Effectiveness and cost of specific treatment elements in a program for homeless mentally ill veterans

OBJECTIVES: The study examined relationships between specific treatment elements and their costs and ten outcome measures using data from a longitudinal outcome study of a Veterans Affairs program for homeless mentally ill veterans. METHODS: Baseline and outcome data over an eight-month period were analyzed for 406 homeless veterans with psychiatric and substance use disorders who were treated in VA's Homeless Chronically Mentally Ill Veterans Program. Multivariate techniques were used to examine the relationship between ten measures of outcome and six treatment elements: program entry via community outreach, the number of contacts with program clinicians, the number of referrals for other services, duration of program involvement, number of days of residential treatment, and increased public support payments. RESULTS: Each of the six treatment elements was significantly related to improvement on at least one of the ten outcome measures. The number of clinical contacts with program staff and the number of days in residential treatment were associated with improvement in the greatest number of outcome domains. However, improvement associated with residential treatment was far more costly than improvement related to other treatment elements. CONCLUSION: This study provides evidence of the effectiveness of a multimodal approach to the treatment of homeless mentally ill persons. However, results indicate that special attention should be paid to to differences in the cost of improvement associated with various treatment elements.     

Using demographic data in a primary prevention substance abuse program for teenagers and parents.

Collected demographic data by 2 questionnaire surveys from 402 high school students (aged 16–19 yrs) and 266 parents to plan a low-cost, community-based adolescent substance abuse program. Information about teens' drug use, attitudes, alternative activities, and preferred helping resources was compared to parents' knowledge of and attitudes toward their children's drug use. Two programs were planned. The teen program emphasized peer support, drug education before age 16 yrs, the school's drug milieu, sex differences in drug attitudes and use, and the role of religious institutions in prevention. Since parents were almost totally unaware of their children's drug use, the parent program focused on drug information and development of communication skills with teens. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing substance abuse treatment needs among the homeless: a telephone-based interactive voice response system

OBJECTIVES: We report on a pilot project that used a telephone-based interactive voice response system accessed by cellular phones at diverse sites, to interview homeless persons on their need for alcohol and other drug treatment. METHODS: Using this technique we surveyed 207 homeless adults at eight shelters in Cleveland, Ohio. RESULTS: The cellular approach was comparable to human-administered interviews in reliability and validity and yielded higher self-reported levels of drug use. CONCLUSIONS: Cellular telephones and interactive voice response interviewing systems can be useful tools in assessing for the health-service needs of difficult-to-reach populations.     

Patient treatment choice and compliance. Data from a substance abuse treatment program

Conservative surgery (CS) is widely accepted today as the treatment of choice for 60 to 80% of the primary breast cancer. Esthetic results of CS are not good in all the cases and improvement can be obtained thanks to the remodelling of the breast after tumorectomy. The scar should be selected according to the location of the tumor; the glandular tissue should be reshaped using local glandular flaps or following the principles of the reduction mammaplasties. Tumorectomy located in the upper part of the gland can be reshaped with an inferior pedicle type of mammoplasty. Defect located in the inferior part of the gland can be reconstructed with a superior pedicle mammoplasty. These sophisticated tumorectomies are providing good esthetic results on the reconstructed breast but require commonly a symmetry procedure on the contralateral breast. Such contralateral reduction allows a better exploration of the opposite breast and histological examination of the reduction specimen. In a series of 76 CS performed at the European Institute of Oncology (IEO), which were associated with some kind of plastic procedure to lower the risk of bad cosmetic results (representing 25% of the CS associated with plastic surgery), we confirmed the value of the mixed oncologic and plastic approach. The esthetic results observed in this series are better than those observed in another series previously published at the Gustave-Roussy Institute (IGR)--good results: 72% (IEO) vs 50% (IGR), and bad results: 6% (IEO) vs 20% (IGR). Statistically such comparison can be criticised, specially because of the short follow-up of the Milan series. However, the difference is rather important if we consider that the series of Milan was a selection of cases with poor esthetic expectation (25% of all the CS performed during the same period), while the series of Paris did not select the patients in what concerns the risk of poor esthetic result.     

Sensation Seeking Scales and consumer satisfaction with a substance abuse treatment program

Satisfaction of 119 addicts with an addiction treatment program was measured by an 11 item satisfaction scale. The scale's internal consistency was acceptable (Cronbach's alpha = .75). The total satisfaction score was weakly but significantly correlated with Zuckerman's Sensation Seeking scales: Those with higher scores on the Boredom Susceptibility scale (i.e., those easily bored) reported less satisfaction, whereas those with higher scores on Thrill and Adventure Seeking scale (i.e., risk, adventure, and thrill seekers) reported higher levels of treatment satisfaction. Older patients were more satisfied with the feedback they received from their psychological tests and also with staff's respect for their rights.     

Impact of assertive community treatment on homeless persons with co-occurring severe psychiatric and substance use disorders

To investigate the possibility of engrafting fetal liver hematopoietic cells by in utero intraperitoneal transplantation, we transplanted donor cells obtained from mouse fetuses at 13, 15 and 17 days of gestation to mouse fetuses at 15, 16 and 17 days of gestation. Engraftment was assessed by Sry gene amplification of DNA extracted from peripheral blood samples of transplanted mice six weeks after birth. In comparison, we performed an in vitro colony-assay of fetal liver cells at 13, 15, and 17 days of gestation. The incidence of engraftment was significantly higher in cells of 15 days of gestation than in cells of 13 or 17 days of gestation, whereas the colony forming activity decreased gradually from 13 to 15 days of gestation. From these results, we suggest that the 15 day liver contains hematopoietic progenitors which have the specific characteristics required for engraftment by intraperitoneal transplantation.     

Day treatment with contingency management for cocaine abuse in homeless persons: 12-month follow-up.

Abstinence, employment, and homelessness treatment outcomes at 12-month follow-up are presented from a study comparing behavioral day treatment plus abstinence-contingent housing and work therapy with behavioral day treatment only among homeless persons who abuse crack cocaine. Within-group improvements were revealed, but group differences for drug abstinence found in J. B. Milby et al. (2000) failed to persist at 12 months. Drug use measurement and treatment termination explanations are discussed. Within- but not between-group differences were found for employment and homelessness outcomes at long-term follow-up. Research extending abstinence contingencies and continuous drug use monitoring is recommended. Questions about effectiveness of contingency management alone, role of coexisting psychiatric disorders on treatment outcome, and individualized treatment dosing are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcome evaluation findings of a Hawaiian culture-based adolescent substance abuse treatment program.

As part of efforts to identify effective culturally appropriate treatment for Hawaiian and Asian and Pacific Islander adolescents with substance abuse and co-occurring disorders, this evaluation research sought to assess the efficacy of the I Mua Mau Ohana program. This long-term residential program combined culturally based experiential learning/therapy, education, spirituality, counseling, and family involvement. Participants were interviewed at intake and followed up at 3, 6, and 12 months using the Government Performance and Results Act (GPRA) Tool and the Global Appraisal of Individual Needs (GAIN) instruments. Results showed long-term improvement in substance use and related problems, decreased criminal justice involvement, and improved mental health and social functioning, while showing positive trends in education and employment. However, unexpected findings were revealed in family functioning. Although promising, further research is needed to substantiate the program's effectiveness and possibility of being considered an evidence-based program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The homeless assessment program: A service-training model for providing disability evaluations for homeless, mentally ill individuals.

Many of the nation's homeless people suffer from unrecognized mental illnesses and do not have access to the kind of disability benefits they would be entitled to when properly assessed. The current system of disability evaluations for Social Security income claims is frequently inadequate and leaves these individuals without any source of income, health insurance, and mental health treatment. This article introduces a model of providing psychological assessments for homeless, mentally ill individuals by supervised student examiners, a model that could be replicated by other psychologists and training institutions. The authors argue that there may be a large number of homeless adults who suffer from disabling mental conditions but who are not properly diagnosed and, therefore, do not qualify for benefits. The authors propose that the model presented can help to fill a gap in services and may serve as a model of socially relevant clinical training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term follow-up of patients who lost weight in a cognitive-behavioral treatment program.

Surveyed 111 clients 6–10 yrs after cognitive-behavioral treatment for obesity concerning their current approaches to weight control during times of maintenance, loss, and gain. When the responses of 36 Ss who had maintained their postprogram weight losses were compared to 75 Ss who gained weight, it was found that Ss who had maintained reduced weights had more carefully planned snacks with regard to time, selection, and calories, and had engaged in more regular physical exercise. The desire to eat was more frequently displaced by other activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Process and outcome in a hostel outreach program for homeless clients with severe mental illness

A longitudinal study followed 55 homeless and severely mentally ill clients of a hostel outreach program to assess outcomes and their relationship to program elements. Results at 18-month follow-up indicated that, despite chronic histories of transiency and shelter use, housing stability had been achieved, and that initial gains in social functioning and symptom reduction had been increased. Development of a strong working alliance proved a key program element in the findings.     

Effects of psychosocial and situational variables on substance abuse among homeless adults.

Finding direct and indirect influences of salient psychosocial and situational variables on problem substance use among homeless people is important in designing evidence-based, effective, and relevant interventions for this special population. A stress-coping paradigm in conjunction with situational items specialized for homeless people was used to explore predictive relationships in a sample of homeless adults (N = 664) among (a) psychosocial variables of self-esteem, social support, positive and negative coping, and emotional distress, (b) situational variables of homelessness history and quality of recent housing, and (c) outcomes of alcohol use, injection drug use (IDU), and non-IDU. Lower self-esteem predicted greater emotional distress, lower positive coping, greater negative coping, and more alcohol use. Social support predicted less emotional distress and more positive coping. Chronic homelessness predicted more emotional distress, less positive coping, greater alcohol use, and IDU. Poor housing was associated with more alcohol use and IDU. Substance abuse interventions among the homeless should have a dual focus that includes attention to psychological issues and negative coping patterns while also addressing situational, environmental factors, including encouraging provision of permanent supportive housing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Five-year follow-up to a behavioral weight-loss program.

60 participants in a behavioral weight-loss program were followed up 4.5 yrs posttreatment. An inexpensive follow-up class was associated with the recruitment of the majority of participants, and 97% of the target sample ultimately volunteered. Ss lost 4.5?±?4.7 kg from pre- to posttreatment and 3.32?±?13 kg pretreatment to follow-up. The most successful weight-loss maintainers reported adhering to behavioral procedures and being more physically active. Ss also reported pursuing 3.0?±?1.8 different types of weight-loss programs after the behavioral treatment and wished to lose a further 25?±?18 kg at follow-up. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lesbian mothers who conceived after donor insemination: a follow-up study

This study investigated the development of family relationships in lesbian families who conceived after donor insemination (DI). The main characteristics of this unknown family structure were analysed. An anonymous donor was used to conceive, the family unit consisted of two mothers and a father was non-existent, and both women had a homosexual orientation. A total of 50 lesbian couples who conceived after DI with children aged between 1 and 2 years participated in this study, using a standardized interview created for this study. After the birth of their child, 56% of the lesbian mothers (n = 100) would have wanted the identity of the donor to be registered, while 10% would have done so at the time of the insemination. Opinions differed in 12 of the 50 couples: the biological mother was in favour of identity registration while the social mother was not. Both women considered themselves a parent of the child with equally shared responsibilities. Mothers were open about the special features of their family structure with children and within their immediate social network. Only 30% disclosed their lesbian identity in a broader social environment. The features of these newly created families may influence the psychological development of the children and therefore make long-term follow-up studies indispensable.     

Pilot trial of a disclosure intervention for HIV+ mothers: The TRACK program.

Objective: The Teaching, Raising, And Communicating with Kids (TRACK) program was a longitudinal pilot-trial intervention designed to assist mothers living with HIV (MLHs) to disclose their serostatus to their young children (age 6–12 years). Method: MLH and child dyads (N = 80 dyads) were recruited and randomized to intervention or control; the intervention group had 3 individual sessions and 1 follow-up phone call. The sessions focused on preparing MLHs for disclosure through behavioral exercises using Derlega's model (V. J. Derlega, B. A. Winstead, K. Greene, J. Serovich, & W. N. Elwood, 2004) of HIV disclosure. Both MLHs and their child were assessed across multiple time points (baseline, 3, 6, and 9 months) regarding disclosure of HIV status, and specific outcome variables (i.e., relationship context, mother's health, child's mental health, and family outcomes). Results: MLHs in the intervention group were 6 times more likely to disclose their HIV status than those in the control group (OR = 6.33, 95% CI [1.64, 24.45]), with 33% disclosing in the intervention group compared with 7.3% in the control group. MLHs in the intervention group showed increases in disclosure self-efficacy across time, increased communication with their child, and improvement in emotional functioning. Children of MLHs in the intervention group exhibited reductions in depression and anxiety, and increases in happiness. Conclusions: TRACK was found to be successful in helping MLHs disclose their HIV status to their children, with positive outcomes noted for both MLHs and their children. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Evaluation of a training program for foster parents of infants with prenatal substance effects

The lack of prepared and available foster parents for children with prenatal substance effects is of increasing concern to the child welfare field. The research study reported here evaluated a multimodal inservice training program designed to enhance the competency of foster parents caring for infants with prenatal substance effects, and to promote an intent to foster such infants. Findings suggest that future foster parent training efforts in this area should focus on knowledge and skill attainment.