Medicine and Health Sciences Commons^™

Homelessness, Alcohol, And Other Drug Abuse: Research Traditions And Policy Responses, Gerald R. Garrett

New England Journal of Public Policy

Although homeless alcoholics and other drug abusers more often elicit public scorn than sympathy, ironically they enjoy a celebrity status as research subjects. This article provides an overview of research literature on the homeless and their alcohol and drug problems. The evolution of public policies concerning control, rehabilitation, and treatment of homeless substance abusers is also traced with special attention to the interaction between scientific literature and policy responses over the past century. Although homeless populations today are more diverse than their counterparts in earlier decades, the analysis suggests that the policies and programs developed in response to the crisis …

Classification And Its Risks: How Psychiatric Status Contributes To Homelessness Policy, Anne M. Lovell

New England Journal of Public Policy

This article examines the extent to which psychiatric classification in public policy research contributes to the equation of homelessness and mental illness. Surveys that measure psychiatric status of homeless persons are reviewed to understand whether they contribute to biased rates of mental illness among homeless persons. The relationship between psychiatric classification and the concept of need is examined and alternatives to current classification are proposed. Classification is discussed particularly in relation to policies of segmentation for "single" homeless adults.

Victimization And Homelessness: Cause And Effect, Pamela J. Fischer

New England Journal of Public Policy

The literature on the contemporary homeless population is reviewed to examine the association of victimization with homelessness. Although few studies have specifically focused on victimization, findings derived from studies investigating pathways to homelessness, prevalence of health, mental health, and substance-use disorders, and demographic profiles and life histories suggest that victimization both causes homelessness and is an outcome of losing housing. Causal sequences ending in homelessness most frequently involve domestic violence, which mainly affects women, although other types of abuse may extrude individuals from their established housing. Once they become homeless, the risk of violence escalates for people living on the …

The Needs Of Hartford's Homeless Mentally Ill, Steven Kessler

New England Journal of Public Policy

A state budget deficit in Connecticut threatens the closing of state mental hospitals and holds the potential of displacing chronically mentally ill patients into homelessness. This article explores the historical association between deinstitutionalization of patients from mental hospitals and subsequent homelessness. One third to two thirds of homeless individuals are mentally ill and require intensive, specific, and targeted responses by the community to end their homelessness. Trends in the care of the chronically mentally ill and the conditions of those who are homeless in Connecticut are explored. Model treatment programs are discussed to suggest possible actions, and recommendations that would …

Aggressive Outreach To Homeless Mentally Ill People, Ellen Nasper, Melissa Curry, Elizabeth Omara-Otunnu

New England Journal of Public Policy

Historically, people with chronic mental illnesses have been particularly at risk for homelessness. In 1984, the Connecticut Department of Mental Health (DMH) articulated policy to insure housing for mentally ill persons. One facet of that policy is to increase mental health services to homeless people. The Greater Bridgeport Community Mental Health Center has addressed this need through the formation of the Homeless Outreach Team (HOT). This article describes the development, organization, clinical work, and future of HOT. The team is run jointly by the Mental Health Center (funded through DMH) and Family Service-Woodfield, a United Way-funded agency that provides case …

Mentally Ill Persons In Emergency And Specialized Shelters: Satisfaction And Distress, Russell K. Schutt, Stephen M. Goldfinger

New England Journal of Public Policy

Emergency and specialized mental health shelters represent different service philosophies and are meant to appeal to different segments of the homeless and homeless mentally ill population. This article describes the different characteristics and needs of users of emergency and specialized mental health shelters for homeless persons in Boston. Service satisfaction is described in relation to these characteristics and needs as well as in terms of shelter type. Implications are identified for social and mental health service policies for the homeless.

Ending Homelessness Among Mentally Disabled People, Steven A. Hitov

New England Journal of Public Policy

This article examines some of the many shortcomings of the mental health system operated by the Massachusetts Department of Mental Health (DMH) and explores the impact of that system on single homeless individuals who suffer from some form of serious or long-term mental disability. To afford that discussion context, however, the article first briefly examines those forces which have, and have not, significantly contributed to the large number of mentally disabled homeless persons. It suggests certain changes, including a shift in departmental focus from hospitals to community services and the creation of a housing subsidy system exclusively for DMH clients, …

The Kindred Bonds Of Mentally Ill Homeless Persons, Richard C. Tessler, Gail M. Gamache, Peter H. Rossi, Anthony F. Lehman, Howard H. Goldman

New England Journal of Public Policy

While the unraveling of the kinship bond has long been suspected to play a role in the epidemiology of homelessness, the connection between kinship and homelessness has been little studied. Based on a normative analysis of the role of family structure in response to adversity, this article explores the impact of the amount and quality of kinship ties on episodes of homelessness experienced by discharged psychiatric patients in Ohio. Survey data derived from personal interviews with both former patients and their kin indicate more strain in relations with kin of the homeless than the nonhomeless. The strain in the kinship …

Housing, Community Support, And Homelessness: Emerging Policy In Mental Health Systems, Paul J. Carling

New England Journal of Public Policy

This article summarizes the dramatic changes in public policy through which public mental health systems are attempting to meet the housing and community support needs of persons with severe and persistent mental illnesses, including those who are homeless. It traces the historical approach to meeting these needs through defining people principally as patients and providing some combination of psychotropic medications, outpatient therapy, and structured, supervised quasi-institutional settings such as group homes, shelters, and segregated single-room-occupancy, or board-and-care facilities. A transition phase in public policy has emphasized defining these individuals essentially as service recipients who need greater or lesser amounts of …

Program Design And Clinical Operation Of Two National Va Initiatives For Homeless Mentally Ill Veterans, Robert Rosenheck, Catherine A. Leda, Peggy Gallup

New England Journal of Public Policy

In 1987, in response to reports of large numbers of veterans among America's homeless, the Department of Veterans Affairs established two new national health care initiatives, which have seen over 40,000 homeless veterans since their inception. We present here evaluation and treatment data on a sample of 14,000 of them. Because of differences in their design, the two programs vary in the degree to which they emphasize community outreach, homelessness prevention, and the provision of aftercare services to patients discharged from other VA programs. In spite of these differences, veterans treated in the two programs have similar health care problems …

The New England Shelter For Homeless Veterans: A Unique Approach, Ken Smith, James M. Yates

New England Journal of Public Policy

It has been estimated that veterans comprise one third of the homeless population. To combat this national disgrace, many small veterans' groups have been formed nationwide to serve their homeless "brothers" in such settings as shelters, group homes, and outreach centers.

A Boston group, the Vietnam Veterans Workshop, based its New England Shelter for Homeless Veterans on the simple but powerful concept of veteran helping veteran. The shelter created a program to accomplish three important functions: providing the basic necessities of a bed, a meal, clothing, and a hot shower; rehabilitating the veterans by offering various activities to comfort and …

Health Care Linkage Project: Improving Access To Care, Martha G. Ferguson, Lon Berkeley, Louis Fourcher, Belinda Guyton, Linda Ross Reiner

Henry Ford Hospital Medical Journal

The primary objective of the Health Care Linkage Project, funded by a grant from the Chicago Community Trust, is to develop, implement, and evaluate a primary health care linkage network within the city of Chicago that creates formalized linkages between community health centers, the Chicago Department of Health clinics, and hospitals. Six linkage networks are currently operational, with an additional two sites phased in during 1991. The success of the pilot project has been demonstrated by hundreds of patients receiving primary care and ancillary services on a more timely basis, by greater coordination between the public and private sector, by …

Urban Health Care: An Integral Part Of The United States Health Care System, Sander M. Levin

Henry Ford Hospital Medical Journal

No abstract provided.

Mount Sinai: A Special Hospital For A Special Community, Benn Greenspan

Henry Ford Hospital Medical Journal

No abstract provided.

Management Of Impotence After Treatment Of Carcinoma Of The Prostate, Dinesh J. Telang, Riad N. Farah

Henry Ford Hospital Medical Journal

Impotence commonly occurs as a result of treatment of carcinoma of the prostate. We review the etiology, evaluation, and treatment options available for these patients as well as our experience with fifty prostate cancer patients who underwent placement of penile prostheses. Several excellent alternatives are available for patients with impotence resulting from treatment of carcinoma of the prostate.

Urban Health Care: Solutions For The 1990s, David R. Nerenz, David W. Benfer

Henry Ford Hospital Medical Journal

No abstract provided.

Urban Health Solutions In The 1990s: No Time For False Promises, Seth Foldy

Henry Ford Hospital Medical Journal

No abstract provided.

Urban Health And The Social Contract: Poverty, Race, And Death, H. Jack Geiger

Henry Ford Hospital Medical Journal

No abstract provided.

Community Health Centers: A Resource For Service And Training, Joan Hedgecock, Maria Castro, William B. Cruikshank

Henry Ford Hospital Medical Journal

The American Medical Student Association (AMSA) Foundation is assisting the U.S. Public Health Service in increasing the number of primary care physicians trained and committed to practice in medically underserved areas. In collaboration with the American Academy of Family Physicians, the Ambulatory Pediatrics Association, and the Society of General Internal Medicine, AMSA conducted an assessment of federally-funded residency programs to identify and describe their affiliations with federally-funded community and migrant health centers (CIMHCs). Of the 260 programs assessed and the 147 responses, 125 offer community-based training. Of these, 73 offer training in primary care centers and 39 offer training in …

Health Care Consortia: A Mechanism For Increasing Access For The Medically Indigent, Patricia A. Caplan, Bonnie Lefkowitz, Lynn Spector

Henry Ford Hospital Medical Journal

In response to poor coordination among health and social service providers, health care consortia have emerged in many areas of the United States. Consortia link multiple providers in a common structure to create comprehensive systems of care. They can he formally structured or informal combinations of providers that engage in coordination hut otherwise do not comprise an independent organization. The functions most common among all types of consortia are shared services and service coordination; however, a number of consortia also operate outreach/education programs. Consortia represent an innovative response to the need both for vertical integration—case management of all levels of …

An Update On The Role Of Ploidy In Prostate Carcinoma, Jill M. Peters-Gee

Henry Ford Hospital Medical Journal

One of the characteristic features of prostate carcinoma is its marked variation in biologic behavior. DNA quantitation has been studied in prostate carcinoma using a variety of techniques. Evaluation of tumor ploidy suggests that this may be the best predictor of the biologic behavior of prostate cancer in individual patients. This comprehensive review addresses the current studies, stage by stage, to clarify the clinical significance of these findings.

Primary Papillary Serous Carcinoma Of The Peritoneum: A Case Of Complete Remission Of Bulky Peritoneal Disease After Chemotherapy, Walid A. Saleh, Cosmas J. M. Van De Ven, Wooshin Kim

Henry Ford Hospital Medical Journal

Peritoneal papillary serous carcinoma is a rare tumor that involves the surface of the pelvic and/or abdominal peritoneum. Long-term survival among patients with this tumor has been rare. Most patients with this cancer have been treated with debulking surgery and postoperative chemotherapy. A case of incompletely resected peritoneal papillary serous carcinoma with a complete response to cisplatin-based chemotherapy is reported. Subsequent laparotomy revealed no residual tumor. This case suggests that primary chemotherapy may be successful in treating unresectable primary papillary serous tumors of the peritoneum.

Back Matter

Henry Ford Hospital Medical Journal

No abstract provided.

The Current Role Of Prostatic Acid Phosphatase And Prostate-Specific Antigen In The Management Of Prostate Cancer, Sugandh D. Shetty, Joseph C. Cerny

Henry Ford Hospital Medical Journal

No abstract provided.

Front Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Universal Health Care For Americans, Frank Clemente

Henry Ford Hospital Medical Journal

No abstract provided.

Training The Urban Health Care Provider: One Department's First Steps, James Schindler

Henry Ford Hospital Medical Journal

As our country faces a national crisis in health care, few have outlined plans to improve the shortage of primary care physicians. This is especially critical in urban areas where sociocultural impacts on health are large. The Department of Family Practice and Community Medicine at the University of Texas School of Medicine in Houston has begun development of a division of Urban Family Medicine to address the special training needs of the urban family practitioner. Subdivisions that have been formed focus on undergraduate curriculum, graduate educational strategies, service, and research and policy to further develop the training model.

Federal, State, And Local Partnerships In Providing Primary Care: One Urban Health Department's Endeavor With A State University Medical Center, Joy L. Getzenberg, D. Patrick Lenihan

Henry Ford Hospital Medical Journal

We describe how the federal government, the City of Chicago, and the State of Illinois worked together to increase the availability and accessibility of health care services on Chicago's underserved west side by reopening a bankrupt, federally-funded community health center. The federal government made the building available to the City which then contracted with a state university medical center to be the provider of services. This partnering has allowed the Chicago Department of Health to offer services in a previously underserved area. The University has gained an opportunity for community-based primary care teaching, as well as community relations. Patients have …

Public Health Care Delivery In Five U.S. Municipalities: Lessons And Implications, David G. Whiteis, J. Warren Salmon

Henry Ford Hospital Medical Journal

Increasing pressures on private and public hospitals have necessitated a reassessment of urban health care delivery. Patients left unserved by stressed private hospitals have placed a greater burden on public institutions, which themselves are often old, underfunded, and in danger of closure. As policy analysts consider remedies, primary care in community-based settings has reemerged as an important component of planning. We present results of a comparative analysis of five public health care delivery systems (Boston, Dallas, Denver, Milwaukee, and Seattle), reflecting their economic, political, and cultural dynamics. Although significant differences in the relative centralization of care and reliance on community-based …

Pace: A Capitated Model Towards Long-Term Care, John Shen, Ann Iverson

Henry Ford Hospital Medical Journal

No abstract provided.