|
|
AbstractEvaluation of Friends Connection: A Consumer-Operated Service for Persons with Co-Occurring Disorders Consumer-operated services are by their nature sensitive to a variety of cultural issues. By recognizing the unique needs and perspectives of consumers they encourage consumers to participate according to their level of ability and interest. In contrast to consumer programs, which function on the basis of equality of provider and recipients, traditional mental health service models place consumers in the role of clients. They leave little opportunity for consumers "to act on their own behalf and to help others" (Trainor, et al, 1997, p. 139), and unintentionally foster dependency (Kaufman, Freund, & Wilson, 1989). Respondents who participated in consumer-operated programs reported that their involvement resulted in increased self-confidence, improved sense of being in control and ability to cope with daily life, and improved skills for interacting with others. These factors produced greater feelings of self-respect and dignity, which resulted in increased involvement with others (Trainor, et al, 1997). This study will evaluate the Friends Connection (FC), a community-based program of the Mental Health Association of Southeastern Pennsylvania (MHASP) that is administratively controlled and operated by consumers. FC is designed to provide peer counseling and support through the provision of social and leisure skill development for consumers dually diagnosed with both mental health and substance abuse disorders. The problem of co-occurring severe mental illness and substance abuse disorder is now widely recognized. These individuals are more likely to be dissatisfied with their life, to face loneliness, and to have limited social networks (Drake & Noordsy, 1994). Further, the members of their social networks are usually also substance abusers, and consequently, have a negative influence on their acceptance of treatment. This dual problem often burdens family members further and strains the consumer’s relations with their family, which can be a major source of positive emotional and instrumental support. Friends Connection has been in existence since 1989. It was established during the closing of Philadelphia State Hospital in 1989 and its development was a joint effort of consumers under the auspices of the Philadelphia Mental Health Care Connection and the City of Philadelphia’s Office of Mental Health. Funds for the program came from funding set aside to provide services to those persons who would be diverted from admission to Philadelphia State Hospital. The program, therefore, was initiated to serve consumers who would have been served in Philadelphia State Hospital had it remained open. As a "diversion fund" program, service utilization and costs for all participants are closely tracked and available. As almost all of the study population is enrolled in the recently implemented Medicaid managed care program in Philadelphia, retrospective and prospective Medicaid paid claims data on utilization and cost are also available. This is an added benefit and will facilitate the study site’s participation in the Coordinating Center’s cost-study. The philosophy of Friends Connection (FC) is predicated on the belief that recovery begins once individuals experience hopefulness and support, paving the way for them to pursue educational and employment interests and maintain stable housing. Through the process of engaging participants in community-based social, education and leisure activities of their choice, participants are empowered to design their own recovery and social rehabilitation plans. This process of building confidence and self-esteem is a powerful enhancement to traditional clinical treatment and self-help programs such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or Double Trouble. The assumption underlying this peer support is that many individuals with mental illness become involved with drugs and alcohol because they are lonely, bored, and stigmatized by their illness. Whether their involvement results in addiction or not, the use of alcohol and/or drugs remains a serious problem for adults with a serious mental illness. To counteract these negative feelings, the Friends Connection provides friendship, counseling, social support and meaningful leisure time activities. Friends Connection will be evaluated as a randomized field trial. The randomization will be to intensive case management team services (ICM) with or without Friends Connection. This design assesses the effectiveness of consumer operated social skills and support interventions as an adjunctive service to intensive case management. As approximately 100% of the study population are enrolled in the recently implemented Medicaid managed care program in Philadelphia, this project would have the added significance of evaluating a consumer-operated service within the context of managed care. This project is a consumer, provider and evaluator collaboration. It takes advantage of a well developed, long-standing relationship among the Mental Health Association of Southeastern Pennsylvania (MHASP), a consumer-run organization; the Philadelphia Office of Mental Health, a funder of traditional and alternative mental health services; and evaluators at the University of Pennsylvania’s Center for Mental Health Policy and Services Research (the Center). Over the past ten years, the MHASP has collaborated with the Center and with the Philadelphia Office of Mental Health on a variety of projects and this project fully integrates the consumer, provider, and evaluator partnership. ContactsJoseph Rogers Mark Salzer Phyllis Solomon Sara Ann Steber Jeanne Whitecraft Related SitesMental Health Association of Southeastern Pennsylvania Center for Mental Health Policy and Services Research, University of Pennsylvania www.med.upenn.edu/cmhpsr/
|
|
|