"That feeling of not feeling": numbing the pain for substance-dependent African American women

Using ethnographic methodology, the author uncovered the meanings and expressions of recovery care for substance-dependent African American women residing in an inner-city transitional home for substance abuse. A convenience sample of 12 key and 18 general participants revealed emotional pain associated with negative life experiences, including overt and covert racism, primarily within society but also within their family networks; and physical, sexual, and emotional abuse from parents, siblings, and male relationships. The women described feelings of abandonment associated with the death of loved ones, particularly mothers. They had attempted to numb their emotional pain with alcohol and drugs. As they moved through treatment and recovery, they began to work through past and current painful life experiences without using alcohol and drugs.

Health and service utilization patterns among homeless men in transition: exploring the need for on-site, shelter-based nursing care

Between September 1999 and May 2000, as part of a larger faculty/student teaching project, data describing the demographic, health problem and service utilization patterns of 183 newly sheltered homeless men (mean age = 42) seeking on-site nursing clinic services were collected and analyzed. Upon arrival to the transitional shelter, 46% of the study participants were medically uninsured or received state subsidized health benefits (49%). Almost all (99%) were in recovery from substance addiction. Despite numerous self-reported health problems, 44% had no primary care provider and 35% were seen only sporadically in local hospital clinics or in emergency departments. During the study period, nurse practitioner students and faculty managed most of the residents' episodic illnesses on-site, while assisting them to secure insurance coverage and medical appointments as a prelude to independent living. This was an attempt to curtail residents' previous pattern of waiting until medical problems became serious before seeking treatment. These findings mirrored those in studies of similar populations equating on-site delivery of health care to cost reduction. Unfortunately, many nurse-managed clinics, like our study site, fail to generate data supporting nurses' clinical efficiency and cost effectiveness in caring for homeless individuals. As such, nurses' work remains invisible and underappreciated. This article argues that future studies examining nurses' work and worth in caring for homeless individuals are necessary in determining future health care service planning with this vulnerable population.

Emotional responses of patients with schizophrenia to their illness. Attitudes of social environment towards schizophrenes

The aim of this paper was to define emotional responses of the patients with diagnosed schizophrenic psychosis to their illness. It was also intended to recognize the attitudes of patients' families and more distant social environment towards them. The study was conducted on 84 patients of the Neuropsychiatric Hospital, both hospitalized and ambulant, treated in Mental Outpatient Clinic and, simultaneously, taken care of by Social Self-Help Home "Misericordia". All the examined patients met the diagnostic criteria in accordance with ICD-10 for schizophrenic psychosis or schizophrenic disorder; all were in the period of symptomatic remission. The study was carried out in the years 2000-2001, using the distributed inquiry questionnaire technique. The supplementary source of information was case records of the examined patients. The predominant feelings of schizophrenics at the moment of becoming aware of having fallen ill with mental disease were fear (anxiety) and sorrow. The passage of time caused changes in emotional responses to mental illness. At the moment of the study the predominant feelings were the acceptance of illness and the sense of inferiority because of it. The sufferers of schizophrenia experienced mainly sympathy, acceptance of the illness and indifference in the environment outside the family circle.

The effects of group intervention for battered women in Korea

This study developed a group intervention model appropriate for battered women in Korea and tested its effectiveness. The sessions in the group intervention were formatted to stress the following topics: assess trauma, identify major problems, deal with feelings, understand self, identify batterer's characteristics, improve stress management strategies, develop action plans, and promote empowerment. The major finding was that the trait anxiety scores of the 16 battered women in the experimental group significantly decreased after the intervention. The change in levels of state anxiety, self-esteem, and depression in the experimental group were not significantly different from those of the 17 the subjects in the control group.

The community/privacy trade-off in supportive housing: consumer/survivor preferences

Supportive housing for psychiatric consumers/survivors can range in form from dispersed apartments to group homes. This research asked: What form is more supportive, apartments or housing with common spaces? Is it privacy and normalcy or community and peer support that promote well-being? The literature is divided. This study convened a charrette for supportive housing residents to express their views. Some 20 supportive housing residents formed two teams, with one team producing a housing design based on the principle of privacy and the other team producing one based on the principle of community. Despite their differing terms of reference, the teams developed similar designs. The results reinforced the importance of both private and common spaces in supportive housing.

The impact of criminal justice institutions on substance abuse treatment

This article explores drug treatment from a community provider perspective. Specifically, it examines the impact of criminal justice institutions on substance abuse treatment: the gray zone where jurisprudence meets the therapeutic.

Computer-assisted tracking of a case management program for the homeless

Computer scan sheet technology was used to evaluate process and outcome variables in a case management shelter program for the homeless. Clients spent up to four months in this program, working on a number of goal areas, including housing, employment, drugs and alcohol, mental and physical health, and literacy. Using Tele-Form, a computer program that allows scan sheets to be designed on screen, case manager recording forms were developed that allowed interventions to be documented on a daily basis, while psychosocial goal areas were documented on scan sheets at intake and termination. Data from these scan sheets were fed into SPSS, a statistical program for the social sciences. Using the case management tracking guidelines developed by Frankel and LaPorte, 1998, the results of this study showed that scan sheet technology was an effective, efficient, and extremely cost-effective way to track case management. The analysis of the data and subsequent discussion suggested ways about how to make case management evaluation more uniform across the country.

Psychological and physical distress of sheltered battered women

We explored the physical and psychological distress of sheltered battered women. A convenience sample of 50 ethnically diverse women was obtained from women who had resided in two shelters for at least 21 days. Participants had experienced multiple traumatic events (8.1+/-4.6); however, only 19 (38.8%) of the participants were diagnosed with posttraumatic stress disorder (PTSD). When we analyzed biopsychosocial variables, we saw beneficial effects of support (financial, social, spiritual). These findings reinforce the need to enhance the resources of battered women, to help them identify existing opportunities, and to fortify self-caring strategies that give them strength.

Recognising pain in older adults living in sheltered accommodation: the views of nurses and older adults

Sixty-six randomly selected older adults and their contact nurses participated in interviews based on standardised assessments of pain and open-ended questions focusing how pain was expressed and recognised. The sample included older adults with normal as well as cognitively impaired function. Seventy-nine percent of older adults with normal cognition were often in pain. Contact nurses assessed pain in 57% of cognitively impaired older adults. The content in the statements showed that pain recognition was a communicative interactive process based on verbal and non-verbal expressions. The process comprised attempts to understand the cause and intention of the expression and to verify the presence of pain. Changes in mood, facial expressions and physiological responses were described less often by older adults than by their nurses. Contact nurses of cognitively impaired older adults judged immobility as the source of pain, that it was possible to see when the person was in pain and that pain was expressed by paralinguistic and body language more often than contact nurses of cognitively healthy older adults. Characteristics of nurses and older adults could facilitate or hinder pain recognition. The findings indicate a need for reflective discussions in the staff group focusing on how to perform systematic assessments of verbal and non-verbal expressions and of hindrances and facilitators for recognising pain in older adults.

Applying social skills training in the context of vocational rehabilitation for people with schizophrenia

This paper describes a model for the conceptualization of social skills necessary for the vocational success of people with schizophrenia. Based on this model, a two-part measure was developed and validated to assess social skills necessary for job search and tenure. The measure consists of a 10-item self-administered checklist and a role-play exercise. The self-administered checklist measures clients' perceived competence in handling work-related social situations. The role-play exercise assesses the social skills necessary for job acquisition and maintenance in two simulated situations (participating in a simulated job interview and requesting urgent leave from work). Furthermore, a social skills training module has been designed, which enhances vocational outcome and fills a gap in the existing, commonly used modules. A pilot study shows that the training module together with appropriate professional support afterward is effective in enhancing the social competence and vocational outcomes of persons with schizophrenia. Implications for cross-cultural applications are discussed.

Sober living houses: potential roles in substance abuse services and suggestions for research

'Sober living houses' are alcohol- and drug-free residences for individuals attempting to establish or maintain sobriety. They offer no formal treatment services but do provide social support and an abstinent living environment. 'Sober living houses' have been used as aftercare placements for clients completing residential treatment, places for clients to live while attending outpatient treatment, or as stand-alone approaches for substance misuse problems. This article identifies areas of research needing attention and suggests that 'sober living houses' have the potential to play a stronger role in the continuum of substance misuse services.

Evaluating the spiritual perspectives of homeless men in recovery

The purpose of this study was to describe the self-reported spiritual perspectives of 100 homeless male residents living in a communal shelter. The residents, in recovery from substance addiction, were asked to complete Reed's 10-item Spiritual Perspective Scale (SPS) as part of their initial health database. Their responses were described within the context of their participation in 12-Step recovery programs, demographic characteristics, and perceived health status. Findings suggest that spirituality is an important health component for this population.

From housing to homes: a review of the literature on housing approaches for psychiatric consumer/survivors

In this paper, we review the literature on housing for psychiatric consumer/survivors since the publication of the Nelson and Smith Fowler (1987) review more than a decade ago. First, we review research and propose a definition to contrast key features of three approaches to housing: (a) custodial, (b) supportive, and (c) supported. Second, we examine studies of the relationships between the characteristics of housing and adaptational outcomes for residents (e.g., personal empowerment). Third, we review studies which have examined out-comes for residents for these three different housing approaches. We conclude by critically reflecting on the values and research of the different approaches to housing, to make recommendations for future policy and planning, practice, and research.

Traumatic brain injury in individuals convicted of sexual offenses with and without bipolar disorder

The authors examined the occurrence of traumatic brain injury (TBI) in individuals convicted of sexual offenses with and without bipolar disorder and a comparison group of patients with bipolar disorder without a history of sexual offending behaviors. Individuals convicted of sexual offenses and diagnosed with bipolar disorder had greater rates of brain injury resulting from head trauma than individuals convicted of sexual offenses without bipolar disorder and comparison patients with bipolar disorder. TBI predated the first sexual offense and/or the onset of bipolar disorder in most subjects.

[Rehabilitation of psychiatric patients in the halfway house--a 10-year retrospective study]

In a period of ten years 159 residents were admitted to a transitional home. 90% of them were diagnosed as chronic schizophrenics with a marked psychic and social handicap. With an average age of 28.7 years and a mean duration of illness of 6.8 years most of the patients had been hospitalized several times; 95% had no job, lived on social assistance or were invalidity pensioners. There was poor success in vocational rehabilitation (22%). Better results were seen in solving the housing problems, showing a clear-cut tendency to move from the family of origin into protected group homes or independent living. Positive effects of social training with gains in life-coping abilities and social competence, i.e., in autonomy in everyday life could be observed as well.

Towards recovery: living in a home-like setting after the move from a hospital ward

Six clients with a diagnosis of schizophrenia were interviewed about their experiences of their lives in a home-like setting, their key care provider and the care received. Their narratives of lived experiences in care were interpreted as living a process of health in the midst of severe mental illness, involving: 'becoming more', 'being disabled', 'comforting/conforming relationship', 'discomforting/unconfirming relationship' and 'caring about the caring relationship'. Fatigue and lack of strength influenced the lives of most clients considerably, and the stories were about problems and conflicts. Nevertheless, the clients seemed really to struggle to make communal life work, and there were experiences of increased competence and better self-confidence in most of the stories. On the whole care was described as good, and the process of health seemed to be supported by experiences of comfort and being confirmed in the client-care provider relationship.