 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
|
| The 131st Annual Meeting (November 15-19, 2003) of APHA |
David E. Pollio, PhD, George Warren Brown School of Social Work, Washington University, One Brookings Dr., Box 1196, St. Louis, MO 63130-4899, (314) 935-7516, depollio@gwbmail.wustl.edu, Karin Eyrich, PhD MPE, Department of Psychiatry, University of Pennsylvania, Treatment Research Institute, Philadelphia, PA 19104, and Carol S. North, MD, MPE, School of Medicine, Washington University, Department of Psychiatry, 660 S Euclid, CB 8134, Renard Building, Room 2210, St. Louis, MO 63110.
Introduction. For homeless populations, research has documented substantial amounts of service use across multiple sectors. This research is limited by cross-sectional design, self-reported service use, data collection within a single agency or service sector, or lack of attention to subgroups. Modeling longitudinal service use across multiple service sectors would be instructive.
Methods. Four hundred randomly-selected homeless persons were interviewed at baseline and 12-months (follow-up) in St. Louis. Information on addictive and mental illness disorders (AMD) and housing status was collected using standardized self-report instruments. Substance use was detected via urine testing. Service use data by sector (shelter, inpatient and outpatient substance, inpatient and outpatient mental health) were collected each month (for 12 months) from all providers serving homeless persons (n=35). OLS and logistic regression models were run. Controlling for lifetime AMDs, the association between service use and outcomes (changes in 12-month AMDs, housing status, and substance use) was tested.
Results. Change in 12-month AMDs was associated with diagnostic-congruent outcomes. Lifetime history of major depression was associated with housing attainment at follow-up. Decrease in cocaine use was associated with increased inpatient and outpatient substance service use. Service use demonstrated little association with outcomes. Improvement in bipolar disorder was associated with increased inpatient mental health, PTSD with increased outpatient mental health service use.
Conclusions: Findings suggest that amount of services is not generally associated with outcomes. Behavioral and other health services delivered in the field demonstrated limited effectiveness. These findings highlight the need for research examining access, appropriateness, and quality of care.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.