All initial contacts or referrals to the psychiatry service are recorded on an intake sheet along with other information. In addition, all appointments are registered weekly and marked as attended or not attended. Thus it is fairly easy to measure the compliance rate over a given period of time. A 26-week period from July 1974 to January 1975 was randomly chosen from two years of available data. During that time 249 referrals were received, of which 72, or 28 per cent, were selfreferrals. A total of 177, or 72 per cent, were referred by health or social agencies or physicians. Ninety-three of the referrals, or 37 per cent, were redirected to a more appropriate person or agency or handled by indirect consultation. The other 156 were given appointments at the clinic, and of those, 138, or 88 per cent, kept the appointment. Thus the over-all no-show rate was 12 per cent, substantially lower than the average of 29 per cent we found in other studies. The source of referral was also considered for the 177 patients who were not self-referrals. Eleven were found to have been referred by sources outside the catchment area who were not well known to team members and who had not been involved in any ongoing liaison or consultation and education program with the service. Of the 18 patients who did not keep their first appointments, eight had unfamiliar referral sources. When they were eliminated, the no-show rate was only 6 per cent. A high rate of missed initial appointments must be considered a negative factor in the evaluation of any psychiatric service and is a major issue in the costeffectiveness of the program. It can be argued, on community psychiatry and public health principles alone, that a psychiatry service’s involvement in community education and consultation is worthwhile. Our findings support the opinions of others that education and consultation also yields benefits in purely clinical terms. The active intake procedure ensures that problems that can be more appropriately handled by other agencies are referred to them, and it has the added benefit of preventing a client from becoming a “mental patient.” Those who do receive an appointment are well prepared for it, and our impression is that they are unlikely to terminate prematurely. If clients do drop out, the active intake procedure permits us to change the approach from direct treatment to consultation.

A PILOT PROGRAM TO TRAIN VOLUNTEERS AS

ADJUNCT

THERAPISTS

Cornelia Hinton, C.V.C. Nancy Romero, M.S.W. Joanne W. Sterling, Ph.D.

children’s

programs, activity aides in the partial hospiand inpatient units, counselors with parents when child abuse and neglect have been identified, and receptionists and clerical workers in many areas of the center. The center’s four neighborhood satellites have used only a small number of volunteers, in clerical-receptionist positions and as aides in parenting groups for mothers of handicapped children. Their use of volunteers has been limited partly because of the satellite teams’ lack of requests for volunteer support and the problem of providing adequate supervision in the outlying centers. Early in 1974 we devised a plan for developing and implementing volunteer programs in the satellites. As needed, each team would designate a volunteer facilitator to make case assignments, provide supervision, and act as liaison with the coordinator of volunteers in the central facility. The need for a volunteer support system was first identified at the Heights satellite, in the northeast area of the city, which had the largest catchment area. A staff psychiatric social worker agreed to act as facilitator. The interdisciplinary team was asked to consider how volunteers might be helpful to them. Then in a questionnaire they indicated specifically how they perceived the volunteer as functioning. Most staff saw the volunteer in the role of a friendly visitor to patients already in the system. At the same time a role definition for the team facilitator was written and presented to the appropriate personnel for their approval. The program began in March 1974 with seven volunteers and has involved a total of 14. Most of the participants had heard of the program and asked to be included; others were interviewed for the centralized volunteer program but were referred to the Heights program. Also, the University of New Mexico in Albuquerque produces many clinically trained graduates, but when our program began few clinical jobs were available. Thus no specific recruitment was found to be necessary. Three of the volunteers were men and 1 1 were women; ten were married and four were single, including widowed or divorced. The level of education and training was high: one Ph.D., six M.A.s, and seven B.A.s. Eight were trained on a professional level in the mental health field. The volunteers included housewives, unemployed or underemployed professionals, graduate students, teachers, and one retired mental health professional. Ages ranged from the mid-20s to the late 60s. Various reasons were given for volunteering for the talization

Ms.

Hinton

nalillo now

Bernalillo County Mental Health and Mental Retardation Center in Albuquerque, New Mexico, has used volunteers in a wide range of activities for the past seven years, They have served as classroom aides in UThe

512

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program. Several volunteers expressed a desire to maintam their existing skills or to increase them. Altruism was also part of their motivation, s!nce several of those volunteers had no aspirations to resume a career. The volunteer coordinator and the team facilitator do the initial screenifig of the volunteers. Methods include interviewing, checking references, and in some cases observing the individual in other volunteer activities. During the interviews motivation is carefully assessed, as is willingness to comply with program limitations and suervision. (For instance, it is important that the volunteers have some time available during the day for supervisory conferences. ) A few applicants were screened out for wanting primarily a training experience, for not accepting the program’s limitations, or for not having basic casework skills. The initial training phase covers four major areas: knowledge of the agency and its services, basic casework and treatment skills, agency forms, and community resources. Supervisory meetings with the team facilitator are held weekly for the first few months, then biweekly, with the more skilled volunteers meeting with the facilitator only as needed. Ongoing training is geared to the current educational needs of the volunteers and to the availability of lectures and workshops through the agency. Training includes lectures by the facilitator and other staff, taped interviews, role-playing, discussions, and private consultation with appropriate staff. The volunteers have continued to be enthusiastic about ongoing training, and the sessions are well attended. Treatment activities in which volunteers have participated have included therapy groups using the transactional analysis approach, groups for young single adults, transition groups for recently discharged patients, and groups for middle-aged women. In addition, a volunteer organized and sustained a community advisory group. The volunteers have seen 70 patients in individual and group therapy. The program has demonstrated that carefully selected volunteers, some of whom have had professional training in the behavioral sciences, can play a significant role in treatment. The recipients of the services have welcomed the supportive efforts of the volunteer therapists, and the program proved to be viable, without additional staff or an increase in funding.U

(Special report Continuedfrom page 507) and Foreign Commerce Committee and the Senate Finance Committee have also endorsed that proposal. Enactment of far-reaching controls on hospital income will not be easy,” he said. We can expect strong and well-organized opposition from the hospital associations and others. But the effort must be made wholeheartedly if we are to bring the inflation spiral under control. It seems to me that organizations such as your own would recognize that it is in your own interests to support actively legislation to reduce the rate of increase in hospital costs. For only by curbing these tremendous increases will there be any hope for substantial expansion of other health programs.” He conceded, however, that even if Congress were successful in bringing inflation in hospital costs under control, money would still be in short supply, and some good health programs may have to be cut to make room for better ones. He said the basic reason is that the Administration has committed itself to achieving a balanced budget by the end of President Carter’s first term, and Congress has accepted that objective. As an example of a good program that might have to be cut, Congressman Giaimo cited the National Institutes of Health’s $41 million research grant-support program. He pointed out that both the Ford and Carter Administrations had proposed eliminating it, arguing that the money made available to universities to provide institutional support for research projects conducted by the schools would be better spent in financing additional targeted research efforts. In the fiscal year 1976-77 budget, when President Ford proposed discontinuing the program, Congress ignored him and appropriated the funds. For fiscal year 1977-78, both the Ford budget and President Carter’s revised budget have again proposed halting the program. Now I cannot totally judge the merits of continuing this $41 million expenditure. But I must ask the question, Is this $41 million being utilized in the most effective way? “So my final message to you is this: tell us where you want to see health programs expanded, but at the same time recognize that some portion of that expansion must come through reductions in other health programs. And tell us which programs should be reduced as well. It is of no value to offer up an aircraft carrier in exchange for mental health research,” Mr. Giaimo said. “While it may be painful to make choices, the necessity to make them has never been more clear. If you, the experts in health care, choose not to help us make those choices, then we will have to make them alone, and we may make them with more error than necessary.” Barbara Armstrong Assistant Editor ‘ ‘





VOLUME

28

NUMBER

7 JULY

1977

513

A pilot program to train volunteers as adjunct therapists.

All initial contacts or referrals to the psychiatry service are recorded on an intake sheet along with other information. In addition, all appointment...
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