Gary A. Morse

Can You Trust Self-Report Data Provided by Homeless Mentally Ill Individuals?.

Reliability and validity of self-report data provided by homeless mentally ill clients were generally favorable. More specifically, test-retest reliability coefficients for eight measures ranged from .81 to .99 over a 1 week period. With two exceptions, internal consistency estimates of reliability ranged from .70 to .96. Interrater reliability estimates on a new self-report measure of client resource use were generally above .75. Client self-reports of service use also agreed with treatment staff estimates for most service categories, providing evidence for the validity of self-reports of service use made by homeless mentally ill individuals.

Outreach to homeless mentally ill people: Conceptual and clinical considerations

This paper describes a model of outreach predicated on developing a trusting, meaningful relationship between the outreach worker and the homeless person with mental illness. We describe five common tasks inherent in this model of outreach (establishing contact and credibility, identifying people with mental illness, engaging clients, conducting assessments and treatment planning, and providing ongoing service). Other issues discussed include: (a) Responding to dependency needs and promoting autonomy; (b) setting limits while maintaining flexibility; (c) resistance to mental health treatment and follow-up service options.

Homeless men and women: Commonalities and a service gender gap

Gender differences among homeless persons on a host of variables were examined. A stratified random sample of 248 homeless persons staying in shelters in St. Louis provided data for the study. More similarities than differences between men and women were found. However, men tended to be homeless for longer periods and were more likely than women to sleep on the streets. Men were also more likely than women to have a drinking problem and to have been convicted of a crime. Men were less likely than women to ever have been married and to be caring for dependent children. The most striking gender differences occurred on service utilization variables; women were much more likely than men to have received social services. Comparison of our data with previous studies and potential explanations for the gender gap in service utilization are offered.

Predicting Chronic Homelessness

Lack of human capital, social alienation, psychiatric pathology, and exposure to stressful life events have all been offered as theoretical explanations for chronic homelessness. In this study, a multiple regression equation that included variables from all four theoretical orientations did significantly predict the length of time homeless. However, only a small percentage of the total variance of chronic homelessness could be explained by these individual-difference variables. Additional research is needed to determine if societal-level variables are more powerful predictors of chronic homelessness.

Development and cross‐validation of a system for classifying homeless persons

The present study used cluster analysis to empirically derive and cross-validate a system for classifying homeless persons on the basis of their service needs. Variables used in the subgroup identification phase of the study included psychopathology, alcoholism, social support, socioeconomic status, and health status. Four subgroups were identified: (1) an economically disadvantaged group, (2) an alcoholic group, (3) a mentally ill group, and (4) a relatively advantaged group. Subsequent analysis revealed few differences between the four groups in background characteristics. Moreover, subgroups were similar in service willingness and utilization, with the exception of utilization and willingness to receive treatment for alcohol and mental health problems. The results suggest the need for policies and services that address the core socioeconomic needs that cut across all subgroups, as well as for additional, specialized services for those with psychiatric or alcohol problems.

Client outcomes and the working alliance in assertive community treatment programs.

This study examined the relationship between outcomes and the working alliance in clients who were receiving assertive community treatment only or integrated assertive community treatment (assertive community treatment plus substance abuse treatment). All 98 participants had a severe mental illness and a substance use disorder. The Working Alliance Inventory assessed the alliance from the perspective of both the client and the case manager at 3 and 15 months into treatment. The six outcome measures were stable housing, client rating of psychiatric distress, interviewer rating of psychiatric symptoms, self-report of days used alcohol or drugs, and interviewer rating of substance use. Only 4 of 24 correlations were significant, indicating little relationship between the strength of the working alliance and client outcome.

Prototypical Profiles of the Brief Psychiatric Rating Scale

Three prototypical profiles of the Brief Psychiatric Rating Scale (BPRS; Overall & Gorham, 1962) were isolated using a Q-type factor-analytic strategy with a sample of homeless men with mental illness (N =165). The 3 profiles-depressed, actively psychotic, and withdrawn-were used to study changes in BPRS profiles over time in a control group and a group that received assertive community treatment (ACT). Over 2 time periods (inception to 12 months and 12-24 months), the 2 groups did not differ in terms of changes in profile shape, but they did differ in terms of changes in profile elevation. The ACT group evidenced a decrease in symptom severity during the last 12 months, whereas the control group showed an increase. Although changes in profile shape in both groups did occur, there was a significant tendency for the shape of the BPRS profiles to remain stable from the inception of the study to the 12-month assessment and from that time to the 24-month assessment. We describe the uses of these prototypical profiles and discuss the applicability of this analytical approach to other assessment instruments.

Predicting psychiatric symptoms among homeless people

Multiple regression was used to predict psychiatric symptoms among homoless people. The following variables were significant predictors of psychiatric symptoms: current life satisfaction, previous psychiatric hospitalization, the number of stressful life events, social support, problem drinking, and childhood unhappiness. The results are discussed in terms of their policy and practice implications, particularly the need for crisis intervention services and for dual-diagnosed clients.

The case manager's view of the helping alliance.

Although the helping alliance has been a topic of investigation in psychotherapy research for decades, few studies have examined the role of the helping alliance in assertive community treatment programs serving people with severe mental illness. In this article, we describe a series of analyses focused on the case manager’s view of the helping alliance. The study addressed two primary questions: What factors facilitate a positive helping alliance in case management? What is the relationship of the helping alliance to client outcomes? Results indicated that few client variables predicted the helping alliance. Providing a wider range of services was associated with a stronger alliance at months but not at 18 months. A strong alliance at 18 months was associated with a strong alliance at 6 months. In addition, the alliance at 18 months was rated more positively for clients who were African-American and who did not have a substance use disorder. The helping alliance predicted client satisfaction, anxiety-depression, and hostility-suspicion outcomes at 6 months. However, the helping alliance did not predict any of the client outcome variables at 18 months.

Consistency of Recall of Sexual and Drug-Using Behaviors for Homeless Persons with Dual Diagnosis

In this paper we present data from a study of the consistency of recall of several sexual and drug-using behaviors gathered from face-to-face interviews with homeless persons who have dual diagnosis (severe mental illness plus a substance use disorder). Factors associated with inconsistent reporting are also examined. One hundred and thirty-three individuals participating in a longitudinal study of HIV risk behaviors were recruited for a retrospective recall study. Participants were completing monthly interviews that included assessments of sexual behaviors and drug use. Participants completed an additional interview using the same instruments and were randomly assigned to a 3- or 6-month recall condition; the data from the additional interview were correlated with the regular, monthly interviews. Results indicated that reports of sexual and substance-using behaviors were generally reported consistently for both 3- and 6-month recall periods; however, coefficients for the 3-month interval were generally better than those for the 6-month interval. One exception was that protected intercourse was generally not reported consistently. Inconsistent reporting of sexual and drug-using behaviors was associated with the severity of substance abuse; inconsistent reporting of sexual behaviors was also associated with African-American race. Our data suggest that a 3-month recall interval is generally superior to a 6-month interval for persons with severe mental illness.