AmericanWork, Inc. Supportive Living Program

119 Pages·2012·1.26 MB·English

AmericanWork, Inc. Supportive Living Program:
A Program Evaluation

by

Shelley Willetts Reed

A dissertation submitted to the Graduate Faculty of
Auburn University
in partial fulfillment of the
requirements for the Degree of
Doctor of Philosophy

Auburn, Alabama
December 8, 2012

Approved by

Jamie Carney, Chair, Professor of Counselor Education and Supervision
Chippewa Thomas, Associate Professor of Counselor Education and Supervision
Melanie Iarussi, Assistant Professor of Counselor Education and Supervision
Abstract

The AmericanWork, Inc. Supportive Living Program is a residential program for the
severe and persistent mentally ill. This program evaluation sought to determine the variables
which impact the consumer transitioning out of the program into independent community living
among participants both currently living at and graduating from the program since its inception
and ending November 30, 2011 (n=129). The goals of the program are to reduce need of
inpatient psychiatric hospitalization and increase independent living within the community. A
logistic regression is utilized for data analysis. Pre-admission, Secondary and Program-specific
variables were evaluated with program-specific variables being found to have a significant
impact on the outcome of the consumer in transitioning into community living. More
specifically, identified discharge barriers were found to negatively impact successful transition of
the participants. By determining those variables which impact transition of participants into
community living, program improvements can be suggested to address these variables (i.e.,
natural supports) with individualized treatment planning to improve success of consumer’s with
severe and persistent mental illness in obtaining and maintaining independent living within the
community.
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Acknowledgments

I want to say a big thank you to my wonderful husband of 8 years, for which without his
love, support and for being such a wonderful father, this would not have been possible. To my
committee and cohort, I appreciate your never fading encouragement and feedback which has
helped me tremendously throughout this entire process. To my friends, co-workers, family and
parents who have learned more about the dissertation process than they would ever want to
know, I say a big thank you for your listening abilities and always knowing how to help me
relax. To those who I love and miss dearly, this one is for each of you! Most importantly, thank
you to my 4 year old son. He shared his mommy time with the computer and has been a
wonderful motivator. His love never fades and I hope that I will provide a good inspiration to
him by showing him that he too can accomplish anything! I love you to the planets and back!
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Table of Contents

ABSTRACT .................................................................................................................................... ii

ACKNOWLEDGMENTS ............................................................................................................. iii

LIST OF TABLES ...........................................................................................................................v

LIST OF FIGURES ....................................................................................................................... vi

INTRODUCTION ...........................................................................................................................1

Purpose .................................................................................................................................15

Significance of Study ...........................................................................................................18

Research Questions ..............................................................................................................20

Definition of Terms..............................................................................................................20

REVIEW OF LITERATURE ........................................................................................................22

Supportive Living Programs ................................................................................................23

Supportive Living Staff..............................................................................................27

Program Staff .............................................................................................................27

Day Treatment (Psychosocial Rehabilitation) Staff ..................................................28

Other Related Staff ....................................................................................................29

Staff Training .............................................................................................................29

Consumer Preference ...........................................................................................................29

Hospital Admissions ............................................................................................................35

Transition Planning ..............................................................................................................38

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Treatment Services...............................................................................................................40

Factors Influencing Community Placement .........................................................................43

Community Integration ..............................................................................................43

Poverty .......................................................................................................................45

Socialization ...............................................................................................................48

Quality of Life............................................................................................................52

Other Treatment Considerations ..........................................................................................54

Co-Occurring Disorders .............................................................................................54

Legal Involvement .....................................................................................................56

Program Evaluation .............................................................................................................60

Need for Evaluation ...................................................................................................60

Evaluations of community Placement .......................................................................62

Conclusion ...........................................................................................................................64

METHODS ....................................................................................................................................66

Research Questions ..............................................................................................................66

Participants ...........................................................................................................................66

Program Evaluation Model ..................................................................................................69

Goal ............................................................................................................................70

Activities ....................................................................................................................70

Population/Inputs .......................................................................................................71

Strategies ....................................................................................................................71

Outputs .......................................................................................................................72

Outcomes ...................................................................................................................72

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Impact ........................................................................................................................73

Procedure .............................................................................................................................73

Data Analysis .......................................................................................................................74

Summary ..............................................................................................................................75

RESULTS ......................................................................................................................................77

Participants ...........................................................................................................................77

Variables ..............................................................................................................................78

Data Analysis .......................................................................................................................81

Discharge Barriers .....................................................................................................82

DISCUSSION ................................................................................................................................84

Lack of Natural Support.......................................................................................................91

Recommendations ................................................................................................................93

Limitations ...........................................................................................................................96

REFERENCES ..............................................................................................................................98

APPENDICES .............................................................................................................................106

Appendix A: Letter of Approval .......................................................................................106

Appendix B: Auburn University Institutional Review Board Approval to Conduct
Study ..................................................................................................................................108

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List of Tables

TABLE 1: Descriptive/Secondary Variables ................................................................................79

TABLE 2: Preadmission and Program Specific Variables ...........................................................80

TABLE 3: Logistic Regression .....................................................................................................81

TABLE 4: Discharge Barriers ......................................................................................................83

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List of Figures

FIGURE 1: Program Logic Model ................................................................................................73

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CHAPTER I

INTRODUCTION

AmericanWork, Inc. is driven by the organization’s Mission of providing services to
maximize the ability of those receiving treatment services to live and thrive independently within
the community (AmericanWork, Inc., 2011). The mission of the AmericanWork, Inc. program
continues to state that as a consumer-owned and operated program, and the goals run parallel
with the recovery and resiliency model that the state of Georgia has adopted. (AmericanWork,
Inc., 2011). AmericanWork, Inc. as an organization, is aware of the “importance of exploring the
consumer’s perspective and the key roles of instilling hope, promoting self-help, spirituality,
education, meaningful employment, the importance of medications and illness management, and
the need to build supports for each consumer as a ‘whole person’ who is seeking a self-directed
life.” (AmericanWork, Inc., 2011, Home, para. 1). AmericanWork, Inc. was started in 1999 by
Ken Whiddon as an agency to provide individualized care to consumers within the community to
meet the consumer where they are at. AmericanWork, Inc. has grown over the years and has
expanded to have facilities throughout the state of Georgia. Services provided include outpatient
care (e.g., doctor services, case management services, groups, individual counseling), peer
support centers, supportive employment, psycho-social rehabilitation day services, group homes
and supervised apartment living. The Columbus, Ga. AmericanWork, Inc. program began in July
2006 with the community based supportive living program opening in May 2007
(AmericanWork, Inc., 2011).
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The Columbus AmericanWork, Inc. supportive living program was developed and
initiated in May 2007 for community-based supportive housing supports. The facility is funded
via a state contract for treatment under the Department of Behavioral Health and Developmental
Disabilities of Georgia (DBHDD). DBHDD’s mission is to “provide and promote local
accessibility and choice of services and programs for individuals, families and communities
through partnerships, in order to create a sustainable, self-sufficient and resilient life in the
community” (Adults, 2011, About DBHDD, para. 4). Consumer choice is an important aspect of
treatment that is embraced and fostered within treatment providers (Adults, 2011). Supportive
living within the AmericanWork, Inc. agency is designed to assist consumers with developing
daily living skills, interpersonal skills, and behavior management skills “to enable the person to
manage symptoms and regain lost functioning due to mental illness, substance abuse, and/or co-
occurring disorders” (AmericanWork, Inc., 2011, Home, Para. 1). Consumers sign a lease to
rent their individual apartments with the landlord. The state contract funds a total of 50 long-
term or multiple admission consumers (35 civil and 15 forensic consumers). However,
AmericanWork, Inc. currently have the staff and facilities to over serve their contract numbers
by serving total of 60 consumers (40 civil and 20 forensic consumers). The average amount of
consumers at the supportive living program is 58. Forensic consumers have various court
mandates in place for treatment. These differing types of legal involvement will be discussed
later in this introduction. This facility is supervised 24 hours per day 7 days per week 365 days
per year. Staff is onsite to provide for supervision, ensure safety, and provide skill building for
independent living. The various services provided at the site will be discussed later in this
introduction as will the criteria for admission and discharge into this program. AmericanWork,
Inc. is supportive housing with structure to allow for independent living and consumer
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