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Biomedical subjects

E L Bassuk

Publications and source records attributed to E L Bassuk.

At least 37 records · Page 2Linked to original sources
PubMed1993

Homeless pregnant women: two generations at risk.

The impact of pregnancy on the course of homelessness and the adverse effects of homelessness on pregnant women and their babies are explored. Recommendations for policy to address the urgent needs of this population are offered, and components of an innovative three-site demonstration program are described.

Adult↗
PubMed1990

Supportive housing for the chronically mentally ill. Matching clients with community environments.

The need for permanent housing for the chronically mentally ill has received a great deal of attention over the last several years. One response to the problem has been the development of supportive housing, that is, non-facility-based permanent homes with placement based on clients' functional capabilities and preferences. However, little research has focused on assessing the match between clients and environmental requirements. This study begins to identify the social and clinical characteristics of clients that contribute to selection into different types of housing environments. Ninety-one clients were sampled from the supportive housing services of a major provider in two New England states. Logistic regression was used to estimate the probability that clients will be placed into apartments vs. other, more restricted settings, based on their clinical and social characteristics. Findings show that the primary determinants of placement were clinical severity, early family history, and adequacy of family support. The less severely ill and better functioning the client, the more likely that he or she was placed in an apartment. This was mitigated, however, by the availability and adequacy of family support. In addition, clients with early family disruptions were also less likely to be placed in apartments. Findings are discussed in light of their implications for providing permanent housing placements for chronically mentally ill persons and for factors in future research to evaluate the success of placement.

Adult↗
PubMed1990

Psychosocial characteristics of homeless children and children with homes.

A comparison was made of 86 children from 49 homeless Boston families headed by women and 134 children from 81 housed Boston families headed by women. In both groups, the mothers were poor, currently single, and had been receiving welfare payments for long periods. Data were collected from the mothers by personal interview; standardized tests were administered to mothers and children (Denver Developmental Screening Test, Simmons Behavior Checklist, Children's Depression Inventory, Children's Manifest Anxiety Scale, and Child Behavior Checklist. The data indicate that many homeless children and poor children with homes have severe and pressing problems. Among preschool children, a higher proportion of homeless children than poor children with homes had one or more developmental delays (P less than .05), although their scores on the Simmons Behavior Checklist were similar. Among school-aged children, the scores of the homeless children were worse than those of the children with homes on the Children's Depression Inventory, Children's Manifest Anxiety Scale, and the Child Behavior Checklist, but only the difference on the Anxiety Scale approached statistical significance (P = .06). Both homeless children and poor children with homes generally had worse scores than most other comparison groups of children. Unless action is taken to improve the lot of all these children, it is likely that many will continue to have significant problems that will seriously hamper their ability to function.

Affective Symptoms↗
PubMed1990

Health care of homeless families. A growing challenge for family medicine.

The number of homeless families in the United States is growing at an alarming rate. Homeless families are at an increased risk for numerous medical conditions and have complex health and psychosocial needs. In response to the growing crisis, policymakers have generally focused on families' immediate needs rather than developing a comprehensive long-term response. Health programs have been challenged to develop effective methods of providing outreach and comprehensive, continuous, coordinated services. Family medicine is uniquely qualified to meet the health care needs of homeless families and can play an important role in providing clinical service, designing medical education, developing research, and defining a national advocacy agenda.

Family↗
PubMed1988

Identifying catastrophic psychiatric cases. Targeting managed-care strategies.

Case management programs, a specialized form of utilization review (UR), focus their interventions on catastrophic cases, which comprise the minority of patients while accounting for the majority of costs. Many case management programs base their case identification and review criteria on diagnosis alone, although research has shown that it is a poor predictor of length of stay. Using claims data from a large nationwide insurer, the authors developed an empirical approach to identifying potentially catastrophic cases. The findings suggest that, in addition to diagnosis, other factors such as age and treatment setting contribute to long stays and high costs and thus should be used to identify catastrophic cases for case management interventions. Strategies to target case management programs must be considered not only in light of their impact on cost but on the quality of care for individual patients.

Adolescent↗
PubMed1988

Why does family homelessness occur? A case-control study.

We compared 49 homeless female-headed families with 81 housed female-headed families in Boston. Most housed families were living in public or private subsidized housing. In both groups the mothers were poor, currently single, had little work experience, and had been on welfare for long periods. Many of their children had serious developmental and emotional problems. Homeless mothers had more frequently been abused as children and battered as adults and their support networks were fragmented; the housed mothers had female relatives and extended family living nearby whom they saw often. The frequency of drug, alcohol, and serious psychiatric problems was greater among the homeless mothers. The homeless mothers may have been more vulnerable to the current housing shortage because they lacked support in time of need. This, in turn, may have been due to their history of family violence. Psychiatric disabilities may have been another contributing factor in the minority of homeless women. The notion that a "culture of poverty" accounts for homelessness was not supported by the data since the homeless were less likely to have grown up in families on welfare. The data suggest that solutions to family homelessness in the current housing market require an increase in the supply of decent affordable housing, income maintenance, and assistance from social welfare agencies focused on rebuilding supportive relationships.

Adult↗
PubMed1986

Characteristics of sheltered homeless families.

To describe the characteristics of homeless families, we interviewed 80 homeless mothers and 151 children living in 14 family shelters in Massachusetts (two-thirds of the shelters in the state). Ninety-four per cent of the families were headed by women, 91 per cent were on AFDC (aid to families with dependent children), with twice as many as the state average having been on AFDC for at least two years; most had long histories of residential instability. Although 60 per cent had completed high school, only a third had worked for longer than one month. One-third of the mothers reported having been abused during their childhood, and two-thirds had experienced a major family disruption. At the time of the interview, almost two-thirds either lacked or had minimal supportive relationships and one-fourth of these named their child as the major support. Eighteen mothers were involved with the Department of Social Services because of probable child abuse or neglect. Seventy-one per cent of the mothers had personality disorders. In contrast to many adult homeless individuals, however, deinstitutionalized persons or those suffering from psychoses were not overrepresented. About 50 percent of the homeless children were found to have developmental lags, anxiety, depression, and learning difficulties, and about half required further psychiatric evaluation. Two-thirds described housing and social welfare agencies as not helpful. Given the many serious problems of the mothers and the difficulties already manifested by their children, comprehensive psychosocial and economic interventions must be made to interrupt a cycle of extreme instability and family breakdown.

Adolescent↗
PubMed1985

Former state hospital patients in private general hospital psychiatric emergency settings.

Increasing numbers of patients formerly hospitalized in state facilities are using private general hospital psychiatric emergency services. To define their clinical needs, the authors compared the characteristics of patients hospitalized in state institutions to those hospitalized privately and to those never hospitalized. They found that two discrete clinical groups exist: those from state and those from private systems. Clinicians reacted most negatively to former state patients. This was also reflected by differences in the dispositions of voluntary patients from the emergency room. Those not hospitalized or privately hospitalized were more likely than former state hospitalized patients to be sent to private facilities.

Adult↗
PubMed1985

The diagnosis and treatment of psychiatric emergencies.

Although the majority of psychiatric patients present to the ER in chronic crisis, the clinician should also be familiar with the assessment and management of acute emergencies. Because emergency patients reflect the entire spectrum of psychiatric psychopathology, the primary care physician should consult with a mental health clinician whenever possible. Following a medical model, a thorough diagnostic evaluation should be completed and specific treatment initiated. Most often, the treatment consists of some combination of psychological, pharmacologic, and physical approaches.

Anxiety Disorders↗