CONSUMEROPERATED SELFHELP CENTERS:

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CONSUMER-OPERATED SELF-HELP CENTERS

• THE RELATIONSHIP BETWEEN THE SOCIAL ENVIRONMENT
  AND ITS ASSOCIATION WITH EMPOWERMENT AND
  SATISFACTION
• University of Medicine and Dentistry of New
  Jersey
• School of Health Related Professions
• Psychiatric Rehabilitation Colloquium Series
• Peggy (Margaret) Swarbrick, PhD, OTR, CPRP
• March 16, 2006

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Abstract

• Self-help centers are a type of consumer-operated
  service that offer a supportive environment and
  are considered a complement to, and an
  alternative service for, mental health consumers
  living in the community. This study was designed
  to address the need for a greater understanding
  of this non-traditional type of service setting.

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• This exploratory, descriptive study examined
  relationships between social environment factors
  and empowerment and satisfaction.

4

• Participants (N 144) involved in
  consumer-operated self-help centers completed a
  161-item survey designed to capture their
  perceptions of satisfaction, empowerment, group
  environment factors, as well as demographic data
  and other characteristics.

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Consumer-operated services (COS)

• are viewed as a legitimate complement to, and an
  alternative service for, mental health consumers
  living in the community.
• are gaining support through federal and state
  allocations (Mowbray, Robinson, Holter, 2002
  Salzer, 2002 Van Tosh del Vecchio, 2000
  Yanos, Primavera, Knight, 2001 Zinman et al.,
  1987).

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COS Research

• Most research consisted of descriptive reports
  and feasibility studies. Some studies on drop-in
  centers and self-help groups looked at impact of
  the group environment on member outcomes.

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COS Fidelity

• Researchers in Michigan have defined the COS
  model, based on the concepts, and created valid
  and reliable criteria for fidelity to the program
  model.
• The Fidelity Rating Instrument for
  Consumer-Operated Services (FRI) (Holter,
  Mowbray, Bellamy, MacFarlane, Dukarski, 2004).
  The FRI criteria were validated through expert
  judgments (and consensus) using a modified Delphi
  method (Holter, et al., 2004).
• Respondents rated structural and process
  components, emphasizing the value of consumerism
  consumer control, consumer choices and
  opportunities for decision-making, voluntary
  participation (absence of coercion), and respect
  for members by staff.

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Self-help centers (a type of COS)

• Are designed to promote empowerment and
  satisfaction by providing members with an active
  role in their programmatic planning and
  day-to-day operations.
• Claim to provide consumers with a social
  environment that promotes member empowerment and
  satisfaction.

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Self-Help Centers (SHCs) in New Jersey

• Initially named Drop-in Centers (11 SHCs).
• In 1998 renamed, Self-help Centers (increased
  funding, scope of operations, funding
  accountability) .

• 21 operated by CSP
• Open 3-7 days per week
• A type of consumer-operated service COS model.

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Self-Help Centers provide

• opportunities for recreation, socialization,
  self-help groups/ activities, advocacy, wellness
  and recovery education and other issues
  identified by the membership.

• a safe, welcoming environment that encourage a
  sense of belonging.
• opportunities to assume a variety of roles.

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Purpose of Study

• Gather data to enhance our understanding of the
  associations between the self-help center social
  environment and participant empowerment and
  satisfaction.
• Determine their value as an accepted component of
  the public mental health system.

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Rationale

• Self-Help Centers have not been scrutinized by
  rigorous research (effectiveness has not been
  empirically evaluated).
• No empirical data on the impact of the Self-Help
  Center social environment, on members level of
  empowerment, satisfaction, or other outcome
  measures.
• As the level of public resources for these
  services increases, the need for an evaluation of
  their effectiveness becomes more acute.

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IV
DV
Group Environment Factors
Empowerment
Satisfaction
Participant Characteristics
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Hypothesis 1

• Participants perception of the self-help center
  social environment will be related to
  participants level of Empowerment.
• Operational Hypothesis 1
• Participants perception of the self-help center
  social environmentas measured both separately
  and jointly by the Group Environment Scale (GES)
  a) GES Relationship subscale b) GES Personal
  Growth subscale and c) GES Systems Maintenance
  and Change subscalewill be related to
  participants level of Empowerment as measured by
  the Making Decisions Empowerment Scale MDES
  (Rogers, et al., 1997).

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• Group Environment Factors
• a) Relationship
• b) Personal Growth
• c) System Maintenance
• Change

Empowerment

• Satisfaction

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Hypothesis 2

• Participants perception of the self-help center
  social environment will be related to
  participants level of Satisfaction.
• Operational Hypothesis 2
• Participants perception of the self-help center
  social environmentas measured both separately
  and jointly by a) the GES Relationship subscale
  b) the GES Personal Growth subscale and c) the
  GES Systems Maintenance and Change subscale
  (Moos, 2002)will be related to participants
  level of Satisfaction as measured by their scores
  on the Self-Help Agency Satisfaction Scale
  SHASS (Segal, et al., 2000).

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Research Questions

• Research Question 1
• What is the relationship among participants
  demographics (gender, ethnicity, marital status,
  and age) and other characteristics (role with
  center, length of involvement with center, and
  attendance rate) and participants level of
  Empowerment, as measured by the MDES ?

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Participant Characteristics Age Gender Marital
Status Ethnicity Diagnosis Role with
Center Experience
Empowerment

• Satisfaction

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Research Question 2

• What is the relationship between participants
  demographics (gender, ethnicity, marital status,
  and age) and other characteristics (role with
  center, length of involvement with center, and
  attendance rate) and participants level of
  Satisfaction as measured by the SHASS?

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Research Question 3

• What is the relationship between the two
  dependent variables participant Satisfaction, as
  measured by their scores on the SHASS, and
  participant Empowerment, as measured by the MDES ?

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Self-help Survey Packet

• Participant characteristics - 32 items
• Satisfaction scale (SHASS) - 11 items
• Making Decisions Empowerment Scale (MDES)- 28
  items
• Group Environment Scale (GES)- 90 items

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Participants

• Have you worked during the last 30 days?
• Yes 93 66
• No 51 34
• Have you volunteered at the self-help center
  during the last 30 days?
• Yes 69 48
• No 75 52
• Primary Financial Support
• SSDI only 37 26
• SSI only 34 23
• SSDI and work 24 17
• SSI and work 22 15
• Work 8 6

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• Participants were generally unmarried,
  middle-aged, living in a stable housing
  situation, poor, and scored high on an
  empowerment scale.

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• Marital
• Single, never married 80 56
• Married 10 7
• Living with significant other 10 7
• Divorced 33 23
• Widowed 4 2
• Separated 7 5
• Education
• Less than High School Diploma/
• Vocational/Technical Training36 25
• High School Diploma or GED 53 37
• Some College 33 23
• Graduated College 17 11
• Post-Graduate Education 5 4

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• Length of Involvement (years) at Self-Help Center
• 3 months to 3 years 90 63
• 4 to 9 years 39 27
• 10 to 15 years 15 10
• Weekly Attendance Rate
• 1 to 3 times per week 83 57
• 4 to 7 times per week 61 43

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Empowerment

• In a regression analysis, stepwise entry, both
  factors were significant predictors of
  Empowerment and the two factors combined account
  for 9 of the variance in the Empowerment scores.
  
• The greatest variance (6) was explained by
  attendance frequency, and length of involvement
  accounted for an additional 3 of the variance of
  Empowerment scores.
• It appears that participants who attend more
  often and participate for extended periods of
  times, in terms of years, report a higher sense
  of Empowerment.

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Empowerment

• This finding is consistent with other studies
  that report that a greater level of participation
  is associated with Empowerment (Zimmerman
  Rappaport, 1988).
• Zimmerman and Rappaport (1998) found that greater
  participation and longer involvement in community
  activities and organizations is associated with
  Empowerment.

28

• Empowerment scores were above average (M 2.95,
  SD 0.28), with a range 2.36 to 3.89.
• The actual versus potential range of scores was
  quite restricted.

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Empowerment

• In terms of role with center there were nearly
  equal numbers of members (52) and leaders (48).
  
• Member and leader Empowerment scores were
  compared and no significant differences were
  found.

30

• No significant differences in terms of
  Empowerment scores based on gender or age.
• These findings are consistent with Rogers and
  associates (1997) and Wowra and McCarter (1999),
  who found in two separate studies that
  respondents characteristics, including gender
  and age, were not significant predictors of
  Empowerment.
• No significant differences between Empowerment
  scores and participants marital status and
  ethnicity.

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• Significant, positive relationships between
  participant satisfaction and two of the three
  social environment factors studied (relationship
  and system maintenance and change) were found.

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The Relationship variable

• was the strongest predictor of Satisfaction.
• Participants seem to be more satisfied in an
  environment where they can form social
  relationships, feel connected to peers, and where
  they are encouraged to express their feelings.
• Mental health consumers often feel isolated,
  lonely, and rejected (Davidson, et al., 1996
  Solomon, 2004). Self-help centers seem to be
  playing an important role in addressing the need
  for support and connection by providing a
  supportive community to address social needs of
  mental health consumers living in the
  community.

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Satisfaction Scores

• A Regression analysis, stepwise entry
• indicate two predictors of Satisfaction
  combined, the Relationship and Systems
  Maintenance and Change factors accounted for 37
  of the variance in scores.
• The greatest variance in scores (28) was
  explained by the Relationship variable.
• The Systems Maintenance and Change variable
  entered in step 2 and accounted for an additional
  9 of the variance of the scores.

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• These findings suggest that Satisfaction may
  result from an environment providing social
  relationships (the amount of cohesion, leader
  support, and expressiveness encouraged in the
  center) and Systems Maintenance and Change (the
  extent to which the center provides order and
  organization, leader control, and promotes
  innovation).

35

• No significant relationships between participant
  empowerment and the three social environment
  factors studied were found, although associations
  were found between participant empowerment and
  self-help center involvement.

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Satisfaction

• consistent with other reported studies that
  demonstrate associations between social
  environment variables (in both self-help groups
  and peer-operated drop-in centers) and
  Satisfaction.
• When a group is reported to be moderate to high
  on the Relationship dimension, participants tend
  to be more satisfied with participation (Moos,
  1994).
• Members of supportive, cohesive, and
  well-organized self-help groups tend to report
  more Satisfaction (Moos, 1994).

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• Participants seem satisfied because the self-help
  center environment offers opportunities to form
  social relationships and they feel part of a
  group of peers.

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Satisfaction can be enhanced when

• there is group cohesion
• leader support
• when members are encouraged to express themselves
  
• when members are encouraged to be involved in
  creating the order and rules

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Qualitative Data

• Best Thing (s) about this center
• Worst Thing (s) about this center
• How can the center be improved

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Best Thing (s) About the Center

• Place where I can be with other people and belong
  39
• Accessible place to go, socialize, and be
  involved in activities 38
• Personal benefits 15
• Other 8

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Best Thing (s)- Social Support

• The best thing about the self-help center is that
  it is a place where I can be with others,
  belong, and find support.
• The self-help center is a place where folks can
  meet people, develop friendships, and feel part
  of a group of peers.

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Best Things.

• a good place to meet people who are in the same
  boat as you develop friendships with other
  members sense of camaraderie with fellow
  members as we are all consumers get to meet
  people and I like socializing with other
  people who have the same kind of problems I
  have.
• A participant emphasized the sense of belonging
  as follows I feel a strong belonginess, caring,
  and empowerment.

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Worst Thing (s) About the Center

• Not enough (funding, services, and hours)
  34
• Conflicts, arguments, and discomfort
  32
• Facilitator and technical consultants 12
  
• Facility-related issues 9
• Other 13

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How Can the Center Be Improved?

• Need for more (services and resources,
  activities, funding, people, and hours) 71
  
• Communication and cooperation 18
• Facility improvements 4
• Other 7

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Implications

• Leadership training
• Environment atmosphere
• Outreach and recruitment
• Future Research

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Findings

• Underscore the role that self-help centers play
  providing relationships and social support in
  helping to address longer-term social needs of
  mental health consumers living in the community.
• Provide some preliminary evidence of the value of
  this service model as an accepted component of
  the public mental health system.