why persons are admitted, except on the basis of unclearly stated need. Some facilities have a clearer view of purpose; i.e., to remove dependency upon the mental hospital or to teach the former patient the social skills required for living in the community. But many houseparents, lacking professional education, are nevertheless responsible for the physical order of the facility and for setting a therapeutic tone. Some suggested areas for further study are better definitions of the hospital disabilities removed by a stay at the agency, and closer examination of how social interaction amongst clients and staff, as well as the use of community resources, brings this about. / Arts, Faculty of / Social Work, School of / Graduate

Today much emphasis is placed on the rehabilitation of the mentally ill. This study undertakes a survey of the values of foster home care as a therapeutic resource in the rehabilitation of such patients. The programs presently in operation in Maryland, U.S.A. and Ontario have been examined to determine their effectiveness in meeting needs evinced by recidivist patients at the Provincial Mental Hospital, Essondale, B.C. A sample group of twenty-one patients was obtained by taking all recidivist patients returning to the hospital from probation between July 1, 1959 and December 31, 1959, who had been active with the social service department during the previous admission. Patients who met these criteria were assessed primarily through the use of rating scales based on information contained in the files. An examination of the needs and resources of these patients indicated that the average patient was unmarried, returning for his fourth admission, without family resources, and limited in social, vocational and educational skills. Previous to this readmission one out of every two had become the client of public welfare agencies, drawing social assistance. The study suggests that patients' needs may be adequately met through a foster care program which provides emotional support, thus helping to stabilize and aid the patient in his adjustment to the community. The use of this system is also indicated for the care of chronic patients whose symptoms of illness are controlled, yet who are unable to accept full responsibility for their own care. The program could also be adapted to provide care for the geriatric patients who today swell the population of mental hospitals. Considering the program under three headings: general policy, required facilities and type of patients, methods of implementing foster home care in the community are indicated. Research would be of value in developing methods of selecting patients who would derive optimum benefit from the program, and in assessing the progress made in the new setting. Foster home care, which has as its goal the placing, of patient's in family settings in the community, is in line with the current emphasis on decentralization of large mental institutions, and, as such, provides a suitable therapeutic resource in the rehabilitation of the mentally ill. / Arts, Faculty of / Social Work, School of / Graduate

The Sustaining Clinic is a recently-added service provided by the Mental Health Centre in British Columbia for a selected group of patients who are unable, for a variety of reasons, to benefit from more intensive therapy than a monthly interview. This study reviews the contribution of the therapeutic team at the Sustaining Clinic (of which the social worker is a part), toward the rehabilitation of a difficult group of mentally-ill patients, most of whom require long-term follow-up care. To emphasize the focus on the appropriate type of patients, the method is to review (1) the problems of a sample group of these patients, and (2) the treatment services given to them; thus, establishing how far this meets their needs. Treatment is evaluated with the aid of three rating scales assessing the patient's functioning at the time of referral and at the time of discharge. The evidence is that (1) The enormous disability associated with these patients is to a large extent imposed, preventable, and treatable. Disability originates particularly from parental rejection, and is later magnified by the rejection mechanisms stemming from cultural attitudes. (2) The treatment provided by the Sustaining Clinic is effective because it is related to the needs of the patient and to the specific conditions surrounding his illness. Therapeutic contributions include regulation of medication, support in cases of stress, limit-setting, information-giving, manipulation of the environment, and providing a figure for identification. (3) More resources than the Clinic can provide will be needed, because of the deep-seated personal and social handicaps of these patients. This study itself can be helpful only if coordinated with others which examine other "halfway house" programs, and the social worker's participation in them. / Arts, Faculty of / Social Work, School of / Graduate

The goal of treatment is the restoration of the mental patient to the community. This study has sought to show that family care is a useful device for rehabilitation, both for the person for whom return to independent living is expected, and as a means of providing a more satisfactory way of life than the hospital environment for the person who will continue to need supervision. The method used was to survey the development of family care in Europe, Canada and the United States, and to compare various characteristics of U. S. programs in New Jersey, Wisconsin, Michigan, California, Idaho, Maryland, Kentucky and Minnesota. A report of the Veterans Administration, Washington, D. C. was examined, and a study was also made of special features of foster care programs in the Veterans Administration Hospital at Bedford, Massachusetts, and St. Cloud, Minnesota. A general assessment was made of existing arrangements for boarding home care of mental patients in British Columbia, with special reference to community resources available, in order to determine the relative merits of boarding home placement versus family care. In this connection the files of all patients placed in boarding home care by one full-time social worker at the Provincial Mental Hospital, Essondale, B. C., between July 1, 1959 and August 31, 1960 (comprising 20 patients in all) were closely examined to establish the main characteristics of the group and their community adjustment. In the concluding chapter, as a result of the various comparisons made, it was possible to draw up a check list of criteria which could serve as a guide in setting up and developing future family care programs. The check list in summary comprises the following points: (1) orientation of hospital employees and the community to the program; (2) preparation of the patient; (3) sufficient number of social workers to operate the program; (4) sponsors suited to the task of caring for patients; (5) adequate physical standards in the home; (6) provision of medical services for patients; (7) provision of clothing and money for incidental expenses and comforts allowance for patients without means; (8) encouragement of appropriate social activities; (9) homes of varying sizes to meet the needs of different patients; (10) location of the home within access of community facilities for the benefit of patients. The broad conclusion is that the provision of adequate services will ultimately depend on the assumption by the community of the responsibility for the rehabilitation of the mentally ill. / Arts, Faculty of / Social Work, School of / Graduate

As a short-term psychiatric centre, Crease Clinic was designed for the treatment of adults. In common with many other adult mental institutions in North America, however, it has increasingly been asked to assume responsibility for the care of adolescents, because of the lack of more appropriate resources for young people. Conscious of the fact that the younger patients need a type of treatment different from that of adults, the Clinic has, at various times, tried to introduce modifications within its main psychiatric programme for the benefit of this age-group. Nevertheless, adolescent patients have continued to pose problems to both the hospital and community, and there are serious questions on both sides as to what legitimate achievements can be expected from their treatment in the Clinic. Accordingly, this study surveys the problems and needs of a selected group of adolescent patients, namely, those suffering from behaviour disorders. In the light of dynamic knowledge of their personality structures, it seeks to evaluate the degree to which the Clinic is meeting the needs, and the directions in which its programme might be strengthened or modified. The group of adolescents, those thirteen to nineteen years of age who were admitted to Crease Clinic in the period 1956 - 1958, numbers forty-four in all. Information derived from the clinical records covers the problems they presented, their family backgrounds, and their living circumstances at the time of admission. The clinical treatment programme is examined in its basic aspects of: (1) "milieu" and activity programmes; (2) psychotherapy and somatic therapies; (3) participation of parents; (4) the role of social service. Data were obtained on this portion of the study from the files of the sample group of patients, from interviews with staff members, and from the writer's personal experience as a social worker in Crease Clinic. The main conclusion reached is that there is a clear need for a specific unit for the treatment of adolescents, whether it be attached to the mental hospital, or established separately within the community. The treatment currently available within the Clinic for these young patients is not adequate to meet their needs; some of the primary deficits appear to be: (1) the limit upon the period of residence in the Clinic; (2) insufficient structuring and coordination of the various therapeutic programmes, and (3) the lack of individually planned treatment related to each patient's particular needs and problems. There is evidence that Crease Clinic can offer this type of patient limited service as an emergency resource for suicidal or assaultive youngsters, as a diagnostic resource for those needing immediate assessment or a period of observation, and as a treatment unit for the minimally-disturbed adolescent whose "acting-out" seems to stem from current situational stresses. However, to effect permanent treatment gains for this group of disturbed adolescents, an appropriately-staffed In-patient resource, designed specifically to meet their needs, is essential. / Arts, Faculty of / Social Work, School of / Graduate

This study deals with that minority segment of the German immigration population which, as evidenced by hospitalization for mental illness, has failed to make a satisfactory adjustment in Canada. Heavy environmental demands of a new country, or personal and social inadequacies, or a combination of both factors, have been held responsible for such failures. This exploratory study seeks to throw light on either interpretation. It examines clinical information, and suggests ways of analyzing case histories so that environmental and personal factors contributing to mental illness, can be more closely investigated. For the purpose of intensive study, ten case records of German immigrants were carefully selected, and were compared with those of twenty Canadian-born patients chosen on the same basis of elimination. The material available was analyzed, and classified with a view to underlining the correlating or diverging factors in the functioning of both groups. The extracted findings led to an assessment scheme in the areas of economic and work capacities, social and personal factors, applicable to individual patients and to comparable groups. A rating scale was designed which could become a measuring tool for present or future functional capacities. In spite of the small numbers used and of the analytical limitations, this attempt resulted in some well-marked similarities and deviations. To supplement this method, two composite examples of patients, reflecting causative influences in the social diagnosis, are presented. The outstanding result of this study is the emergence of similarities rather than differences between the German and Canadian patient groups. This suggests that the impact of immigration stress cannot be solely responsible for mental illness in the German group. Migration to a completely unfamiliar country, it is assumed, renders certain dormant inadequacies, for example in social relations, more prominent than a pattern of mobility or instability in one's native country would do. However, in both groups there is also the indication of low-grade functioning in economic, social and personal areas, and evidence that personal, as well as precipitating situational forces, could be accountable for mental illness in both. This experimental study strongly suggests the need for further research in this field along the same lines. However, some social work implications can be, and have been drawn from the study. / Arts, Faculty of / Social Work, School of / Graduate

This study surveys the personal circumstances and situations upon discharge, of young women who have been in the Provincial Mental Hospital a number of years, and have no home to which to return* It was found that nine out of ten patients without usable family resources have problems of such a nature on discharge as to require the services of a social worker. Their problems include obtaining work or maintenance to meet their basic needs of food, clothing, and shelter. They also need personal assistance and encouragement in obtaining employment, making new friends and acquaintances, and participating in recreational activities. The method used was to compile pertinent information from the hospital files of patients aged thirty-five and under, who left on "probationary discharge to self" during a given one-year period (actually, July 1, 1957 "to June 50, 1958). Eighteen patients were found to meet this criteria, whose cases could be studied extensively. The findings suggest that the average patient without family resources has come from a home in which there has been much stress, and is limited in educational, vocational, and social skills (e.g., lack of friends and acquaintances, relationships with the opposite sex, etc.). Social workers, both at the hospital and in welfare agencies throughout British Columbia, were active in helping approximately 90 percent of these patients meet their needs. Such help included making arrangements for finances, job finding, accommodation finding, transportation, and providing emotional support. Only 56 percent of these patients were able to make an adjustment that did not result in re-admission to the hospital: which suggests that follow-up, and after-care programs should be strengthened to include more extensive use of hostels (such as the Vista in Vancouver), and of family care programs. The possibility of smaller local centres for psychiatric care is another idea that merits consideration, to avoid prolonged separation from the community in which the patient is to return. / Arts, Faculty of / Social Work, School of / Graduate