Social and Behavioral Sciences Commons^™

Impact Of A Logistics Management Program On Admitted Patient Boarders Within An Emergency Department, Mary Ann Healy-Rodriguez, Rula Wilson, Chris Freer, Laura Pontiggia, Stephen Metraux, Lyndsey Lord

Stephen Metraux

Introduction: ED crowding is a public health issue, and hospitals across the country must pursue aggressive strategies to improve patient flow to help solve this growing problem. The logistics management program (LMP) is an expansion of the bed management process to include a systematic approach to patient flow management throughout the facility and a clinical liaison or field agent to drive throughput at all points of care. The purpose of this study was to examine the effects of an LMP on ED length of stay (ED evaluation times and ED placement times), as well as inpatient length of stay (IPLOS). …

Validation Of Self-Reported Veteran Status Among Two Sheltered Homeless Populations, Stephen Metraux, Magdi Stino, Dennis P. Culhane

Stephen Metraux

Objectives. We assessed the accuracy of self-reported veteran status among sheltered homeless adults to assess the reliability of using self-report to deter- mine the number of veterans in homeless populations and examine whether there are demographic correlates to inaccurate reporting of veteran status. Methods. Records on 5,860 sheltered adults from Columbus, Ohio, and 16,346 sheltered adults from New York City (NYC) were matched with U.S. Department of Veterans Affairs (VA) records. We analyzed the agreement between veteran self-reporting and official records using descriptive measures, diagnostic tests, and logistic regression. Results. The degree of concordance was moderate. Using VA records rather …

Housing Assistance Among Low-Income Families With Children In 20 American Cities, Angelina Fertig, Jung Min Park, Stephen Metraux

Stephen Metraux

No abstract provided.

Public Assistance Receipt Among Older Youth Exiting Foster Care, Thomas Byrne, Stephen Metraux, Minseop Kim, Dennis P. Calhune, Manuel Moreno, Halil Toros, Max Stevens

Stephen Metraux

No abstract provided.

Risk Factors For Becoming Homeless Among A Cohort Of Veterans Who Served In The Era Of The Iraq And Afghanistan Conflicts, Stephen Metraux Ph.D, Limin X. Clegg Ph.D, John D. Daigh Md, Dennis P. Culhane Ph.D, Vincent Kane Mss

Stephen Metraux

Objectives. In this population-based cohort study, we assessed baseline risk factors for homelessness, including the role of service in the Iraq or Afghanistan conflicts, among a large cohort of recent veterans. Methods. Data for this study came from administrative records for 310 685 veterans who separated from active military duty from July 1, 2005, to September 30, 2006. We used survival analysis methods to determine incidence rates and risk factors for homelessness, based on baseline data for military factors, demographic characteristics, and diagnoses of behavioral health disor- ders and traumatic brain injury. Results. Service in Iraq or Afghanistan and, more …

The Age Structure Of Contemporary Homelessness: Evidence And Implications For Public Policy, Dennis P. Culhane, Stephen Metraux, Thomas Byrne, Magdi Stino, Jay Bainbridge

Stephen Metraux

No abstract provided.

Rethinking Homelessness Prevention Among Persons With Serious Mental Illness, Ann Elisabeth Montgomery, Stephen Metraux, Dennis Culhane

Stephen Metraux

During recent years, the need to consider effective and innovative ways to prevent and end homelessness among individuals with serious mental illness has been abetted by an increased and more sophisticated understanding of the composition of the homeless population, the emergence of evidence-based practices to address homelessness, and the passage of the Patient Protection and Affordable Care Act. This article summarizes the evolving understanding of the role that serious mental illness plays in homelessness as well as the interventions that are effective at preventing and ending homelessness among persons with serious mental illness. This summary contextualizes a discussion of the …

Hazardous Drinking And Its Association With Homelessness Among Veterans In Care, Ghose Toorjoo, David A. Fiellin, Adam J. Gordon, Stephen Metraux, Matthew B. Goetz, Oni Blackstock, Keith Mcinnes, Maria C. Rodriguez-Barradas, Amy C. Justice

Stephen Metraux

Background: While scholarship on alcohol use and homelessness has focused on the impact of alcohol abuse and dependence, little is known about the effects of lower levels of misuse such as hazardous use. Veterans receiving care in the Department of Veterans Affairs Health Care System (VA) constitute a population that is vulnerable to alcohol misuse and homelessness. This research examines the effects of hazardous drinking on homelessness in the Veterans Aging Cohort Study, a sample of 2898 older veterans (mean age = 50.2), receiving care in 8 VAs across the country. Methods: Logistic regression models examined the associations between (1) …

Homelessness And Children's Use Of Mental Health Services: A Population-Based Study, Jung Min Park, Stephen Metraux, Dennis P. Culhane, David S. Mandell

Stephen Metraux

This study examined whether children who become homeless differ from other low-income children in their mental health service use before and after their first homeless episode, and to what extent homelessness is associated with an increased likelihood of mental health service use. Differences between children with and without new onset of sheltered homelessness in the use of mental health services emerged following homelessness and widened over time. Sheltered homelessness and foster care placement history were asso- ciated with increased odds of receiving inpatient and ambulatory mental health services. Findings underscore the importance of collaborations between homeless assistance, foster care, and …

Los Angeles County’S Enterprise Linkages Project: An Example Of The Use Of Integrated Data Systems In Making Data-Driven Policy And Program Decisions., Thomas Byrne, Stephen Metraux, Manuel Moreno, Dennis P. Culhane, Halil Toros, Max Stevens

Stephen Metraux

Governments at all levels are tasked with administering public pro- grams that serve large numbers of people. The use of integrated data systems (IDS), which can be used to link administrative records from multiple public agencies into one database, offer a unique mechanism for providing the type of comprehensive information that is important for understanding the complex needs of vulnerable populations and for making data-based policy and program decisions that translate into more effective and efficient policies. In this paper, we draw on recent efforts to restructure Los Angeles County’s General Relief (GR) Program – a cash assistance program for …

Prevalence And Risk Of Homelessness Among Us Veterans, Jamison Fargo Ph.D, Ms, Stephen Metraux Ph.D, Thomas Byrne Msw, Ellen Munley, Anne Elizabeth Montgomery Ph.D, Harlan Jones, George Sheldon Ph.D, Vincent Kane Msw, Dennis Culhane Ph.D

Stephen Metraux

Introduction Understanding the prevalence of and risk for homelessness among veterans is prerequisite to preventing and ending homelessness among this population. Homeless veterans are at higher risk for chronic disease; understanding the dynamics of homelessness among veterans can contribute to our understanding of their health needs. Methods We obtained data on demographic characteristics and veteran status for 130,554 homeless people from 7 jurisdictions that provide homelessness services, and for the population living in poverty and the general population from the American Community Survey for those same jurisdictions. We calculated prevalence of veterans in the homeless, poverty, and general populations, and …

Geographic Access To And Availability Of Community Resources For Persons Diagnosed With Severe Mental Illness In Philadelphia Usa, Stephen Metraux, Eugene Brusilovskiy, Janet A. Prvu-Bettger, Ying-Ling Irene Wong, Mark S. Salzer

Stephen Metraux

This study assesses whether there are differences in geographic access to and availability of a range of different amenities for a large group of persons diagnosed with severe mental illness (SMI) in Philadelphia (USA) when compared to a more general set of residential addresses. The 15,246 persons who comprised the study group had better outcomes than an equal number of geographical points representative of the general Philadelphia population on measures of geographic proximity and availability for resources considered important by people diagnosed with SMI. These findings provide support for the presence of geographic prerequisites for attaining meaningful levels of community …

Changes In Maternal Health And Health Behaviors As A Function Of Homelessness., Jung Min Park, Angela Fertig, Stephen Metraux

Stephen Metraux

This longitudinal study examines the influence of homelessness on maternal health and health behaviors. Using data from the Fragile Families and Child Wellbeing Study, it follows 2,631 families from 20 large US cities over 5 years. Over that period, 9.8 percent of the sample reportedly experienced at least one homeless spell and an additional 23.6 percent experienced one or more doubled-up episodes. Estimated rates of disability, depression, and anxiety are two to three times higher for the homeless group than for those with no homeless spell. Mothers who become homeless are found to have poorer health outcomes both before and …

The Patterns And Costs Of Services Use Among Homeless Families., Stephen Metraux Ph.D, Dennis P. Culhane Ph.D, Jung Min Park Ph.D

Stephen Metraux

This study examines families’ use of behavioral health hospitalization and foster care placement before, during, and after shelter use, comparing families based on shelter pattern and type of housing exit. Results show that inpatient and foster care services use drops in the homelessness period, but rebounds after exit, regardless of pattern of shelter use and type of housing exit. Results suggest that shelters supplant use of services, but not on a sustained basis. Despite declines in concurrent services use, the home- lessness period is overall more costly for episodically and long-term shelter users, primarily owing to the high costs of …

The Impact Of Shelter Use And Housing Placement On Mortality Hazard For Unaccompanied Adults And Adults In Family Households Entering New York City Shelters: 1990–2002, Stephen Metraux, Nick Eng, Jay Bainbridge, Dennis P. Culhane

Stephen Metraux

This study examines mortality among New York City (NYC) homeless shelter users, assessing the relationships between mortality hazard and time in shelter, patterns of homelessness, and subsequent housing exits for both adults in families and single adults. Administrative records from the NYC shelter system were matched with death records from the Social Security Administration for 160,525 persons. Crude mortality rates and life tables were calculated, and survival analyses were undertaken using these data. Life expectancy was 64.2 and 68.6 years for single adult males and single adult females, respectively, and among adults in families, life expectancy was 67.2 and 70.1 …

Examining The Impact Of Mental Illness And Substance Use On Recidivism In A County Jail, Amy B. Wilson, Jeffery Draine, Trevor Hadley, Stephen Metraux, Arthur C. Evans

Stephen Metraux

No abstract provided.

A Prevention-Centered Approach To Homelessness Assistance: A Paradigm Shift?, Stephen Metraux, Dennis P. Culhane, Thomas Byrne

Stephen Metraux

No abstract provided.

Service Use And Costs For Persons Experiencing Chronic Homelessness In Philadelphia: A Population-Based Study, Stephen R. Poulin Ph.D, Marcella Maguire Ph.D, Stephen Metraux Ph.D, Dennis P. Culhane Ph.D

Stephen Metraux

No abstract provided.

Behavioral Health Services Use Among Heads Of Homeless And Housed Poor Families, Jung Ming Park Ph.D, Stephen Metraux Ph.D, Dennis Culhane Ph.D

Stephen Metraux

Abstract: objectives. This study compares the use of and cost for behavioral health ser- vices among heads of homeless and housed poor families. methods. Medicaid records for 59,135 heads of families receiving Temporary Assistance to Needy Families benefits were matched with data from Philadelphia’s municipal shelter system. Propensity score matching was used to select a matched control group to those identified as having been homeless between 1997 and 2003. Behavioral health services utilization was then assessed based on Medicaid claims records. results. Substantially higher levels of behavioral health services use and corresponding costs were found among heads of families with …

The Impact Of Mental Illness Status On The Length Of Jail Detention And The Legal Mechanism Of Jail Release, Jeffrey Draine, Amy Blank Wilson, Stephen Metraux, Trevor Hadley, Arthur C. Evans

Stephen Metraux

Institutional Discharges And Subsequent Shelter Use Among Unaccompanied Adults In New York City, Stephen Metraux Ph.D, Thomas Byrne Ph.D, Dennis P. Culhane Ph.D

Stephen Metraux

This study empirically examines the link between homelessness and discharges from other institutions. An administrative record match was undertaken to determine rates of discharge from institutional care for 9,247 unaccompanied adult shelter users in New York City. Cluster analysis and multinomial logistic regression analysis was then used to assess associations between different types of institutional discharges and the likelihood of persons subsequently experiencing extended shelter stays. Results show that 28% of the cohort was discharged from institutional care within the 90-day period preceding their initial shelter entry, with different types of institutional discharge associated with differences in subsequent patterns of …

Physician Utilization By Insurance Type Among Youth With Type 2 Diabetes, Carrie Macadam-Marx, Robert I. Field, Stephen Metraux, Stephen T. Moelter, Diana Brixner

Stephen Metraux

Objective: To evaluate the relationship between insurance type (Medicaid vs private insurance) and access to physician care for youth with type 2 diabetes mellitus by quantifying whether these youth saw a physician during the year before their first diabetes documentation. Study Design: Retrospective cohort study. Methods: Youth with Medicaid or private insurance aged 5 to 19 years with type 2 diabetes were identified by an electronic medical record review. The first indication of type 2 diabetes defined the index date. Youth with type 1 diabetes and female patients with polycystic ovaries were excluded. Descriptive statistics evaluated differences in office visits …

Disparities In Level Of Amputation Among Minorities: Implications For Improved Preventative Care, Kristin M. Lefebvre, Stephen Metraux

Stephen Metraux

Objectives: The purpose of this study was to evaluate the relationship between race and level of amputation and to discuss the implications if a disparity was found. Methods: From the 2003 Healthcare Cost and Utilization Nationwide Inpatient Sample, 80 845 (weighted) discharges with a diagnosis of vascular disease and black or white race were evaluated for a disparity in level of amputation. Level of amputation was categorized using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes into above-knee and below-knee amputation. SPSS 15.0 complex samples software (SPSS Inc, Chicago, Illinois) was used for univariate and multivariate statistical analysis. …

The Prevalence Of Musculoskeletal Conditions Among The Adult U.S. Population: Considerations For Physical Therapists., Michael P. Johnson, Stephen Metraux

Stephen Metraux

Study Design: Retrospective, Cross-sectional. Objectives: Identify the prevalence of musculoskeletal conditions (MSC) among the non-institutionalized U.S. population using an expanded set of ICD-9-CM codes that correspond to the range of conditions seen in Physical Therapist (PT) Practice. Examine prevalence rates among adults and older adults (65 years and older). Background: MSCs are the most common health problem in the U.S. and prevalence increases with age. Previous studies examining MSC prevalence were based on a limited set of conditions seen by physicians, therefore may not be representative of those who receive PT services. Disease prevalence is used to determine resource allocation …

Examining Relationships Between Receiving Mental Health Services In The Pennsylvania Prison System And Time Served, Stephen Metraux

Stephen Metraux

No abstract provided.

Prevalence Of Episodic Homelessness Among Adult Childbearing Women In Philadelphia, Pa, David A. Webb, Jennifer F. Culhane, Stephen Metraux, Jessica M. Robbins, Dennis P. Culhane

Stephen Metraux

No abstract provided.