CMHS/CSAT Collaborative Demonstration Program for Homeless Individuals1

The Collaborative Demonstration Program for Homeless Individuals is providing an opportunity for several community agencies in the United States to explore innovative intervention and treatment strategies to address the needs of homeless people with co-occurring (mental illness and substance abuse) disorders. This cooperative agreement, funded jointly by the Center for Mental Health Services (CMHS) and the Center for Substance Abuse Treatment (CSAT), is a $3 million project supporting programs in various community     

University-assisted community school program of West Philadelphia: democratic partnerships that make a difference

The university-assisted community school model is showing results for children and youth in West Philadelphia. The University of Pennsylvania's (Penn's) Center for Community Partnerships has coordinated universitywide efforts, in partnership with the community, in order to create and develop community school programs. The Sayre program aims to become a university-assisted community school, with a comprehensive community problem-solving curriculum and communitywide program that is fully integrated across both the Sayre curriculum and the curriculum of a number of Penn's schools. The Penn-Sayre project demonstrates that higher education can be a permanent anchor for revitalizing schools and communities if the vast resources it possesses, particularly its faculty, students, and staff, are brought to bear in a coordinated fashion.     

Challenges in evaluating programs serving homeless families

Homeless families, usually headed by single mothers, are the fastest growing segment of the homeless population. Although families with children make up a large percentage of those experiencing homelessness, there have been few studies on the effectiveness of services for homeless families offered by shelters transitional housing programs, and other agencies. This article summarizes the research that has been conducted on families that are homeless and the limitations of this research for program evaluation. Challenges to program evaluation are identified: the lack of published studies in the area; the fact that program evaluation is rarely built into programs or funded; the methodological issues in tracking families; the difficulty in assessing the impact on families; implementation issues; the range of barriers to housing stability faced by homeless families; and changes in society at large that influence the results of evaluation. Six recommendations are made for meeting these challenges: evaluation from a coherent theory of change; setting reasonable and differential expectations for clients; strengthening linkages with other agencies that serve the same client population; increasing the emphasis on follow-up; utilizing prevention efforts to reduce the number of families that become homeless; and working for expanded low-income housing and expanded subsidies.     

Developing a manualized couples treatment for domestic violence: overcoming challenges

This paper describes challenges faced in a four-year project to develop a manualized couples treatment program for domestic violence. The couples treatment program is an add-on to a male batterer program where the male partner has perpetrated mild-to-moderate violence, yet both partners want to remain together. The project involved the cooperation of a variety of community agencies and referrals from key domestic violence programs. While some anticipated challenges did not materialize over the course of the project, unanticipated challenges did. Qualitative data collected from therapists and clients throughout the project was used to refine the treatment approach.     

Houston Homeless Street Outreach

Abstract

Several cities in the nation have developed innovative programs to assist the homeless who are “living on their streets.” This paper describes one such program developed in Houston, Texas. The Homeless Street Outreach was a collaborative project of several service agencies in the greater Houston area. The outcome of this outreach project indicates that a coordinated effort can bring about delivery of more comprehensive services to the homeless population. The principles that emerge from the outreach include involvement of the homeless in planning and development, service agencies taking “ownership” of the project, and agency flexibility in delivering services to the homeless.     

Changing the method of working with homeless people: a photovoice project in Italy

In Italy, many organizations are experimenting with the Housing First (HF) model to promote a change in how they work with homeless people. This change creates some difficulties, especially in promoting freedom of choice in people involved in the HF programs. This study explored the definition of “home” in homeless people’s points of view. The study participants were 5 homeless men involved in a HF program called “The Road Home” implemented in the city of Padua. Data were collected using Photovoice, a photographic method based on participatory action research. During the project, the participants took photographs to illustrate their definitions of “home” and then engaged in a critical dialogue about the images represented in the photographs. The results of the study showed that occupants identified the home as being related to family, friendship, cohabitation, and hope for the future. The Photovoice project provided an opportunity to promote discussions that revealed the true needs of the people involved, and in the meantime, it brought a change to the program and to the community, in addition to promoting the HF model in the community.     

A Faith-Based Alternative Youth Education Program

Abstract

Community-based and faith-based programs are on-going partners in the social welfare mix which characterizes U.S. welfare provision. In the face of calls for more rigorous research on the capacity and impact of faith-based and community-based programs which use public funds, the research community must gain sophistication in addressing methodological issues inherent in participatory designs for the study of such programs. This article describes concerns which arose while implementing participatory research during a federally-funded, intensive 10-month long case study of a faith-based alternative education program for at risk youth. The project was funded through the Department of Health and Humans Services, Administration for Children and Family. The challenges to data collection are presented and suggestions for doing participatory research in similar settings are discussed.     

The Dartmouth Assertive Community Treatment Scale (DACTS). A generalizability study

Generalizability theory was used to assess the reliability of the Dartmouth Assertive Community Treatment Scale (DACTS), which was developed to assess treatment reliability to assertive community treatment (ACT). Program staff and local evaluators who were participating in a national demonstration program to serve homeless mentally ill clients provided data. The total scale score for the DACTS demonstrated acceptable internal consistency and interrater reliability. Although the stability of the total DACTS score was quite low, many items on the DACTS were quite stable. The generalizability analyses provide additional detail on the effects of site, occasion, and site by occasion interactions on the reliability of the DACTS.     

Project Employ: engineering hope and breaking down barriers to homelessness

The homeless population in the US has dramatically increased in the past two decades. People who are homeless often lack skills sets such as stress management and social skills, independent living skills, and skills for vocational and leisure engagement. Best practice vocational education and training programs for individuals who are homeless recognize that success in the worker role often hinges on a person's capacity to manage day-to-day living. Life skills and pre-employment training are essential components of vocational programs but no more important than interpersonal skill development including anger management, developing self esteem and motivation, building goal setting capacity, and skills for money management, personal budgeting and self-advocacy. These areas of performance have all been traditionally included in occupational therapy's domain of practice. This article describes Project Employ, a grant funded supportive employment program that has grown out of collaboration between Duquesne University's Department of Occupational Therapy and Bethlehem Haven, an emergency shelter and residential recovery program and primary service provider for homeless people in Pittsburgh, Pennsylvania. The purpose of this article is to describe the history, structure and outcomes of Project Employ.     

Schools uniting neighborhoods: the SUN initiative in Portland, Oregon

The SUN Community Schools Initiative is a community-driven model that allows each school community to design the programs that fit neighborhood needs in Portland, Oregon. County and city governments, local school districts, and community agencies have jointly leveraged resources to support fifty-one community schools. The program is managed by the Multnomah County Department of School and Community Partnerships. The City Parks and Recreation Bureau oversees twelve sites staffed by city employees. Strong support across political systems aligns funding and reduces the fragmentation in existing funding patterns.     

Coordinating health, extended care, and community support services: reforming aged care in Australia

Under pressure to maximize the cost-effectiveness of programs, efforts to improve coordination have become increasingly central to the development of the broader health and welfare service delivery system in Australia in the past few years. This article reviews recent experience in two related fields: (1) the coordination of different community care services for older people and people with disabilities, funded by the Home and Community Care program; and (2) the attempt to enhance links between community and residential care services, hospitals, and other health care providers. Why coordination has emerged as such an important issue in the field of community care and, increasingly, across the entire system of what the Australian government now terms health and family services is discussed. A number of measures that have been introduced or are proposed to improve a coordination of services are briefly reviewed. These range from individualistic approaches based on information and referral, through schemes involving gatekeeping, case management and brokerage of services, to models involving the reconfiguration of organizational structures, linkages, and finances. These measures are not mutually exclusive and are increasingly likely to be applied in more complex mixed models of service coordination. It is argued that coordination at the level of direct-service provision is difficult if government policies that direct services lack coordination.     

Mentoring as a Bridge to Positive Outcomes for Teen Mothers and Their Children

This paper compares historical and psychosocial realities of teenage parenting to prevailing contemporary myths. The authors explore the negative consequences of current remedies based on these myths. Community volunteer mentoring programs are suggested as a cost-effective intervention that can benefit communities and promote positive outcomes for at-risk pregnant teenagers. The authors suggest strategies for implementation of a community volunteer mentoring program based on an existing program in an urban community health center. Detailed information for social workers in community agencies is provided with regard to community education, recruitment, training, and ongoing support and supervision of mentors; funding requirements; and program evaluation.     

The cost of implementing a jail diversion program for people with mental illness in San Antonio,Texas

Jail diversion programs for people with mental illness are designed to redirect offenders with mental illness into community treatment. Although much has been published about program models and their successes, little detail is available to policy makers and community stakeholders on the resources required to start and implement a jail diversion program and which agencies bear how much of the burden. The current study used data on a model jail diversion program in San Antonio, Texas, to address this research gap. Data on staff costs, client contacts, planning, and implementation were collected for three types of diversion: pre-booking police, post-booking bond, and post-booking docket. An activity-based costing algorithm was developed to which parameter values were applied. The start-up cost for the program was $556,638.69. Pre-booking diversion cost $370 per person; 90% of costs were incurred by community mental health agencies for short-term monitoring and screening (>80% of activities). Post-booking bond and docket diversion cost $238 and $205 per person, respectively; the majority of costs were incurred by the courts for court decisions. Developing a multiple-intercept jail diversion program requires significant up-front investment. The share of costs varies greatly depending on the type of diversion.     

Coordinating Health,Extended Care,and Community Support Services

Abstract

Under pressure to maximize the cost-effectiveness of programs, efforts to improve coordination have become increasingly central to the development of the broader health and welfare service delivery system in Australia in the past few years. This article reviews recent experience in two related fields: (1) the coordination of different community care services for older people and people with disabilities, funded by the Home and Community Care program; and (2) the attempt to enhance links between community and residential care services, hospitals, and other health care providers. Why coordination has emerged as such an important issue in the field of community care and, increasingly, across the entire system of what the Australian government now terms health and family services is discussed. A number of measures that have been introduced or are proposed to improve a coordination of services are briefly reviewed. These range from individualistic approaches based on information and referral, through schemes involving gatekeeping, case management and brokerage of services, to models involving the reconfiguration of organizational structures, linkages, and finances. These measures are not mutually exclusive and are increasingly likely to be applied in more complex mixed models of service coordination. It is argued that coordination at the level of direct-service provision is difficult if government policies that direct services lack coordination.     

The Value of Cultural Adaptation Processes: Older Youth Participants as Substance Abuse Preventionists

This National Institutes of Health (National Institute on Drug Abuse) funded study employed focus groups to explore the value of: (a) engaging youth as experts in their own drug culture to engage them in open, honest discussion around substance use in their communities; and (b) allowing youth within a range of settings to systematically recreate unique workbook and video scenarios while maintaining the core components of an evidence-based substance abuse prevention program. Researchers collaborated with community based agencies that serve high risk youth, including youth who were incarcerated, homeless, in alternative high schools, in low-income housing programs, and on the US-Mexico border. The research indicates that high-risk youth in community settings can be actively engaged in adapting evidence-based prevention curricula. Youth emphasized their reasons for using drugs, as well as the salient consequences, and the value of tailored scenarios that incorporate their life experiences, language, drugs of choice, and relevant motivators. Serendipitous findings noted attitude changes related to dissonance between the adaptation component participants’ behaviors and their input as “Preventionists.” Findings have implications for developing prevention strategies that may be helpful for older, high-risk youth.     

Evaluation of community-based AIDS education and risk reduction projects in ethnic and racial minority communities: A survey of projects funded by the U.S. public health service

The purpose of this study was to describe proposed program evaluation methods used to determine effectiveness of selected federally funded AIDS education and risk reduction interventions focused on ethnic and racial minority populations. Funding for AIDS prevention programs has grown significantly since 1985, when the first allocation of $11 million was earmarked for general AIDS prevention and education. In 1987, funds specifically targeting minority populations were set aside from AIDS prevention and education programs. Nine agencies/divisions within the Department of Health and Human Services (DHHS) were identified as having funded AIDS prevention and education projects targeted toward ethnic and racial minority populations. The grants and contracts reviewed for this study were limited to those programs receiving Federal funding through DHHS. Few programs provided information within the broader context of sex education and drug education. The modification of needle-sharing behavior among IV drug users and unprotected sex with an IV drug user were the two most frequent risk factors targeted. All 63 programs used at least one formative evaluation method. The most frequently used formative techniques were monitoring achievement of project objectives and counting the number of people participating in program activities. Forty programs counted the amount of AIDS literature distributed. Thirty-three programs conducted a baseline assessment of AIDS knowledge, and 33 programs conducted a baseline assessment of risk behaviors for HIV infection. Results from this study support the National Academy of Sciences recommendation that while summative evaluation will ultimately be valuable, it would be premature to begin developing outcome evaluation strategies at the present time. It is incumbent upon program planners and evaluators to ensure that premature program evaluations are not made in an effort to eliminate direct federal funding of minority community-based strategies to stop the spread of HIV infection.     

A Two-Level Community Intervention Model for Homeless Mothers with Mental Health or Substance Abuse Disorders

ABSTRACT

This paper describes a two-tiered community intervention model in response to a call from the Center for Mental Health Services for the development of best-practice strategies for homeless mothers with mental health and/or substance use disorders and their children. This model incorporates best practice principles gained from previous research projects pitched at the system and client levels. The model has been conceptualized, presented, and funded by CMHS and is currently being implemented in a local community. This model is unique in that it develops an intervention that addresses both levels of service delivery (i.e., system and client) in a single project. Blending systems integration/wraparound service philosophy and consumer-driven/strength-based development approaches provides a model that encompasses interventions at the individual client level via supported case management, and improved coordination and collaboration at the service system level. While this model was developed for a specific community population, the approach is general inits applicability to other areas of practice.     

Integrated Program Development: A Model for Meeting the Complex Needs of Homeless Persons

Homelessness is caused both by structural and personal factors. Thus, comprehensive services are required to meet the complex needs of homeless persons. This article reviews case management and group work practice with homeless persons and argues that effective social work practice must incorporate both intervention methods. Integrated Program Development (IPD), a program framework for shelter services, is presented. A pilot project at the Salvation Army Family Haven in St. Louis, Missouri illustrates the costs and benefits of empowerment-oriented group work with homeless persons. Three approaches for establishing group work for homeless people are suggested. Each approach requires that group workers, with community organizing skills, be employed by social service administrators.