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This resource is devoted exclusively to reporting the results of rigorous research concerning substance abuse treatment outcomes for homeless persons. The Effectiveness of Social Interventions for Homeless Substance Abusers reveals that while dropout rates are high for this population, it is essential to develop treatment programs that not only focus on the addiction, but also address the tangible needs of the homeless, notably housing, income support, and employment.
"Brings together leading and emerging researchers to advance understanding of the complex relationships between homelessness and health. Covering a wide range of topics from youth homelessness to end-of-life care, contributors outline policy and practice recommendations to respond to this public health crisis."--Back cover.
Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.
Americans are accustomed to anecdotal evidence of the health care crisis. Yet, personal or local stories do not provide a comprehensive nationwide picture of our access to health care. Now, this book offers the long-awaited health equivalent of national economic indicators. This useful volume defines a set of national objectives and identifies indicatorsâ€"measures of utilization and outcomeâ€"that can "sense" when and where problems occur in accessing specific health care services. Using the indicators, the committee presents significant conclusions about the situation today, examining the relationships between access to care and factors such as income, race, ethnic origin, and location. The committee offers recommendations to federal, state, and local agencies for improving data collection and monitoring. This highly readable and well-organized volume will be essential for policymakers, public health officials, insurance companies, hospitals, physicians and nurses, and interested individuals.
Chronic homelessness is a highly complex social problem of national importance. The problem has elicited a variety of societal and public policy responses over the years, concomitant with fluctuations in the economy and changes in the demographics of and attitudes toward poor and disenfranchised citizens. In recent decades, federal agencies, nonprofit organizations, and the philanthropic community have worked hard to develop and implement programs to solve the challenges of homelessness, and progress has been made. However, much more remains to be done. Importantly, the results of various efforts, and especially the efforts to reduce homelessness among veterans in recent years, have shown that the problem of homelessness can be successfully addressed. Although a number of programs have been developed to meet the needs of persons experiencing homelessness, this report focuses on one particular type of intervention: permanent supportive housing (PSH). Permanent Supportive Housing focuses on the impact of PSH on health care outcomes and its cost-effectiveness. The report also addresses policy and program barriers that affect the ability to bring the PSH and other housing models to scale to address housing and health care needs.
There have always been homeless people in the United States, but their plight has only recently stirred widespread public reaction and concern. Part of this new recognition stems from the problem's prevalence: the number of homeless individuals, while hard to pin down exactly, is rising. In light of this, Congress asked the Institute of Medicine to find out whether existing health care programs were ignoring the homeless or delivering care to them inefficiently. This book is the report prepared by a committee of experts who examined these problems through visits to city slums and impoverished rural areas, and through an analysis of papers written by leading scholars in the field.
How can ethnographic studies be generalized, in contrast to concentrating on the individual case? Noblit and Hare propose a new method for synthesizing from qualitative studies: meta-ethnography. After citing the criteria to be used in comparing qualitative research projects, the authors define the ways these can then be aggregated to create more cogent syntheses of research. Using examples from numerous studies ranging from ethnographic work in educational settings to the Mead-Freeman controversy over Samoan youth, Meta-Ethnography offers useful procedural advice from both comparative and cumulative analyses of qualitative data. This provocative volume will be read with interest by researchers and students in qualitative research methods, ethnography, education, sociology, and anthropology. "After defining metaphor and synthesis, these authors provide a step-by-step program that will allow the researcher to show similarity (reciprocal translation), difference (refutation), or similarity at a higher level (lines or argument synthesis) among sample studies....Contain(s) valuable strategies at a seldom-used level of analysis." --Contemporary Sociology "The authors made an important contribution by reframing how we think of ethnography comparison in a way that is compatible with the new developments in interpretive ethnography. Meta-Ethnography is well worth consulting for the problem definition it offers." --The Journal of Nervous and Mental Disease "This book had to be written and I am pleased it was. Someone needed to break the ice and offer a strategy for summarizing multiple ethnographic studies. Noblit and Hare have done a commendable job of giving the research community one approach for doing so. Further, no one else can now venture into this area of synthesizing qualitative studies without making references to and positioning themselves vis-a-vis this volume." -Educational Studies
This important text provides a comprehensive survey of homelessness in America: its scope and causes, its diverse populations, and the array of responses at the individual, community, and systems levels. Expert contributors explore the links between trauma and homelessness, the cycle of homelessness and health/mental health problems, and barriers preventing people from accessing services. Case studies of effective programs and practices focus on science-based interventions, broad understanding of client needs, and close coordination between systems and agencies. Finally, specialized chapters discuss issues and experiences common to homeless youth and young adults, including housing instability on college campuses and empowerment-based strategies for engaging youth voice in programming . Included in the coverage: Homelessness and health disparities: a health equity lens Affordable housing and housing policy responses to homelessness Street talk: homeless discourses and the politics of service provision Multisectoral collaborations to address homelessness Trauma-informed care in homelessness service settings: challenges and opportunities Incorporating youth voice into services for young people experiencing homelessness Homelessness Prevention and Intervention in Social Work fills a critical gap in the social work curriculum as a main or a supplementary text. It also makes an accessible resource for clinicians and community practitioners seeking current knowledge on the topic, practical approaches to working with clients experiencing homelessness, and useful information for effective program and policy design.
All across the United States, individuals, families, communities, and health care systems are struggling to cope with substance use, misuse, and substance use disorders. Substance misuse and substance use disorders have devastating effects, disrupt the future plans of too many young people, and all too often, end lives prematurely and tragically. Substance misuse is a major public health challenge and a priority for our nation to address. The effects of substance use are cumulative and costly for our society, placing burdens on workplaces, the health care system, families, states, and communities. The Report discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment so that they can address a person's overall health, rather than a substance misuse or a physical health condition alone or in isolation. It also provides suggestions and recommendations for action that everyone-individuals, families, community leaders, law enforcement, health care professionals, policymakers, and researchers-can take to prevent substance misuse and reduce its consequences.
This book is the first complete guide to implementing the Community Reinforcement Approach (CRA), an empirically based, highly effective cognitive-behavioral program for treating alcohol problems. CRA acknowledges the powerful role of environmental contingencies in encouraging or discouraging drinking, and attempts to rearrange these contingencies so that a non-drinking lifestyle is more rewarding than a drinking one. Unique in its breadth, the approach utilizes social, recreational, familial, and vocational strategies to aid clients in the recovery process. This authoritative manual is a hands-on guide to applying these therapeutic procedures. The authors present a step-by-step guide to each component of the treatment plan, many of which have been shown to be effective forms of treatment in themselves. Topics include behavioral skills training, social and recreational counseling, marital therapy, motivational enhancement, job counseling, and relapse prevention. Each chapter provides detailed instructions for conducting a procedure, describes what difficulties to expect, and presents strategies for overcoming them. Sample dialogues between clients and therapists, annotated by the authors, further illuminate the treatment process. The book concludes with a chapter that both addresses the common mistakes made when implementing CRA, and emphasizes the flexibility and benefits of this total treatment plan. This book is an invaluable resource for a wide range of practitioners including psychologists, psychiatrists, substance abuse counselors, and social workers.