Although homelessness has been recognized as a serious and growing urban social problem, scientifically acceptable methods for estimating the composition and size of the homeless population have been lacking. A new research approach to estimating the size and composition of undomiciled urban populations is presented, and its utility is illustrated through a description of the literal homeless of Chicago. The homeless in the Chicago sample are unaffiliated persons living in extreme poverty, with high levels of physical and mental disability. Homelessness is interpreted as a manifestation of extreme poverty among persons without families in housing markets with declining stocks of inexpensive dwelling units suitable for single persons.

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The purpose of this article is to suggest dimensions for conceptualizing continuity of care and to propose some appropriate and useful measures. The dimensions considered include discharge planning, successful and rapid transfer, and implementing individualized service plans. Because discontinuity is more easily measured than continuity, most of the emphasis is on gaps, lags, and interruptions in the system of care. All are relevant to effective management of psychosocial rehabilitation programs. To illustrate, we describe the use of these measures in a study of 100 persons in transition from hospital to community living in western Massachusetts. Defining and Measuring Continuity of CareAlthough it has a long history in general medicine, in mental health continuity of care is a relatively new concept (Steinwachs, 1979;Rogers and Curtis, 1980). The first comprehensive review of its use in the mental health literature did not appear until 1981 (Bachrach, 1981). The recent emergence of the concept coincides with the growing decentralization of mental health services and the multi-faceted problems of the chronically mentally ill whose need for care is ongoing as well as episodic (Test, 1979).The concept is used both negatively and positively. In its negative form, the expression "continuity of care" calls attention to communities and program staff being unprepared to provide appropriate services to the many patients discharged from mental hospitals, and to the inability of community mental health centers to provide food, shelter, clothing, and opportunities for social interaction. In its positive form, "continuity of care" is used to signify an ideal to be fulfilled. While strategies vary for improving continuity in the system of care, all involve the development of a continuum of services and psychosocial interventions to help those who have been in institutions for many years adjust to community living (Johnson Foundation, 1985).Although the concept is in broad use, in both negative and positiveThis document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

To understand how providers can address partner abuse more effectively, the authors conducted semistructured interviews with 49 clients of a hospital-based domestic violence (DV) program. Due to the potentially grave consequences survivors face for disclosing abuse, it often took the right combination of circumstances in their lives and/or the presence of an understanding and caring provider for them to disclose. Following disclosure, survivors frequently found referral to the in-house DV program most helpful, along with other emotional and practical support. Findings from this study reveal additional ways in which health care providers can respond more effectively to this pervasive problem.