During the past ten years, there has been a new development in self-help: Self-help agencies (SHAs), incorporated as voluntary organizations, managed and staffed by former patients. SHAs claim their own helping goals and technologies which are expected by selfhelp proponents to have positive effects on the outcomes experienced by seriously mentally disabled individuals. These agencies further claim to serve individuals who will not use traditional mental health services. The proposed research will structurally model and test a theory of enabling derived from SHA practice. In a randomized clinical trial of 597 individuals in 2 experimental and 1 control group--i.e.,a group receiving community-based care, from County Mental Health Agencies (CMHAs), a CMHA and SHA assistance group, and an SHA assistance group--assessments will be made at baseline, 1, 3, and 6 months to determine impacts on functional status and enabling outcomes. The SHA assistance group will be self-selected, the two CMHA groups randomly assigned. The content of each helping endeavor will be rated for consistency with current treatment ideologies: CMHA practice with the Training in Community Living model; SHA practice with the Enabling Theory model. In order to test this theory, we propose to develop a data base necessary to document the amount and types of services received in 7 SHAs. This management information system (MIS) will be the same in all SHAs and compatible with CMHA data reporting. We will also develop a measurement package for SHAs, measuring the key outcomes of enabling intervention: empowerment, self-esteem, locus of control, and material assistance. Finally, we intend to compare the characteristics of users of CMHAs and SHAs to determine the extent of overlap and difference in the populations served (particularly, re dual diagnosis). To develop the MIS comparisons and the measurement package, we will complete a validation/pretest of 300 individuals assessed at baseline, 1, 3, and 6 months. The research will yield the following products: a packaged microcomputer-based MIS for SHAs; an assessment package for understanding how successful SHAs are in enabling members; a comparison of service populations; an assessment of person-agency fit; and a theoretically-based structural model of SHA practice, which will allow us to determine whether the enabling ideology of SHAs is truly a unique and incremental service, not simply a mental health service offered by nonprofessionals who are less skilled, receive lower pay, and perform the same tasks, perhaps with more commitment than professional care-givers.
| Segal, S P; Silverman, C; Temkin, T (1995) Measuring empowerment in client-run self-help agencies. Community Ment Health J 31:215-27 |
| Segal, S P; Silverman, C; Temkin, T (1995) Characteristics and service use of long-term members of self-help agencies for mental health clients. Psychiatr Serv 46:269-74 |
