Evan Cohen

Tracking and Follow-Up Methods for Research On Homelessness

To conduct comprehensive treatment effectiveness studies, evaluators must frequently track, locate and interview service recipients long after program participation has ended. For some populations, this is an arduous task. But, despite wide variations in retention rates, the published literature from follow-up studies rarely provides information on their tracking, locating, or interviewing techniques. The present report concerns a 12-month follow-up study of individuals who were homeless and mentally ill, which achieved a remarkably high retention rate—over 70%. Quantitative information is presented on client characteristics related to locatability and agreement to be interviewed, as well as qualitative information on successful techniques, from a focus group session with research interviewers.

Describing the homeless mentally ill: Cluster analysis results

Presented descriptive data on a group of homeless, mentally ill individuals (N = 108) served by a two-site demonstration project, funded by NIMH. Comparing results with those from other studies of this population produced some differences and some similarities. Cluster analysis techniques were applied to the data, producing a 4-group solution. Data validating the cluster solution are presented. It is suggested that the cluster results provide a more meaningful and useful method of understanding the descriptive data. Results suggest that while the population of individuals served as homeless and mentally ill is quite heterogeneous, many have well-developed functioning skills--only one cluster, making up 35.2% of the sample, fits the stereotype of the aggressive, psychotic individual with skill deficits in many areas. Further discussion is presented concerning the implications of the cluster analysis results for demonstrating contextual effects and thus better interpreting research results from other studies and assisting in future services planning.

Social problem-solving skills of children with traumatic brain injury

Studies of specific social skill deficits in adults with traumatic brain injury (TBI) have begun to appear [1,2], but there are few empirical studies of children with TBI. This study examined social problem-solving skills in boys and girls with TBI and a matched group of non-injured peers, ages 7-13. The TBI group generated fewer total solutions on a social problem-solving measure, largely reflecting situation-specific differences in generated solutions. The TBI group also generated fewer positive assertive, and more indirect responses to peer group entry situations than the comparison group. Implications are discussed for a model of social information processing in paediatric brain injury.

The effects of insurance benefits coverage on functional and psychosocial outcomes after spinal cord injury

This retrospective study examined the effects of type of payor (ie, catastrophic, Medicaid, and private) and extent of benefits and independent living (IL) resources received on functional and psychosocial outcomes after spinal cord injury (SCI). One hundred seventy SCI persons with dates of injury from 1985 to 1990 and who were on average 4 years after their initial discharge from rehabilitation participated in the study. Benefits and resources received from discharge to 2 years post-injury in housing, transportation, personal care assistance (PCA), and equipment were assessed. Outcome variables included measures of psychological distress, self-esteem, and participation in physical and work/school activities. Extent of benefits received after SCI was found to be both a function of source of payor and of subjects neurological classification. While an effect of total benefits received could not be detected on SCI subjects post-discharge physical activity, and benefits paid by self only were associated with physical activity. Transportation benefits received and type of payor were positively associated with work/school outcomes. Younger subjects, sponsored by private payors, and with incomplete injuries were more likely to be working or going to school after SCI. Benefits and payor were also associated with psychological distress. Privately sponsored subjects were less distressed, whereas those sponsored by Medicaid were most distressed. Extent of benefits received was found to be inversely associated with distress and self-esteem. Persons with lower self-esteem received more postdischarge benefits, whereas those who paid for their own benefits and those who received communication equipment benefits paid by insurance, reported higher self-esteem. Implications for possible policy changes based on these results are discussed.

The challenge of outcome evaluation in homeless services: Engagement as an intermediate outcome measure

Abstract Evaluating treatment outcomes for programs serving individuals who are homeless and mentally ill presents many challenges in terms of measures available and timeframes for data collection and analysis. These difficulties pose significant obstacles in terms of responsiveness to the need for short-term justification of program funding and for program modifications to improve operations. Information is presented from a two-site intervention in Michigan, providing outreach and in vivo services to individuals who are homeless and mentally ill, which measured client engagement with project services. The projects use of engagement as an intermediate outcome measure is described. Data is presented supporting the validity of the measure. Documentation is provided on the measures utility in evaluating program performance and in improving project operations. Discussion follows on interpretation of program-level and individual client differences in engagement status.

Short versus longer term effectiveness of an outreach program for the homeless mentally Ill

Presents 12-month follow-up results from an outreach/linkage intervention with persons who are homeless and mentally ill, contrasting these with results obtained at 4 months. Both sets reflect the success of the program in placing individuals in independent housing. However, longer term data provide useful information regarding client movement patterns and increased tenure in nonhomeless living arrangements beyond the termination of specialized services. Analyses of 12-month residential outcomes identified four variables as significant predictors: recruitment source, project service duration, CMH service duration, and client age. In contrast to 4-month predictors, variables reflecting baseline client functioning were no longer significantly related to outcome, suggesting that the positive effects of the intervention may take longer to achieve with some clients. Discussion focuses on the implications of these effectiveness results for future research designs and measures as well as the utility and limitations of preexperimental approaches for evaluating innovative service models when implementation and efficacy experiences are lacking.