Exploratory study of the use of community treatment orders with clients of an Ontario ACT team

ABSTRACT

Community Treatment Orders (CTOs) have raised questions about coercion, lack of autonomy, and effectiveness in reducing hospitalizations and improving service users’ quality of life. This study examined the experiences of clients and clinicians when CTOs are used in combination with Assertive Community Treatment (ACT) in a recovery oriented approach. Eleven clients who were or had previously been on a CTO and eight ACT clinicians were interviewed. Although most clients had negative feelings about CTOs, some acknowledged their lives had improved. Clinicians reported that the decision to employ a CTO is sometimes debated within the team but they agreed that combining CTOs and ACT resulted in regular access to mental health supports, fewer hospitalizations and overall improvement of quality of life for their clients.     

CMHS/CSAT Collaborative Demonstration Program for Homeless Individuals

The Collaborative Demonstration Program for Homeless Individuals is providing an opportunity for several community agencies in the United States to explore innovative intervention and treatment strategies to address the needs of homeless people with co-occurring (mental illness and substance abuse) disorders. This cooperative agreement, funded jointly by the Center for Mental Health Services (CMHS) and the Center for Substance Abuse Treatment (CSAT), is a $3 million project supporting programs in various community agencies to develop, document, and evaluate programs for persons who are homeless with co-occurring disorders to be used as models in other communities. The program models include: Assertive Community Treatment, Psychosocial Rehabilitation, Therapeutic Community, and an integrated treatment model. The first phase of the two-phase project funded 16 programs in the U.S. to develop manuals within their primary treatment modalities for homeless people with co-occurring disorders. For Phase II of the project, six of the 16 model programs were competitively selected to demonstrate program impact through formal program evaluation efforts. The data derived from the various projects will be compiled into a compendium of information for state agencies and community service providers throughout the U.S.     

Resilience,mental health and Assertive Community Treatment

Clinicians try to promote resilience by building an effective therapeutic relationship with their clients. Assertive Community Treatment (ACT) is an established approach for providing services to individuals with severe mental illness who have not fared well in the regular mental health system. This work underscores the importance of a resilient therapeutic relationship in preventing relapse and assuring adherence to therapeutic outcomes. Persistent psychiatric illness takes a toll on the resilience of the client, while the relationship work takes a toll on the resilience of the clinician. This article explores the concept of relational resilience between clinician and client as a dynamic process of shared success and failure, progress and regression through cycles of crisis, stabilization, relapse, and partial recovery. This is a qualitative study exploring how ACT clinicians promote and sustain resilience and is based on interviews with social workers, nurses, occupational and recreational therapists, coordinators, and psychiatrists.     

Subjectivity as “evidence”: an exploration of medication adherence in the treatment of schizophrenia using in-depth interviews

Anti-psychotic medication is considered one of the most efficaciousinterventions for the treatment of severe schizophrenia, yet ratesof adherence are notoriously and consistently low despite volumesof medical research. Scientific knowledge has failed to improvemedication adherence because it systematically rejects subjectiveexperience in conceptualizing mental illness. In this paper, thecontent of interviews with people diagnosed with schizophreniareceiving Assertive Community Treatment are interpreted from aFoucaldian perspective to illuminate how disciplinary assumptionsperpetuate power inequities and may be a barrier to adequateresearch generation and effective treatments. Implications for futureresearch methodology and clinical approaches are discussed.     

Assertive Community Treatment as Community Change Intervention

Individuals with severe mental illnesses (SMI) are a vulnerable population, struggling to cope with fragmented and often unwelcoming community service systems. Research has examined Assertive Community Treatment (ACT) as an intervention for SMI individuals, but little research has explored ACT's potential as a community system change intervention. Using focus groups with ACT teams, we explored changes in community service systems as a result of ACT teams' presence. Changes identified included increased understanding of SMI; increased access to services; and increased collaboration across service systems. Processes by which these changes occurred included knowledge communication, negotiation, renaming by association, and ongoing relationships.     

The Dartmouth Assertive Community Treatment Scale (DACTS). A generalizability study

Generalizability theory was used to assess the reliability of the Dartmouth Assertive Community Treatment Scale (DACTS), which was developed to assess treatment reliability to assertive community treatment (ACT). Program staff and local evaluators who were participating in a national demonstration program to serve homeless mentally ill clients provided data. The total scale score for the DACTS demonstrated acceptable internal consistency and interrater reliability. Although the stability of the total DACTS score was quite low, many items on the DACTS were quite stable. The generalizability analyses provide additional detail on the effects of site, occasion, and site by occasion interactions on the reliability of the DACTS.     

Understanding engagement in the Program of Assertive Community Treatment (PACT) from the perspectives of individuals receiving treatment

ABSTRACT

Engagement of individuals with serious mental illnesses in community mental health services is a significant challenge. The Program of Assertive Community Treatment (PACT) is an individual-centered and self-contained mental health program that provides psychiatric treatment, rehabilitation, and support services to persons with serious mental illness who have a history of or likelihood of disengagement with services. Understanding what helps and hinders consumers’ involvement in PACT services may provide information on how to tailor engagement strategies to individuals based on their treatment needs and preferences. The current study builds on existing studies by exploring factors that help and hinder engagement in PACT services from the perspectives of individuals receiving treatment. We conducted open-ended, semi-structured interviews with 17 individuals receiving PACT services. Nine themes were identified through thematic analysis: Desirable qualities of PACT, Focusing on positive outcomes, PACT as a safety net, Recovery orientation, Practical barriers, Conflictual relationships, and Medication side-effects. We conclude that the development of a trusting, therapeutic relationship that is collaborative and person-centered and that is facilitated by both practical and emotional support is critical to engaging individuals in treatment and maximizing positive outcomes.     

Building Community, Empowerment and Self-sufficiency

Started in January 2000, the Camfield Estates-MIT Creating Community Connections Project, a partnership between the Camfield Tenants Association (CTA) and the Massachusetts Institute of Technology (MIT), has the goal of establishing Camfield Estates as a model for other housing developments as to how individuals, families, and a community can make use of information and communications technology to support their interests and needs. To achieve this goal, CTA and MIT have formed a unique partnership and an infrastructure that combines the three primary models for community technology - a community network where state-of-the-art desktop computers, software, and high-speed Internet connectivity have been offered to every family, a community technology center (CTC) located on the premises in the community center, and community content delivered through a community-based web system, the Creating Community Connections (C3) System - along with an agenda to build community, empowerment, and self-sufficiency amongst the residents. This paper is a case study of the Camfield Estates-MIT project to date, including the history and background of the project, the approaches taken to build community, empowerment and self-sufficiency, the methodology that has been employed, and early results from the initiative.     

Don't get bugged: practical strategies for managing bedbug infestation in psychiatric rehabilitation programs

Bedbug infestation has become a major problem in the United States. Infestations can be frightening and expensive and appear to be more prevalent in urban settings and low-income housing such as homeless shelters, public housing, and single-room occupancy apartments. This exposes consumers and staff of psychiatric rehabilitation agencies to higher risk of infestation. This brief report outlines practical suggestions for managing bedbug infestation in such agencies. Drawing on resources readily available on the Internet and the experience of Thresholds, a large provider of psychiatric rehabilitation services based in Chicago, this report describes strategies for responding to infestation. Providers need to assume that bedbug infestation is a significant risk and prepare accordingly. Assertive, persistent, and calm response is recommended.     

The Case of Cubans: Racial Inequality in U.S. Homeownership and Home Values

Prior research finds that human capital may explain racial housing inequality, whereas others note the historical role that race played in creating unequal housing conditions. This study uses the case of Cubans in the United States to examine whether human capital explains Black–White housing inequalities, or if they are a result of nativity/cohort differences—a proxy for the federal policies that supported Cubans’ economic and social incorporation. Using pooled data from the American Community Survey, I examine how human capital characteristics and nativity/migration cohorts shape odds of homeownership and predicted home values among Cubans. Extended analyses using decomposition methods find that although human capital characteristics are important, they play a smaller role in explaining Black–White differences in homeownership and home values. Indicative of the changing structure of racial stratification in the United States, results reveal substantial inequality among the oldest of Cuban immigrants and U.S.‐born Cubans, despite a trend toward declining inequality among recent arrivals. Supported by the literature of systemic racism, the case of Cubans shows how human capital explanations do not sufficiently explain racial housing inequalities and how the future of racial stratification is one of inter‐ and intra‐ethnic group inequality.     

Evidence of a Housing Decision Chain in Rural Community Vitality*

Abstract The purpose of this research was to explore and explain the role housing plays in rural community vitality. Community vitality refers to economic strength and social well‐being. In spring 2002 we collected primary interview data from informants in 134 small rural communities in nine north‐central states and identified related secondary data from the U.S. census. We developed a structural‐equation‐path model, which supported a “housing decision chain” that influenced community vitality. Based on this research, local housing decisions do play an important role in community vitality. Strong local leaders use housing planning to secure funding to produce a change in the quantity of housing, which in turn positively influences community vitality. Housing inventory also mediated the effects of total population and percentage population change on community vitality, indicating that housing supply is a fundamental ingredient in community growth strategies. These findings support the conclusion that a combination of housing plans and strategies orchestrated by skilled, committed leadership strengthens rural communities. Heretofore the ling between housing and community vitality has not been investigated; evidence‐based data has been missing from the debate on viable rural community‐development strategies.     

Table of Contents

Court Rules Against Insurance Industry in Pennsylvania SA Spending Lags as Public Sector Assumes Greater Burden Conflict Brews as ‘Sober Homes’ Blur Treatment‐Housing Distinction New Group to Take on Advocacy of SAMHSA Mixed Results from Baltimore's Buprenorphine Initiative Criteria for Transfer of Buprenorphine Patients from Addiction Treatment to Community Physicians Briefly Noted Names Resources State Watch Coming up     

Challenges and dilemmas facing community development corporations in the United States

In the United States, Community Development Corporations (CDCs)are one of the prime vehicles for delivering housing to low-incomehouseholds. Beyond the difficulties involved with securing theneeded resources to develop, rehabilitate and manage housing,CDCs are facing a series of challenges and dilemmas that couldthreaten their viability. This article discusses some of thekey challenges and dilemmas facing CDCs and offers a numberof suggestions for how they might be best confronted.     

Community Land Trusts in the United States

ABSTRACT

Land trusts are a means to conserve land and/or wildlife (e.g., donating one's farm to The Nature Conservancy) or encourage affordable homeownership and local control of land. The topic of this article is the latter type of land trusts, called Community Land Trusts (CLTs), that have been touted as an innovative means to provide and preserve affordable housing. Through a synthesis of the literature, this article introduces social workers to CLTs. This includes defining Community Land Trusts, reporting on their brief history in the United States, discussing their advantages and disadvantages, and examining the limited empirical evidence. This review suggests that Community Land Trusts are an arena for future social work practice and research.     

Editorial

This initial report details the origin, development, and “charter residents” of the new ElderSpirit Community, a resident-managed elder-only cohousing community focusing on mutual support and affordable housing. The 33 resident sample was white, 79% female, averaged 70.4 years of age (range = 63 to 84 years), and was more likely to be childless and/or divorced/never married compared to the general older population. Mutual support was significant in choosing the ElderSpirit Community, and this case demonstrates that elders can proactively choose this new option: living intentionally with neighbors to provide an added layer of support. The ElderSpirit Community is important given the caregiver shortage and desire for nursing home alternatives.     

完善重庆公租房社区管理的思考

公租房社区是在新的住房保障形势下随公租房的大量建设而涌现的新型城市社区,这种社区不能完全套用现有一般城市社区管理方法。本文以大规模建设公租房的典型城市——重庆为样本,在分析其公租房社区管理现状、问题的基础上,通过借鉴国内外经验及分析公租房社区不同于一般城市社区的特点,提出完善公租房社区管理的思考。     

Housing hardship and energy insecurity among native-born and immigrant low-income families with children in the United States

The costs for rent and utilities account for the largest share of living expenses, yet these two critical dimensions of material hardship have seldom been examined concurrently in population-based studies. This paper employs multivariate statistical analysis using American Community Survey data to demonstrate the relative risk ratio of low-income renter-occupied households with children experiencing ‘rent burden', ‘energy insecurity', or a ‘double burden’ as opposed to no burden. Findings suggest that low-income households are more likely to experience these economic hardships in general but that specific groups are disproportionately burdened in different ways. For instance, whereas immigrants are more likely to experience rental burden, they are less likely to experience energy insecurity and are also spared from the double burden. In contrast, native-born African Americans are more likely than all other groups to experience the double burden. These results may be driven by the housing stock available to certain groups due to racial residential segregation, decisions regarding the quality of housing low-income householders are able to afford, as well as home-country values, such as modest living and energy conservation practices, among immigrant families. This paper also points to important policy gaps in safety net benefits related to housing and energy targeting low-income households.     

Challenges and Dilemmas in Community Development

Abstract

When community development begins in low-income communities, involving residents in revitalization activities frequently falters. The community is often excluded from development decisions and may feel betrayed as its input is ignored. This paper presents the dilemmas that arose when a Community Development Corporation (CDC) began building two units of affordable housing and received 80 applications. Suggestions for addressing the dilemmas and the implications for community practice rely on integrating grassroots community organizing throughout the development process while engaging in an ethnically sensitive, empowerment-oriented approach using coalitions and interagency collaboration.     

Disentangling the housing satisfaction puzzle: Does homeownership really matter?

There is a general consensus that homeownership has beneficial effects for both individuals and society in many outcomes. However, research regarding the effect of homeownership on individuals’ subjective well-being remains inconclusive. In this paper, for the first time, we provide empirical evidence for the link between homeownership and housing satisfaction using panel data. We use the eight waves of the European Community Household Panel (ECHP) covering the period 1994–2001. We observe that renters who become homeowners not only experience a significant increase in housing satisfaction, but also after changing their tenure status, they obtain a different utility from the same housing context. This evidence might provide support to the hypothesis that a share of the differences in the perceived utility derived from housing can be attributed to (un)fulfilled expectations or aspirations regarding homeownership.