Using a NIATx based local learning collaborative for performance improvement.

Local governments play an important role in improving substance abuse and mental health services. The structure of the local learning collaborative requires careful attention to old relationships and challenges local governmental leaders to help move participants from a competitive to collaborative environment. This study describes one county's experience applying the NIATx process improvement model via a local learning collaborative.

A review of expressed emotion research in health care.

Much research has been carried out on the impact of family relationships on the development and course of different illness. Research on Expressed Emotion (EE) developed out of studies of the impact of family members on patients with schizophrenia, and has provided us with a robust measure of relatives' emotional attitudes towards patients, which has now been applied in the study of numerous psychiatric and medical illnesses. This review outlines the history of EE research in schizophrenia, and discusses the evidence for the association between family EE and the course of schizophrenic illness.

Patient satisfaction and experience with health services and quality of care.

This article discusses the use of patient satisfaction and personal health care experiences as a measure of health care quality. It also presents a field-proven patient experience and satisfaction assessment methodology known as the Patient Experience Survey (PES) that has been employed throughout the country for the last decade. Finally, it offers recommendations and comments on the use of patient satisfaction data in quality assessment and improvement.

Patient satisfaction surveys and multicollinearity.

The measurement of patient satisfaction is now an integral part of hospital market research. Just as consumer satisfaction is a function of the extent to which providers do things right, the value of consumer-oriented market research is directly related to whether the research itself is done right. The use of poorly designed consumer research instruments, no matter how well executed, can cause multicollinearity among the independent variables, which, in turn, can result in misleading conclusions.

Chronic back pain and work disability: Vocational outcomes following multidisciplinary rehabilitation.

Studies indicate that work disabled chronic back pain patients out of work for longer than three months have a reduced probability of returning to work. The escalating personal and economic costs (indemnity and health care) associated with such long term disability have facilitated efforts at multiple levels to prevent and more effectively manage work disability. Multidisciplinary rehabilitation (MDR) targeted at return to work represents one such approach.

The consistency of estimates obtained through central-location sampling: analysis of the Partnership for a Drug-Free America Attitude Tracking Study.

To evaluate the reliability and validity of estimates of drug use obtained through multiple-site central-location sampling, data from the Partnership Attitude Tracking Study (PATS), collected annually beginning in 1987, are tracked longitudinally and compared with data collected through traditional household interviews. Comparisons with demographic estimates from Current Population Surveys indicate that central-location sampling can provide a broadly representative sample of the adult population. However, there is some coverage bias in central-location sampling, most notably in the underrepresentation of adults who do not have high school diplomas.

Sociodemographic and attitudinal correlates of alcohol and other drug use among children and adolescents: analysis of a large-scale attitude tracking study.

Data from the Partnership Attitude Tracking Study are analyzed to provide a greater understanding of the contributing factors to alcohol and other drug use among children and adolescents. The data were collected from children (ages 9 to 12) and teenagers (ages 13 to 17) in central locations (usually shopping malls) located in 100 primary sampling units across the United States. The analysis, which primarily employed stepwise multiple regression for model estimation, reinforced the importance of friends use, perceived risk, and tobacco and alcohol use in predicting marijuana use.

Family management of schizophrenia: a comparison of behavioral and supportive family treatment.

This paper reports a comparison of behavioral and supportive family treatment for family management of schizophrenia. The family project applied two psycho-educational approaches to a highly "treatment resistant" population of young adults afflicted with chronic mental illness. The study compares and contrasts the effects of behavioral and supportive family management programs on clinical outcomes.

Psychiatric service utilization differences by sex and locale.

Underutilization of psychiatric services by men relative to women may reflect discrepancies between the male sex role in Western societies and the patient role. We hypothesize that this will be more important in a rural than a nonrural setting for two reasons. First, the relative lack of anonymity in a rural setting makes more evident incongruities between sex role conventions and actual behaviour.

Patient satisfaction and the use of health services. Explorations in causality.

Little research exists that examines the causal relationship between patient satisfaction and the use of health services. This study of a representative sample of low income families suggests that a relationship does exist. Furthermore, results reported indicate it is bidirectional and reciprocal in nature, and that it is highly related to the provider from which patients seek care.

Klinefelter's syndrome and psychopathology: a case study of the combined effects of nature and nurture.

A patient with Klinefelter's syndrome and genotype 47 XXY was abused and ostracized by his family during childhood. Later, this pattern was repeated by a series of homosexual lovers. The separate and interactive effects between genetic and psychosocial risk factors may account for this patient's subsequent psychosexual and personality disorders and reminds scholars of psychopathology of the importance of early detection and intervention.

Intensive inpatient treatment of young adult chronic patients.

Young adults with chronic mental disorders have become a major concern among mental health professionals during the past decade. Many of these patients require frequent hospitalizations, are noncompliant with treatment, experience behavioral crises that threaten themselves or others, abuse drugs and alcohol, and alienate their families and support systems. The authors describe an intensive inpatient program for young adult chronic patients who have repeatedly failed to respond to community-based and standard state hospital care and appear to need extended institutional care.

Coping skills training for children: effects on distress before, during, and after hospitalization for surgery.

Thirty-three parent-child dyads (children's mean age = 7.2 years, SD = 1.2) were randomly assigned to information, anxiety reduction, or coping skills presurgical preparatory interventions.

Mental health problems of children: analysis of a cumulative psychiatric case register.

The advent of community mental health centers has brought a marked increase in treatment of mental health problems of children, especially for minorities. The number of children receiving care and the prevalence and the utilization rates by age, sex, and race from 1960 to 1977 in a large metropolitan county in upstate New York have been described previously. For the same time and community, the episodes of care by diagnostic grouping, type and length of treatment, and health status at the end of an episode have now been examined.

Satisfaction with medical care: replications and theoretic reevaluation.

Satisfaction with medical care is frequently measured in health services research but for many different reasons. The widening conceptualizations and uses of satisfaction reported make comparisons between studies difficult. Questions regarding the structure and dimensionality of satisfaction remain.

Patient satisfaction with mental health services: a meta-analysis to establish norms.

Patients typically express high rates of satisfaction with their mental health care. This finding and the lack of well controlled studies on patient satisfaction in the literature underscore the need for meaningful guidelines for clinicians and program evaluators in interpreting patient satisfaction data. To address this problem a meta-analysis was undertaken to establish norms on patient satisfaction for various types of mental health programs.

The increasing number of children using psychiatric services: analysis of a cumulative psychiatric case register.

Psychosocial problems of children have received increasing attention in the pediatric literature, but it remains unclear to what extent psychiatric services are available and used for the treatment of these problems. This paper examines the utilization of psychiatric services by children over an 18-year period in Monroe County, NY, where a psychiatric case register monitors utilization since 1960. Reporting to the register is estimated at more than 90% of utilization for the child population.