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Objective: The study examined relationships between specific treatment elements and their costs and ten outcome measures using data from a longitudinal outcome study of a Veterans Affairs program for homeless mentally ill veterans. Methods: Baseline and outcome data over an eight-month period were analyzed for 406 homeless veterans with psychiatric and substance use disorders who were treated in VA's Homeless Chronically Mentally Ill Veterans Program. Multivariate techniques were used to examine the relationship between ten measures of outcome and six treatment elements: program entry via community outreach, the number of contacts with program clinicians, the number of referrals for other services, duration of program involvement, number of days of residential treatment, and increased public support payments. Results: Each of the six treatment elements was significantly related to improvement on at least one of the ten outcome measures. The number of clinical contacts with program staff and the number of days in residential treatment were associated with improvement in the greatest number of outcome domains. However, improvement associated with residential treatment was far more costly than improvement related to other treatment elements. Conclusion: This study provides evidence of the effectiveness of a multimodal approach to the treatment of homeless mentally ill persons. However, results indicate that special attention should be paid to to differences in the cost of improvement associated with various treatment elements.
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Objective: This study evaluated the impact of a Department of Veterans Affairs outreach and residential treatment program for homeless mentally ill veterans on utilization and cost of health care services provided by the VA. Methods: Veterans at nine program sites (N = 1,748) were assessed with a standard intake instrument. Services provided by the outreach program were documented in quarterly clinical reports and in residential treatment discharge summaries. Data on nonprogram VA health service utilization and health care costs were obtained from national VA data bases. Changes in use of services and cost of services from the year before initial contact with the program to the year after were analyzed by t test. Multivariate analyses were used to examine the relationship of these changes to indicators of Clinical need and to participation in the outreach program. Results: Although utilization of inpatient service did not increase after veterans' initial contact with the program, use of domiciliary and outpatient services increased substantially. Total annual costs to the VA also increased by 35 percent, from $6,414 to $8,699 per veteran per year. Both clinical need and participation in the program were associated with increased use of health services and increased cost. Veterans with concomitant psychiatric and substance abuse problems used fewer health care services than others. Conclusions: Specialized programs to improve the access of homeless mentally ill persons to health care services appear to be effective, but costly. Dually diagnosed persons seem especially difficult to engage in treatment.
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Purpose: The purpose of this study is to describe the prevalence of food insecurity among college students and its relationship to on-campus food purchasing patterns and barriers to eating a healthy and sufficient diet, including the relative cost of food items on campus compared to national chain grocery stores. Design: A campus-wide survey using stratified sampling among undergraduates and food audit. Setting: An urban public university in New England. Subjects: A total of 951 surveys completed by undergraduates. Measures: Demographic characteristics, behavioral factors and food security status (measured using the USDA 6-item short form) were collected. Method: Descriptive and multivariable analyses were conducted to describe differences between food insecure and food secure undergraduates. Results: Overall, 35% of undergraduates experienced food insecurity in the past year (response rate = 92%). Food insecure undergraduates had different on-campus purchasing patterns than their food secure counterparts. Food insecure students were more likely to report barriers to healthy eating on all measures, including prices (AOR= 8.12, P <.0001), to experience housing insecurity (AOR= 2.64, P =.001) and to report that transportation is a barrier to buying groceries (AOR= 1.63, P =.01). After multivariable adjustment, food insecure undergraduates had higher odds of being African American (AOR= 1.57, P =.031) or other races (more than 1 race) (AOR= 3.35, P =.002) compared to white undergraduates. Conclusions: Food insecure college students face a variety of barriers to healthy eating on campus, including high food pricing on campus and limited transportation options. Further research is needed to inform campus resource development, policies and programming focused on food insecurity prevention for college students. © The Author(s) 2022.
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To achieve healthy communities, addressing food insecurity (FI) is critical. This study describes a unique food distribution program combining a mobile Summer Food Service Program (SFSP) for children with a mobile pantry for adults. A survey (n = 153) of participants at six locations in New Haven Connecticut revealed that 36% reported FI and 76% were first-time pantry users. Three- quarters participated in SNAP, WIC, or both, and two-thirds had children who were fed by SFSP. Major federal programs do not eliminate FI, therefore local voluntary organizations are essential partners to address the food crisis caused by the COVID-19 pandemic.
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- English (2)