At the time of this article, Dr. Brenda B. Benda, author of this article, was a Professor in the School of Social Work at the University of Arkansas at Little Rock. Current bibliography information could not be located. Objective of Article: This article examined gender differences in predictors of readmission to inpatient drug treatment among homeless veterans because Veteran Affairs (V. A. ) medical centers currently do not have services that are designed specifically for women and that there is limited sensitivity about or understanding of women’s needs at the V. A. edical centers (p. 60).
At the time of this study, Selgado’s study (as cited in Benda, 2005) shows women only comprised 5 percent of veterans with access to health care services in the V. A. , or approximately 1. 4 million of a total of 25. 5 million veterans. The lack of specialized services seems the primary reason that most women seek medical services outside the V. A. , often at their own expense. Therefore, a study of factors associated with substance abuse relapse among homeless veterans will provide useful information for designing specialized services at the V.
A. for women in drug treatment (p. 60). Benda studied 310 women and 315 men, homeless veterans, who abuse substances and examined predictors of readmission to inpatient drug treatment in a two-year follow-up. This study appears to be the first study of gender differences in predictors of readmission among homeless veterans, and it examines the possibilities of various social support systems mediate or moderates the relationships between different traumatic experience over the life span and readmission (p. 59). Purpose of Article:
The purpose of this article is to examine and answer the following research questions: (1) what gender differences, if any, exist, in predictors of readmission to inpatient care for drug abuse among homeless veterans, (2) are abuses at different stages of the life span, combat exposure, and recent traumatic events commensurate predictors, and do employment, housing, family or friend relationships, and spirituality (3) mediate or (4) moderate the relationships between traumata and relapse (p. 63). However, Benda limited this study to the analysis of employment, housing, social support, and spirituality.
This study also offers preliminary information for designing and prioritizing specialized services at the V. A (p. 63). Methodology and Procedures: The institutional human subjects review board at the V. A. approved the study. A convenience sample of all homeless female veterans that entered an inpatient V. A. domiciliary program for substance abuse was selected over a three-year period. Only 13 women, or 4 percent, that entered this program declined to participate in the study, leaving 310 women who responded to the survey.
A systematic random sample of homeless men that entered the same program over the same three-year period was selected to have an equivalent number of men (p. 64). Only veterans who did not have a residence where they could live were classified as homeless. Veterans were considered homeless if they had spent at least a week in the 30 days preceding the admission to the V. A. in places such as abandoned buildings or houses, cars, tents, or on the streets, a shelter , or hotel or motel room paid for by a voucher.
A written consent to participate in the study was obtained from all veterans before four staff social workers conducted two intake interviews which were conducted within the first two weeks of admission (p. 66). A third interview was conducted at discharge from the inpatient domiciliary program to aftercare services-this interview provided client evaluations of the inpatient program and an assessment of emotions and thoughts that are often problematic to survival in the community.
The final interview (aftercare interview) was conducted two months after release from the inpatient domiciliary program to find out what extend traumatic life events and various social supports predict tenure in the community (p. 66-67). The outcome analyzed was the proportion of time in the community without readmission to an inpatient program for substance abuse and other psychiatric disorders during the two-year follow-up study (p. 67).
This outcome was selected because the primary goals of domiciliary programs are to lengthen the period of sobriety and independent living among homeless veterans. Individual follow-ups were used, so everyone was followed for a full two years, or until they were re-hospitalized for substance abuse or psychiatric disorders (p. 68). Findings: The findings show that sexual and physical abuses in childhood, during active duty in the military, and in the past two years are more potent predictors of readmission for women than for men.
Women’s readmission to inpatient care for drug abuse also is heightened more by increases in depression, suicidal thoughts, and traumatic events, whereas it is lessened with greater family, friend, church, and other support (p. 75). The findings also showed men’s return to inpatient treatment increases in likelihood with greater substance abuse, aggression, and cognitive impairments, while it decreases with more employment stability and job satisfaction (p. 75).
Conclusion: This study found some statistical interactions that are important for further investigation in research and practice which show that stable housing and employment, spiritual well-being, and family and church support are more positively related to tenure in the community for women who have experienced less childhood abuse and recent traumatic events. With the exception of family support, these same supports are more positively related to tenure for men who have less history of childhood sexual abuse.
Numerous questions also arise from the findings such as: (1) why social supports reduce the effects of traumata more for persons who have experienced lower level of trauma, (2) how social support assuages traumatic events, and (3) what combinations of social supports of traumata are optimal (p. 78). Opinion: The writer’s personal experience of working with Homeless veterans who suffers from indicators such as substance abuse, personal traumata, and combat exposure is clearly discussed and evaluated in this article.
The writer also applauds this journal article for the in-debt analysis which provided guidance for the V. A. in implementing the current Homeless Veterans Initiative of 2011 which provides a range of services to homeless veterans, including health care, housing, job training, and education (Department of Veteran Affairs, 2012). In addition, the writer also believes that treatment of substance abuse, mental illness, and personal traumata should be at the forefront of the implementation of these programs for homeless veterans. Without evaluation and treatment of these conditions, recurrence of homelessness will be evident.
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