HIV risks among homeless men differentiated by cocaine use and psychiatric distress.

This study examined the relationship among cocaine use, psychiatric distress, and HIV risk behaviors of homeless men. A 3 x 2 ANOVA was computed to determine overall mean HIV risk behavior, with the first factor representing three levels of psychiatric distress (low, moderate, and high) and the second factor representing use or no use of cocaine. Overall, homeless men who used cocaine had significantly higher HIV risk scores than did noncocaine users. Among the homeless men who used cocaine, those men who reported high psychiatric distress had significantly higher HIV risk scores than did noncocaine users and cocaine users with low psychiatric distress. Moreover, these risk scores predominantly represented three high risk sexual behaviors; lack of condom use, multiple sex partners, and participation in commercial sex. Outreach efforts that target both substance use and especially high-risk sexual practices are urged for this population.

Efficacy of enhanced outreach counseling to reenroll high-risk drug users 1 year after discharge from treatment.

OBJECTIVE: Because discharged methadone maintenance patients represent a population at particularly high public health risk, the authors studied such patients 1 year after their discharge from a methadone program. METHOD: The locations of 94 of 110 discharged patients were successfully determined 1 year after discharge. Nine (10%) of these patients had died, 37 (39%) were already reenrolled in treatment, and 7 (7%) did not require treatment. The 41 remaining subjects were randomly assigned to either the enhanced outreach counseling condition (N = 27) or a standard referral condition (N = 14). RESULTS: Within 2 weeks following this intervention, 17 (63%) of the 27 patients in the enhanced outreach counseling program and one (7%) of the 14 patients not in the program had reenrolled in treatment. CONCLUSIONS: These data suggest that enhanced outreach counseling may be an effective outreach strategy as well as a risk-reduction for discharged methadone maintenance patients.

Purchasing of services contracting: a symbiosis of voluntary organizations, government, and clients.

In the last twenty years, the phenomenon of government contracting with nonprofit human service organizations to deliver welfare services has intensified. This phenomenon, also known as privatization or purchase of services, is intriguing for welfare as well as nonprofit scholars. Using the functional-structuralist approach, the author explores analytically the mutual benefits as well as risks involved in contracting. He reviews four theoretical approaches regarding the evolution and function of voluntary organizations and how they and the public authorities divide the provision of welfare services. He discusses what each party gains, how each party takes advantage of this arrangement, and how these relationships affect services and clients. This article is based on personal experience in the U.S.A. and Israel as well as the literature from other countries including many European countries. Finally, he proposes that the framework presented in this article guide a cross-national, empirical analysis of the relationships between nonprofits and governments in welfare provision and its consequences.

Reliability and validity of the Addiction Severity Index with a homeless sample.

The Addiction Severity Index (ASI) is an instrument widely used to assess the treatment problems of substance users. Its psychometric properties have been tested and found satisfactory for many types of substance abusers entering treatment. However, there are many other subgroups of substance users not in formal treatment, such as homeless substance users. While the ASI has been used with this subgroup, its psychometric properties remain questionable. This study examined the reliability and validity of the ASI in a sample of 98 homeless substance users awaiting temporary housing placement. Test-retest reliability found the ASI to have moderate to high reliability coefficients in each of the seven domains assessed. Both composite score and severity rating measures were found to be quite independent with low intercorrelations. Three of the seven ASI composite scores were tested for and found to have moderate concurrent validity: alcohol (r = .31 to .36), drug (r = .46), and psychiatric (r = .53 to .66). Composite score interitem correlations were .70 or greater in each of the domains except for employment (.50) and family (.52). These data suggest that, although there are some limitations in using the ASI with homeless substance users, it demonstrated acceptable reliability and validity.

Two modes of case management: assessing their impact.

This is a study of two strategies of case management-Community Treatment Teams (CTTs) and Intensive Case Management Teams (ICMTs). A random sample of 30 cases from the CTT group were matched with 30 cases from the ICMT group using 4 criteria. Data were collected from case records and verified with case managers. The analysis revealed that although the CTTs engaged in more case management activities, there were few significant differences in the outcomes of the two approaches. The results are discussed in relation to a possible "ceiling effect" of case management, cost effectiveness, and limitations in the sample.

Childhood risk factors in dually diagnosed homeless adults.

Although the negative long-term effects of specific childhood risk factors--sexual and physical abuse, parental mental illness and substance abuse, and out-of-home placement--have been recognized, most studies have focused on just one of these risks. This article examines the prevalence of these five childhood risk factors among dually diagnosed (mentally ill and substance abusing) homeless adults in rehabilitation programs. It further assesses the impact of each risk factor individually and in combinations of two on the social functioning skills and rehabilitation progress of these multiply disadvantaged clients.

Serving the dually diagnosed homeless: program development and interventions.

In this paper the authors present the specific characteristics of the dually diagnosed (severely mentally ill and substance abusers) population and describe a hybridized program and interventions which have been empirically shown to be effective in working with these multiply impaired individuals. The article is based upon a three-year federally funded demonstration project. The following interventions were found to be effective: engagement, care and nurturing, structure, limit setting and the development of responsibility, positive reinforcement, and self esteem. The authors describe these interventions and highlight their impact in both staff management and working with funding sources.

Elderly volunteers: assessing their potential as an untapped resource.

In these times of dwindling resources for human services, the elderly are considered by many policy analysts and researchers to be the largest untapped source for volunteer recruitment. In this article we identify the origins of this societal expectation, its current actualization, and then analyze factors contributing to and deterring actual deployment of large numbers of elderly as volunteers. To assist in this analysis we have employed the conceptual framework that examines expected age, period, and cohort effects among the elderly on volunteerism in order to provide a basis for more realistic projections. Our findings indicate that elderly volunteers cannot be viewed as the cure-all to a squeeze on economic resources. In light of expected changes in future cohorts, elderly volunteers can be expected to increase their contribution only if creative recruitment and training methods will be used by volunteer administrators.

Public reaction to establishment of community residential facilities for mentally retarded persons in Israel.

Public attitudes and projected behavior associated with the establishment of community residence facilities for mentally retarded persons in Israel and the relationship between them were studied. Attitudes were clustered into two major types: those referring to general images of retarded persons and those relevant to potential interactions between retarded persons and one's own community. A three-phase model in which the effects of general attitudes on behavior are mediated through more specific attitudes was specified and tested.

Mentally retarded workers' reactions to their jobs.

Reactions of 34 mentally retarded employees to their jobs were examined in a field study conducted at a sheltered workshop. Three experienced social workers observed a group of retarded employees whose job was assembling toys. The workers were then interviewed on their perceptions of and reactions to their job characteristics and supervision, and these were related to performance data that included performance time, productivity, and effort ratings. Results showed that performance measures were related to perceived job characteristics and that growth-need strength (people's needs for personal development and achievement) affected these relationships. On the basis of these results, we discussed the feasibility of using motivation models for retarded workers that were designed for nonretarded workers.