50 Years after Deinstitutionalization by Perry Brea L.;

Author:Perry, Brea L.;
Language: eng
Format: epub
Publisher: Emerald Publishing Limited
Published: 2016-07-01T00:00:00+00:00

METHODS

Sample

Structured interviews (n = 294) were completed at two urban public mental health outpatient clinics in a Northeastern City in the United States as part of a study aimed at understanding the meaning and impact of limited literacy in the lives of people with serious mental illness. Individuals aged 18 and older who received services at one of the two clinics were not under guardianship, and were capable of communicating with their mental health providers in English were eligible to participate in the study. Participants were randomly recruited by study staff, although due to clinic specific factors this was done differently at the two sites. At one clinic every fifth patient presenting for care was eligible, and at the other clinic recruitment was randomized by day of the week. A rigorous consent process was utilized with an awareness of the challenges of limited literacy and the study was fully approved by multiple Institutional Review Boards.

The interview not only assessed multiple types of literacy (reading, numeracy and aural) but also collected information about each participant that could help us understand the relationships, and explore mechanisms, among psychiatric disorders, limited literacy and mental health service utilization. This included questions about participants’ gender, race, ethnicity, immigration history, language, socioeconomic status, and education. Multiple tests of neurocognitive impairment were administered, as were measures of health care utilization, stigma, discrimination and understandings of recovery.

Assessment of social status was part of the demographic battery and included the MacArthur Scale of Subjective Social Status (the “MacArthur ladder”) to assess participants’ perception of their standing in the community (Kilpatrick & Cantril, 1960; Nicklett & Burgard, 2007). Respondents were shown a picture of a ladder with 10 rungs. They were instructed to mark an “X” on the rung that best represented where they stand in the community. The first rung (bottom rung) indicated the lowest standing in the community whereas the 10th rung (top rung) indicated the highest standing. If respondents put an “X” between two rungs, the interviewer would ask the respondent to choose the lower or higher rung. A few participants opted out of participating in the MacArthur ladder, leaving the sample size for this chapter at 276 individuals. After marking the ladder, three qualitative follow-up questions were asked to learn more about the participants’ responses. These included: “Can you tell me briefly how you thought about community when you drew the ‘X’ on the ladder?”; “Can you tell me briefly why you put yourself where you did?”; and “How do you feel about being positioned where you feel you are?”

In this chapter, we utilize data gathered from the assessments of Social Status including the quantitative data derived from the participant’s placement of the “X” on the ladder and their responses to the first two qualitative questions. Qualitative responses were read and analyzed by both authors and a coding scheme for responses was developed through an iterative process. Ultimately eight codes were created as a way to organize participants’ understandings of community and those eight codes were grouped into four emerging themes (Table 2).

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