The International Journal of Psychosocial Rehabilitation

The Effectiveness of Community Support Systems and Psychosocial Rehabilitation Services for Mentally Ill Children and their Families

Elizabeth C. Bloom

Ottawa University



Citation:

Bloom, E. (2009).The Effectiveness of Community Support Systems and Psychosocial Rehabilitation Services for
Mentally Ill Children and their Families
. International Journal of Psychosocial Rehabilitation. Vol 14(1).  4-20

 


Abstract
The purpose of this study is to see the level of effectiveness of community support and/or psychosocial rehabilitation services for children and families. This study utilized a sample of participants receiving said services from ninety to 120 days in the form of a fourteen question survey. Results show an increase of functioning for the child(ren) and families receiving community-based services. The results imply that psychosocial rehabilitation and/or community support services are an effective service with high levels of recipient satisfaction and an increased independence from acute care services, however additional research is needed in this area.

Review of the Literature
With the expense of providing effective services burgeoning throughout the United States it has become increasingly important to obtain treatment completion, outcomes, and efficient utilization of available services. Treatment completion and successful outcomes are increased when the mental health system provides culturally appropriate treatment including habilitation and support services (Barton, 1999). Traditionally, those that have participated as service recipients in the mental health system have languished for want of culturally appropriate care. (Walker, 2001). As the current mental health system evolved in the United States it has repeatedly proven to be unequal and ineffective in meeting the mental health needs of children from ethnically or culturally diverse backgrounds (Walker, 2001). If the status quo continues so that communities maintain a perception that their unique cultural heritage, needs and beliefs are not being addressed, trust for the community mental health system may continue to erode. It is vital to increase service recipient trust and confidence in the mental health system if there is to be an expectation of successful and effective outcomes of said services. Thus, the services provided to children and families must capture family experience, culture, views and beliefs (Granat, Lagander, Börjesson 2002). 

There is an increase in effective coping with disorders, both emotional and behavioral disorders in the part of the parent when the family receives psychosocial rehabilitation and/or support services (Davidson, Dosser, 1982). Conversely, when the parent’s ability to cope with the disorders or disabilities of their child(ren) are strengthened and supported through psychosocial rehabilitation then positive outcomes are more frequent and family stability improves. Another benefit to children is that with psychosocial rehabilitation/support services, hospital stays are shortened and successful post hospitalization transitions tend to normalize lifestyle, meaning that children are able to be a productive member of their community (Hughes, 1999). Research supports that children and families who participated in psychosocial rehabilitation services averaged 6.51 days of inpatient care versus an average of 38.74 days when typical mental health care services without psychosocial rehabilitation activity (Hughes, 1999). When mental health service recipients are discharged from inpatient care employing psychosocial rehabilitation services patients decrease their reliance on inpatient services by a significant amount, one study discovering a nineteen percent reduction over a three year period in contrast to those that were discharged without the coordination of psychosocial rehabilitation services (Hughes, 1999). Consequently, the group that did not have psychosocial rehabilitation services at discharge from inpatient mental health services increased their utilization of inpatient services eighteen percent over three years (Hughes, 1999). This drastic decrease of utilization of inpatient services shows that when children and families receive psychosocial rehabilitation and/or support services when they need these services, hospitalization rates decrease. For the mental health system to be effective in treatment planning and implementation a broad spectrum approach must be employed which includes collaboration and active participation in decision making by the family coupled with an array of services including psychosocial rehabilitation (Walker, 2001). As leadership by the family/caregivers develops, the needs for services that are easily accessible and customized for the family receiving services are needed.

The family that is receiving psychosocial rehabilitation and/or support services must feel increasingly comfortable and in charge of the treatment process which builds stronger working alliances and trust between service providers and service recipients. The correlation with the level of success and the comfort level of the caregiver with the staff is substantial (Walker, 2001). The utilization of staff that are based within the community and can provide the services to the individual family’s culture will prove to be more comfortable receiving psychosocial rehabilitation services and will show higher treatment outcomes as well as overall stability (Hughes, 1999; Jenson, Hawkins, Catalano, 1986).

The increase of utilization of mental health services for children/families requires a reduction in stigma from the community in which they live. The responsibility of reducing the stigma lies on the system to promote a supportive community through education, skills training and skill development (Hughes, 1999; Feehan, Stanton, McGee, Silva, 1990). The focus of these mental health system programs should develop the feelings of improved self-empowerment, self direction and increase the individual’s feelings of autonomy (Hughes, 1999; Barton, 1999, Young, Ensing 1999; Feehan, Et al, 1990). The feeling of autonomy will show the service recipient that their recovery from mental illness is successful. The successes that the service recipient continues to have within their community will increase their level of empowerment (Walker, 2001). The empowerment that comes from driving their own successful treatment and recovery process will create a successful individual living in the community. A community that supports individuals that are recovering from mental illness will decrease the stigma associated with mental illness. As the stigma that is around mental health in various communities’ decreases, the trust from the individuals needing and seeking mental health services will improve. When the community supports individuals/families with mental illness the community and the individuals/families can contribute to the community in which they live in a successful manner, the entire community can celebrate the victories around recovery (Hughes, 1999; Barton, 1999; Young, Ensing 1999; Feehan, Et al, 1990). The stigma of mental illness also effects the utilization of services. One study showed that fifty percent of parents with children with mental disorders did not seek help for the disorder. This reluctance to seek assistance decreased with the addition of social support services within the community (Feehan, Et al, 1990).

Support and psychosocial rehabilitation skills need to be individualized to encompass the family culture, beliefs and culture to be an effective service (Stanhope, Solomon, Pernell-Arnold, Sands, Bourjolly, 2005; Walker, 2001). The effectiveness of the service is also dependent on the family’s leadership in the collaborative effort to ensure that the family is getting the types of services needed. Support and rehabilitation services are designed to add positive interactions to the child/family’s everyday life. When psychosocial rehabilitation services are employed successfully there is a corresponding elevation of quality (Anthony, 1993). The utilization of support and psychosocial rehabilitation services for a family with a child that has a mental illness can advance cohesive family interactions and act as a stabilizing force in the family’s overall functioning (Granat, Lagander, Börjesson 2002).

Community support/psychosocial rehabilitation services are general and broad by definition, for this reason they can be tailored to the specific needs and culture of the family allowing flexibility with time and intensity (Barton, 1999; Stanhope, Et al 2005). The psychosocial rehabilitation services that the family receives should also be provided in the place that is least restrictive for the recipient as well as the services should be provided at the time the family requests to maximize the utilization of the tools that the provider(s) are teaching the child and family (Barton, 1999). The psychosocial rehabilitation/support services are delivered in the community that the family identifies with, not just the location of the community. The utilization of services that are based in the family’s preference of community allows the family to identify and connect with the various communities that may be apart of the culture or beliefs of the family (Walker, 2001; Granat, Lagander, Börjesson 2002). As services are delivered in the desired settings of the child/family the functioning of the child increases and the parents well being also increases and the family is better able to care for itself, independent of formal mental health services (Walker, 2001; Granat, Lagander, Börjesson 2002).

Psychosocial rehabilitation services are by nature tailored to the specific situations in which the services are appropriate based on the collaboration with the family (Barton, 1999). Psychosocial rehabilitation services focus on autonomy, independence, and stabilization to decrease the use of acute care (Barton, 1999). Psychosocial rehabilitation and support services are often used simultaneously however the two concepts are very different by definition (Barton, 1999). Psychosocial rehabilitation needs to have one or more of the following interventions to be accurately called psychosocial rehabilitation. Behavior skills training is used to increase cognitive functioning through curriculum-based interventions and learning experiences (Barton, 1999; Granat, Lagander, Börjesson 2002). Peer support usually includes community-based programs in non-clinical settings (Barton, 1999).

Vocational services are set by the client’s vocational goals. The empowerment to have successful, gainful employment increases the client’s motivation to take control of their own recovery (Barton, 1999; Young, Ensing, 1999). The client’s community resource development is vital to the success of the client in the community. The community resource development area can include direct support for services such as family education as well as indirect supports to include child/family networking abilities to create autonomy from the community behavioral health system (Barton, 1999).

Many components of psychosocial rehabilitation require skills training as a prerequisite for psychosocial rehabilitation services, or in conjunction with psychosocial rehabilitation services (Barton, 1999). It should be noted that psychosocial rehabilitation services can include training set curriculum for various interventions and this focus is targeted to the specific needs of the family and child(ren) involved (Barton, 1999; Young, Ensing, 1999). This targeting of services allows the recovery process to be clear, concise and exclusive to the goals and objectives of the service recipients (Barton, 1999; Young, Ensing, 1999). 

The need for quality programming is increasing as the number of children in out of home placements is increasing (Clawson, Luze, 2008). Studies try to evaluate other psychosocial rehabilitation/support services with limited success (Granat, Lagander, Börjesson 2002). The limited success in measuring psychosocial rehabilitation services is that habilitation is a multi-faceted, broad spectrum of service continuum that is complex to evaluate (Granat, Lagander, Börjesson 2002). To foster ongoing improvement in programming requires continuous, ongoing collection and evaluation of service provisions (Granat, Lagander, Börjesson 2002). Consumer’s responses to community based services increases the functionality of services as the demand for quality services increases (Stricker, 2001). The demand of the clients of psychosocial rehabilitation service is to provide quality services throughout the broad spectrum of services available to them (Hughes, 1999; Stricker, 2001). Services are consistently evaluated by stakeholders that interact with the clients as well. The feedback by the stakeholders is also continually evaluated for opportunities for improvement in order to provide services for other children/families in the community (Stricker, 2001; Granat, Lagander, Börjesson 2002).

As families receive the psychosocial rehabilitation services in the setting of the family choice, the caregiver(s) of the child feel more competent in addressing the needs of their family and as this competency grows, the need for high intensity, restrictive and costly services (i.e. repeated hospitalizations) will diminish (Barton, 1999). Families that utilize psychosocial rehabilitation see an increase in treatment outcomes and client stability (Jenson, Hawkins, Catalano, 1986). The increase in client stability increases the family’s ability to manage and to function autonomously. A family that receives psychosocial rehabilitation services will have tools to lead a satisfying life that is full of new meaning and increased control (Anthony 1993). Parents reported an increase of stress having a child with behavior problems; however the utilization of support and psychosocial rehabilitation services for families appears to increase the functioning of the child and the well being of the parents which empowers the family’s autonomy (Long, Gurka, Blackman 2008; Granat, Lagander, Börjesson 2002).

A child/family that utilizes psychosocial rehabilitation services has an increase of relief and symptom control which creates opportunities for self-sufficiency and autonomy from mental health services (Anthony, 1993; Hughes, 1999). Psychosocial rehabilitation services increase client stability as well as the sense of self and increase self-sufficiency to decrease from expensive, restrictive acute care systems for persons with mental illness (Jenson, Hawkins, Catalano, 1986; Barton, 1999; Young, Ensing, 1999).  As symptom control increases for the client, the parent(s)/caregiver(s) are better able to care for the family (Anthony, 1993). As the intensity, frequency and /or duration of psychosocial rehabilitation/ support services are decreased over time, the child/family has increased independence and has tools to better care for the family’s needs (Hughes, 1999).

Utilizing psychosocial rehabilitation/support services in conjunction with reinforcement based interventions show better outcomes for changing behavior (Brown, Michaels, Oliva, Woolf, 2008). Changing the behaviors that will help stabilize the family and keep the individual in the least restrictive environment will empower the family toward independence (Brown, Et al 2008; Hughes, 1999). The use of strategies that engage parents in the activities that the child(ren) enjoy, will create a less stressful environment for the family (Pullen, 2008, Gottlieb, 1987). Teaching the recipient(s) of support/psychosocial rehabilitation services aversions to coercive behavior modification strategies will increase independence of the individual to make positive decisions (Swanson, Tepper, 2000).

The way the family communicates is an opportunity for engagement and building of relationships between family members (Pullen, 2008). The utilization of psychosocial rehabilitation/support services increase effective interactions and opportunities of positive, constructive communication between parent(s)/guardian(s), service providers, and children (Walker, 2001). Through different approaches or interventions of communication, taught through psychosocial rehabilitation services that increases the functioning of the child(ren) receiving services; the parent(s)/guardian(s) are able to adapt their style of communication to reach the(ir) child(ren) more effectively (Pullen, 2008; Granat, Lagander, Börjesson, 2002). The utilization of psychosocial rehabilitation/support services improves the mentally ill youth’s social interactions with non-impaired youth after receiving services after ten weeks (Lochman, Haynes, Dobson, 1981). The basis of social interaction is communication. The increase of communication directly correlates with the social interactions and social successes of children and families (Lochman, Haynes, Dobson, 1981; Pullen, 2008; Feng, Lo, Tsi, Cartledge, 2008).

Methods

Process
The survey tool is an exploratory survey to establish a baseline to measure the satisfaction and effectiveness of future services. The survey tool was developed through a process of peer collaboration focusing on what outcomes need to be measured, and how to best capture said outcomes. The tool design explores and captures the perception of service recipient families of psychosocial rehabilitation services as delivered in a community setting.

The data was started to be collected ninety through 120 days after the inception of psychosocial rehabilitation services that were provided to the family in the least restrictive, most therapeutic environment for the child. The rationale for the lag in capturing data was to reduce the likelihood of creating multiple confounds.  One paradox that was discussed with the peer collaboration team was the program was new in providing psychosocial rehabilitation services. The delivery of services from the first day through the ninety day period focused on rapport building activities and collaborating with the family about their preferences for services. Further discussion of data collection lead to creating an internal work process flow. This process would create ease in the direct support staff to complete the documentation as well as a process in capturing the necessary data from the families. The team found that there needed to be a standard of service delivery for each family. At the service standard implementation, the team found that refinement of the standard needed ongoing refinement to ensure individualized services. The services delivery staff needed adequate training to assure that confounds were not due to the lack of knowledge on the part of service delivery staff. The training captured a broad spectrum of curriculum to create a competency before delivering services.

A Likert scale was selected for capturing data from families. The team agreed upon utilizing the Likert scale for various reasons. The scale creates ease for capturing accurate, meaningful data. The Likert scale is easily understandable by service recipient families. Lastly, a scale is statistically functional in an exploratory research project. Additionally, at the end of the survey, an open response section was provided for personal observations of service recipient families was provided. This information is extremely antidotal and will not be included in this research.

The tool has fourteen different questions that are rated on a Lickert scale of one through five.  The rating scale also had a definition of the following (1 Totally disagree, 2 Disagree, 3 Neutral, 4 Agree, 5 Strongly Agree) The peer review team collaborated prior to deployment and discussed the effectiveness of  measuring the effectiveness of psychosocial rehabilitation and/or community support services provided to children and families. 


Tool Development
Question one “My family’s culture, values and beliefs were respected.The peer review team was in seventy five percent agreement that this question did appear to measure the level of respect that was shown to each individual family’s culture, values, and beliefs. The question’s design is to capture information regarding the culture, values, and beliefs of the family is being respected throughout the course of the support and/or rehabilitation services in the home or community where the services are needed. After thorough review by an ethics panel, the question was included.

Question two “The staff was available when I needed them.” The peer review team was in fifty percent agreement that of the question effectiveness. The team decided that this question may be ineffective in measuring a “crisis type” situation for the family as staff members are generally not always available if the child/family goes into crisis. The question was intended to measure that services were available at the time when the family needed them most. The question focuses on utilizing services at the times when the family felt they needed them most. The question’s significance to the research is deemed that psychosocial rehabilitation services reach their maximum effectiveness when utilized when the family can engage or at the time where the services are needed most on a consistent basis. The ethics review panel discussed the question and the question was included.

Question three “I felt comfortable with staff.” The peer review team was in fifty percent agreement that the question was a valid instrument in measuring the level of rapport built with staff. The peer review team established a possible confound to the question in that the the family member that is filling out the survey may have a different level of interaction or rapport with the staff member. The peer review team also concluded that the question can not effectively measure the timliness of the rapport established as each family’s dynamic is different. The question’s intent is to measure the level of rapport and the timliness of rapport that is being established with the family. The question’s significance to exploratory research is that the comfort level with staff dramatically impacts the overall course of the effectiveness of the services being delivered to the family. The ethics review panel, question could show usefulness in the research and was added.

Question four “My (My family’s) experience with the program was excellent.” The peer review team was in twenty five percent agreement that this question measured the overall effectiveness of the program. The level of effectiveness varies greatly from family to family to meet the family’s specific goals and needs. Evaluating the effectiveness of services, especially to children across settings is vital to quality service delivery. The question measures the overall experience of the program’s services. Question four’s measurement of the overall experience deems vital to the evolution of the program. The ethics review panel’s review of the question was positive and consequently added.

Question five “My family received the kind of services needed.” The peer review group was in fifty percent agreement that the question would be an effective instrument. The group concluded that families may not know the type or the extent of the services needed to help their family depending on the state of the family at the time that services are agreed upon. Question five’s design is to gain the family’s perspective regarding the types of services they are receiving.  The peer review panel discussed the importance of family perception of services. The utilization of question five also shows the influence of family voice as the type of services that the family needs. The ethics review panel approved the utilization of question five.

Question six “Services were delivered in a timely manner.” The peer review team discussed a twenty-five percent agreement that the question is effective in measuring access to care services. The team discussed that putting a timeframe on the question may have made the question more effective. The intention of question six ensured that the services that the family is receiving had been implemented in a timely manner as perceived by those families. The family perception of the timliness of services is importance in measuring the response time to the request of services. The ethics review panel perceived question six as ethical and was added to the tool.

Question seven “Services were adequately explained to my family.” The peer review team was in seventy-five percent agreement that this question adequately measures the level of understanding that the family has in regards to the type of services that is available to them through the support services /psychosocial rehabilitation program. The question design measures that the family felt the explanation of psychosocial rehabilitation/support services was clear before service inception for the family. The understanding of services is vital to research. The family’s thorough understanding of the program and how the goals of the services are designed will influence the utilization of support and psychosocial rehabilitation services. The ethics review panel is in agreeance and will be utilized in the tool.

Question eight “Overall the program is excellent.”  The team reached a seventy-five percent agreement that the question adequately measures the family’s overall perspective of the program.  The question’s design is to give the “family voice” perspective to the researcher that the program, the staff, and the goals were excellent. This question’s value is to the research is that the family voice is being utilized to give feedback to the effectiveness of the support and psychosocial rehabilitation services program. The ethics panel’s review deemed the question’s approval and was added to the tool.

Question nine “As a family, we are more in control of problems and feel better able to manage.” The review team was in twenty-five percent agreement that the question is effective in measuring the level of control that the family has as a result of the support/rehabilitation services provided. The team discussed that there may be other services in place for the family to learn and utilize new skills in conjunction with the support/rehabilitation services. This question was designed to measure the level of control that the family has as a result of the skills that the family learns to utilize from the support and psychosocial rehabilitation services that are being provided to them. Question nine elicits that support and psychosocial rehabilitation services increases the family’s control of their problems. Question nine also elicits that the family is better able to manage their problems as a result of support and psychosocial rehabilitation services. The ethics review panel discerned that the question can be utilized within the tool.

Question ten “My family is more self-sufficient in caring for their needs.” The peer review team showed a twenty-five percent agreement that this question is effective in measuring self-sufficiency as a family due to the use of support/psychosocial rehabilitation services. The team discussed that support services/psychosocial rehabilitation services can be utilized in conjunction with other services. The question’s importance is crucial to show the increase in self-sufficiency from the utilization of support/rehabilitation services that are being provided to the family. This question passed the ethics review panel and was added.

Question eleven “Discipline efforts with the children are more successful.” The peer review team established a seventy-five percent agreement of the question. The team decided that the question adequately measures the increased levels of success of Positive Behavioral Support based discipline techniques. The question elicits to research the increased effectiveness of discipline that utilizes a Positive Behavioral Support approach. Question eleven passed a thorough review by the ethics panel.

Question twelve “Our knowledge of how to change child behavior has improved.” The team had a fifty percent agreement rate that question twelve was effective in its design. The team collaborated that the question needed specific information to be a more effective measure of knowledge increase due to psychosocial rehabilitation services. The question’s intent is to measure the amount of increase of knowledge that the family has gained while utilizing support/rehabilitation services. Question twelve’s usefulness to the research is to indicate that the increase of knowledge to change the target behaviors is a result of support/psychosocial rehabilitation services. The question also went through the ethics review panel and was approved for use.

Question thirteen “My child’s behavior and attitude has improved.” Peer reviewers were in seventy-five percent agreement of the question’s effectiveness. The group showed that support and rehabilitation services are effective in changing behaviors and an increase of positive attitudes. This question shows that the target behaviors that the child displayed have decreased and the child’s attitude has improved since the implementation of support/psychosocial rehabilitation services. This question shows that the measure is important as the utilization of support and psychosocial rehabilitation services is being explored. The ethics review panel distinguished the question as ethical and could be utilized for research.

Question fourteen “My family’s communication skills have improved.” Peer reviewers are in fifty percent agreement that the question measures increased communication skills within a family. The question was designed to measure the increase of communication skills due to support/rehabilitation services in the home. The question’s significance to research is the increase of communication within the confines of the family. The utilization of communication skills proves to have an important role in the success of support/psychosocial rehabilitation services. The ethics review panel reviewed the final question and ruled it to be ethical and to be used in the research tool.

Tool deployment
The tool was distributed to 229 families receiving support/psychosocial rehabilitation services for ninety days and over. The research staff collected eighty-four individual surveys at the end of the ninety day collection period that could be evaluated for data reporting. The staff also received twenty-one surveys that could not be evaluated for various reasons including but not limited to: incomplete surveys, poor comprehension by respondent, or language barriers.

Collection of data
The fourteen question survey and a self addressed stamped envelope was distributed by the staff members that work with the family’s to ensure proper and timely delivery. The survey tool was then completed by the adult family member/custodial guardian of the child. After completion, the survey was returned via mail.

Results

Key:100 percent would represent perfect service

 Eighty-four total responses from total program participation to date of 229 which is a 36.6percent return rate on surveys 

 

East

West

Aggregate

1

My family’s culture, values and beliefs were respected.

4.7 of 5

4.7 of 5

4.7 of 5

94%

2

The staff was available when my family needed them.

4.4 of 5

4.5 of 5

4.45 of 5

89%

3

I felt comfortable with the staff.

4.6 of 5

4.6 of 5

4.6 of 5

92%

4

My (my family’s) experience with the program was excellent.

4.2 of 5

4.2 of 5

4.2 of 5

84%

5

My family received the kind of service needed.

4.2 of 5

4.1 of 5

4.15 of 5

83%

6

Services were delivered in a timely manner.

4.3 of 5

4.4 of 5

4.35 of 5

87%

7

Services were adequately explained to my family

4.1 of 5

4.4 of 5

4.25 of 5

85%

8

Overall the program is excellent

3.8 of 5

4.4 of 5

4.1 of 5

82%

9

As a family, we are more in control of problems and feel better able to manage.

3.8 of 5

3.8 of 5

3.8 of 5

76%

10

My family is more self-sufficient in caring for their needs.

3.8 of 5

4.8 of 5

4.3 of 5

86%

11

Discipline efforts with the children are more successful.

3.3 of 5

3.7 of 5

3.5 of 5

70%

12

Our knowledge of how to change child behavior has improved.

3.6 of 5

3.6 of 5

3.6 of 5

72%

13

My child’s behavior and attitude has improved.

3.6 of 5

3.6 of 5

3.6 of 5

72%

14

My family’s communication skills have improved

3.6 of 5

3.8 of 5

3.7 of 5

74%


Discussion

The survey tool was designed to measure the effectiveness of the support and/or psychosocial rehabilitation services to children and families. The survey tool proved to be useful in areas of staff development and areas of informal practice improvement. The behavioral health recipient’s name was provided on each survey which assisted in tailoring individual supervision and training practices for staff development. This process was efficient for fine tuning service delivery, but may have created some discomfort on the part of the recipient in making completely factual disclosures. This confound was discovered as families may have felt that if they responded negatively, then the services they were receiving would be taken away. Another confound discovered is that if the response was negative that the information would be shared with the staff and the staff member may have ill will towards the family in service. Results of the tool were not shared with individual staff members nor were the results punitive in any way for the staff. During staff debriefing sessions, general themes across the feedback from the families were addressed for staff development and growth.

The tool seemed able to accurately capture that the family’s culture, values, and beliefs were respected through the process of receiving individualized psychosocial rehabilitation/support services. The support for providing services that capture the culture, and values that are individual to the family receive tools through services that the family can continue to employ after the program is finished. Antidotal evidence that was provided from the families encompassed utilizing community based programs that include the family’s values or belief system throughout the course of the psychosocial rehabilitation/community support services increase the family’s independence and overall functioning. Families also included that the staff that worked within the family’s community and found programs within the family’s community increased the rapport built with the family.

The services that are deployed for each family is individualized and thus the peer review team established that the questions regarding excellence of the program may be ineffective at measuring the desired outcomes. The peer review team also concluded that the tool’s question can not effectively measure the timliness of the rapport established as each family’s dynamic is different. The tool’s intent is to measure the level of rapport and the timliness of rapport that is being established with the family. The family’s antidotal evidence supported that the use of activities within the community increased the alliance between the staff member and the family. It is believed that the faster that a staff member can build the rapport with a family then the services will be more effective at an increased rate. The staff members stated in debriefing sessions that building rapport has been challenging with each family that the staff member has worked with. The main reason stated through the debriefing process is the uniqueness of each family and techniques needed to change to meet the family’s need.

The survey totals show an aggregate score of seventy percent or higher success rate from the family perspective. The family voice is powerful as the driving force of treatment goals and services that are provided for individualized services. The exploratory tool in rudimentary form shows that the families that receive support and psychosocial rehabilitation services show at minimum a seventy percent improvement in at least one area of their family’s lives.

The support and psychosocial rehabilitation services provide an increase in stability and consistency. The results of the deployment of the survey tool show an increase of positive family function. The positive impacts of support and psychosocial rehabilitation services are felt by the family as a whole, not just the one member that is receiving services. The increase in stability for the family can act as the start of their independence from formal mental health services.  The stability from support/psychosocial rehabilitation services also increase the family’s utilization of community supports and community based services. The antidotal data captured supports the family’s independence and successful utilization of community based programs. At staff debriefing sessions, staff also captured that the family shows increased independence over the course of the program and was more willing to try utilizing community services and programs.

Staff availability to serve families when the family needed staff is a powerful force in the effectiveness of the psychosocial rehabilitation/support program. The staff availability to provide services at the time and place that the family needed them increased the overall compliance with the treatment plan which also increased the effectiveness of the services. The ability to provide services in the setting and time that the family needs most increases the likelihood of being able to provide support through the time that the target behaviors are most likely to occur. The antidotal evidence supports that having staff available during the times that the family needs increases the satisfaction with service plans and increased empowerment through skill development in the places that the family may struggle. During the staff debriefment process, the staff expressed that having a collaborative schedule with the family seemed to be more effective than dictating to the family of the staff’s availability. Staff stated that the cancellation rate of the families that they serve was minimal throughout the course of the program. Through the process of evaluating the cancellation rate, the program did not account for families that stated they wanted psychosocial rehabilitation/support services through the child and family team process, however the need of the family changed to where the family felt that these services would not be appropriate at the time services became available.

The accuracy of the level of comfort with the staff presented confounds such as possibly feeling that the staff may present ill will towards the families based on the response given. However in analyzing the demographics of the family and the demographic of the staff member were similar, the family’s comfort level is significantly higher at the ninety days of service benchmark. The staff also reported that the rapport building process with the family seemed easier when the family receiving services demographic was similar to the staff. This information is antidotal in nature as this area was not critically measured during the study.

The overall excellence of the program is also difficult to define through the data collected. The families surveyed stated that the program overall is excellent, however through the data, the confound of the family’s comfort level of answering this question may not accurately capture the data of the family’s actual experience with the program. The ongoing process for improvement in the program requires the feedback about the overall experience with the program and the service design. The utilization of the family’s experience with the program also has similar confounds around the nature of the question. The need for program to improve and meet the needs of the family relies on the feedback that the family provides through their experience with a psychosocial rehabilitation/support service program

While the survey tool did not capture hospitalizations, the antidotal data would support fewer hospitalizations and short stays in acute care did occur. The data collected also shows increased family independence from services with the utilization of support and rehabilitation services as part of treatment of mentally ill children. Antidotal data and statements from families with children that have repeated the hospitalizations state that the support and/psychosocial rehabilitation services that are in place create a structured, more stable environment for the child to return home to and create an environment where the child and family can recover from acute care facilities. This stabilization and support for the child and family also creates an environment of empowerment that the child and family can function without the acute care facilities as the families get tools to use and support from the community.

The tool has various areas of improvement to get a more in-depth perspective in regards to support and psychosocial rehabilitation campaigns. The questions that were utilized in the tool show general themes around the family view of support/psychosocial rehabilitation services for children and families. The tool does not take into account the complexity of cases or the level of dysfunction within the family’s that participated in the survey. The levels of improvement look different for each family that has been served with support services/psychosocial rehabilitation, which the tool does not account for. The theme of improvement does not rule out any dysfunction or the cessation of any type of dysfunction. The utilization of the tool leaves further research and more options of specific information that can be explored at a later time.

The results have been broken down by each site that the program operates from, and then the data was combined to give an aggregate total for the program. The representation of the data collected represents children with an age range of four through seventeen years of age receiving services within the community behavioral health population. The population does not exclude ages birth to four, however the program did not receive a request to serve any families in said age range.

The tool’s design is decipher if the service design is effective in measuring the effectiveness of community support and psychosocial rehabilitation services. The literature that is cited in this work showed that there is still a need for additional research in the role of support and rehabilitation services that are to be delivered in the most therapeutic, least restrictive environment to further the recovery process.



References 

Anthony, W. (1993, April). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11. Retrieved October 1, 2008, from Academic Search Premier database.

 Barton, Richard. (1999). Psychosocial Rehabilitation Services in Community Support Systems: A Review of Outcomes and Policy Recommendations. Psychiatric Services,50(4). 525-534.

 Boyd, N. (2001, January). Handbook of quality management in behavioral health, George Stricker, Warwick Troy, and Sharon Shueman, 2000, Kluwer–Plenum, New York, 410 pp. Behavioral Interventions, 16(1), 67-69. Retrieved September 14, 2008, from Academic Search Premier database.

 Brown, F., Michaels, C., Oliva, C., & Woolf, S. (2008, Fall 2008). Personal Paradigm Shifts Among ABA and PBS Experts. Journal of Positive Behavior Interventions, 10(4), 212-227. September 14, 2008, from Academic Search Premier database.

 Clawson, C., & Luze, G. (2008, Fall2008). Individual Experiences of Children With and Without Disabilities in Early Childhood Settings. Topics in Early Childhood Special Education, 28(3), 132-147. Retrieved November 24, 2008, from Academic Search Premier database.

 Davidson, B., Dosser, D.A. (1982). A Support System for Families with Developmentally Disabled Infants. Family Relations, 31, 295-299.

 Feehan, M., Stanton, W., McGee, R., Silva, P. (1990). Parental Help-Seeking for Behavioral and Emotional Problems in Childhood and Adolescence. Community Health Studies, 14(3), 303-309.

 Feng, H., Lo, Y., Tsai, S., & Cartledge, G. (2008, Fall 2008). The Effects of Theory-of-Mind and Social Skill Training on the Social Competence of a Sixth-Grade Student With Autism. Journal of Positive Behavior Interventions, 10(4), 228-242. Retrieved September 14, 2008, from Academic Search Premier database.

 Gottlieb, B.H. (1987). Marshalling Social Support for Medical Patients and their Families. Canadian Psychology, 28(3), 201-217.

 Granat, T., Lagander, B., & Börjesson, M. (2002, November). Parental participation in the habilitation process — evaluation from a user perspective. Child: Care, Health & Development, 28(6), 459-467. Retrieved September 18, 2008, doi:10.1046/j.1365-2214.2002.00298.x

 Hughes, W. (1999, May). Managed Care, Meet Community Support: Ten Reasons to Include Direct Support Services in Every Behavioral Health Plan. Health & Social Work, 24(2), 103. Retrieved September 14, 2008, from Academic Search Premier database.

 Jenson, J.M., Hawkins, J.D., Catalino, R.F. (1986). Social Support in Aftercare Services for Troubled Youth. Child and Youth Services Review, 8(4), 323-348.

 Lochman, J.E., Haynes, S.M., Dobson, E.G. (1981). Psychosocial Effects of an Intensive Summer Communication Program for Cleft Palate Children. Child Psychiatry and Human Development, 12, 54-62.

 Long, C., Gurka, M., & Blackman, J. (2008, Fall 2008). Family Stress and Children's Language and Behavior Problems: Results From the National Survey of Children's Health. Topics in Early Childhood Special Education, 28(3), 148-157. Retrieved November 1, 2008, from Academic Search Premier database.

 Markowitz, F. (2001, March). Modeling Processes in Recovery from Mental Illness: Relationships Between Symptoms, Life Satisfaction, and Self-Concept. Journal of Health & Social Behavior, 42(1), 64-79. Retrieved October 1, 2008, from Academic Search Premier database.

 Markowitz, F. (2001, March). Modeling Processes in Recovery from Mental Illness: Relationships Between Symptoms, Life Satisfaction, and Self-Concept. Journal of Health & Social Behavior, 42(1), 64-79. Retrieved October 1, 2008, from Academic Search Premier database.

 Pullen, Lara C. (2008, October). The P.L.A.Y. Project: A Revolutionary Treatment Approach for Children with Autism. EP Magazine, 2008, October, 42-43.

 Stanhope, V., Solomon, P., Pernell-Arnold, A., Sands, R., & Bourjolly, J. (2005, Winter2005). EVALUATING CULTURAL COMPETENCE AMONG BEHAVIORAL HEALTH PROFESSIONALS. Psychiatric Rehabilitation Journal, 28(3), 225-233. Retrieved September 18, 2008, from Academic Search Premier database.

 Swanson, J., & Tepper, M. (2000, Summer2000). Psychiatric Advance Directives: An Alternative to Coercive Treatment?. Psychiatry: Interpersonal & Biological Processes, 63(2), 160. Retrieved September 18, 2008, from Academic Search Premier database  (W)

 Trainor, A. (2008, Fall2008). Using Cultural and Social Capital to Improve Postsecondary Outcomes and Expand Transition Models for Youth With Disabilities. Journal of Special Education, 42(3), 148-162. Retrieved November 1, 2008, from Academic Search Premier database.

 Walker, J. (2001, September). Caregivers' Views on the Cultural Appropriateness of Services for Children with Emotional or Behavioral Disorders. Journal of Child & Family Studies, 10(3), 315-331. Retrieved September 17, 2008, from Academic Search Premier database.

 Young, S., & Ensing, D. (1999, Winter99). Exploring recovery from the perspective of people with psychiatric disabilities. Psychiatric Rehabilitation Journal, 22(3), 219. Retrieved September 17, 2008, from Academic Search Premier database.


Appendix A

 Defination of Terms

Psychosocial rehabilitation: A behavioral health service that is provided in the recipients home, in the location where the target behavior is most likely to occur, or in community settings that teaches the recipient about but is not limited to: emotional management, emotional regulation, positive coping mechanisms.

 Skills training: A behavioral health service that teaches a service recipient a particular skill that can include, but is not limited to : vocational, social, organizational, personal care, or educational.

 Support services: A behavioral health service that is provided in the recipients home, in the location where the target behavior is most likely to occur, or in community settings that teaches the  recipient and/or the caregiver of the recipient positive ways to change target behavior(s).

 Target behavior: A behavior that is re-occuring that may need to be altered in duration, frequency, or intensity to create a sense of normalcy for the individual or family

 


Appendix B

Survey Tool

 

Community Support Services

Please check at least one below

 

  East Valley                       West Valley

 

 

Client Name: _______________________________  

Date: _______________

 

 

Instructions:

By filling out this survey, you can help us learn what parts of our program are or have been most helpful to you.  Please read each statement on the following page and decide how well it describes you and your family.

Ø     There are no right or wrong answers; just give your opinion

Ø     If you have trouble with a statement, give the first answer that comes to mind

Ø     Your answers are confidential

 

Directions

If you strongly disagree with the statement ---- put an X over  u

If you disagree with the statement ---- put an X over  v

If you neutral ---- put an X over  w

If you agree with the statement ---- put an X over  x

If you strongly agree with the statement ---- put an X over  y

 

 

 

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

 

Since being involved in the program, my family has a better home life.

u

v

w

x

y

 

 

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

1

My family’s culture, values and beliefs were respected.

u

v

w

x

y

2

The staff was available when my family needed them.

u

v

w

x

y

3

I felt comfortable with the staff.

u

v

w

x

y

4

My (my family’s) experience with the program was excellent.

u

v

w

x

y

5

My family received the kind of service needed.

u

v

w

x

y

6

Services were delivered in a timely manner.

u

v

w

x

y

7

Services were adequately explained to my family

u

v

w

x

y

8

Overall the program is excellent

u

v

w

x

y

9

As a family, we are more in control of problems and feel better able to manage.

u

v

w

x

y

10

My family is more self-sufficient in caring for their needs.

u

v

w

x

y

11

Discipline efforts with the children are more successful.

u

v

w

x

y

12

Our knowledge of how to change child behavior has improved.

u

v

w

x

y

13

My child’s behavior and attitude has improved.

u

v

w

x

y

14

My family’s communication skills have improved

u

v

w

x

y

 

Your Comments:

 

What do/did you like best about this program?

 

 

 

 

 

 

 

What do/did you like least about this program?

 

 

 

 

 

 

 

 

 

 





Copyright © 2009 Southern Development Group, SA. All Rights Reserved.  
A Private Non-Profit Agency for the good of all, 
published in the UK & Honduras