Search results for ‘Subject term:"dual diagnosis"’ Sort:
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Housing preferences and choices among adults with mental illness and substance use disorders: a qualitative study
- Authors:
- TSAI Jack, et al
- Journal article citation:
- Community Mental Health Journal, 46(4), August 2010, pp.381-388.
- Publisher:
- Springer
Forty adults with dual disorders who were living in either supervised or independent housing arrangements were interviewed to examine housing preferences, decision making processes surrounding housing choices, and perceived barriers to housing. Many clients indicated their housing preferences had changed over time, and some clients related housing preferences to recovery. Although the majority of clients preferred independent housing, many also described benefits of supervised housing. Clients’ current living situations appeared to be driven primarily by treatment provider recommendations and availability of housing. Common barriers to obtaining desired housing were lack of income and information. These findings have implications for supported housing models and approaches to providing housing for clients.
The role of occupational meaningfulness and citizenship as mediators between occupational status and recovery: a cross-sectional study among residents with co-occurring problems
- Authors:
- NESSE Linda, et al
- Journal article citation:
- Advances in Dual Diagnosis, 14(3), 2021, pp.99-118.
- Publisher:
- Emerald
Purpose: Engagement in meaningful occupations and being included as full citizens of the community, is essential in everyday life, and may be of considerable relevance for recovery and quality of life. However, persons with co-occurring substance use and mental health problems experience extensive obstacles to engagement in occupations and citizenship. The relationship between objective measures of occupational status and subjective experiences of occupational meaningfulness, citizenship and recovery, is scarcely researched in the context of co-occurring problems. As such, the purpose of this study is to examine associations between occupational status, occupational meaningfulness, citizenship and recovery and quality of life and to examine the roles of occupational meaningfulness and citizenship as possible mediators between occupational status and recovery and quality of life. Design/methodology/approach: The study used a cross-sectional design with a sample of 104 residents at supported housing sites across six Norwegian cities. Findings: Linear regression analyzes indicated that occupational status was significantly associated with the citizenship domains caring for others and community participation and with the quality of life measure positive affect. Occupational meaningfulness and citizenship were significantly associated with different domains of recovery and quality of life. Furthermore, mediation analyzes showed that the relationship between occupational status and recovery and quality of life was mediated by caring for others and community participation. Originality/value: The results suggest that emphasizing opportunities for occupational meaningfulness and citizenship in practice may have positive implications for recovery among persons with co-occurring problems. (Edited publisher abstract)
Health service preferences among veterans in supported housing in relation to needs expressed and services used
- Authors:
- SCHUTT Russell K., et al
- Journal article citation:
- Journal of Mental Health, 30(1), 2021, pp.27-35.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Background: Understanding consumer service preferences is important for recovery-oriented care. Aims: To test the influence of perceived service needs on importance attached to treatment for alcohol, drug, mental health, and physical health problems and identify the influence of service needs and preferences on service use. Methods: Formerly homeless dually diagnosed Veterans in supported housing were surveyed in three waves for 1 year, with measures of treatment interests, health problems, social support, clinician-assessed risk of housing loss, and sociodemographics. Multiple regression analysis was used to identify independent influences on preferences in each wave. Different health services at the VA were distinguished in administrative records and baseline predictors for services used throughout the project were identified with multiple regression analysis. Results: Self-assessed problem severity was associated with the importance of treatment for alcohol, drug, mental health, and physical health problems. Social support also had some association with treatment interest for alcohol abuse, as did baseline clinician risk rating at the project’s end. Preferences, but not perceived problem severity, predicted the use of the corresponding health services. Conclusions: The health beliefs model of service interests was supported, but more integrated service delivery models may be needed to strengthen the association of health needs with service use. (Edited publisher abstract)
Integrating permanent supportive housing and co-occurring disorders treatment for individuals who are homeless
- Authors:
- SMELSON David A., et al
- Journal article citation:
- Journal of Dual Diagnosis, 12(2), 2016, pp.193-201.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objectives: This pilot study examined the feasibility and preliminary outcomes of systematically integrating permanent supportive housing and an evidence-based co-occurring disorders intervention called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (MISSION). Methods: This single-group open pilot enrolled 107 people with co-occurring disorders experiencing chronic homelessness from two Massachusetts inner-city and rural areas. Enrolled subjects were interested in receiving permanent supportive housing along with 1 year of MISSION services. Data were collected through baseline and 6- and 12-month follow-up assessments. Results: Participants were mostly male (76.6%), Caucasian (52.3%), and unemployed (86.0%), with an average of 8.34 years of homelessness. Self-reported lifetime problems with anxiety (75.7%) and depression (76.6%) were common, as was use of alcohol (30.8%), cannabis (31.8%), and cocaine (15.9%). Almost all participants (95.3%) were placed into permanent housing, which took on average 42.6 days from enrollment. Among those placed, nearly 80% of the clients were able to retain housing through the end of the study. Overall retention was high, with 86.0% remaining in MISSION treatment until the end of the study. While there were no significant changes in rehospitalisation, service utilisation, or substance use, there were modest significant mental health symptom improvements from baseline to program completion. Conclusions: This pilot study suggests that co-occurring disorder interventions like MISSION are feasible to integrate with permanent supportive housing despite the somewhat differing philosophies, and preliminary data suggested substantial improvements in housing and modest improvements in mental health symptoms. While caution is warranted given the lack of a comparison group, these findings are consistent with other rigorous studies using MISSION among homeless individuals who did not receive permanent supportive housing. (Edited publisher abstract)
Integrating the integrated: merging Integrated Dual Diagnosis Treatment (IDDT) with Housing First
- Author:
- PRINGLE Janice
- Journal article citation:
- Community Mental Health Journal, 53(6), 2017, pp.672-678.
- Publisher:
- Springer
This study reports on a housing program that merged two evidence-based practices frequently applied in tandem: Integrated Dual Diagnosis Treatment and Housing First. Quantitative measures show that consumers in the program were receptive to supportive housing and core services. These quantitative measures, when considered alongside qualitative interviews, suggest that in order for more consumers to move through the IDDT stages of educational and vocational advancement, the staff will need to emphasize the permanence of supportive housing. Thus, the study also demonstrates the importance of integrating results of qualitative evaluations with quantitative data to strengthen a program’s evidence base. (Publisher abstract)
Case management models in permanent supported housing programs for people with complex behavioral issues who are homeless
- Authors:
- CLARK Colleen, GUENTHER Christina C., MITCHELL Jessica N.
- Journal article citation:
- Journal of Dual Diagnosis, 12(2), 2016, pp.185-192.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Objective: This article examines two evidence-based models of case management for people with co-occurring disorders and histories of chronic homelessness and to better understand their roles in permanent supported housing. The two models are examined to see how they assist in ending homelessness, as well as the role they play in an individual's recovery from co-occurring disorders. Methods: Participants in two supported housing programs were interviewed at baseline and 6 months. One program used Critical Time Intervention (n = 144) and the other used Assertive Community Treatment (n = 90). Staff in both programs were interviewed about their experiences and fidelity assessments were conducted for each program. Results: Both programs operated at high levels of fidelity. Despite similar criteria for participation, there were significant differences between groups. Critical Time Intervention participants were older, were more likely to be male, were more likely to be homeless, and reported greater psychiatric symptoms and higher levels of substance use. Separate outcome analyses suggested that each program was successful in supporting people to transition from homelessness to stable housing; 88.6% of Assertive Community Treatment participants were homeless at baseline, while at 6 months 30% were homeless, and 91.3% of those in the Critical Time Intervention were homeless at baseline, while 44.3% were homeless at 6 months. Participants in the Critical Time Intervention program also showed significant decreases in alcohol use, drug use, and psychiatric symptoms. The preliminary results suggest that each case management model is helpful in assisting people with complex behavioural health needs and chronic homelessness to move to stable housing. Conclusions: Permanent supported housing seems to be an effective way to end homelessness among people with co-occurring disorders. Further research is needed to determine which case management models work most effectively with supported housing to help policy makers and program directors make informed decisions in developing these programs. (Edited publisher abstract)
Substance abuse recovery after experiencing homelessness and mental illness: case studies of change over time
- Authors:
- HENWOOD Benjamin, et al
- Journal article citation:
- Journal of Dual Diagnosis, 8(31), July 2012, pp.238-246.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The authors examined how consumers with dual diagnosis who were formerly homeless, but now living in supportive housing, understand their recovery from substance abuse or dependence. Their aims were to discover what can be learned about substance misuse recovery from consumers considered to be doing well, how past substance abuse fits into their present-day narratives, and how policies of harm reduction versus abstinence are considered to affect recovery efforts. As part of a federally funded study in New York, 38 individuals (84% male, mean age 51 years) who met criteria for having achieved a measure of success in mental health recovery were purposively sampled from two supportive housing agencies; one using harm reduction and the other an abstinence model. In-depth interviews and case study analysis were used to focus on substance abuse recovery in the larger context of participants’ lives. Recovery from substance abuse was depicted as occurring either through discrete decisions or gradual processes; achieving recovery was distinct from maintaining recovery. Themes related to achievement included: pivotal events and people; maturation; institutionalisation. Central themes to maintaining recovery were: housing; self-help; the influence of significant others. These findings revealed a complex picture of overcoming substance abuse that largely took place outside formal treatment and was heavily dependent on broader contexts.
A clear view ahead...
- Author:
- BOWLER Shirley
- Journal article citation:
- Connect, 39, Spring 2010, p.13.
- Publisher:
- Homeless Link
Clear-view is a dual diagnosis supported housing project which provides 24-hour support for 14 men and women who are committed to becoming and staying free of drugs. While there are day centres offering support to people with both a mental illness and a substance misuse problem, Clear-view is the only residential service specifically set-up to support dual diagnosed clients. The project, which began in 2006, is the result of a partnership between ECHG, Hull City Council, Hull Supporting People, Hull City Safe and the Housing Corporation. Residents are referred to Clear-view, and, once accepted on the waiting list, encouraged to attend pre-tenancy support. Residents must provide a commitment to remain drug-free. When residents move in they are provided with fully furnished and equipped apartments, supported to cook healthy meals, encouraged to take regular exercise, and have the opportunity to gain ICT skills to help them prepare for education and employment. Every resident must attend 5 group meetings a week, and peer support and role models are an important element of resident’s recovery.
Ethics in professional interaction: justifying the limits of help in a supported housing unit
- Authors:
- JUHILA Kirsi, RAITAKARI Suvi
- Journal article citation:
- Ethics and Social Welfare, 4(1), April 2010, pp.57-71.
- Publisher:
- Taylor and Francis
- Place of publication:
- Abingdon
In this study, the researchers examined professional ethics in action in daily work at a supported housing unit situated in a large Finnish city targeted at clients with mental health and substance abuse problems, by studying interactions in meetings among the unit's professionals where discussions covered rationing resources and setting limits to helping work in situations where the need for professional help is not questioned. Five types of implicit ethical justification for limiting helping activity were identified: the unit deals with certain kinds of problems only, clients need more intensive care and control, excessive care produces dependency, clients make their own choices in life, and the interests of other clients ought to be considered. The researchers noted that ethical issues and difficulties are constantly discussed and negotiated in mundane professional work practices, even though the word ethics is not necessarily mentioned, and that although the workers reflect continuously on the ethical justifications of the limits of helping, this does not mean that they end up limiting help in situations where no real alternatives for getting help for the present clients exist.
Comparing two service delivery models for homeless individuals with complex behavioral health needs: preliminary data from two SAMHSA treatment for homeless studies
- Authors:
- YOUNG M. Scott, et al
- Journal article citation:
- Journal of Dual Diagnosis, 5(3), July 2009, pp.287-304.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This study presents preliminary data comparing two programmes: one based out of a community mental health centre utilised the Assertive Community Treatment (ACT) with supported housing (ACT-SH); and the other based out of a substance abuse treatment agency and used the Comprehensive, Continuous, Integrated System of Care (CCISC) in a residential treatment facility (CCISC-RT). Participants completed clinical assessment interviews before being admitted to the programmes and again 6 months later. Measures included the Brief Symptom Inventory (BSI) to measure mental health symptoms; the Treatment Services Needed and Received (TSNR) to assess service needs, utilisation, and levels of unmet needs; and an assessment of employment, housing, and past-month substance use. Findings suggest that participants in both interventions reported significant reductions in substance use and mental health symptoms, although the CCISC-RT programme was associated with slightly greater reductions in mental health symptoms. Both programmes were also associated with significant improvements in residential stability, although participants in the ACT-SH programme were more likely to own or rent their own residence 6 months following programme enrolment. This study indicates that both the ACT and CCISC models of care can be successfully implemented to serve the homeless with behavioural health needs. Although the CCISC-RT programme was based in a residential treatment facility and delivered a greater intensity of behavioural health services than the ACT-SH programme, results indicate that either approach can successfully be used to assist homeless individuals in obtaining a variety of services, reducing both substance misuse and mental health symptoms.