Managing MICA clients in a modified therapeutic community with enhanced staffing

To determine how effective a modified therapeutic community (TC) with enhanced mental health staffing would be in treating mentally ill chemical abusing (MICA) clients in a "mainstream" program, Project Return Foundation, Inc. (PRF) conducted a treatment outcome evaluation study involving 438 residents. Client admissions were screened by mental health specialists for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) diagnoses and then placed into one of three diagnostic groups: non-MICA; general MICA (not requiring psychotropic medication); and, severe MICA (requiring psychotropic medication). Clients were administered the Tennessee Self-Concept Scale (TSCS; Roid & Fitts, 1991) after admission and at 6-month intervals thereafter. Results indicated that: (a) the three diagnostic groups were significantly different at initial TSCS testing, with the non-MICA group evidencing the least lowest measures of self-esteem and lesser degrees of psychopathology; the severe MICA group had the lowest psychological scores; (b) all three diagnostic groups showed significant improvement in their TSCS scores after 6 to 7 months of treatment; (c) covariance analyses observed that the three diagnostic groups did not significantly differ at 6 month testing when the initial TSCS testing was taken into account; and, (d) significant gender differences on several TSCS scales were noted, in that women scored lower than men in self-esteem and higher than men in psychopathology. Research limitations and clinical observations are considered.