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The findings corroborate high rates of co-occurring substance dependence disorders among frequently hospitalized patients with severe mental illness. They also reveal a high prevalence of cocaine dependence and a dramatic pattern of negative correlates of cocaine dependence. The findings suggest that successful interventions for substance dependence may improve these patients' life circumstances and that psychiatric patients may be particularly receptive to such interventions during hospitalization.
With the advent of more effective treatments and corresponding improvement in morbidity and mortality, people living with HIV and AIDS are increasingly considering a return to the workplace. This study examined subjective and objective indicators of need among a sample of 235 HIV-infected individuals entering a vocational rehabilitation programme for people with HIV. In addition to help with training and job placement, participants indicated a need for assistance with finances, money management, housing access and access to health care, as well as with alcohol or drug problems, legal problems and social relationships. Subsequent to learning of their diagnoses, the sample reported a median decrement in financial resources of 60%. Over half had experienced housing instability in the year prior to entering the study, including 15% who had been homeless, even though most were linked to case management services. A third had used illegal drugs in the prior month, 41% drank to intoxication and 20% lacked even monthly phone contact with friends. Results suggest that back to work programmes for people with HIV and AIDS will need to address a broad range of psychosocial issues beyond job training and placement.
A measure of service individualization, derived from the goals in clients' treatment plans, was developed and used to evaluate this treatment process variable for 141 severely mentally ill persons served by three psychosocial rehabilitation programs. Relatively few of the 364 goals reviewed were highly individualized. Level of service individualization was inversely related to clients' functional skills, residential independence, level of education, and a primary diagnosis of an affective disorder, but positively related to a diagnosis of schizophrenia or another psychotic disorder. The goal individualization measure differentiated both between programs and among staff members, even after controlling for differences on client variables.
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