During the past 10 years, there has been a new development in self-help: Self-help agencies (SHA), incorporated as voluntary organizations, managed and staffed by former patients. SHAs claim their own helping goals and technologies which are expected by self-help proponents to have positive effects on the outcomes experienced by seriously mentally disabled individuals. SHAs further claim, and our initial data document, that they serve individuals who are under-served by community mental health agencies (CMHAs). Data from several sources indicate that the mental health system is relying on SHAs to deliver significant amounts of mental health services. The proposed research investigates two hypotheses: 1) combining SHA and CMHA service is an effective way to meet the patient's need for professional medical input, psychosocial services, self determination, and empowerment; and 2) SHAs can enable the mental health system to better serve traditionally under-served groups, particularly African-Americans, the dually diagnosed, and the homeless. The study design is a three group clinical trial. Of the 600 individuals in the clinical trial, 400 will be people who normally come to CMHAs. Following entry into the CMHA, 200 will be randomly assigned to a CMHA outpatient treatment group and 200 to a group getting a combination of SHA/CMHA services. The third study group will be 200 people who normally come to SHAs. Interviews will be conducted at baseline, 1, 3 and 6 months to determine the impacts of services on functional status, quality of life, empowerment and material resources. We will also determine which factors promote or detract from service outcomes by structurally modeling a theory of joint CMHA/SHA practice. The intervention will be measured by interviews, observations, and a management information system (MIS) designed for SHAs that is compatible with the CMHA MIS and provides data on the amount and types of services received. Content of helping endeavors will further be rated for consistency with SHA and CMHA practice models. Descriptive analyses comparing the naturally selected SHA (N=200) and CMHA (N=400) intakes will enable us to determine the extent of overlap in potential users, with particular emphasis on diagnostic and demographic comparisons. Thus, we will be able to assess the degree of specialization of the organizations and their potential for naturally occurring joint service efforts. Comparisons of service outcomes in the randomized groups will allow us to determine the effectiveness of separate and joint efforts and specify what about these efforts contribute to their effectiveness. The research has yielded the following products: a packaged microcomputer- based MIS for SHAs, a measurement package to assess the success of SHA and CMHA efforts and an analysis of the descriptive characteristics and services used by longterm SHA users. The new research will test a service model with the potential to meet previously unmet needs of the under- served mentally disabled. It will yield a comparison of intake service populations; an understanding of how SHA and CMHA services might be combined; an assessment of the relative effectiveness of CMHA service compared to a combination of CMHA and SHA service; and a theoretically- based structural model of the effect of practice on outcomes.
| 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 |
