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.     

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.     

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.     

Iowa Case Management for Rural Drug Abuse

OBJECTIVE: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. METHOD: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual (TAU), or to a fourth condition of TAU only. All were assessed at intake and followed at 3, 6, and 12 months. RESULTS: Clients in all four conditions significantly decreased substance use by 3 months after intake and maintained most gains over time. However, the addition of ICM to TAU did not improve substance use outcomes. CONCLUSION: Overall, the addition of case management did not significantly improve drug treatment as hypothesized by both researchers and clinicians. Some results were mixed, possibly due to the heterogeneous sample, wide range of case management activities, or difficulty retaining participants over time.     

A 12-Month Follow-Up Evaluation of Integrated Treatment for Homeless Individuals With Co-Occurring Disorders

ABSTRACT

This study examined the effectiveness of the Comprehensive, Continuous, Integrated System of Care (CCISC) model in addressing co-occurring mental health and substance use disorders. Clients were eligible for participation if they had co-occurring disorders and were homeless or at risk of homelessness. Forty-eight clients received a comprehensive array of services consistent with the CCISC model. Measures assessing housing, employment, mental health, and substance use were completed at baseline, 6-month, and 12-month follow-up. Results demonstrated significant improvements in housing, employment, mental health, and substance use at 12-month follow-up. These results underscore the effectiveness of implementing evidence-based care.     

Incremental Validity of Stressful Life Experiences in Predicting Psychiatric Comorbidity Among Women in Substance Abuse Treatment

ABSTRACT

The dynamic contribution of stressful life experiences in predicting psychiatric comorbidity continues to challenge clinical practice and research. This study tested incremental validity of stressful life experiences related to psychiatric comorbidity among 128 young women in a Midwestern substance abuse treatment facility. Respondents reported low income, homelessness, and health and mental health issues. Using the Addiction Severity Index (ASI), Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision, and Stressful Life Experience (SLE) Screen as correlates, hierarchical linear regression demonstrated support for incremental validity of SLE uniquely accounting for 6.5% of variance in ASI psychiatric scores. Findings support future use of SLE in clinical settings for assessment and intervention purposes.     

Gambling Behaviors Among Oxford House Residents: A Preliminary Investigation

ABSTRACT

The present study investigated the prevalence of gambling behaviors among 71 individuals recovering from substance-dependent disorders and living in self-run recovery homes (Oxford Houses). Residents were given the South Oaks Gambling Screen to assess gambling behaviors and pathological gambling, and 19.7% of the sample was identified as having probable pathological gambling. These residents reported proportionately more involvement in a variety of gambling behaviors than other residents. Engagement in various gambling activities was consistent with previous investigations and suggested that self-run recovery homes such as Oxford Houses might be suitable referral sources for recovering persons who have comorbid gambling problems.     

Redefining Success: A Qualitative Investigation of Therapeutic Outcomes for Noncompleting Drug Court Clients

ABSTRACT

Utilizing a convenience sample from a drug court program, the authors investigated the benefits of treatment for noncompleting drug court clients (n = 30). Using an as-treated design, the qualitative investigation assessed whether noncompleters received any benefit from their drug court experience. In-depth interviews were conducted to determine both benefits gained and reductions in harm that occurred as a result of drug court participation. Data analysis was guided by the grounded theory method. Outcomes of coding indicated that participants' motivation and self-efficacy were enhanced through the intervention. Further, participants reported that their relationships with family, therapists, or peers were improved as a result of their involvement with drug court. Individuals in the study sample reported abstinence or decreased substance use, as well as improvements in employment and/or educational attainment. Participants’ perceptions of barriers to program completion were also noted. Study outcomes suggest that expansion of a harm reduction approach in social service practice may have utility for drug-abusing populations. Limitations of the research, including lack of generalizability, are discussed. Further research of harm reduction effects with a larger, heterogeneous sample size is recommended.     

Predicting Retention in Three Substance Abuse Treatment Modalities Among Anglo,African American,and Mexican American Juvenile Offenders

Abstract

Many of the same factors that predict delinquent behavior also predict adolescent drug use. This study examined factors that predict, and interventions that maximize, substance abuse treatment retention in three modalities among high-risk Anglo, Mexican American, and African American juvenile offenders. The study sample includes youth (N = 211) who were discharged from probation supervision and who received substance abuse services through a CSAT-funded federal demonstration project. The key predictors examined included the stage-of-change (i.e., precontemplation, contemplation, preparation) in which a juvenile fell, various dimensions captured by the Comprehensive Addiction Severity Index for Adolescents, and other intervention status (probation, case management, and mental health treatment). The research questions were addressed using statistical models known as survival analysis that treated time from entry into substance abuse treatment to exit from substance abuse treatment as the outcomes. Among key findings were that females were 73% more likely to leave day treatment relative to males; for each additional family problem ever experienced, Mexican American adolescents were 15% more likely to leave residential treatment compared with African American adolescents; and African American and Mexican American adolescents in the contemplation stage-of-change were 50% less likely to leave day treatment compared with Anglo adolescents. Applications for practice and research with this population are discussed.     

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.     

The relationship between adverse childhood experiences,health and life satisfaction in adults with care experience: The mediating role of attachment

Adverse childhood experiences (ACEs) are associated with a plethora of negative outcomes. Research has also found that adults who were separated from parental care and lived in alternative care settings during childhood have high levels of ACEs and are more likely to have poor outcomes. A growing body of research has supported the importance of attachment as a mechanism underlying the relationship between ACEs and adult wellbeing. However, little work has examined the role that attachment may play in the outcomes of adults who resided in residential and foster care during childhood. The current study examined the role of attachment avoidance and anxiety in the associations between ACEs and mental health, physical health, and life satisfaction in a sample of 529 adults with alternative care experience from 11 nations. Attachment avoidance partially mediated the relationship between ACEs and life satisfaction, mental health, and physical health. Attachment anxiety partially mediated the relationship between ACEs and life satisfaction and mental health, but not physical health. Taken together, the present study suggests that both attachment anxiety and avoidance play important, but unique, roles in understanding the relationship between ACEs and health and wellbeing for adults with care experience. Implications and limitations are discussed.     

Mindfulness,meditation, and breathing exercises: reduced anxiety for clients and self-care for social work interns

ABSTRACT

The purpose of this article is to identify and describe a teaching tool that supports social work student success in the classroom and in field placement. The project introduced mindfulness, meditation, and breathing techniques to 2nd-year master of social work (MSW) students in a group classroom setting and engaged students as they applied those techniques in their internship settings with clients. Students were introduced to mindfulness, meditation, and breathing techniques through lecture, experimental exercises, video clips, and case studies and used the group setting to learn to use those tools to add trauma-informed mindfulness interventions to the clinical techniques they concurrently practiced in field placement. Students learned methods to incorporate those interventions into their psychotherapy/counseling sessions with clients and discovered that mindfulness-specific interventions also helped regulate their own autonomic nervous systems, contributing to decreased anxiety. Thus, mindfulness skills taught in social work programs have significant multidimensional benefits; engaging a group classroom setting to learn to utilize mindfulness, meditation and breathing techniques can reduce stress and anxiety for clients and promote adaptive self-care skills for MSW students.     

Colorful Disclosures: Identifying Identity-Based Differences and Enhancing Critical Consciousness in Supervision

ABSTRACT

Managing microaggressions and marginalizing experiences while negotiating the ongoing oppression that occurs in micro, mezzo, and macro settings can be particularly challenging for clinicians of color. Thus, supervision with clinicians of color must include affirmation, empowerment, and exploration of the intracultural/intercultural dynamics inherent in the treatment-providing process and clinical supervision. Through case studies, autoethnographic studies of our supervision experiences, and interviews with supervisors and supervisees, we reflect on how axes of identity, including race, power, and privilege, inform practitioners’ clinical lenses and affect their vulnerability in treatment and the clinical supervision dyad. Special attention is placed on the clinical supervisor–clinician–client triad (the triple process) and the interpersonal dynamics of cultural sensitivity, cultural humility, and authentic responsiveness that supervisors aim to model and cultivate in the supervisory relationship. In addition to sustaining clinical growth for clinicians of color, adding this level of complexity to supervision supports equity in direct clinical practice, enhancing efficacy outcomes for clients and communities. Recommendations and pedagogical strategies are offered to support supervisors in initiating difficult dialogues and shifting the paradigm to promote this transformational perspective.     

Addressing Unmet Needs in Incarcerated Women With Co-occurring Disorders

ABSTRACT

This article will present findings related to critical needs in a group of 281 incarcerated women with co-occurring disorders. The women completed interviews while incarcerated and again at various time points after community reentry. Findings revealed that the number of basic needs increased over time, and a low level of social support was related to negative outcomes. Recommendations for this population include holistic evaluation assessments and integrated treatment plans that encourage staff to comprehensively assess clients at intake and link them to support services during and after incarceration. Implications of this female empowerment model will be discussed.     

IX. Children referred by the schools to the Worcester child guidance clinic 1

Abstract

The level of job rewards for social workers has been correlated with the quality of service to clients. A purposive quota sample of 127 Licensed Independent Clinical Social Workers in Massachusetts employed in three settings completed the Job Role Quality Scale. Respondents found Decision Authority, Flexibility, and Impact (sense of helping others) most rewarding. Private practitioners reported a significantly higher level of reward than respondents in public and private agencies. Administrative interventions directed toward increasing job rewards and decreasing job concerns, may reduce social work staff turnover and enhance the quality of service to clients.     

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.     

Secure Attachment to Family and Community

ABSTRACT

Disproportionately large numbers of high risk clients from Multiple Problem Families (MPFs) utilize a disproportionately large percentage of Medicaid, Health and Human Services. Clients from these families are involved in domestic violence, addiction, child abuse and neglect. They are over represented on the caseloads of state protective service agencies. The approach outlined in this paper is based on social attachment theory models. It stresses the use of long-term, home-based therapy, and community support agencies to establish and maintain safe secure attachment for these fragile families. The therapeutic goals are to foster attachments that lead to increased mentalisation, and to decrease the crisis-driven behavior that often results in high cost utilization of state services. A placement prevention model, outlined as an alternative “mentalising social system” approach, is proposed for treating disruptive MPF children. Family oriented, in-home, community-based treatment is found to be more cost effective and therapeutically helpful for these children than costly inpatient psychiatric admission followed by residential care.     

Mistrust and Self-Isolation: Barriers to Social Support for Older Adult Methadone Clients

Objectives: The purpose of this study is to explore barriers to the use, maintenance, and expansion of social supports in older adult methadone clients. Methods: The data for this analysis were derived from a qualitative study of the needs of aging methadone clients. Data were collected through face-to-face interviews with 24 methadone clients over the age of 50. Results: A lack of trust was identified as a principal barrier to the use, maintenance, and expansion of the social supports of older adult methadone clients. Causes of this mistrust include issues associated with aging, past traumatic experiences, and difficult personal relationships. Implications: These findings imply that addressing the issue of self isolation and recognizing the reason older adult methadone clients engage in this behavior is a key element in getting this specific population to use, maintain, and foster healthy social supports. A common phrase echoed throughout the interviews is that a person cannot trust anybody. Because of this mistrust, some clients keep to themselves by electing to self-isolate and decline to use, maintain, or foster new relationships. As a result, these individuals are less likely foster and/or engage in healthy social relationships, which are a key component of substance abuse treatment and abstinence maintenance.     

Correlates of Treatment Retention Among Persons with Serious Mental Illness Receiving Integrated Care in a Community Mental Health Setting

ABSTRACT

Knowledge about methods to retain community mental health (CMH) clients in integrated primary and behavioral health care (PBHC) programs is needed to address longstanding health disparities. A preexisting data set that contained the clinical records of 446 PBHC program participants was used to examine whether baseline sociodemographic, health, and psychosocial characteristics predicted retention in care at 6 months post-enrollment. Results indicated that less than half of PBHC participants (43.7%) were retained in care, and approximately 17% of the variance in retention was explained by the inclusion of seven predictors in the model (overall health, medications, laboratory data, primary care provider, disorder type, transportation, and living arrangement). Clients with thought disorders were almost twice as likely as those with mood disorders to be retained in care, and greater frequency of prescribed medications also increased the likelihood of treatment continuation (ORs = 1.99 and 1.20, respectively). Future research should identify factors that improve retention in integrated PBHC programs overall, and among persons with mood disorders, in particular.