G. J. Huba

A Short Depression Index for Women

The CES-D is a well-known index of acute depressive symptoms experienced over a 7-day period that has been used in literally hundreds of studies. This article presents the psychometric derivation of 8- and 4-item screening versions of the CES-D for use in research with community-based samples. These short depressive symptom indices can be used in those instances where a brief assessment is needed for broad screening or research purposes. Using data from a heterogeneous community sample of 411 women, the 8-item CES-D was found to correlate .93 with the full 20-item CES-D while the 4-item CES-D was found to correlate .87 with the full CES-D. In a second sample of 83 women in a residential drug abuse program, the 8- and 4-item measures correlated .54 and .47, respectively, with the BPI Depression scale.

Level of Burden: Women with More Than One Co-Occurring Disorder

Utilizing an expanded concept of level of burden, the impact of multiple problems experienced by women in a residential drug abuse treatment program on treatment retention and outcomes is investigated. Level of burden is defined in this study as the number and severity of problems, including psychological problems, cognitive impairment, chronic health problems, HIV/AIDS status, as well as substance abuse. In the first study of 260 women, the ability to retain women in treatment as a function of their level of burden is examined using the technique of survival analysis. Results indicate that early in the course of treatment, high-burden clients tend to be the highest risks for early termination. In addition, there is a significant interaction between time in the program and level of burden. In the second study of 68 women, partial correlations between level of burden and ratings of outcomes by program staff at time of discharge are examined. Results show that many of the treatment outcomes are significantly negatively correlated with the initial levels of burden. Implications for treatment providers and directives for future studies are discussed.

A model for adolescent-targeted HIV/AIDS services: conclusions from 10 adolescent-targeted projects funded by the Special Projects of National Significance Program of the Health Resources and Services Administration.

This article describes a model of service for youth living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and youth at high risk for HIV, based on the lessons learned from a set of innovative service projects funded by the Health Resources and Services Administration Special Projects of National Significance (SPNS) Program. Although each project has a unique focus, all collectively seek to enroll youth with HIV into care through new or existing HIV service networks, and direct recruitment via street outreach and other similar methods. The use of various outreach methods tends to yield different patterns of engagement of youth in services. An ideal approach may use a combination of complementary outreach methods. Data at both the national and local levels point to five major elements that capture the innovations of the collective service model: (a) peer-youth information and dissemination; (b) peer-youth advisory groups; (c) peer-youth outreach and support; (d) professional, tightly linked medical social support networks; and (e) active case management and advocacy, for individual clients as well as the programs themselves, to link the various components together. One of the most important factors in the models success is that youth and professionals share an equal partnership in all stages of program design, planning, and implementation. Youth and professionals each share their expertise in a dynamic process. In addition, active case management is crucial, not only to ensure that clients receive needed services, but also to ensure that the programs themselves run in a coordinated, tightly linked way. Given needs of adolescent clients and existing adult-oriented service networks, the use of active case management and the active participation of youth in the services system are critical.

Childrens Hospital Los Angeles: a model of integrated care for HIV-positive and very high-risk youth.

Childrens Hospital Los Angeles (CHLA) provides an integrated care model for youth with and at high risk for human immunodeficiency virus (HIV) infection, through a grant from the Special Projects of National Significance Program, HIV/acquired immunodeficiency syndrome (AIDS) Bureau, Health Resources and Services Administration. The project has provided outreach to 8400 youth at risk and has provided clinical services to 296 young men (16.6% HIV positive) and 352 young women (9.1% HIV positive). Situated within the Division of Adolescent Medicine at Childrens Hospital Los Angeles, the project consists of a general medical clinic for youth along with psychosocial services including case management, counseling, and related ancillary services. A key part of the model is to provide health services within a general medical clinic for youth where participation in the clinic does not serve to identify a youth to his or her peers in the waiting room as having HIV. Another key part of the model is to provide extensive outreach within the community including contacts at bars and social clubs where high-risk youth congregate, on the street, and through the social networks of youth already identified as having HIV who participate in the CHLA clinics. In the last 2 years of the program, the peer outreach component has been strengthened and peer support activities have also been implemented. The program also has developed a Computer-Assisted Adolescent Referral System (CAARS), available on diskette and on the Internet, for the referral of youth to services in the Hollywood area.

Elder Abuse Forensic Centers

Elder abuse forensic centers present a new model of multidisciplinary collaboration on elder abuse cases. The “clients” of a forensic center are Adult Protective Services (APS), law enforcement, and the Long-term Care Ombudsman. Centers take the basic multidisciplinary team model and add a geriatrician and a psychologist. Additionally, forensic center team members make home visits with APS and others for the purposes of conducting psychological or medical evaluations, lessening the burden of multiple interviews for the alleged abuse victims, and gathering evidence for possible prosecution. The challenges and successes of the four California forensic center teams are discussed.

Effects of women-sensitive, long-term residential treatment on psychological functioning of diverse populations of women

A number of studies have found that women who abuse substances enter treatment with greater psychological problems and more vulnerabilities than men. This article reports on a 5-year study of clients in a comprehensive, residential drug treatment program for women and their children. Psychological assessments on 362 women included the Basic Personality Inventory (BPI), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Luria-Nebraska Neuropsychological Battery, Screening Test (LNNB-ST). Early in the course of treatment, the typical client tends to experience a great deal of distress, as evidenced by scores on the CES-D. Other assessments indicate she is relatively alienated, mistrustful of others, and resentful of rules imposed on her by others. Repeated assessments show that these psychological indicators improve significantly as the client progresses through the treatment program. Additional studies are needed to focus on long-term treatment outcomes of women in programs designed specifically for them.

Women living with drug abuse and HIV disease: drug abuse treatment access and secondary prevention issues.

In collaboration with the National Institute on Drug Abuse, the Health Resources and Services Administration is conducting a multisite, longitudinal study on issues of service needs, service utilization, and access to care for drug abusers with HIV. This article discusses access to drug abuse treatment and HIV secondary prevention for 116 women interviewed during the studys first year in five U.S. cities. Using interview data from 115 service providers in those same cities, it also discusses drug abuse treatment availability and barriers to service expansion for drug users with HIV. Study findings indicate that there are highly significant gaps between the drug abuse treatment services these women feel they need and those they have been able to receive; these were particularly pronounced for drug detoxification and residential and outpatient drug-free treatment. Women who used crack cocaine or injection drugs had particularly high levels of need for residential and outpatient drug abuse treatment, while women who use crack were found to have significantly less experience with the drug abuse treatment system than IDUs. HIV secondary prevention was also found to be a critical need for these women, many of whom were engaging in behaviors that place them at risk for reinfection, infection with other diseases, and transmission to others. Providers indicated that lack of funding was the major barrier to expanding services for this population; other barriers, such as lack of ancillary services and transportation, were also noted. Two positive findings were that many drug abuse treatment agencies in these cities provide a wide range of ancillary services and that many different kinds of agencies offer drug abuse treatment services.

Unmet Needs in Groups of Traditionally Underserved Individuals with HIV/AIDS: Empirical Models

SUMMARY Over the course of the HIV epidemic, the demographics of the populations of affected individuals have changed. Groups that traditionally have been underserved in systems of care have a number of unmet service needs. This article presents results based on data from 478 patients in five national demonstration projects which were funded to enroll individuals from traditionally underserved groups and to help them access services using different strategies. The participants in these programs had a high level of unmet need prior to enrolling in care. Data on client service needs were related to 17 indicators of traditionally underserved status including demographic characteristics and risk behaviors, using the data modeling method of Exhaustive CHAID (Chi-squared Automatic Interaction Detector). Crack cocaine users with HIV/AIDS were more likely than other patient groups to have unmet service needs. Patients who were homeless or in precarious housing also were vulnerable. Results are discussed in terms of designing and evaluating innovative service models to close these service gaps.

Perceived barriers to receiving HIV services in groups of traditionally underserved individuals: empirical models.

SUMMARY Persons living with HIV/AIDS face many issues that make them highly vulnerable to a number of health and social problems. As the demographics of the epidemic have shifted in recent years, many members of traditionally underserved groups have encountered barriers to entering the services system. This article uses data from seven national demonstration projects funded to enroll persons with HIV/AIDS who tend to “fall through the cracks” and help them access needed services. Data on the initial perceptions of the participants about barriers to accessing services were related to 17 indicators of traditionally underserved status including demographic characteristics and behavioral variables using the data modeling method of Exhaustive CHAID (Chi-squared Automatic Interaction Detector). Through the modeling methods, the groups most likely to experience a large number of barriers to service participation are identified. Having children needing care is particularly predictive of the level of barriers to care.

Evaluation of the effects of outreach to women with multiple vulnerabilities on entry into substance abuse treatment.

This paper examines ways in which the level of participation in intensive outreach contributes to entry into substance abuse treatment. It was hypothesized that the number of outreach contacts to substance abusing women predicts the likelihood of their entry into drug abuse treatment. As such women often have multiple vulnerabilities that impact upon their needs and readiness for seeking treatment, we also examine the relationships among readiness to seek assistance, the womens level of involvement with the outreach project, and admission to treatment. A sample of 665 women who participated in an enhanced outreach and treatment readiness preparation program was tracked to examine patterns of referral and entry into substance abuse treatment. The number of outreach contacts was inversely related to receiving referrals to substance abuse treatment, as well as to the completion of those referrals (for a subsample of 551 women who had received referrals). In addition, victims of domestic violence were 50% more likely to receive a referral to drug abuse treatment, but of the women who received such a referral, the lack of involvement in a violent relationship predicted entry into treatment. Findings are discussed in terms of their implications for designing and implementing outreach and treatment programs for women with multiple therapeutic issues, particularly substance abuse and domestic violence.