Case Management Models in Permanent Supported Housing Programs for People with Complex Behavioral Issues who are Homeless

OBJECTIVE:

The purpose of this article is to examine two evidence-based models of case management for people with co-occurring disorders and histories of chronic homelessness, and to better understand their roles in permanent supported housing. Critical Time Intervention and Assertive Community Treatment are examined in terms of key elements, how they assist in ending homelessness, as well as the role they play in an individual's recovery from co-occurring disorders.

METHODS:

Participants in two supported housing programs were interviewed at baseline and 6 months. One program used Critical Time Intervention (n = 144) and the other used Assertive Community Treatment (n = 90). Staff in both programs were interviewed about their experiences and fidelity assessments were conducted for each program.

RESULTS:

Both programs operated at high levels of fidelity. Despite similar criteria for participation, there were significant differences between groups. Critical Time Intervention participants were older, more likely to be male, more likely to be homeless, and reported greater psychiatric symptoms and higher levels of substance use (all p's < .001). Separate outcome analyses suggested that each program was successful in supporting people to transition from homelessness to stable housing; 88.6% of Assertive Community Treatment participants were homeless at baseline, while at 6 months 30% were homeless (p < .001), and 91.3% of those in the Critical Time Intervention were homeless at baseline, while 44.3% were homeless at 6 months (p < .001). Participants in the Critical Time Intervention program also showed significant decreases in alcohol use, drug use and psychiatric symptoms (all p's < .01). The preliminary results suggest that each case management model is helpful in assisting people with complex behavioral health needs and chronic homelessness to move to stable housing.

CONCLUSIONS:

Permanent supported housing seems to be an effective way to end homelessness among people with co-occurring disorders. Further research is needed to determine which case management models work most effectively with supported housing to help policy makers and program directors make informed decisions in developing these programs.

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By:  Clark C1, Guenther CC1, Mitchell JN1.

• 1 University of South Florida , Department of Mental Health Law and Policy. 
• J Dual Diagn. 2016 Apr 12:0

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Disciplinary Responses to Misconduct among Female Prison Inmates with Mental Illness, Substance Use Disorders & Co-Occurring Disorders

OBJECTIVE:

Most female inmates have mental health, substance use, or co-occurring disorders (CODs), which can create greater difficulty adjusting to incarceration and higher rates of prison misconduct. The response of prison officials to institutional misbehaviors has important implications for female inmates' experiences while incarcerated, their likelihood of parole, and the clinical course of their condition. This article examined whether disciplinary actions are more severe for women with CODs.

METHOD:

Data were provided by the Pennsylvania Department of Corrections for all female state prison inmates incarcerated between January 1, 2007, and July 30, 2009 (N = 2,279). The final sample of 211 women included those who had committed a minor misconduct during their incarceration. Disorder categories were created based on intake assessments, and multivariate models were estimated to determine the effect of disorder category on whether the prison imposed a severe or minor disciplinary response to the misconduct.

RESULTS:

The odds of receiving severe disciplinary responses to minor misconduct was significantly greater for women with CODs than those with the singular disorders of mental illness or substance abuse disorders, or those with no disorders.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:

Findings suggest correctional institutions are responding in a punitive manner to the symptomatic manifestations of CODs in female inmates. These findings suggest the importance of screening instruments in correctional settings that assess for the presence of dual disorders. In addition, correctional administrators must implement training protocols for correctional officers and staff on the complexity of CODs and the ability to identify behavioral and emotional symptoms associated with this vulnerable subset of the offender population. 

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By:   Houser K1, Belenko S2.

• 1Department of Law and Justice Studies.
• 2Department of Criminal Justice, Temple University. 

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Racial Differences in Veterans’ Satisfaction with Addiction Treatment Services

Racial minorities experience lower rates of alcohol treatment completion than whites. Treatment satisfaction is an important factor in alcohol treatment retention, yet few studies have explored the satisfaction of racial minorities while in treatment. This study examined racial differences in addiction treatment satisfaction and explored factors that might mediate or moderate racial differences in satisfaction.

We surveyed non-Hispanic black and non-Hispanic white veterans with an alcohol-related diagnosis about addiction treatment servicesat a large Veterans Affairs medical center. Treatment satisfaction was measured using the 8-item Client Satisfaction Questionnaire, dichotomized as low versus non-low satisfaction in analyses. The χ and logistic regression methods were used to test for associations of race and sociodemographic characteristics with treatment satisfaction.

Among 271 black and 304 white veterans with an alcohol-related diagnosis, race was not statistically associated with treatmentsatisfaction in bivariate analyses (P > 0.05). However, we identified significant interactions of race with mental health diagnoses in predictingtreatment satisfaction in multivariable analyses. In post hoc comparisons among veterans with zero mental health diagnoses, black veterans had a greater probability of reporting low satisfaction than whites. In veterans with 4 or more diagnoses, whites had a greater probability than blacks of reporting low satisfaction. Regardless of race, past homelessness was associated with low satisfaction.

Racial minorities, veterans with unstable housing, and white veterans with co-occurring mental health disorders may be at risk of experiencing low treatment satisfaction.

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By: Jones AL1, Hanusa BH, Appelt CJ, Haas GL, Gordon AJ, Hausmann LR.

• 1VA Center for Health Equity Research and Promotion (ALJ, AJG, LRMH), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Mental Illness Research, Education and Clinical Center (BHH, CJA, GLH), Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Sociology (CJA), Duquesne University, Pittsburgh, PA; and Department of Psychiatry (GLH) and Division of General Internal Medicine, Department of Medicine (AJG, LRMH), University of Pittsburgh School of Medicine, Pittsburgh, PA.  

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