Patient Profile Findings Show
Serious Client Impairments
Adult patients who turn to the clinics of JBFCS's Madeleine Borg Community Services typically suffer from serious impairment in every major life sector. While the difficulties they experience are long-term and persistent, at the time when they turn to MBCS they are on a trajectory toward servere demoralization. Child patients in nearly all cases suffer from serious to servere problems in multiple spheres of life, including family, school, peer and intrapersonal difficulties. Families served by the agency tend to be quite isolated, and what contacts they have with other systems tend to be aversive rather than supportive.
These findings, from the Patient Profile Study, were recently released by Robert Abromovitz, M.D., Chief Psychiatrist, and Bruce Grellong, Ph.D., Chief Psychologist, JBFCS, Principal Clinical Inverstigators for the study, and Mark Mattaini, D.S.W., CUSSW, Principal Research Investigator. In this descriptive study, data were provided by MBCS clinical staff for 875 cases seen at least three times by the agency. They were selected on a random basis from the total MBCS client population, and thus constitute a representative sample. In addition to the Principal Investigators, 168 clinicians from the agency participated in the study, as did many other agency staff including the MBCS unit directors under the supervision of Morris Black, C.S.W., Director of Community Services. Also vital was the technical assistance provided by the Quality Assurance Staff.
Substantial intergenerational patterns of serious psychosocial problems were discovered among the adult population. For example, more than eighty percent of adult patients came from families of origin in which significant marital and parent-child problems were present, and forty-four percent were abused or neglected as children (seventeen percent had been sexually abused). Forty percent had a history of sigificant school and work performance problems.
At the time of intake, most of the patients who were married or living as married were experiencing significant problems in their own families, and in other relationships. Two-thirds were impaired seriously enough to interfere to a considerable degree with the ability to cope with everyday roles and activities. Eighty-seven percent presented with clinically significant depression, almost half at a servere level; more than half also manifested serious anxiety. Substantial co-morbidity was discovered, with about two-thirds of the adult patients suffering from personality disorders, usually in conjunction with another disorder, often depression. About a quarter of the patients also suffer from serious medical problems, in addition to the psychosocial difficulties they experienced. Nearly half experienced a servere, extreme, or catastrophic level of overall psychosocial stressors at the time of intake, a pattern that held for the child patients seen as well.
While most families represented in the population experience serious external and internal difficulties, ranging from workplace and financial problems to substance abuse and medical disabilities, eight distinct clusters of household types were identified in the study. Two of these family clusters are represented in the figure below, including one large group of families that are very isolated, with limited interaction with each other or the environment, and a second cluster of "multi-problem" families who experience an exceptionally high level of negatives from all systems.
Overall, the data suggest that patients seen by the MBCS are experiencing serious trouble functioning in all areas, an overwhelming level of household conflict, external stressors, and intrapsychic pain, and are turning to the agency at a time of great need. The data indicate that most patient difficulties appear to moderate with treatment. Profiles of five distinct clusters of adult patients, and two of child patients, as well as the eight family clusters, also emerged from the data. The robust database resulting from the Patient Profile Study is already proving useful for program planning. The full report will be available by December 1990.