Substance Abuse,Homelessness, Developmental Decision-Making and Spirituality: A Women's Health Issue

ABSTRACT

A qualitative methodology was used to examine the relationship between homeless women's spirituality, substance abuse, moral reasoning and developmental decision-making. Findings indicated that a lack of development in spirituality and the ability to make decisions in childhood is related to homeless, addicted women's inability to maintain abstinence and achieve social independence. Spirituality impacted decisions to abstain from substance abuse and increased the women's social independence. Findings suggest that treatment needs to incorporate spirituality, family of origin, and the development of skills for independent decision-making. The authors propose that childhood maltreatment, homelessness and substance abuse impede spiritual development. Therefore, substance abuse treatment needs to include a focus on spirituality and moral reasoning in the recovery process.     

Creating a Family Centered Wellness Team: Lessons learned in creating an integrated continuum of care for families facing homelessness,addiction, and trauma recovery.

Abstract

Homelessness is often experienced by women and children, and recent evidence suggests that women and children are the fastest growing segments of the homeless population. Homelessness is often accompanied by mental illness, substance abuse, and histories of violence, for both women and their children. While trauma informed care has been incorporated into women's treatment systems there has not been widespread application of this knowledge to family centered work with homeless families. This paper explores the need for family strengthening approaches and identifies one model currently being evaluated that seeks to decrease service fragmentation, increase positive family interaction, and deepen the family's connections with each other and with the community.     

Homelessness and Substance Abuse: Which Comes First?

Abstract

The present paper uses a social selection and social adaptation framework to investigate whether problematic substance use normally precedes or follows homelessness. Clarifying temporal order is important for policy and program design. The paper uses information from a large dataset (n=4,291) gathered at two services in Melbourne, supplemented by 65 indepth interviews. We found that 43% of the sample had substance abuse problems. Of these people, one-third had substance abuse problems before they became homeless and two-thirds developed these problems after they became homeless. We also found that young people were more at risk of developing substance abuse problems after becoming homeless than older people and that most people with substance abuse issues remain homeless for 12 months or longer. The paper concludes with three policy recommendations.     

Homelessness,housing instability,intimate partner violence,mental health,and functioning: A multi-year cohort study of IPV survivors and their children

Abstract

Homelessness and housing instability frequently accompany intimate partner violence and can negatively impact health and functioning. When children are exposed to homelessness or housing instability their ability to develop and function is compromised. The purpose of this study is to examine the differential impact of homelessness and unstable housing on health and functioning of women and their children over a 2-year period. Two hundred and seventy-seven mothers reporting intimate partner violence (stalking, physical, or sexual violence by an intimate partner) were asked about housing stability, abuse, risk for murder, mental health, employment/wages, and their child's functioning over a 2-year period. Outcomes of mothers reporting homelessness and unstable housing were compared to mothers reporting stable housing. Over one-third (36%) of the mothers reported at least one episode of unstable housing over the 2-year period and 11% reported homelessness. Measures of maternal mental health and child functioning were worse for both unstably housed and homeless women, compared to stably housed women, with a higher risk for sexual abuse and risk for murder for homeless women. New models of rapid rehousing are needed that address not only the housing problems of women who have experienced intimate partner violence but also the mental health and safety issues that the women and their children face.     

Qualitative Research for and in Practice: Findings from Studies with Homeless Adults Who Have Serious Mental Illness and Co-Occurring Substance Abuse

This article draws upon findings from the New York Services Study, a Federally-funded qualitative study conducted in practice settings representing two fundamentally different approaches to serving homeless adults with serious mental illness and co-occurring substance abuse. The findings yielded four themes??cumulative adversity, individual acts of kindness in a system designed to control, discordant case managers?? perspectives, and the benefits of permanent housing. Recommendations for practice include respecting individuality, being sensitive to previous traumas, and working to achieve housing security sooner rather than later. Future research is needed to study the micro-level contexts of service delivery and how they inhibit or encourage engagement in care.     

Responding to the Mental Health and Grief Concerns of Homeless HIV-Infected Gay Men

Summary

Aging, homeless HIV-infected gay men confront multiple bereavement and mental health issues. Needs assessment interviews with this population in the streets of New York City facilitate the initial review and provision of clinically and culturally appropriate service delivery strategies for these disenfranchised gay men to access bereavement support and mental health care systems.     

The Seven Challenges: An Effective Treatment for Adolescents with Co-Occurring Substance Abuse and Mental Health Problems

ABSTRACT

Recent developments in the provision of the substance abuse treatment for adolescents has included a focus on age appropriate treatment with consideration for adolescents' relatively low level of motivation for treatment and high incidence of co-occurring substance use and mental health problems. This study examines 3- and 6-month substance use and mental health outcomes for youth (n = 36) participating in The Seven Challenges Program. Results indicate significant reductions in both substance use and mental-health-related measures at 3 months with all measures except substance abuse frequency continuing to improve at the most distal 6-month assessment. The Seven Challenges treatment model is presented along with a discussion of the findings.     

A theory based evaluation of an intervention to promote positive health behaviors and reduce social isolation in people experiencing homelessness

ABSTRACT

Homelessness adversely affects an individual's ability to access healthcare, opportunities for social interaction and recreational activities such as physical activity. This study aimed to evaluate the impact of a community-based physical activity and peer support intervention on the health and wellbeing of homeless participants. This study employed semi-structured interviews to investigate the perceived impact of the Street Fit Scotland intervention on the health and wellbeing of 10 homeless adults. Interviews were audio recorded and transcribed verbatim. A thematic analysis was conducted. Participants reported that their health and wellbeing had improved since attending the intervention. This was attributed to improvements in self-esteem, social interaction and mental wellbeing. Participants generally felt that their physical activity had increased since attending Street Fit Scotland, and a number of individuals reported that they were making healthier choices with regards to health behaviors. A theory of change logic model was developed that demonstrated how each component of the intervention influences the observed and intended outcomes. Attendance of Street Fit Scotland had positive effects on participant's health and wellbeing, particularly concerning self-esteem, health behaviors, social interaction, and physical activity. More efforts should be made to evaluate small-scale interventions that are reaching vulnerable population groups.     

Linking Housing,Social Services and Family Well-Being

Abstract

Securing adequate housing is a key component in achieving family well-being and a decent quality of life. It is expected that as many as twenty percent of the families currently on welfare, many of whom are disproportionately female and African American, may not be employable by the end of their lifetime benefit. These families, classified as “hard-to-serve” or “hard-to-employ,” are headed by an adult who may be struggling with substance abuse, physical or mental health problems, as well as low literacy and social competency issues that inhibit achieving self-sufficiency. This author will examine existing literature on welfare-dependent households coping with substance abuse and mental health problems, and how the lack of affordable housing impacts their ability to achieve self-sufficiency. This article presents a case study     

Comorbid Substance Abuse and Mental Illness

Abstract

Literature concerning assessment and treatment of comorbid substance abuse and mental illness is reviewed. Currently, comorbidity is under-diagnosed and dually diagnosed clients are under-served. Those clients, who are so diagnosed, are most often offered dichotomous parallel or serial interventions. However, research suggests that an integrated approach is preferable. Enhanced training of mental health and substance abuse professionals is urgently needed as is further research concerning the efficacy of various treatment modalities. Improved identification and treatment of comorbidity may reduce the revolving door effect among these individuals and thereby lower health care costs.     

Developmental Outcomes of Children of Homeless Substance-Abusing Mothers

Abstract

This study evaluated the impact ofan extended shelter-based child development/family therapy intervention, called Building Blocks, on the development of children of substance- abusing homeless mothers. The homeless children had greater than expected percentages ofdevelopmental deficits in a number of the developmental domains. Those children who participated in the extended child development/family therapy services were one fourth as likely to have a developmental deficit at 12 months compared to children who did not receive these services. Interventions must be intensive and long-term to improve the developmental outcomes of children with multiple risks ofpoverty, homelessness, and family substance abuse.     

An Exploration of Family Violence Among the Homeless

Abstract

This research found a high incidence of family violence among homeless people. The most common form of violence was physical; the least common was sexual abuse. The data also reported a high percentage of violence among homeless people confronted with mental illness. The policy and practice implications for these findings are discussed.     

Mental Health and Substance Abuse Screening in Primary Care

ABSTRACT

An automated screening system for substance abuse and mental health problems was developed and implemented in a rural primary care clinic. Eighty-nine patients were assessed with this system. The incidence of identified problems, 35% in total, was consistent with that found in previous studies of patients in general and medical settings. Additionally, over half of the patients assessed felt at least some need for mental health or substance abuse treatment. Nonetheless, because of the staff's concerns over patient privacy, impeding patient flow, and the physician's perceived ability to adequately identify these problems without assistance, the system was not adopted.     

A Follow-up Study of Homeless Women

This article presents an in-depth analysis of the changes observed in 25 homeless women with drug and alcohol abuse problems participating in a case management program. Participation in the program ranged from 6 to 44 months. Thirty-two percent of all participants’ situations were considered to have improved, while 20% remained stable. Less improvement was noted in the situations of women followed for 3 years or more (14.3% improved, 28.6% stable). Domains showing the most improvement were housing, financial situation, and substance abuse. Deterioration was primarily attributable to physical and mental health problems. These findings could indicate that although a case management program can initially contribute to improving the living conditions of its clients, acquisitions are difficult to maintain over an extended period. Health and substance abuse play a crucial role in the deterioration process.     

Adverse Childhood Experiences and Healthcare Costs in Adult Life

ABSTRACT

The current study aims to present the prevalence of adverse childhood experiences and examine the healthcare costs associated with primary, allied, and specialist healthcare services. The Australian Longitudinal Study on Women’s Health is a general health survey of four nationally representative age cohorts. The current study uses 20 years of survey and administrative data (1996–2015) from the cohort born 1973–1978. Overall, 41% of women indicated at least one category of childhood adversity. The most commonly reported type of childhood adversity was having a household member with a mental illness (16%), with the most commonly reported ACES category being psychological abuse (17%). Women who had experienced adversity in childhood had higher healthcare costs than women who had not experienced adversity. The healthcare costs associated with experiences of adversity in childhood fully justify a comprehensive policy and practice review.     

Women's Experience of Co-Occurring Substance Abuse and Mental Health Conditions

ABSTRACT

This study explored the relationship between gender and co-occurring substance abuse and mental health conditions among a sample of 754 consumers of behavioral health services in the southwest U.S. Logistic regression was used to determine factors that would predict women's unique experience of dual diagnosis. Women were almost seven times more likely than men in this sample to have a diagnosis of posttraumatic stress disorder in conjunction with substance abuse. Women were also significantly more likely to experience anxiety and mood disorders and to have been married. Implications of these findings for social work practice are suggested.     

Co-Occurring Disorders Among Female Jail Detainees: Implications for Service Delivery

ABSTRACT

The increase in the numbers of women incarcerated in prisons and jails has given rise to questions about their mental health and substance abuse treatment needs. This study used DSM-IV criteria to describe both lifetime and current diagnoses for substance use disorders, major depressive disorder, posttraumatic stress disorder and generalized anxiety disorder in a sample of 198 female jail detainees. Women were asked about readiness for treatment and AODA and mental health service use. Findings underscore the view that female jail detainees have complicated diagnostic histories and that the jail setting can provide opportunities for assessment and services.     

Spirituality and Religion in the Lives of Runaway and Homeless Youth

Abstract

This qualitative study, part of a larger study of resiliency, explores the impact of spirituality on runaway and/or homeless youth. Interviews with 19 former runaway and homeless youth were analyzed to explore their experience of spirituality as they coped with the adversity in their lives. Five themes related to spirituality emerged: a belief in divine intervention; having a personal relationship with a nonjudgmental higher power; use of prayer; participation in traditional and nontraditional religious practices; and finding meaning and purpose in life, including a desire to “give back” to their community. Implications for social work practice and research are addressed.     

Prevalence and correlates of diabetes mellitus among homeless veterans nationally in the Veterans Health Administration

Abstract

Background: Homeless people are at high risk for many chronic medical conditions although their risk of diabetes has not been well studied. Current epidemiological studies of diabetes prevalence among homeless adults have been based mostly on self-report data not supported by clinical assessments.

Objectives: To determine the prevalence and risk factors for diabetes mellitus (DM) among homeless veterans in the Veteran Health Administration (VHA).

Methods: The sample included 3?464?364 veterans with documented body mass indexes (BMI), 137?720 (4%) of whom had been homeless. Logistic regression models were used to determine the odds of having DM among homeless veterans compared to non-homeless veterans. Bivariate and multi-variate analyses were then used to identify potential risk factors for DM among homeless veterans.

Results: The prevalence of DM in homeless veterans was 19%. Homeless veterans with DM, compared to those without it were older, more likely to have a BMI?>?40 and more likely to have DM-related co-morbidities.

Conclusions: There is a high prevalence of DM among homeless veterans in the VHA compared to previous reports for homeless adults (8%). Tailored approaches to improve access to DM screening, prevention, and treatment could benefit homeless veterans.     

A follow-up study of homeless women

This article presents an in-depth analysis of the changes observed in 25 homeless women with drug and alcohol abuse problems participating in a case management program. Participation in the program ranged from 6 to 44 months. Thirty-two percent of all participants' situations were considered to have improved, while 20% remained stable. Less improvement was noted in the situations of women followed for 3 years or more (14.3% improved, 28.6% stable). Domains showing the most improvement were housing, financial situation, and substance abuse. Deterioration was primarily attributable to physical and mental health problems. These findings could indicate that although a case management program can initially contribute to improving the living conditions of its clients, acquisitions are difficult to maintain over an extended period. Health and substance abuse play a crucial role in the deterioration process.