Longitudinal cost of services in a homeless sample with cocaine use disorder

ABSTRACT

Homeless people with cocaine use disorder have multiple comorbidities and costly service needs. This study examined service costs associated with cocaine use and substance service use in substance, psychiatric, and medical service sectors. 127 homeless participants with cocaine use disorder were interviewed annually. Self-report and agency-report service use and cost data were combined. Pairwise comparisons were made with cocaine abstinence and substance service use in relation to mean and yearly proportional service costs in 3 service sectors. Among substance service users, the achievement of abstinence was not associated with decreased substance service costs. Cocaine abstinence was associated with proportional reduction of substance service costs over time. Substance service use was associated with proportional reduction of psychiatric service costs over time among the abstinent subgroup. Conversely, substance service use was associated with continuing higher medical service expenditures in the abstinent subgroup and higher psychiatric service expenditures in those not abstinent. Homeless individuals who achieved cocaine abstinence after using substance services had decreased substance service expenditures. Individuals with continued substance service use had greater medical and psychiatric service costs. Policy-based on maximizing benefits while minimizing costs appears insufficiently complex to incorporate the multiple needs and associated with the costs of treating homeless populations.     

The Effect of Severe Child Sexual Abuse and Disclosure on Mental Health during Adulthood

This study examined the relationship among severe child sexual abuse, disclosure, and mental health symptoms during adulthood. The sample consisted of 172 adults who were sexually abused in childhood. The multivariate model showed that respondents in their 30s and 40s who were abused by more than one abuser, who were injured by their abusers, who were abused by a biological relative, who told someone about the abuse when it occurred, and who did not discuss their abuse in depth within one year of the abuse had a greater number of mental health symptoms. Abuse severity and disclosure history should be assessed by professionals to identify clients who are at higher risk of mental health symptoms and to focus therapy.     

PRODUCING EPISTEMOLOGIES OF IGNORANCE IN THE POLITICAL ASYLUM APPLICATION PROCESS 1

The granting of political asylum is implicated in other often competing agendas and discourses, including national security, the obligation to provide safe haven, the histories of past immigrants and asylum seekers, and the criminalization of people who cross borders illegally, for whatever motive. Political asylum serves two sometimes contradictory ends: protection of the state and refuge for the applicant. This contradiction is at the root of the production of ignorance in a process that overtly seeks to generate knowledge. Restricted access to knowledge is part of persecution both as a form of control, and in the classification of knowledge as illicit, covert, or traitorous. We examine the conditions for producing knowledge and ignorance in the political asylum process in which the stories presented by applicants are evaluated by bureaucrats to determine whether they are credible and whether they meet the criteria of a well-founded fear of return to the homeland. We discuss narratives told by both asylum seekers in the United States and the United Kingdom and those who help them through the asylum process.     

Postindustrial Capitalism,Social Class Language Games,and Black Underachievement in the United States and United Kingdom

Against Ogbu's oppositional culture hypothesis, this article offers a class or structural/relational framework to contextualizing and understanding why it is that Blacks have more limited skills in processing information from articles, books, tables, charts, and graphs compared with their White counterparts in the United States and United Kingdom. We synthesize Marxian conceptions of identity construction within capitalist relations of production with the Wittgensteinian notion of “language games” to offer a more appropriate relational framework within which scholars ought to understand this Black–White academic achievement gap in America and the United Kingdom.     

“They Treat us Like Pests:” Undocumented Immigrant Experiences Obtaining Health Care in the Wake of a “Crackdown” Ordinance

This article presents findings from a qualitative study of Latino immigrant experiences seeking health care services in the wake of an anti-immigrant “crackdown” ordinance similar to Arizona's SB 1070. Prince William County, Virginia's 2007 “Rule of Law” ordinance escalated law enforcement efforts that targeted this population for deportation and ordered staff to ensure that no one receive social services other than those required by federal law. This article sought to answer the questions: (1) Were undocumented immigrants able to obtain health care? (2) How do immigrants characterize their experiences with health providers? Data were gathered via semi-structured interviews (n = 57) with Latinos in a low-income neighborhood. Analysis of Spanish-language narratives found that many were dissuaded from seeking care because of high costs as well as lack of familiarity with the health care system. Others perceived that they were treated with insensitivity or outright hostility—and believed this treatment was a deliberate effort to discourage them from seeking help.     

Evaluating the Impact of Post‐Qualifying Social Work Education

Post‐qualifying awards in social work are well established within the continuing professional development agenda for qualified social workers in the UK. The evaluation of education and training should be an integral part of this agenda because it is important to ensure that programmes continue to meet standards of delivery, are successful in meeting their aims and objectives and are making an impact on practice. However, there is a limited amount of published work on the evaluation of post‐qualifying social work education, with studies often focusing on programme delivery rather than on their impact on practice.

This paper explores evaluative work within the current post‐qualifying social work framework and discusses the results of an evaluation of the Vulnerable Adults and Community Care Practice programme, a specialist post‐qualifying social work education programme run by a UK university, as an example of an evaluation of the impact on practice. The results indicate positive evidence of impact on practice and demonstrate examples of how the programme has had a direct effect on individuals, teams, organisations and on people who use services.     

Multiple sex partners among college women and men: Sexual behaviors and sexual satisfaction revisited

The purpose of this investigation was to examine the effects of number of lifetime sex partners on sexual behaviors, sexual attitudes, and sexual satisfaction for never‐married college women and men. An anonymous questionnaire was administered in select classes at a midwestern state university. One‐partner group (one sex partner) women, in comparison to few‐partner (two to five sex partners) and many‐partner (six or more sex partners) group women, were more likely to have been older at first intercourse and to report psychological sexual satisfaction, mastur‐batory guilt, and commitment and love as conditions for sexual intercourse. For men, one‐partner group respondents were also more likely than few‐partner and many‐partner group respondents to report older age at first intercourse, masturbatory guilt, and commitment and love as conditions for sexual intercourse. In an era in which early sexual fulfillment clashes with concerns over unsafe sexual practices, these data provide insights into the influence of multiple partner experience on the sexual behavior patterns of young adults.