Context and opportunity: multiple perspectives on parenting by women with a severe mental illness.

OBJECTIVE: The capabilities framework and a community-based participatory research (CBPR) approach frame this study. We consider the real opportunities for parenting available for women with serious mental health diagnoses, despite complications posed by their own capacity, material constraints, social network disruptions, and, by law, custom and policy related to mental health conditions and child custody decisions. METHOD: We convened focus groups with mothers currently living in shelters apart from their children, service providers in supported housing programs, grandmothers caring for children of mothers with mental health and substance use problems, and a policy discussion with mental health administrators. Qualitative analyses explored common and divergent perspectives on parenting experiences and aspirations of particularly marginalized mothers. RESULTS: Perspectives of mothers and other stakeholders converged in recognizing the parenting challenges facing mothers experiencing homelessness and mental health and substance use problems, but their views on the implications of this diverged sharply. Mothers' current aspirations were limited by contextual obstacles to maintaining contact with children; other stakeholders saw contact as risky and reunification as improbable. All stakeholders described systemic barriers to supporting contact and ongoing mothering roles. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Evidence-based parenting interventions require facilitating policy contexts that do not foreclose parenting possibilities for mothers whose current challenges dictate modest immediate parenting goals. CBPR amplifies voices of lived experience to demonstrate what is possible over time for mothers with complex lives and histories. These become possibilities that a person can imagine for herself and are essential to inform the evidence base for practice and policy.

Rates and correlates of HIV and STI infection among homeless women.

We studied the prevalence of biologically confirmed HIV, Chlamydia, and gonorrhea in a randomly selected sample of sheltered homeless women in New York City, and explored their association with demographic, homeless history, and clinical risk factors. 329 women were randomly selected from 28 family and single adult shelters. The estimated prevalence of HIV in the study sample is 0.6 % (±0.3 %); for Chlamydia it is 6.7 % (±2.2 %); for gonorrhea it is 0.9 % (±0.04 %). A history of childhood sexual abuse, arrest history, current psychotic symptoms, and substance use disorder placed women at greater risk of infection. We consider contextual factors that may yield underestimates of HIV prevalence in our sample and discuss how a more comprehensive prevalence estimate might be constructed. Findings underscore the importance of offering HIV/STI testing, counseling, and HIV risk prevention interventions to homeless women and suggest that interventions should be tailored to the needs of specific subgroups of homeless women.

Pulmonary thromboendarterectomy for thromboembolic pulmonary hypertension.

Pulmonary artery thromboendarterectomy (PTE) is a surgical procedure that offers the only cure for chronic thromboembolic pulmonary hypertension (TPH), a progressive form of secondary pulmonary hypertension. Current estimates indicate that 1% to 5% of patients who survive a pulmonary embolus will develop chronic TPH with progressively worsening pulmonary hypertension and right-sided heart failure. This bilateral procedure is performed through a sternotomy incision using cardiopulmonary bypass, profound hypothermia, and intermittent circulatory arrest with antegrade cerebral perfusion. As an alternative to lung transplantation, PTE offers patients with chronic TPH an improved quality of life.

Community integration in the early phase of housing among homeless persons diagnosed with severe mental illness: successes and challenges.

The present investigation used qualitative methods to explore the response to housing and experience of community integration of formerly homeless individuals diagnosed with severe mental illness recently housed in both independent and staffed residential settings. Findings indicate that entering into housing after a long period of homelessness is associated with improvements in community integration for most individuals diagnosed with severe mental illness. However, for a meaningful minority, the adaptation to housing may also be associated with challenges that can complicate the integration process. Implications of findings are discussed in the context of how best to tailor programs to meet the complex needs of persons diagnosed with severe mental illness and to maximize community integration.

Two genealogies of supported housing and their implications for outcome assessment.

Drawing on ongoing fieldwork in New York City, the authors distinguish two "genealogies," or developmental traditions, of supported housing. "Housing as housing" originated in the mental health field to champion normalized, less-structured alternatives to clinically managed residential programs. "Integrated housing development" traces its origins to the movement to combat homelessness by preserving and creating affordable housing. The authors detail the distinctive premises, guiding concerns, and developmental logic of each lineage, contrasting the consumer advocate focus of the first genealogy with the emphasis on housing supply of the second. As housing and service investment strategies, the two approaches run different risks, speak to distinctive constituencies, and play to specific strengths. The authors argue that any attempt to take the measure of their success or to assess their comparative value as social investments must go beyond client outcome and come to terms with discrepant notions of the social good that they represent.