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Armoon B, Fleury MJ, Griffiths MD, Bayani A, Mohammadi R, Ahounbar E. Emergency Department Use, Hospitalization, and Their Sociodemographic Determinants among Patients with Substance-Related Disorders: A Worldwide Systematic Review and Meta-Analysis. Subst Use Misuse 2023; 58:331-345. [PMID: 36592043 DOI: 10.1080/10826084.2022.2161313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Identifying the determinants of emergency department (ED) use and hospitalization among patients with substance-related disorders (SRD) can help inform healthcare services and case management regarding their unmet health needs and strategies to reduce their acute care. Objectives: The present study aimed to identify sociodemographic characteristics, type of used drug, and risky behaviors associated with ED use and hospitalization among patients with SRD. Methods: Studies in English published from January 1st, 1995 to April 30th, 2022 were searched from PubMed, Scopus, Cochrane Library, and Web of Science to identify primary studies on ED use and hospitalization among patients with SRD. Results: Of the 17,348 outputs found, a total of 39 studies met the eligibility criteria. Higher ED use and hospitalization among patients with SRD were associated with a history of homelessness (ED use: OR = 1.93, 95%CI = 1.32-2.83; hospitalization: OR = 1.53, 95%CI = 1.36-1.73) or of injection drug use (ED use: OR = 1.34, 95%CI = 1.13-1.59; hospitalization: OR = 1.42, 95%CI = 1.20-1.69). Being female (OR = 1.24, 95%CI = 1.14-1.35), using methamphetamine (OR = 1.99, 95%CI = 1.24-3.21) and tobacco (OR = 1.25, 95%CI = 1.11-1.42), having HIV (OR = 1.70, 95%CI = 1.47-1.96), a history of incarceration (OR = 1.90, 95%CI = 1.27-2.85) and injury (OR = 2.62, 95%CI = 1.08-6.35) increased ED use only, while having age over 30 years (OR = 1.40, 95%CI = 1.08-1.81) and using cocaine (OR = 1.60, 95%CI = 1.32-1.95) increased hospitalization only among patients with SRD. Conclusions: The finding outline the necessity of developing outreach program and primary care referral for patients with SRD. Establishing a harm reduction program, incorporating needle/syringe exchange programs, and safe injection training with the aim of declining ED use and hospitalization, is likely be another beneficial strategy for patients with SRD.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University InstituteMontreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University InstituteMontreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.,Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.,Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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Grattan RE, Tryon VL, Lara N, Gabrielian SE, Melnikow J, Niendam TA. Risk and Resilience Factors for Youth Homelessness in Western Countries: A Systematic Review. Psychiatr Serv 2022; 73:425-438. [PMID: 34320827 PMCID: PMC8799752 DOI: 10.1176/appi.ps.202000133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The experience of homelessness for young people can affect social, emotional, and physical development, resulting in poorer physical and mental health outcomes. To reduce rates of youth homelessness, a better understanding of both risk and resilience is needed to inform future intervention development. This article presents a systematic review of published research reporting risk or resilience factors related to homelessness among young people in Western countries. METHODS After thorough examination for inclusion criteria, 665 abstracts of peer-reviewed quantitative studies of risk or resilience factors for homelessness among young people (ages 0-25) that included an adequate comparison group (e.g., not homeless) were selected. After abstract and full-text screening, 16 articles were reviewed. A primary prevention framework was used to create an explanatory model for the onset of homelessness using risk and resilience factors. RESULTS Common risk factors for youth homelessness included difficulties with family, mental health or substance use problems, a history of problem behaviors, a history of foster care, homelessness as a child, and running away. Common protective factors included a supportive family, a college education, and high socioeconomic status. Findings were integrated into a provisional developmental model of youth homelessness risk. Clinical implications of the model for service development are discussed, and a model for monitoring homelessness risk and resilience factors is proposed. CONCLUSIONS Factors affecting homelessness risk among youths and adults differ, with family, foster care, and schooling playing a much more important role among youths. Findings highlight opportunities for youth homelessness prevention strategies and monitoring.
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Affiliation(s)
- Rebecca E Grattan
- Department of Psychiatry and Behavioral Sciences, Davis School of Medicine (Grattan, Tryon, Lara, Niendam), and Center for Healthcare Policy and Research (Melnikow), University of California, Sacramento, Sacramento; ISN Innovations, Institute for Social Neuroscience, Melbourne, Australia (Grattan); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Gabrielian); Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, West Los Angeles, Los Angeles (Gabrielian)
| | - Valerie L Tryon
- Department of Psychiatry and Behavioral Sciences, Davis School of Medicine (Grattan, Tryon, Lara, Niendam), and Center for Healthcare Policy and Research (Melnikow), University of California, Sacramento, Sacramento; ISN Innovations, Institute for Social Neuroscience, Melbourne, Australia (Grattan); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Gabrielian); Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, West Los Angeles, Los Angeles (Gabrielian)
| | - Natalia Lara
- Department of Psychiatry and Behavioral Sciences, Davis School of Medicine (Grattan, Tryon, Lara, Niendam), and Center for Healthcare Policy and Research (Melnikow), University of California, Sacramento, Sacramento; ISN Innovations, Institute for Social Neuroscience, Melbourne, Australia (Grattan); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Gabrielian); Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, West Los Angeles, Los Angeles (Gabrielian)
| | - Sonya E Gabrielian
- Department of Psychiatry and Behavioral Sciences, Davis School of Medicine (Grattan, Tryon, Lara, Niendam), and Center for Healthcare Policy and Research (Melnikow), University of California, Sacramento, Sacramento; ISN Innovations, Institute for Social Neuroscience, Melbourne, Australia (Grattan); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Gabrielian); Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, West Los Angeles, Los Angeles (Gabrielian)
| | - Joy Melnikow
- Department of Psychiatry and Behavioral Sciences, Davis School of Medicine (Grattan, Tryon, Lara, Niendam), and Center for Healthcare Policy and Research (Melnikow), University of California, Sacramento, Sacramento; ISN Innovations, Institute for Social Neuroscience, Melbourne, Australia (Grattan); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Gabrielian); Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, West Los Angeles, Los Angeles (Gabrielian)
| | - Tara A Niendam
- Department of Psychiatry and Behavioral Sciences, Davis School of Medicine (Grattan, Tryon, Lara, Niendam), and Center for Healthcare Policy and Research (Melnikow), University of California, Sacramento, Sacramento; ISN Innovations, Institute for Social Neuroscience, Melbourne, Australia (Grattan); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Gabrielian); Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, West Los Angeles, Los Angeles (Gabrielian)
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Isaak CA, Reynolds K, Sareen J, Distasio J. The entrepreneurship of survival among urban adults experiencing homelessness and mental illness. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:1548-1562. [PMID: 31212376 DOI: 10.1002/jcop.22204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/03/2019] [Accepted: 05/08/2019] [Indexed: 06/09/2023]
Abstract
AIMS Using an entrepreneurship lens, this study examined the narratives of urban adults experiencing homelessness and living with mental illness, to explore strategies used for day-to-day survival. METHODS Semi-structured qualitative interviews were conducted with 14 females, 30 males, and one individual identifying as "other," living in a mid-sized Canadian city. The average age was 39 years. Data were transcribed verbatim and analyzed using thematic analysis informed by grounded theory. FINDINGS Participants described creative and intentional strategies for managing life on the street without permanent shelter, including recognition of opportunities, mobilization of their own or acquired resources, and use of social connections and communication skills, and strategies that demonstrated entrepreneurial processes. CONCLUSIONS Findings suggest that participants used survival entrepreneurship strategies and processes to navigate daily life while experiencing homelessness. Recognition and validation of the propensity for enterprise and self-sufficiency are central for both individual recovery and ending homelessness within similar populations.
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Affiliation(s)
- Corinne A Isaak
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- End Homelessness Winnipeg, Winnipeg, MB, Canada
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jino Distasio
- Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada
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Moore DT, Rosenheck RA. Comprehensive services delivery and emergency department use among chronically homeless adults. Psychol Serv 2018; 14:184-192. [PMID: 28481603 DOI: 10.1037/ser0000111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Homeless adults use emergency department (ED) services more frequently than other adults, but the relationships between homelessness, health status, outpatient service use, and ED utilization are poorly understood. Data from the Collaborative Initiative to Help End Chronic Homelessness (CICH) were used to compare ED use among chronically homeless adults receiving comprehensive housing, case management, mental health, addiction, and primary care services through CICH at 5 U.S. sites (n = 274) and ED use among comparison group clients receiving generally available community services (n = 116) at the same sites. Multiple imputation was used to account for missing data and differential rates of attrition between the cohorts. Longitudinal models were constructed to compare ED use between the 2 groups during the first year after initiation of CICH services. A mediation analysis was performed to determine the relative contributions of being housed, the receipt of outpatient services, and health status to group differences in ED utilization. Participants receiving CICH services were significantly less likely to report ED use (odds ratio = 0.78, 95% confidence interval [0.65, 0.93]) in the year after program entry. Decreased ED use was primarily mediated by decreased homelessness-not by increased access to other services or health status. This suggests that becoming housed is a key driver of reduced ED utilization and that efforts to provide housing for homeless adults may result in significantly decreased ED use. Further research is needed to determine the long-term effects of housing on health status and to develop services to improve health outcomes. (PsycINFO Database Record
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Castillo EG, Shaner R, Tang L, Chung B, Jones F, Whittington Y, Miranda J, Wells KB. Improving Depression Care for Adults With Serious Mental Illness in Underresourced Areas: Community Coalitions Versus Technical Support. Psychiatr Serv 2018; 69:195-203. [PMID: 29032700 PMCID: PMC5794612 DOI: 10.1176/appi.ps.201600514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Community Partners in Care (CPIC) was a group-randomized study of two approaches to implementing expanded collaborative depression care: Community Engagement and Planning (CEP), a coalition approach, and Resources for Services (RS), a technical assistance approach. Collaborative care networks in both arms involved health care and other agencies in five service sectors. This study examined six- and 12-month outcomes for CPIC participants with serious mental illness. METHODS This secondary analysis focused on low-income CPIC participants from racial-ethnic minority groups with serious mental illness in underresourced Los Angeles communities (N=504). Serious mental illness was defined as self-reported severe depression (≥20 on the Patient Health Questionnaire-8) at baseline or a lifetime history of bipolar disorder or psychosis. Logistic and Poisson regression with multiple imputation and response weights, controlling for covariates, was used to model intervention effects. RESULTS Among CPIC participants, 50% had serious mental illness. Among those with serious mental illness, CEP relative to RS reduced the likelihood of poor mental health-related quality of life (OR=.62, 95% CI=.41-.95) but not depression (primary outcomes); reduced the likelihood of having homelessness risk factors and behavioral health hospitalizations; increased the likelihood of mental wellness; reduced specialty mental health medication and counseling visits; and increased faith-based depression visits (each p<.05) at six months. There were no statistically significant 12-month effects. CONCLUSIONS Findings suggest that a coalition approach to implementing expanded collaborative depression care, compared with technical assistance to individual programs, may reduce short-term behavioral health hospitalizations and improve mental health-related quality of life and some social outcomes for adults with serious mental illness, although no evidence was found for long-term effects in this subsample.
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Affiliation(s)
- Enrico G Castillo
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Roderick Shaner
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Lingqi Tang
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Bowen Chung
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Felica Jones
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Yolanda Whittington
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Jeanne Miranda
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Kenneth B Wells
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
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Moore DT, Rosenheck RA. Factors Affecting Emergency Department Use by a Chronically Homeless Population. Psychiatr Serv 2016; 67:1340-1347. [PMID: 27417899 PMCID: PMC5133170 DOI: 10.1176/appi.ps.201500526] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Homeless adults make extensive use of emergency department (ED) services. This study examined factors associated with moderate and high ED use in a cohort of chronically homeless individuals. METHODS A cross-sectional analysis identified factors related to ED use in a cohort of 755 individuals at 11 sites at entry into the Collaborative Initiative to Help End Chronic Homelessness (CICH). Bivariate analyses identified sociodemographic, housing status, health status, and service-related factors associated with moderate and high ED use. Independent risk factors were then identified by using a multivariate multinomial model. Hierarchical regression was used to compare the strengths of association between ED use and blocks of factors composed of sociodemographic, housing, health, and service-related characteristics. RESULTS In a three-month period, 30% of participants visited the ED one or two times (moderate ED use) and 12% visited three or more times (high-ED use). ED use was most strongly associated with poor health and utilization of other non-ED services and to a lesser extent with housing status. CONCLUSIONS Increased ED utilization was associated with both general medical and psychiatric morbidity and greater use of non-ED services. Thus ED use was related to high need and acuity and was not ameliorated by use of other services. Housing instability and homelessness contributed less robustly to increased ED use. More coordinated services may better address the complex medical, housing, and psychosocial needs of chronically homeless individuals.
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Affiliation(s)
- David Thomas Moore
- The authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Rosenheck is also with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven, Connecticut
| | - Robert A Rosenheck
- The authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Rosenheck is also with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven, Connecticut
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Somers JM, Moniruzzaman A, Rezansoff SN. Migration to the Downtown Eastside neighbourhood of Vancouver and changes in service use in a cohort of mentally ill homeless adults: a 10-year retrospective study. BMJ Open 2016; 6:e009043. [PMID: 26739726 PMCID: PMC4716157 DOI: 10.1136/bmjopen-2015-009043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/31/2015] [Accepted: 10/20/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Little research has investigated the role of migration as a potential contributor to the spatial concentration of homeless people with complex health and social needs. In addition, little is known concerning the relationship between possible migration and changes in levels of service use over time. We hypothesised that homeless, mentally ill individuals living in a concentrated urban setting had migrated from elsewhere over a 10-year period, in association with significant increases in the use of public services. SETTING Recruitment was concentrated in the Downtown Eastside neighbourhood of Vancouver, Canada. PARTICIPANTS Participants (n=433) met criteria for chronic homelessness and serious mental illness, and provided consent to access administrative data. METHODS Linked administrative data were used to retrospectively examine geographic relocation as well as rates of health, justice, and social welfare service utilisation in each of the 10 years prior to recruitment. Generalised estimating equations were used to estimate the effect of migration on service use. RESULTS Over a 10-year period there was significant movement into Vancouver's Downtown Eastside neighbourhood (from 17% to 52% of the cohort). During the same period, there were significant annual increases in community medical services (adjusted rate ratio (ARR) per year=1.08; 95% CI 1.06 to 1.10), hospital admissions (ARR=1.08; 95% CI 1.04 to 1.11), criminal convictions (ARR=1.08; 95% CI 1.03 to 1.13), and financial assistance payments (ARR=1.04; 95% CI 1.03 to 1.06). Migration was significantly associated with financial assistance, but not with other types of services. CONCLUSIONS Significant increases in service use over a 10-year period coincided with significant migration into an urban area where relevant services were concentrated. These results highlight opportunities for early intervention in spatially diverse neighbourhoods to interrupt trajectories marked by worsening health and extremely high service involvement. Further research is urgently needed to investigate the causal relationships between physical migration, health and social welfare, and escalating use of public services. TRIAL REGISTRATION NUMBERS ISRCTN57595077 and ISRCTN66721740; Post-results.
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Affiliation(s)
- Julian M Somers
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Akm Moniruzzaman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Stefanie N Rezansoff
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Tsai J, Ramaswamy S, Bhatia SC, Rosenheck RA. A Comparison of Homeless Male Veterans in Metropolitan and Micropolitan Areas in Nebraska: A Methodological Caveat. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2015; 56:357-367. [PMID: 26354600 DOI: 10.1007/s10464-015-9746-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study explored differences between homeless male veterans in metropolitan and micropolitan cities in Nebraska on sociodemographic, housing, clinical, and psychosocial characteristics as well as health service use. A convenience sample of 151 homeless male veterans (112 metropolitan, 39 micropolitan) were recruited from Veterans Affairs facilities and area shelters in Omaha, Lincoln, Grand Island, and Hastings in Nebraska. Research staff conducted structured interviews with homeless veterans. Results showed that compared to homeless veterans in metropolitans, those in micropolitans were more likely to be White, unmarried, living in transitional settings, and were far more transient but reported greater social support and housing satisfaction. Veterans in micropolitans also reported more medical problems, diagnoses of anxiety and personality disorders, and unexpectedly, were more likely to report using various health services and less travel time for services. Together, these findings suggest access to homeless and health services for veterans in micropolitan areas may be facilitated through Veterans Affairs facilities and community providers that work in close proximity to one another. Many homeless veterans in these areas are transient, making them a difficult population to study and serve. Innovative ways to provide outreach to homeless veterans in micropolitan and more rural areas are needed.
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Affiliation(s)
- Jack Tsai
- Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave., 151D, West Haven, CT, 06516, USA.
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Sriram Ramaswamy
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Department of Psychiatry, Creighton University, Omaha, NE, USA
| | - Subhash C Bhatia
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Department of Psychiatry, Creighton University, Omaha, NE, USA
| | - Robert A Rosenheck
- Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave., 151D, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
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Edens EL, Tsai J, Rosenheck RA. Does stimulant use impair housing outcomes in low-demand supportive housing for chronically homeless adults? Am J Addict 2014; 23:243-8. [PMID: 24724881 DOI: 10.1111/j.1521-0391.2014.12089.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/01/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recent research suggests low-demand housing (i.e., not contingent upon abstinence) is effective in helping people exit homelessness, even among recent active substance users. Whether active users of illicit drugs and stimulants have worse housing outcomes than primary alcohol users, however, is unknown. METHODS A total of 149 participants in a multisite supportive housing program who reported high levels of active substance use at program entry were classified as either (1) predominantly "Alcohol Use" (>10 of 30 days alcohol, but not >10 days of drug use) or (2) "Illicit Drug Use" (>10 of 30 days any single illicit drug use with or without alcohol use). Sub-analysis of the "Illicit Drug Use" group compared participants reporting high levels of "Stimulant Use" (>10 days cocaine, crack, or methamphetamine use) to those with high levels of "Non-stimulant Use" (>10 days marijuana or other non-stimulant drug use). Group differences in housing outcomes were examined with mixed model multivariate regression. RESULTS During 24-month follow-up, days housed increased dramatically for both the "Alcohol Use" and the "Illicit Drug Use" groups without significant differences. Sub-analysis of illicit drug users showed stimulant use was associated with fewer days housed (p = .01) and more days homeless (p = .02) over time. CONCLUSIONS Among illicit drug users, stimulant users have somewhat less successful housing outcomes than other active drug and alcohol users, though both groups maintained substantial housing improvements in low-demand housing.
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Affiliation(s)
- Ellen L Edens
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System & The VISN 1 Mental Illness Research, Education, and Clinical Center (MIRECC), West Haven, Connecticut
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Notaro SJ, Khan M, Kim C, Nasaruddin M, Desai K. Analysis of the health status of the homeless clients utilizing a free clinic. J Community Health 2013; 38:172-7. [PMID: 22828926 DOI: 10.1007/s10900-012-9598-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The purpose of this study is to evaluate the health status of the homeless population who utilize a free clinic. The study specifically aims to compare the prevalence of asthma, diabetes, tuberculosis, mental health disorders, sexually transmitted diseases, sinus problems, and hepatitis among the homeless population. Investigators collected data from paper medical records during patient visits from 2004 to 2009. Diagnosed health conditions among the homeless population were compared to the general clinic users using logistic regression. There were several similarities between the general clinic and homeless population, however, the homeless population had statistically significant (p < 0.05) outcomes for diagnosed cases of tuberculosis, hepatitis, anxiety, and bipolar disorders. Prevalence of diabetes, sinus problems, asthma, diabetes, and depression were similar among both populations. The odds ratios among hepatitis, tuberculosis, STDs, bipolar disorder and anxiety disorder indicated the homeless had a significantly greater risk of developing hepatitis, tuberculosis, and bipolar disorder. This study adds to the literature by illustrating the characteristics of the homeless population who utilize the free health clinic and their medical conditions. Previous studies have shown the free clinic clients have a lower level of health than the general population. This study finds that the homeless clients of a free clinic have an even worse level of health than the general clinic clients. This research can contribute to the improvement of the healthcare delivery system in providing access to needed health care services for the homeless population.
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Affiliation(s)
- Stephen J Notaro
- Department of Kinesiology and Community Health, University of Illinois, Champaign, IL 61820, USA.
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Garnick DW, Horgan CM, Acevedo A, McCorry F, Weisner C. Performance measures for substance use disorders--what research is needed? Addict Sci Clin Pract 2012; 7:18. [PMID: 23186374 PMCID: PMC3564737 DOI: 10.1186/1940-0640-7-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 08/31/2012] [Indexed: 11/29/2022] Open
Abstract
In 2010, the Washington Circle convened a meeting, supported by the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), for a multidisciplinary group of experts to focus on the research gaps in performance measures for substance use disorders. This article presents recommendations in three areas: development of new performance measures; methodological and other considerations in using performance measures; and implementation research focused on using performance measures for accountability and quality improvement.
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Affiliation(s)
- Deborah W Garnick
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Constance M Horgan
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Andrea Acevedo
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Frank McCorry
- Chair, Washington Circle and FAM Consulting, Yorktown Heights, NY, USA
| | - Constance Weisner
- Division of Research, Northern California Kaiser Permanente, University of California, San Francisco, CA, USA
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Tsai J, Rosenheck RA. Racial differences among supported housing clients in outcomes and therapeutic relationships. Psychiatr Q 2012; 83:103-12. [PMID: 21811835 DOI: 10.1007/s11126-011-9187-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study examined racial differences between African American and White supported housing clients in clinical outcomes and in their relationships with their landlords, medical and mental health care providers, and religious faith. Housing, mental health, and substance abuse outcomes of 204 White clients and 269 Black clients participating in a national homeless initiative were examined, along with their ratings of their relationships with landlords, health care providers, and religious participation. There were no significant racial differences found on outcomes or on client ratings of the helpfulness of relationships with landlords and health care providers. However, Black participants reported significantly stronger religious faith and religious participation than White participants. Together, these results suggest the religious faith of Black clients should be appreciated as a potential asset in supported housing services and that efforts to maintain racial equality should be continued in the delivery of health services.
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Affiliation(s)
- Jack Tsai
- VA New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave., 151D, West Haven, CT 06516, USA.
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13
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A comparison of treatment outcomes among chronically homelessness adults receiving comprehensive housing and health care services versus usual local care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2012; 38:459-75. [PMID: 21259068 DOI: 10.1007/s10488-011-0333-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Service use and 2-year treatment outcomes were compared between chronically homelessness clients receiving comprehensive housing and healthcare services through the federal Collaborative Initiative on Chronic Homelessness (CICH) program (n = 281) a sample of similarly chronically homeless individuals receiving usual care (n = 104) in the same 5 communities. CICH clients were housed an average of 23 of 90 days (52%) more than comparison group subjects averaging over all assessments over a 2-year follow-up period. CICH clients were significantly more likely to report having a usual mental health/substance abuse treater (55% vs. 23%) or a primary case manager (26% vs. 9%) and to receive community case management visits (64% vs. 14%). They reported receiving more outpatient visits for medical (2.3 vs. 1.7), mental health (2.8 vs. 1.0), substance abuse treatment (6.4 vs. 3.6), and all healthcare services (11.6 vs. 6.1) than comparison subjects. Total quarterly healthcare costs were significantly higher for CICH clients than comparison subjects ($4,544 vs. $3,326) due to increased use of outpatient mental health and substance abuse services. Although CICH clients were also more likely to receive public assistance income (80% vs. 75%), and to have a mental health/substance provider at all, they expressed slightly less satisfaction with their primary mental health/substance abuse provider (satisfaction score of 5.0 vs. 5.4). No significant differences were found between the groups on measures of substance use, community adjustment, or health status. These findings suggest that access to a well funded, comprehensive array of permanent housing, intensive case management, and healthcare services is associated with improved housing outcomes, but not substance use, health status or community adjustment outcomes, among chronically homeless adults.
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14
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Chronically Homeless Women Report High Rates of Substance Use Problems Equivalent to Chronically Homeless Men. Womens Health Issues 2011; 21:383-9. [DOI: 10.1016/j.whi.2011.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 03/15/2011] [Accepted: 03/16/2011] [Indexed: 11/19/2022]
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Olivet J, McGraw S, Grandin M, Bassuk E. Staffing Challenges and Strategies for Organizations Serving Individuals who have Experienced Chronic Homelessness. J Behav Health Serv Res 2010; 37:226-38. [DOI: 10.1007/s11414-009-9201-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 11/09/2009] [Indexed: 10/20/2022]
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16
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Foster S, LeFauve C, Kresky-Wolff M, Rickards LD. Services and Supports for Individuals with Co-occurring Disorders and Long-Term Homelessness. J Behav Health Serv Res 2009; 37:239-51. [DOI: 10.1007/s11414-009-9190-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 08/12/2009] [Indexed: 10/20/2022]
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17
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McGraw SA, Larson MJ, Foster SE, Kresky-Wolff M, Botelho EM, Elstad EA, Stefancic A, Tsemberis S. Adopting Best Practices: Lessons Learned in the Collaborative Initiative to Help End Chronic Homelessness (CICH). J Behav Health Serv Res 2009; 37:197-212. [DOI: 10.1007/s11414-009-9173-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 02/07/2009] [Indexed: 10/20/2022]
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