Cost -effectiveness of services and treatments for ambulatory dually diagnosed CMHC clients: Implications for managed care

This paper reports a cost-effectiveness analysis of standard therapeutic interventions received by ambulatory dually diagnosed clients of a Community Mental Health Center (CMHC). For the purposes of this study dually diagnosed was defined as a DSM-III-R or IV diagnosis of a major mental disorder and a concomitant substance abuse disorder. The prevalence of dually diagnosed people among the mentally ill and their unique and problematic nature continues to challenge and encumber CMHCs and poses grave public health risks. An absence of research on these clients in community-based settings and the cost-effectiveness of their standard CMHC care has hindered the development of effective community-based intervention strategies. This exploratory and descriptive effort is a first step toward providing information on which to base programmatic management decisions.^ Data for this study were derived from electronic client records of a CMHC located in a large Southwestern, Sun-belt metropolitan area. A total of 220 records were collected on clients consecutively admitted during a two-and-one-half year period. Information was gathered profiling the clients' background characteristics, receipt of standard services and treatments, costs of the care they received, and length of CMHC enrollment and subsequent psychiatric hospitalizations. The services and treatments were compared with regard to their costs and predicted contributions toward maintaining clients in the community and out of public psychiatric hospitals.^ This study investigated: (1) the study groups' background, mental illness, and substance abuse characteristics; (2) types, extent, and patterns of their receipt of standard services and treatments; (3) associations between the receipt of services and treatments, community tenure, and risk of psychiatric hospitalization; and, (4) comparisons of average costs for services and treatments in terms of their contributions toward maintaining the clients in the community.^ The results suggest that substance abuse and other lifestyle factors were related to the dually diagnosed clients' admissions to the CMHC. The dually diagnosed clients' receipt of care was associated strongly with their insurability and global functioning. Medication Services were the most expensive yet effective service or treatment. Supported Education was the third most expensive and second most effective. Psychosocial Services, the second most expensive, were only effective in terms of maintaining clients in the community. Group Counseling, the fourth most expensive, had no effect on community maintenance and increased the risk of hospitalization when accompanied by Medication Services. Individual Counseling, the least expensive, had no effect on community maintenance. But it reduced the risk of hospitalization when accompanied by Medication Services. Networking/Referral, the fifth most expensive service or treatment, was ineffective.^ The study compared the results with findings in the literature. Implications are discussed regarding further research, study limitations, practical applications and benefits, and improvements to theoretical understandings, in particular, concepts underscoring Managed Care. ^

Income disparity among persons with disabilities assessed by education and sex : findings from a field survey conducted in Metro Manila, the Philippines

How do persons with disabilities (PWDs) earn a living? From the view point of poverty reduction, this question is quite critical in developing countries. This paper presents an investigation of economic activities of PWDs in the Philippines where, among developing countries, disability-related legislation is relatively progressive. In 2008, a field survey was conducted in cooperation with Disability People’s Organizations (DPOs) using a tailor-made questionnaire in four representative cities of Metro Manila. The level and determinants of income of PWDs were examined with Mincer regression. Conclusions are as follows: (1) The incidence and depth of poverty are greater among sample PWDs than that of the total population in Metro Manila. (2) There is remarkable income disparity among PWDs which is associated with education and sex. (3) After controlling individual, parental, and environmental characteristics, it was found that female PWDs are likely to earn less than male PWDs due to fewer opportunities to participate in economic activities. It is suggested that female PWDs are doubly handicapped in earning income.

Exploring Existentially-Based Interventions For Career Transitions in Sport

From Introduction: Career transition issues have become of increasing interest in the field of sport psychology. Confronting the end of an athletic career is an inevitable reality that every athlete will confront in his or her lifetime (Baillie, 1993), regardless of level of competition (Kerr & Dacyshyn, 2000) or the amount of free choice related to the transition. Many athletes are able to cope with the effects of the transition process effectively, and see retirement as an opportunity to pursue new ventures and identity roles in life. However, retirement from sport can be an event that often results in various adjustment difficulties for an athlete involving emotional, social, financial, and vocational conflicts. Some athletes have reported experiencing effects such as depression, eating disorders, decreased self-esteem, increased suicidality, and substance abuse (Kerr and Dacyshyn, 2000). These types of distress can be exacerbated by the fact that many athletes fail to adequately anticipate and prepare for their impending transition (Baillie, 1993), and often embark on the retirement process without any formalized support (Stier, 2007).Typically, the role of a sport psychologist has been to assist in maximizing an athlete's competitive performance during the course of their career. However, as a sport psychologist's primary responsibility is to serve active competitors and athletic organizations, this tends to come at the expense of failing to provide follow-up care for the athlete as he or she retires from sport (Taylor, Ogilvie, and Lavallee, 2006). Since the 1970's, when the efforts of professionals in European sports organizations first received attention, there has been growing interest in academic circles about career transition

Postcolonial healing landscapes and mental health in a remote Indigenous community in subarctic Ontario, Canada

The concept of therapeutic landscape is concerned with a holistic, socio-ecological model of health, but most studies have attempted to explore land-health links from a Western perspective. On an Indigenous reserve in Northern Ontario, part of the Canadian subarctic, we explore the importance of spaces and places in creating postcolonial therapeutic landscapes to treat the wounds inflicted by colonialism. The aim of this research is to gain insight from views and experiences of First Nations residents living on reservations that are undergoing a process of regaining traditional spiritual beliefs and teachings to construct therapeutic spaces to face mental health problems caused by legal opioid analgesic abuse. This qualitative study used semi-structured interviews with Cree and Ojibwe participants to understand how they are reconnecting with earth, spirituality and traditional animist beliefs on their way to recovery. We find that practices such as taking part in ceremonies and ritual spaces, and seeking knowledge and advice from Elders assist with personal healing and enable Indigenous people to be physically and mentally healthy. Our research findings provide important insights into the relationship between space, healing and culture as determinants of health and well-being and document some key factors that contribute to substance abuse recovery.

Description des relations familiales : la perspective d’hommes en situation d’itinérance atteints de troubles concomitants

Les personnes en situation d’itinérance, principalement des hommes, représentent pour certains une culture au sein de laquelle on identifie des personnes atteintes de troubles concomitants de santé mentale et d’abus de substances. Déjà vulnérables de par leur statut domiciliaire précaire, les personnes atteintes de cette concomitance le sont davantage et tendent à être plus isolées de leur famille que celles ne rencontrant pas cette double problématique. Le soutien familial est toutefois reconnu comme un élément favorisant l’engagement de comportements de santé et réduisant l’itinérance. Le but de cette étude était alors de décrire, du point de vue des hommes en situation d’itinérance atteints de troubles concomitants de santé mentale et d’abus de substances, les relations qu’ils entretiennent avec leur famille. Pour ce faire, le devis choisi fût une ethnographie ciblée. Différents degrés d’observation participante au sein de la Mission Old Brewery et des entrevues avec neuf informateurs-clés ont été les principales méthodes de collecte des données. L’analyse des données qualitative était soutenue par le guide proposé par Roper et Shapira (2000) ainsi que l’épistémologie constructiviste et l’approche systémique familiale de Calgary (Wright & Leahey, 2013) qui furent les cadres de référence de cette étude. Les résultats font ressortir trois thèmes explicitant 1) l’influence du contexte de vie dans les relations familiales, 2) la teneur conflictuelle de ces relations ainsi que 3) le soutien familial perçu. Finalement, des recommandations pour la pratique infirmière ainsi que des pistes pour de futures recherches sont suggérées.

Description des relations familiales : la perspective d’hommes en situation d’itinérance atteints de troubles concomitants

Les personnes en situation d’itinérance, principalement des hommes, représentent pour certains une culture au sein de laquelle on identifie des personnes atteintes de troubles concomitants de santé mentale et d’abus de substances. Déjà vulnérables de par leur statut domiciliaire précaire, les personnes atteintes de cette concomitance le sont davantage et tendent à être plus isolées de leur famille que celles ne rencontrant pas cette double problématique. Le soutien familial est toutefois reconnu comme un élément favorisant l’engagement de comportements de santé et réduisant l’itinérance. Le but de cette étude était alors de décrire, du point de vue des hommes en situation d’itinérance atteints de troubles concomitants de santé mentale et d’abus de substances, les relations qu’ils entretiennent avec leur famille. Pour ce faire, le devis choisi fût une ethnographie ciblée. Différents degrés d’observation participante au sein de la Mission Old Brewery et des entrevues avec neuf informateurs-clés ont été les principales méthodes de collecte des données. L’analyse des données qualitative était soutenue par le guide proposé par Roper et Shapira (2000) ainsi que l’épistémologie constructiviste et l’approche systémique familiale de Calgary (Wright & Leahey, 2013) qui furent les cadres de référence de cette étude. Les résultats font ressortir trois thèmes explicitant 1) l’influence du contexte de vie dans les relations familiales, 2) la teneur conflictuelle de ces relations ainsi que 3) le soutien familial perçu. Finalement, des recommandations pour la pratique infirmière ainsi que des pistes pour de futures recherches sont suggérées.

Changing lives : programs that make a difference for youth at high risk.

Mode of access: Internet.

Cost-effectiveness and preventive implications of employee assistance programs /

"Printed 1995"--T.p. verso.

Managed mental health care : what to look for, what to ask.

Shipping list no. 96-320-P.

Global Research Network Meeting on HIV Prevention in Drug-Using Populations : inaugural meeting report, June 25-26, 1998, Geneva, Switzerland /

Shipping list no.: 99-0352-P.

Recovery training and self-help : handbook for program administrators /

"Printed 1993"--T.p. verso.

Toward a drug-free generation : a nation's responsibility; final report /

Shipping list no.: 90-718-P.

Toward equality of well-being : strategies for improving minority health : strategic planning and coordination process.

S/N 037017-024-01504-1 (GPO).

Cue extinction : in-service training curriculum /

"Printed 1993"--T.p. verso.

Teen drinking prevention program.

"Printed 1995"--P. [4] of cover.