PubMed · 10250732
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A Lavine, C H Polivka. 1981. Deinstitutionalization in Florida.. https://pubmed.ncbi.nlm.nih.gov/10250732/
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BACKGROUND: Mental health policy in England is undergoing radical change involving the integration of services aimed at improving outcomes for patients. At the same time, there is limited evidence about how conventional services are performing. The present paper reports data on the services provided and short-term outcomes achieved in eight community services in England. METHOD: A survey of caseloads of nurses and social workers was undertaken using a single-page assessment tool (MARC1) (n = 3024). After 5 months a random sample of psychotic cases was followed up (n = 393). RESULTS: A tendency was observed for health and social care practitioners to use the services available from within their own organisation. Over time, in the most severe cases, there was a substantial increase in provision of the services of the other organisation. Outcomes in terms of changes in HoNOS, GAS and MARC1 scores were similar for both professional groups, and both reported similar amounts of met and unmet need (and in the same categories) at follow-up. CONCLUSION: The most likely explanation for the change in service provision is the separate operation of different professional groups acting as gatekeepers for their own resources.
Drawing on ongoing fieldwork in New York City, the authors distinguish two "genealogies," or developmental traditions, of supported housing. "Housing as housing" originated in the mental health field to champion normalized, less-structured alternatives to clinically managed residential programs. "Integrated housing development" traces its origins to the movement to combat homelessness by preserving and creating affordable housing. The authors detail the distinctive premises, guiding concerns, and developmental logic of each lineage, contrasting the consumer advocate focus of the first genealogy with the emphasis on housing supply of the second. As housing and service investment strategies, the two approaches run different risks, speak to distinctive constituencies, and play to specific strengths. The authors argue that any attempt to take the measure of their success or to assess their comparative value as social investments must go beyond client outcome and come to terms with discrepant notions of the social good that they represent.
OBJECTIVE: This study compared client characteristics, service use, and health care costs of two groups of veterans who were contacted by outreach workers: a group of veterans who were contacted while incarcerated at the Los Angeles jail and a group of homeless veterans who were contacted in community settings. METHODS: Between May 1, 1997, and October 1, 1999, a total of 1,676 veterans who were in jail and 6,560 community homeless veterans were assessed through a structured intake procedure that documented their demographic, clinical, and social adjustment characteristics. Data on the use and costs of health services during the year after outreach contact were obtained from national databases of the Department of Veterans Affairs (VA). Chi square and t tests were used for statistical comparisons. RESULTS: The veterans who were contacted in jail obtained higher scores on several measures of social stability (marital status and homelessness status) but had higher rates of unemployment. They had fewer medical problems but higher levels of psychiatric and substance use problems, although the rate of current substance use was lower among these veterans than among the community homeless veterans. One-year service access for the jailed veterans was half that of the community homeless veterans. No differences were observed in the intensity of use of mental health services among those who used services, but the jailed outreach clients used fewer residential, medical, and surgical services. Total health care expenditures for the veterans who received outreach contact in jail were $2,318 less, or 30 percent less, than for those who were contacted through community outreach. CONCLUSIONS: Specialized outreach services appear to be modestly effective in linking veterans who become incarcerated with VA health care services. Although it is clinically challenging to link this group with services, the fact that the rate of current substance use is lower during incarceration may provide a window of opportunity for developing linkages between inmates and community rehabilitative services.