Rising inability to obtain needed health care among homeless persons in Birmingham, Alabama (1995-2005).

BACKGROUND: Homeless persons depend disproportionately on the health-care safety net for medical services. National reports identify financial strains to this safety net. Whether this has affected homeless persons is unknown. OBJECTIVES: We quantified changes in the proportion of homeless persons reporting unmet need for health care in Birmingham, Alabama, comparing two periods, 1995 and 2005. We assessed whether a period effect was independent of characteristics of persons surveyed. DESIGN: Analysis of two surveys conducted with identical methods among representative samples of homeless persons in 1995 (n = 161) and 2005 (n = 161). MEASUREMENTS: Report of unmet need (inability to obtain care when needed) was the dependent variable. Two survey periods (1995 and 2005) were compared, with multivariable adjustment for sociodemographic and health characteristics. Reasons for unmet need were determined among the subset of persons reporting unmet need. RESULTS: Unmet need for health care was more common in 2005 (54%) than in 1995 (32%) (p < 0.0001), especially for non-Blacks (64%) and females (65%). Adjusting for individual characteristics, a survey year of 2005 independently predicted unmet need (odds ratio 2.68, 95% CI 1.49-4.83). Among persons reporting unmet need (87 of 161 in 2005; 52 of 161 in 1995), financial barriers were more commonly cited in 2005 (67% of 87) than in 1995 (42% of 52) (p = 0.01). CONCLUSION: A rise in unmet health-care needs was reported among Birmingham's homeless from 1995 to 2005. This period effect was independent of population characteristics and may implicate a local safety net inadequacy. Additional data are needed to determine if this represents a national trend.

Assessing practitioner's knowledge of evaluation: initial psychometrics of the Practice Evaluation Knowledge Scale.

Practice evaluation is an important component in the implementation of evidence-based practice. Until recently it has been difficult to assess practitioner knowledge in evaluation in the field. This study discusses the development and initial psychometrics of an 8-item scale to assess practitioner competency in evaluation. The Practice Evaluation Knowledge Scale demonstrated excellent internal consistency (alpha = .925) and validity. Results indicate that this scale shows promise as a valid measure of social work practitioner knowledge of practice evaluation.

Social assets and mental distress among the homeless: exploring the roles of social support and other forms of social capital on depression.

This paper explores the role of social capital in mediating the effects of stressors on depression among a disadvantaged population. Utilizing a survey of 155 homeless people in a mid-sized southern U.S. city, the authors address the relevance of social capital for quality of life. The paper provides a critical test of whether social support and other forms of social capital matter when monetary and human capital is extremely limited. Under these resource-restricted circumstances does social capital add to our understanding of the distress process or does it merely restate the well established relationship between social support and quality of life outcomes? Various forms of social capital are measured: religious social capital, group participation, social trust, and bridging social capital along with a commonly used measure of social support -- perceived strong tie support. Findings suggest that social capital matters for even the most resource poor populations. In addition, social capital variables add significantly to the variance explained in depressive symptomatology over and above that traditionally explained by perceived social support.

Just thinking about it: social capital and suicide ideation among homeless persons.

Suicide ideation is a sensitive indicator of personal well-being. While ideation occurs in roughly 3 percent of the US population annually, in this study rates are 10 times higher. This article explores the role of social capital in mediating negative life circumstances on ideation for a sample of 161 homeless adults in a mid-sized Southern US metropolitan area. Our results imply that social capital does not function the same way for homeless persons as it does for the general population. This finding supports growing evidence that social capital's much touted benefits for personal well-being may not apply to disadvantaged populations.

A scale to assess attitudes toward euthanasia.

The topic of euthanasia has been a matter of public debate for several decades. Although empirical research should inform policy, scale measurement is lacking. After analyzing shortcomings of previous work, we offer a systematically designed scale to measure attitudes toward euthanasia. We attempt to encompass previously unspecified dimensions of the phenomenon that are central to the euthanasia debate. The results of our pretest show that our attitude towards euthanasia (ATE) scale is both reliable and valid. We delineate active and passive euthanasia, no chance for recovery and severe pain, and patient's autonomy and doctor's authority. We argue that isolating these factors provides a more robust scale capable of better analyzing sample variance. Internal consistency is established with Cronbach's alpha=.871. Construct external consistency is established by correlating the scale with other predictors such as race and spirituality.

Factors associated with health-compromising behavior among the homeless.

This exploratory study examined a set of sociodemographic, risk, and protective factors associated with health-compromising behavior among the homeless. One hundred and sixty-one homeless adults living in a midsize, southern metropolitan area were surveyed. Information was collected using structured in-depth interviews that assessed residential and event histories, life circumstances, mental and physical health symptoms, and health-related risk behaviors (drug and alcohol use, risky sexual practices, sleeping outdoors, aggressive behavior, and weapon possession). Descriptive results showed differences in health-compromising behavior for ascribed characteristics such as age, race, and gender. Younger people, nonwhites, and men took more risks. Multivariate results indicated that while sociodemographic risk factors were important predictors of health-compromising behavior for people who are homeless, other variables, including childhood memories, victimization, and local nativism, were also significant. The implications of these findings are explored in the larger context of a social policy framework.