Journal of mental health administration最新文献

This article examines the costs of treatment under the Fort Bragg Demonstration. It focuses on the direct costs of mental health services and suggests that expenditures on those services were much higher at the Demonstration. Increased access and greater "doses" of services provided at the Demonstration are identified as the proximal causes of the system-level cost difference. Consideration is given to whether these differences in costs and in service use can be attributed to the continuum of care per se or to differences in the financial arrangements under which care was provided. Supplemental analyses suggest that these expenditures were not offset by cost savings elsewhere. Implications for mental health policy are discussed.

The aim of this study was to describe patterns of service use over time by a group of persons with chronic mental illness who were homeless at the time of the index admission. Subjects were all persons admitted to Skid Row Mental Health Services in a recent year who had 25 or more previous admissions to any Los Angeles County Department of Mental Health service (N = 49). Sequences of type of service at each of the 25 admissions were compared with optimal matching and categorized with cluster analysis. Patients in earlier clusters had many inpatient admissions; those in later clusters had many admissions to outpatient, residential, and jail services. Service use by individuals in each cluster showed the same trends. However, there were also different patterns of service use for patients in cluster within the same tie frame. Analyzing multiple admissions sequentially helps to locate likely places to intervene in downward-spiraling careers.

Concurrent substance and psychiatric problems have been shown to significantly reduce the probability of successful treatment outcomes while increasing vulnerability to a range of troubles including homelessness, incarceration, physical health problems, and criminal victimization. This article presents an ethnographic analysis of treatment processes in a residential social model treatment program specifically designed for individuals with dual diagnoses in an effort to inform current debates with empirically grounded knowledge regarding therapeutic practice itself. The article focuses on four fundamental themes bearing on therapeutic practice in this residential program: social model treatment; the formulation of clinical identities; recovery, personal responsibility, and authority; and the measurement of therapeutic success. In conclusion, the article suggests that the central role played by program residents in the therapeutic process deserves particular attention and makes recommendations regarding mental health services delivery that, if followed, might invigorate treatment efficacy.

Many states have been interested in revising their systems of care for young people. The Alaska Youth Initiative (AYI) attempted to improve the system of care by providing community-based, individualized services to youths who would otherwise be institutionalized outside the state. Major policy changes included emphasis on local service provision, individualized services, unconditional care, and coordination of services. The AYI's performance on its original goals is mixed. Complications in implementation arose from lack of provider training, conflict over coordination at the state level, and difficulty in individualizing programs. Although significant successes have occurred, administrators could improve the implementation of similar types of programs by making specific plans to address concerns of various stakeholders, providing fiscal incentives for cooperation for state workers, and providing ongoing training in both clinical and administrative areas.

This article reports on a process evaluation of the Texas Children's Mental Health Plan, a statewide initiative to provide interagency coordinated mental health services to severely emotionally disturbed children and their families. Researchers followed the activities of the state management team and three local sites during the first year and a half of the project's implementation. This article delineates the major positive effects of the plan as well as the facilitating factors and barriers to the development of such an effort.

Area variation studies rarely focus on perceptions of service system performance in their comparative analyses. Using an instrument designed specifically for assessing key stakeholders' perceptions of the performance of mental health service delivery systems, this study compared three areas in Massachusetts that differ significantly with regard to service system structure and resource allocation. Despite these differences, key stakeholders' perceptions of service adequacy, availability, quality, and coordination did not vary substantially, although the findings suggest that to some extent organizational structure may have more effect than resource availability and allocation on perceptions of key stakeholders within the three systems. These differences were also of far less magnitude than differences in hospitalization rates and other more traditional measures of service system performance. The authors argue that stakeholders' perceptions should be considered, along with other standard performance measures, in evaluating service system performance.

The purpose of this investigation was to attempt to describe the health care needs of families providing in-home care to members with developmental disabilities as well as the characteristics and demographics of families providing in-home care. The survey included 761 families who participated in a federal demonstration project in rural southern Georgia. The results indicated that impoverished families need increased assistance to provide adequate medical and health care when providing in-home care to relatives experiencing developmental disabilities. Implications for administration of programs and development of policies are discussed.