Length of time spent homeless: Implications for employment of homeless persons

This study investigated the relationship between the length of time spent homeless and employment outcomes for homeless participants in job training programs. Participants furnished information about their psychological resources (internality and learned resourcefulness) and social support when they entered employment training programs. Employment outcomes were status as employed or unemployed at termination from the programs and the level of employment at follow-up, approximately 3 weeks after termination from training. Participants reported on the number of weeks they had been homeless prior to program entrance. Psychological resources and social support were expected to buffer against a negative influence of a greater duration of homelessness on the employment outcomes. For persons who had lower levels of psychological resources and social support, endurance of a greater period of time homeless was associated with less successful employment outcomes. Implications for the provision of employment services to homeless individuals are discussed.     

Risk of mental ill-health among homeless women in Madrid (Spain)

Several studies have revealed that homeless people suffering from mental health problems are more vulnerable than homeless without those mental health problems. Nevertheless, there is a lack of evidence describing the real circumstances of homeless women. This paper explores the differences between homeless women at high risk of mental ill-health compared with those who do not present this risk. The sample consisted of a group of 120 homeless women in Madrid (Spain). For this study, we collected data on background information (trajectory of homelessness and stressful life events experienced) and current aspects (living conditions, physical health, and social support). The risk of mental ill-health has been measured by the short version of the General Health Questionnaire (GHQ-28). The results showed that homeless women with higher risk of mental ill-health had become homeless at a younger age, had experienced more stressful life events in their lives, had a poorer physical health, felt less happy, had less social support, and a greater feeling of loneliness when compared with homeless women who did not present risk of mental ill-health. Improving knowledge about the risk of mental ill-health among homeless women is essential for the design of specific psychological interventions within this population.

     

Progression of HIV disease among women following delivery

OBJECTIVE: To assess patterns of HIV disease progression among HIV-1-infected women following delivery. METHODS: Four hundred ninety-seven women enrolled in PACTG 185, a phase 3 trial of passive immunoprophylaxis in addition to zidovudine (ZDV) for the prevention of perinatal transmission, were included. Visits occurred twice during pregnancy; at delivery; and at 12, 26, 48, and 78 weeks postpartum. Repeated-measures linear regression and proportional hazards models were applied. RESULTS: Trial treatment (HIV hyperimmune globulin vs. immune globulin) was not related to postpartum disease progression. Longitudinal analysis of HIV-1 RNA demonstrated stable levels during pregnancy, significantly increased HIV-1 RNA by 12 weeks postpartum even on stable therapy, and a gradual increase thereafter. Changes in CD4+ lymphocyte percentage over 18 months of follow-up were similar for women continuing or stopping ZDV postpartum. Compared with those receiving no therapy, the hazard ratio for AIDS or death among women who received monotherapy postpartum was 0.52 (95% confidence interval [CI]: 0.25-1.04), 0.17 (CI: 0.06-0.49) for women who received combination therapy, and 0.24 (CI: 0.06-1.01) for women who received highly active antiretroviral therapy. CONCLUSIONS: RNA levels increased significantly from delivery to 12 weeks postpartum. Changes in HIV-1 RNA and CD4+ lymphocyte percentage were similar among women continuing or stopping therapy after delivery, and response to antiretroviral therapy was as expected postpartum.     

Mode of delivery and postpartum morbidity among HIV-infected women: the women and infants transmission study

Cesarean delivery before onset of labor and rupture of membranes (i.e., scheduled cesarean delivery) is associated with a lower risk of vertical transmission of HIV. The following a priori hypotheses were tested: among HIV-infected women, scheduled cesarean delivery is associated with a higher risk of postpartum morbidity, longer hospitalization, and a higher risk of rehospitalization than spontaneous vaginal delivery. Postpartum morbidity occurred following 178 of 1,186 (15%) of deliveries during 1990 to 1998 in The Women and Infants Transmission Study. The most commonly reported postpartum morbidity events were: fever without infection, hemorrhage or severe anemia, endometritis, urinary tract infection, and cesarean wound complications. Several time trends were observed: the median duration of ruptured membranes decreased (p < .001), intrapartum antibiotic use increased (p < .001), the median antepartum plasma HIV RNA concentration decreased (p < .001), and the incidence of any postpartum morbidity decreased (p = .02). With spontaneous vaginal delivery as the reference category, both scheduled (odds ratio [OR] = 4.69; 95% confidence interval [95% CI], 2.03-10.84), and nonscheduled (OR, 2.50; 95% CI, 1.24-5.04) cesarean deliveries were associated with fever without infection; with urinary tract infection (OR, 3.79; 95% CI 1.04-13.85; OR, 3.86; 95% CI, 1.55-9.60, respectively), and with any postpartum morbidity (OR, 3.19; 95% CI 1.69-6.00; OR, 4.10; 95% CI, 2.71-6.19, respectively). Nonscheduled cesarean deliveries were more likely to be complicated by endometritis (OR, 6.98; 95% CI, 3.53-13.78). Adjusted ORs relating mode of delivery and each of the outcomes (fever without infection, urinary tract infection, endometritis, and any postpartum morbidity) were similar to unadjusted ORs. Results of this analysis indicate scheduled cesarean delivery is associated with an increased risk of any postpartum morbidity and, specifically, postpartum fever without infection. The potential for postpartum morbidity with scheduled cesarean delivery should be considered in light of possible adverse events associated with other interventions to decrease the risk of vertical transmission of HIV. Counseling of HIV-infected pregnant women regarding scheduled cesarean delivery as a possible intervention to decrease maternal-infant transmission of HIV should include discussion of these results, as well as new data as they become available, regarding the incidence and severity of postpartum morbidity events among HIV-infected women according to mode of delivery.     

Interagency teams: A vehicle for service delivery reform

Human service delivery organizations often have great difficulty implementing new service delivery technologies. This study examines the extent to which interagency service delivery teams facilitate the implementation of a popular reform that significantly challenges the status quo: family‐centered service delivery. Survey data from 121 providers representing 25 agencies within one county suggest that interagency teams may promote provider implementation of new service delivery practices. Teams members were more likely than nonteam members to implement practices consistent with family‐centered service delivery. Consumer focus group data support these findings, with consumers noting that services received from providers in the team context were more individualized, empowering, and comprehensive than the services they typically received in the county. The implications of these findings for practitioners and scholars interested in facilitating human service delivery reform are discussed. © 2002 Wiley Periodicals, Inc.     

Meta-stereotypes among women living homeless: Content,uniformity, and differences based on gender in Madrid,Spain

This paper examines the content and degree of uniformity of meta-stereotypes among women living homeless in Madrid, Spain, and the differences with their male counterparts. The study was conducted utilizing a structured interview with a representative sample of men living homeless (n = 158) and a convenience sample of a similar size (n = 138) of women living homeless. The results show that the meta-stereotypes of women living homeless in Madrid are characterized by mainly negative (e.g., consumers of alcohol, drug users, lazy, criminals) or indulgent (e.g., physically and psychologically worn out, rejected by society, sick) contents, with very limited positive (e.g., courteous, respectful, polite) contents, and a high degree of uniformity. There are no major differences in the content of meta-stereotypes of the female interviewees in terms of their age, academic background, motherhood, or nationality. Compared to men in the same situation, a larger percentage of women living homeless agree with negative and indulgent meta-stereotypes, and a smaller percentage agree with positive meta-stereotypes.     

Maternal support in the delivery room and birthweight among African-American women

OBJECTIVES: We performed a hospital-based case control study of African-American mothers to explore the relationship between maternal support by a significant other in the delivery room and very low birthweight (VLBW). METHODS: We administered a structured questionnaire to mothers of VLBW (less than 1,500 g; N=104) and normal birthweight (greater or equal to 2,500 g; N=208) infants. RESULTS: The odds ratio for VLBW comparing women without social support in the delivery room to those with a companion was 3.5 (2.1-5.8). Several traditional risk factors were not associated with VLBW, but older maternal age and perceived racial discrimination were. CONCLUSIONS: Maternal support in the delivery room or factors closely associated with it significantly decreases the odds of delivering a VLBW infant for African-American women.     

Models for service delivery in children's mental health: Common characteristics

Identified seven characteristics in the selected programs recognized by the Task Force on Model Programs in Service Delivery in Child and Family Mental Health sponsored by the Section on Clinical Child Psychology and the Division of Child, Youth, and Family Services. The 23 model programs demonstrate successful implementation in meeting the needs of children and families. Interacting commonalities include (a) a focus on the ecology of the child; (b) collaboration for comprehensive, yet versatile services; (c) clearly defined missions; (d) reduction of barriers to access; (e) ability to be replicated and adapted; (e) demonstrated accountability and effectiveness; and (g) strong and dynamic leadership. The different programs illustrate these characteristics to varying degrees. The exemplar programs reveal what is good about the practice and science of mental health delivery and point to the future for better services.     

A comparison of homeless women and their intimate partners

In this study, we examine differences among 448 homeless women and their male partners in terms of sociodemographic and psychological characteristics, risky sexual and drug-use behaviors, and childhood abuse and adult victimization. Findings reveal women scored significantly lower on mental health and self-esteem, and significantly higher on depression, anxiety, and hostility measures, than their intimate partners. Scores for the dyad were nevertheless indicative of poor mental health functioning. Homeless women and their intimate partners both reported low levels of injection drug-use (5% and 6%); higher percentages of both groups reported practicing unprotected sex (70% vs. 72%) and sex with multiple partners (26% vs. 23%). Homeless women were less likely to report non-injection drug use, but more likely to report childhood and adult sexual abuse, than their intimate partners. Implications for Acquired Immune Deficiency Syndrome (AIDS) risk reduction and safety enhancement programs for the dyad are discussed. © 1999 John Wiley & Sons, Inc.     

The changing face of clinical genetics service delivery in the era of genomics: a framework for monitoring service delivery and data from a comprehensive metropolitan general genetics service

PurposeClinical genetics is an evolving specialty impacted by the availability of increasingly sophisticated investigational technologies. Methods for monitoring the changes in workload and workflow are necessary to ensure adequate service resourcing.MethodsA literature search of known workload and workflow studies was completed, identifying metrics of value. A framework of metrics to allow consistent capture in clinical genetics practice was developed. This framework was then applied to local general genetics service data to evaluate recent changes in service delivery.ResultsLiterature regarding service delivery metrics in clinical genetics services is limited and inconsistent in application. The metric framework generated is a useful tool for consistent and ongoing evaluation of general genetics services. Through application of the framework, new service delivery trends and significant changes in workload were identified.ConclusionStudies of clinical genetics service delivery suffer from the use of inconsistent metrics. This framework will allow for monitoring of changes to service delivery, caseload volume, caseload complexity, and workforce over time. Local data presented demonstrate the significant effect that implementing clinical genomic sequencing has had on clinical service delivery. Applying this framework produces a comprehensive service characterization, enabling funding bodies to justify resourcing that addresses the growing demand of clinical genetics.     

Agreement between self‐report and archival public service utilization data among chronically homeless individuals with severe alcohol problems

Public service utilization data are often used as key outcomes in studies on homelessness. Although self‐report data on these outcomes are accessible and cost‐effective, various factors may affect retrospective recall in homeless populations. It is therefore necessary to establish validity of self‐report to ensure the integrity of studies involving such populations. Participants (N=134) were chronically homeless individuals with severe alcohol problems who participated in a housing first effectiveness trial (Larimer et al., 2009 ). The authors compared 30‐day and 3‐year retrospective self‐report data on sobering center, jail, and hospital use with archival records corresponding to the same timeframes. Analyses indicated good category‐specific agreement for 30‐day self‐report and archival data on sobering center (82%; κ=.58) and jail use (89%; κ=.60). Hospital use, however, was self‐reported significantly more frequently than indicated by archival data (78%; κ=.30). Three‐year data showed inadequate agreement across all three variables. © 2011 Wiley Periodicals, Inc.     

Health surveillance project among single homeless men in Bristol

The establishment of a health surveillance system for the single homeless is described. Health checks were performed in two Salvation Army hostels by a district nurse supported by general practitioners and other workers from one health centre. High levels of morbidity were discovered and the residents were largely treated by the primary health care team. Those residents who were referred to other agencies were shown to have a high attendance rate. An open access clinic was later set up by the district nurse in one of the hostels. This was well received by residents and staff and reduced the call out rate for the general practitioners.

In some parts of the UK, special medical centres for the single homeless have been established on the premiss that it is unrealistic to expect general practitioners to provide an adequate service. However, this study describes an effective service based on primary care which is acceptable to homeless people while being relatively cheap and easy to administer. We recommend the development of a peripatetic service as outlined in this study, offering health care at hostels, day centres and other places where the homeless are to be found.

     

Duration of homeless spells among severely mentally ill individuals: A survival analysis

The major objective of this study was to identify predictors of the duration of homeless spells among persons with severe mental illness (SMI). This was the first study to incorporate time-varying covariates into the survival analysis model predicting the length of homeless spells. The sample consisted of 215 individuals who had participated in two experiments evaluating the effectiveness of various treatment programs for homeless individuals. Persons who received assertive community treatment exited homelessness sooner than individuals who received brokered case management, outpatient treatment, or services from a drop-in center. More assistance in finding and maintaining housing were especially predictive of shorter homeless spells. Inclusion of variables which varied over time in the model (e.g., income and frequency of service contacts) reduced the impact of many of the demographic variables in the model. This survival analysis demonstrated that the efforts of human service agencies to assist homeless mentally ill individuals do make a difference. In general, persons who received more services exited homelessness sooner. © 1998 John Wiley & Sons, Inc.     

Just thinking about it: social capital and suicide ideation among homeless persons

Suicide ideation is a sensitive indicator of personal well-being. While ideation occurs in roughly 3 percent of the US population annually, in this study rates are 10 times higher. This article explores the role of social capital in mediating negative life circumstances on ideation for a sample of 161 homeless adults in a mid-sized Southern US metropolitan area. Our results imply that social capital does not function the same way for homeless persons as it does for the general population. This finding supports growing evidence that social capital's much touted benefits for personal well-being may not apply to disadvantaged populations.     

Risk of uterine rupture during labor among women with a prior cesarean delivery.

BACKGROUND: Each year in the United States, approximately 60 percent of women with a prior cesarean delivery who become pregnant again attempt labor. Concern persists that a trial of labor may increase the risk of uterine rupture, an uncommon but serious obstetrical complication. METHODS: We conducted a population-based, retrospective cohort analysis using data from all primiparous women who gave birth to live singleton infants by cesarean section in civilian hospitals in Washington State from 1987 through 1996 and who delivered a second singleton child during the same period (a total of 20,095 women). We assessed the risk of uterine rupture for deliveries with spontaneous onset of labor, those with labor induced by prostaglandins, and those in which labor was induced by other means; these three groups of deliveries were compared with repeated cesarean delivery without labor. RESULTS: Uterine rupture occurred at a rate of 1.6 per 1000 among women with repeated cesarean delivery without labor (11 women), 5.2 per 1000 among women with spontaneous onset of labor (56 women), 7.7 per 1000 among women whose labor was induced without prostaglandins (15 women), and 24.5 per 1000 among women with prostaglandin-induced labor (9 women). As compared with the risk in women with repeated cesarean delivery without labor, uterine rupture was more likely among women with spontaneous onset of labor (relative risk, 3.3; 95 percent confidence interval, 1.8 to 6.0), induction of labor without prostaglandins (relative risk, 4.9; 95 percent confidence interval, 2.4 to 9.7), and induction with prostaglandins (relative risk, 15.6; 95 percent confidence interval, 8.1 to 30.0). CONCLUSIONS: For women with one prior cesarean delivery, the risk of uterine rupture is higher among those whose labor is induced than among those with repeated cesarean delivery without labor. Labor induced with a prostaglandin confers the highest risk.     

Morbidity trends in the population of a specialised homeless primary care service

An increasing body of research demonstrates that homelessness is an independent risk factor for morbidity and premature death. This paper compares the frequency of diagnoses between 2003 and 2009 in the computerised records of a specialist practice for homeless people. The changing morbidity trends revealed offer a basis for comparison with other services and suggest benefits from collaborative working, particularly around substance misuse and mental health.