The primary individual factor associated with homelessness is substance abuse. Data from the New York City Commission on the Homeless indicate that 65% of homeless single adults in New York City shelters have drug or alcohol problems. Aside from a small number of """"""""Clean and Sober"""""""" dorms, there are only three shelters that have incorporated treatment programs into the shelter setting to confront this problem. Two of these, the Willow Shelter under the supervision of Project Return Foundation, and the 3rd Street Shelter (MBC), administered by Manhattan Bowery Corporation, have adapted and modified the therapeutic community (TC) approach for the treatment of homeless adults with substance abuse problems. This population is transient and socially disaffiliated, and are especially difficult to engage in treatment and in the larger commitment of recovery. The major objective of the current study is to improve short-term (30-day) retention and treatment compliance among admissions to the Willow and MBC shelters. The 4 specific research aims to this proposal are: 1) To increase 30-day retention rates and treatment compliance among admissions to 2 shelter-based TCs; 2) To identify the predictors of retention, dropout and compliance under baseline and enhanced treatment conditions; 3) To compare the effect of the same intervention to increase short-term retention presented at 2 shelter-based TCs with different treatment approaches and different baseline retention rates; 4) To derive profiles of men and women admitted to shelter-based TCs for homeless people with substance abuse problems, which will provide information relevant to dropout/retention. A focus will be on the decision-making process concerning remaining in treatment. The study is comparable to an early phase efficacy design, such as an open trial employed in medical research. A single intervention will be presented at each program for one 4-month period, preceded by a 4-month baseline period. Monthly admissions to Willow and MBC are 60 and 70, respectively; the anticipated sample is 480 Willow clients and 560 MBC clients. Admissions profile data will include personal/social history, drug use and criminal activity, psychopathology and psychiatric disturbance, motivation and readiness for treatment. Progress during treatment will be assessed with repeated administrations of selected psychological scales, the CMRS and measures of compliance. A 30-day dropout interview will be completed on clients who leave treatment prior to 30 days to provide a comparison of """"""""stayers"""""""" and """"""""leavers"""""""" at the critical 30-day point. The present project addresses the critical need to engage substance abusers in treatment, particularly those who are socially disaffiliated. It will demonstrate the impact of an intervention in non- intrusive ways, providing the critical step toward introducing second stage designs that involve more controlled conditions.
| Jainchill, N; Hawke, J; Yagelka, J (2000) Gender, psychopathology, and patterns of homelessness among clients in shelter-based TCs. Am J Drug Alcohol Abuse 26:553-67 |
