Factors Associated With Departure From Supported Independent Living Programs for Persons With Serious Mental Illness

BackgroundWomen who use heroin and other drugs (WWUD) are a key population with elevated risk of physical and sexual violence perpetrated by intimate partners and non-partners. While housing instability has been shown to be associated with violence in high-income settings, this is an underexplored topic in sub-Saharan Africa. In this research, we aimed to assess the relationship between housing instability and various forms of violence within a sample of WWUD in Dar es Salaam.MethodsThis analysis uses data from a parent study from 2018. A total of 200 WWUD were recruited through respondent-driven sampling methods and administered a survey. Two multivariable logistic regression models were built to assess the relationship between housing instability and physical violence (Model 1) and housing instability and sexual violence (Model 2) while controlling for a number of sociodemographic characteristics.ResultsApproximately 35% of participants were classified as housing unstable. More than half of participants (62%) reported experiencing physical violence in the past 12 months, and more than a third (36%) reported sexual violence in the same time period. Housing instability was found to be independently associated with both physical and sexual violence victimization in the past year when adjusting for covariates (Model 1 adjusted odds ratio [AOR]: 2.40, 95% CI 1.22–4.46; Model 2 AOR: 1.93. 95% CI 1.02–3.67).ConclusionTo our knowledge, this is the first study to document a significant association between housing instability and violence among WWUD communities in sub-Saharan Africa. This analysis adds to the growing body of literature on the relationship between stable housing and livelihood and health outcomes across differing populations. The cyclical nature of housing instability and violence may be disrupted through housing programming that provides safety, security, and stability for WWUD.

This study examined the effectiveness of the Pathways to Housing supported housing program over a five-year period. Unlike most housing programs that offer services in a linear, step-by-step continuum, the Pathways program in New York City provides immediate access to independent scatter-site apartments for individuals with psychiatric disabilities who are homeless and living on the street. Support services are provided by a team that uses a modified assertive community treatment model. Housing tenure for the Pathways sample of 242 individuals housed between January 1993 and September 1997 was compared with tenure for a citywide sample of 1, 600 persons who were housed through a linear residential treatment approach during the same period. Survival analyses examined housing tenure and controlled for differences in client characteristics before program entry. After five years, 88 percent of the program's tenants remained housed, whereas only 47 percent of the residents in the city's residential treatment system remained housed. When the analysis controlled for the effects of client characteristics, it showed that the supported housing program achieved better housing tenure than did the comparison group. The Pathways supported housing program provides a model for effectively housing individuals who are homeless and living on the streets. The program's housing retention rate over a five-year period challenges many widely held clinical assumptions about the relationship between the symptoms and the functional ability of an individual. Clients with severe psychiatric disabilities and addictions are capable of obtaining and maintaining independent housing when provided with the opportunity and necessary supports.

Daytime variation of aerosol optical depth in North China and its impact on aerosol direct radiative effects

Among 958 applicants to a supportive housing program for low-income persons living with HIV (PLWH) and mental illness or a substance use disorder, we assessed impacts of housing placement on housing stability, HIV care engagement, and viral suppression. Surveillance and administrative datasets provided medical and residence information, including stable (e.g., rental assistance, supportive housing) and unstable (e.g., emergency shelter) government-subsidized housing. Sequence analysis identified a "quick stable housing" pattern for 67% of persons placed by this program within 2years, vs. 28% of unplaced. Compared with unplaced persons not achieving stable housing quickly, persons quickly achieving stable housing were more likely to engage in care, whether placed (per Poisson regression, ARR: 1.14;95% CI 1.09-1.20) or unplaced (1.19;1.13-1.25) by this program, and to be virally suppressed, whether placed (1.22;1.03-1.44) or unplaced (1.26, 1.03-1.56) by this program. Housing programs can help homeless PLWH secure stable housing quickly, manage their infection, and prevent transmission.

Families in poverty face numerous barriers to establishing stable economic footing. This paper estimates experimental effects of a holistic, individualized wraparound service intervention for low-income individuals. The intervention includes a detailed assessment, an individualized service plan, intensive case management administered by a two-person team with small caseloads, and strategic financial assistance. The program improved employment and housing outcomes two years postenrollment. Given the customized nature of the services, overall program effects mask heterogeneity. Exploratory analysis suggests that the program helped employ participants who lacked employment but had stable housing and that those without stable housing were helped in securing it. (JEL I32, I38, L31, R23)

BackgroundIndividuals who are homeless or vulnerably housed are at an increased risk for mental illness, other morbidities and premature death. Standard case management interventions as well as more intensive models with practitioner support, such as assertive community treatment, critical time interventions, and intensive case management, may improve healthcare navigation and outcomes. However, the definitions of these models as well as the fidelity and adaptations in real world interventions are highly variable. We conducted a systematic review to examine the effectiveness and cost-effectiveness of case management interventions on health and social outcomes for homeless populations.Methods and findingsWe searched Medline, Embase and 7 other electronic databases for trials on case management or care coordination, from the inception of these databases to July 2019. We sought outcomes on housing stability, mental health, quality of life, substance use, hospitalization, income and employment, and cost-effectiveness. We calculated pooled random effects estimates and assessed the certainty of the evidence using the GRADE approach. Our search identified 13,811 citations; and 56 primary studies met our full inclusion criteria. Standard case management had both limited and short-term effects on substance use and housing outcomes and showed potential to increase hostility and depression. Intensive case management substantially reduced the number of days spent homeless (SMD -0.22 95% CI -0.40 to -0.03), as well as substance and alcohol use. Critical time interventions and assertive community treatment were found to have a protective effect in terms of rehospitalizations and a promising effect on housing stability. Assertive community treatment was found to be cost-effective compared to standard case management.ConclusionsCase management approaches were found to improve some if not all of the health and social outcomes that were examined in this study. The important factors were likely delivery intensity, the number and type of caseloads, hospital versus community programs and varying levels of participant needs. More research is needed to fully understand how to continue to obtain the increased benefits inherent in intensive case management, even in community settings where feasibility considerations lead to larger caseloads and less-intensive follow-up.

Background: People with co-occurring substance use and mental health disorders who experience chronic homelessness often have difficulty engaging in both treatment and support services. Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking (MISSION) is a multicomponent wraparound integrated co-occurring substance use and mental health disorders treatment and linkage intervention comprised of three evidence-based components (Critical Time Intervention case management and peer support, Dual Recovery Therapy, and Peer Support). Although prior MISSION studies have demonstrated positive outcomes for this population, and fidelity (i.e., fidelity to the model) has predicted improvements in criminal legal outcomes, the present study builds on these findings by examining to what extent fidelity to the MISSION model improves behavioral health and housing outcomes. Methods: Individuals with co-occurring substance use and mental health disorders experiencing chronic homelessness (N = 108) completed a comprehensive intake and were offered up to 12-months of MISSION treatment and services. Services received and fidelity to the MISSION model were tracked weekly. Generalized linear mixed models were used to examine whether fidelity to the overall MISSION model and to each component predicted improvements in behavioral health, substance use, and housing stability outcomes. Results: Among the sample, 70.3% were male, 78.8% were non-Hispanic, 72.3% were White, and were homeless for 8.3 years on average. Fidelity to the overall MISSION model ranged from 0.0 to 296.0%. Generalized linear mixed models demonstrated mixed relationships between fidelity to the MISSION model (and each component) including improvements in behavioral health, reduced overall illicit substance use and alcohol use in the past 6-months, and improvements in housing stability. Conclusions: This study demonstrated that fidelity to the MISSION model had a direct impact on improving outcomes for individuals with co-occurring substance use and mental health disorders who have experienced chronic homelessness. These findings have important implications for settings that implement MISSION or other multicomponent interventions as fidelity to the model will yield greater behavioral health, substance use, and housing stability improvements.

Positive personality traits have been linked with various positive outcomes such as job performance, job satisfaction etc. However emotional intelligence and creativity have been scarcely linked with the entrepreneurship. Bering in mind the importance of entrepreneurship, present study has investigated the impact of emotional intelligence, entrepreneurial education and creativity on the entrepreneurial intentions. Data were collected from the students who were in their last semester of their degree. Smart-PLS was used for data analysis. The results of the study revealed that emotional intelligence has significant positive impact on the entrepreneurial intentions of students. Furthermore, results also showed a significant positive relationship between creativity and entrepreneurial intentions. Finally results also showed a positive relationship between the entrepreneurial education and entrepreneurial intentions. All the hypothesis was supported by the results of the study. Study findings concluded that students who are emotionally intelligent, creative and when they are provided with the quality education regarding the entrepreneurship, their intentions tend to be more inclined towards the entrepreneurship. Future directions are limitations are provided at the end of the study.

Nutritional supplements are used to boost nutritional stability. Unfortunately, many of them are provided in large volume bases or have a milk-like taste. Many, additionally, are poor tasting or leave a terrible aftertaste. Refusal rates can be high and costly for the facility with little positive impact on nutrition. This study examines a new grape flavored supplement with arginine and its effects on wound healing as well as boosted prealbumin levels over a period of 4 weeks. Seven residents were chosen and all had a history of poor absorption and nutrition as well as pressure ulcers, vascular wounds, burns, or nonhealing incisions which had failed to progress over a period of 4 weeks or more. All had been on some type of protein supplement prior to switching to this supplement which they had refused and all had weight loss. Each had prealbumin levels drawn prior to study initiation and measurements of all wounds were taken. Each client was started on the liquid supplement of one ounce twice a day. Each serving contained 16 gm of protein and 2.5 gm of arginine and a sugar-free grape flavored base. New prealbumin levels were drawn in one month and all were followed weekly for wound improvement or decline. Weights were monitored weekly for gain or loss and tolerance and acceptance of the new supplement was examined. At the end of the study, 100% of the study group had tolerated and accepted the new supplement without waste. All showed signs of expedient wound healing and 86% of the group remained weight stable or showed needed weight gain. Additionally, 86% of the group improved visceral protein stores and 14% remained stable. It is important to note that this product did NOT contain tryptophan which has been argued in the nutritional community as being a necessary component in supplementation. A positive outcome was achieved with no waste thus leading to cost savings. (Wound measurements, prealbumin levels, weights, and pictorials will be rendered for the poster).

The purpose of this study is to identify whether there is a relationship between learning Turkish as a foreign language, and to what extent, if there is such a relationship. A screening model was used in this qualitative research study. Finding out the existence of a relationship between the subjects’ self-confidence, and their success in learning Turkish as a foreign language was aimed without modifying or influencing them. Participants of the study included 53 students attending A1 level Turkish as a foreign language program of the Aristotle University of Thessaloniki. Two different tools including a survey and a final exam were used to collect data. The final exam results and the survey data were transferred into SPSS. All percentages, statistical comparisons, and ratings were figured out using the SPSS software. At the end of the study, it was concluded that subjects with higher self-confidence were more successful than the subjects with lower self-confidence, and self-confidence led to a more positive outcome in learning Turkish. It was also concluded that speaking more than one language had a positive effect on learning Turkish. Key words: Self-confidence, foreign language achievement, Turkish as a foreign language.

A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

Housing has received little attention in the research on teen mothers. A qualitative longitudinal study presented a unique opportunity to examine how teen mothers house their families over time. The study began in 1988 and has followed teen mothers and family members for 7 waves over 28 years. The 7th wave began in 2016. The specific aims of this substudy were to describe the housing trajectories of teen mothers over 28 years and to explore how their housing trajectories were shaped by family resources, housing programs, and discrimination. Data from 9 families were analyzed using interpretive phenomenology. Housing instability was pervasive for Black mothers who were disadvantaged as children. Their stories included many moves, doubling up, sending children to live with others, depression, unreliable partners, and racism. Housing instability was a source of toxic stress, interrupted personal and family goals, undermined family routines, and reflected a legacy of discriminatory housing policies. In contrast, White advantaged mothers were stably housed as children and adults, which reflected longstanding family resources, stable marriages, husbands' steady employment, and tax deductions for homeownership. These stark differences in housing trajectories reflect and reproduce multigenerational social and health inequities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

What policies and policy processes are needed to ensure that people with psychiatric disabilities have access to appropriate housing?

Commitment plays an essential role in organizing work outcomes. As long as employees show commitment to the organization, favorable outcomes can be seen. When specific factors lead towards dissatisfaction of employees, it results in negative work behaviors and performance. The current review is an attempt to highlight salient features of normative commitment so that it could help policymakers to control deviating behavior of employees. Review analysis shows that two-face theory does not support the bi-directional concept of normative commitment rather motivational theory supports the uni-dimensional concept of normative commitment. Furthermore, NC profile faces validity problems which two faces theory is failed to explain. Also, high NC/AC profile is not favorably related to positive work outcomes as compared to AC profile only. Normative commitment profile changes its effects on other commitment profiles. If AC is loud, NC profile is experienced as good duty face while, if CC is high then NC profile is experienced as indebted obligation face. At the end of the study, research implications have been discussed. Future scholars need to focus more on the two-face concept of normative commitment to getting a clear picture of this profile.

Estimates suggest that up to half of waking life is spent daydreaming; that is, engaged in thought that is independent of, and unrelated to, one’s current task. Emerging research indicates that daydreams are predominately social suggesting that daydreams may serve socio-emotional functions. Here we explore the functional role of social daydreaming for socio-emotional adjustment during an important and stressful life transition (the transition to university) using experience-sampling with 103 participants over 28 days. Over time, social daydreams increased in their positive characteristics and positive emotional outcomes; specifically, participants reported that their daydreams made them feel more socially connected and less lonely, and that the content of their daydreams became less fanciful and involved higher quality relationships. These characteristics then predicted less loneliness at the end of the study, which, in turn was associated with greater social adaptation to university. Feelings of connection resulting from social daydreams were also associated with less emotional inertia in participants who reported being less socially adapted to university. Findings indicate that social daydreaming is functional for promoting socio-emotional adjustment to an important life event. We highlight the need to consider the social content of stimulus-independent cognitions, their characteristics, and patterns of change, to specify how social thoughts enable socio-emotional adaptation.