Gibbon JL, O'Toole TP, Hanusa BH; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1999; 16: 151.
Program for Health Care to Underserved Populations, Pittsburgh, PA 15213, USA.
RESEARCH OBJECTIVE: Since the majority of homeless individuals are men, prior research has focused on the patterns of drug use and substance abuse treatment needs for men. This study describes the substance abuse treatment histories and treatment needs, comorbidities and the particular services that are needed to improve the treatment for homeless women. STUDY DESIGN: A cross-sectional survey of homeless adults (age=18 years) living in Pittsburgh and Philadelphia was conducted to ascertain treatment histories, barriers to treatment, alcohol and substance abuse histories, demographic information and service needs. Face-to-face interviews were conducted using a modified version of the National Technical Center Telephone Substance Dependence Needs Assessment (NTC) Questionnaire. Sites and individuals at each site were selected randomly. Of the 531 interviewees, 106 (20.0%) were female. PRINCIPAL FINDINGS: The women were predominantly African American (81.1%), between 18-35 years of age (49.1%), had completed high school (49.1%), were unemployed (76.4%), and single (64.2%). The majority had Medicaid insurance (62.3%), 26.4% were unsheltered, and 29.2% had been homeless for more than 3 years. 65.1% had one or more medical comorbidities and 54.7% had one or more mental health comorbidities. 21 (20.4%) were pregnant in the past year with a surprising 81.0% of these women receiving prenatal care. 76.5% were homeless while caring for their children. Overall, 34.9% used no alcohol or drugs in the past year, 13.2% used crack/cocaine only, 7.5% used alcohol only, 21.9% used a combination of the two substances and 18.9% used a combination of three illicit substances in the past year. Using DSM-III-R criteria, 53/106 (50.0%) were dependent on crack/cocaine, with 33.3% severely dependent. According to ASAM criteria, of the women with a current need for treatment (N=63), 30.2% qualified for partial hospitalization treatment, 36.5% qualified for medically monitored inpatient care and 33.3% for medically managed inpatient care. The actual treatment received for those with a current need was 52.4% no treatment, 3.2% outpatient care, 4.8% intensive outpatient care, 4.8% nonhospital residential rehabilitation and 34.9% inpatient care. Of those women who actually sought treatment (N=33), 75.8% actually received it in the past year. However, according to ASAM criteria, 100% qualified for some form of inpatient care while only 60.6% actually received inpatient care. More than half of the women felt they needed more mental health care (55.7%) and family counseling (50.0%) to improve the quality of their lives. Overall, the top five needs these women identified as important to improve the quality of their lives were a home/stability (29.2%), rehabilitation/counseling (22.6%), a job/job skills (12.3%), money management skills (10.4%), and a relationship with God (6.6%). CONCLUSIONS: The homeless women in this study were young (=35 years), unemployed, living in emergency shelters (26.4%) or unsheltered (26.4%), Medicaid-insured and had familial responsibilities. The majority of these women cared for their children while they were homeless. They exhibited severe dependence on crack/cocaine and had high unmet demands for treatment. Although 75.8% of the women with a demand for treatment received it, only 45.9% received appropriate care. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: These findings confirm the notion that chemically dependent homeless women are an underserved population. More needs to be done to eliminate the disparity between treatment needs and available services. The homeless women's reports of unmet needs for mental health services and family counseling services are substantiated by the data.
Publication Types:
Keywords:
- Adult
- Child
- Comorbidity
- Cross-Sectional Studies
- Female
- Health Services Needs and Demand
- Hospitalization
- Housing
- Humans
- Male
- Medicaid
- Mental Disorders
- Mental Health Services
- Pennsylvania
- Philadelphia
- Questionnaires
- Substance-Related Disorders
- economics
- therapy
- hsrmtgs
Other ID:
UI: 102194563
From Meeting Abstracts