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PubMed1997

Housing status among formerly homeless dually diagnosed adults.

OBJECTIVE: Residential outcomes of homeless adults with severe mental illness and a substance use disorder were studied over 18 months during which participants received integrated dual diagnosis services and housing supports based on a continuum model. METHODS: Interviews with 158 participants at baseline and at six-, 12-, and 18-month follow-ups assessed housing status, residential history, substance abuse and progress toward recovery, psychiatric symptoms, and quality of life. Complete data were available for 122 participants. If participants lived continuously in high-quality housing with no housing loss or nights of homelessness during the final six months of the study, they were classified as having stable housing. RESULTS: Of the 122 participants for whom complete data were available, 64 (52 percent) achieved stable housing. Most participants who achieved stable housing first entered staffed and supervised housing and then moved to independent arrangements by the end of the study. Stable housing during the final evaluation period was associated with lower substance use, greater progress toward substance abuse recovery, and higher quality of life. Final housing status was not predicted by baseline variables but was predicted by progress toward recovery during months 0 to 6 and 6 to 12 and by less severe drug use during months 6 to 12. Participants who abused no illicit drugs during months 6 to 12 were almost three times as likely to achieve stable housing as those who abused illicit drugs. CONCLUSIONS: Housing stability is strongly mediated by substance abuse and progress toward recovery. Nevertheless, when formerly homeless persons with dual diagnoses are provided integrated dual diagnosis treatment, they can gradually achieve stable housing.

Adult↗
PubMed2002

The National Survey of Psychiatric Morbidity among prisoners and the future of prison healthcare.

It has long been known that psychiatric disorders are highly prevalent among prisoners (Coid, 1984; Gunn et al., 1991; Maden et al., 1995; Joukamaa, 1995; Bland et al., 1998; Lamb and Weinberger, 1998). However, the Survey of Psychiatric Morbidity Among Prisoners in England and Wales (Singleton et al., 1998) represents a considerable advance on earlier surveys. By using the same standardized psychiatric assessment procedures, and similar questions on medication, service use and social functioning, its findings can be compared with previous national surveys of adults living in private households (Meltzer et al., 1995), residents in institutions (Meltzer et al., 1996), homeless persons (Gill et al., 1996), and with the forthcoming household survey in England, Wales and Scotland. It should also inform the future organisation of healthcare for prisoners, following recent recommendations from a joint Home Office/Department of Health Working Party that Health Authorities must work with prisons in their catchment areas to carry out joint health needs assessments, agree prison healthcare improvement strategies and jointly plan and commission services (HM Prison Service and NHS Executive 1999). The ultimate test of the survey will be whether it provides a benchmark to evaluate the future effectiveness of the new policy changes.

England↗
PubMed2001

Research with homeless people uncovers a model of health.

This grounded theory research study, explored health experiences of 11 homeless persons in shelters in three New Brunswick cities and the strategies that they used to attain, maintain, or regain health. Audiotaped interviews were conducted, transcribed verbatim, and analyzed. The model that emerged from analysis consists of three pathways to health. This model of health has two central components, person and health. Person is influenced directly by family values and beliefs, and directly and indirectly by societal values and beliefs. Health is the outcome and is reached through two mediating factors of lifestyle behaviors and sector services. The first pathway to health contains the mediating factor of lifestyle behaviors, the second contains the mediating factor of sector services, and the third contains both mediating factors. Pathway strategies of choosing, accessing, and appraising appropriateness of methods influence the active participation of the person that directs the action within the model. Implications of the study include that a fragmented system of help hinders access to services intended to promote health in this population.

Adaptation, Psychological↗
PubMed1993

Training imperatives for volunteers caring for high-risk, vulnerable populations.

Today, vulnerable populations expand as the threats of homelessness and communicable diseases continue to grow. Volunteers are moved to serve in areas in which they may not be well prepared. We identify the caring needs of high-risk, vulnerable populations and the needs of volunteers; we also conceptualize, develop, implement, and evaluate a training program for volunteers who serve homeless persons and families. This training program and the imperatives that undergird it are presented as a model applicable to the training of volunteers serving high-risk, vulnerable populations.

Adult↗
PubMed2005

In the absence of home: the meaning of homelessness.

Sociologists, economists, social workers, and psychologists provide data and analyses of the human calamity of homelessness. The general public can seem indifferent to such reports, perhaps overwhelmed by the intractability and scope of the problem. This essay describes how writers can give voice to the homeless by telling the story of individual people. Novelists, who use imagination to envision the interior life of the single homeless person, are particularly powerful. They create a negative image that contains all the essential elements of home, enabling readers to create in their own imagination the reality of what it means to live on the outside.

Ill-Housed Persons↗
PubMed2002

Tuberculosis prevention versus hospitalization: taxpayers save with prevention.

This study describes who pays for inpatient tuberculosis (TB) care and factors associated with payer source. The authors analyzed TB hospitalization costs for a prospective cohort of active TB patients at 10 U.S. sites. Private insurance paid for 9 percent and private hospitals for 6 percent of TB hospitalization costs. Public sources (federal, state, and local governments and public hospitals) paid more than 85 percent of TB hospitalization costs. Preventive services (treatment for latent TB infection; housing, food, and social work for homeless persons; substance abuse treatment for substance abusers; and antiretroviral medication for HIV-infected persons) targeted to those at high risk for TB hospitalization could save taxpayers between $4 million and $118 million. Since public resources are used to pay nearly all the costs of late-stage TB care, the public sector could save by shifting resources currently used for inpatient care to target preventive services to persons at high risk for TB hospitalization.

AIDS-Related Opportunistic Infections↗
PubMed2004

Self-reported changes in drug and alcohol use after becoming homeless.

OBJECTIVES: We identified substance use patterns and factors associated with increased substance use after users become homeless. METHODS: We carried out a 2-city, community-based survey that used population-proportionate sampling of 91 sites with random selection at each site. RESULTS: Five hundred thirty-one adults were interviewed; 78.3% of them met Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for substance abuse or dependence. Most of those who met the criteria reported using drugs and alcohol less since they became homeless, commonly because they were in recovery. Factors independently associated with increased use were no health insurance (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.02, 2.58), alcohol abuse or dependence (OR = 3.5; 95% CI = 1.85, 6.78), and selling plasma (OR = 2.6; 95% CI = 1.32, 5.14) or panhandling (OR = 3.0; 95% CI = 1.65, 5.55) to acquire drugs. CONCLUSIONS: Becoming homeless plays a role in self-reported substance use. Multiservice treatment programs and tailored interventions for homeless persons are needed.

Adult↗
PubMed1994

Humanistic constructs and counseling homeless men.

The present humanistic model for counseling homeless men assumed that counseling goals evolve from each client's internal frame of reference and may include a positive adaptation to his homeless experience. The model encompasses Rogers' necessary components of psychotherapy, Sullivan's interpersonal theory of psychiatry, Adler's use of wellness and encouragement, and Privette's peak-performance contribution. Factor analysis of history of homelessness, background data, ratings of subjective health and of happiness, and scores on Jones and Crandall's Short Index of Self-actualization yielded nine factors relevant to counseling. Empirical support was reported for placing a counseling services program in a multiservice facility for homeless persons.

Adaptation, Psychological↗
PubMedDate not supplied

Emergence of related nontoxigenic Corynebacterium diphtheriae biotype mitis strains in Western Europe.

We report on 17 isolates of Corynebacterium diphtheriae biotype mitis with related ribotypes from Switzerland, Germany, and France. Isolates came from skin and subcutaneous infections of injecting drug users, homeless persons, prisoners, and elderly orthopedic patients with joint prostheses or primary joint infections. Such isolates had only been observed in Switzerland.

Adult↗
PubMed2005

Bed bug infestations in an urban environment.

Until recently, bed bugs have been considered uncommon in the industrialized world. This study determined the extent of reemerging bed bug infestations in homeless shelters and other locations in Toronto, Canada. Toronto Public Health documented complaints of bed bug infestations from 46 locations in 2003, most commonly apartments (63%), shelters (15%), and rooming houses (11%). Pest control operators in Toronto (N = 34) reported treating bed bug infestations at 847 locations in 2003, most commonly single-family dwellings (70%), apartments (18%), and shelters (8%). Bed bug infestations were reported at 20 (31%) of 65 homeless shelters. At 1 affected shelter, 4% of residents reported having bed bug bites. Bed bug infestations can have an adverse effect on health and quality of life in the general population, particularly among homeless persons living in shelters.

Animals↗
PubMed2006

Possibilities for relapsing fever reemergence.

Relapsing fever Borrelia infections have attracted little attention in recent years; however, where endemic, these infections still result in considerable illness and death. Despite the marked antimicrobial drug susceptibility of these organisms, therapy is often delayed through lack of clinical suspicion. With increasing travel, infections may be imported, through exotic relapsing fever infection or through resurgence of infected disease vectors. Although louseborne relapsing fever is now geographically limited, it was once of global importance. The possibility for reemergence was recently highlighted by the probable reemergence of louseborne relapsing fever in homeless persons from France. Host limitations enforced through louseborne transmission are less applicable for the tickborne forms of relapsing fever. Although the latter have reduced potential for epidemic spread, they have the ability to infect diverse hosts, thus establishing reservoirs of infection and presenting greater challenges for their control.

Animals↗
PubMed1993

Use of therapeutic milieu in a community setting.

1. Many of the same components that contribute to the success of milieu therapy in inpatient facilities also promote treatment success for clients living in the community. 2. Treatment goals at the Rosati Center, a transitional residential program for chronically mentally ill homeless persons in St. Louis, generally include supporting residents as they secure their own permanent housing; helping residents apply for entitlements so that they can support themselves upon discharge; connecting residents with outpatient psychiatric treatment; and assisting residents to structure their time and activities as a means to improving coping skills. 3. Program evaluations of the transitional living program at the Rosati Center revealed that implementation of therapeutic milieu concepts (in combination with case management concepts) can be successful. The facility served 228 persons during a 5 1/2-year period. Nearly half of those persons were discharged having fully met the objectives of the transitional program.

Adult↗
PubMed2000

Interventions for Weight Gain in Adults Treated With Novel Antipsychotics.

BACKGROUND: Weight gain is a significant side effect associated with typical and atypical antipsychotic agents. It has the potential to add to the increased morbidity and mortality associated with schizophrenia and schizoaffective disorder. Because the newer antipsychotic medications have proved to be superior to traditional agents in controlling the positive and negative symptoms of schizophrenia, it is additionally critical to address the relationship of these newer agents to weight gain. METHOD: Prior to the availability of novel antipsychotic medication, we looked at a group of 17 residents, of whom 71% had significant weight gain on treatment with traditional antipsychotic medications between 1991 and 1994. This prompted our interest in weight gain, especially after the introduction of novel antipsychotic medications, and our decision to look closely at their diets and help them make changes that would minimize their weight gain. We monitored the effect of a comprehensive primary intervention strategy on controlling obesity in a retrospective study of 32 patients with DSM-IV schizophrenia or schizoaffective disorders. All patients were residents in an adult care facility for formerly homeless persons with serious mental illness. Intervention consisted of complete medical and psychiatric care; switch to a patient-optimal atypical drug; low-calorie, monitored diet; nutritional education; and supportive care. RESULTS: There was no significant change in mean body weight at 12 and 18 months after initiation of intervention. Weight gain was observed in only 30% of study patients after the intervention as opposed to 71% at the start of the study. In general, as the negative symptoms of schizophrenia improved, patients were found to become more receptive to education and to become proactive in their health care. The lack of weight gain was consistently seen with all 3 agents tested-clozapine, olanzapine, and risperidone. CONCLUSION: A patient's diet appears to be a better predictor of weight gain than the choice of novel antipsychotic medication. Clinicians might prescribe nutritional and lifestyle changes alongside medication with weight gain potential.

Journal Article↗
PubMed1991

Health care and the homeless: a marketing-oriented approach.

Recent research suggests that the homeless in the United States are a large and diverse population. Studies have identified their wide range of health care needs, which currently are poorly serviced by health care professionals. The author proposes an improved process for the delivery of health care to the homeless. The marketing concept--defining needs and working to develop solutions--is applied to this critical problem to benefit homeless persons as well as health care providers.

Attitude of Health Personnel↗
PubMed1994

Health on wheels.

To adequately meet the needs of the poor and underserved, we must bring healthcare services to them. Saint Joseph's Hospital of Atlanta is doing just that through its Mercy Mobile Health Program. Even though Mercy Mobile has been available for a decade, the health status of Atlanta's homeless and working poor has deteriorated. The program has therefore increased its services to include primary care, disease prevention, health promotion, case management, and information and referral. With four vans and two mobile clinics, the program operates five days and three evenings a week, often in space donated by churches and other not-for-profit organizations. It provided more than 50,000 episodes of care last year. Developing strategies and resources to treat medically-at-risk, hard-to-reach clients with multiple diagnoses is a complex task, requiring the resources of more than one organization. One example of an effective collaborative effort is the "Street Home" program for HIV-infected homeless persons. This program, which provides early intervention and primary care to persons with HIV, is funded through the federal Ryan White "CARE" (Comprehensive AIDS Resources Emergency) Act.

Catholicism↗
PubMed1997

The veterans healthcare system: preparing for the twenty-first century.

Since its establishment in 1946, the veterans healthcare system has greatly expanded in both size and responsibility. It is now the largest integrated healthcare system in the United States, the nation's largest provider of graduate medical and other health professionals training, and one of the largest research enterprises in America. It is also the nation's largest provider of services to homeless persons, an essential provider in the public healthcare safety net, and an increasingly important element in the federal response to disasters and national emergencies. Patterned after what was considered the best in American healthcare, for most of the past 50 years the Department of Veterans Affairs (VA) healthcare has focused primarily on acute inpatient care, high technology, and medical specialization. Now, in response to societal and industrywide forces, the Veterans Health Administration (VHA) is reengineering the veterans healthcare system, changing the operational and management structure from individual hospitals to 22 integrated service networks and transitioning the system to one that is grounded in ambulatory and primary care. This article briefly describes the history and functions of the veterans healthcare system, its service population, and key aspects of its restructuring.

Delivery of Health Care, Integrated↗
PubMed1988

The paradox of psychiatric deinstitutionalization: historical perspective and policy implications.

Deinstitutionalization has, in effect, resulted in the creation of new forms of asylum for the mentally ill. Rather than being generated in a planful, humanitarian manner, the reduction in the census of state hospitals has been governed by federal health and welfare programs not designed for the mentally ill. By relying upon Medicaid and SSI, states were able to shift their financial burden for the mentally ill to the federal government. Reliance upon Medicaid has resulted in nursing homes playing a major role in psychiatric care. SSI stipends are not adequate to cover rising housing costs--even in low-income areas. As a result, large numbers of the mentally ill are among the populations of homeless persons in the United States.

Deinstitutionalization↗
PubMed1999

[Dermatologic consultation in a precarious situation: a prospective medical and social study at the Hôpital Saint-Louis in Paris].

INTRODUCTION: The aim of our study was to evaluate the outcomes and the cost of the dermatological consultation for poor and destitute patients, in Saint-Louis Hospital. PATIENTS AND METHODS: We carried out a prospective study from May to October 1996. One hundred and eighty-nine patients (237 consultations) who had no social welfare, were examined. RESULTS: They revealed that 82 p. 100 were male, 63.7 p. 100 were French, 13.9 p. 100 came from Maghreb, 9.7 p. 100 from Sub-Saharan Africa, 73 p. 100 were homeless and 25.7 p. 100 were alcoholic. The average age was around 37.6. The main medical disorders: scabies (56.5 p. 100), lice (22.4 p. 100) and cutaneous infections (7.2 p. 100) were related to the patients' living conditions and their social and economic situation. The other diseases observed were identical to the ones detected in regular health care centers. Complementary laboratories were necessary in 9.3 p. 100 consultations. Only 2 p. 100 of patients were admitted in Hospital. Local treatment was applied by nurses in 67 p. 100 of cases. Drugs were delivered free of charge by the Hospital's pharmacy in 64 p. 100 of cases. The cost of drugs was 83 FF per patient. The mean of duration of treatment was 10.5 days. DISCUSSION: Social workers are a key element in helping the patients to recover their social rights (49 p. 100 of patients have recovered social rights after 6 months). The frequency of skin diseases is higher in this population than in general population, especially in homeless persons. Access to health care is a problem of public health.

Adult↗