Referral and housing processes in a long-term supported housing program for homeless veterans.

OBJECTIVE: The study examined client characteristics, case management variables, and housing features associated with referral, entry, and short-term success in a Department of Veterans Affairs (VA) national intensive case management and rental assistance program for homeless veterans. METHODS: Information collected from homeless veterans at the time of initial outreach contact and from case managers during the housing search was used to create logistic regression models of referral into the program and successful completion of several stages in the process of obtaining stable independent housing. RESULTS: Overall, only 8 percent of the more than 65,000 eligible veterans contacted by outreach workers were referred to the program. Those referred were more likely to be female, to have more sources of income, to have recently used VA services (including residential treatment), and to have serious mental health problems. Once in the program, 64 percent of veterans eventually moved into an apartment, and 84 percent of those who obtained an apartment were stably housed one year later. In general, activities of case managers, such as accompanying the veteran to the public housing authority and securing additional sources of income, were associated with success in the housing process. The therapeutic alliance, clients' housing preferences, and the quality of housing were unrelated to retention of housing. CONCLUSIONS: This supported housing program was judged appropriate for a small percentage of eligible veterans. However, a large proportion of clients were successful in attaining permanent housing, which lends support to the effectiveness of the supported housing approach.

Mortality among homeless and nonhomeless mentally ill veterans.

This study directly compared mortality risk in homeless and nonhomeless mentally ill veterans and compared mortality rates in these groups with the general U.S. population. The study used a retrospective cohort design to assess mortality over a 9-year period in homeless (N = 6,714) and nonhomeless (N = 1,715) male veterans who were treated by Department of Veterans Affairs specialized mental health programs. The study showed that mortality rates in all homeless members of the cohort were significantly higher than the general U.S. population. Relative to nonhomeless cohort members, significant increases in mortality risk were observed in cohort members who at baseline were age 45 to 54 and had been homeless 1 year or less (RR = 1.55, 95% CI = 1.02, 2.36) and those age 55 and older who had been homeless 1 year or less (RR = 1.83, 95% CI = 1.33, 2.52). Similar, but nonsignificant trends were observed in cohort members who had been homeless more than 1 year at baseline. Additionally, medical problems at baseline and history of prior hospitalization for alcohol problems elevated mortality risk. Employment at baseline and minority group membership reduced mortality risk. The study suggests that mentally ill veterans served by specialized VA mental health programs are at elevated risk of mortality, relative to the general population. Homelessness increases this risk, particularly in older veterans, and this difference does not abate after entry into a health care system.

Homeless veterans' satisfaction with residential treatment.

OBJECTIVE: Because little is known about homeless individuals' satisfaction with mental health services or the association between satisfaction and measures of treatment outcome, the study examined those issues in a group of homeless veterans. METHODS: Demographic and clinical data were obtained from intake assessments conducted before veterans' admission to residential treatment facilities under contract with the Department of Veterans Affairs Health Care for Homeless Veterans program, a national outreach and case management program. Clients completed a satisfaction survey and the Community-Oriented Programs Environment Scale, which asks them to rate dimensions of the treatment environment. Outcome data came from discharge outcome summaries completed by VA case managers. RESULTS: Overall satisfaction with residential treatment services was high among the 1,048 veterans surveyed. Greater satisfaction was associated with more days of drug abuse and more days spent institutionalized in the month before intake and with an intake diagnosis of drug abuse. Regression analyses indicated that satisfaction was most strongly related to clients' perceptions of several factors in the treatment environment. Policy clarity, clients' involvement in the program, an emphasis on order, a practical orientation, and peer support were positively related to satisfaction; staff control and clients' expression of anger were negatively related. Satisfaction was significantly associated with case managers' discharge ratings of clinical improvement of drug problems and psychiatric problems. CONCLUSIONS: Homeless veterans are more satisfied in environments they perceive to be supportive, orderly, and focused on practical solutions. The results indicate that client satisfaction is not related to treatment outcomes strongly enough to serve as a substitute for other outcome measures.

Residential treatment for dually diagnosed homeless veterans: a comparison of program types.

This study compared two types of residential programs that treat dually diagnosed homeless veterans. Programs specializing in the treatment of substance abuse disorders (SA) and those programs addressing both psychiatric disorders and substance abuse problems within the same setting (DDX) were compared on (1) program characteristics, (2) clients' perceived environment, and (3) outcomes of treatment. The study was based on surveys and discharge reports from residential treatment facilities that were under contract to the Department of Veterans Affairs Health Care for Homeless Veterans program, a national outreach and case management program operating at 71 sites across the nation. Program characteristics surveys were completed by program administrators, perceived environment surveys were completed by veterans in treatment, and discharge reports were completed by VA case managers. DDX programs were characterized by lower expectations for functioning, more acceptance of problem behavior, and more accommodation for choice and privacy, relative to SA programs after adjusting for baseline differences. Dually diagnosed veterans in DDX programs perceived these programs as less controlling than SA programs, but also as having lower involvement and less practical and personal problem orientations. At discharge, a lower percentage of veterans from DDX than SA programs left without staff consultation. A higher percentage of veterans from DDX than SA programs were discharged to community housing rather than to further institutional treatment. Program effects were not different for psychotic and non-psychotic veterans. Although differences were modest, integration of substance abuse and psychiatric treatment may promote a faster return to community living for dually diagnosed homeless veterans. Such integration did not differentially benefit dually diagnosed veterans whose psychiatric problems included a psychotic disorder.

A longitudinal assessment of teacher perceptions of parent involvement in children's education and school performance.

This study examines the ways in which parental involvement in children's education changes over time and how it relates to children's social and academic functioning in school. Teachers provided information on parent involvement and school performance for 1,205 urban, kindergarten through third-grade children for 3 consecutive years. They rated the following four dimensions of parent involvement: frequency of parent-teacher contact, quality of the parent-teacher interactions, participation in educational activities at home, and participation in school activities. As predicted, the frequency of parent-teacher contacts, quality of parent-teacher interactions, and parent participation at school declined from Years 1 to 3. Every parent involvement variable correlated moderately with school performance and parent involvement in Years 1 and 2, and accounted for a small, but significant amount of variance in Year 3 performance after controlling for initial performance level. Participation in educational activities at home predicted the widest range of performance variables. Results suggest that enhancing parental involvement in children's schooling relates to improvements in school functioning.

Substance use and psychiatric problems of homeless Native American veterans.

OBJECTIVE: This study estimated the proportion and representation of Native Americans among homeless veterans and compared their psychiatric and substance abuse problems with those of other ethnic groups of homeless veterans. METHODS: The study was based on data from the Department of Veterans Affairs' Health Care for Homeless Veterans program, a national outreach program operating at 71 sites across the country. Alcohol, drug, and psychiatric problems of Native American veterans (N=950) reported during intake assessment were compared with problems reported by white, black, and Hispanic veterans (N=36,938). RESULTS: Native Americans constituted 1.6 percent of veterans in the program. Age-adjusted analyses suggested that relative to the general veteran population (of which 1.3 percent are Native Americans), Native Americans are overrepresented in the homeless population by approximately 19 percent. Regression analyses controlling for demographic characteristics found that Native American veterans reported more current alcohol abuse, more previous hospitalizations for alcohol dependence, and more days of recent alcohol intoxication than members of other ethnic groups. In contrast, Native American veterans reported fewer drug dependence problems than other minority groups and fewer current psychiatric problems and previous psychiatric hospitalizations than the reference group of white homeless veterans. CONCLUSIONS: Native Americans are overrepresented in the homeless veteran population. They have more severe alcohol problems than other minority groups but somewhat fewer psychiatric problems.

Involvement in multiple problem behaviors of young urban adolescents.

This paper examines four areas of "problem behavior" (i.e., delinquency, high-risk sexual behavior, school failure, and substance abuse) in a sample of urban sixth and seventh grade students. We report descriptive statistics regarding rates of problem behaviors in each of the four categories and examine their interrelationships. The results suggest that the prevalence of problem behaviors in this sample is substantial. Data show a high degree of co-occurrence among problem behaviors in different areas, although many individuals also exhibit more limited involvement. These results underscore the importance of studying younger adolescents in poor, urban communities who may have different patterns and rates of problem behavior involvement than older youth from other contexts. The data also suggest that efforts to prevent high-risk involvements for youth in poor, urban communities should be broad-ranging and be implemented prior to middle school.

Prediction of early social and academic adjustment of children from the inner city.

Investigated predictors of five measures of early school adjustment for an ethnically diverse cohort of 683 inner-city kindergartners and first graders. Data from 2 consecutive years were collected from teachers, school records, and children. A multiple-regression preduction model significantly explained children's competence behavior, problem behavior, reading achievement, mathematics achievement, and school absences. Prior adjustment and sociodemographic factors explained a majority of the variance in adjustment. Perceived quality of parent involvement was signifcantly related (in the expected direction) to all five outcomes. Exposure to life events was significantly associated in the expected direction with competence behavior, problem behavior, and school absences but not with reading and mathematics achievement. Together, parent involvement and life-event variables explained as much as 12% of the variance in adjustment independent of sociodemographic and prior adjustment factors. The role of family and school factors in the adjustment of children at risk is discussed [corrected].

The comparator hypothesis of conditioned response generation: manifest conditioned excitation and inhibition as a function of relative excitatory strengths of CS and conditioning context at the time of testing.

In the present research water-deprived rats were used in a conditioned lick suppression paradigm to test and further develop Rescorla's (1968) contingency theory, which posits that excitatory associations are formed when a conditioned stimulus (CS) signals an increase in unconditioned stimulus (US) likelihood and that inhibitory associations develop when the CS signals a decrease in US likelihood. In Experiment 1 we found that responding to a CS varied inversely with the associative status of the context in which the CS was trained and that this response was unaltered when testing occurred in a distinctively dissimilar context with a different conditioning history, provided associative summation with the test context was minimized. These results suggest that manifest excitatory and inhibitory conditioned responding is modulated by the associative value of the training context rather than that of the test context. In Experiment 2 it was demonstrated that postconditioning decreases in the associative value of the CS training context reduced the effective inhibitory value of the CS even when testing occurred outside of the training context. Moreover, this contextual deflation effect was specific to the CS training context as opposed to any other excitatory context. Collectively, these studies support the comparator hypothesis, which states that conditioned responding is determined by a comparison of the associative strengths of the CS and its training context that occurs at the time of testing rather than at the time of conditioning. This implies that all associations are excitatory and that responding indicative of conditioned inhibition reflects a CS-US association that is below (or near) the associative strength of its comparator stimulus. It is suggested that response rules which go beyond a monotonic relation between associative value and response strength can partially relieve learning theories of their explanatory burdens, thereby allowing for simpler models of acquisition.

Retrieval variability: sources and consequences.

A memory model that differentiates between active traces (ongoing electrochemical neural transmission) and passive traces (chemical/structural modification of neurons) is briefly outlined. Evidence suggests that new information is initially encoded as a passive representation within a fraction of a second, leaving little opportunity for retroactive interference with storage processes. Instead, it appears that retroactive interference results from disruption of post-acquisition processing which is necessary for subsequent retrieval. Using this hybrid cognitive-physiological framework, we examine possible sources of associative performance deficits. A distinction is made between similarity interference (arising from the content similarity of the target and interfering traces) and processing interference (arising from the competition between the two traces for use of a limited capacity processor). Both types of interference can act proactively or retroactively, and the similarity-processing and proactive-retroactive dimensions are viewed as orthogonal to the question of whether information is permanently lost or merely subject to a reversible retrieval failure. When reminder techniques (pretest cuing) are used, numerous instances of memory failure commonly identified as "acquisition failures" are found to be reversible without the occurrence of relevant new learning. This literature review constitutes the greater part of the paper. It is concluded that many memory failures are due at least in part to retrieval failure. Consideration of potential retrieval processes in light of the studies that are reviewed argues for the expansion of the initial active-passive trace distinction to three types of traces. In addition to active traces, these include two distinct types of passive traces, i.e., a small content-addressable reference catalog with innately defined dimensions that is used to locate more detailed passive traces, and a large capacity store of detailed passive traces that is location-addressable. The latter type of passive trace presumably is laid down almost instantaneously as events occur, i.e., in real time, whereas the reference catalog type of passive trace, which is used to address the detailed traces, is established somewhat after the sequence of events is complete. Hence, the reference catalog trace is more vulnerable and results in retrieval failure when it is disrupted.(ABSTRACT TRUNCATED AT 400 WORDS)

The roles of information reactivation and nonassociative arousal in recovery from ECS-induced retrograde amnesia.

Restoration of memory by pretest reminder treatments following ECS-induced amnesia in principle could be mediated by nonassociative arousal and/or reactivation of information by the reminder stimuli. In the present research, arousal value of the reminder treatment was largely a function of the novelty of the context in which the reminder cues occurred. After producing ECS-induced amnesia in rats for a signaled passive avoidance task, presentation of the signal outside of the training and test context proved to be an effective reminder cue. However, prereminder familiarization with the reminder location, which was sufficient to reduce exploratory behavior suggestive of a decrease in the arousal value of the context, did not influence recovery from amnesia. These data indicate that reminder treatments are capable of reversing experimental amnesia by initiating further processing of previously acquired information even when the treatment does not produce appreciable arousal.

A retrograde gradient for disruption of a conditioned aversion to drinking cold water by ECS administered during the CS-US interval.

Rats were used to examine the effects, upon a conditioned aversion to cold drinking water, of electroconvulsive shock (ECS) delivered during the delay between cue and unconditioned stimulus. An injection of LiCl (US) 30 min after ingestion of novel cold water (CS) produced a reliable aversion to the cold water. ECS given immediately following the ingestion of cold water substantially attenuated this aversion. An orderly decrease in the attenuation of the aversion was observed when ECS was delayed 5, 10 or 20 min after offset of the cold water cue. The results indicate that ingestive cue aversions can be formed without electrochemical neural-transmission-based representation of the cue being maintained during the CS-US interval. The differential effectiveness of ECS suggests that this agent retroactively interferes with processing of the ingestive cue.

Blocking but not conditioned inhibition results when an added stimulus is reinforced in compound with multiple pretrained stimuli.

Conditioned barpress suppression by rats was used to explore the associative status of an initially neutral stimulus that was reinforced in simultaneous compound with two independently pretrained conditioned excitors. In contrast to the Rescorla-Wagner model, which predicts that the target stimulus (X) will be inhibitory following such A+/B+/ABX+ training, the present study found no evidence that X acquired inhibitory associative strength. Rather, the pretrained stimuli merely served to block conditioned excitatory responding to the target stimulus.

Attenuation of experimental retrograde amnesia through pretraining administration of a dissimilar amnestic agent.

Experiment 1 found that pretraining administration of electroconvulsive shock (ECS) attenuated ECS-induced amnesia of one-trial passive avoidance training in rats. Similarly, pretraining injections of cycloheximide (CXM) attenuated the amnestic effects of CXM at training. Experiment 2 demonstrated the ability of pretraining ECS to attenuate CXM-induced amnesia and pretraining CXM to attenuate ECS-induced amnesia. These studies join others in observing comparable behavioral effects of ECS-like amnestic agents and antimetabolite-like amnestic agents despite their different means of primary action. Collectively, these studies support the view that the two families of amnestic agents produce amnesia through a common mechanism.