Evaluation in the Substance Abuse and Mental Health Services Administration.

The evaluation policy of the Substance Abuse and Mental Health Services Administration (SAMHSA) is described in this article. Three studies are presented that exemplify SAMHSA's evaluations. These include evaluations of a program to prevent substance abuse among pregnant and postpartum women and their infants; a Job Corps treatment enrichment program; and the McKinney program for homeless persons with severe mental illnesses. Each of these evaluations demonstrated the effectiveness of the programs in reducing substance abuse or homelessness and in improving the health and well-being of the consumers served. SAMHSA will use the results of these and similar evaluations to guide policy and program development. Through its evaluations, SAMHSA must identify effective approaches to prevention, treatment, and rehabilitation. By using its evaluation results to guide policy and program development, SAMHSA aims to improve the quality of the public system of substance abuse and mental health services.

Evaluation of Public Health Service programs under the Government Performance and Results Act.

The Public Health Service (PHS) is made up of a number of agencies whose collective mission has traditionally been to protect and improve the mental and physical health of the American people and to close the gaps in the health status of disadvantaged populations. However, the Clinton Administration's National Performance Review and its associated "reinventing government" initiatives are beginning to show promise of substantially reshaping the structure and functions of the federal government. Regardless of the final shape that the reinvented government takes, the Government Performance and Results Act (GRPA) will provide the framework within which that government plans, implements, and evaluates its programs. Whereas some have argued that GPRA will strengthen the role of evaluation within federal agencies, GPRA has been seen primarily as a management and budget issue, and limited attention has been paid to important issues of measurement, attribution of outcomes, and reporting time lines. Nevertheless, GPRA provides the opportunity to make the government more effective and efficient and restore the faith of the American people in government.

Looking behind the numbers in counting the homeless: an invited commentary.

Many of criticisms of the Census Bureau's S-Night count of the homeless advanced by Wright and Devine are appropriate. However, a more important issue--the lack of agreement in the field on an appropriate conceptual definition of homelessness--undermines their overall critique.

The Master Questionnaire: preliminary report on an obesity assessment device.

Behavioral obesity researchers are increasingly concerned with thorough assessment of obesity. The present report describes the preliminary testing and refinement of the Master Questionnaire (MQ), a true-false scale developed expressly for use in obesity research. It was initially divided into four subscales: Spouse Support, Energy Balance Habits, Cognitive Factors, and Energy Balance Knowledge, and was intended for use as an outcome measure and as a predictor of change in obesity status. Its stability, internal consistency, sensitivity to treatment-related change, and predictive validity were examined. Test-retest reliability and sensitivity to treatment-related change were each found to be acceptable for three out of four subscales. Two subscales, Energy Balance Knowledge and Cognitive Factors, predicted outcome. The major weakness of the subscales was a lack of unidimensionality which would limit their utility. Cluster and factor analyses were used to develop five new subscales with acceptable levels of internal consistency. While some additional development and validation is still needed, the available evidence suggests that we have the nucleus of a strong assessment tool for obesity research.

Nursing home care for mental patients: descriptive data and some propositions.

Nursing homes play an important role in the community-based care of chronic mental patients, yet there is little research in that setting. The present study gathered and analyzed descriptive data on 20 nursing homes in a large urban area, including data about structure, staffing, policy, treatment, residents, discharge, psychosocial climate, and neighborhood characteristics. Results suggested a clear difference between skilled nursing versus intermediate care facilities, with the latter playing a larger role in caring for mental patients. More important, data suggested such facilities play primarily a custodial rather than treatment role, and that managers expect patients in nursing homes to stay indefinitely. In view of this, our justifications for community care, such as social integration, need to be examined anew.