Catherine Seibyl

Patterns in Work Functioning and Vocational Rehabilitation Associated with Coexisting Psychiatric and Substance Use Disorders

Archival data from 25,480 adults entering the Compensated Work Therapy (CWT) program of the Veterans Health Administration were analyzed to identify differences in work functioning and vocational rehabilitation among participants with psychiatric disorders alone, substance use disorders (SUD) alone, and psychiatric disorders with coexisting SUD. The co-existence of psychiatric disorders and SUD was associated with better work functioning, more participation in vocational rehabilitation, and a better outcome, compared to psychiatric disorders alone. Poorer functioning was seen on all variables relative to participants with SUD alone. These findings are due in part to correlates of substance abuse, but they may suggest that clinicians should focus on work and vocational goals to support other clinical efforts for clients with dual diagnoses.

Hospitalized Younger: A Comparison of a National Sample of Homeless and Housed Inpatient Veterans

Background. Homelessness is associated with high rates of hospitalizations and age-adjusted mortality. Few studies have examined whether homeless people are admitted to the hospital at an earlier age than the general population or for different diagnoses. Methods. We compared the age at admission and the primary discharge diagnoses in a national sample of 43,868 hospitalized veterans. Results. The difference in median age between homeless and housed inpatients ranged from 10–18 years for medical-surgical diagnoses and 3–4 years for psychiatric and substance abuse diagnoses (p#.005 for all diagnoses). Homeless veterans were more likely to have been admitted for psychiatric and substance abuse diagnoses (79.9%), compared with housed veterans (29.1%). Conclusions. Substance abuse and psychiatric illness account for the majority of admissions among homeless veterans. Among all diagnostic groups, homeless people were admitted at younger ages. Our findings suggest that homeless people have either a more rapid disease course, leading to earlier morbidity, or lower admission threshholds sufficient to generate hospital admission.

Continuity of care and clinical effectiveness: outcomes following residential treatment for severe substance abuse.

Background. Continuity of care (COC) has often been viewed as a crucial indicator of treatment quality for patients with severe psychiatric or addictive disorders. However, the relationship between COC and clinical outcomes has received little empirical evaluation. Research Design. This study used hierarchical linear modeling to examine the relationship between six indicators of COC and seven outcome measures addressing symptoms, substance abuse, and social functioning. Subjects. Patient interviews were conducted with 1576 veterans 3 months after their discharge from one of 22 residential work therapy programs for the treatment of severe substance abuse. Results. Few significant relationships were found between COC and outcome measures in analyses conducted at both the client and program level and fewer than half of these show better outcomes with greater COC. When a Bonferroni corrected P level of P <0.0012 was used, none of the relationships were statistically significant. Conclusion. Although there were significant relationships between outcomes and measures of services received during residential treatment, postdischarge COC does not seem to be related to improved outcomes, at least when examined following long term intensive residential treatment. Thus, our results are specific to the context of aftercare following long-term residential rehabilitation and indicate that the value of standard performance measures may vary by treatment context.

Factors associated with receipt of pension and compensation benefits for homeless veterans in the VBA/VHA homeless outreach initiative

Public support payments may facilitate exit from homelessness for persons with mental illness. We examined data from 10,641 homeless veterans contacted from October 1, 1995 to September 30, 2002 in a collaborative outreach program designed to facilitate access to Department of Veterans Affairs (VA) disability benefits. Those who were awarded benefits (22% of contacted veterans) were more likely to report disability, poor to fair self-rated health, and were more likely to have used VA services in the past. Thus, this program achieved only modest success and was most successful with veterans who were already receiving VA services and who might have received benefits even without the outreach effort.