Housing the Homeless Mentally Ill

This paper presents the housing outcomes from an assertive case management program for the homeless mentally ill. The program was evaluated using an experimental design. Qualifying clients in a state hospital were randomly assigned to the case management program or routine services. At six month follow-up, over twice as many experimental as control clients were housed. None of the experimental clients had returned to living on the streets or in shelters     

Therapeutic management of violence in residential care for severely mentally ill clients: An application of intrapsychic humanism∗

The innovative psychology, intrapsychic humanism, is applied to formulate guidelines for effectively managing violent symptoms of severely mentally ill clients in residential settings, with the aims of: 1) helping staff reduce client violence; and 2) helping clients regulate their violent behavior. Using intrapsychic humanism, staff can understand, anticipate, and respond therapeutically to client violence. Triggers of violence, such as aversive reactions to pleasure and destructive reactions to real losses are described. Residential program structures that strengthen clients’ constructive motives and staff's caregiving motives are outlined.     

Homelessness and the High Performance Cycle: A New Lens for Studying Exit Strategies

ABSTRACT

Although social work scholarship has recognized the presence and utility of goals and goal setting among the homeless, the literature remains underdeveloped. This study evaluates the extent to which the work motivation literature, mostly applied in formal business settings, can improve current understandings of how persons successfully escape homelessness. Specifically, this study focuses on the high performance cycle, a model in organizational behavior research that outlines the specific processes involved in setting and achieving goals and that provides a robust framework for analyzing goal setting among homeless persons. The article compares those who have successfully exited homelessness to those who remain chronically homeless using 40 in-depth, semistructured interviews with homeless center clients in a multicity area in the Intermountain West. Interviews addressed the employment and housing histories of research participants, their views about living unhoused, and their attempts to exit homelessness. The participants' narratives matched themes described in goal-setting research, which suggests the utility of adopting processes outlined by the high performance cycle when assisting clients in exiting homelessness. Social service professionals can benefit by incorporating the goal-setting scholarship in their work with homeless populations. Future research might use quantitative surveys and experiments to determine the generalizability of this exploratory analysis.     

Transcending Differences: Using Concrete Subject-Matter in Heterogeneous Groups

ABSTRACT

The need to conduct social group work with heterogeneous members is a reality. Yet the social work literature does not offer much guidance in how to work with diverse groups of people. This paper illustrates a method of social group work that utilizes tangible and palpable subject matter as a therapeutic vehicle to create strong group cohesion with heterogeneous group members. It aims to explain how and why using non-personal subjects as the heart of the group helps people connect to themselves, to the world and to each other in a personal way. The examples given are from two groups that are very different in their compositions and very different from each other. One is a psycho-educational group at a Continuing Day Treatment Program for severely and persistently mentally ill elderly and the other is a group with adolescent and pre-adolescent females in a community center. Four benefits of using this method of social group work are outlined.     

Moving into Homelessness After Psychiatric Hospitalization

A six-month follow-up study of 132 former patients of a state hospital examines those subjects who become homeless and compares them with those subjects who do not. A quantitative and qualitative approach is used to document the process of homelessness that occurs after psychiatric hospitalization. A set of policy options is resented that can respond to the special needs of homeless mentally ill persons.     

Client Violence Against Social Workers at Homeless Assistance Organizations in South Korea

This study examined the essence of client violence that social workers encounter at homeless assistance organizations in South Korea. Based on 149 self‐administered questionnaires in 29 homeless assistance organizations in Seoul metropolitan areas, the study verified that client violence against social workers was prevalent. More than 70% of respondents experienced physical violence from their clients; 78.5% reported emotional violence; 53% reported property damage. This study also found that client violence emerged differently according to gender and types of agencies in the field. The results suggested that effective prevention strategies against client violence should be encouraged to maintain valuable human resources and to create a safe workplace in the field of social work.     

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.     

Perceptions of Students about Younger and Older Men and Women who May Be Homeless

ABSTRACT

Future human service providers will interact with homeless persons in health, mental health, and social service practice contexts. This study investigated the perceptions of students enrolled in social work courses who are pursuing degrees in human service programs toward older and younger female and male homeless individuals. Respondents (N = 207) were given one of four vignettes in which a character was identified as an older male, a younger male, an older female, or a younger female who was frequently seen near an interstate highway, talking to him/herself and appearing unkempt, thin, and frail. Most respondents perceived the vignette character as mentally ill, neglectful of health, likely to have HIV, tuberculosis, hepatitis A and/or hepatitis B and/or hepatitis C, likely to experience suicidal thoughts/ideation, and to have head lice/scabies/body lice. Older men were more likely to be perceived as military veterans with a history of mental illness and substance abuse. Older women were least likely to be perceived as having a history of substance abuse or using a handout to purchase ethanol. Older women were perceived to be homeless because they could not afford other living accommodations. A general linear model revealed significant differences in 7 of 41 items that respondents answered based on the gender and age of the vignette characters. These perceptual differences between male and female homeless persons will require additional investigation.     

Effective personalised housing support for people with disabilities – case study analysis

International policy trends favour personalised approaches to housing support for people with disabilities. Previous research is inconclusive about whether these approaches are effective compared to group home support in the way they use government resources and benefit clients, partly because it does not usually consider the experiences of people who use the support. In this research we compared six new, innovative case studies of personalised housing support to previous research about group home support. We included qualitative data about client experiences, in particular regarding social networks, decision making, community service use and participation in domestic tasks. We found that client outcomes were positive in all four categories, while the financial costs to clients and government were similar to group home support. The results offer evidence that current, personalised approaches to housing support can be an effective policy option that allows people with disabilities to make choices about how to live and participate in their communities, without increasing the cost to government.     

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.     

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.     

Community worker perceptions of the Income Management regime in Shepparton

This paper focuses on how community workers in Shepparton viewed the impact of the Place Based Income Management (PBIM) trial on the lives of their clients, their clients' families, and the broader community. The paper responds to criticism that there has been a lack of community voices in the development of PBIM or of their inclusion in the formal evaluation framework, raised in Philip Mendes's 2013 study of this trial site. A key policy goal underlying Income Management is that the tool assists low income people to become better money managers. Our study found that Shepparton community workers also used the parlance of ‘tool’ to describe the programmatic value of the BasicsCard in their interactions with clients. However, the BasicsCard appeared marginal to their discussions. Three clear themes emerged from the interviews: Shepparton's focus on voluntary clients, and ascertaining why participation in the local trial had dropped; that support for IM centred on the voluntary measure and the extra resources available to assist clients; and pragmatically locating the program in the middle of a welfare continuum that stretched from the voluntary Centrepay at one end to the highly coercive and restrictive paternalism of State Trustees at the other.     

Social Workers' Implementation of Client Participation: What Factors Make the Difference?

ABSTRACT

Client participation is both a value and a strategy in social work, involving clients in decisions influencing their lives. Nevertheless, the factors encouraging its use by social workers in social services have received little research attention. This article reports on a study drawing on Goal Commitment Theory to examine, for the first time, four categories of variables that might predict its implementation: background variables (intervention method, age, experience, education, supervision); personal resources (self-esteem, mastery); organizational variables (superiors' support, organizational commitment); and situational factors (previous client participation, perception of client participation).

A sample of 661 Israeli social workers completed questionnaires. Hierarchical regression analysis and t-tests revealed that intervention method, mastery, superiors' support, and both situational variables contributed significantly to explaining the variance in client participation. Moreover, social workers valued client participation significantly more than they used it. The implications for researchers and professionals in social services are discussed. Proper training could increase social workers' awareness of client participation and provide tools for implementation. Policy makers should set standards for its use and evaluation, and require its inclusion in all interventions. Further research investigating clients and managers of social services could provide a broader picture of the factors impacting client participation.     

Changes in the group defined as severely mentally ill: five years after the mental health-care reform in Sweden

A mental health-care reform was implemented in Sweden in 1995. The objective of this study has been to investigate whether, five years after the reform, there were any changes in the group of persons considered to be severely mentally ill. To estimate the number and needs of severely mentally ill persons, a survey was made in 1995/96 and again in 2000/2001, using the same definition of 'severely mentally ill', and the same interview form used on both occasions. Needs were assessed using the Camberwell Assessment of Need. In the 1995/96 survey, 602 individuals were identified as severely mentally ill. In 2000/2001, the number was 828. Those surveyed in 2000/2001 had, on average, fewer unmet needs. The results indicate that one reason for the difference in the size of the groups was that the way the concept of severely mentally ill was interpreted had changed.     

Observational Research in Intergenerational Programming

Summary

Research in the field of intergenerational programming is rapidly growing in both quantity and quality. Both those who plan and work directly with intergenerational program participants in the human services and those who hold positions as researchers and evaluators need to be encouraged to research and evaluate their programs. We argue that observational research, though not without its shortcomings, should be more widely used to study and evaluate intergenerational program effectiveness and the relationships among people within them. We also provide some examples of observational strategies useful in practice-based research. We conclude that by recording details of the actual program interactions and relationships and examining them carefully or preserving them for later scrutiny, intergenerational program planners can learn to make relationship-based interventions successful and rewarding for their clients and themselves.     

The first interview as a guide to treatment 1

Abstract

This article is based on an exploratory study that examines clinical workers’ reactions to assault by a client within an established treatment relationship. Findings indicate that client assaults experienced as traumatic result in psychological processes and stages of resolution similar to those experienced by other victims of assault. The primary difference is fewer long‐term personal effects. Professional effect is significant and influences workers’ relationships with clients and their views of themselves as clinical workers. Long‐term positive professional effects are noted, and interviewed workers provide insight and advice for all who work with violent clients.     

SLOF: a behavioral rating scale for assessing the mentally ill

Rating scales for assessing the mentally ill usually focus on the role functioning of clients and their psychiatric symptomatology. This article introduces a rating scale to measure more directly observable behavioral functioning and daily living skills of clients in mental hospitals and in the community. Results are presented from a series of studies designed to test the instrument's psychometric properties.     

Discharge procedures for mentally ill people: The prespective of former psychiatric patients on their professional social network

The analysis of the perspective of mentally ill people on their social network is not complete if the professional arena is left out. This article draws on literature about social network and other forms of human interaction to support the social network concept and an idea about how the professional arena has developed and become a vital part of the network. Fifty-three former patients were interviewed to get their perspective on the professional network. Intimate relations with family and friends seemed to be a model even for contacts with professionals. A social psychological analysis of the satisfaction of the long-term mentally ill respondents with relations to home care workers and their dissatisfaction with psychiatric professionals seemed to be connected to the professionals' ability to undertake a caring relationship.     

Social Context of Service Use Among Homeless Youth in Los Angeles,California

ABSTRACT

Little is known about rates and correlates of service use or the role that social context plays in service engagement among homeless youth. This study compares two distinct service areas and uses a social network approach to examine how environmental factors (e.g., neighborhood), social factors (e.g., social capital and network engagement) and individual level factors that relate to service use patterns among homeless youth in Los Angeles, California. A sample of 938 youth was recruited from three drop-in centers in two distinct service sites. Individuals were surveyed about their individual and social network attributes. Univariable and multivariable analyses were utilized to understand the influence of social-contextual variables on service use. Service use behaviors varied across site and service type with youth in Hollywood showing greater engagement than youth at the Beach site. Across both sites and several service types, staff emotional support was positively correlated with levels of service use. The site comparisons also point to the fact that even within a single geographic area, like Los Angeles County, client profiles and rates of service use can significantly vary. Future research needs are presented with specific emphasis on understanding the needs of non-service-seeking youth.