Deborah Fisk

Lesbian Mothers With Planned Families: A Comparative Study of Internalized Homophobia and Social Support

This study compared the perception of social support and the degree of internalized homophobia for two demographically similar groups: lesbians with planned families and lesbians who did not have children. Results found that lesbians with planned families perceived significantly less social support from friends overall, from gay men and lesbian friends specifically, and more support from their families-of-origin than lesbians who did not have children. Lesbians with planned families also reported significantly higher internalized homophobia specific to disclosure of sexual identification. The authors suggest that selective disclosure may be an adaptive response rather than a true measure of internalized homophobia.

Engaging Persons with Substance Use Disorders: Lessons from Homeless Outreach

Assertive mental health outreach individuals to choose between eating at a soup kitchen and keeping an appointment emerged in the early 1980s as clinicians and researchers learned that many individwith a clinician (Dennis, Buckner, Lipton, & Levine, 1991; Koegel, 1992). uals who are homeless and have a mental illness shun community mental health cenAssertive mental health outreach (outreach) is an effective method of engaging ters for a number of reasons, including (1) the requirement of the centers that the mentally ill homeless persons into treatment and case management (Lam & Rohomeless acknowledge having a mental illness before receiving help (Segal, Bausenheck, 1999) and is associated with good client outcomes in several domains (Romohl, & Johnson, 1977), (2) the drawbacks of stigma and medication side effects that senheck, 2000). Outreach is not an inexpensive practice, however (Rosenheck, can come with treatment, and (3) the exigencies of homeless life, which may force Gallup, & Frisman, 1995; Rosenheck, 2000), since its practice spans the process of trust building, gradual engagement, and the individual’s acceptance of mental health and other social services (Swayze, Michael Rowe, Ph.D., is Associate Clinical Pro1992; Brickner, 1992; Susser, Goldfessor of Sociology in the Department of Psychifinger, & White 1990; Morse et al., 1996). atry at the Yale School of Medicine in New HaPolicy makers and researchers will conven, Connecticut. Deborah Fisk, M.S.W., is tinue to evaluate the place and worth of Clinical Director of Case Management, Conoutreach-based work in public mental necticut Mental Health Center, Department of Psychiatry, Yale School of Medicine. Jennifer health care when other individuals with seFrey, Ph.D., is Adjunct Professor in the Departrious mental illness are willing to come ment of Psychiatry at the Yale School of Mediinto clinics for treatment. However, our cine. Larry Davidson, Ph.D., is Associate Profesinterest in this article is to examine two sor of Psychology in the Department of Psychiatry at the Yale School of Medicine. related questions. First, how can assertive Address for correspondence: Michael Rowe, mental health outreach be adapted to Ph.D., Program on Poverty, Disability, and Urwork effectively with persons who have ban Health; 205 Whitney Avenue, Suite 306; “only” substance addictions? Second, how New Haven, CT 06511. E-mail: michael. can outreach teams make a successful rowe@yale.edu.

Sober Housing and Motivational Interviewing: The Treatment Access Project

This paper describes an innovative program that provides rental subsidies for sober housing and supportive services to persons in early recovery who are homeless and have substance use disorders. Preliminary data point to the success of this program in enhancing recovery and exiting from homelessness. In supporting sober house placements, the Treatment Access Project creates a bridge that supports these individuals in their transition from clinical treatment services to the community. Integration with natural community supports can help to build self-efficacy, which can enhance the likelihood that this population will obtain and maintain abstinence, gainful employment, and permanent housing.

Clinical Responsibility and Client Autonomy: Dilemmas in Mental Health Work at the Margins

Mental health outreach to homeless persons requires practice standards for cases in which clinical assessment and client autonomy conflict. After reviewing the principles of mental health outreach and presenting case examples, conditions and boundaries within which outreach workers negotiate the clinical responsibility/client autonomy dilemma are discussed. Guidelines to support sound clinical practice while respecting client autonomy are also discussed.

First-Episode Psychosis and the Criminal Justice System: Using a Sequential Intercept Framework to Highlight Risks and Opportunities

In first-episode psychosis there is a heightened risk of aggression and subsequent criminal justice involvement. This column reviews the evidence pointing to these heightened risks and highlights opportunities, using a sequential intercept model, for collaboration between mental health services and existing diversionary programs, particularly for patients whose behavior has already brought them to the attention of the criminal justice system. Coordinating efforts in these areas across criminal justice and clinical spheres can decrease the caseload burden on the criminal justice system and optimize clinical and legal outcomes for this population.