Recovery in context: Sober living houses and the ecology of recovery.

Sober living houses (SLHs) are an increasingly common element of the recovery support services landscape, yet little is known about their neighborhood context. This study describes neighborhoods in which SLHs are located and examines differences by house characteristics. SLHs in Los Angeles County (N = 297) were geocoded and linked with U.S. Census, alcohol outlet, recovery resources, and accessibility data. Regression analyses tested differences by house characteristics. Co-ed houses were in neighborhoods that were less ethnically diverse and farther away from recovery resources. Larger house capacity was associated with increased density of off-premise alcohol outlets but also increased proximity to treatment. Higher fees were associated with lower neighborhood disadvantage and off-premise alcohol outlet density but the greater distance from treatment programs and other recovery resources. House characteristics are associated with neighborhood factors that both support recovery and place residents at risk.

Persisting gaps in M-OUD coverage at post-discharge recovery houses necessitate our continued advocacy.

Effective treatment of opioid use disorder (OUD) must target both the medical and psychosocial aspects of a patient's condition. This, in turn, requires a collaboration between medical providers and social supports. We would like to illustrate a key difficulty in this collaboration for some patients in our country: many post-discharge recovery houses continue to refuse to allow patients to remain on medication treatment for OUD (M-OUD). This barrier to M-OUD access in recovery houses is a significant obstacle to effective OUD treatment.

Distribution and Neighborhood Correlates of Sober Living House Locations in Los Angeles.

Sober living houses (SLHs) are alcohol and drug-free living environments for individuals in recovery. The goal of this study was to map the distribution of SLHs in Los Angeles (LA) County, California (N = 260) and examine neighborhood correlates of SLH density. Locations of SLHs were geocoded and linked to tract-level Census data as well as to publicly available information on alcohol outlets and recovery resources. Neighborhoods with SLHs differed from neighborhoods without them on measures of socioeconomic disadvantage and accessibility of recovery resources. In multivariate, spatially lagged hurdle models stratified by monthly fees charged (less than $1400/month vs. $1400/month or greater), minority composition, and accessibility of treatment were associated with the presence of affordable SLHs. Accessibility of treatment was also associated with the number of affordable SLHs in those neighborhoods. Higher median housing value and accessibility of treatment were associated with whether a neighborhood had high-cost SLHs, and lower population density was associated with the number of high-cost SLHs in those neighborhoods. Neighborhood factors are associated with the availability of SLHs, and research is needed to better understand how these factors affect resident outcomes, as well as how SLHs may affect neighborhoods over time.

[Intersection of acute psychiatric wards and sheltered housing - parameters of patients with long inpatient episodes]. / Schnittstelle psychiatrische Akutstationen und betreute Wohneinrichtungen - Charakteristika von Patienten mit langen Klinikaufenthalten.

OBJECTIVE: This paper describes socio-demographic, clinical, and treatment-related parameters of psychiatric patients who were hospitalized for at least two months on an acute psychiatric ward compared to patients with a shorter inpatient treatment episode. Furthermore, it is evaluated how frequent these long-staying patients are awaiting a room in a sheltered housing facility. METHODS: We investigated the longest inpatient treatment period of all patients aged between 18 and 65 years on an acute ward of the Psychiatric University Hospital Zurich (n = 3,928) using the basic documentation of the years 2006 to 2010. RESULTS: 20 % of all patients on acute wards had a stay of more than 60 days. Socio-demographic and clinical characteristics are similar to those of "heavy users" of mental health services. Social work is involved more frequently, and placement in sheltered housing facilities is intended in one third of those patients. CONCLUSIONS: A substantial part of the patients who stay at least once longer than two months on an acute ward are discharged to sheltered housing. Besides severity of illness it is likely that lack of availability of an adequate housing option contributes to length of stay. Intensified cooperation of the psychiatric clinic with sheltered housing facilities as well as alternative options for those in need of assisted housing and mental health care might help to reduce their extensive usage of inpatient treatment capacities. Interventions and services have to be adapted to local conditions.

High cost residential placements for adults with intellectual disabilities.

BACKGROUND: Concern has been expressed repeatedly about the cost and quality of residential placements for adults with learning disabilities and additional needs. This study sought to identify characteristics of the highest cost placements in the South-East of England. METHOD: Lead learning disability commissioners in the South-East of England were asked to provide information about the five highest cost residential placements that they commissioned for adults with learning disabilities. RESULTS: The average placement cost of £172k per annum disguised wide variation. Individuals placed were mainly young and male with high rates of challenging behaviour and/or autism spectrum disorder. Most placements were in out-of-area residential care. The highest costs were associated with hospital placements and placements for people presenting challenging behaviour. CONCLUSIONS: Young, male adults with learning disability, challenging behaviour and/or autism continue to receive very high cost residential support, often in out-of-area residential care. There remains limited evidence of plans to redirect resources to more local service developments.

[Analysis of patterns of in-patient and out-patient mental health care by use of routine data]. / Sektorübergreifende Analyse psychiatrischer Behandlungs- und Versorgungsleistungen mittels Routinedaten.

OBJECTIVE: The Centre of Psychiatry Suedwuerttemberg routinely records data on service use of in-patient units, day hospitals and out-patient services on a daily basis as well as data on the respective patients according to the German Basic Documentation (BADO). Other psychiatric services in the catchment area of the districts Ravensburg and Bodenseekreis such as services of sheltered living, residential homes and vocational services collect identical data per day of use. Aim of the study is to compare routinely recorded data of mental health service use and direct cost of service use with sample data. We compared analyses of mental health service use and direct cost of service use with routinely recorded data with analyses using sample data. METHODS: Concerning the year 2008, we joined these different data sets, processing them in order to obtain pseudonymity and fulfil data protection requirements. This joint data set maps the total expenditures for psychiatric care utilisation in this region. RESULTS: Using a data set of this kind, analyses of health economy are possible which are comparable or even superior to those from sample data. CONCLUSION: Routinely recorded data are a cost-saving alternative to sample data.

["Treated and promoted or detained and left behind" - intensive psychiatric care of residents of a psychiatric hostel over seven years]. / "Behandelt und gefördert oder verwahrt und vergessen"- die psychiatrische versorgung der bewohner eines psychiatrischen heimes im längschnitt.

OBJECTIVE: In this observational study indicators for the quality of psychiatric care in a psychiatric hostel will be examined for all residents over a period of 7 years. METHODS: Data has been collected at an annual basis. Relationships among variables have been analysed by means of random effects regression analyses for longitudinal data. RESULTS: GAF score increases slightly. Number of psychopharmacological drugs and neuroleptics as well as inpatient costs remains stable. Psychiatric treatment costs are negatively related to the functional level, residents' age and the duration of stay in the residential facility. Even under control of several variables, variance of total costs was found to be mainly explained by the costs of inpatient and psychopharmacological treatment. DISCUSSION: Increase of the general functional level indicates a positive development of autonomy. Changes and the influence factors of psychopharmacological treatment may indicate a need-oriented drug therapy. Some findings may indicate an institutionalisation process and an increasing of medical conditions in chronically mentally ill people.

Does supported accommodation improve the clinical and social outcomes for people with severe psychiatric disability? The Project 300 experience.

OBJECTIVE: The present study was designed to investigate the clinical and social outcomes for a group of individuals (n = 181) discharged into supported accommodation from three long-stay facilities in Queensland. METHOD: Data were collected prospectively using a battery of standardized measures and individual interviews at 6 weeks pre-discharge and again at 6, 18, 36, and 84 months post-discharge. RESULTS: While there was little functional gain at follow up, the clients, as a group, did not deteriorate. Sixty per cent of the clients were engaged in some form of structured community activity and the need for hospitalization decreased significantly in the follow-up period. The ongoing costs of the programme, while remaining high, were significantly less than inpatient alternatives. CONCLUSION: The provision of community accommodation with adequate clinical and non-clinical support is a suitable option for a large proportion of individuals with serious mental illness.

Halfway houses for alcohol dependents: from theoretical bases to implications for the organization of facilities.

The purpose of this paper is to supply a narrative review of the concepts, history, functions, methods, development and theoretical bases for the use of halfway houses for patients with mental disorders, and their correlations, for the net construction of chemical dependence model. This theme, in spite of its relevance, is still infrequently explored in the national literature. The authors report international and national uses of this model and discuss its applicability for the continuity of services for alcohol dependents. The results suggest that this area is in need of more attention and interest for future research.

Halfway houses for alcohol dependents: from theoretical bases to implications for the organization of facilities: [review]

The purpose of this paper is to supply a narrative review of the concepts, history, functions, methods, development and theoretical bases for the use of halfway houses for patients with mental disorders, and their correlations, for the net construction of chemical dependence model. This theme, in spite of its relevance, is still infrequently explored in the national literature. The authors report international and national uses of this model and discuss its applicability for the continuity of services for alcohol dependents. The results suggest that this area is in need of more attention and interest for future research.

Administrative and financial responsibilities for sheltered housing for mentally ill and handicapped persons in Germany and its impact on housing supply.

BACKGROUND: The integration of mentally ill and handicapped persons in the society requires the availability of various forms of sheltered housing in the community, most important ambulatory (supported) housing facilities. In Germany the administrative and financial responsibility for sheltered housing for mental ill and handicapped persons is usually assigned to two authorities: the welfare authorities at Lander (state) level are responsible for hostels, the welfare authorities on community and district level are responsible for ambulatory housing. However some Lander have distributed these responsibilities differently and other Lander offer subsidy programmes to promote the implementation of ambulatory housing. OBJECTIVE: To evaluate the different modes of distributing the responsibilities for administration and financing of sheltered housing for their impact on the supply with ambulatory and stationary housing in the 16 German Lander. METHOD: (1) Analysis of the practise of distributing the responsibilities for housing between Lander and community welfare-authorities in the 16 Lander. Analysis of the subsidy programmes in the Lander that aim to promote the implementation of ambulatory housing. (2) Assessment of the capacities in housing for mentally ill and handicapped persons in the Lander. (3) Comparing (1) and (2). RESULTS AND DISCUSSION: Lander that have the responsibilities for ambulatory housing and for hostels organised on the same authority-level, offer generally more housing in ambulatory facilities and less in hostels than Lander that do not. However, three Lander, despite having all responsibilities for housing at one authority level, provide accommodation for mentally ill and handicapped persons predominantly in hostels. There are so far no indications whether it would be more favourable to have a unique authority for housing based on Lander or on community level. Subsidy programmes to promote the implementation of supported housing are successful if they sponsor at least 50% of costs and if they exist for a considerable duration of time. CONCLUSION: Organising the responsibilities for housing for mental ill and handicapped persons on one authority level and the availability of subsidy programmes have a positive impact on the supply with ambulatory housing. However other factors also have to be considered to influence the supply with ambulatory housing, such as political will, attitudes towards the mentally ill, interests of hostel operators, pre-existing hostel infrastructure, available funds. These factors need to be researched further.

Out of touch or on the money: Do the clinical objectives of addiction treatment coincide with economic evaluation results?

Previous economic studies have examined the association between substance abuse treatment and reduced costs to society, but it remains uncertain whether the economic measures used in cost and benefit-cost analyses of treatment programs correspond in direction and magnitude with clinical outcomes. In response to this uncertainty, the present study analyzed a longitudinal data set of addiction treatment clients to determine the statistical agreement between clinical and economic outcomes over time. Data were collected from 1,326 clients in the Chicago cohort of the Persistent Effects of Treatment Study. These individuals were interviewed at baseline as well as at 6-, 24-, 36-, and 48-month followup periods (91.6% followup). Correlations between clinical and economic measures were generally small (rho of 0.1 to 0.3) and often became non-significant once we controlled for baseline severity. The results demonstrate that although some associations exist, outcomes should be evaluated along both clinical and economic dimensions.

Comorbid dysthymia and substance disorder: treatment history and cost.

OBJECTIVE: The purpose of this study was to determine the treatment history and cost of previous treatment among patients with comorbid substance-related disorder and dysthymia, as compared to patients with substance-related disorder only. METHOD: Retrospective data were obtained regarding past treatment. Treatment cost was calculated on the basis of the 1996 cost of various treatment modalities. The setting was alcohol-drug programs located within departments of psychiatry in two centers. A total of 642 patients were assessed, of whom 39 had substance-related disorder and dysthymia and 308 had substance-related disorder only (the remaining patients had other comorbid conditions). Data collection instruments included an interview-based questionnaire regarding previous psychiatric and substance abuse treatment. Current cost of treatment in various settings was assessed on the basis of a survey of facilities used by patients in this area. RESULTS: Patients with substance-related disorder and dysthymia had received more substance-related disorder treatment in 18 of 20 measures. Patients with substance-related disorder and dysthymia used 4.7 times more substance-related disorder treatment dollars than patients with substance-related disorder only, although their demographic characteristics were similar. Past self-help activities and pharmacotherapy were remarkably similar for both groups. Although substance-related disorder treatment differed considerably between the two groups of patients, other types of psychiatric treatment (i.e., non-substance-related treatment) did not differ between the two groups. CONCLUSIONS: Patients with substance-related disorder and dysthymia are referred to (or seek) substance-related disorder treatment more often than patients with substance-related disorder only but are referred to (or seek) non-substance-related psychiatric treatment no more often than patients with substance-related disorder only. The cost of previous substance-related disorder treatment was several times higher for the patients with substance-related disorder and dysthymia.

Clinical usefulness of an aftercare worker for psychotic patients discharged from half-way houses in Hong Kong.

BACKGROUND: The aim was to assess the clinical usefulness and economic viability of an aftercare worker for psychotic patients discharged from half-way houses in Hong Kong. METHOD: A sample of 32 chronic psychotic patients was provided with a full-time aftercare worker. A matched control group received no such service. RESULTS: The experimental group was found to have greater and better employment prospects, better mental status with less hospitalisation and less law-breaking behaviour than the control group. Some of these benefits were converted into economic terms and the tangible costs incurred in the project were calculated. CONCLUSIONS: The provision of an aftercare service is clinically useful and economically viable.

Transitional housing for veterans with a psychiatric diagnosis.

1. Veterans with a psychiatric diagnosis needed affordable housing and emotional support to successfully reintegrate into the community. 2. A supervising nurse established a structured, transitional housing program with a housing manager and mandatory weekly meetings. 3. The focus of the house program was centered on resident independence and responsibility. 4. The housing program is cost effective and has shown a 79% success rate in assisting clients to become productive members of the community.

Factors affecting SSI support for sheltered care residents with serious mental illness.

The complexity of Supplemental Security Income (SSI) regulations and procedures allegedly inhibits eligible persons with serious mental illness from obtaining and retaining support. This study examined factors affecting continued SSI support among 393 sheltered care residents with serious mental illness ten years after an initial positive eligibility determination. At follow-up between 1983 and 1985 of 225 cohort members, 182 were receiving SSI benefits, 28 were eligible for SSI due to their low income but were not receiving benefits, and 15 were income-ineligible. The financially needy were most likely to receive SSI support for longer periods of time, and the most severely disturbed spent the least amount of time on SSI. Income-eligible nonrecipients were likely to be young, transient patients using emergency room services as opposed to receiving outpatient counseling.

Costs of providing residential and related support services to individuals with mental retardation.

The per diem costs of providing residential services for persons with mental retardation in group homes, family homes, and apartments in the Macomb-Oakland Region of Michigan and in Region V in eastern Nebraska were found to vary far more by type of living arrangement than by resident level of need. Nearly all of the variation in the per diem costs of staffed, as opposed to family-operated, living arrangements could be explained in terms of staff-to-resident ratios and staff compensation levels.