Pre–Post Release Health in US Adult Male Convicts

Abstract

This study sought to determine whether need for healthcare and reported health status among adult men (N?=?1,113) in US Federal prisons (in 12 states) changed from pre-release to 15?months after release by analyzing data collected by the Serious and Violent Offender Reentry Initiative (SVORI). Specifically, the study was guided by three questions: (1) were there changes in treatment for specific diseases; (2) were there changes in health status, need for care, and access to and satisfaction with healthcare; and (3) did various social determinants of health predict any of the health outcomes at 15-month follow-up. The analysis of SVORI data found that men reported lower physical and mental health status and declines in receiving treatment following release, but greater satisfaction with healthcare. Further, analysis found the best predictors of health status as being satisfied with access to health care as well as employment. The greatest declines were in mental health treatment, however those ceasing treatment did not report worse physical health status, mental health scores, housing, employment, or recidivism. Future research is needed to determine the significance of the link between employment, satisfaction with access to health care, and health status among ex-prisoners.     

Six-Month Follow-Up Changes for TANF-Eligible Clients Involved in Kentucky's Targeted Assessment Program

ABSTRACT

Welfare reform has been successful in helping clients achieve self-sufficiency. However, some individuals experience problems associated with basic needs, physical health, mental health, substance abuse, and intimate partner violence (IPV) that can impede transitioning from welfare to work and/or interfere with parental responsibilities. The Targeted Assessment Program (TAP) was created more than a decade ago to identify and address these problems and help clients move off the welfare rolls in Kentucky. Self-reported interview data were used to examine changes and effect sizes between baseline assessment and 6-month follow-up from a sample (n = 322) of Temporary Assistance for Needy Families-eligible clients participating in Kentucky's TAP. Using McNemar's test for correlated proportions, paired-sample t-tests, and measures of effect size, significant changes with varied effect sizes were found for selected basic needs, as well as physical health, mental health, substance use, and IPV barriers. Findings suggest that social service practitioners could incorporate strengths-based case management and motivational interviewing into their practice. Further research is suggested utilizing longitudinal and controlled studies on evidence-based practice that address pretreatment and assessment strategies involving case management and motivational interviewing.     

Human Capital, Physical Health, and Mental Health of Welfare Recipients: Co-occurrence and Correlates

Drawing on a large random sample of welfare recipients in the post–welfare reform era, this article examines the prevalence of mental health disorders, substance dependence, and physical health or disability, their co-occurrence with human capital problems, and their relation to employment. Half of the participants have none of these potential barriers to employment. Mental health and human capital problems, when present, tend to occur in isolation about half the time. Women with co-occurring human-capital, mental-health, and physical-health problems have the poorest work outcomes. The findings suggest the need to design and implement more assessment, referrals, and service provision to support women in meeting the challenges in the transition from welfare to work.     

The Relationship Between Length and Number of Homeless Episodes and Engagement in Survival Sex

Survival sex is associated with many health problems, including increased substance use and HIV risk. Current research on survival sex among homeless individuals has given little attention to the unique effects of how length and number of homeless episodes influence engagement in survival sex. Using secondary data analysis from the Washington, DC, Metropolitan Area Drug Study (DC*MADS) (N = 783), the authors examined the relationship of days and number of times homeless to engagement in survival sex, while controlling for other sociodemographic and clinical characteristics. Results showed that length of homelessness and number of homeless episodes, as well as current age, previous drug use, depression, and institutionalization, increased the odds of engaging in survival sex. Results support current efforts on interventions to transition homeless individuals into housing as rapidly as possible. Service providers assisting the homeless can affect engagement in survival sex and its associated risks through creating referral networks for integrated treatment programs for co-occurring substance use and mental health problems while advocating for early housing interventions and increased housing retention. Further research is needed regarding the ways in which length of homeless episodes affects risky behaviors such as survival sex, with a particular focus on all age groups.     

Examining Protective Factors for Dysthymia Among Individuals Attending Substance Abuse Treatment

ABSTRACT

Dysthymia affects millions of people and has been associated with impaired psychosocial and occupational functioning and poor clinical treatment outcomes. Yet few studies have examined protective factors that can be utilized to help individuals with dysthymia in clinical settings, particularly among individuals with comorbid substance use disorders. The purpose of this study was to examine the potential protective quality of adult attachment dimensions, spirituality, and meaning in life among clients with and without dysthymia in treatment for addiction. Data were obtained from 305 self-report questionnaires administered to clients attending a residential substance abuse treatment center. Approximately 25% of the sample met criteria for dysthymia. Results from logistic regression analyses indicated that purpose and meaning in life and attachment anxiety were the most important protective factors against having dysthymia. These results suggest that mental health professionals may need to integrate these protective factors into the treatment of individuals with dysthymia and substance use disorders, which may enhance treatment outcomes and maximize treatment effectiveness. Future studies should continue to explore protective factors that can assist individuals who experience these comorbid conditions and consider replicating this study using an ethnically diverse sample and other clinical settings to determine the generalizability of the findings.     

Ability of the Behavioral Model to Predict Utilization of Five Services by Individuals Suffering from Severe Mental Illness and Homelessness

Abstract

This study examined the ability of the behavioral model to predict utilization of five specific services in a sample of individuals who suffered from severe mental illness and who were homeless at baseline. Nearly 4000 individuals from 18 sites provided data at baseline and 12 months later for this study. Hierarchical logistic regression was used to analyze the data. The behavioral model did not explain much of the variance of utilization of medical services, housing services, and public support. The behavioral model did explain a moderate amount of the variance of utilization of psychiatric services and substance abuse services. Enabling variables explained more of the variance of psychiatric services than either predisposing or need variables. In contrast, predisposing and need variables explained more of the variance of utilization of substance abuse services than enabling variables. Social support from professionals and self-perceived need for service were the most consistent predictors of all of the service utilization variables.     

Characteristics of Women Seeking Services at a Transitional Housing Facility for Women Leaving Street-Based Sex Work: Implications for Social Service Providers

ABSTRACT

Women who decide to leave street-based sex work often struggle with addiction, trauma-related mental health consequences, and exclusion from employment and housing. To offer recommendations for social service providers, this article draws upon primary data from interviews and surveys with 87 residents at a transitional housing facility for women leave sex work to elucidate: 1) a demographic profile of the women, 2) life history patterns and circumstances that encourage women to leave street-based sex work and 3) recommendations for service providers. Results indicate the need for service providers to assist women with basic needs, strengthen referral networks, and extend trauma-informed services.     

Deaths of people with serious mental disorder: An exploration of deaths in custody and fatal police contacts

People with serious mental disorders (PSMDs) are overrepresented both in prison deaths and during fatal encounters with the police in the community (deaths after police contact, DAPC). To identify common factors present across cases of who died during contact with the criminal justice system in Queensland, publicly available coroners reports were analysed (N = 38). The findings of the study indicated psychosis and mood disorders were the most common diagnosis in incarcerated PSMD deaths, and suicide was the most common cause of death for incarcerated PSMDs. Within incarcerated settings, access to healthcare records, medication compliance, risk assessment and monitoring, and safe housing of at‐risk prisoners may be potential areas to explore with regard to prevention. Similarly, PSMD DAPCs were more likely to be experiencing mood or psychosis disorders than other forms of mental disorder, and suicide and police shootings were the most common causes of death. In PSMD DAPC, inadequate mental health access, treatment noncompliance and comorbid substance use were included as potential areas that could direct research efforts toward prevention.     

Veterans’ Use of Programs and Services as They Transition to Civilian Life: Baseline Assessment for the Veteran Metrics Initiative

Abstract

A substantial minority of veterans struggle as they reintegrate into civilian life, reporting problems with vocational attainment, legal/financial/housing challenges, physical and mental health conditions, and social/interpersonal issues. While there are thousands of programs and services offered to veterans, little is known about which ones they use. In the current exploratory study, veterans separated from active duty in the prior three-months (48,965) were invited to complete a survey. Two primary questions were addressed: What programs/services did veterans use to assist in their reintegration to civilian life? What specific components/attributes of those programs did veterans report using? A total of 9566 veterans completed the survey. Approximately, two-thirds of veterans used at least one program to enhance their well-being, while one-third reported using multiple programs across multiple domains. Veterans primarily sought assistance for employment and educational advancement. Fewer veterans sought assistance for legal/financial/housing, health, and social functioning challenges. Social service providers and policy makers should be aware of the resources veterans use as they reintegrate into civilian life. Future research should examine factors that predict the use and nonuse of veteran reintegration programs, how use changes over time, and what factors predict program/service use, particularly among veterans at risk for poor transition outcomes.     

Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis

ABSTRACT

Increasingly, social workers and behavioral health practitioners use assessment instruments to support service planning and to monitor progress. Following statewide implementation of the Adult Needs and Strengths Assessment (ANSA) to identify behavioral health symptoms, related functional challenges, risks, and strengths, this validation study explored the underlying structure of the instrument. An exploratory factor analysis used routinely collected information for Midwestern adults with diagnosed behavioral health disorders who participated in community-based services (N = 46,013). Five factors with adequate to good internal consistency (α = 0.733?0.880) emerged: personal recovery, trauma and stress related problems, substance use risks, self-sufficiency, and cultural-linguistic considerations. Validation of the ANSA supports use of the instrument to engage individuals and families, to plan services, to monitor progress, and to conduct research. Implications for social work education, supervision, and practice include the importance of understanding culture, holistic assessment, and services supporting personal recovery for individuals living with mental illness or substance use disorders. Confirmation of findings requires additional research.     

Supportive Housing for Addicted,Incarcerated Homeless Adults

ABSTRACT

Homeless populations often suffer from mental illness, substance abuse, and criminality. Interventions, such as supportive housing, can have positive impacts, although benefits can be limited. This study examined outcomes for clients (N = 102) of a new supportive housing intervention. Use of formal treatment, jail contact, and community stability were compared pre- and post-housing. Jail bookings and residential substance abuse treatment significantly declined post-housing, while clients improved in income level, access to food, and housing stability. Results from official justice and treatment system data suggest that supportive housing can lead to significant changes. Future research is necessary to understand the relationship between client characteristics and outcomes.     

Further Evidence of Racial Disparities in Drug Court Outcomes: Enhancing Service-Delivery to Reduce Criminal Recidivism Rates for Non-White Participants

Abstract

The first drug court began in 1989, and since their inception, they have expanded to over 3,000 in the United States and United States territories. The long-term goal of drug courts is to reduce criminal recidivism rates for nonviolent offenders who have substance use disorders. This study adds to the literature by using secondary data to compare criminal recidivism rates between drug court participants (n?=?163) and probationers who had diagnosed substance use disorders and arrests that were eligible for drug court but they did probation instead (n?=?185). Criminal recidivism was measured up to 36?months post drug court/probation discharge, which provides a more accurate assessment of the long-term effectiveness of drug court. Furthermore, this study identified which drug court participants were most likely to recidivate. Drug court participants were less likely to recidivate than the probation group. However, differences between the two groups may have contributed to the difference in criminal recidivism rates and also suggest that screening criteria may exclude some non-White participants from drug court. Non-white participants were more likely to recidivate than their White counterparts. Implications for future research and drug court practice are discussed, focusing on enhancing the service-delivery of education and employment opportunities to non-White drug court participants.     

An Ecological Systems Comparison Between Homeless Sexual Minority Youths and Homeless Heterosexual Youths

ABSTRACT

This study examined risk and protective outcomes by comparing homeless sexual minority youths to heterosexual homeless youths regarding family, peer behaviors, school, mental health, stigma, discrimination, substance use, and sexual risk behaviors. Structured interviews (N = 147) were conducted with individuals aged 16 to 24 years old in Toronto. Bivariate analyses indicated statistically significant differences between homeless sexual minorities (n = 66) and their heterosexual counterparts (n = 81) regarding all variables: family, peer behaviors, stigma, discrimination, mental health, substance use, and sexual risk behaviors, with the exception of school belonging. Implications for future research are suggested.     

Adverse Childhood Experiences and Substance Use History among Vulnerable Older Adults Living in Public Housing

ABSTRACT

Previous research shows strong correlations between adverse childhood experiences (ACE) and later life health. The current study examines the relationship between ACEs and substance use among older adults living in public housing. Results show that about one-third of participants had four or more ACEs, and ACE score predicted likelihood of substance use history. Over half of older adults with four or more ACEs experienced substance abuse in their lifetime compared to one out of ten older adults with less than four ACEs. Findings shed light on a vulnerable group and point to next steps in research and practice.     

Making a home, finding a job: investigating early housing and employment outcomes for young people leaving care

This paper presents findings from a new study of outcomes for young people leaving care funded by the Department for Education and Skills. It reports findings for a sample of 106 young people in relation to progress made in housing and employment some 12–15 months after leaving care. The generally poor employment outcomes of care leavers are acknowledged, but ingredients that make for success are also highlighted, including the value of settled care and post‐care careers, sound career planning and, significantly, the value of delaying young people’s transitions from care. Early career paths also interconnect with how young people fare in housing, in developing life skills and with other problems in their lives after leaving care. Housing outcomes were more encouraging and predominantly shaped by events after leaving care, and faring well in housing was the factor most closely associated with positive mental well‐being in young people. Some groups that are at risk of faring badly are identified, including young people with mental‐health problems, young people with persistent offending or substance misuse problems and, in some respects, young disabled people. The implications of these findings for leaving care services are considered.     

Predicting Material Hardship Among Former Welfare-to-Work Participants: An Income- and Resource-Packaging Model

ABSTRACT

Material hardship is of concern because it refers to physical deprivation related to meeting the basic needs of food, housing, utilities, and other items. This study tests a predictive income- and resource-packaging model of material hardship using survey data collected from 459 former welfare-to-work program participants. Logistic regression results show that receiving social support in the form of living rent-free decreased the odds for experiencing material hardship. The predictors of working in the informal economy, being sanctioned while on public assistance, having mental health issues, and having transportation problems all increased the odds for experiencing material hardship. The measures of formal employment income, Temporary Assistance for Needy Families income, work-first program participation, sharing living expenses, monetary social support, and assistance from nonprofit organizations were unrelated to predicting material hardship experiences. Policymakers interested in improving conditions for needy families should question the use of sanctions and carefully monitor material hardship among those sanctioned. Future programs and future research should consider the extent to which low-income women participate in the informal economy to make ends meet, rely on social networks to live rent-free, and struggle with poor health and transportation problems.     

Reducing Alcohol Abuse in Gay Men: Clinical Recommendations From Conflicting Research

ABSTRACT

Gay men entering the health care system present with unique needs essential for health care providers to comprehend and address. While data indicate mental health and substance abuse disorders are more prevalent among gay men compared with their heterosexual counterparts, the literature assessing abuse of alcohol by gay men is conflicting. This article explores the conflicting research examining the use and abuse of alcohol by gay men, common findings and themes among studies addressing the issue, the theoretical concepts of internalized homophobia and heterosexism as they relate to alcohol abuse, and clinical strategies providers can implement when encountering this issue among their gay male patients. This comprehensive assessment of the literature will also provide direction for future critical inquiries and outline ways to improve the current methods of inquiry.     

Young Adult Outcomes of Juvenile Court–Involved Girls

ABSTRACT

The recent increase in the number of girls involved in the juvenile justice system has resulted in increased academic and public attention. Thus far, this attention has focused on entry into the juvenile justice system rather than longer-term consequences. This research helps fill this gap by examining a sample of 700 maltreated and/or impoverished juvenile court–involved females. Competing risks models were used to control for time from juvenile-court entry to adult outcomes: criminal justice system involvement, use of public mental health or substance use services, and income maintenance use. Results indicate that there are distinct predictors associated with the different outcomes, although learning disability and adolescent parenthood were associated with higher risk of both mental health/substance use services and income maintenance. Individualized services for juvenile court–involved girls are suggested. Prospective, longitudinal research is needed to investigate intrapsychic and behavioral dynamics associated with females' young adult outcomes.     

Alcohol Misuse Among Older Adult Public Housing Residents

Low-income older adults living in public housing are at heightened risk for substance misuse. This study identified the prevalence of alcohol misuse among older public housing residents (n?=?187) and explored predictors of problem drinking. Including weekly drinking levels and binge drinking, 23% of the sample engaged in problem drinking behaviors. Logistic regression analysis revealed that race, gender, employment status, years smoking, and illegal drug use were significant predictors of problem drinking. No residents were receiving substance abuse treatment. As the number of older adults increase, training social workers to assess and treat alcohol misuse in older adults is critical.     

Examining Depression,Anxiety, and Foster Care Placement as Predictors of Substance Use and Sexual Activity in Adolescents

ABSTRACT

This study investigated the impact of anxiety and depression on sexual activity and substance use behaviors in a sample of 56 community- (traditional living arrangements) and foster care-dwelling adolescents aged 12 to 17 years. It was hypothesized that higher levels of anxiety and depression would be related to higher rates of risky sexual activity and substance use. Regression analyses were used to examine impact of the internalizing predictors on the risky behaviors. Results of the sample were presented with group membership emerging as a robust predictor of both sexual activity and substance use. Results suggest that adolescents within out-of-home care are at increased risk for engaging in these behaviors when compared with community-dwelling peers, and they may benefit from specific interventions aimed at decreasing participation. Future research may focus on assessing the effectiveness of interventions for these youth.