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37 result(s) for "Draine, Jeffrey"
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The State of Knowledge of the Effectiveness of Consumer Provided Services
There is a mixed record of research on consumer delivered services. There has been a great deal of descriptive work that supports the feasibility of consumer provided services. Only a limited number of studies have been reported that focus on outcomes for people who receive services from consumers. This new literature is at a critical juncture. This paper examines the state of research on three types of consumer provided services-consumer operated services, consumer partnership services, and consumers as employees. All these service types include consumers as paid providers who deliver mental health services to others, not primarily for their own benefit. This excludes self-help programs. Research resources need to be focused less on consumer provided services as adjunctive to professional services and more on determining the effectiveness of stand-alone consumer provided services in order to develop evidence to influence policy decisions.
Reincarceration Risk Among Men with Mental Illnesses Leaving Prison: A Risk Environment Analysis
Reentry interventions for persons with mental illness leaving prison have consisted primarily of linkage to mental health services and have produced mixed results on psychiatric and criminal recidivism. These interventions primarily focus on intra-individual risk factors. However, social and environmental factors may also increase risk of reincarceration by constraining choices and pro-social opportunities for community reintegration upon release from prison. In order to add to the knowledge base on understanding reincarceration risk for men with mental illnesses leaving prison, we examined interpersonal and environmental factors that exposed men to heightened risk for reincarceration. As part of a larger study examining the effectiveness of Critical Time Intervention for men with mental illness leaving prison, in-depth interviews were conducted with 28 men within 6 months of release from prison. Policies and practices at local and state levels, community conditions, and interpersonal obligation and conflict were identified as increasing risk for reincarceration.
Bridging Health Disparity Gaps through the Use of Medical Legal Partnerships in Patient Care: A Systematic Review
Over the past two decades, we have seen an increase in the use of medical-legal partnerships (MLPs) in health-care and/or legal settings to address health disparities affecting vulnerable populations. MLPs increase medical teams' capacity to address social and environmental threats to patients' health, such as unsafe housing conditions, through partnership with legal professionals. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, we systematically reviewed observational studies published from January 1993-January 2016 to investigate the capacity of MLPs to address legal and health disparities. We identified 13 articles for qualitative analysis from an initial pool of 355 records. The resulting pool of 13 articles revealed more information regarding the capacity of MLPs to address legal outcomes than their capacity to address health outcomes; only 4 studies directly addressed the impact of MLP intervention on patient wellbeing and/or patient utilization of healthcare services. We call for further evaluation/longitudinal studies that specifically address MLPs' short and long term effects upon patient health disparities. Finally, given the demonstrated capacity of MLPs to address unmet legal needs, and their evident potential in regards to improving health outcomes, we present the MLP model as a framework to address HIV-related legal and health disparities.
Investigating the Impact of Housing First on ACT Fidelity
This study examined the extent to which an ACT team employed within a Housing First program conforms to the fidelity standards of the ACT model. The aim was to specifically identify the extent to which accommodations have been made to suit the context and priorities of Housing First. Results indicate that some deviations from the ACT model could be attributed to the consumer choice approach inherent to Housing First. Other deviations may result from serving individuals that are more disconnected from social supports than other individuals with mental illness, with longer street histories, and greater involvement with substance use.
The efficacy of a consumer case management team: 2-year outcomes of a randomized trial
This article reports the results of a randomized trial of a team of case managers who are mental health consumers compared to a team of nonconsumer. Using a repeated measures MANOVA design, consumer case managers were found to be as effective as a team of nonconsumer case managers in maintaining the stability of severely mentally disabled clients served over a 2-year period. Implications for the employment of consumers in mental health services and the vocational capacity of persons with mental illness are discussed.
Adherence to HIV Treatment and Care Among Previously Homeless Jail Detainees
HIV-infected persons entering the criminal justice system (CJS) often experience suboptimal healthcare system engagement and social instability, including homelessness. We evaluated surveys from a multisite study of 743 HIV-infected jail detainees prescribed or eligible for antiretroviral therapy (ART) to understand correlates of healthcare engagement prior to incarceration, focusing on differences by housing status. Dependent variables of healthcare engagement were: (1) having an HIV provider, (2) taking ART, and (3) being adherent (≥95% of prescribed doses) to ART during the week before incarceration. Homeless subjects, compared to their housed counterparts, were significantly less likely to be engaged in healthcare using any measure. Despite Ryan White funding availability, insurance coverage remains insufficient among those entering jails, and having health insurance was the most significant factor correlated with having an HIV provider and taking ART. Individuals interfacing with the CJS, especially those unstably housed, need innovative interventions to facilitate healthcare access and retention.
The working alliance and consumer case management
The Working Alliance Inventory was used to measure the strength of the therapeutic relationship between seriously mentally disabled case management clients and their case managers in a randomized trial of consumer-provided case management services. It was found that while there was no difference in the strength of the alliance between the consumer and nonconsumer teams of case managers, there were positive relationships between alliance and some outcomes, including quality of life, symptomatology, attitudes toward medication compliance, and satisfaction with mental health treatment.
The Assets and Challenges of Formerly Incarcerated Latino Men’s Social Support Networks in Promoting Healthy Behaviors
After being exposed to high-risk environments in correctional facilities, formerly incarcerated Latino men (FILM) encounter new risks upon reentering their community of residence including drug use and sexual risk behaviors. Families and close social support networks are critical in potentially mitigating the stressors and risks associated with reentry and reducing the likelihood of recidivism. We conducted a study to examine the material and cognitive assets that familial networks can use to provide support to FILM to engage in health-promoting practices. This analysis is based on linear and logistic regression modeling of cross-sectional data collected through a computer-administered survey with dyads of FILM (ages 18–49, who had been in jail or prison within the past 5 years) and their nominated social network (n = 130 dyads). We found that both male and female social supports (MSS and FSS) have significantly higher levels of structural resources (education and employment) than FILM. Though FSS reported higher self-efficacy on health-promoting practices than FILM, contrary to what we predicted, FILM and FSS/MSS reported similar levels of mental health and behavioral risks. Our results suggest a number of limitations in designing family-based intervention strategies, but they also provided insight into the specificities needed to enhance the social support networks of FILM.
Influences of Economic, Social and Cultural Marginalization on the Association Between Alcohol Use and Sexual Risk Among Formerly Incarcerated Latino Men
Formerly incarcerated Latino men (FILM) have been significantly impacted by the HIV/AIDS and alcohol abuse epidemics in the United States. In this analysis, we examine the role of social, economic and cultural marginalization in the likelihood of alcohol-related sexual risk taking behavior among FILM. We recruited a non-random sample of FILM, ages 18–49 (n=259). We performed logistic regression modeling to test four hypotheses examining the direct and moderating effects of socio-cultural factors. Drinking before sex was strongly associated with high likelihood of condomless intercourse (adjusted odds ratio, AOR=2.93; 95% CI 1.74, 4.94). Low acculturation and social marginalization factors were significant moderators of the association between high-risk alcohol use and sexual risk behavior among FILM. Our data suggest that risk reduction initiatives geared towards reducing alcoholrelated sexual risk taking among FILM should target FILM with low levels of acculturation, and those with high levels loneliness, anxiety, and/or depression.
Balancing Accessibility and Selectivity in 21st Century Public Mental Health Services: Implications for Hard to Engage Clients
This research highlights the importance of expanding examinations of service accessibility for hard to engage client populations to include assessments of individuals’ ability to gain entrance to services and the system’s ability to meet the service needs of particular client populations. The results of this research provide a framework to support these examinations. The increasing levels of selectivity and targeting of mental health services to particular client populations found in this study raise fundamental questions about the goals of service accessibility in 21st century public mental health services generally, and for hard-to-engage clients particularly. These findings also point to the need for examinations of the eligibility criteria and gatekeeping mechanism that are used to target services to particular client populations to determine if they are working as intended and to assess what impact these mechanisms have on hard to engage clients’ ability to gain entrance to needed services.