Ready (or not)to graduate:

Mental and physical health characteristics associated with completing public housing-based, substance abuse treatment in Key West, Florida

Presented at the 131st annual meeting of the American Public Health Association, 17 November, 2003, San Francisco.

William N. Elwood, Ph.D.Research and Development DirectorGuidance Clinic of the Middle Keys, Inc.

Marathon and Key West, FL

Kathryn Greene, Ph.D.Associate Professor

School of Communication, Information, and Library ScienceRutgers UniversityNew Brunswick, NJ

For reprints, visit www.doctorelwood.com

Issues for Clients and Treatment Client profiles can enable programs to refine outreach efforts and to

generate more accurate referrals. Such profiles can help reduce early discharge and recidivism

during treatment. Variables associated with successful completion include

■ social support ■ legal problems■ financial resources ■ incarceration histories.

Additional problems include ■ problems with family and friends ■ homelessness

■ neighborhood drug problems ■ substance-related violence.

Greetings from Safeport!GCMK’s residential treatment program and compound within Key West Housing Authority’s public housing community.

A gated compound of 25 apartments and a treatment-administration building, within a larger public housing complex.

Clients must qualify for public housing if not already tenants.

Clients rent homes and finance their own needs.

The treatment provider concentrates solely on behavioral health services.

Treatment in PhasesPhase I: Residential Connections to services Group, individual counseling Remain on-site

Phase II: Day Continued counseling Part-time employment Long-term planning Vocational training

Phase III: Outpatient Reduced counseling hours Finalize housing plans Full-time employment Integrate aftercare participation

Phase IV: Aftercare Group, individual counseling Relapse prevention skills Live beyond compound

Data and Method

Between December 2001 and August 2003, 93 individuals entered treatment at the program in Key West, Florida.

Each person received a description of rights as a client and as a program evaluation participant; each provided informed consent.

During respective dyadic interviews, participants responded to questions in the Addiction Severity Index (5th edition, McLellan et al., 1992).

Interviews generally lasted two hours (range: 45 minutes to three hours).

Data and Method 2 Analyses were conducted using percentages and correlations, and

logistic regressions predicting completion status (i.e., completed program or not, within 14 months).

Predictor variables included, * education * employment length

* money spent on drugs/alcohol * family conflict

* prior charges * medical problems

* times in treatment * number of close friends

* length of current relationship. All results reported were significant at the .05 level, or better except

for correlations (p < .01).

Sample: N = 93 52 men (56%) 41 women (44%) 63% White/Anglo 22% African-American 13% Cuban-Latino 2% Other Age 19 to 66 (x = 38.9, SD =

9.93) (2000 Census of Monroe County, FL: 92%

White, 5% African-American, 12% Latino)

African-AmericanCuban-LatinoWhite-AngloOthers

Ready for Safeport:Characteristics of clients admitted to treatment

Education completed, years (x = 11.9, SD = 2.21) Longest full-time job, years (x = 3.97, SD = 4.71) Money spent on alcohol 30 days before admission [LTD]

(x = $49.85, SD 98.2) Money spent on drugs, LTD (x = $135.60, SD = 320.7) Troubled by medical problems, LTD (x = .91, SD = 1.53) Number of prior legal charges (x = 5.16, SD = 6.28) Previous alcohol/drug abuse treatments (x = 1.84, SD = 3.37) Length of current romantic relationship, in years

(x = 10.75, SD = 8.85) Days of family conflict, LTD (x = 3.74, SD = 8.39)

Graduates versus Terminators 68 clients completed

treatment services in accordance with treatment plan (graduates).

24 clients were discharged or withdrew from services against treatment advice (terminators).

Complete Partial

1 2 3 4 5 6 7 8 9 10 1. Age 1.00 2. Education .24* 1.00 3. Employment -.06 .01 1.00 4. Charges .04 -.16 -.05 1.00 5. $ on drugs -.01 .17 -.05 -.04 1.00 6. Times in treatment .19 .18 .01 -.02 .14 1.00 7. Medical problems .32** .03 -.06 .06 .23* .11 1.00 8. Family conflict -.12 -.06 -.04 -.09 .31** .22* -.09 1.00 9. Close friends -.11 -.06 -.03 -.02 .12 -.04 -.06 -.04 1.0010. Relationship length .37** .13 .04 -.06 .07 .04 .13 -.02 .03 1.00

* p < .01** p < .001

Zero Order Correlation Matrix for Continuous Variables

Regression Model The logistic regression model,

predicting graduation, was performed including nine predictor variables.

The model fit the data (chi-square (9) = 22.5, p < .01), and successfully predicted 82.6 percent of clients who graduated.

The model was more successful predicting graduation (97%) than non graduation (41.7%).

Predictors of Completion

Predictors

Family conflict (β = -.18, p < .01)

Education (β = .14, p < .05),

Number of close friends (β = -.13, p < .05)

Not significant

employment length money spent on drugs legal charges medical problems times in treatment length of current relationship

Ready to GraduateClients who graduate Safeport are more likely than those who terminate early,

To have less family conflict To be high school graduates To be invested in close

friendships

Recommendations Programs looking to create profiles of clients likely to complete their

programs might draw upon client variables related to personal relationships.

Client service coordination should include educational opportunities, particularly GED training and testing.

Programs should place additional focus and services on family support and personal relationship skills.

Recruitment efforts should advance ethnic diversity, as the Safeport program has a more diverse clientele than the community at large.