Trauma Symptoms of Individuals with Mental Illness at Risk for Homelessness Participating in a Life Skills Intervention

This study investigated 1) trauma symptom changes following the implementation of a life skills intervention; 2) the relationship between demographic characteristics, cognitive functioning, life skill knowledge and changes in trauma symptoms; and 3) predictive factors of trauma symptoms during housing transitions. Participants (N = 72) enrolled in intervention modules to increase residential stability (room and self‐care, money management, nutrition management or safe community participation), completed the Impact of Event Scale‐Revised, ACLS‐2000 and a Practical Skills Test at baseline, post‐intervention and 3 and 6 months later to examine differences in trauma symptoms and treatment outcomes. Trauma symptoms were highest at baseline and decreased significantly for most participants over time. For a subgroup of females experiencing abuse and individuals who were homeless less than 1 year, there was an increase in symptoms at 3 months post‐intervention (highest rate of housing transition). This small convenience sample represents a limited geographic area. Replication of the study with larger groups for generalization, and further investigation into the specific impact of symptoms on function were recommended for future research. Copyright © 2010 John Wiley & Sons, Ltd.     

Health Status,Quality of Life,Residential Stability,Substance Use,and Health Care Utilization among Adults Applying to a Supportive Housing Program

Supportive housing, defined as subsidized housing in conjunction with site-based social services, may help improve the health and residential stability of highly disadvantaged individuals. This study examined changes in health status, quality of life, substance use, health care utilization, and residential stability among 112 homeless and vulnerably housed individuals who applied to a supportive housing program in Toronto, Canada, from December 2005 to June 2007. Follow-up interviews were conducted every 6 months for 18 months. Comparisons were made between individuals who were accepted into the program (intervention) and those who were wait-listed (usual care) using repeated-measures analyses. Individuals who were accepted into the housing program experienced significantly greater improvements in satisfaction with living situation compared with individuals in the usual care group (time, F _3,3,261 = 47.68, p < 0.01; group × time, F _3,3,261 = 14.60, p < 0.01). There were no significant differences in other quality of life measures, health status, health care utilization, or substance use between the two groups over time. Significant improvement in residential stability occurred over time, independent of assigned housing group (time, F _3,3,261 = 9.96, p < 0.01; group × time, F _3,3,261 = 1.74, p = 0.17). The ability to examine the effects of supportive housing on homeless individuals was limited by the small number of participants who were literally homeless at baseline and by the large number of participants who gained stable housing during the study period regardless of their assigned housing status. Nonetheless, this study shows that highly disadvantaged individuals with a high prevalence of poor physical and mental health and substance use can achieve stable housing.     

Effects of a brief worksite stress management program on coping skills, psychological distress and physical complaints: a controlled trial

Objectives: To examine the effects of single-session, small-group stress management program on knowledge about stress, coping skills, and psychological and physical distress. Methods: A total of 300 employees from a company in western Japan were invited to participate in the study. Those who consented to enter the study were assigned to an intervention (n=149) or waiting list control group (n=151). Participants in the intervention group received a small-group stress management program. The program was primarily aimed at increasing knowledge about stress and improving coping skills. To investigate the intervention effect, change scores in outcome variables were calculated by subtracting the scores at pre-intervention from those at post-intervention (8 weeks after the pre-intervention survey). Next, the difference in the scores between groups was examined using analyses of covariance (ANCOVA) with the pre-intervention score as the covariate. Results: Favorable intervention effects were found on knowledge about stress and on coping skills (P<0.001 and P=0.012, respectively) and adverse effects on psychological distress (P=0.022). However, this adverse effect on psychological distress did not exist among those who initially perceived higher levels of job control. Conclusion: The single-session stress management program was effective on improving knowledge about stress, and coping skills, where job control moderated the effect of the program on psychological distress.     

Resiliency and survival skills among newly homeless adolescents: Implications for future interventions

Recent studies on homeless adolescents suggest that the profiles of homeless adolescents are heterogeneous, and that certain clusters of homeless adolescents demonstrated resiliency and positive coping strategies. This study examined the relationship between human immunodeficiency virus (HIV)-related risk factors and resiliency (survival skills) of homeless adolescents over a two-year period. Those who did not engage in unprotected sex reported significantly higher survival skills scores. Similarly, those who were monogamous during the study period reported significantly higher survival skills scores. However, there was a significant decline in survival skills scores after 6 months, regardless of the HIV-related risk factors. Findings from this study point to the urgent need to identify and target resilient adolescents early on to provide interventions to facilitate the transition to stable living situations before their resiliency deteriorates.     

Resiliency and survival skills among newly homeless adolescents: Implications for future interventions

Recent studies on homeless adolescents suggest that the profiles of homeless adolescents are heterogeneous, and that certain clusters of homeless adolescents demonstrated resiliency and positive coping strategies. This study examined the relationship between HIV-related risk factors and resiliency (survival skills) of homeless adolescents over a 2-year period. Those who did not engage in unprotected sex reported significantly higher survival skills scores. Similarly, those who were monogamous during the study period reported significantly higher survival skills scores. However, there was a significant decline in survival skills scores after 6 months, regardless of the HIV-related risk factors. Findings from this study point to the urgent need to identify and target resilient adolescents early on to provide interventions to facilitate the transition to stable living situations before their resiliency deteriorates.     

Rural physicians' skills enrichment program: A cohort control study of retention in Alberta

Objective: The Rural Physician Action Plan of Alberta introduced an enrichment program in 2001 to improve physician access to skills training. The objective of this study was to evaluate this program and measure retention compared with matched controls over 5 years. Design: Longitudinal, matched, case control study and program evaluation. Setting: Rural communities in Alberta, Canada. Participants: Rural physicians. Interventions: Thirty‐one rural physicians self‐selected their personal skills training program and listed three goals they wished to attain. They were matched by age, specialty, years in practice and size of community with rural physicians who did not participate in a skills training or upgrading program. Main outcome measures: Goal attainment for subject physicians, use of skills at 5 years and comparison of rural retention of physicians at 5 years. Results: Thirty‐two of thirty‐five physicians classified their goal attainment to be as expected or greater, and all were using their new skills at 5 years. Of the matched physicians, 29 training participants remained in rural practice at 5 years compared with only 22 of 29 matched control: relative risk 1.31, confidence interval 1.06–1.62 P < 0.05. Conclusions: The enrichment program provides focused, valued skills training for rural physicians and long‐term benefits to rural communities.     

The health and housing in transition study: a longitudinal study of the health of homeless and vulnerably housed adults in three Canadian cities

Objectives

While substantial research has demonstrated the poor health status of homeless populations, the health status of vulnerably housed individuals is largely unknown. Furthermore, few longitudinal studies have assessed the impact of housing transitions on health. The health and housing in transition (HHiT) study is a prospective cohort study that aims to track the health and housing status of a representative sample of homeless and vulnerably housed single adults in three Canadian cities (Toronto, Ottawa, and Vancouver). This paper discusses the HHiT study methodological recruitment strategies and follow-up procedures, including a discussion of the limitations and challenges experienced to date.

Methods

Participants (n?=?1,192) were randomly selected at shelters, meal programmes, community health centres, drop-in centres, rooming houses, and single-room occupancy hotels from January to December 2009 and are being re-interviewed every 12?months for a 2-year period.

Results

At baseline, over 85% of participants reported having at least one chronic health condition, and over 50% reported being diagnosed with a mental health problem.

Conclusions

Our findings suggest that, regardless of housing status, participants had extremely poor overall health.     

Capturing intervention effects over time: reanalysis of a critical time intervention for homeless mentally ill men

OBJECTIVES: We analyzed whether a method for identifying latent trajectories--latent class growth analysis (LCGA)--was useful for understanding outcomes for individuals subject to an intervention. METHODS: We used LCGA to reanalyze data from a published study of mentally ill homeless men in a critical time intervention (CTI) program. In that study, 96 men leaving a shelter's on-site psychiatric program were randomly assigned to experimental and control groups. The former received CTI services and the latter usual services. Each individual's housing circumstances were observed for 18 months after program initiation. Our outcome measure was monthly homelessness: a person was considered homeless in a month if he was homeless for even 1 night that month. RESULTS: Four latent classes were found among the control group, but just 3 among the experimental group. Control, but not experimental, group individuals showed a small class of chronically homeless men. The size of the never-homeless class was 19 percentage points larger for the experimental than for the control group. J- and inverted-U-shaped patterns were also found among both groups, but with important differences in timing of patterns. CONCLUSIONS: Our results reveal effects not apparent in the original analysis, suggesting that latent class growth models improve intervention evaluation.     

A residential recovery program for homeless alcoholics: Differences in program recruitment and retention

This paper describes the Sober Transitional Housing and Employment Project (STHEP), a longterm residential recovery program in Los Angeles for homeless alcoholics. This NIAAA community demonstration project aimed to reintegrate homeless alcoholics into the urban environment and to increase levels of sobriety, housing, and employment. Participants first completed a 90-day program in a rural location and then transferred to a downtown recovery home for an additional 120 days. Services included enhanced vocational and housing assistance and specialized group activities. The evaluation examined patterns of recruitment and program retention, in comparison to a control group which received only the first phase, without enhanced services. Whites, women, and younger residents were less likely to sign up for the project waiting list and to accept entry into the project when randomized. STHEP participants were more likely to complete the first phase, particularly black males, compared to the control group. Upon completion of the second phase, whites were more likely to discharge to a rental situation, blacks to a sober group living facility, and women to live with others. Differences in program recruitment and completion may be explained by employment history, economic status, and gender, race, and age differences in subsistence patterns while homeless. The findings suggest the need for program planners to take into consideration the diverse backgrounds and needs of homeless alcoholics and to match individual needs to services. This study was completed while Dr. Grella was at the Pacific Institute for Research and Evaluation, Venice, Calif.     

A time-series perspective on effectiveness of a health teaching program on chronic obstructive pulmonary disease

The purpose of this research was to study the long-term effects of attendance at "Help Yourself to Better Breathing" classes on knowledge attainment, coping strategies, and anxiety, depression, and hostility in individuals with chronic obstructive pulmonary disease. Data were gathered immediately and six months following completion of the program. The results were then compared to those obtained before program attendance. The data showed a significant difference between the pretest, immediate post-test, and the six-month knowledge scores. Coping scores remained the same, which may indicate that not enough emphasis is placed on the development of these skills. There was a significant lowering of the depression scores at the six-month post-testing, and anxiety and hostility scores were lower, but not significantly so. In addition, some participants after the classes were completed chose to enroll in the Better Breathers Program support group and in a pulmonary rehabilitation program. Overall, this study indicates that beneficial effects are evidenced six months following attendance at "Help Yourself to Better Breathing" classes.     

Housing outcomes for hospitalized homeless veterans

This study examines housing status at the time of hospital discharge in a national sample of 3,502 veterans who were homeless at admission to a Veterans Health Administration (VHA) medical center. A supplemental survey on homelessness was added to the annual VHA inpatient census over a 4-year period (1995 through 1998). Data from this survey were used to identify homeless veterans hospitalized on the final day of the fiscal year and to document their housing status at discharge. A signal detection technique, Receiver Operating Characteristic analysis, was used to identify predictors of housing status at discharge. At discharge, only 13% of the veterans in our analytic sample were literally homeless, 40% were doubled up, and 33% were transferred to another an institution; only 13% were living independently. Housing status at admission (specifically, staying with friends or family temporarily rather than literally homeless), treatment in a psychiatric or substance abuse program rather than a medical program, and a greater income level or access to VHA benefits were found to be associated with better housing outcomes. As one might expect, homelessness was infrequently resolved during an acute inpatient hospitalization, but few veterans returned to literal homelessness at the time of discharge.     

To house or not to house: the effects of providing housing to homeless substance abusers in treatment

OBJECTIVES: Housing typically is not provided to homeless persons during drug abuse treatment. We examined how treatment outcomes were affected under 3 different housing provision conditions. METHODS: We studied 196 cocaine-dependent participants who received day treatment and no housing (NH), housing contingent on drug abstinence (ACH), or housing not contingent on abstinence (NACH). Drug use was monitored with urine testing. RESULTS: The ACH group had a higher prevalence of drug abstinence than the NACH group (after control for treatment attendance), which in turn had a higher prevalence than the NH group. All 3 groups showed significant improvement in maintaining employment and housing. CONCLUSIONS: The results of this and previous trials indicate that providing abstinence-contingent housing to homeless substance abusers in treatment is an efficacious, effective, and practical intervention. Programs to provide such housing should be considered in policy initiatives.     

Dutch homeless people 2.5 years after shelter admission: what are predictors of housing stability and housing satisfaction?

Housing stability is an important focus in research on homeless people. Although definitions of stable housing differ across studies, the perspective of homeless people themselves is generally not included. Therefore, this study explored the inclusion of satisfaction with the participant's current housing status as part of the definition of housing stability and also examined predictors of housing stability with and without the inclusion of homeless person's perspective. Of the initial cohort consisting of 513 homeless participants who were included at baseline in 2011, 324 (63.2%) were also interviewed at 2.5‐year follow‐up. To determine independent predictors of housing stability, we fitted multivariate logistic regression models using stepwise backward regression. At 2.5‐year follow‐up, 222 participants (68.5%) were stably housed and 163 participants (51.1%) were stably housed and satisfied with their housing status. Having been arrested (OR = 0.36, 95% CI: 0.20–0.63), a high level of somatisation (physical manifestations of psychological distress) (OR = 0.52, 95% CI: 0.30–0.91) and having unmet care needs (OR = 0.77, 95% CI: 0.60–0.99) were negative predictors of housing stability. Having been arrested (OR = 0.43, 95% CI: 0.25–0.75), high debts (OR = 0.45, 95% CI: 0.24–0.84) and a high level of somatisation (OR = 0.49, 95% CI: 0.28–0.84) were negative predictors of stable housing when satisfaction with the housing status was included. Because inclusion of a subjective component revealed a subgroup of stably housed but not satisfied participants and changed the significant predictors, this seems a relevant addition to the customary definition of housing stability. Participants with characteristics negatively associated with housing stability should receive more extensive and individually tailored support services to facilitate achievement of housing stability.     

A typology of childhood problems among chronically homeless adults and its association with housing and clinical outcomes

Studies of chronically homeless adults have not adequately investigated the impact of adverse childhood experiences. The current retrospective, longitudinal study profiles the childhood experiences reported by 738 participants in an 11-site supported housing initiative and examines how their childhood profile is related to their homeless history, their psychosocial status before entry into supported housing, and their outcomes once enrolled in supported housing. A two-step cluster analysis revealed three childhood profiles: Relatively Numerous Childhood Problems, Disrupted Family, and Relatively Few Childhood Problems. Results found that participants with Relatively Numerous Childhood Problems were significantly younger when they were first homeless and had worse drug use before entry into supported housing than other participants. There were no differences in housing, substance use, or mental and physical health outcomes once participants were enrolled in supported housing. Prevention of homelessness should focus, to the extent possible, on individuals with extensive childhood problems.     

Does patient feedback improve the consultation skills of general practice trainees? A controlled trial

Medical Education 2010: 44 : 156–164 Context This study aimed to assess if an additional patient feedback training programme leads to better consultation skills in general practice trainees (GPTs) than regular communication skills training, and whether process measurements (intensity of participation in the programme) predict the effect of the intervention. Methods We carried out a controlled trial in which two sub‐cohorts of GPTs were allocated to an intervention group (n = 23) or a control group (n = 30), respectively. In 2006, allocated first‐year GPTs in the VU University Medical Centre attended a patient feedback training programme in addition to the regular communication skills training. The control group attended only regular communication skills training. Trainees were assessed by simulated patients who visited the practices and videotaped the consultations at baseline and after 3 months. The videotapes were randomly assigned to eight trained staff members. The MAAS‐Global Instrument (range 0–6) was used to assess (a change in) trainee consultation skills. Results were analysed using a multi‐level, linear mixed‐model analysis. Results Data on 50 GPTs were available for the follow‐up analysis. Both intervention group and control group GPTs improved their consultation skills: mean MAAS‐Global scores for all participants were 3.29 (standard deviation [SD] 0.75) at baseline and 3.54 (SD 0.66) at follow‐up (P = 0.047). The improvement in MAAS‐Global scores in the intervention group did not differ significantly from the improvement in the control group. The analysis showed a trend for intensity of participation in the patient feedback programme to predict greater improvement in MAAS‐Global scores. Discussion Although the baseline scores were already in the high range, consultation skills in both groups improved significantly. This is reassuring for current teaching methods. The patient feedback programme did not improve consultation skills more than regular communication skills training. However, a subgroup of GPTs who participated intensively in the programme did improve their consultation skills further in comparison with the less motivated subgroup.     

Early Intervention Options for Acute Low Back Pain Patients: A Randomized Clinical Trial with One-Year Follow-Up Outcomes

Introduction In an earlier study, Gatchel et al. (J Occup Rehabil 13:1–9, 2003) demonstrated that participants at high risk for developing chronic low back pain disability (CLBPD), who received a biopsychosocial early intervention treatment program, displayed significantly more symptom improvement, as well as cost savings, relative to participants receiving standard care. The purpose of the present study was to expand on these results by examining whether the addition of a work-transition component would further strengthen the effectiveness of this early intervention treatment. Methods Using an existing algorithm, participants were identified as being high-risk (HR) or low-risk (LR) for developing CLBPD. HR participants were then randomly assigned to one of three groups: early intervention (EI); early intervention with work transition (EI/WT); or standard care (SC). Participants provided information regarding pain, disability, work status, and psychosocial functioning at baseline, periodically during treatment, and again 1 year following completion of treatment. Results At 1-year follow-up, no significant differences were found between the EI and EI/WT groups in terms of occupational status, self-reports of pain and disability, coping ability or psychosocial functioning. However, significant differences in all these outcomes were found comparing these groups to standard care. Conclusion The addition of a work transition component to an early intervention program for the treatment of ALBP did not significantly contribute to improved work outcomes. However, results further support the effectiveness of early intervention for high-risk ALBP patients.     

Risk factors for long-term homelessness: findings from a longitudinal study of first-time homeless single adults

OBJECTIVES: We examined risk factors for long-term homelessness among newly homeless men and women who were admitted to New York City shelters in 2001 and 2002. METHODS: Interviews were conducted with 377 study participants upon entry into the shelter and at 6-month intervals for 18 months. Standardized assessments of psychiatric diagnosis, symptoms, and coping skills; social and family history; and service use were analyzed. Kaplan-Meier survival analysis and Cox regression were used to examine the association between baseline assessments and duration of homelessness. RESULTS: Eighty-one percent of participants returned to community housing during the follow-up period; the median duration of homelessness was 190 days. Kaplan-Meier survival analysis showed that a shorter duration of homelessness was associated with younger age, current or recent employment, earned income, good coping skills, adequate family support, absence of a substance abuse treatment history, and absence of an arrest history. Cox regression showed that older age group P<.05) and arrest history (P<.01) were the strongest predictors of a longer duration of homelessness. CONCLUSIONS: Identification of risk factors for long-term homelessness can guide efforts to reduce lengths of stay in homeless shelters and to develop new preventive interventions.     

长期住院慢性精神分裂症患者社会技能训练效果评价

目的探讨社会技能训练对长期住院的慢性精神分裂症患者社会功能的影响。方法在山西省荣军精神康宁医院长期住院的慢性精神分裂症患者中选取符合入组标准和排除标准的82人,随机分为干预组40人和对照组42人。干预组按顺序实施语言训练、角色训练和职业技能培训,疗程12个月。干预前1个月内和干预后1个月内,采用大体评定量表（GAS）、日常生活能力量表（ADL）、简易智力状态检查（MMSE）、住院精神病人社会功能评定量表（SSPI）和阴性症状评定量表（SANS）对两组患者的精神症状、社会功能和生活自理能力进行评估。结果两组患者在年龄、病程、疾病亚型、抗精神病药物、阳性家族史等方面的差异均无统计学意义（P〉0．05）。干预后,干预组GAS、ADL、SSPI和SANS得分优于对照组,差异有统计学意义（P〈0．05）,MMSE得分与对照组的差异无统计学意义（P〉0．05）。干预组自身比较,干预后SSPI、ADL、GAS、SANS量表得分显著优于干预前（P〈0．05）。结论社会技能训练能较好的缓解慢性精神分裂症患者的精神症状,改善其社会功能和日常生活能力,降低或延缓精神残疾,是较为有效的精神康复措施。     

Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis

OBJECTIVES: We examined the longitudinal effects of a Housing First program for homeless, mentally ill individuals' on those individuals' consumer choice, housing stability, substance use, treatment utilization, and psychiatric symptoms. METHODS: Two hundred twenty-five participants were randomly assigned to receive housing contingent on treatment and sobriety (control) or to receive immediate housing without treatment prerequisites (experimental). Interviews were conducted every 6 months for 24 months. RESULTS: The experimental group obtained housing earlier, remained stably housed, and reported higher perceived choice. Utilization of substance abuse treatment was significantly higher for the control group, but no differences were found in substance use or psychiatric symptoms. CONCLUSIONS: Participants in the Housing First program were able to obtain and maintain independent housing without compromising psychiatric or substance abuse symptoms.