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Bibliography #25 – Veterans – December
2006
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version | back
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 Order #: 15280
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Authors: |
United States Government Accountability Office.
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Title: |
Homeless Veterans
Programs: Improved Communications and Follow-Up Could Further Enhance the
Grant and Per Diem Program. |
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Source: |
(Report:
53 Pages)
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Abstract: |
This report focuses
on GAO's analysis of VA data and
methods used for the homeless estimates and performance assessment, and its
visits to selected GPD providers in four states to observe the extent of
collaboration. About one-third of
the nation's adult homeless population are veterans, according to the
Department of Veterans Affairs (VA).
Many of these veterans have experienced substance abuse, mental
illness, or both. The VA's Homeless
Providers Grant and Per Diem (GPD) program, which is up for
reauthorization, provides transitional housing to help veterans prepare for
permanent housing. As requested, GAO
reviewed (1) VA homeless veterans estimates and the number of transitional
housing beds, (2) the extent of collaboration involved in the provision of
GPD and related services, and (3) VA's assessment of GPD program
performance (authors). Available From: U.S. Government Accountability
Office, 441 G Street NW, Room LM, Washington, DC 20548, www.gao.gov. |
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Order #: 14510 |
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Authors: |
Benda,
B.B.
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Title: |
Gender Differences in
Predictors of Suicidal Thoughts and Attempts Among Homeless Veterans that
Abuse Substances. |
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Source: |
Suicide and
Life-Threatening Behavior 35(1): 106-116, 2005. (Journal Article: 11 Pages)
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Abstract: |
This study of 315 male and
310 female military veterans who are homeless in a V.A. inpatient program
designed to treat substance abusers, many of whom suffer psychiatric
disorders, was designed to examine gender differences in factors associated
with the odds of having suicidal thoughts, and of attempting suicide, in
comparison to being nonsuicidal. A
maximum likelihood estimation multinomial logistic regression showed
childhood and current sexual and physical abuses, depression, fearfulness,
relationship problems, limited social support, and low self-esteem was more
strongly associated with suicidal thoughts and attempts for women than for
men veterans. Extent of alcohol and
other drug abuse, aggression, resilience, self-efficacy, combat exposure,
combat-related PTSD, and work problems were more strongly associated with
suicidal thoughts and attempts for men than for women. Implications of these findings for V.A.
programs are discussed (authors). |
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Order #: 14895 |
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Authors: |
LePage,
J.P., Bluitt, M., House-Hatfield, T., McAdams, H., Burdick, M., Dudley, D.,
Michaels, S., Merrell, C., Otto, S., Lenger-Gvist, J., Eisworth, J., Newton, J.A., Gaston, C.
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Title: |
Improving Success in a
Veterans Homeless Domiciliary Vocational Program: Model Development and
Evaluation. |
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Source: |
Rehabilitation Psychology
50(3): 297-304, 2005. (Journal Article:
8 Pages)
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Abstract: |
This study’s objective was
to determine predictors of success in a vocational rehabilitation component
of a Veterans Affairs Rehabilitation Program. The first of two experiments evaluated
risk factors for failure to find competitive employment. Eight factors were found to be
significant and were combined into a Risk Factor Scale. The second assessed attainment of
employment following program changes based on identified risk factors. The authors assigned patients to a
competitive job-search-only track or a hybrid program combining competitive
job search and the potential for supported employment. Overall employment rates increased, and
success rates for those seeking only competitive employment rose. Employment rates of those unlikely to
find competitive employment increased.
Findings demonstrated the effect of developing systematic data on
risk factors for failing to find employment, implementing changes based on
the data, and applying the benefit of these changes to program functioning
(authors). |
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Order #: 14893 |
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Authors: |
Murphy,
R.A., Kasprow, W.J., Rosenheck, R.A.
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Title: |
Predictors of
Children's Involvement in Parents' Treatment Among Homeless Veterans in
Community Residential Care. |
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Source: |
Psychiatric Services 56(9)
:1147-1149, 2005. (Journal Article: 3 Pages)
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Abstract: |
This study identified the
proportion of homeless veterans who are parents and described
characteristics of homeless veterans whose children became involved in
their treatment. Of the 9,444
veterans surveyed, 37.7 percent were parents of children younger than 18
years; yet children were involved in parents' treatment in only 10.6
percent of these cases. Parents
whose children were involved in their treatment were more likely to have
direct custody, be female, have greater social stability, and have more
psychiatric and medical problems.
These parents were also less likely to have been exposed to combat
fire. Services to homeless parents might be improved through coordination
of adult- and child-focused funding streams and programmatic efforts to
provide comprehensive interventions.
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Order #: 14299 |
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Authors: |
Schutt,
R.K., Weinstein, B., Penk, W.E.
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Title: |
Housing Preferences of
Homeless Veterans With Dual Diagnoses. |
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Source: |
Psychiatric Services
56(3): 350-352, 2005. (Journal Article:
3 Pages)
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Abstract: |
This study compared
residential preferences of 141 homeless veterans with dual diagnoses with
those of 62 homeless nonveterans with dual diagnoses. Clinicians rated both groups while they
were in transitional shelters before they were placed in housing. Both samples strongly rejected group home
living, but a majority of nonveterans desired staff support. Clinicians recommended staffed group
homes for most veterans and nonveterans.
This survey underscores the disjuncture between consumers' and
clinicians' preferences as well as the need to provide a range of housing
options to accommodate varied preferences (authors). |
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Order #: 14659 |
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Authors: |
United
States Interagency Council on Homelessness.
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Title: |
Representing the Needs
and Interests of Homeless Veterans in State, County, and City 10-Year Plans
to End Chronic Homelessness. |
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Source: |
Washington, DC: United States Interagency Council on Homelessness, 2005. (Report: 9
Pages)
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Abstract: |
This publication includes
background information on homelessness among veterans, links to federal web
sites and national, state, and local veterans serving organizations, as
well as directories of Veterans Benefits Administration (VBA) Regional
Office Homeless Outreach Veterans Coordinators, and Veterans Health
Administration (VHA) VISN Homeless Coordinators. These resource materials
were developed to represent the needs and interests of homeless veterans in
State Interagency Councils on Homelessness and 10-Year Plans to End Chronic
Homelessness, and to strengthen and improve plans as they move ahead in
both design and implementation stages. Available From: United States
Interagency Council on Homelessness, Federal Center SW, 409 Third Street SW, Suite 310, Washington, DC 20024, (202) 708-4663,
www.ich.gov/library/final_document_on_homeless_veterans.pdf |
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Order #: 14284 |
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Authors: |
Benda,
B.B.
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Title: |
Gender Differences in
the Rehospitalization of Substance Abusers Among Homeless Military
Veterans. |
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Source: |
Journal of Drug Issues
34(4): 723-750, 2004. (Journal Article:
28 Pages)
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Abstract: |
This study of military
veterans treated in an inpatient drug treatment program was designed to
examine any gender differences in predictors of rehospitalization for
substance abuse or other psychiatric disorders. A survey was administered to 310 women
and 315 men, involving several ecological predictors that rarely if ever
had been investigated. For example,
Cox’s proportional hazard model indicated that childhood and current sexual
and physical abuses were stronger predictors among women, whereas degree of
substance abuse, cognitive disorders, aggression, and disadvantageous peer
associations were stronger predictors among men. Social service implications of those
findings were presented (authors). |
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Order #: 14026 |
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Authors: |
Benda,
B.B.
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Title: |
Life-Course Theory of
Readmission of Substance Abusers Among Homeless Veterans. |
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Source: |
Psychiatric Services
55(11): 1308-1310, 2004. (Journal Article:
3 Pages)
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Abstract: |
This study examined
outcomes of 310 female and 315 male homeless veterans who were admitted to
a Department of Veterans Affairs inpatient program for dual diagnoses of a
substance use disorder and another mental illness. Participants were
surveyed to determine gender differences for types of transforming
experiences and for types of abuse as predictors of readmission within two
years. Predictors were selected primarily from life-course theory and were
analyzed with Cox's proportional hazards model. Transforming experiences,
such as enhanced ego identity and spiritual well-being, attenuated the
effects of childhood abuses, combat exposure, and depression for both
genders. Transforming experiences also reduced the risk of readmission that
was associated with aggression for men and abuse that occurred either in
the military or recently for women (author). |
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Order #: 14546 |
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Authors: |
Fletcher,
C.E.
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Title: |
Health Care Providers'
Perceptions of Spirituality While Caring for Veterans. |
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Source: |
Qualitative Health
Research 14(4): 546-561, 2004. (Journal
Article: 16 pages)
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Abstract: |
This study convened five
focus groups at two Veterans Administration Medical Centers to determine
health care provider's views on spirituality, its role in the health of
patients, and barriers to discussing spiritual issues with patients.
Participants were nurses, physicians, social workers, psychologists, and
chaplains. Common themes included: the lack of education for professionals
regarding how to address patients' spiritual needs; and systems-related
issues, including communication systems that do not function well, how
spiritual needs are addressed on admission, support or lack thereof by
hospital administrators, and lack of support for the spiritual needs of
staff. The aging and illnesses of many current veterans plus the escalated
potential of war highlight the importance of addressing veterans' spiritual
needs (authors). |
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Order #: 14035 |
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Authors: |
Mares,
A.S., Rosenheck, R.A.
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Title: |
Perceived Relationship
Between Military Service and Homelessness Among Homeless Veterans with
Mental Illness. |
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Source: |
Journal of Nervous and
Mental Disease 192(10): 715-719, 2004. (Journal
Article: 4 Pages)
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Abstract: |
This study examined the
perceived relationship between military service and the risk of
homelessness after discharge and identified specific aspects of military
service that homeless veterans experience as having increased their risk
for becoming homeless. A cross-sectional survey was conducted among 631
homeless veterans enrolled in the VA Therapeutic Employment Placement and
Support Program from January 2001 through September 2003. Associations of
sociodemographic characteristics, clinical status, and military service
characteristics (independent variables) were examined in relation to
perceptions of increased risk for homelessness and time to first episode of
homelessness after leaving the military (two dependent variables), using
analysis of variance, logistic regression, and multiple regression
statistical analyses. Fewer than one third of the homeless veterans in this
study reported that military service increased their risk for
homelessness--either somewhat or very much. Among those veterans who
perceived military service as increasing their risk for becoming homeless,
the three aspects of military service most commonly identified included:
substance abuse problems that began in the military; inadequate preparation
for civilian employment; and loss of a structured lifestyle. The relatively
small proportion of homeless veterans who attributed homelessness to their
military service, coupled with the long 14-year average lag time between
discharge and their first episode of homelessness, is consistent with
epidemiological data suggesting that military service itself does not
substantially increase the risk for becoming homeless among veterans. |
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Order #: 14891 |
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Authors: |
Nakashima,
J., McGuire, J., Berman, S., Daniels, W.
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Title: |
Developing Programs for
Homeless Veterans: Understanding Driving Forces in Implementation. |
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Source: |
Social Work in Health Care
40(2): 1-12, 2004. (Journal Article: 12 Pages)
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Abstract: |
This article looks at how
between 1992 and 2003, services for homeless veterans at the Veterans
Affairs Greater Los Angeles Healthcare System went from inappropriate
utilization of hospital medical and psychiatric beds, to a continuum of
residential treatment, transitional housing, and employment programs
through arrangements with private agencies.
The authors use elements of Hasenfeld and Brock's Political Economy
Model (1991) to explain this transformation in service delivery that was
spearheaded by a VA social work leadership team. It is argued that three driving forces
crucial to program implementation were present: technological certainty,
economic stability, and concentration of power. Evidence of the implementation's impact
includes creation of new homeless program beds, a reduction in use of
medical/psychiatric beds, and a large number of formerly homeless veterans
with housing and employment at program discharge. Study limitations and implications for
future studies are discussed (authors).
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Order #: 13271 |
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Authors: |
National
Coalition for the Homeless.
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Title: |
Homeless Veterans. |
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Source: |
Washington, DC: National Coalition for the Homeless, 2004. (Fact Sheet: 3
pages)
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Abstract: |
This fact sheet examines
homelessness among U.S. veterans.
Background information, demographics, and programs and policy issues
are also discussed. The authors
include a list of additional resources for further study (authors). Available
From: National Coalition for the Homeless, 1012 Fourteenth Street, NW,
#600, Washington, DC 20005, (202) 737-6444, www.nationalhomeless.org. |
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Order #: 13603 |
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Authors: |
Nyamathi,
A., Sands, H., Pattatucci-Aragon, A., Berg, J., Leake, B., Hahn, J.,
Morisky, D.
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Title: |
Perception of Health
Status by Homeless U.S. Veterans. |
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Source: |
Family & Community
Health 27(1): 65-74, 2004. (Journal Article:
10 pages)
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Abstract: |
In this article,
perceptions of health status among 331 homeless veterans and homeless
nonveterans were examined. According
to the authors, homeless veterans were significantly less apt to perceive
their health as fair/poor compared to non-veteran homeless men, and that
homeless veterans were also more likely to report having a regular source
of care. The article states that
logistic regression analysis indicated the adjusted odds of fair/poor
health were more than two times greater for persons reporting depressive
symptomatology than for those without this history; veterans continue to
remain less likely to report fair/poor health than nonveterans. The authors
conclude that high rates of substance abuse were observed for the entire
sample, and that such differences in perceived health result in important
health access issues (authors). |
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Order #: 13394 |
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Authors: |
Rosenheck,
R., Neale, M.
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Title: |
Therapeutic Limit
Setting and Six-Month Outcomes in a Veterans Affairs Assertive Community
Treatment Program. |
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Source: |
Psychiatric Services
55(2): 139-144, 2004. (Journal Article:
6 pages)
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Abstract: |
This study examined the
relationship of limit-setting interventions and six-month outcomes in
assertive community treatment. Case
managers from forty Veterans Affairs assertive community treatment teams at
different sites documented their use of limit-setting activities with
clients during the first six months of treatment. The authors assert that
clients exposed to limit-setting interventions had poorer outcomes than
others on many measures, suggesting that within the limits of a
nonexperimental study, such interventions do not appear to prevent adverse
outcomes (authors). |
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Order #: 13471 |
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Authors: |
Benda, B.
|
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Title: |
Discriminators of
Suicide Thoughts and Attempts Among Homeless Veterans Who Abuse Substances. |
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Source: |
Suicide and
Life-Threatening Behavior 33(4): 430-442, 2003. (Journal Article: 12 pages)
|
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Abstract: |
In this article,
six-hundred military veterans who are homeless and abused substances were
examined to determine what factors discriminate between non-suicidal
veterans, those who had suicidal thoughts, and persons who had attempted
suicide. The authors assert that several factors were considered based on attachment
theory, including caregiver attachment, sexual abuse, physical abuse,
resilience, self-efficacy, and self-esteem. The article states that suicide
attempters were discriminated from others by psychiatric comorbidity, early
abuse, severity of substance abuse, and longevity of drug use. In contrast,
the article states that discriminators between non-suicidal homeless
substance abusers and others were elements of attachment and commitments
such as marriage, employment, and religiosity. Some implications of the
findings for intervention are discussed (author). |
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Order #: 12910 |
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Authors: |
Curran,
G., Kirchner, J., Allee, E., Booth, B.
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Title: |
Datapoints: Detection
of Substance Use Disorders in Veterans Affairs Primary Care Clinics. |
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Source: |
Psychiatric Services
54(10): 1326, 2003. (Journal Article:
1 pages)
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Abstract: |
The objective of this
study was to investigate patterns of diagnosis of substance use
disorders. The primary care data
from the VA's national outpatient service use database for five fiscal
years (1997-2001) was gathered.
According to the authors, the overall rates of diagnosis for
substance use disorders increased.
The authors suggest additional focused research at the clinic level
to improve the understanding of results (authors). |
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Order #: 12262 |
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Authors: |
Desai,
M.M., Rosenheck, R.A., Kasprow, W.J.
|
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Title: |
Determinants of Receipt
of Ambulatory Medical Care in a National Sample of Mentally Ill Homeless
Veterans. |
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Source: |
Medical Care 41(2):
275-287, 2003. (Journal Article: 12 pages)
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Abstract: |
This study used the
Behavioral Model for Vulnerable Populations to identify determinants of
receipt of outpatient medical care within 6 months of initial contact with
a national homeless veterans outreach program. Data from structured interviews conducted
at the time of program intake were merged with Veterans Affairs
administrative data to determine subsequent medical service use. The authors conclude that a majority of
homeless veterans contacted through a national outreach program failed to
receive medical services within 6 months of program entry. Greater efforts are needed to ensure that
people who are homeless and have mental illnesses are successfully linked
with and engaged in medical treatment (authors). |
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Order #: 12754 |
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Authors: |
Desai,
R., Rosenheck, R., Agnello, V.
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Title: |
Prevalence of Hepatitis
C Virus Infection in a Sample of Homeless Veterans. |
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Source: |
Social Psychiatric
Epidemiology 38(7): 396-401, 2003. (Journal
Article: 6 pages)
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Abstract: |
This article measures the
prevalence of Hepatitis C Virus infection in a sample of homeless veterans
treated in a Domiciliary Care for Homeless Veterans (DCHV) program in Massachusetts. The
authors examine risk factors and correlates for HCV infection, including
substance abuse and service in Vietnam. The
authors assert that a high prevalence of HCV infection in this population
is not likely to be geographically unique, and may indicate particularly
high risk for homeless men. The
article states that an increase in screening and education for all people
who are homeless, particularly those with a history of injection drug use,
is necessary. The authors also state
that public systems of health care, including the VA should expect
increasing costs of care related to HCV infection as prevalence cases
develop serious medical sequelae of HCV infection (authors). |
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Order #: 12577 |
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Authors: |
Gamache,
G., Rosenheck, R., Tessler, R.
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Title: |
Overrepresentation of
Women Veterans Among Homeless Women. |
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Source: |
American Journal of Public
Health 93(7): 1132-1136, 2003. (Journal
Article: 5 pages)
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Abstract: |
This article is based on a
study which estimated the proportion of veterans among homeless women and
their risk of homelessness relative to that of nonveterans. The data came from two surveys of
homeless women (one clinical and one nonclinical), and one survey of
domiciled women. According to the
authors, the proportion of veterans among homeless women was greater than
the proportion of domiciled women, and after computing the odds ratios for
being a veteran among homeless women compared with nonhomeless women,
homeless women were significantly more likely than nonhomeless women to be
veterans. The article concludes that
women veterans are at greater risk for homelessness than are nonveterans. The authors assert that further study is
needed to determine whether increased risks for veterans are a product of
military service or reflect volunteers' self-selection into the armed
forces (authors). |
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Order #: 14030 |
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Authors: |
Gibson,
G., Rosenheck, R., Tullner, J.B., Grimes, R.M., Seibyl, C.L.,
Rivera-Torres, A., Goodman, H.S., Nunn, M.E.
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Title: |
A National Survey of
the Oral Health Status of Homeless Veterans. |
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Source: |
Journal of Public Health
Dentistry 63(1): 30-37, 2003. (Journal
Article: 7 Pages)
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Abstract: |
This study reports results
from a survey designed to assess the oral health needs of a national sample
of homeless veterans and compare the dental needs of homeless veterans
participating in VA-sponsored rehabilitation programs with domiciled
veterans in VA substance addiction programs. Homeless veterans enrolled in a
nationwide rehabilitation program completed a survey including questions
concerning patients' perceptions of their oral health, dental service needs
and use, and alcohol and tobacco use. A sample of these veterans
subsequently received dental exams. A comparison group of domiciled
veterans enrolled in VA substance abuse programs completed a similar
survey. A sample of these veterans also received dental exams. Sociodemographic variables,
patient-reported oral health information and risk behaviors, and findings
from dental exams described two remarkably similar populations. As expected, the homeless veterans
exhibited poor oral health, but it was not different from domiciled
veterans enrolled in substance addiction programs. Lifestyle choices, such
as heavy drinking and smoking, may contribute more to poor oral health than
living conditions (authors). |
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Order #: 12776 |
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Authors: |
Long, J.
|
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Title: |
Reciept of Health
Services by Low-Income Veterans. |
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Source: |
Journal of Health Care for
the Poor and Underserved 14(3): 305-317, 2003. (Journal Article: 12 pages)
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Abstract: |
This article discusses how
well the Veterans Health Administration (VHA) has been meeting its goal of
serving low-income veterans. The
author investigates where low-income veterans go for care, whether there
are disparities in care across income level for veterans, and whether
low-income veterans using the VHA have better access to care compared with
low-income veterans not using the VHA.
The data for these analyses come from the 1992 National Survey on
Veterans, and this article establishes the benchmark by which to interpret
data that is currently being collected (authors). |
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Order #: 12011 |
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Authors: |
McGuire,
J., Rosenheck, R.A., Kasprow, W.J.
|
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Title: |
Health Status, Service
Use, and Costs Among Veterans Receiving Outreach Services in Jail or
Community Settings. |
|
Source: |
Psychiatric Services
54(2): 201-207, 2003. (Journal Article:
7 pages)
|
|
Abstract: |
This article describes a
study that compared client characteristics, service use, and health care
costs of two groups of veterans who were contacted by outreach workers: a
group of veterans who were contacted while incarcerated at the Los Angeles jail and a group of homeless veterans who were
contacted in community settings. The
findings show that specialized outreach services appear to be modestly
effective in linking veterans who become incarcerated with VA health care
services. Although it is clinically challenging to link this group with
services, the fact that the rate of current substance use is lower during
incarceration may provide a window of opportunity for developing linkages
between inmates and community rehabilitative services (authors). |
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Order #: 13098 |
|
Authors: |
O'Toole,
T., Conde-Martel, A., Gibbon, J., Hanusa, B., Fine, M.
|
|
Title: |
Health Care of Homeless
Veterans: Why Are Some Individuals
Falling Through the Safety Net? |
|
Source: |
Journal of Internal
Medicine 18(11): 929-933, 2003. (Journal
Article: 5 pages)
|
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Abstract: |
This article discusses the
importance of understanding the needs of those veterans who are homeless.
The authors describe characteristics of homeless male veterans and factors
associated with needing VA benefits from a two-city, community survey of
531 homeless adults. Overall, 425 were male, of whom 127 were veterans.
Significantly more veterans had a chronic medical condition and two or more
mental health conditions. Only 35.1 percent identified a community clinic
for care compared with 66.8 percent of non-veterans; 47.7 percent
identified a shelter-based clinic and 59.1 percent reported needing VA
benefits. According to the authors, those reporting this need were less
likely to report a medical comorbidity, although 66.7 percent had a mental
health comorbidity and 82.7 percent met Diagnostic Screening Manual
(DSM)-IIIR criteria for substance abuse/dependence. They were also
significantly more likely to access shelter clinics compared with veterans
without this need. The authors conclude that homeless veterans continue to
have substantial health issues and active outreach is needed for those
lacking access to VA services (authors).
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Order #: 13604 |
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Authors: |
Schutt,
R., Cournoyer, B., Penk, W., Drebing, C., Van Ormer, A., Krebs, C.,
Losardo, M.
|
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Title: |
Building the Future:
Psychosocial Rehabilitation With a Veterans Construction Team. |
|
Source: |
Psychiatric Rehabilitation
Journal 27(2): 186-189, 2003. (Journal
Article: 4 pages)
|
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Abstract: |
In this article, the
authors discuss the Veterans Construction Team (VCT) as an innovative form
of Compensated Work Therapy for unemployed veterans who are homeless and
who have a history of substance abuse and/or serious mental or medical
illness. The authors also assert
that the VCT model builds social support and self-esteem, while delivering
tangible services to public entities and providing a relatively high rate
of pay and exceptional opportunities for skill development. In interviewing program manager, office
staff, field supervisors and VCT participants, this article outlines the
VCT model, reviews VCT's development and operations, and describes
participant reactions (authors). |
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Order #: 11310 |
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Authors: |
United States Department of Veterans Affairs.
|
|
Title: |
VA Programs for
Homeless Veterans. |
|
Source: |
Washington, DC: U.S. Department of Veterans Affairs, 2002. (Program Description: 4 pages)
|
|
Abstract: |
This fact sheet describes
the programs and services offered by the VA for homeless veterans. The VA is the only federal agency that
provides substantial hands-on assistance directly to homeless persons.
Although limited to veterans and their dependents, VA's major homeless
programs constitute the largest integrated network of homeless assistance
programs in the country, offering a wide array of services and initiatives
to help veterans recover from homelessness and live as self-sufficiently
and independently as possible. Nearly one-quarter of homeless veterans have
said they have used VA homeless services and 57 percent have said they have
used VA health-care services (authors). Available From: U.S. Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420 (202) 273-5700, www.va.gov/pressrel/hmls01fs.htm. |
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Order #: 14031 |
|
Authors: |
Cheung,
R.C., Hanson, A.K., Maganti, K., Keeffe, E.B., Matsui, S.M.
|
|
Title: |
Viral Hepatitis and
Other Infectious Diseases in a Homeless Population. |
|
Source: |
Journal of Clinical
Gastroenterology 34(4): 476-480, 2002. (Journal
Article: 4 Pages)
|
|
Abstract: |
This study's objective was
to determine the prevalence of four common infectious diseases-hepatitis B,
hepatitis C, human immunodeficiency virus (HIV), and tuberculosis-as well
as co-infection rates and risk factors in a homeless population. The prevalence of infectious diseases,
especially viral hepatitis, among the homeless population is largely
unknown. This study consists of a
retrospective analysis of the history and laboratory data collected from
all homeless veterans admitted to a Veterans Administration (VA)
domiciliary from May 1995 to March 2000.
Of the homeless veterans admitted to a VA domiciliary program, 597
of 829 were screened for markers of all four infectious diseases. The overall prevalence of anti-hepatitis
C virus (HCV) antibody, and positive result for purified protein derivative
(PPD), anti-HIV antibody, and hepatitis B surface antigen (HbsAg) were
41.7%, 20.6%, 1.84% and 1.17%, respectively. At least one of the four markers was
positive in 52.6% and more than one in 12%.
Co-infection with HCV occurred commonly in veterans who were
positive for anti-HIV and HBsAg.
Four self-reported major risk factors (intravenous drug use, alcohol
abuse, previous imprisonment, and prior stay in a shelter) were
evaluated. Multivariate analysis
indicates that intravenous drug use and anti-HBs reactivity are independent
risk factors for HCV infection, HCV infection for anti-hepatitis B surface
antibody reactivity, and older age for PPD positivity. Chronic hepatitis C and co-infections are
common among the homeless population.
Patients infected with HIV and hepatitis B virus frequently are
co-infected with HCV. Infections
frequently are associated with certain identifiable risk factors (authors). |
|
|
Order #: 11422 |
|
Authors: |
McGuire,
J., Rosenheck, R., Burnette, C.
|
|
Title: |
Expanding Service
Delivery: Does it Improve Relationships Among Agencies Serving Homeless
People with Mental Illness? |
|
Source: |
Administration and Policy
in Mental Health 29(3): 243-256, 2002. (Journal
Article: 15 pages)
|
|
Abstract: |
This study examines the
association of expanded funding of client-level homeless services, a
bottom-up approach, with strengthening of inter-organizational
relationships. The study compared
Veterans Affairs/non-Veterans Affairs inter-agency relationships at
Veterans Affairs facilities supporting community-oriented programs, at
Veterans Affairs facilities supporting on-site internally focused homeless
programs, and at facilities with the no specialized homeless programs. Veterans Affairs facilities that
supported community-oriented homeless programs enjoyed stronger Veterans
Affairs-community agency relationships than the other two Veterans Affairs
facility types. The study identifies
an effective bottom-up resource-based approach to services integration
(authors). |
|
|
Order #: 14032 |
|
Authors: |
Muir,
A.J., Provenzale, D.
|
|
Title: |
A Descriptive
Evaluation of Eligibility for Therapy Among Veterans with Chronic Hepatitis
C Virus Infection. |
|
Source: |
Journal of Clinical
Gastroenterology 34(3): 268-271, 2002. (Journal
Article: 4 Pages)
|
|
Abstract: |
The goal of this study was
to assess the number of chronic hepatitis C patients eligible for
therapy. Recent studies have shown
improved response rates to treatment of chronic hepatitis C infection.
However, treatment with interferon alfa has major side effects, and many
patients may not be eligible for therapy.
One hundred consecutive patients with positive hepatitis C
serologies at the Durham Veterans Affairs Medical Center were evaluated. Medical records were reviewed, and the patients
were interviewed. Patients were considered ineligible for therapy if they
had severe mental illness, hazardous alcohol consumption, current drug
abuse, decompensated cirrhosis, dementia, terminal illness, diabetic
ketoacidosis, and severe cardiac or pulmonary disease or if they were
homeless. Of the 100 patients, 92%
were male and 51% were African American. The mean age was 47.3 +/- 5.6
years. Only 32 of the 100 patients were eligible for therapy. Hazardous
alcohol consumption was present in 44%. Major depressive symptoms were
present in 12%. The minority of
chronic hepatitis C patients were eligible for therapy. Significant rates
of hazardous alcohol consumption and psychiatric disorders were present.
For these patients to complete or become eligible for therapy, a multidisciplinary
approach with psychiatric and substance abuse treatment will be necessary
(authors). |
|
|
Order #: 12252 |
|
Authors: |
National
Coalition for Homeless Veterans.
|
|
Title: |
Homeless Veterans Fact
Sheet. |
|
Source: |
Washington, DC: National Coalition for Homeless Veterans, 2002. (Brochure: 4
pages)
|
|
Abstract: |
In this pamphlet, the
authors discuss why veterans are homeless, the number of veterans who are
homeless, and the demographic breakdown of who these veterans are. Services and programs are also
discussed. A brief description of
the organization is given, and recommendations on how individuals can help
are given. Available From: National Coalition for Homeless Veterans, 333 1/2 Pennsylvania Avenue, SE, Washington, DC 20003, (800) VET-HELP, www.nchv.org. |
|
|
Order #: 10953 |
|
Authors: |
Oddone,
E.Z., Petersen, L.A., Weinberger, M., Freedman, J.,
Kressin, N.R.
|
|
Title: |
Contribution of the
Veterans Health Administration in Understanding Racial Disparities in
Access and Utilization of Health Care. |
|
Source: |
Medical Care 40 (1):
I-3-I-13, 2002. (Journal Article: 11 pages)
|
|
Abstract: |
The authors first
introduce the context and reasons for conducting racial variation research
with regard to health care disparities in the veterans population. They discuss four general paradigms for
explaining these disparities and continue with more specific factors. The section on clinical factors includes
a discussion of ischemic heart disease, cerebral vascular disease, and
mental health disorders. The section
on the role of the patient includes a discussion on patient perceptions of
health, patient preferences, patient trust and satisfaction, and
patient-physician interaction.
Finally, the section on the role of the provider includes a
discussion on provider education. |
|
|
Order #: 11612 |
|
Authors: |
Tessler,
R., Rosenheck, R., Gamache, G.
|
|
Title: |
Comparison of Homeless
Veterans With Other Homeless Men in a Large Clinical Outreach Program. |
|
Source: |
Psychiatric Quarterly,
73(2):109-119, 2002. (Journal Article:
6 pages)
|
|
Abstract: |
This paper compares
homeless veterans with homeless nonveterans from different eras in an
effort to better understand the connection between military service and
urban homelessness. Two research questions are addressed based on
interviews with over 4,000 homeless men who enrolled in a national outreach
program for persons suffering from serious mental illness: first, is there
anything unique in the social and personal characteristics of homeless
veterans in the 1990s that would help to explain their relatively high
prevalence in the homeless population, especially among those who were 19
or younger when the draft ended in 1973? Second, aside from age, are the
homeless veterans of the era of the All-Volunteer Force different from
homeless veterans who served during the era of the military draft? The
results replicate many findings from research in the 1980s showing that
even homeless veterans with psychiatric disorders tend to have more
personal resources compared to homeless men who did not serve in the Armed
Forces. Although veterans from the era of the All-Volunteer Force are
different from veterans from the era of the draft, the introduction of the
All-Volunteer Force per se does not appear to have changed the composition
of the adult male homeless population (authors). |
|
|
Order #: 12119 |
|
Authors: |
Thompson,
R., Katz, I.R., Kane, V.R., Sayers, S.L.
|
|
Title: |
Cause of Death in
Veterans Receiving General Medical and Mental Health Care. |
|
Source: |
Journal of Nervous and
Mental Disease 190(11): 789-792, 2002. (Journal
Article: 4 pages)
|
|
Abstract: |
This article examines the
rates of causes of death among veterans served by Pennsylvania Veterans
Affairs Medical Centers (VAMCs) and the relations between recent mental
health treatment, age at death, and cause of death. The authors also examine site differences
in VAMCs across Pennsylvania in rates of unnatural deaths in general and
suicide in particular (authors). |
|
|
Order #: 11116 |
|
Authors: |
Gamache,
G., Rosenheck, R., Tessler, R.
|
|
Title: |
The Proportion of
Veterans Among Homeless Men: A Decade Later. |
|
Source: |
Social Psychiatry and
Psychiatric Epidemiology 36(10): 481-485, 2001. (Journal Article: 5 pages)
|
|
Abstract: |
The purpose of this report
is to evaluate the risk of homelessness among veterans as compared to
non-veterans, and to ascertain whether the exceptionally high risk of
homelessness among post-Vietnam era veterans first observed in 1987 was
still evident one decade later.
Results show that the cohort of veterans aged 20-34 that was most at
risk in the 1980s, although no longer the youngest, still has the highest
risk for homelessness. The observed
cohort effect, which demonstrates an especially high risk of homelessness
among veterans of the immediate post-Vietnam era, even as they age, may
reflect the continuing influence of the early problems in recruiting for
the All Volunteer Force (AVF). In
contrast to the national draft, which promised a fair representation of the
entire population of draft eligible young men, the AVF also had the
potential to attract young men with fewer alternative opportunities
(authors). |
|
|
Order #: 10306 |
|
Authors: |
Gelberg,
L., Robertson, M.J., Leake, B., Wenzel, S.L., Bakhtiar, L., Hardie, E.A.,
Sadler, N., Getzug, T.
|
|
Title: |
Hepatitis B Among
Homeless and Other Impoverished U.S. Military Veterans in Residential Care
in Los Angeles. |
|
Source: |
Public Health 115,
286-291, 2001. (Journal Article: 6 pages)
|
|
Abstract: |
This paper presents a
secondary analysis of cross-sectional survey and clinical data for 370 male
veterans who were residents of a domiciliary care program for homeless
veterans in Los Angeles. About one-third (30.8%) of the sample tested
positive for current or past HBV infection (ie, seropositive or either HBV core antibody or surface
antigen). After multivariate
analysis, rates of HBV were significantly higher among veterans who were
older, non-white, or who had a history of regular heroin use (a proxy
measure for injection drug use), drug overdose, or drug detoxification
treatment. The rate of current or
past HBV infection among veterans in this sample (30.8%) was high compared
to an estimated 5% to 8% of the general US population.
Also, 3% of the sample were currently infected with HBV. Strategies for intervention include
broader screening, immunization, and treatment interventions with this
high-risk group. |
|
|
Order #: 10058 |
|
Authors: |
McMurray-Avila,
M.
|
|
Title: |
Homeless Veterans and
Health Care: A Resource Guide for Providers, with Appendices. |
|
Source: |
Nashville, TN: National Health Care for the Homeless Council,
2001. (Resource Guide: 98 pages)
|
|
Abstract: |
This publication compiles
current information about health care issues and resources for homeless
veterans in a format that will be useful to service providers, homeless
veterans, and others concerned about their health and welfare. It describes
the complex array of services provided by the Veteran's Administration
(VA), explores the barriers that exist, and describes helpful
collaborations between the VA and homeless service providers in several
communities. Available From: National Health Care for the Homeless Council,
P.O. Box
60427, Nashville, TN 37206, (615) 226-2292,
www.nhchc.org/Publications/HomelessVetsHealthCare.pdf,
http://www.nhchc.org/Publications/HomelessVetsAppendices.pdf |
|
|
Order #: 10610 |
|
Authors: |
United
States Department of Veteran Affairs.
|
|
Title: |
Federal Benefits for
Veterans and Dependents. |
|
Source: |
Washington, DC: U.S. Department of Veteran Affairs, Office of Public
Affairs, 2001. (Resource Guide: 102 pages)
|
|
Abstract: |
This publication describes
the various benefits that veterans and their dependents are eligible to
receive. It first explains who
qualifies and how one files a claim.
It then discusses in more detail the health care benefits, as well
as disability compensation, pension, education, employment, home loan
guaranties, life insurance, and burial benefits. Available From: U.S. Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, (202) 273-5700, www.va.gov |
|
|
Order #: 14847 |
|
Authors: |
Gamache,
G., Rosenheck, R., Tessler, R.
|
|
Title: |
Military Discharge
Status of Homeless Veterans with Mental Illness. |
|
Source: |
Military Medicine 165(11):
803-808, 2000. (Journal Article: 5 Pages)
|
|
Abstract: |
The high proportion of
veterans among homeless men is perplexing given the opportunities
associated with military service and the benefits long available to
veterans. One little-examined risk factor for homelessness is that many
homeless men may have received punitive discharges that result in
ineligibility for Department of Veterans Affairs benefits. Data from a
sample of homeless male veterans with mental illness enrolled in the Access
to Community Care and Effective Services and Supports Program are used to
examine punitive discharges as a risk factor for homelessness and to
compare veterans with punitive and non-punitive discharges on premilitary,
military, and postmilitary experiences. Only 7% of homeless veterans
received punitive discharges. Pre-military experiences are associated with
such discharges, but military experiences are not. Although a punitive
discharge is a strong risk factor for subsequent homelessness, such
discharges primarily reflect premilitary vulnerabilities and are a relatively
minor reason for homelessness because they affect a small proportion of the
general veteran population (authors).
|
|
|
Order #: 8503 |
|
Authors: |
Kasprow,
W.J., Rosenheck, R.
|
|
Title: |
Mortality Among
Homeless and Nonhomeless Mentally Ill Veterans. |
|
Source: |
Journal of Nervous and
Mental Disease 188(3): 141-147, 2000. (Journal
Article: 7 pages)
|
|
Abstract: |
This article compares
mortality risk in homeless and nonhomeless mentally ill veterans and
compares mortality rates in these groups with the general U.S.
population. The study assessed
mortality over a nine-year period in homeless and nonhomeless male veterans
who were treated by Department of Veterans Affairs (VA) specialized mental
health programs. The study showed
that mortality rates in all homeless veterans were significantly higher
than the general population.
Relative to the nonhomeless, significant increases in mortality risk
were observed in those who at baseline were age 45 to 54 and had been
homeless one year or less and those age 55 and older who had been homeless
one year or less. 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 when compared to the general population (authors). |
|
|
Order #: 8433 |
|
Authors: |
McFall,
M., Malte, C., Fontana, A., Rosenheck, R.
|
|
Title: |
Effects of an Outreach
Intervention on Use of Mental Health Services by Veterans with
Posttraumatic Stress Disorder. |
|
Source: |
Psychiatric Services
51(3): 369-374, 2000. (Journal Article:
6 pages)
|
|
Abstract: |
This article examines the
effectiveness of an outreach intervention designed to increase access to
mental health treatment among veterans disabled by chronic posttraumatic
stress disorder (PTSD) and identify patient-reported barriers to care. Participants were 594 male Vietnam
veterans who were not enrolled in mental health care at a Department of
Veterans Affairs (VA) center but who were receiving VA benefits for
PTSD. Half the sample were placed in
the intervention group and received a mailing that included materials
describing treatment available and informing them about how to access
care. Veterans in the intervention
group were significantly more likely to schedule an intake appointment,
attend the intake, and enroll in treatment.
Patient-identified barriers associated with failure to seek VA
mental health care included personal obligations that prevented clinic
attendance, inconvenient clinic hours, and receipt of mental health
services from a non-VA provider. |
|
|
Order #: 8777 |
|
Authors: |
Rosenheck,
R.A., Dausey, D.J., Frisman, L., Kasprow, W.
|
|
Title: |
Outcomes After Initial
Receipt of Social Security Benefits Among Homeless Veterans With Mental
Illness. |
|
Source: |
Psychiatric Services
51(12): 1549-1554, 2000. (Journal Article:
6 pages)
|
|
Abstract: |
This article examines the
relationship between receiving disability payments and changes in health
status, community adjustment, and subjective quality of life. The study evaluated outcomes among
homeless mentally ill veterans who applied for Social Security Disability
Insurance or Supplemental Security Income through a special outreach
program. Veterans who were awarded benefits were compared with those who
were denied benefits; their sociodemographic characteristics, clinical
status, and social adjustment were evaluated just before receiving the
initial award decision and again three months later. Beneficiaries did not differ from those
were denied benefits on any baseline sociodemographic or clinical
characteristics. However, beneficiaries
were more willing to delay gratification, as reflected in scores on a time
preference measure. Three months
after the initial decision, beneficiaries had significantly higher total
incomes and reported a higher quality of life. They spent more on housing, food,
clothing, transportation, and tobacco products but not on alcohol or
illegal drugs. The authors conclude
that receipt of disability payments is associated with improved subjective
quality of life and is not associated with increased alcohol or drug use. |
|
|
Order #: 9882 |
|
Authors: |
Cohen,
C.I., D'Onofrio, A., Larkin, L., Berkholder, P., Fishman, H.
|
|
Title: |
A Comparison of
Consumer and Provider Preferences for Research on Homeless Veterans. |
|
Source: |
Community Mental Health
Journal 35(3): 273-280, 1999. (Journal
Article: 8 pages)
|
|
Abstract: |
Despite the dramatic
growth of homelessness research, there have been no systematic assessments
of consumer and provider preferences regarding the content of this
research. Therefore, 87 clients and 28 staff of a homeless veterans program
were administered a 15-item questionnaire requesting identification of the
5 "most" and 5 "least" important research topics. Staff
and clients differed significantly on 6 items considered most important and
4 items considered least important. Clients wanted more research that
focused on material needs, whereas staff preferences were more broadly
distributed. The fact that appreciable data exist for many of the research
topics that respondents identified as important raises concerns about the
accessibility of homelessness research.
|
|
|
Order #: 8064 |
|
Authors: |
Kasprow,
W., Frisman, L., Rosenheck, R.
|
|
Title: |
Homeless Veterans'
Satisfaction with Residential Treatment. |
|
Source: |
Psychiatric Services
50(4): 540-545, 1999. (Journal Article:
6 pages)
|
|
Abstract: |
This article examined
homeless individuals' satisfaction with mental health services and the
association between satisfaction and measures of treatment outcome. Demographic and clinical data were
obtained from intake assessments conducted before veterans' admission to
residential treatment facilities under contract with the Dept. of Veteran
Affairs Health Care for the 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. 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. 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. |
|
|
Order #: 7855 |
|
Authors: |
Rosenheck,
R., Frisman, L., Kasprow, W.
|
|
Title: |
Improving Access to
Disability Benefits Among Homeless Persons with Mental Illness: An
Agency-Specific Approach to Services Integration. |
|
Source: |
American Journal of Public
Health 89(4): 524-528, 1999. (Journal
Article: 5 pages)
|
|
Abstract: |
This article presents the
results of a special initiative designed to improve access to Social
Security benefits, including both Supplemental Security Income (SSI) and
Social Security Disability Insurance (SSDI), among homeless mentally ill
veterans participating in the Department of Veterans Affairs (VA) Health
Care for Homeless Veterans (HCHV) program.
In the initiative, both a Social Security Claims Representative and
a state Disability Determination Analyst were co-located with HCHV clinical
teams to facilitate applications for Social Security benefits. The project has three objectives: to
increase applications for SSI and SSDI among entitled veterans; to increase
awards for disability benefits; and to increase the proportion of timely
decisions. |
|
|
Order #: 8199 |
|
Authors: |
United
States General Accounting Office.
|
|
Title: |
Homeless Veterans: VA
Expands Partnerships, but Homeless Program Effectiveness is Unclear. |
|
Source: |
Washington, DC: U.S.
General Accounting Office, 1999. (Report:
50 pages)
|
|
Abstract: |
Despite spending $640
million on homeless programs between fiscal years 1987 and 1997, the
Department of Veterans Affairs (VA) has little information about their
effectiveness. VA's homeless program
sites routinely submit data about the clients' characteristics and site
operations. Yet little is known about whether the clients remain housed or
employed or relapse into homelessness, and VA's Northeast Program
Evaluation Center has little information about whether its programs are
more beneficial than other strategies for helping the homeless. The General
Accounting Office recommends that VA undertake program evaluations to
clarify the effectiveness of its homeless initiatives and to obtain
information on how to improve them. Where appropriate, VA should make
decisions about the type of data needed and the methods to be used in coordination
with other federal agencies that have homeless programs. Available From: U.S.
General Accounting Office, 441 G Street, NW, Washington, DC 20548, (202)
512-6000, www.gao.gov/archive/1999/he99150t.pdf. |
|
|
Order #: 7302 |
|
Authors: |
Conrad,
K.J., Hultman, C.I., Pope, A.R., Lyons, J.S., Baxter, W.C., Daghestani,
A.N., Lisiecki, J.P., Elbaum, P.L., McCarthy, M., Manheim, L.M.
|
|
Title: |
Case Managed
Residential Care for Homeless Addicted Veterans: Results of a True
Experiment. |
|
Source: |
Medical Care 36(1): 40-53,
1998. (Journal Article: 14 pages)
|
|
Abstract: |
This article examined the
effectiveness of case-managed residential care (CMRC) in reducing substance
abuse, increasing employment, decreasing homelessness, and improving
health. A five-year experiment
included 358 homeless addicted male veterans at three, six, and nine months
during their enrollment and at 12, 18, and 24 months after the completion
of the experimental CMRC program.
The experimental group showed significant improvement compared with
the control on the medical, alcohol, employment, and housing measures
during the two-year period. These
group differences tended to occur during the treatment year, however, and
to diminish during the follow-up year (authors). |
|
|
Order #: 7397 |
|
Authors: |
Humphreys,
K., Rosenheck, R.
|
|
Title: |
Treatment Involvement
and Outcomes for Four Subtypes of Homeless Veterans. |
|
Source: |
American Journal of
Orthopsychiatry 68(2): 685-694, 1998. (Journal
Article: 10 pages)
|
|
Abstract: |
This article presents the
results of a longitudinal study that examined treatment services and
outcomes in a nationwide sample of 565 homeless veterans who were
classified as alcoholic, psychiatrically impaired, multi-problem, or
best-functioning. All four groups
experienced some improvement in their primary problem area, in employment
status, and in residential quality at eight-month follow-up. There were significant differences,
however, in degree of improvement across groups. Implications for the design of homeless
programs and policies are discussed (authors). |
|
|
Order #: 7996 |
|
Authors: |
Irving,
L.M., Seidner, A.L., Burling, T.A.
|
|
Title: |
Hope and Recovery from
Substance Dependence in Homeless Veterans. |
|
Source: |
Journal of Social and
Clinical Psychology 17(4): 389-406, 1998. (Journal
Article: 18 pages)
|
|
Abstract: |
This article examines the
relationship between current hopeful thinking about goals ("state
hope") and recovery from substance dependence as assessed among
residents and graduates of a residential treatment program for substance
dependent homeless veterans.
Contrary to the authors' predictions, residents and graduates did
not differ in their level of state hope.
As predicted, higher state hope was related to greater time
abstinent and better quality of life, as well as greater self-efficacy, placing
less emphasis on the advantages of substance use, and greater perceived
social support. Also as predicted,
current hopeful thinking was correlated with a greater number of
recovery-related variables for residents than for graduates of the
program. The implications and
limitations of the results are discussed.
|
|
|
Order #: 7292 |
|
Authors: |
Kasprow,
W.J., Rosenheck, R.
|
|
Title: |
Substance Use and
Psychiatric Problems of Homeless Native American Veterans. |
|
Source: |
Psychiatric Services
49(3): 345-350, 1998. (Journal Article:
6 pages)
|
|
Abstract: |
This study estimated the
proportion and representation of Native Americans among homeless veterans
and compared their psychiatric and substance use problems with those of other
ethnic groups of homeless veterans.
The study was based on data from the Department of Veterans Affairs'
Health Care for the Homeless Veterans program, which operates in 71 sites
across the country. The authors
found that Native Americans are overrepresented in the homeless veteran
population. They have more severe
alcohol problems than other minority groups but somewhat fewer drug
dependence and psychiatric problems (authors). |
|
|
Order #: 9932 |
|
Authors: |
Kasprow,
W.J., Rosenheck, R., Frisman, L., DiLella, D.,
|
|
Title: |
Residential Treatment
for Dually Diagnosed Homeless Veterans: A Comparison of Program Types. |
|
Source: |
American Journal of
Addiction 8(1): 34-43, 1998 (Journal Article:
10 pages)
|
|
Abstract: |
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:
program characteristics; clients'
perceived environment; and 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 the Homeless Veterans Program, a national outreach and case
management program operating at seventy-one 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. |
|
|
Order #: 9870 |
|
Authors: |
Rosenheck,
R., Seibyl, C.L.
|
|
Title: |
Homelessness: Health
Service Use and Related Costs. |
|
Source: |
Medical Care 36(8):
1256-1264, 1998. (Journal Article: 9 pages)
|
|
Abstract: |
This study examines health
service use and costs for homeless and domiciled veterans hospitalized in
psychiatric and substance abuse units at Department of Veterans Affairs
(VA) medical centers, nationwide. A national survey of residential status
at the time of admission was conducted on all VA inpatients hospitalized in
acute mental health care units on September 30, 1995. Survey data were merged with computerized
workload data bases to assess service use and cost during the 6 months
before and after the date of discharge from the index hospitalization. Of
9,108 veterans with complete survey data, 1,797 had been literally homeless
at the time of admission, and 1,380 were doubled up temporarily, for a
total homelessness rate of 35%. Combining patients from general psychiatry
and substance abuse programs, the average annual cost of care for homeless
veterans, after adjusting for other factors, was $27,206; $3,196 higher
than the cost of care for domiciled veterans. Approximately 26% of annual
inpatient VA mental health expenditures are spent on the care of homeless
persons. Homelessness adds
substantially to the cost of health care services for persons with mental
illness in VA, and most likely, in other "safety net" systems
that serve the poor. These high costs, along with the prospect of declining
public funding for health and social welfare programs, and an anticipated
increase in the numbers of homeless mentally ill persons, portend a
difficult time ahead for both homeless patients and the organizations that
care for them. |
|
|
Order #: 14833 |
|
Authors: |
Rosenheck,
R., Seibyl, C.L.
|
|
Title: |
Participation and
Outcome in a Residential Treatment and Work Therapy Program for Addictive
Disorders: The Effects of Race. |
|
Source: |
American Journal of
Psychiatry 155(8): 1029-1034, 1998. (Journal
Article: 5 Pages)
|
|
Abstract: |
This study examined
differences in program participation and outcome between black and white
veterans with addictive disorders who participated in an intensive Department
of Veterans Affairs (VA) residential work therapy program. Data on 962
veterans treated in the VA Compensated Work Therapy/Transitional Residence
Program were gathered. Multivariate analyses were used to compare black and
white veterans on admission characteristics, program participation, and
3-month outcome. The black subjects were younger than the white veterans
and had more severe drug abuse problems, less severe alcohol and
psychiatric problems, and more extensive social support networks. There
were no differences between groups in 11 of 13 measures of program
participation, although the blacks felt more positively about the
therapeutic milieu and worked more hours per month in the work therapy
program than the whites. The black veterans also showed more improvement in
alcohol use and housing. The proportion of black participants at the site
level had no impact on measures of program participation or outcome among
black participants with one exception: blacks were more likely to achieve
sobriety at 3 months when treated in programs with higher proportions of
black participants. Detailed data on program participation and outcome in a
large study group showed no evidence of less program participation or worse
outcome among black patients (authors).
|
|
|
Order #: 7389 |
|
Authors: |
United
Stated Department of Labor.
|
|
Title: |
Hiring Disabled or
Low-Income Veterans Can Earn Employers Substantial Tax Savings: The Work Opportunity and Welfare-to-Work Tax Credits. |
|
Source: |
Washington, DC: United States Department of Labor, 1998. (Information Packet: 1 page)
|
|
Abstract: |
This fact sheet, aimed
toward the veteran community, describes two tax credit programs offered to
employers: the Work Opportunity Tax Credit (WOTC) and the Welfare-to-Work
Tax Credit (WtWTC). The WOTC is a
tax credit that encourages businesses to hire eight targeted groups of job
seekers that include disabled veterans, members of a family receiving
welfare, or SSI recipients. The
WtWTC encourages businesses to hire
long-term welfare recipients. The
fact sheet provides information about who may qualify, whom to contact for
further details, and how employers can apply for these tax credits. Available
From: U.S. Department of Labor, Frances Perkins Building, 200 Constitution Avenue, NW, Washington, DC 20210, (866) 4-USA-DOL, www.dol.gov. |
|
|
Order #: 6956 |
|
Authors: |
Applewhite,
S.L.
|
|
Title: |
Homeless Veterans:
Perspectives on Social Services Use. |
|
Source: |
Social Work 42(1): 19-30,
1997. (Journal Article: 12 pages)
|
|
Abstract: |
This article describes a
study that analyzed the nature and scope of homelessness and issues related
to social services use. The study
used focus group interviews to examine the expressed needs of homeless
veterans and the obstacles encountered in obtaining health and human
services. Results indicated that
veterans self-reported a high incidence of health and mental health
problems, limited resources, negative public perceptions and treatment,
insensitive service providers, dehumanizing policies and procedures, and
high levels of stress and frustration with the service delivery
system. They encountered personal,
situational, and bureaucratic barriers to obtaining these services and were
highly critical of service providers. The author concludes that these
findings suggest a need for greater emphasis on advocacy-based case
management services, affordable housing, employment opportunities,
increased sensitivity in service delivery systems, and empowerment-centered
practice (author). |
|
|
Order #: 14843 |
|
Authors: |
Fontana, A., Rosenheck, R.
|
|
Title: |
Effectiveness and Cost
of the Inpatient Treatment of Posttraumatic Stress Disorder: Comparison of
Three Models of Treatment. |
|
Source: |
American Journal of
Psychiatry 154(6): 758-765, 1997. (Journal
Article: 7 Pages)
|
|
Abstract: |
This study compared the
outcomes and costs of three models of Department of Veterans Affairs (VA)
inpatient treatment for posttraumatic stress disorder (PTSD): long-stay specialized inpatient PTSD
units; short-stay specialized evaluation and brief-treatment PTSD units;
and nonspecialized general psychiatric units. Data were drawn from 785 Vietnam veterans undergoing treatment at 10 programs
across the country. The veterans were followed up at 4-month intervals for
1 year after discharge. Successful data collection averaged 66.1% across
the three follow-up intervals. All models demonstrated improvement at the
time of discharge, but during follow-up symptoms and social functioning
rebounded toward admission levels, especially among participants who had
been treated in long-stay PTSD units. Veterans in the short-stay PTSD units
and in the general psychiatric units showed significantly more improvement
during follow-up than veterans in the long-stay PTSD units. Greatest
satisfaction with their programs was reported by veterans in the short-stay
PTSD units. Finally, the long-stay PTSD units proved to be 82.4% and 53.5%
more expensive over 1 year than the short-stay PTSD units and general
psychiatric units, respectively. The paucity of evidence of sustained
improvement from costly long-stay specialized inpatient PTSD programs and
the indication of high satisfaction and sustained improvement in the far
less costly short-stay specialized evaluation and brief-treatment PTSD
programs suggest that systematic restructuring of VA inpatient PTSD
treatment could result in delivery of effective services to larger numbers
of veterans (authors). |
|
|
Order #: 6716 |
|
Authors: |
Frisman,
L.K., Rosenheck, R.
|
|
Title: |
The Relationship of
Public Support Payments to Substance Abuse Among Homeless Veterans With
Mental Illness. |
|
Source: |
Psychiatric Services
48(6): 792-795, 1997. (Journal Article:
4 pages)
|
|
Abstract: |
A suspicion that
disability payments may exacerbate substance use among persons with
chemical addictions recently led Congress to limit federal disability
entitlements of applicants whose disability status is related to substance
abuse, even if they have another serious mental disorder. This study empirically explored the
relationship between receipt of disability payments and substance use among
homeless mentally ill veterans. The
study sample included 2,474 homeless veterans with a current diagnosis of
schizophrenia and a substance abuse or dependence disorder who were
assessed in a community outreach program sponsored by the Department of
Veterans Affairs. After adjustment
for other relevant factors, receipt of disability payments showed no significant
relationship to the number of days of substance use a month, even among
frequent users of alcohol and drugs.
Findings about substance use among the homeless veterans with
serious mental disorders in this study provide no support for the assertion
that disability payments exacerbate substance use (authors). |
|
|
Order #: 9884 |
|
Authors: |
Jacobson,
J.M., Eckstrom, D.L.
|
|
Title: |
Assessing Homeless
Veterans Using the Omaha Assessment Tool in a Nontraditional Home Care
Setting. |
|
Source: |
Home Care Providers 2:
22-27, 1997. (Journal Article: 6 pages)
|
|
Abstract: |
Homelessness is having an
inappropriate place to stay and sleep and not having a mailing address for
a period of overnight to six months or more. The homeless population is
diverse and difficult to count. This article discusses assessment of
homeless veterans using the Omaha Assessment Tool in a nontraditional home
care setting. |
|
|
Order #: 7101 |
|
Authors: |
Kasprow,
W.J., Rosenheck, R., Chapdelaine, J.D.
|
|
Title: |
Health Care for
Homeless Veterans Programs: The
Tenth Annual Report. |
|
Source: |
West
Haven, CT: U.S. Department of Veterans Affairs, Northeast Program Evaluation Center, 1997. (Report: 155 pages)
|
|
Abstract: |
This report is the 10th in
a series concerning the Department of Veterans Affairs' Health Care for
Homeless Veterans (HCHV) programs.
The programs involve a number of specialized programs in addition to
providing outreach services to severely mentally ill veterans, linkage with
VA services, and treatment and rehabilitation services. This report provides an overview of the
program's history and services, describes monitoring of the program and
veterans served, discusses program process and treatment outcomes, and explains
the supported housing program. A
summary of program performances is also included. Available From: U.S.
Department of Veterans Affairs, Northeast Program Evaluation Center, VA CT
Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, (203)
932-5711, www.visn1.med.va.gov/vact. |
|
|
Order #: 9580 |
|
Authors: |
Kizer,
K.W., Fonseca, M.L., Long, L.M.
|
|
Title: |
The Veterans Healthcare
System: Preparing for the Twenty-first Century. |
|
Source: |
Hospital Health Service
Administration 42(3): 283-298, 1997. (Journal
Article: 16 pages)
|
|
Abstract: |
Since its establishment in
1946, the veterans healthcare system has greatly expanded in both size and
responsibility. It is now the largest integrated healthcare system in the
United States, the nation's largest provider of graduate medical and other
health professionals training, and one of the largest research enterprises
in America. It is also the nation's largest provider of services to
homeless persons, an essential provider in the public healthcare safety
net, and an increasingly important element in the federal response to
disasters and national emergencies. Patterned after what was considered the
best in American healthcare, for most of the past 50 years the Department
of Veterans Affairs (VA) healthcare has focused primarily on acute
inpatient care, high technology, and medical specialization. Now, in
response to societal and industry-wide forces, the Veterans Health
Administration (VHA) is reengineering the veterans healthcare system,
changing the operational and management structure from individual hospitals
to 22 integrated service networks and transitioning the system to one that
is grounded in ambulatory and primary care. This article briefly describes
the history and functions of the veterans healthcare system, its service
population, and key aspects of its restructuring. |
|
|
Order #: 6929 |
|
Authors: |
Lomas,
B., Gartside, P.S.
|
|
Title: |
Attention-Deficit
Hyperactivity Disorder Among Homeless Veterans. |
|
Source: |
Psychiatric Services
48(10): 1331-1333, 1997. (Journal Article:
3 pages)
|
|
Abstract: |
This article reports the
results of a screening for ADHD among participants in a Department of
Veterans Affairs domiciliary program for chronic mentally ill homeless
veterans. Eighty-one participants
who were not psychotic and did not have central nervous system damage were
screened for attention-deficit hyperactivity disorder (ADHD). Results indicated that 50 of the 81
participants screened positive, yet none of the patients or their
clinicians had considered ADHD a possible influence on their lives. The authors concluded that these results
suggest that clinical staff working with homeless veterans should receive
better training in recognizing the various manifestations of ADHD among
adults (authors). |
|
|
Order #: 6456 |
|
Authors: |
Porat,
H., Marshall, G., Howell, W.
|
|
Title: |
The Career Beliefs of
Homeless Veterans: Vocational Attitudes as Indicators of Employability. |
|
Source: |
Journal of Career
Assessment 5(1): 47-59, 1997. (Journal
Article: 13 pages)
|
|
Abstract: |
This article analyzes
homeless veterans' attitudes toward employment. Using the Career Beliefs Inventory (CBI)
the vocational attitudes of 279 homeless veterans were compared to those of
two control groups: one employed, and the other unemployed. Even though the three groups had
significant demographic, medical, and social differences, there were
remarkable similarities in how they viewed employment, including having a
high interest in achieving and improving their socioeconomic conditions;
desire to excel over others within the workplace; interest in learning new
job skills; and believing that obstacles can be overcome, undermining the
common notion that homeless veterans are unwilling to take active, positive
steps to improve their employability.
|
|
|
Order #: 6976 |
|
Authors: |
Rosenheck,
R., Leda, C., Frisman, L., Gallup, P.
|
|
Title: |
Homeless Mentally Ill
Veterans: Race, Service Use, and Treatment Outcomes. |
|
Source: |
American Journal of
Orthopsychiatry 67(4): 632-638, 1997. (Journal
Article: 7 pages)
|
|
Abstract: |
This article reports the
findings of a study that used outcome data from a Department of Veterans
Affairs Homeless Chronically Mentally Ill veterans program to determine
whether there are differences between black and white veterans in program
participation, receipt of other health services, and in degree of observed
improvement, and whether or not such differences are related to the use of
residential treatment services. The
authors found that comparisons of service use and treatment outcomes for
145 black and 236 white homeless veterans with mental disorders showed few
differences. The greater improvement
on psychological and alcohol problem measures shown by white veterans was
true only in comparisons with black veterans who had not been admitted to
residential treatment, suggesting that residential treatment may be an
especially important first step out of homelessness for black
veterans. The authors concluded that
the findings of the present study suggest that blacks have a greater need
for residential treatment services to maximize their gains in some areas
(authors). |
|
|
Order #: 7114 |
|
Authors: |
Seibyl,
C.L., Rosenheck, R., Sieffert, D., Medak, S.
|
|
Title: |
Fiscal Year 1996
End-of-Year Survey of Homeless Veterans in VA Acute Inpatient Programs. |
|
Source: |
West Haven, CT: Northeast
Program Evaluation Center, VA Health Services Research and Development
Service, 1997. (Report: 139 pages)
|
|
Abstract: |
This report presents
findings from a national end-of-year survey of homelessness among 17,836
veterans hospitalized in acute care sections at Department of Veterans
Affairs (VA) medical centers as of midnight on Sept. 30, 1996. Altogether 2,045 veterans had been
homeless at the time of their admission: 1,331 were literally homeless,
residing in shelters, the streets or similar circumstances, while 1,074
were temporarily doubled-up with family or friends. Rates of homelessness varied form a high
47.2% in substance abuse treatment programs, to 24.3% in psychiatry beds,
and 4.7% in medical and surgical beds.
The authors conclude that these data show that the VA continues to
treat many homeless veterans in its acute inpatient units, and that the
extensive closure of substance abuse and psychiatric beds in the VA during
fiscal year 1996 reduced the availability of these services to numbers of
homeless veterans that had used them.
The authors state their hope that alternative forms of community
treatment are made available to homeless veterans who would otherwise have
received VA hospital treatment (authors). Available From: Northeast Program
Evaluation Center, West Haven Veterans Administration Medical Center, 950
Campbell Avenue, West Haven, CT 06516, (203) 932-5711,
www.visn1.med.va.gov. |
|
|
Order #: 6269 |
|
Authors: |
Stovall,
J., Flaherty, J.A., Bowden, B., Schoeny, M.
|
|
Title: |
Use of Psychiatric
Services by Homeless Veterans. |
|
Source: |
The Journal of Mental
Health Administration 24(1): 98-102, 1997. (Journal
Article: 5 pages)
|
|
Abstract: |
The authors describe a
study where patients treated in a Department of Veterans Affairs (VA)
emergency room were evaluated to delineate the differences in use of
services between homeless and domiciled veterans who have mental
disorders. Data were obtained and
compared on DSM-III-R diagnoses, number of hospitalizations, lengths of
stay, and outpatient visits in the preceding year. Homeless veterans with mental disorders
were significantly more likely to have emergency visits and psychiatric
admissions in the preceding 12 months than were the domiciled
veterans. However, the average
length of stay was shorter for the homeless group. These differences must be accounted for
in the design of programs targeting homeless veterans with mental illness
(authors). |
|
|
Order #: 6957 |
|
Authors: |
Stovall,
J.G., Cloninger, L., Appleby, L.
|
|
Title: |
Identifying Homeless
Mentally Ill Veterans in Jail: A
Preliminary Report. |
|
Source: |
Journal of the American Academy of Psychiatry and Law 25(3): 311-315, 1997. (Journal Article: 5 pages)
|
|
Abstract: |
This article describes a
program for identifying and providing treatment and housing for homeless
mentally ill veterans detained at the Cook County Jail in Chicago.
Preliminary data are provided describing characteristics of the
veterans assessed, as well as those veterans who follow up with services
upon release. The authors conclude that the initial phases of the project
indicate that a large urban jail is a useful location for outreach efforts
that target homeless mentally ill veterans (authors). |
|
|
Order #: 6737 |
|
Authors: |
United States Department of Veterans Affairs.
|
|
Title: |
Heading Home: Breaking
the Cycle of Homelessness Among America's Veterans. |
|
Source: |
Washington, DC: U.S. Department of Veterans Affairs, 1997. (Report: 118
pages)
|
|
Abstract: |
This post-summit action
report and resource directory summarizes what was learned from the first
National Summit, convened in February 1994, to discuss homelessness among
veterans. Included are priorities for action, consensus principles upon
which to base intervention strategies, and suggested guidelines for
implementation of summit recommendations. The report also reviews the
impact of the McKinney Act programs on local service and homeless
assistance networks. Three new initiatives, which build upon the summit
recommendations and expand the model of VA assistance, are also discussed. Available
From: U.S. Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420 (202) 273-5700, www.va.gov. |
|
|
Order #: 7020 |
|
Authors: |
Wilson,
N., Kizer, K.
|
|
Title: |
The VA Health Care
System: An Unrecognized National Safety Net. |
|
Source: |
Health Affairs, 16(4):
200-204, 1997. (Journal Article: 4 pages)
|
|
Abstract: |
The dominance of local
health care markets in conjunction with variable public funding results in
a national patchwork of "safety nets" and beneficiaries in the United States rather than a uniform system. This DataWatch
describes how the recently reorganized Dept. of Veterans Affairs serves as
a coordinated, national safety-net provider and characterizes the veterans
who are not supported by the market-based system. |
|
|
Order #: 14844 |
|
Authors: |
Zatzick,
D.F., Marmar, C.R., Weiss, D.S., Browner, W.S., Metzler, T.J., Golding,
J.M., Stewart, A., Schlenger, W.E., Wells, K.B.
|
|
Title: |
Posttraumatic Stress
Disorder and Functioning and Quality of Life Outcomes in a Nationally
Representative Sample of Male Vietnam Veterans. |
|
Source: |
American Journal of
Psychiatry 154(12): 1690-1695, 1997. (Journal
Article: 5 Pages)
|
|
Abstract: |
In this study, the authors
undertook an archival analysis of data from the National Vietnam Veterans
Readjustment Study. The study subjects consisted of the nationally
representative sample of male Vietnam veterans who participated in the National Vietnam
Veterans Readjustment Study. The authors estimated PTSD at the time of the
interview with the Mississippi Scale for Combat-Related Posttraumatic
Stress Disorder. They examined the following outcomes: diminished
well-being, physical limitations, bed day in the past 2 weeks, compromised
physical health status, currently not working, and perpetration of
violence. Logistic models were used to determine the association between
PTSD and outcome; adjustment was made for demographic characteristics and
comorbid psychiatric and other medical conditions. The risks of poorer
outcome were significantly higher in subjects with PTSD than in subjects
without PTSD in five of the six domains. For the outcome domains of
physical limitations, not working, compromised physical health, and diminished
well-being, these significantly higher risks persisted even in the most
conservative logistic models that removed the shared effects of comorbid
psychiatric and other medical disorders. The suffering associated with
combat related-PTSD extends beyond the signs and symptoms of the disorder
to broader areas of functional and social morbidity. The significantly
higher risk of impaired functioning and diminished quality of life uniquely
attributable to PTSD suggests that PTSD may well be the core problem in
this group of difficult to treat and multiply afflicted patients (authors). |
|
|
Order #: 3982 |
|
Authors: |
Castellani,
B., Wootton, E., Rugle, L., Wedgeworth, R., Prabucki, K., Olson, R.
|
|
Title: |
Homelessness, Negative
Affect, and Coping Among Veterans With Gambling Problems Who Misused
Substances. |
|
Source: |
Psychiatric Services
47(3): 298-299, 1996. (Journal Article:
2 pages)
|
|
Abstract: |
A total of 154 formerly
homeless veterans with substance use disorders were assessed six months
after treatment to determine: whether those who had concurrent gambling
problems had poorer coping skills than those without a gambling problem;
and whether gambling impacted housing and employment stability. Findings indicate
that although the gamblers had poorer coping skills, they did not differ
from their non-gambling counterparts in terms of housing and employment
stability. |
|
|
Order #: 6705 |
|
Authors: |
Rosenheck,
R., Frisman, L.
|
|
Title: |
Do Public Support
Payments Encourage Substance Abuse? |
|
Source: |
Health Affairs 15(3):
192-200, 1996. (Journal Article: 8 pages)
|
|
Abstract: |
This commentary describes
a study of homeless veterans with substance abuse problems who were
contacted through a Department of Veterans Affairs community outreach
program. The goal was to discern the relationship between substance use and
both amount and source of income (employment versus public support payments
versus other sources such as criminal activity and gifts) and thereby test
the assumptions that are driving policy in this area. In this study,
veterans used some portion of their public support payments to purchase
alcohol and drugs, thus contradicting some existing evidence driving policy
on support payments to persons with substance abuse problems. The authors
caution that there is evidence of inefficient and ineffective use of public
resources. |
|
|
Order #: 6434 |
|
Authors: |
Rosenheck,
R., Leda, C.A., Frisman, L.K., Lam, J., Chung, A.
|
|
Title: |
Homeless Veterans. |
|
Source: |
In Baumohl, J. (ed.),
Homelessness In America. Phoenix,
AZ: Oryx Press 97-108, 1996. (Book Chapter:
12 pages)
|
|
Abstract: |
The authors explain that
for as long as there has been armed forces, homeless veterans have been
subjects of concern. Military risk factors for homelessness are examined
including post-traumatic stress disorder, service in combat, socioeconomic
status, substance abuse, and mental health.
The authors conclude that homelessness among veterans is not clearly
related to military experience, rather it is the result of the same
interrelated economic and personal factors that cause homelessness in the
civilian population. Available From: Greenwood Publishing Group, 88 Post
Road West, Westport, CT 06881, (203)
226-3571, www.greenwood.com. |
|
|
Order #: 9890 |
|
Authors: |
Smith,
C.B., Goldman, R.L., Martin, D.C., Williamson, J., Weir, C., Beauchamp, C.,
Ashcraft, M.
|
|
Title: |
Overutilization of
Acute-care Beds in Veterans Affairs Hospitals. |
|
Source: |
Medical Care 34: 85-96,
1996. (Journal Article: 12 pages)
|
|
Abstract: |
The authors tested the
hypothesis that the Dept. of Veterans Affairs (VA) hospitals would have
substantial overutilization of acute care beds and services because of
policies that emphasize inpatient care over ambulatory care. Reviewers from
24 randomly selected VA hospitals applied the InterQual ISD (Intensity,
Severity, Discharge) criteria for appropriateness concurrently to a random
sample of 2,432 admissions to acute medical, surgical, and psychiatry
services. Reliability of hospital reviewers in applying the ISD criteria
was tested by comparing their reviews with those of a small group of expert
reviewers. Validity of the ISD criteria was tested by comparing the
assessments of master reviewers with the implicit judgments of panels of
nine physicians. The physician panels validated the ISD admission criteria
for medicine and surgery, whereas the psychiatry criteria were not
validated. Hospital reviewers reliably used all three criteria sets. Rates
of nonacute admissions to acute medical and surgical services were > 38%
as determined by the hospital and master reviewers and by the physician
panels. Nonacute rates of continued stay were > 32% for both medicine
and surgery services. Similar rates of nonacute admissions and continued
stay were found for all 24 hospitals. Reasons for nonacute admissions and
continued stay included lack of an ambulatory care alternative,
conservative physician practices, delays in discharge planning, and social
factors such as homelessness and long travel distances to the hospital.
Substantial overutilization of acute medicine and surgical beds was found
in a representative sample of VA hospitals. Correcting this situation will
require changes in physician practice patterns, development of ambulatory
care alternatives to inpatient care, and modification of current VA
policies determining eligibility for care.
|
|
|
Order #: 9891 |
|
Authors: |
United
States General Accounting Office.
|
|
Title: |
Substance Abuse
Treatment: VA Programs Serve Psychologically and Economically Disadvantaged
Veterans. |
|
Source: |
Gaithersburg, MD: U.S.
General Accounting Office, 1996. (Report:
19 pages)
|
|
Abstract: |
To better understand the
VA's current substance abuse program, this report provides the following
information: characteristics of veterans who receive substance abuse
treatment; services offered; methods to monitor the effectiveness of
treatment programs; community services available; and implications of
changing the VA's current methods for delivering treatment services. Available
From: U.S. GAO, P.O. Box 6015, Gaithersburg, MD 20884, (202) 512-6000,
www.gao.gov/archive/1997/he97006.pdf, (GAO/HEHS-97-6) |
|
|
Order #: 5964 |
|
Authors: |
Wenzel,
S.L., Bakhtiar, L., Caskey, N.H., Hardie, E., Redford, C., Sadler, N.,
Gelberg, L.
|
|
Title: |
Dually Diagnosed
Homeless Veterans in Residential Treatment: Service Needs and Service Use. |
|
Source: |
Journal of Nervous and
Mental Disease 184(7): 441-444, 1996. (Journal
Article: 4 pages)
|
|
Abstract: |
It is documented that
co-occurrence of psychiatric and substance disorders among homeless persons
is associated with greater service needs and difficulty with engagement and
maintenance in treatment. The author
address the extent to which characteristics of homeless veterans with dual
disorders differ from those with neither diagnosis or a single diagnosis of
serious mental illness or substance dependence. The authors contend that such differences
may be important for refining approaches to serve homeless veterans within
treatment programs. The study
reports statistics on demographics, age, length of military involvement,
legal status, and recent social service use. The authors conclude that for the
Department of Veterans Affairs to fully achieve its aim of meeting the
biopsychosocial needs of troubled homeless veterans, it is necessary to
improve the understanding of the subgroup of homeless veterans with dual
diagnoses (authors). |
|
|
|
| |