Methods. A cross-sectional, in-person interview survey of mentally ill veteran patients living in VA-approved B&C homes in Los Angeles, Ca. A total of 180 residents (75% response) living in 30 B&C homes participated. Measures included the Sheltered Care Environment Scale (Moos & Lemke, 1996) for social climate, and the Quality of Life Interview (Lehman, 1988) for satisfaction. Multiple regression was used to estimate the effect of B&C home size and social climate on resident satisfaction, adjusting for individual sociodemographic and illness factors, including: age, race, education, income, general health status, overall functioning, medication compliance, and symptom severity.
Results. Adjusting for individual factors, size of B&C home
had no effect on either satisfaction with living situation or life in general.
One aspect of B&C home social climate, cohesion, had a strong effect
on satisfaction with living situation (p<.001) and a moderate effect
on satisfaction with life in general (p<.05). Cohesion refers
to how helpful and supportive staff members are toward residents, and how
involved and supportive residents are with each other. The other
six aspects of social climate -- conflict, independence, self-disclosure,
organization, resident influence, and physical comfort -- showed no effect
on living situation or general life satisfaction.
Adding cohesion to a regression model containing individual factors
only increased the proportion of variance explained (adjusted R-square)
from 19 to 51% for satisfaction with living situation, and 20 to 23% for
satisfaction with life in general.
Implications. Policy makers and clinicians seeking to improve SMI patient satisfaction with living environment and life in general may do so by increasing the cohesion of B&C home living environments.
Sources of support. VA Office of Academic Affiliation predoctoral
fellowship and VA Mental Illness Research, Education & Clinical Center
research grant to first author.
Abstract
Living Environment and Treatment Outcomes Among Mentally Ill Adults
Purpose. To examine the effect of living environment on treatment outcomes of mentally ill adults. Specifically, to examine the effect of board-and-care (B&C) home size and social climate on resident satisfaction with living situation and life in general.
Methods. A cross-sectional, in-person interview survey of mentally ill veteran patients living in VA-approved B&C homes in Los Angeles, Ca. A total of 180 residents (75% response) living in 30 B&C homes participated. Measures included the Sheltered Care Environment Scale (Moos & Lemke, 1996) for social climate, and the Quality of Life Interview (Lehman, 1988) for satisfaction. Multiple regression was used to estimate the effect of B&C home size and social climate on resident satisfaction, adjusting for individual sociodemographic and illness factors, including: age, race, education, income, general health status, overall functioning, medication compliance, and symptom severity.
Results. Adjusting for individual factors, size of B&C home had no effect on either satisfaction with living situation or life in general. One aspect of B&C home social climate, cohesion, had a strong effect on satisfaction with living situation (p<.001) and a moderate effect on satisfaction with life in general (p<.05). Cohesion refers to how helpful and supportive staff members are toward residents, and how involved and supportive residents are with each other. The other six aspects of social climate -- conflict, independence, self-disclosure, organization, resident influence, and physical comfort -- showed no effect on living situation or general life satisfaction.
Adding cohesion to a regression model containing individual factors only increased the proportion of variance explained (adjusted R-square) from 19 to 51% for satisfaction with living situation, and 20 to 23% for satisfaction with life in general.
Implications. Policy makers and clinicians seeking to improve SMI patient satisfaction with living environment and life in general may do so by increasing the cohesion of B&C home living environments.