Search

Many of the nearly six million autistic adolescents and adults in the United States require support to navigate daily life. Family members often provide the first line of support for autistic youth by providing care and coordinating services. Although considerable research has examined the perspectives of family members caring for young autistic children, comparatively less has focused on those caring for transition-age youth who often struggle to access needed services as they leave child-serving systems of care. This study examined caregiver-reported barriers to service for 174 adolescents and young adults on the spectrum (ages 16-30) and the association between such barriers and unmet service needs. Exploratory factor analysis suggested two service barrier domains: access (e.g., cost) and quality (e.g., providers not trained). Regression models indicated that caregivers whose youth were diagnosed at older ages perceived both greater access and quality barriers. Male caregivers reported fewer access barriers, and those who perceived greater caregiver burdens (daily life disruptions, financial difficulties, and worries) reported more access barriers. Caregivers whose youth lived with them reported fewer quality barriers. Greater access--but not quality--service barriers predicted greater unmet service needs. Findings have implications for service delivery to autistic youth and specific directions for future research.

This study explored predictors of service use among 174 transition-age youth (age 16-30) with an Autism Spectrum Disorder using Andersen's (J Health Soc Behav 36(1):1-10, 1995) healthcare utilization model. Family caregivers were interviewed about past 6-month use of 15 services. On average, youth used 6.1 and needed 3.2 additional services. Greater service use was associated with two predisposing (caregiver college educated, caregiver not married/partnered), two enabling (youth has Medicaid waiver, youth in high school), and one need factor (lower adaptive functioning). Use of specific services was most strongly related to enabling (Medicaid waiver, in high school) and need factors (lower adaptive functioning, comorbid mental health diagnosis). Findings provide a snapshot of the "service cliff" faced by families and highlight the need for additional research.

Objectives: The quality of relationship between family caregivers and care recipients with dual disorders can impact care recipients’ well-being and treatment outcomes as well as caregivers’ well-being and involvement in care. This paper examines the impact of caregiver stressors and well-being on relationship quality of family caregivers of women with substance use disorders or co-occurring substance and mental disorders.Methods: Eighty-two women receiving in-patient or out-patient substance abuse treatment and the family member/significant other, nominated by each woman, who provided her with the most social support, were interviewed in this nonexperimental cross-sectional study. A stresscoping model was utilized to identify the impact of family caregivers’ stressors (care recipient behavioral, substance abuse, and mental healthproblems) and caregiver well-being (burden and depressive symptomatology) on caregivers’ perceptions of the quality of their relationship with their care recipient.Results: Findings from multiple regression analyses, across four types of caregiver well-being, show that greater perceived support to the caregiver was predicted by fewer perceived care recipient substance abuse problems, whereas higher levels of undermining of the caregiver was predicted by greater care recipient behavioral problems and by the family caregiver being a significant other of the care recipient. Care recipient classification as having a current dual disorder as compared to a current substance use disorder only was not a significant predictor of perceived support given to the caregiver or of perceived undermining of the family member.Conclusions: The findings suggest interventions for family caregivers need to be tailored to address different and possibly multiple groups of caregivers, specific types of stressors, and care recipient behavioral problems.

Significant barriers exist to the implementation of evidence-based practices into routine mental health and substance abuse settings. This paper discusses the role and function of technical assistance centers to help support the implementation process using, as a guide, the experience of the Ohio Substance Abuse and Mental Illness Coordinating Center (SAMI CCOE) in helping mental health and substance abuse agencies to implement Integrated Dual Disorders Treatment (IDDT), an evidence-based practice for adults with co-occurring substance and mental disorders A description of the SAMI CCOE is presented followed by discussion of an implementation framework, using stages of organizational change, to help understand and guide the process of implementing evidence-based practices. The paper concludes with a discussion of lessons learned in helping organizations to implement integrated treatment for adults with co-occurring disorders. (Contains 1 figure.)

Objectives: This study examines consumer and agency level predictors of competitive employment for consumers with co-occurring disorders. Methods: The study sample included 191 consumers from mental health agencies receiving Integrated Dual Diagnosis Treatment services, including a subgroup which was referred for Supported Employment Services. Results: Logistic regression analyses show consumers with schizoaffective disorder, greater psychiatric distress, and those not referred for Supported Employment services were less likely to enter competitively employment. Lack of previous employment and consumers' perceived disability negatively affected employment through referral status. Conclusions: Implications for mental health practice, service delivery, and future research are discussed. (Contains 2 tables.)

This study utilized a stress-process model to examine the impact of having a female family member with substance use or co-occurring substance use and mental disorders on family caregivers' depressive symptomatology. Participants were 82 women receiving substance abuse treatment and the family member providing the most social support for each woman. Greater caregiver depressive symptomatology was predicted by greater care recipient emotional problems, less care recipient social support, and poor caregiver health. Implications of findings for treatment and future research are discussed. (Contains 2 tables.)

Public policy aimed at supporting the caregiving capacity of families has risen to prominence on the public agenda in the United States. Initiatives at the state and federal levels have created some initial services. Three trends that are pushing the issue of family caregiving to the surface are discussed, including large-scale social, demographic, and economic changes. The pressures on women from increased caregiving demands are discussed, along with the taken-for-granted cultural value placed on the home as a locus of care for family members who need assistance with common daily activities. Experiments at the state level with consumer-directed care and capitated wrap-around services are described. The authors argue that support for caregiving families is likely to remain a prominent concern of the public and policy makers for the foreseeable future.

Family members provide the majority of care for individuals with disabilities in the United States. There is growing recognition that family caregiving deserves and may require societal support, and evidence-based practices have been established for reducing stress associated with caregiving. A substantial research literature on family support has developed, but researchers, advocates, and professionals have often worked in separate categorical domains such as family support for caregiving for the frail elderly, for individuals with mental illnesses, and for people with developmental disabilities. This article considers the merits of a cross-categorical analysis of family support. Examples of concepts from one domain of family support are applied to other domains to illustrate the potential benefits of a broader exchange of ideas.

This cross-sectional study utilized a stress-process model to examine the impact of caregivers' (N = 82) perceptions of their relationship quality with a female family member (i.e., care-recipient) with substance-use or co-occurring substance and mental disorders on caregivers' perceived burden. Regression findings indicate that relationship quality impacts both subjective and objective burden. Higher levels of emotional support given to the care recipient by the caregiver predicted lower levels of caregiver displeasure; whereas higher levels of undermining of the care recipient by the caregiver predicted higher levels of caregiver stigma. Higher levels of emotional support received by the caregiver from the care recipient were associated with lower levels of caregiver displeasure and lower objective burden; higher levels of undermining of the caregiver by the care recipient predicted higher objective burden. Implications for practice and service delivery are presented. (Contains 1 figure and 3 tables.)

This article describes one school's effort to establish a social work research development center in the area of coexisting drug and mental disorders (dual disorders), within the context of the social work profession's efforts to compete more effectively for federal research grants. This center was funded as part of a successful application in response to the National Institute on Drug Abuse's announcement of support for a Social Work Research Development Program stressing the development of social work research in drug abuse intervention and services research. The center builds on the school's previous research and training experiences in the area of co-occurring drug and mental disorders. The center's purpose, structure, and institutional impact are described, with particular attention to the challenges faced in both its formation and its operation and the lessons learned that could generalize to other similar efforts.

The Ohio Supported Employment Coordinating Center of Excellence is a joint project of the Mandel School of Applied Social Sciences and the Department of Psychiatry at Case Western Reserve University. The center is focused on helping to implement and evaluate evidence-based employment services provided to individuals with a severe mental illness. The staffing and funding of the center is described, as are the current research projects, future directions, and the implementation lessons learned. This article is the latest in a series of reports of social work research centers published in "Research on Social Work Practice".

There are significant knowledge gaps concerning the experiences of families of persons with co-occurring substance and mental disorders and the impact of families on treatment of individuals with these disorders. This paper presents a conceptual framework for examining family involvement of adults in treatment for co-occurring substance and mental disorders. An overview of the characteristics, problems, and needs of these individuals and their family members is presented. The extant literature pertaining to our conceptual framework is reviewed with focus on predictors of family involvement with clients, predictors of family member involvement in clients' treatment, and consequences of family involvement for client treatment outcomes. Gaps in the research literature and implications for future research and practice are discussed.

This article describes the rationale, implementation, and assessment of a summer-study format, part-time doctoral program that was designed to address the shortcomings of traditional part-time doctoral education in social welfare. Findings of a comparative analysis between 67 full-time and 52 part-time doctoral students suggest that the program offers a number of significant advantages over traditional part-time education. There were no statistically significant differences between summer-study and full-time students in Graduate Record Examination and Miller Analogies Test scores, in rates of graduation, or in length of time to complete the degree. Educational limitations of the program for summer-study students as compared to full-time students are presented. (Contains 1 figure.)

Through a synthesis of literature on caregiving, empowerment, social inequalities, and racial disparities in health and income, the authors built an argument for African American women caregivers' vulnerability to powerlessness and the applicability of an empowerment approach to social work practice with these caregivers. The article discusses two realities of African American women caregivers' experiences (strong coping and vulnerability) and two relevant theoretical frameworks (stress and coping and empowerment frameworks) for framing these experiences. Drawing on empowerment and other relevant literature, the authors recommend three practice strategies with these caregivers.

The authors examine the services and importance of the Institute for the Advancement of Social Work Research. Topics include reference materials for social work research, goals of the institute, and future goals.

Issues concerning the research goals of the Cuyahoga County Community Mental Health Research Institute are examined, focusing on its role as a public-academic partnership and the challenges it has faced in implementing its research findings. Topics include the institute's founding in 1994; its goals for mental health service, education, and research; community relations; organizational structure and funding; accomplishments; barriers to implementing research findings; and the institute's impact on policy.

The scientific literature on family caregiving in aging and mental illness is discussed. Topics include the extent and nature of family caregiving, conceptual models of the caregiving experience, caregiving demands and effects in aging and mental illness, intervention studies in aging and mental illness, and implications for further research.

This study discusses barriers to the utilization of community-based mental health services by African-American and Hispanic elderly persons. The study sample consists of 'key Informants,' chosen because they were knowledgeable about the mental health needs and use of mental health services by African-American or Hispanic elderly persons. Principal component analysis using orthogonal rotation was conducted on the 23 item barrier scale and identified three levels of service barriers for the entire sample and for each subsample of African-American and Hispanic informants. Based upon the study findings, a number of strategies are offered to improve utilization and overcome service delivery barriers. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworth.com]

The literature examining the role of social network size and support in moderating the relationship between stress and illness in the aged population has not taken racial differences into account. This study compares the potential moderating influence of social network size and support on the relationship between life stress and depressive symptoms for black and white community-dwelling elderly people at increased risk for institutionalization. Study data come from in-person interviews with a sample of 191 old-old (75 years and older) and poor residents of a three-census-tract area in Pittsburgh. Approximately 50 percent were white and 50 percent were black. Results indicate that the moderating effects of social network size and support were different for the black people than for the white people in this sample. For white aged people, having greater social support and a larger social network reduces the association between stress and depressive symptoms, as expected. For black elderly people, however, having more network members and receiving support from them is associated with a stronger relationship between stress and depressive symptomatology.

This paper describes the conceptualization and field experience with a cooperative model of respite care for the frail elderly. Planning and program development were successfully completed yet implementation did not come to fruition. A survey of family caregivers, conducted to analyze obstacles to implementation, is instructive in identifying attitudinal barriers to use of a cooperative model for providing respite care for the frail elderly. The reasons for the program's failure and the lessons learned from it are examined and discussed. Implications are drawn for the planning and development of new intervention programs.