Assessing the Psychosocial Environment of Halfway Houses for the Retarded Loren Pankratz, Ph.D.*
ABSTRACT: The Community-Oriented Programs Environment Scale (COPES) was used to assess the psychosocial environment of two halfway houses for the mentally retarded. Residents of the houses were individually asked each question and the staff completed the same scale. Results showed general agreement between staff and residents, suggesting that the retarded were adequately able to describe their treatment program. The results were meaningfully graphed on the existing norms for the mentally disturbed.
The idea of a halfway h o u s e is to p r o v i d e a transitional living situation b e t w e e n a more structured situation (like an institution) and more i n d e p e n d e n t living (like an apartment). The halfway h o u s e m u s t certainly be more than merely a living situation away from the institution. It must also be halfway in terms of vocational adjustment, social living, and psychological support. Ideally, it w o u l d be s u p p o r t i v e only insofar as the resident n e e d s assistance and w o u l d gradually allow the resident more selfdetermination. The psychological and social e n v i r o n m e n t is an i m p o r t a n t aspect of the halfway house. For example, one s t u d y revealed that 15 out of 25 "transitional hostels" for the mentally ill had a more restrictive social e n v i r o n m e n t than the least restrictive hospital w a r d (Apte, 1968). A n o t h e r s t u d y e x a m i n e d the e n v i r o n m e n t of hospitals and residential care facilities for the retarded. In all cases there was evidence of antitherapeutic measures of r e g i m e n t a t i o n , block treatment, depersonalization, and social distance (Kushlick, 1969). Recently Moos (1972) d e v e l o p e d a q u e s t i o n n a i r e to assess the psychosocial e n v i r o n m e n t of halfway houses, day programs, sheltered w o r k s h o p s , and rehabilitation centers. This scale is k n o w n as the C o m m u n i t y - O r i e n t e d Programs E n v i r o n m e n t Scale (COPES). Its 10 subscales a t t e m p t systematically to assess relationship variables, p r o g r a m variables, and system m a i n t e n a n c e variables. The thrust of the present s t u d y was to d e t e r m i n e the feasibility of using the COPES for assessing halfway houses for the retarded. Two basic issues are raised: (1) Can the mentally r e t a r d e d m e a n i n g f u l l y r e s p o n d to the questionnaire items, and (2) will the results be m e a n i n g f u l on existing norms. The current n o r m s are based mostly o n mentally d i s t u r b e d veterans and no programs for the retarded were included.
* Dr. Pankratz is with the Psychology Service, VeteransAdministration Hospital, Portland, Oregon 97207. He is also associated with the Gutman Rehabilitation Programs in Portland, Oregon. The author wishes to thank Douglas Johnson and Jacki Stalder for their assistance in collecting data. Community Mental Health Journal, Vol. 11 (3), 1975
341
342
Community Mental Health Journal
METHOD
The Setting T h e two halfway h o u s e s for t h e retarded are similar in p h y s i c a l a s p e c t s as well as operation. Both are large, older h o m e s in a transitional section of a m e t r o p o l i t a n area. T h e y were d e s i g n e d to help r e s i d e n t s w i t h a w i d e variety of social, behavioral, a n d vocational p r o b l e m s . T h e a v e r a g e l e n g t h of stay is a b o u t 8 m o n t h s , w h e n r e s i d e n t s m o v e into less struct u r e d r o o m a n d b o a r d s i t u a t i o n s or a p a r t m e n t s . The two h o u s e s w e r e c o n s i d e r e d ideal for the s t u d y b e c a u s e the p r o g r a m s are well established. T r e a t m e n t p l a n s are m a d e in an o p e n arena, so there is general a g r e e m e n t a m o n g t h e staff a b o u t the n a t u r e of the p r o g r a m .
Subjects Both r e s i d e n t s a n d staff were a s s e s s e d on the s a m e i n s t r u m e n t . Table 1 p r e s e n t s the age a n d l e n g t h of i n s t i t u t i o n a l i z a t i o n for the residents. M o s t were f u n c t i o n i n g at t h e mild a n d m o d e r a t e r a n g e of retardation, w i t h one male a n d one female in the borderline range. All h a d s o m e degree of b e h a v i o r a l a n d vocational p r o b l e m s . The staff were p e r s o n s i n v o l v e d in the care of the retarded r e s i d e n t s . T h e y i n c l u d e d b o t h e m p l o y e e s of the halfway h o u s e s a n d p e r s o n s from public a g e n c i e s p r o v i d i n g service. It s h o u l d be n o t e d that s o m e were i n v o l v e d w i t h the daily o p e r a t i o n of the p r o g r a m a n d that o t h e r s were m o r e peripherally a c q u a i n t e d .
The Measure. T h e a t t i t u d e s t o w a r d the psychosocial e n v i r o n m e n t w e r e m e a s u r e d by the 102-item COPES. Each i t e m r e q u i r e s only a true or false r e s p o n s e . The q u e s t i o n n a i r e is scored into 10 subscales. Each q u e s t i o n w a s read i n d i v i d u a l l y to each resident. Q u e s t i o n s were r e w o r d e d or parap h r a s e d at the e x a m i n e r ' s discretion if the r e s i d e n t s e e m e d c o n f u s e d .
RESULTS A N D D I S C U S S I O N Figures 1 a n d 2 s h o w h o w the staff a n d r e s i d e n t s of the two h o u s e s c o m p a r e d w i t h the 20 psychiatric c o m m u n i t y p r o g r a m s in the n o r m group. I n s p e c t i o n of these g r a p h s indicate general a g r e e m e n t b e t w e e n staff a n d residents a b o u t the nature of the p r o g r a m . The average subscale score of the staff w a s c o m p a r e d w i t h the average subscale of the residents. These difference scores for the 10 subscales a g a i n dramatically revealed that the staff a n d r e s i d e n t s w e r e in a g r e e m e n t a b o u t the nature of the p r o g r a m . The m e a n difference score (in absolute values) for the w o m e n ' s h o u s e w a s 1.20, a n d the m e a n difference score for the m e n ' s h o u s e w a s 1.53. The greatest d i s a g r e e m e n t b e t w e e n residents a n d staff w a s at the h o u s e for
TABLE 1
Age and Length of Institutionalization of Resident Subjects AG.__.KE !RESIDENT iffales Females
09
Mean
Range 18-36
22,5
ken!th of I n s t l t u t_i o n a l i z a t l o n = 0; o t h e r s • - 14.0 y e a r s I
25.5
19-32
O; others X
]2.0 years
Loren Pankratz
343
FIGURE 1 Standard Score Comparison of Subscales
(House for Males) q
q
q
O
Program Involvemen
Suppor
,D
-..
1I 1I rt
Spontane~t v
Autonom~
Practical Or lentat~On /// i ,/ /
Personal Problem
I
0 rlentatlon .
I
Anger and Agressior,
Order and Ocgan~zat~on
Program Clarity
:i w
~O
Start Cuntro~
males. The residents scored l o w e r than the staff o n the variables of "program i n v o l v e m e n t " and "support." There is a r e a s o n a b l e e x p l a n a t i o n for this discrepancy. The test w a s a d m i n i s t e r e d at a time w h e n the h o u s e p a r e n t s w e r e n e w . Additionally, s o m e residents w e r e o u t of jobs and w a n t e d to leave. H o w e v e r , the temporary set back apparently did not effect the resident's v i e w of the total program. In fact, o n e resident told his h o u s e p a r e n t that he decided to stay after a n s w e r i n g the q u e s t i o n n a i r e . The results s e e m c o n g r u e n t b e t w e e n h o u s e s and b e t w e e n residents and staff. This s u g g e s t s that the residents did, in fact, u n d e r s t a n d the q u e s t i o n -
344
Community Mental Health Journal
FIGURE 2
Standard Score Comparison of Subscales (House for Females) q
q
q
q
O
q
q
Program Involvement /' /
Support
Spontanett y
Autonomy
Practical Or ~entallon
Persona# Problem Orientation
Anger and Agress~on
Order and Organtzatton
/"
I
Program Clartt y ~n
Z
Z
Staff Control
naire. Experimenter bias is unlikely to a c c o u n t for the a g r e e m e n t since different persons a d m i n i s t e r e d the test to the residents. Additionally, n o n e w a s acquainted w i t h the staff or the program. The COPES description of the t w o h o u s e s for the retarded s e e m to fit neatly on the existing psychiatric n o r m s . Additionally, the subscales provided no surprises for those w h o k n e w the program. The graphed results appeared to describe the program adequately. The staff control subscale w a s the o n l y o n e that e x c e e d e d three standard deviations. This s u g g e s t s that staff are m o r e controlling w i t h the m e n t a l l y retarded than w i t h the m e n t a l l y disturbed. This subscale m a y present a ceiling
Loren Pankratz
345
effect on future studies on the retarded; that is, all q u e s t i o n s on the staff control subscale will be a n s w e r e d in one direction, p r o v i d i n g no variability bet w e e n programs. These e n c o u r a g i n g results lead to a r e c o m m e n d a t i o n of the COPES for assessing p r o g r a m s for the mentally retarded. This scale has several features that s h o u l d make it valuable. First, it is not often that c o n s u m e r s of mental health services are asked for their imput. The COPES allows the retarded to p r o v i d e feedback regarding their treatment. Otto and Moos (1973) have s u g g e s t e d that the COPES can be used to describe p r o g r a m s a d e q u a t e l y for p e r s o n s w h o m a y w a n t to make referrals. They have also gathered some i n f o r m a t i o n r e g a r d i n g p r o g r a m expectation and s u b s e q u e n t p e r f o r m a n c e (Otto & Moos, 1974). Finally, there is a parallel version of the COPES for assessing hospital w a r d e n v i r o n m e n t (Moos & Houts, 1968). This makes it possible to c o m p a r e directly inhospital and o u t - o f - h o s p i t a l programs. U s i n g b o t h scales w o u l d provide some evidence that a halfway h o u s e was, in fact, h a l f w a y to i n d e p e n dent c o m m u n i t y life. REFERENCES Apte, R. Halfway houses. London: Bell and Sons, 1968. Kushlick, A. Care of the mentally subnormal. Lancet, 1969, 1196-1197. Moos, R. Assessment of the psychosocial environments of community-oriented psychiatric treatment programs. Journal of Abnormal Psychology, 1972, 79, 9-18. Moos, R., & Houts, P. Assessment of the social atmospheres of psychiatric wards. Journal of Abnormal Psychology, 1968, 73, 595-604. Otto, J., & Moos, R. Evaluating descriptions of psychiatric treatment programs. American Journal of Orthopsychiatry, 1973, 43, 401-410. Otto, J., & Moos, R. Patient expectations and attendance in community treatment programs. Community Mental Health Journal, 1974, 10, 9-15.
ABSTRACT: The Community-Oriented Programs Environment Scale (COPES) was used to assess the psychosocial environment of two halfway houses for the mentally retarded. Residents of the houses were individually asked each question and the staff completed the same scale. Results showed general agreement between staff and residents, suggesting that the retarded were adequately able to describe their treatment program. The results were meaningfully graphed on the existing norms for the mentally disturbed.
The idea of a halfway h o u s e is to p r o v i d e a transitional living situation b e t w e e n a more structured situation (like an institution) and more i n d e p e n d e n t living (like an apartment). The halfway h o u s e m u s t certainly be more than merely a living situation away from the institution. It must also be halfway in terms of vocational adjustment, social living, and psychological support. Ideally, it w o u l d be s u p p o r t i v e only insofar as the resident n e e d s assistance and w o u l d gradually allow the resident more selfdetermination. The psychological and social e n v i r o n m e n t is an i m p o r t a n t aspect of the halfway house. For example, one s t u d y revealed that 15 out of 25 "transitional hostels" for the mentally ill had a more restrictive social e n v i r o n m e n t than the least restrictive hospital w a r d (Apte, 1968). A n o t h e r s t u d y e x a m i n e d the e n v i r o n m e n t of hospitals and residential care facilities for the retarded. In all cases there was evidence of antitherapeutic measures of r e g i m e n t a t i o n , block treatment, depersonalization, and social distance (Kushlick, 1969). Recently Moos (1972) d e v e l o p e d a q u e s t i o n n a i r e to assess the psychosocial e n v i r o n m e n t of halfway houses, day programs, sheltered w o r k s h o p s , and rehabilitation centers. This scale is k n o w n as the C o m m u n i t y - O r i e n t e d Programs E n v i r o n m e n t Scale (COPES). Its 10 subscales a t t e m p t systematically to assess relationship variables, p r o g r a m variables, and system m a i n t e n a n c e variables. The thrust of the present s t u d y was to d e t e r m i n e the feasibility of using the COPES for assessing halfway houses for the retarded. Two basic issues are raised: (1) Can the mentally r e t a r d e d m e a n i n g f u l l y r e s p o n d to the questionnaire items, and (2) will the results be m e a n i n g f u l on existing norms. The current n o r m s are based mostly o n mentally d i s t u r b e d veterans and no programs for the retarded were included.
* Dr. Pankratz is with the Psychology Service, VeteransAdministration Hospital, Portland, Oregon 97207. He is also associated with the Gutman Rehabilitation Programs in Portland, Oregon. The author wishes to thank Douglas Johnson and Jacki Stalder for their assistance in collecting data. Community Mental Health Journal, Vol. 11 (3), 1975
341
342
Community Mental Health Journal
METHOD
The Setting T h e two halfway h o u s e s for t h e retarded are similar in p h y s i c a l a s p e c t s as well as operation. Both are large, older h o m e s in a transitional section of a m e t r o p o l i t a n area. T h e y were d e s i g n e d to help r e s i d e n t s w i t h a w i d e variety of social, behavioral, a n d vocational p r o b l e m s . T h e a v e r a g e l e n g t h of stay is a b o u t 8 m o n t h s , w h e n r e s i d e n t s m o v e into less struct u r e d r o o m a n d b o a r d s i t u a t i o n s or a p a r t m e n t s . The two h o u s e s w e r e c o n s i d e r e d ideal for the s t u d y b e c a u s e the p r o g r a m s are well established. T r e a t m e n t p l a n s are m a d e in an o p e n arena, so there is general a g r e e m e n t a m o n g t h e staff a b o u t the n a t u r e of the p r o g r a m .
Subjects Both r e s i d e n t s a n d staff were a s s e s s e d on the s a m e i n s t r u m e n t . Table 1 p r e s e n t s the age a n d l e n g t h of i n s t i t u t i o n a l i z a t i o n for the residents. M o s t were f u n c t i o n i n g at t h e mild a n d m o d e r a t e r a n g e of retardation, w i t h one male a n d one female in the borderline range. All h a d s o m e degree of b e h a v i o r a l a n d vocational p r o b l e m s . The staff were p e r s o n s i n v o l v e d in the care of the retarded r e s i d e n t s . T h e y i n c l u d e d b o t h e m p l o y e e s of the halfway h o u s e s a n d p e r s o n s from public a g e n c i e s p r o v i d i n g service. It s h o u l d be n o t e d that s o m e were i n v o l v e d w i t h the daily o p e r a t i o n of the p r o g r a m a n d that o t h e r s were m o r e peripherally a c q u a i n t e d .
The Measure. T h e a t t i t u d e s t o w a r d the psychosocial e n v i r o n m e n t w e r e m e a s u r e d by the 102-item COPES. Each i t e m r e q u i r e s only a true or false r e s p o n s e . The q u e s t i o n n a i r e is scored into 10 subscales. Each q u e s t i o n w a s read i n d i v i d u a l l y to each resident. Q u e s t i o n s were r e w o r d e d or parap h r a s e d at the e x a m i n e r ' s discretion if the r e s i d e n t s e e m e d c o n f u s e d .
RESULTS A N D D I S C U S S I O N Figures 1 a n d 2 s h o w h o w the staff a n d r e s i d e n t s of the two h o u s e s c o m p a r e d w i t h the 20 psychiatric c o m m u n i t y p r o g r a m s in the n o r m group. I n s p e c t i o n of these g r a p h s indicate general a g r e e m e n t b e t w e e n staff a n d residents a b o u t the nature of the p r o g r a m . The average subscale score of the staff w a s c o m p a r e d w i t h the average subscale of the residents. These difference scores for the 10 subscales a g a i n dramatically revealed that the staff a n d r e s i d e n t s w e r e in a g r e e m e n t a b o u t the nature of the p r o g r a m . The m e a n difference score (in absolute values) for the w o m e n ' s h o u s e w a s 1.20, a n d the m e a n difference score for the m e n ' s h o u s e w a s 1.53. The greatest d i s a g r e e m e n t b e t w e e n residents a n d staff w a s at the h o u s e for
TABLE 1
Age and Length of Institutionalization of Resident Subjects AG.__.KE !RESIDENT iffales Females
09
Mean
Range 18-36
22,5
ken!th of I n s t l t u t_i o n a l i z a t l o n = 0; o t h e r s • - 14.0 y e a r s I
25.5
19-32
O; others X
]2.0 years
Loren Pankratz
343
FIGURE 1 Standard Score Comparison of Subscales
(House for Males) q
q
q
O
Program Involvemen
Suppor
,D
-..
1I 1I rt
Spontane~t v
Autonom~
Practical Or lentat~On /// i ,/ /
Personal Problem
I
0 rlentatlon .
I
Anger and Agressior,
Order and Ocgan~zat~on
Program Clarity
:i w
~O
Start Cuntro~
males. The residents scored l o w e r than the staff o n the variables of "program i n v o l v e m e n t " and "support." There is a r e a s o n a b l e e x p l a n a t i o n for this discrepancy. The test w a s a d m i n i s t e r e d at a time w h e n the h o u s e p a r e n t s w e r e n e w . Additionally, s o m e residents w e r e o u t of jobs and w a n t e d to leave. H o w e v e r , the temporary set back apparently did not effect the resident's v i e w of the total program. In fact, o n e resident told his h o u s e p a r e n t that he decided to stay after a n s w e r i n g the q u e s t i o n n a i r e . The results s e e m c o n g r u e n t b e t w e e n h o u s e s and b e t w e e n residents and staff. This s u g g e s t s that the residents did, in fact, u n d e r s t a n d the q u e s t i o n -
344
Community Mental Health Journal
FIGURE 2
Standard Score Comparison of Subscales (House for Females) q
q
q
q
O
q
q
Program Involvement /' /
Support
Spontanett y
Autonomy
Practical Or ~entallon
Persona# Problem Orientation
Anger and Agress~on
Order and Organtzatton
/"
I
Program Clartt y ~n
Z
Z
Staff Control
naire. Experimenter bias is unlikely to a c c o u n t for the a g r e e m e n t since different persons a d m i n i s t e r e d the test to the residents. Additionally, n o n e w a s acquainted w i t h the staff or the program. The COPES description of the t w o h o u s e s for the retarded s e e m to fit neatly on the existing psychiatric n o r m s . Additionally, the subscales provided no surprises for those w h o k n e w the program. The graphed results appeared to describe the program adequately. The staff control subscale w a s the o n l y o n e that e x c e e d e d three standard deviations. This s u g g e s t s that staff are m o r e controlling w i t h the m e n t a l l y retarded than w i t h the m e n t a l l y disturbed. This subscale m a y present a ceiling
Loren Pankratz
345
effect on future studies on the retarded; that is, all q u e s t i o n s on the staff control subscale will be a n s w e r e d in one direction, p r o v i d i n g no variability bet w e e n programs. These e n c o u r a g i n g results lead to a r e c o m m e n d a t i o n of the COPES for assessing p r o g r a m s for the mentally retarded. This scale has several features that s h o u l d make it valuable. First, it is not often that c o n s u m e r s of mental health services are asked for their imput. The COPES allows the retarded to p r o v i d e feedback regarding their treatment. Otto and Moos (1973) have s u g g e s t e d that the COPES can be used to describe p r o g r a m s a d e q u a t e l y for p e r s o n s w h o m a y w a n t to make referrals. They have also gathered some i n f o r m a t i o n r e g a r d i n g p r o g r a m expectation and s u b s e q u e n t p e r f o r m a n c e (Otto & Moos, 1974). Finally, there is a parallel version of the COPES for assessing hospital w a r d e n v i r o n m e n t (Moos & Houts, 1968). This makes it possible to c o m p a r e directly inhospital and o u t - o f - h o s p i t a l programs. U s i n g b o t h scales w o u l d provide some evidence that a halfway h o u s e was, in fact, h a l f w a y to i n d e p e n dent c o m m u n i t y life. REFERENCES Apte, R. Halfway houses. London: Bell and Sons, 1968. Kushlick, A. Care of the mentally subnormal. Lancet, 1969, 1196-1197. Moos, R. Assessment of the psychosocial environments of community-oriented psychiatric treatment programs. Journal of Abnormal Psychology, 1972, 79, 9-18. Moos, R., & Houts, P. Assessment of the social atmospheres of psychiatric wards. Journal of Abnormal Psychology, 1968, 73, 595-604. Otto, J., & Moos, R. Evaluating descriptions of psychiatric treatment programs. American Journal of Orthopsychiatry, 1973, 43, 401-410. Otto, J., & Moos, R. Patient expectations and attendance in community treatment programs. Community Mental Health Journal, 1974, 10, 9-15.
