Carol Mowbray - US grants

The literature on seriously mentally ill (SMI) women and their parenting experiences establishes that these women are at risk for parenting problems, but because of methodological limitations, fails to identify to what extent these problems can be mitigated. The purpose of the research proposed is to: 1) Identify and describe seriously mentally ill women who have parenting responsibilities in terms of their demographics and personal characteristics, their self-perceptions as mothers, the resources available to them, and the stressors they face, especially concerning care of children. 2) Investigate how these women are functioning in the community as well as the parenting problems they are experiencing. 3) Analyze the relationship between community functioning and parenting problems and relevant variables from the literature review: diagnosis, chronicity, race, age of onset, social supports, and mental health, treatment. 4) Examine the changes over a 12-month period in these women's community functioning and parenting problems and how these relate to changes in resources and stressors and to personal characteristics. The research framework will be based on Moos' Stress-Adaptation paradigm. The initial study sample will include 312 SMI women, recruited from caseloads and public psychiatric hospital referrals of three community mental health agencies in metropolitan Detroit. Data will include interviews of these women, Management Information System data on service utilization, and CMH staff assessments, collected at study entry and 12 months later. The study is designed to address previous deficits in the research literature on serious mental illness and mothering problems by including a large sample with diversity in terms of race, chronicity, etc., by utilizing standardized and more reliable instruments, and by systematically and comprehensively studying personal characteristics as well as environmental context. With these design improvements, the research should produce information relevant to service delivery and to the future development of intervention models for SMI women with children.

DESCRIPTION (Applicant's abstract): Long-term, persistent mental illness is typically associated with poverty and unemployment. Despite advances in MH treatment methods, prospects for full rehabilitation remain poor for most adults with psychiatric disabilities. Consumer-operated services as alternatives or adjuncts to professional treatments have been promoted for potential benefits in engaging and empowering individuals with serious mental illnesses. Effectiveness research, using experimental designs, has yet to be done. Given the heterogeneity of programs labeled "consumer-operated," it is argued that such research will not be useful until a model is fully described, criteria established, and validated methods available to measure fidelity to this treatment model. This R24 application proposes to describe the most common model of consumer-operated services - the drop-in center (CDI), to establish fidelity criteria, and to operationalize and validate them. We will collect data on all the CDIs in Michigan (n=29)- interviewing consumer-users and key informants, collecting qualitative observational measures, and examining records and other documentation. The same data will be collected on structurally comparable programs (clubhouses), matched for geographic location. Through this R24, we will have a rich description of the operation of consumer-operated drop-in centers, as well as of clubhouses, utilizing criteria from the literature and consumer experts. We will analyze how the CDIs differ from clubhouses, according to a large number of users of these settings. The R24 will produce fidelity criteria, certified by a group of consumer experts and validated through reports of consumers using the services - in terms of levels reported and discriminant validity. Furthermore, we will operationalize these criteria through more readily available data (records, documents, and key informants) so that future research on CDIs can establish fidelity with less resource-intensive methods than interviewing center users. As we are completing this R24, we will design a multisite (R01) effectiveness study of consumer-operated drop-ins, using an experimental design. The fidelity measure from this R24 and the program manual produced will be integral to the R01, providing a consistent quality assessment of the model being delivered, as well as process measures for use as moderating variables to interpret differential intermediate and long-term behavioral outcomes for CDI users. A preliminary conceptual model for the future effectiveness study is presented. Initiating this research through the UM Center for Research on Poverty, Risk and Mental Health will enable an established investigator (Mowbray) to work with new faculty (Holter) and senior faculty (Garvin), and to involve other young investigators (post-doc and doctoral students) on a mental health services research topic that will serve as the basis for further significant studies on consumerism and recovery. These studies of consumer-operated services will benefit from the expertise of our colleagues at the poverty center ways to measure human capital. The R24 will enable us to develop relationships with consumer groups and consumer researchers around the country, colleagues in psychiatry and other related areas at UM, and other national sites undertaking MH services research.

DESCRIPTION (Applicant's abstract): This competing continuation application seeks funding to continue the research of the Univ. of Michigan School of Social Work's Center on Poverty, Risk, and Mental Health. We aim, over five years, to: 1) Move beyond risk factor/pre-intervention research studies and further develop treatment and mental health services research; 2) Build capacity to sustain a research program through continued faculty development, and 3) Advance social work's capacity to produce research that influences social work researchers, poverty researchers, practitioners, and policy makers. Core research areas are: psychiatric epidemiology/ pre-intervention research on poverty and mental health among low-income single mothers and their children and preventive intervention/mental health services research including randomized interventions for welfare recipients, at-risk infants, pre-school children, juvenile delinquents with serious emotional disturbance and their families, and evaluations of service delivery for adults with long-term mental illness. Our research seeks to reduce the public health burden of excess mental disorder among the poor by identifying potent and changeable risk and protective factors elucidating the pathways through which they operate, developing more effective methods for early detection of mental disorders and their precursors, and developing, testing, and evaluating effective interventions and services. We require infrastructure support in key areas: methods for identifying risk and protective factors and for understanding the pathways and processes through which they contribute to excess mental disorder, methods to detect individuals at increased risk, and methods to develop selective and indicated preventive interventions, and interventions to prevent relapse, comorbidity, and disability. We will build our infrastructure through multidisciplinary collaboration with mental health researchers within the University and at other institutions, via technical staff support, seminars and workshops, core funding for pilot studies, and strategic hiring of additional faculty. Outcomes will include R01 and K-award proposals, publications, and a cadre of well-trained researchers. We will disseminate findings so that our research is translated into improved policies and services. Continued support will institutionalize 1 ZMH1 3 1 R24 MH51363-06 May, 2000 DANZIGER, SHELDON H our capacity to provide national leadership and help reduce the public health burden of mental disorder.