Gerald J. Stahler

PREDICTING RECIDIVISM FOR RELEASED STATE PRISON OFFENDERS: Examining the Influence of Individual and Neighborhood Characteristics and Spatial Contagion on the Likelihood of Reincarceration

We examined the influence of individual and neighborhood characteristics and spatial contagion in predicting reincarceration on a sample of 5,354 released Pennsylvania state prisoners. Independent variables included demographic characteristics, offense type, drug involvement, various neighborhood variables (e.g., concentrated disadvantage, residential mobility), and spatial contagion (i.e., proximity to others who become reincarcerated). Using geographic information systems (GIS) and logistic regression modeling, our results showed that the likelihood of reincarceration was increased with male gender, drug involvement, offense type, and living in areas with high rates of recidivism. Older offenders and those convicted of violent or drug offenses were less likely to be reincarcerated. For violent offenders, drug involvement, age, and spatial contagion were particular risk factors for reincarceration. None of the neighborhood environment variables were associated with increased risk of reincarceration. Reentry programs need to particularly address substance abuse issues of ex-offenders as well as take into consideration their residential locations.

Educational Policy and Reform for Homeless Students. An Overview.

This article provides an overview of educational reform efforts that have been targeted toward assisting homeless students. The authors first review some of the difficulties and barriers that confront homeless children in terms of school access and academic success. The authors then examine four different types of educational reforms for homeless students—mainstreamed schools, supplemental supports, transitional schools (separate schools), and modified comprehensive schools—in relation to the existing barriers for homeless students. Using a case study approach, the authors briefly describe the first modified comprehensive school in the nation and the programs that are being implemented at the school. This article concludes that school reforms for homeless children need to be tailored to the specific context of the community and not be based on national one-size-fits-all reform policy. Recommendations are provided to assist in the planning of educational programs to enhance the academic success of the homeless student.

A Faith-Based Intervention for Cocaine-Dependent Black Women

Abstract The purpose of the present study was to obtain preliminary data on the effectiveness of a faith-based treatment adjunct for cocaine-using homeless mothers in residential treatment. The Bridges intervention utilizes various Black church communities to provide culturally-relevant group activities and individual mentoring from volunteers. Eighteen women who were recent treatment admissions were randomly assigned to receive Standard Treatment plus Bridges or Standard Treatment with an Attention Control. Participants were assessed at intake and three and six months after intake. Bridges treatment resulted in significantly better treatment retention (75% vs. 20% at six months) than standard residential treatment alone. In addition, Bridges produced superior outcomes at the six month followup assessment on a secondary measure of cocaine abstinence. Creating a community of social support through Black churches appears feasible and promising, and may be a cost-effective means of providing longer-term post-treatment support for cocaine-addicted women.

Childhood Trauma, Avoidance Coping, and Alcohol and Other Drug Use Among Women in Residential and Outpatient Treatment Programs

Abstract This study evaluates the different types of childhood trauma, avoidance coping, and patterns of drug and alcohol use among 112 alcohol and drug abusing females in outpatient and residential treatment. A passive research design with self-report surveys was administered to female participants during treatment to assess the relationship between childhood trauma, coping methods, and alcohol and drug use. A multiple regression analysis demonstrated that women with a history of emotional abuse were more likely to engage in avoidance coping skills than those without a history of emotional abuse, which provides some support for the theory that alcohol and drug abuse may be an avoidance coping method for childhood trauma.

Retention Issues in Treating Homeless Polydrug Users

The present paper describes client engagement issues encountered in a research demonstration program that provides treatment for homeless polydrug users in Philadelphia. To better understand the reasons for premature program disengagement, various points of attrition in the subject recruitment and program sequence were identified, process evaluation data were used to closely monitor attrition, client interviews with program dropouts were conducted, and feedback was solicited from staff. In response to the problem, a multi-pronged strategy was formulated to reduce the number of clients leaving prior to completing treatment, and to increase the number who reengage with the program.

Racial and Ethnic Disparities in Outpatient Substance Use Disorder Treatment Episode Completion for Different Substances.

This study investigates how racial and ethnic disparities in treatment episode completion vary across different problem substances in an urban sample of 416,224 outpatient treatment discharges drawn from the 2011 U.S. Treatment Episode Dataset-Discharge (TEDS-D) data set. Fixed effects logistic regression is employed to test for the association of race and ethnicity with treatment episode completion for different substances of use while controlling for confounding demographic, socioeconomic, and geographic clustering factors. Results show that African Americans and Hispanics are less likely to complete a treatment episode than Whites, and that these disparities vary among users of different substances. For African Americans, this disparity is observed over all substances, but is particularly acute among users of alcohol and methamphetamine, substances for which African Americans generally have lower rates of use disorder as compared to Whites. For Hispanics, this disparity is driven primarily by users of heroin, for which Hispanics are only 75% as likely as Whites to complete a treatment episode. For users of cocaine and methamphetamine, there is no significant difference between Hispanics and Whites in the likelihood of treatment episode completion. These results contribute to emerging research on the mechanisms of substance use disorder treatment outcomes and highlight the need for culturally appropriate treatment programs to enhance treatment program retention and associated positive post-treatment outcomes.

Geographic Barriers to Community-Based Psychiatric Treatment for Drug-Dependent Patients

The World Health Organization has urged governments worldwide to implement evidence-based treatment services for drug addiction and mental health disorders, but the role of geographic characteristics in influencing treatment continuity for this population has been largely understudied. Here, we employ logistic regression (N = 294) to investigate how accessibility and neighborhood socioeconomic context influenced treatment continuity for a sample of 294 drug-dependent patients who received acute inpatient psychiatric treatment at a large, inner-city hospital in Philadelphia, Pennsylvania, and who were then referred to outpatient care. Results indicate that longer travel time to treatment, a high crime rate in the patients home neighborhood, and traveling from a relatively lower to a higher crime neighborhood for treatment suppress treatment continuity. These contextual influences are moderated by ethnicity, where whites are influenced more strongly by travel time to treatment. This likely reflects the locations of treatment programs relative to patterns of residential segregation. African Americans both reside and attend treatment within the very highest crime areas, and this appears to have a particularly negative impact on treatment continuity for African Americans. This research highlights the need for more careful consideration of geographic issues in psychiatric treatment planning.

Editors’ Introduction: Homelessness and substance abuse in the 1990s

Gerald Stahler is an assistant professor in the Department of Geography and Urban Studies at Temple University (Room 309, Gladfelter Hall, Philadelphia, PA 19122). His research interests center on the evaluation ofhuman services programs as well as on substance abuse among the homeless. Eric Cohen, a sociologist, is completing a postdoctoral fellowship in the Department of Psychiatry at the University of Pennsylvania. He is involved in research on crack and heroin addiction.

Residential and outpatient treatment completion for substance use disorders in the U.S.: Moderation analysis by demographics and drug of choice

BACKGROUND This study investigates the impact of residential versus outpatient treatment setting on treatment completion, and how this impact might vary by demographic characteristics and drug of choice, using a national sample of publicly funded substance abuse programs in the United States. METHODS This is a retrospective analysis using data extracted from the 2011 Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episode Data Set (TEDS-D). A total of 318,924 cases were analyzed using logistic regression, fixed-effects logistic regression, and moderated fixed-effects logistic regression. RESULTS Residential programs reported a 65% completion rate compared to 52% for outpatient settings. After controlling for other confounding factors, clients in residential treatment were nearly three times as likely as clients in outpatient treatment to complete treatment. The effect of residential treatment on treatment completion was not significantly moderated by gender, but it was for age, drug of choice, and race/ethnicity. Residential compared to outpatient treatment increased the likelihood of completion to a greater degree for older clients, Whites, and opioid abusers, as compared to younger clients, non-Whites, and alcohol and other substance users, respectively. CONCLUSION We speculate that for opioid abusers, as compared to abusers of other drugs, residential treatment settings provide greater protection from environmental and social triggers that may lead to relapse and non-completion of treatment. Greater use of residential treatment should be explored for opioid users in particular.

Do therapists bias their ratings of patient functioning under peer review

The present study was an attempt to examine the rating bias of therapists participating in an evaluation of an experimental quality assurance, system at a community mental health center. The test program was intended to identify patients who demonstrated lack of progress or poor level of functioning after two months of treatment, and to employ a clinical assessment process by independent clinicians to evaluate problems in the quality of care.It was believed that the therapists knowledge that they might have their clinical work-assessed would lead to biased ratings of more severe symptomatology in their patients. The results of this study partially supported the hypothesis., Patients in the peer review system were rated as more dysfunctional at admission on Psychological Functioning than patients in the control groups. No differences, however, were, found on Basic Life Functioning, Anti-Social Behavior, or Mental Processes. The implications for these results relative to psychotherapy research, quality assurance, and program evaluation are discussed.