Homeless mentally ill veterans: race, service use, and treatment outcomes.

Comparisons of service use and treatment outcomes for 145 black and 236 white homeless veterans with mental disorders showed few differences. A greater improvement in psychiatric symptoms and alcohol problems among white than black veterans did not hold true when black veterans had participated in the residential treatment component of the program. The implications of the findings for the successful treatment of homeless black veterans are discussed.

Effectiveness and cost of specific treatment elements in a program for homeless mentally ill veterans.

OBJECTIVES: The study examined relationships between specific treatment elements and their costs and ten outcome measures using data from a longitudinal outcome study of a Veterans Affairs program for homeless mentally ill veterans. METHODS: Baseline and outcome data over an eight-month period were analyzed for 406 homeless veterans with psychiatric and substance use disorders who were treated in VA's Homeless Chronically Mentally Ill Veterans Program. Multivariate techniques were used to examine the relationship between ten measures of outcome and six treatment elements: program entry via community outreach, the number of contacts with program clinicians, the number of referrals for other services, duration of program involvement, number of days of residential treatment, and increased public support payments. RESULTS: Each of the six treatment elements was significantly related to improvement on at least one of the ten outcome measures. The number of clinical contacts with program staff and the number of days in residential treatment were associated with improvement in the greatest number of outcome domains. However, improvement associated with residential treatment was far more costly than improvement related to other treatment elements. CONCLUSION: This study provides evidence of the effectiveness of a multimodal approach to the treatment of homeless mentally ill persons. However, results indicate that special attention should be paid to to differences in the cost of improvement associated with various treatment elements.

Health care utilization and costs after entry into an outreach program for homeless mentally ill veterans.

OBJECTIVE: This study evaluated the impact of a Department of Veterans Affairs outreach and residential treatment program for homeless mentally ill veterans on utilization and cost of health care services provided by the VA. METHODS: Veterans at nine program sites (N = 1,748) were assessed with a standard intake instrument. Services provided by the outreach program were documented in quarterly clinical reports and in residential treatment discharge summaries. Data on nonprogram VA health service utilization and health care costs were obtained from national VA data bases. Changes in use of services and cost of services from the year before initial contact with the program to the year after were analyzed by t test. Multivariate analyses were used to examine the relationship of these changes to indicators of clinical need and to participation in the outreach program. RESULTS: Although utilization of inpatient service did not increase after veterans' initial contact with the program, use of domiciliary and outpatient services increased substantially. Total annual costs to the VA also increased by 35 percent, from $6,414 to $8,699 per veteran per year. Both clinical need and participation in the program were associated with increased use of health services and increased cost. Veterans with concomitant psychiatric and substance abuse problems used fewer health care services than others. CONCLUSIONS: Specialized programs to improve the access of homeless mentally ill persons to health care services appear to be effective, but costly. Dually diagnosed persons seem especially difficult to engage in treatment.

Combat stress, psychosocial adjustment, and service use among homeless Vietnam veterans.

Clinical data were gathered on 627 homeless Vietnam veterans evaluated in a Department of Veterans Affairs clinical program for homeless mentally ill veterans. More than two-fifths (43 percent) of the 627 veterans showed evidence of combat stress that was associated with more severe psychiatric and substance abuse problems, although not with greater social dysfunction. In comparison with Vietnam veterans assessed in a national epidemiological study, homeless veterans were severely socially and vocationally dysfunctional. While homeless mentally ill veterans with combat stress used VA mental health services more frequently than did homeless mentally ill Vietnam veterans with other disorders, many received no mental health services. Combat stress appears to be a significant problem among homeless mentally ill Vietnam veterans.

Involvement in an outreach and residential treatment program for homeless mentally ill veterans.

Descriptive data derived from initial assessment interviews and from standardized 3-month progress reports are presented on 1684 homeless, chronically mentally ill veterans who were contacted at nine sites in a national Department of Veterans Affairs outreach program. Levels of involvement in the program were modest, with only 16% of those screened having over 10 clinical contacts and 24% still involved after 3 months. Demographic and clinical characteristics were weakly associated with continued involvement, but those admitted to residential treatment were 5.4 times more likely to be involved in the program than those not admitted. Admission to residential treatment appears to be the strongest determinant of clinical engagement of the homeless mentally ill.

Vietnam era and Vietnam combat veterans among the homeless.

Of 10,524 homeless veterans assessed in a 43-site VA program, 50 percent served during the Vietnam War era, compared to only 29 percent of all veterans in the general population. This reflects the greater risk of homelessness among men aged 30-44 rather than the impact of Vietnam Era service. The proportion of homeless veterans who served in the Vietnam Theater (44.9 percent), and the proportion exposed to combat fire (40.5 percent) were similar to those of nonhomeless veterans. Homeless combat veterans who are not White were more likely to have psychiatric, alcohol, and medical problems than homeless noncombat Vietnam veterans who are not White.

Initial assessment data from a 43-site program for homeless chronic mentally ill veterans.

In May 1987 the Veterans Administration established the Homeless Chronically Mentally Ill Veterans Program at 43 sites to provide outreach, health care, and residential rehabilitation services. Intake assessment data on 10,529 homeless veterans screened as potential candidates for clinical services during the program's first 11 months are presented. With a median age of 40, the homeless veterans were considerably younger than veterans in the general U.S. population. More had served in the Vietnam era than in other military eras. Almost three-fifths were white, and a third were black; more than 40 percent were receiving some form of public support. Almost half manifested one or more severe psychiatric symptoms at screening, and almost two-thirds had previously been hospitalized for either a psychiatric or a substance abuse problem.

Evaluation of flatbed reciprocal motion agitators for resuspension of stored platelet concentrates.

We studied the storage characteristics of platelet concentrates prepared in polyolefin (PL-732) and thin-film polyvinyl chloride (CLX) plastic bags and stored on a newly designed flatbed reciprocal motion agitator with a 1.5 inch (3.8 cm) lateral movement and an oscillation frequency of 70 cycles/min. We also studied the ability of this device to resuspend the platelet button formed after preparative centrifugation. Results showed that platelet concentrates stored on the 1.5-inch shaker had storage characteristics equivalent to those reported for the conventional 70 cycles/min, 1-inch (2.5-cm) lateral movement flatbed shaker. Due to a more rapid acceleration and deceleration rate, however, the 1.5-inch shaker resuspended the platelet button formed after preparative centrifugation much more efficiently than did the less dynamic 1-inch shaker. Furthermore, with either agitator, platelet aggregates in the CLX bag were more readily resuspended than were aggregates in the PL-732 bag due in part to differences in plastic bag wall elasticity.