Caroline Kaufmann - Academia.edu (original) (raw)

Papers by Caroline Kaufmann

Research paper thumbnail of Psychiatric evaluation of patient decision-making: Informed consent to ECT

Social Psychiatry, 1981

Informed consent is a legal doctrine particular to Anglo-Saxon law. The doctrine specifies the ri... more Informed consent is a legal doctrine particular to Anglo-Saxon law. The doctrine specifies the rights of patients to receive information about medical treatment prior to making a decision to consent to or refuse a procedure. The application of informed consent to psychiatry has provoked controversy and confusion. The ability of some mental patients to understand the nature of recommended treatment

Research paper thumbnail of Informed consent and patient decisionmaking

International Journal of Law and Psychiatry, 1981

The professions of medicine and law often have taken opposing sides on issues concerning patient ... more The professions of medicine and law often have taken opposing sides on issues concerning patient care. Differences over the right to treatment, experimentation on institutionalized patients, and de-institutionalization of mental patients are but a few examples where the two professions have fallen into debate over the ethical and practical responsibilities owed to patients. The vocal and public nature of those debates may foster a popular conception of inherent conflict between the two disciplines. From this point of view, the present controversy over informed consent to treatment may be regarded as one battle in an ongoing war between two powerful professional disciplines. Conflict between psychiatry and law over informed consent for mental patients is well documented in the literature. Lawyers have championed the doctrine of informed consent as an instrument for reform of the doctor-patient relationship (Note, 1970), as a check on the indiscriminate use of therapeutic procedures (Plotkin, 1977), and as a new theory of medical liability (Meisel, 1977). Physicians have attacked the doctrine as a myth, unsuitable to the realities of clinical practice (Leeb & Bowers, 1976; Laforet, 1976) and a legal ploy to entrap the unwary physician in litigation (Delee, 1976; Burnham, 1966). Almost all major medical specialities have found reason to take exception to the doctrine. However, medicine and law are not uniformly divided on the issue. Some lawyers have been critical of informed consent (Seidelson, 1976; Chayet, 1976). A few physicians have supported it as a means to protect the patient and involve him or her in medical decisionmaking (Crile, 1976, 1972; Hatcher, 1976).

Research paper thumbnail of Psychiatric Treatment and the Romance of the Law

Contemporary Sociology, 1985

Hailed by its proponents as a doctrine that promises more equitable doctorpatient relationships, ... more Hailed by its proponents as a doctrine that promises more equitable doctorpatient relationships, informed consent has also been decried as posing serious threats to the quality of care in this country. Ultimately, what is at stake in the controversy is nothing less than two equally entrenched but compelling strains in American legal and political history-the protection of individual autonomy versus societal regulation of individual freedom for the greater common good. In the case of psychiatric patients, the issue is further complicated because it is often precisely the patient's very capacity for autonomous action that is in question. Central to the ethical doctrine of informed consent is that patients not only be apprised of and give their written consent to a particular treatment-as required by law-but that they understand what the treatment entails and consent to it.

Research paper thumbnail of The right to health care: Some cross-national comparisons and U.S. Trends in policy

Social Science & Medicine. Part F: Medical and Social Ethics, 1981

All developed. mdustrlahzed nattons provtde some system of health care for the treatment of acute... more All developed. mdustrlahzed nattons provtde some system of health care for the treatment of acute and chrome Illness. However. nations differ m terms of then policy toward the provIsIon and dtstrtbutton of health services Basic to pohcy regarding access to medical care IS the notlon of health care as a right. Thts paper exammes the evolutton of the concept of a right to health care m three mdustrtahzed nations-the U S S.R.. Great Brltam and the U S Trends m the U.S. health care delivery system suggest an emergmg pohcy which favors equity through federally subsldlzed care for the mdtgent. However. the US health care system tolerates unequal distribution of servtces The U.S.S R and U.K. health care systems have adopted exphclt pohcles which support the right of all their ctttzens to health care. US policy supportmg the right to health care has been hampered by two primary factors Ftrst IS opposttlon wnhm the medical professton toward the notion of health care as a right Second IS the mablhty of federal agencies to develop a comprehensrve plan for health care dehvery INTRODUCTlOh

Research paper thumbnail of Role Obligations and Health Status in Chronic Disease: The Experience of Men and Women with Arthritis

Disability, Handicap & Society, 1986

Research paper thumbnail of The Self Help Employment Center: Some outcomes from the first year

Psychosocial Rehabilitation Journal, 1995

Research paper thumbnail of Perfect mothers, perfect babies: an examination of the ethics of fetal treatments

Reproductive and genetic engineering, 1988

... There is a contradiction in the ethics of medicine that supports intervention to restore the ... more ... There is a contradiction in the ethics of medicine that supports intervention to restore the ... Society tends to view disabled individuals as burdens to their families, themselves, and to society. ... women receive a clear message concerning their duty to carry healthy babies – and only ...

Research paper thumbnail of Development and Evaluation of Drop-In Centers Operated by Mental Health Consumers

Psychiatric Services, 1993

As part of a statewide initiative begun in 1989 to promote consumer involvement, the Pennsylvania... more As part of a statewide initiative begun in 1989 to promote consumer involvement, the Pennsylvania Office of Mental Health initially funded the development of nine consumer-operated drop-in centers. This paper describes some of the programs and services developed by the centers and presents results of a survey of consumers' use of and satisfaction with services. During the six-month survey period, a total of 478 consumers used services; average daily attendance at each center was 28. Most centers had one paid position supplemented by heavy use of volunteers. Most projects had collaborative relationships with a few providers who maintained a low profile in daily operations. Although consumers were highly satisfied with the drop-in centers, they desired improvements in the number of paid staff, hours of operation, management, and transportation.

Research paper thumbnail of Fetal Surgery

Women & Health, 1985

Advances in microsurgery provide physicians with the opportunity to correct malformations of the ... more Advances in microsurgery provide physicians with the opportunity to correct malformations of the fetus prior to birth. However, these techniques are being developed at a time when the legal status of the unborn is unclear and the rights of pregnant women to determine the nature of their care are not universally recognized. This paper examines some of the social implications

Research paper thumbnail of Informed consent and patient decision making: Two decades of research

Social Science & Medicine, 1983

Patient consent to medical treatment has been a subject of concern within the United States profe... more Patient consent to medical treatment has been a subject of concern within the United States professional communities for over two decades. This paper traces the development of research literature on patient decision making and informed consent to medical treatment in three fields of research: medicine, law and the social sciences. A general model for stages in the development of scientific specialties is applied as a test for the development of informed consent as a specialty interest in each research field. Results indicate a relatively advanced stage of development within medicine and law. Research in the social science disciplines tend to lag behind in terms of cumulative number of publications. In addition. social science research which is potentially relevant to the ethical and policy issues of consent in medical treatment appears to lack a clear programmatic thrust. with little attention given to the policy implications of the work. In contrast. the medical and legal literatures indicate a direct concern with social policy and reflect attempts on the part of physicians and lawyers to influence the policy making process.

Research paper thumbnail of The Employment Intervention Demonstration Program: Major findings and policy implications

Psychiatric Rehabilitation Journal, 2008

This article summarizes the published results of the Employment Intervention Demonstration Progra... more This article summarizes the published results of the Employment Intervention Demonstration Program (EIDP), a federally-funded, multi-site study examining the effectiveness of supported employment programs for 2273 unemployed individuals with psychiatric disabilities in the U.S. Findings confirm the effectiveness of supported employment across different models, program locations, and participant populations. The study's results are discussed in the context of public policies designed to encourage return to work for those with a severe mental illness.

Research paper thumbnail of Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness

The Journal of Rehabilitation Research and Development, 2007

Effects of co-occurring disorders on work outcomes were explored among individuals with severe me... more Effects of co-occurring disorders on work outcomes were explored among individuals with severe mental illness who were participating in a multisite randomized study of supported employment. At seven sites, 1,273 people were randomly assigned to an experimental supported employment program or a control condition and followed for 2 years. Multivariate regression analysis examined work outcomes including earnings, hours worked, and competitive employment, as well as whether psychiatric disability was disclosed to coworkers and supervisors. Individuals with any comorbidity had lower earnings and were less likely to work competitively. Those with physical comorbidities had lower earnings, worked fewer hours, and were less likely to work competitively. Disclosure was more likely among those with both cognitive and physical comorbidities, as well as those with learning disabilities. Competitive employment was less likely among those with intellectual disability, visual impairment, and human immunodeficiency virus/acquired immunodeficiency syndrome. The experimental condition was positively related to all outcomes except disclosure. The results suggest that, with some exceptions, comorbidities affect employment outcomes, requiring tailored services and supports to promote vocational success.

Research paper thumbnail of Chapter 14: Self-Help Group Participation Among People with Severe Mental Illness

Prevention in Human Services, 1995

An experimental design was attempted to test the effectiveness of self-help group participation a... more An experimental design was attempted to test the effectiveness of self-help group participation among people with severe and long-standing mental illnesses. A sample of 90 individuals was randomized to either experimental or control groups with experimentals invited to join self-help groups and given outreach to encourage participation. Control subjects were not invited to join self-help groups. Results showed low rates

Research paper thumbnail of Effectiveness of Supported Employment for Individuals with Schizophrenia: Results of a Multi-Site, Randomized Trial

Clinical Schizophrenia & Related Psychoses, 2008

Background: Prior studies of supported employment efficacy for individuals with schizophrenia hav... more Background: Prior studies of supported employment efficacy for individuals with schizophrenia have yielded mixed results, with some finding poorer outcomes for those with this diagnosis and others finding no differences. Aims: This multi-site effectiveness trial examined the relative impact of diagnosis with schizophrenia and evidence-based practice supported employment on the likelihood of competitive employment. Method: At seven U.S. sites, 1,273 outpatients with severe mental illness were randomly assigned to either an experimental supported employment program or to a comparison/services as usual condition and followed for two years. Data collection involved semi-annual, in-person interviews, and weekly recording of all paid employment by vocational and research staff. Mixed-effects random regression analysis was used to examine the effects of study condition, schizophrenia diagnosis, and their interaction, on the likelihood of competitive employment. Results: Subjects in experimental group programs and those with diagnoses other than schizophrenia (predominantly bipolar disorder and major depression) were significantly more likely to be competitively employed than those in control programs and those with diagnoses of schizophrenia. However, an interaction effect between study condition and diagnosis was observed in which experimental group treatment ameliorated the negative effects of diagnosis on employment outcome. Discussion: Evidence-based supported employment interventions are superior to services as usual/comparison programs in assisting individuals with schizophrenia to attain competitive employment. Given recent evidence of this model's effectiveness outside the U.S. and interest in its promotion internationally, it has global potential to further the recovery potential of individuals with psychiatric disabilities.

Research paper thumbnail of Effects of local unemployment rate on vocational outcomes in a randomized trial of supported employment for individuals with psychiatric disabilities

The purpose of this study was to explore the effects of local unemployment rates on evidence-base... more The purpose of this study was to explore the effects of local unemployment rates on evidence-based supported employment (SE) programs tailored for people with psychiatric disabilities. Participants (n = 1, 273) from 7 states in the US were randomly assigned to experimental SE or services as usual/comparison conditions and followed for 24 months. Mixedeffects random regression analysis found that both local unemployment rate and study condition were significant predictors of competitive employment and working 40 or more hours per month. An interaction between study condition and unemployment rate was found, in which participants in areas with low unemployment receiving best practice SE had consistently better outcomes than all others. However, even in areas with high unemployment, those who received evidence-based SE had outcomes superior to those in the control condition. This confirms the influence of local labor market forces on individuals with psychiatric disabilities participating in vocational rehabilitation programs. It also suggests that those who are attempting to return to work in areas with weak local economies are likely to fare especially poorly if they are not receiving high quality SE interventions. Thus, use of evidence-based SE can help to ameliorate the effects of high unemployment on work outcomes.

Research paper thumbnail of Epidemiology of the Post-Polio Syndrome

American Journal of Epidemiology, 1992

A late-onset syndrome, consisting of muscle weakness, muscle pain, and unaccustomed fatigue, has ... more A late-onset syndrome, consisting of muscle weakness, muscle pain, and unaccustomed fatigue, has been reported with increasing frequency among former poliomyelitis patients. A population-based cohort of poliomyelitis patients from Allegheny County, Pennsylvania, was traced and surveyed to estimate the prevalence and incidence and to identify determinants of the post-polio syndrome. A questionnaire validated in clinical examinations of 40 cohort members was used in the survey. The prevalence of the post-polio syndrome was 28.5% of all paralytic cases (95% confidence interval 24.4-32.6). The risk of post-polio syndrome was significantly higher among patients who sustained substantial permanent impairment after polio and among females. The incidence did not vary with age at acute onset, acute severity, or level of physical activity after recovery. The strongest determinant of post-polio syndrome onset was the length of the interval following the acute illness, with incidence peaking at 30-34 years. Of all cases of post-polio syndrome, 79% reported no major change in impairment status since onset. This study demonstrates that poliomyelitis patients are not equally susceptible to post-polio syndrome within the interval of 30-40 years after the original illness. For syndrome cases, the onset was associated with new neuromuscular symptoms and functional changes but not with major new impairment.

Research paper thumbnail of Roles for Mental Health Consumers in Self-Help Group Research

The Journal of Applied Behavioral Science, 1993

This article describes emerging roles of mental health consumers in self-help group research. Exa... more This article describes emerging roles of mental health consumers in self-help group research. Examples taken from recent empirical studies of self-help group activities among people with long-term and serious mental health disabilities illustrate new roles that transcend traditional relationships in research. A working typology for these roles include informed participant, key informant, advisor, staff member, and co-investigator as practical additions to the more traditional role of the research subject. Current guidelines for the protection of human subjects in research are limited in their ability to address ethical and procedural issues that arise out of these new role relationships. Self-help group research should address ethical issues that are not currently addressed by the established requirements of informed consent and IRB oversight. The author recommends that consumer review and approval be included as an integral part of the development and evaluation of human subject is...

Research paper thumbnail of Roles for Mental Health Consumers in Self-Help Group Research

The Journal of Applied Behavioral Science, 1993

This article describes emerging roles of mental health consumers in self-help group research. Exa... more This article describes emerging roles of mental health consumers in self-help group research. Examples taken from recent empirical studies of self-help group activities among people with long-term and serious mental health disabilities illustrate new roles that transcend traditional relationships in research. A working typology for these roles include informed participant, key informant, advisor, staff member, and co-investigator as practical additions to the more traditional role of the research subject. Current guidelines for the protection of human subjects in research are limited in their ability to address ethical and procedural issues that arise out of these new role relationships. Self-help group research should address ethical issues that are not currently addressed by the established requirements of informed consent and IRB oversight. The author recommends that consumer review and approval be included as an integral part of the development and evaluation of human subject is...

Research paper thumbnail of Psychiatric evaluation of patient decision-making: Informed consent to ECT

Social Psychiatry, 1981

Informed consent is a legal doctrine particular to Anglo-Saxon law. The doctrine specifies the ri... more Informed consent is a legal doctrine particular to Anglo-Saxon law. The doctrine specifies the rights of patients to receive information about medical treatment prior to making a decision to consent to or refuse a procedure. The application of informed consent to psychiatry has provoked controversy and confusion. The ability of some mental patients to understand the nature of recommended treatment

Research paper thumbnail of Informed consent and patient decisionmaking

International Journal of Law and Psychiatry, 1981

The professions of medicine and law often have taken opposing sides on issues concerning patient ... more The professions of medicine and law often have taken opposing sides on issues concerning patient care. Differences over the right to treatment, experimentation on institutionalized patients, and de-institutionalization of mental patients are but a few examples where the two professions have fallen into debate over the ethical and practical responsibilities owed to patients. The vocal and public nature of those debates may foster a popular conception of inherent conflict between the two disciplines. From this point of view, the present controversy over informed consent to treatment may be regarded as one battle in an ongoing war between two powerful professional disciplines. Conflict between psychiatry and law over informed consent for mental patients is well documented in the literature. Lawyers have championed the doctrine of informed consent as an instrument for reform of the doctor-patient relationship (Note, 1970), as a check on the indiscriminate use of therapeutic procedures (Plotkin, 1977), and as a new theory of medical liability (Meisel, 1977). Physicians have attacked the doctrine as a myth, unsuitable to the realities of clinical practice (Leeb & Bowers, 1976; Laforet, 1976) and a legal ploy to entrap the unwary physician in litigation (Delee, 1976; Burnham, 1966). Almost all major medical specialities have found reason to take exception to the doctrine. However, medicine and law are not uniformly divided on the issue. Some lawyers have been critical of informed consent (Seidelson, 1976; Chayet, 1976). A few physicians have supported it as a means to protect the patient and involve him or her in medical decisionmaking (Crile, 1976, 1972; Hatcher, 1976).

Research paper thumbnail of Psychiatric Treatment and the Romance of the Law

Contemporary Sociology, 1985

Hailed by its proponents as a doctrine that promises more equitable doctorpatient relationships, ... more Hailed by its proponents as a doctrine that promises more equitable doctorpatient relationships, informed consent has also been decried as posing serious threats to the quality of care in this country. Ultimately, what is at stake in the controversy is nothing less than two equally entrenched but compelling strains in American legal and political history-the protection of individual autonomy versus societal regulation of individual freedom for the greater common good. In the case of psychiatric patients, the issue is further complicated because it is often precisely the patient's very capacity for autonomous action that is in question. Central to the ethical doctrine of informed consent is that patients not only be apprised of and give their written consent to a particular treatment-as required by law-but that they understand what the treatment entails and consent to it.

Research paper thumbnail of The right to health care: Some cross-national comparisons and U.S. Trends in policy

Social Science & Medicine. Part F: Medical and Social Ethics, 1981

All developed. mdustrlahzed nattons provtde some system of health care for the treatment of acute... more All developed. mdustrlahzed nattons provtde some system of health care for the treatment of acute and chrome Illness. However. nations differ m terms of then policy toward the provIsIon and dtstrtbutton of health services Basic to pohcy regarding access to medical care IS the notlon of health care as a right. Thts paper exammes the evolutton of the concept of a right to health care m three mdustrtahzed nations-the U S S.R.. Great Brltam and the U S Trends m the U.S. health care delivery system suggest an emergmg pohcy which favors equity through federally subsldlzed care for the mdtgent. However. the US health care system tolerates unequal distribution of servtces The U.S.S R and U.K. health care systems have adopted exphclt pohcles which support the right of all their ctttzens to health care. US policy supportmg the right to health care has been hampered by two primary factors Ftrst IS opposttlon wnhm the medical professton toward the notion of health care as a right Second IS the mablhty of federal agencies to develop a comprehensrve plan for health care dehvery INTRODUCTlOh

Research paper thumbnail of Role Obligations and Health Status in Chronic Disease: The Experience of Men and Women with Arthritis

Disability, Handicap & Society, 1986

Research paper thumbnail of The Self Help Employment Center: Some outcomes from the first year

Psychosocial Rehabilitation Journal, 1995

Research paper thumbnail of Perfect mothers, perfect babies: an examination of the ethics of fetal treatments

Reproductive and genetic engineering, 1988

... There is a contradiction in the ethics of medicine that supports intervention to restore the ... more ... There is a contradiction in the ethics of medicine that supports intervention to restore the ... Society tends to view disabled individuals as burdens to their families, themselves, and to society. ... women receive a clear message concerning their duty to carry healthy babies – and only ...

Research paper thumbnail of Development and Evaluation of Drop-In Centers Operated by Mental Health Consumers

Psychiatric Services, 1993

As part of a statewide initiative begun in 1989 to promote consumer involvement, the Pennsylvania... more As part of a statewide initiative begun in 1989 to promote consumer involvement, the Pennsylvania Office of Mental Health initially funded the development of nine consumer-operated drop-in centers. This paper describes some of the programs and services developed by the centers and presents results of a survey of consumers' use of and satisfaction with services. During the six-month survey period, a total of 478 consumers used services; average daily attendance at each center was 28. Most centers had one paid position supplemented by heavy use of volunteers. Most projects had collaborative relationships with a few providers who maintained a low profile in daily operations. Although consumers were highly satisfied with the drop-in centers, they desired improvements in the number of paid staff, hours of operation, management, and transportation.

Research paper thumbnail of Fetal Surgery

Women & Health, 1985

Advances in microsurgery provide physicians with the opportunity to correct malformations of the ... more Advances in microsurgery provide physicians with the opportunity to correct malformations of the fetus prior to birth. However, these techniques are being developed at a time when the legal status of the unborn is unclear and the rights of pregnant women to determine the nature of their care are not universally recognized. This paper examines some of the social implications

Research paper thumbnail of Informed consent and patient decision making: Two decades of research

Social Science & Medicine, 1983

Patient consent to medical treatment has been a subject of concern within the United States profe... more Patient consent to medical treatment has been a subject of concern within the United States professional communities for over two decades. This paper traces the development of research literature on patient decision making and informed consent to medical treatment in three fields of research: medicine, law and the social sciences. A general model for stages in the development of scientific specialties is applied as a test for the development of informed consent as a specialty interest in each research field. Results indicate a relatively advanced stage of development within medicine and law. Research in the social science disciplines tend to lag behind in terms of cumulative number of publications. In addition. social science research which is potentially relevant to the ethical and policy issues of consent in medical treatment appears to lack a clear programmatic thrust. with little attention given to the policy implications of the work. In contrast. the medical and legal literatures indicate a direct concern with social policy and reflect attempts on the part of physicians and lawyers to influence the policy making process.

Research paper thumbnail of The Employment Intervention Demonstration Program: Major findings and policy implications

Psychiatric Rehabilitation Journal, 2008

This article summarizes the published results of the Employment Intervention Demonstration Progra... more This article summarizes the published results of the Employment Intervention Demonstration Program (EIDP), a federally-funded, multi-site study examining the effectiveness of supported employment programs for 2273 unemployed individuals with psychiatric disabilities in the U.S. Findings confirm the effectiveness of supported employment across different models, program locations, and participant populations. The study's results are discussed in the context of public policies designed to encourage return to work for those with a severe mental illness.

Research paper thumbnail of Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness

The Journal of Rehabilitation Research and Development, 2007

Effects of co-occurring disorders on work outcomes were explored among individuals with severe me... more Effects of co-occurring disorders on work outcomes were explored among individuals with severe mental illness who were participating in a multisite randomized study of supported employment. At seven sites, 1,273 people were randomly assigned to an experimental supported employment program or a control condition and followed for 2 years. Multivariate regression analysis examined work outcomes including earnings, hours worked, and competitive employment, as well as whether psychiatric disability was disclosed to coworkers and supervisors. Individuals with any comorbidity had lower earnings and were less likely to work competitively. Those with physical comorbidities had lower earnings, worked fewer hours, and were less likely to work competitively. Disclosure was more likely among those with both cognitive and physical comorbidities, as well as those with learning disabilities. Competitive employment was less likely among those with intellectual disability, visual impairment, and human immunodeficiency virus/acquired immunodeficiency syndrome. The experimental condition was positively related to all outcomes except disclosure. The results suggest that, with some exceptions, comorbidities affect employment outcomes, requiring tailored services and supports to promote vocational success.

Research paper thumbnail of Chapter 14: Self-Help Group Participation Among People with Severe Mental Illness

Prevention in Human Services, 1995

An experimental design was attempted to test the effectiveness of self-help group participation a... more An experimental design was attempted to test the effectiveness of self-help group participation among people with severe and long-standing mental illnesses. A sample of 90 individuals was randomized to either experimental or control groups with experimentals invited to join self-help groups and given outreach to encourage participation. Control subjects were not invited to join self-help groups. Results showed low rates

Research paper thumbnail of Effectiveness of Supported Employment for Individuals with Schizophrenia: Results of a Multi-Site, Randomized Trial

Clinical Schizophrenia & Related Psychoses, 2008

Background: Prior studies of supported employment efficacy for individuals with schizophrenia hav... more Background: Prior studies of supported employment efficacy for individuals with schizophrenia have yielded mixed results, with some finding poorer outcomes for those with this diagnosis and others finding no differences. Aims: This multi-site effectiveness trial examined the relative impact of diagnosis with schizophrenia and evidence-based practice supported employment on the likelihood of competitive employment. Method: At seven U.S. sites, 1,273 outpatients with severe mental illness were randomly assigned to either an experimental supported employment program or to a comparison/services as usual condition and followed for two years. Data collection involved semi-annual, in-person interviews, and weekly recording of all paid employment by vocational and research staff. Mixed-effects random regression analysis was used to examine the effects of study condition, schizophrenia diagnosis, and their interaction, on the likelihood of competitive employment. Results: Subjects in experimental group programs and those with diagnoses other than schizophrenia (predominantly bipolar disorder and major depression) were significantly more likely to be competitively employed than those in control programs and those with diagnoses of schizophrenia. However, an interaction effect between study condition and diagnosis was observed in which experimental group treatment ameliorated the negative effects of diagnosis on employment outcome. Discussion: Evidence-based supported employment interventions are superior to services as usual/comparison programs in assisting individuals with schizophrenia to attain competitive employment. Given recent evidence of this model's effectiveness outside the U.S. and interest in its promotion internationally, it has global potential to further the recovery potential of individuals with psychiatric disabilities.

Research paper thumbnail of Effects of local unemployment rate on vocational outcomes in a randomized trial of supported employment for individuals with psychiatric disabilities

The purpose of this study was to explore the effects of local unemployment rates on evidence-base... more The purpose of this study was to explore the effects of local unemployment rates on evidence-based supported employment (SE) programs tailored for people with psychiatric disabilities. Participants (n = 1, 273) from 7 states in the US were randomly assigned to experimental SE or services as usual/comparison conditions and followed for 24 months. Mixedeffects random regression analysis found that both local unemployment rate and study condition were significant predictors of competitive employment and working 40 or more hours per month. An interaction between study condition and unemployment rate was found, in which participants in areas with low unemployment receiving best practice SE had consistently better outcomes than all others. However, even in areas with high unemployment, those who received evidence-based SE had outcomes superior to those in the control condition. This confirms the influence of local labor market forces on individuals with psychiatric disabilities participating in vocational rehabilitation programs. It also suggests that those who are attempting to return to work in areas with weak local economies are likely to fare especially poorly if they are not receiving high quality SE interventions. Thus, use of evidence-based SE can help to ameliorate the effects of high unemployment on work outcomes.

Research paper thumbnail of Epidemiology of the Post-Polio Syndrome

American Journal of Epidemiology, 1992

A late-onset syndrome, consisting of muscle weakness, muscle pain, and unaccustomed fatigue, has ... more A late-onset syndrome, consisting of muscle weakness, muscle pain, and unaccustomed fatigue, has been reported with increasing frequency among former poliomyelitis patients. A population-based cohort of poliomyelitis patients from Allegheny County, Pennsylvania, was traced and surveyed to estimate the prevalence and incidence and to identify determinants of the post-polio syndrome. A questionnaire validated in clinical examinations of 40 cohort members was used in the survey. The prevalence of the post-polio syndrome was 28.5% of all paralytic cases (95% confidence interval 24.4-32.6). The risk of post-polio syndrome was significantly higher among patients who sustained substantial permanent impairment after polio and among females. The incidence did not vary with age at acute onset, acute severity, or level of physical activity after recovery. The strongest determinant of post-polio syndrome onset was the length of the interval following the acute illness, with incidence peaking at 30-34 years. Of all cases of post-polio syndrome, 79% reported no major change in impairment status since onset. This study demonstrates that poliomyelitis patients are not equally susceptible to post-polio syndrome within the interval of 30-40 years after the original illness. For syndrome cases, the onset was associated with new neuromuscular symptoms and functional changes but not with major new impairment.

Research paper thumbnail of Roles for Mental Health Consumers in Self-Help Group Research

The Journal of Applied Behavioral Science, 1993

This article describes emerging roles of mental health consumers in self-help group research. Exa... more This article describes emerging roles of mental health consumers in self-help group research. Examples taken from recent empirical studies of self-help group activities among people with long-term and serious mental health disabilities illustrate new roles that transcend traditional relationships in research. A working typology for these roles include informed participant, key informant, advisor, staff member, and co-investigator as practical additions to the more traditional role of the research subject. Current guidelines for the protection of human subjects in research are limited in their ability to address ethical and procedural issues that arise out of these new role relationships. Self-help group research should address ethical issues that are not currently addressed by the established requirements of informed consent and IRB oversight. The author recommends that consumer review and approval be included as an integral part of the development and evaluation of human subject is...

Research paper thumbnail of Roles for Mental Health Consumers in Self-Help Group Research

The Journal of Applied Behavioral Science, 1993

This article describes emerging roles of mental health consumers in self-help group research. Exa... more This article describes emerging roles of mental health consumers in self-help group research. Examples taken from recent empirical studies of self-help group activities among people with long-term and serious mental health disabilities illustrate new roles that transcend traditional relationships in research. A working typology for these roles include informed participant, key informant, advisor, staff member, and co-investigator as practical additions to the more traditional role of the research subject. Current guidelines for the protection of human subjects in research are limited in their ability to address ethical and procedural issues that arise out of these new role relationships. Self-help group research should address ethical issues that are not currently addressed by the established requirements of informed consent and IRB oversight. The author recommends that consumer review and approval be included as an integral part of the development and evaluation of human subject is...