Browsing by Subject "Homeless Persons"
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Item Integrated Model for Hepatitis C Screening and Linkage to Care in Homeless Population(2019-01-22) Xia, Amy; Balakrishnan, Naveen; Tran, Minh; Pagels, PattiBACKGROUND: Hepatitis C is a major cause of morbidity and mortality as up to 46% of people infected with Hepatitis C develop cirrhosis and up to 20% develop hepatocellular carcinoma. Over the past year, a new initiative through the DFW Hep B Free organization at the University of Texas Southwestern (UTSW) was formed to target Hepatitis C among the homeless population, starting with screening at the Union Gospel Mission's Calvert Place homeless shelter. This underserved population is vulnerable because of inadequate healthcare access and resources, in addition to other risk factors such as former incarceration and injection drug usage. The main barriers to care for a transient, homeless population are 1) their lack of access to regular healthcare and screenings, 2) their inability to receive screening results via phone or mail, and 3) the difficulty of linking patients to affordable, accessible healthcare and treatment. METHODS: Our model integrates a student-run screening program, an on-site clinic at the shelter, and specialized hepatology services at Parkland Health Hospital System (PHHS), a local safety-net provider, to maximize the strengths that each component offers. Using OraQuick Rapid Hepatitis C Virus (HCV) tests, which screen for HCV antibodies and produce results in 20 minutes, we can deliver test results and provide counseling on the screening day. Under an IRB through a faculty hepatologist, patients that test positive are registered into Parkland Hospital's hepatitis surveillance program. The program then provides patient navigation, financial support, and treatment. RESULTS: On average, the HCV antibody positive rate from screenings at Calvert Place is 12.7% (N=126). 100% of positive patients were contacted with their result. For patients who tested positive (n=16), 2 (12.5%) did not need care (resolved HCV). From the 14 of 16 that had active HCV infections, 50% were lost to follow up and 50% were linked to care at Parkland hepatology clinic. CONCLUSION: Through our integrated model, we have created the foundations for a sustainable system to break down barriers to care while ultimately connecting HCV-positive homeless patients to treatment.Item Long-Term Efficacy of a Therapeutic Community Program for the Homeless: Personality, Substance Abuse, and Social Support Factors That Affect Outcome(2006-12-19) Houghteling, Lisa Nicole; Herman, JohnHomelessness is a social problem that is multidetermined and requires complex and comprehensive solutions. The issues of homelessness are heterogeneous in nature, with a multitude of complex problems encumbering this diverse population. The high incidence of co-occurring mental illness and substance abuse compound the already harsh consequences of homelessness and often exacerbate the extreme disaffiliation from others experienced by these individuals. Many attempts have been made to remedy this problem, often by addressing each of the issues of homelessness separately. However, there exists a consensus among researchers that this problem must be addressed from a multidimensional treatment approach in order to effectively bring about lasting change. The Therapeutic Community Program at Austin Street Centre in Dallas, Texas is an approach that has combined several treatment modalities into one comprehensive program addressing a variety of issues simultaneously. Group therapy is the cornerstone of this approach, whereby individuals work out their interpersonal difficulties and gain a sense of community and belonging while addressing the issues of mental illness and substance abuse. Previous research on the effectiveness of this Therapeutic Community Program has been promising, albeit preliminary. Despite a high attrition rate, participants demonstrated significant improvements with regard to substance abuse, psychological distress, occupational performance, and interpersonal functioning compared to a group of controls who did not participate in the program. The current study aimed to further these results by demonstrating similar gains in terms of social and psychological functioning, as well as, provide a preliminary investigation into factors that affect program attrition and outcome. A group of 75 therapeutic community program participants at Austin Street were compared to a group of 30 controls who utilized only the basic overnight shelter services offered. As in the previous study, the therapeutic community program was found to be an effective means to a positive outcome. Program participants remained in the therapeutic community for longer and were more likely to experience a positive outcome than controls. Significantly fewer program participants evidenced signs of substance dependence at 3 month follow-up than at intake. Those program participants who evidenced less substance abuse at 3 months were more likely to experience a positive outcome. Additionally, these individuals were shown to have fewer problems relating interpersonally and fewer psychiatric symptoms at baseline than those who continued to abuse substances. Program participants also demonstrated a steady decrease in psychiatric symptoms, symptom distress, problems relating interpersonally, and problems in their social role.Item Successful Long-Term Outcomes of Previously Transitionally-Housed Female-Headed Families(2005-08-11) Moore-Betasso, Melody; Evans, Harry M.Despite efforts on the part of federal, state, and local government as well as concerned community organizations, homelessness, especially among female-headed families, has continued to increase. Despite the need for outcome studies and an increased understanding of how to serve these families, few research studies have attempted to determine what factors contribute to long-term success. The current study explored the impacts of therapy, substance abuse, domestic violence, mental illness, and social support on long-term success for women who were previously transitionally housed. In addition, the children's self-esteem, self-efficacy, substance abuse, and mental illness were also taken into account. Success was defined as either six months or more stable housing or six months or more stable employment. The majority of the participants met criteria for success by at least one definition, and half of the participants were successful by both definitions. It was found that the optimal length of stay in a transitional housing center is one year, with longer stays being less likely to contribute to permanent housing. Women who were successfully housed reported more psychological symptoms than those who were not, identifying the need for follow-up services for past-residents of shelters and transitional housing centers, who are likely experiencing increased stress as they attempt to live independently. Overall, there was a low prevalence of substance abuse among both women and children. Further, children were not found to be likely to report psychological symptoms. Children whose mothers were successfully housed were found to have greater personal and social self-esteem as well as consider academics more important than those whose mothers were not successfully housed. The results of the current study indicate the effectiveness of a specific transitional housing center located in Dallas, Texas, the Shared Housing Center.Item The Utilization of GPS Technology in Tracking Homeless Adults: A Pilot Study(2012-05-18) Wohlford, Sarah Elizabeth; North, Carol S.; Black, Melissa; Dean, DenisThe purposes of the present study were to examine the feasibility of using GPS technology in a difficult-to-follow homeless population and to develop GPS tracking methods that researchers can utilize in future studies. Twenty individuals were recruited from a homeless day center. Each carried a GPS unit to record their movements for approximately 24 hours. Participants completed interviews consisting of demographic questions, a pre-tracking survey, and a post-tracking survey about planned and reported travels respectively and also submitted urine specimens for substance use testing. GPS data were downloaded from the tracking device and exported into ArcMap 10 and SAS 9.3 for analysis. Concerted efforts were made to achieve successful deployment with the first eight participants, necessitating refinement of the research procedures. Thereafter, 81% success was attained in collecting adequate deployment data. Travel distances varied (.05-36 miles), mostly taken on foot and by city bus. No GPS units were lost during deployment, although one was water-damaged in a shower. Challenges encountered in the study included battery problems (power drainage, theft), signal loss, lengthy initial calibrations (up to 15 minutes), inaccurate recordings due to drift of satellite anchors to positions, and difficulties re-engaging with participants post deployment. The study demonstrated the feasibility of using GPS technology to track movements of a difficult-to-track population. This work has clarified the need to integrate GPS and self-report data to maximize the precision of geospatial data. The success of this pilot study suggests novel potentials for GPS technology to improve service access and identify geospatial barriers to care.