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PURPOSE Could practitioners and members (consumers) of mental health or other organizations interact socially by regularly going out for drinks or dinner together, for example? The American Psychological Association explicitly states for example, "your psychologist shouldn't also be your friend." However such social interactions have occurred for decades in certain clubhouse-modeled community mental healthcare, and maybe research and a more balanced perspective is warranted. DESIGN/METHOD We interviewed six clubhouse staff that interact socially with members and held three focus groups with 20 members. RESULTS/CONCLUSIONS In relation to what we call a social interaction policy, we herein highlight: (a) four policy dimensions (e.g. activity types; relationship closeness); (b) a spectrum of policy challenges (e.g., dealing with romantic overture; feelings of exclusion or hurt and effects on mental health; symptom flare-up while out socializing; financial constraints of members such as dinner costs on limited incomes); and (c) a wide variety of policy benefits such as: (a) learning opportunities for members who can process with staff the ups and downs of social relationships; (b) social skill and network development; (c) enhanced assessment across different times/settings; (d) addressing stigma among staff who must grapple with internal resistance to spend free time with members; (e) enrichment of staff social life; (f) reducing internalized stigma among members when staff value them more holistically; and (g) empowerment of members when staff freely (and optionally) offer a valuable resource (spare time). We offer suggestions for certain types of agencies that may wish to implement social interaction policies. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Religiosity is understudied among child welfare-involved adolescents. This study examined the effects religiosity on seven outcomes [substance use disorder (SUD), positive future expectations, delinquency, depression, loneliness, school disengagement, and early sexual activity] in order to understand and support child welfare-involved youth and minimize the effects of trauma. Utilizing the National Survey of Child and Adolescent Well-Being (Wave I & II), which uses a representative sample of children and adolescents with a child maltreatment report, we used logistic regression to predict each of the seven outcomes longitudinally. Youth (n = 474) who reported that religiosity was very important in Wave I were 53% less likely (OR .47, CI .24–.90, p

IntroductionThe role of overcrowded and multigenerational households as a risk factor for COVID-19 remains unmeasured. The objective of this study is to examine and quantify the association between overcrowded and multigenerational households, and COVID-19 in New York City (NYC).MethodsWe conducted a Bayesian ecological time series analysis at the ZIP Code Tabulation Area (ZCTA) level in NYC to assess whether ZCTAs with higher proportions of overcrowded (defined as proportion of estimated number of housing units with more than one occupant per room) and multigenerational households (defined as the estimated percentage of residences occupied by a grandparent and a grandchild less than 18 years of age) were independently associated with higher suspected COVID-19 case rates (from NYC Department of Health Syndromic Surveillance data for March 1 to 30, 2020). Our main measure was adjusted incidence rate ratio (IRR) of suspected COVID-19 cases per 10,000 population. Our final model controlled for ZCTA-level sociodemographic factors (median income, poverty status, White race, essential workers), prevalence of clinical conditions related to COVID-19 severity (obesity, hypertension, coronary heart disease, diabetes, asthma, smoking status, and chronic obstructive pulmonary disease), and spatial clustering.Results39,923 suspected COVID-19 cases presented to emergency departments across 173 ZCTAs in NYC. Adjusted COVID-19 case rates increased by 67% (IRR 1.67, 95% CI = 1.12, 2.52) in ZCTAs in quartile four (versus one) for percent overcrowdedness and increased by 77% (IRR 1.77, 95% CI = 1.11, 2.79) in quartile four (versus one) for percent living in multigenerational housing. Interaction between both exposures was not significant (βinteraction = 0.99, 95% CI: 0.99-1.00).ConclusionsOver-crowdedness and multigenerational housing are independent risk factors for suspected COVID-19. In the early phase of surge in COVID cases, social distancing measures that increase house-bound populations may inadvertently but temporarily increase SARS-CoV-2 transmission risk and COVID-19 disease in these populations.

While there are documented risk factors for criminal justice system involvement (CJSI) among persons with severe mental illness, little is known about risk for CJSI among people with co-occurring severe mental illness and substance use disorders. Using logistic regression, we identified sociodemographic and clinical risk factors that most increase risk of CJSI among people with co-occurring disorders (N = 10,855: National Survey of Drug use and Health, 2006-2014), and examined whether co-occurring disorders increase CJSI risk and risk of violent offenses in relation to severe mental illness alone versus substance use disorder alone. Seventeen percent of people with co-occurring disorders in our study were arrested and booked for breaking the law in the past year. At heightened risk were males, Blacks (relative to Whites), younger people, people with less education, divorced or separated individuals (relative to married), the unemployed, persons in the largest households (6 or more people, relative to one person), people in substance abuse treatment, and persons with certain drug use disorders (e.g., both alcohol and marijuana, relative to alcohol only). At reduced risk were Asians (relative to Whites), people with the highest incomes, and people with marijuana use disorders (relative to alcohol). In relation to people without severe mental illness or substance use disorder, those with co-occurring disorders were 7.47 times as likely (CI = 6.56-8.51, p .001) to be arrested and booked for breaking the law in the last 12 months, while those with severe mental illness (only) were 1.84 times as likely (CI = 1.64-2.08, p .001) and those with substance use disorder (only) were 5.32 times as likely (CI = 4.86-5.83, p .001). After using our findings to identify people who are at greatest risk for CJSI, preventative interventions could be offered.

Although studies show that loneliness increases risk of illness and hastens death, it is poorly understood among persons with severe mental illness (SMI). Using data on 150 people with SMI, we used logistic regression to predict (1) loneliness from sociodemographic and clinical characteristics, and (2) psychiatric hospitalization from presence of loneliness. We also examined mediating effects. Study participants who were most willing to ask for help were 70% less likely (odds ratio [OR], 0.30; confidence interval [CI], 0.09-0.99; p < 0.05) to be lonely than those who were least willing, and participants with high levels of internalized stigma were 9.25 times as likely (CI, 9.25; OR, 2.29-37.32; p < 0.01) as other participants to be lonely. Participants who were most lonely were 2.69 times (CI, 1.03-7.04, p < 0.05) as likely to be placed in psychiatric hospitals as those who were less lonely. Loneliness mediates the association between internalized stigma and psychiatric hospitalization (OR, 1.30; CI, 1.04-1.73). Findings can be used to help prevent inpatient stay.

In relation to interventions in the helping professions (e.g., medications or talk therapies in mental health), how do we decide what works and what fails to work? As Eileen Gambrill suggests in he...

We highlighted ways in which clubhouses promote togetherness in order to highlight lessons in togetherness that can be learned by non-clubhouse programs. Using three hour-long focus groups (N = 20)...

In Addictions Counseling, Cynthia and Samuel Faulkner provide a concise and valuable guide to substance abuse treatment that can help students and new practitioners begin to understand an immense b...

IMPACT: Patients living in overcrowded zip codes were at increased risk of contracting severe COVID-19 after controlling for confounding disease and socioeconomic factors OBJECTIVES/GOALS: This study sought to examine whether residences in over-crowded zip codes with higher reported over-crowding represented an independent risk factor for severe COVID-19 infection, defined by presentation to an emergency department. METHODS/STUDY POPULATION: In this zip code tabulated area (ZCTA)-level analysis, we used NYC Department of Health disease surveillance data in March 2020 merged with data from the CDC and ACS to model suspected COVID-19 case rates by zip code over-crowdedness (households with greater than 1 occupant per room, in quartiles). We defined suspected COVID-19 cases as emergency department reported cases of pneumonia and influenza-like illness. Our final model employed a multivariate Poisson regression models with controls for known COVID-19 clinical (prevalence of obesity, coronary artery disease, and smoking) and related socioeconomic risk factors (percentage below federal poverty line, median income by zip-code, percentage White, and proportion of multigenerational households) after accounting for multicollinearity. RESULTS/ANTICIPATED RESULTS: Our analysis examined 39,923 suspected COVID-19 cases across 173 ZCTAs in NYC between March 1 and March 30 2020. We found that, after adjusted analysis, for every quartile increase in defined over-crowdedness, case rates increased by 32.8% (95% CI: 22.7%% to 34.0%, P < 0.001). DISCUSSION/SIGNIFICANCE OF FINDINGS: Over-crowdedness by zip code may be an independent risk factor for severe COVID-19. Social distancing measures such as school closures that increase house-bound populations may inadvertently worsen the risk of COVID-19 contraction in this setting.

Much has been written about social lives of people with severe mental illness (SMI). Before social lives can flourish, however, people with SMI must first get close to other people. We studied this closeness by holding three hour-long focus groups at Fountain House, a community mental health agency in New York City. We found that closeness between two people with SMI is challenging because someone with depression, for example, may have trouble understanding someone with a different disorder (e.g., schizophrenia). Romantically, closeness is also challenging—SMI is hard to explain to partners. In the workplace, closeness is difficult because SMI can alienate co-workers. It could push them away. In mental health programs, we found that closeness has more of a chance to develop (1) during evening and weekend activities; (2) when activities are planned often enough to prevent isolation; and (3) when staff reach out to people before extended absence causes distance.

In relation to child abuse, child neglect has been understudied even though it is more common and causes at least as much harm. While child maltreatment (in a single category) has been linked to substance use disorders (SUD), and while child abuse alone (without neglect) has been linked to SUD, it remains unclear whether differences exist in the link between SUD and child abuse alone (without neglect) versus SUD and child neglect alone (without abuse). Utilising the National Survey of Child and Adolescent Well-Being II (NSCAW II, 2014): Wave I - 2008-09; Wave II - 18 months later: N = 5872), we used logistic regression to longitudinally assess whether past-year abuse versus past-year neglect in Wave I are equally influential in predicting newly diagnosed substance dependence in Wave II (among youth without SUD in Wave I). After adjusting for several factors, we found that past-year child neglect in Wave I was a significant predictor of newly diagnosed substance dependence in Wave II among youth who did not have SUD in Wave I. Other forms of youth maltreatment were unrelated. The findings suggest that child welfare and substance abuse professionals could pay special attention to youth with past-year neglect in order to help prevent the emergence of new substance dependence disorders. Copyright © 2015 John Wiley & Sons, Ltd. 'Child neglect has been understudied even though it is more common and causes at least as much harm' Key Practitioner Messages * Child neglect was found to be a significant predictor of newly diagnosed substance dependence. * Child welfare and substance abuse professionals could pay special attention to youth in the child welfare system to help prevent the emergence of new substance dependence disorders. * Models such as differential response and home visitation could help address child neglect and prevent negative outcomes. Copyright © 2014 John Wiley & Sons, Ltd. 'Neglect was found to be a significant predictor of newly diagnosed substance dependence' Language: en

There are times when people with severe mental illness (SMI) must be willing to ask for help (e.g., with managing symptoms). But what makes one person ask for help and another decide to go it alone? We used logistic regression to assess willingness to request assistance among 150 people with SMI. Hispanics were more likely (OR 8.51, CI 2.05-35.36, p .01) than Caucasians to be willing to ask for help, and people with the highest incomes (relative to the lowest) were more likely (OR 7.23, CI 1.76-29.97, p .01). Individuals with the most social support (relative to the least) were more likely (OR 12.36, CI 3.01-50.85, p .001) to be willing to request assistance, and people who were willing to ask for help were more likely (OR 2.07, CI 1.01-4.26, p .05) than less willing individuals to report being happy. More research is needed in order to better understand predisposition to seek aid, and interventions are needed that promote it.

This study examined risk for opioid analgesic use disorders (OAUD) using the 2007 National Survey of Drug Use and Health (N = 17,727 adolescents). Males with poor grades in school (D or F) and females who argued frequently (11 + times past-year) with parents were about 3 times as likely (males: adjusted odds ratio [AOR] = 2.59, CI = 1.06–6.35, p

This study delineated the extent to which a broad set of risk factors in youth, a period well suited to primary prevention strategies, influences the likelihood and timing of first lifetime psychiatric hospitalizations. Logistic regression was used to delineate early risk factors for psychiatric hospitalization among Americans in a nationally representative survey (NCS-R, Part II, 2001-2003: N = 5,692). Results suggest that inpatient stay is more common and happens at earlier ages among Americans who report growing up with versus without: (1) depressed parents or caregivers, (2) family members who victimized them, or (3) one of three child mental illnesses (conduct, oppositional defiant, or separation anxiety disorder). In order to prevent inpatient stay, findings call for longitudinal research on early vulnerability for psychiatric hospitalization among families with: (1) depressed parents of children or adolescents, (2) violence against children, and (3) children that have externalizing or separation anxiety disorders.

Whereas most studies of inpatient stay for mental illness examine whether substance use is present, this study identified types or combinations of abused substances that most increased hospitalization risk.Logistic regression of data from the 2007 National Survey of Drug Use and Health (N=37,654) was used to predict past-year hospitalization of individuals with DSM-IV substance use disorders.Even after the inclusion of control variables, adults with four types of substance abuse or dependence were more likely to be hospitalized than adults without substance abuse or dependence. High-risk disorders included abuse of or dependence on opioid analgesics (odds ratio [OR]=6.85, p.001), cocaine (OR=2.65, p.05), alcohol and cocaine (OR=2.58, p.05), and alcohol and marijuana (OR=3.10, p.01).Researchers examining inpatient stays may find it beneficial to look at abuse of specific substances or combinations of substances, and efforts to prevent inpatient stays could target people with high-risk substance use disorders.

We summarize Medicare utilization and payment for inpatient treatment of non-dementia psychiatric illnesses (NDPI) among the elderly during 1992 and 2002. From 1992 to 2002, overall mean Medicare expenditures per elderly NDPI inpatient stay declined by $2,254 (in 2002 dollars) and covered days by 2.8. However, these changes are complicated by expanded use of skilled nursing facilities and hospital psychiatric units, and decreased use of long-stay hospitals and general hospital beds. This suggests that inpatient treatment for NDPI is shifting into less expensive settings which may reflect cost-cutting strategies, preferences for less restrictive settings, and outpatient treatment advances.

Satisfaction with inpatient psychiatry can promote positive treatment outcomes. Using information on 315 inpatients with schizophrenia, this study tested the hypothesis that some services promote more satisfaction than others. Relative to less satisfied counterparts, inpatients were more likely to approve of care if staff invested high levels of effort into education about: (1) control of symptoms with psychiatric medication, (2) adverse effects of stress on symptoms, and (3) social skills. Other services were appreciated less. In order to enhance intervention outcomes, the findings suggest that limited resources should be invested to a greater extent in practices that are valued most highly by patients.

Objective: It is now well documented that satisfaction with mental health services is influenced by a variety of other factors (e.g., race, diagnosis, functioning level). Because of a generally brighter outlook, this study examined whether care satisfaction is also influenced by contentment in housing, social relations, or existence in general. Method: Data were collected from 264 individuals with schizophrenia who were discharged from psychiatric hospitals into community services (M = 37 years of age, SD = 9.41, 61% male). Results: Satisfaction with services was determined partially by satisfaction with housing and interpersonal relations even after accounting for the influence of age, gender, race, and level of functioning. The association was statistically significant in inpatient and outpatient care. Conclusion: Future satisfaction assessments in social work research and practice may need to account for contentment with other areas of life.

While most children living in foster care experience emotional disturbance as a result of their maltreatment or out-of-home placement, most do not receive needed mental health assistance that can p...

This longitudinal study of 246 individuals with schizophrenia examined family involvement and satisfaction with outpatient care after three months of psychiatric hospital discharge. Almost 10% of the individuals reported being dissatisfied with care. Controlling for demographic variables, individuals whose family members were not helped to cope with the mental illness had almost seven times the odds of being dissatisfied. Because care disapproval increases re-hospitalization risk (Druss, Rosenheek, & Stolar, 1999), suggestions are offered for how to facilitate kin coping.

This study was an investigation of intergenerational relationships related to the individuation process as reported by Mexican (N = 2,388) and European American (N = 2,907) adolescents. The primary aim was to examine the construct within theories of adolescent development that emotional separation in parent-adolescent relationships is an inherent aspect of the developmental process that occurs across the two ethnic groups. The authors conducted confirmatory factor analyses on a subscale INFUS of an instrument developed to measure family process, the Personal Authority in the Family System Questionnaire (PAFS-Q) developed by Bray, Williamson, and Malone. In sum, findings indicate (a) the need for better measurement testing, (2) the need to revisit the concept of autonomy from the family as a universal task during adolescent development, and (3) caution in the clinical use of concepts such as fusion and independence when delivering mental health services to Mexican adolescents and their families.

The authors evaluated the evolution of inpatient care for psychiatric illness in 1992 and 2002 for senior community-dwelling Medicare beneficiaries.National Medicare Provider Analysis and Review files for 1992 and 2002 were analyzed.From 1992 to 2002, rates of inpatient hospital use for treatment of psychiatric illness declined 28%, from 429 to 311 stays per 100,000 eligible beneficiaries, mostly because of reduced hospitalization for depression, and next, for substance use disorder. Inpatient care patterns for patients with schizophrenia and bipolar disorder changed little. Although stays were shorter in 2002 in general, rehospitalization rates remained the same in 2002 as they were in 1992.Trends in hospitalizations differed by diagnoses, which may be representative of general changes in treatment philosophy during the 1990s.

Although adolescents with delinquency are known to have higher-than-average rates of depression or substance use disorder (SUD), research on the topic is inconsistent. It remains unclear weather depression or SUD leads to delinquency, whether delinquency leads to depression or SUD, or whether there is bi-directionality. Utilizing the National Survey of Child and Adolescent Well-Being (Wave I: 2008–2009; Wave II: 18 months later: N = 5872), we used logistic regression to predict depression from delinquency (and vice versa), and SUD from delinquency (and vice versa). After inclusion of control variables, we found that females with minor theft in Wave I were more than 4 times as likely (adjusted odds ratio [aOR] = 4.34; 95% CI: 1.10–17.16) as females without minor theft to be depressed in Wave II, and those with public disorder in Wave I were almost 3 times as likely (aOR = 2.74; 95% CI: 1.03–7.30) as those without public disorder to have SUD in Wave II. Overall delinquency also predicted depression or SUD, and SUD predicted delinquency. Practitioners could address risk for depression or SUD among child welfare-involved adolescent females by focusing on overall delinquency or on specific types of delinquency (minor theft for depression and public disorder for SUD) and by offering interventions (e.g., cognitive-behavioral psychotherapy) that have been shown to be effective in preventing depression or SUD. In addition, with respect to our finding that SUD predicts delinquency among adolescent females, practitioners can help prevent delinquency by offering interventions (e.g., intensive outpatient treatments) that have well documented effectiveness in addressing SUD.

A longitudinal analysis was used to explore the relationship between diagnosis of serious mental illness and subsequent new diagnoses of HIV.Logistic regression was used to predict HIV/AIDS diagnoses in 2002–2004 among Medicaid beneficiaries in eight states (N=6,417,676) who were without HIV in 2001. Results for beneficiaries with and without serious mental illness, a substance use disorder, and psychiatric comorbidities in 2001 were compared.After controlling for substance abuse or dependence and other factors, the analyses indicated that the odds of new HIV/AIDS diagnoses among beneficiaries with or without serious mental illness did not differ significantly. Compared with beneficiaries without a substance use disorder or serious mental illness, individuals with a substance use disorder but without serious mental illness were 3.1 times (OR=3.13, p.001) more likely, and those with both substance abuse or dependence and serious mental illness were 2.1 times (OR=2.09, p.001) more likely, to receive a new HIV diagnosis in 2002–2004. However, people with serious mental illness but without a substance use disorder in 2001 were 23% less likely (OR=.77, p.001) than people without serious mental illness or a substance use disorder in 2001 to receive a new HIV diagnosis.After substance abuse or dependence was controlled for longitudinally, little independent association between serious mental illness and the risk of new HIV diagnoses was found. HIV-prevention services for low-income individuals should be delivered to all persons with serious mental illness, but especially those with comorbid substance use disorders.

This study examined the relationship between alexithymia and (a) hemis-patial bias; (b) the accuracy of interpreting emotion-relevant information; and (c) the style of interpreting emotion-relevant information. Subjects were 137 college students. Alexithymia was measured using the Toronto Alexithymia Scale. Hemispatial bias was measured using a free-vision chimeric face task. Interpretations of emotion-relevant information were assessed using the Profile of Nonverbal Sensitivity (PONS) and a second instrument designed for this study called the Emotional Story Test (EST). Although high levels of alexithymia were associated with hemispatial bias, alexithymia was not associated with the accuracy of subjects' interpretations. In contrast, alexithymia was associated with low ratings of emotional intensity and with subjects' inclinations to choose angry and dominant interpretations.

The relationship between alexithymia and hedonic capacity was examined in a sample of 119 college students as well as in a sample of 54 married individuals. Subjects completed self-report measures of hedonic capacity, alexithymia. and depression and negative affect. The results indicated that difficulty identifying and communicating one′s emotions was consistently associated with a diminished capacity to experience pleasure in social, but not physical, situations. Alexithymia and social hedonic capacity continued to be related when variance shared with depression or negative affect was removed from the relationship. The implications of these results for our understanding of alexithymia are discussed.

Objectives. We compared the influence of substance abuse with that of other comorbidities (e.g., anxiety, HIV) among people with mood disorder (N = 129 524) to explore risk factors for psychiatric hospitalization and early readmission within 3 months of discharge. Methods. After linking Medicaid claims data in 5 states (California, Florida, New Jersey, New York, and Texas) to community-level information, we used logistic and Cox regression to examine hospitalization risk factors. Results. Twenty-four percent of beneficiaries with mood disorder were hospitalized. Of these, 24% were rehospitalized after discharge. Those with comorbid substance abuse accounted for 36% of all baseline hospitalizations and half of all readmissions. Conclusions. Results highlight the need for increased and sustained funding for the treatment of comorbid substance abuse and mood disorder, and for enhanced partnership between mental health and substance abuse professionals.

Objective: This study examined predictors of psychiatric rehospitalization among elderly persons. Methods: Readmission within six months of an index hospitalization was modeled by using Medicare data on all hospitalizations with a primary psychiatric diagnosis in the first half of 2002 (N=41,839). Data were linked with state and community-level information from the U.S. census. Results: Twenty-two percent of beneficiaries were rehospitalized for psychiatric reasons within six months of discharge. After the analyses adjusted for sociodemographic factors, readmission was most likely among persons with a primary diagnosis of schizophrenia (hazard ratio [HR]=2.63), followed by bipolar disorder (HR=2.51), depression (HR=1.75), and substance abuse (HR=1.38) (reference group was “other” psychiatric conditions). A baseline hospital stay of five or more days for an affective disorder was associated with a reduced readmission hazard (HR=.68, relative to shorter stays), yet the opposite was true for a nonaffective disorder (HR=1.26). For persons with nonaffective disorders, an elevated hazard of readmission was associated with comorbid alcohol dependence (HR=1.32), panic disorder (HR=1.76), borderline personality disorder (HR=2.33), and drug dependence (HR=1.17). However, for persons with affective disorders, having a personality disorder other than borderline personality disorder or dependent personality disorder (HR=1.27) and having an “other” anxiety disorder (HR=1.15) were significantly associated with an increased risk of rehospitalization. Obsessive-compulsive disorder increased the readmission hazard in both groups. Conclusions: Readmission risk factors may differ for affective disorders and nonaffective disorders. Very short hospitalizations were associated with increased risk of rehospitalization among persons with an affective disorder, which underscores the need for adequate stabilization of this group of patients during hospitalization. Results also highlight the specific types of comorbidities associated most strongly with rehospitalization risk. (Psychiatric Services59:1038–1045, 2008)

This prospective study examined jail stay in a cohort of persons with schizophrenia and other psychotic disorders who experienced their first hospital admission and who were participating in the Suffolk County Mental Health Project. Demographic and clinical risk factors for jail placement were investigated over a four-year period after hospital discharge.The sample included 538 first-admission respondents diagnosed as meeting DSM-IV criteria for having schizophrenia, psychotic mood disorder, or other psychotic disorders. Initial interviews occurred in the hospital; face-to-face follow-ups occurred at the six-, 24-, and 48-month points, and telephone contact was maintained every three to six months. Multivariate logistic regression analysis was used to examine the demographic and clinical risk factors.Forty-seven respondents (9%) were incarcerated over the follow-up period. Among them, 20 were incarcerated multiple times. The prevalence, incidence, reasons for incarceration, and time served did not vary significantly by diagnosis. The most significant predictors of jail stay and time to incarceration during the follow-up were being male or black and having been incarcerated before admission. Predictive effects of other risk factors (for example, symptom severity or substance abuse) were smaller or statistically insignificant.The results suggest a need for mental health care professionals to routinely evaluate, document, and collaboratively address incarceration history, especially when working with black males, in an effort to avert future incarceration.

To inform psychiatric practice and research that enhances subjective quality of life (SQL) in diverse persons with schizophrenia, this study explored whether SQL differs in blacks and whites with varying educational attainment. Participants were interviewed upon discharge from 4 New York City psychiatric hospitals and after 3 months in community care (N = 264, mean age of 37 years, 61% male, 56% black). Linear regression equations predicted white and black SQL from educational attainment and control variables (ethnicity, age, functioning level, symptom severity). Educational accomplishment predicted lower SQL (F = 3.53, df = 4,227, p < 0.01), especially among whites (F = 5.87, df = 4,92, p < 0.001). However, the association was statistically insignificant in blacks who had SQL peaks and valleys with more years of school. Findings suggest that psychiatric care and research should account for educational and cultural variation in assessing and promoting SQL.

While persons with multiple hospitalizations for schizo phrenia have been found to differ from those with fewer, it remains unclear whether differences exist in illness awareness (personal understanding of psychopathology) or therapeutic alliance with inpatient staff (treatment involvement). This cross-sectional descriptive study therefore examined whether inpatients with more extensive hospitalization history 1) have less illness awareness and therapeutic alliance (perhaps contributing to the recidivism), 2) have more awareness and alliance (possibly because they have learned from experience), or 3) do not differ relative to persons with fewer inpatient stays. Results from staff and patient interviews (N = 307) suggest that illness awareness is greater in persons with more hospitalizations, while therapeutic alliance appears to weaken. Individuals with greater recidivism may therefore need less help than others in building a self-knowledge of psychopathology that may already have developed. Instead, enhanced engagement in care may be more important after multiple disappointing relapses.

In order to promote life control, this proposal suggests strategies to help people who use community mental health services to access small loans or "microcredit" for entrepreneurship in self-help groups.

While psychosocial care approaches such as assertive community treatment or partial hospitalization can help prevent psychiatric inpatient stay, the ability of specific services to prevent admission is less clear (e.g., recognizing signs of impending relapse, promoting daily structure). Therefore, within 3 months of psychiatric hospital discharge, this study examined the extent to which inpatient readmission among 264 persons with schizophrenia was averted by interventions addressing medication education, symptom education, service continuity, social skills, daily living, daily structure, and family issues. After accounting for demographic characteristics in logistic regression equations, findings suggested that interventions addressing symptom education, service continuity, and daily structure were most effective in preventing inpatient stay among individuals with four or more prior hospitalizations. However, these services became statistically insignificant in preventing readmission among counterparts with fewer previous inpatient stays. While protective effects may differ among persons with varying hospitalization histories, results indicate that resource-poor outpatient centers could focus on these three interventions when care must be limited to rehospitalization prevention.

Three months after inpatient discharge, quality of life was examined in 259 individuals with schizophrenia. As in findings by Lehman, Rachuba, and Postrado (1995), Black participants reported a higher quality than Whites after controlling for gender, degree of psychopathology, functioning level, substance abuse, and baseline life quality. Implications are discussed.

Risk for jail or prison recidivism is well documented among incarcerated individuals with schizophrenia. However, it is less clear that risk is also high for psychiatric hospital readmission after accounting for mediating influences such as psychopathology severity, functioning level, substance misuse, and demographic characteristics. Relative to counterparts without prior time in jail, this study therefore assessed whether formerly incarcerated individuals with schizophrenia were more likely to repeatedly use hospital care after controlling for level of functioning and symptomatology. Among 315 inpatients, former inmates had a greater mean number of previous hospital stays than other patients (t = -2.13; df = 305; p = 0.03) and were more likely to visit the emergency room or be rehospitalized within 3 months of discharge (chi2 = 8.83; df = 1; p = 0.003). They were twice as likely to be readmitted, moreover, even after accounting in logistic regression for age, sex, race, global functioning, psychopathology severity, alcohol abuse or dependence, and drug abuse or dependence (OR = .49; CI = .26-.95). Implications for community care are discussed, and the suggestion is made that jail diversion programs should be renamed and refocused as "jail and hospital diversion."

In this era of managed care and welfare reform, the two systems of public health and public welfare are increasingly focused on a shared population and the services designed to promote self-sufficiency and good health among low-income individuals, families and communities. The two service systems are often constrained by categorical funding mechanisms that contribute to service fragmentation, discontinuity and redundancy. This paper focuses on the changing nature of health and welfare, the impact of categorical funding mechanisms, the barriers to service integration, the potentials for partnership, and concludes with implications for enhancing service integration and the quality of services.