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Social support and psychiatric severity are known to influence substance abuse. However, little is known about how their influences vary under different conditions. We aimed to study how different types of social support were associated with substance abuse outcomes among persons with low and moderate psychiatric severity who entered Sober Living Houses (SLHs). Two hundred forty-five individuals entering 16 SLHs were interviewed at baseline and 6, 12 and 18 months. The Brief Symptom Inventory assessed psychiatric symptoms and the Important People Instrument and a modified AA Affiliation Scale assessed social support. Social support variables predicted substance abuse outcomes for persons with low and moderate psychiatric severity. However, they were the strongest and most consistent predictors for the low severity group.

This article features the three-dentist House Call Dentist (HCD) team, a division of the nationally known Blende Dental Group based in San Francisco, headed by Dr. David Blende. Dr. Blende is best known for providing dental care utilizing sleep and sedation modalities, and as a leader in the field of dentistry for patients with special needs. The HCD team serves patients who cannot travel even 10 miles to visit the dentist. If the patient needs treatment that cannot be done in the home, the HCD team handles the arrangements for the procedures to be done at the HCD office or in a local hospital. In addition to visiting private homes, HCD provides dental screenings at group homes, including special needs assisted living and senior communities.

In 2003 foster youth employed by a foster youth advocacy organization suggested that an evaluation of group home services to foster youth be conducted in Alameda County, California. This report presents the development and conduct of this evaluation study; how funding was obtained; and how foster youth were hired, trained, and employed to produce a timely and informative evaluation of the performance of 32 group homes where some of the foster youth formerly resided. The results of the study are described in another paper. This report contributes to evaluation practice in the newly emerging field of youth-led evaluations. The achievements of this project in utilizing group home clients to evaluate services with which they were familiar may stimulate other evaluators to develop similar projects, thereby enriching the development of our youth and promoting more informative evaluation findings.

The California Youth Connection obtained funding from two foundations to evaluate the performance of group homes serving foster youth in Alameda County, California, in order to inform state policy-making. The evaluation team initially included 14 foster youth that personally experienced group home living. Three inter-related aspects of service were studied: structure, process, and client outcomes, specifically residents' increase in developmental assets leading to the ability to transition successfully to independent living by the age of 18 years. Data were collected at 32 group homes from 127 residents and 72 staff members using three questionnaires. Both structural and process aspects of services influenced residents' satisfaction with services. However, only the process of care predicted changes in residents' developmental assets. State-level regulatory agencies learned from these results that auditing only structural aspects of services was not sufficient to promote effective services. Further, one structure item and two process items were identified as less consistently occurring in the group homes: timely distribution of clothing allowances, healthy communication between staff and youth, and staff support of regular exercise for the residents. Focusing on these aspects of service first should promote more change in outcomes and satisfaction for foster youth residing in group homes. (Contains 4 tables.)

A study of 1,878 persons with developmental disabilities who had been transferred from California state institutions into community care found the mortality rates for movers exceeded institutional rates by 51%. The effect was largest shortly after the move and in subjects who had moved most recently. (Author/CR)

A model program for severely emotionally disturbed hearing-impaired adolescents evolved in Santa Cruz County (California). A private day school program integrated its activities with a group home; Individualized Education Programs were designed jointly with residential treatment plans; and residential and school staff maintained a behavioral system of consistent contracts, rules, and rewards. (Author/JDD)

The study compared the characteristics of individuals residing in either institutional or community settings in Arizona, Colorado, Nevada, and one regional center in California. The results show that the more severely mentally retarded persons, with their attendant handicaps and maladaptive behavior, are still likely to be found in an institutional setting. (Author/PHR)

Abstract: This paper presents findings from a structured review of treatment models that are relevant to group care and residential treatment settings for children involved with the child welfare system. Initiated and guided by The California Evidence-Based Clearinghouse for Child Welfare, five treatment models — Positive Peer Culture, Teaching Family Model, Sanctuary Model, Stop-Gap Model, and Re-ED — were reviewed for effectiveness. In this paper, each model''s treatment features are described and relevant outcome studies reviewed in terms of their effectiveness as well as relevance for child welfare practice. Findings indicate that four of the models are either supported or promising in terms of evidence for effectiveness. Implications for group care practice and research are discussed. [Copyright &y& Elsevier]

More than 2,000 persons with developmental disabilities have been transferred from California state institutions into community care in recent years. We investigated whether this has been accompanied by a change in mortality rates, using data on 1,878 clients moved since April 1993. Mortality rates were compared to those expected for comparable persons in institutions. Risk-adjusted mortality rates for movers exceeded institutional rates by 51%,p< .05. After removal of cancer deaths in both groups, this increased to 67%. The effect was largest shortly after the move and in the subjects who had moved most recently. The deinstitutionalization process in California appears to have resulted in a substantial increase in mortality, indicating the need to ensure continuous, consistent, and competent medical care and supervision in the community. [ABSTRACT FROM AUTHOR]

The authors analyzed death rates from external causes (accidents, injuries, homicides, etc.) for persons with developmental disability in California. There were 520 such deaths during the 1981–1995 study period, based on 733,705 person-years of exposure; this represents all persons who received any services from the state. Compared with the general California population, persons with developmental disability were at lower risk of homicide, suicide, and poisonings (standardized mortality ratios, 0.31–0.68), but higher risk of pedestrian accidents, falls, fires, and, especially, drowning (standardized mortality ratio = 6.22). A major focus of the study was comparisons between different residential settings. Persons in semi-independent living had significantly higher risk than did those in their family home or group homes, with homicides rates being three times higher and pedestrian accidents rates being doubled, while persons in institutions had much lower risks with respect to most causes. Of the 28 deaths due to drug and medication overdoses, 79 percent occurred in supported living or small-group homes. Avoidable deaths could be reduced by making direct care staff more aware of the risks and better trained in acute care, along with improved monitoring of special incidents. Am J Epidemiol 1998;147:855-62. [ABSTRACT FROM AUTHOR]

The article focuses on issues related to the management of Rosedale, a Jewish child-care agency in San Francisco, California which serves children who are in need of out-of-home placement. Originally established in the second half of the nineteenth century as a Jewish orphanage, the agency underwent structural decentralization and modernization in 1965. Care was provided in seven group homes in which children were segregated according to age and sex. The group homes were anonymous-looking, capacious, well maintained and attractively furnished houses which were physically dispersed throughout a middle-class, ethnically integrated neighborhood of the city.

Objectives: To determine if the Power Through Choices (PTC) intervention can increase the use of birth control and reduce pregnancy among system-involved youths living in group care homes., Methods: We performed a 2-arm cluster randomized controlled trial involving group care homes operated by child welfare or juvenile justice systems in California, Maryland, and Oklahoma with assessments immediately before and after the intervention, and at 6- and 12-month follow-up. We collected data from 2012 to 2014 via self-administered questionnaires. Participants (n = 1036) were young (mean age = 16.1 years), predominantly male (79%), racially/ethnically diverse (37% Hispanic, 20% Black, 21% White, 17% multiracial), and sexually experienced (88%)., Results: At 6-month follow-up, participants in the intervention group had significantly lower odds of having recent sexual intercourse without using birth control (adjusted odds ratio [AOR] = 0.72; 95% confidence interval [CI] = 0.52, 0.98). At 12-month follow-up assessment, participants in the intervention group had significantly lower odds of ever being pregnant or getting someone pregnant (AOR = 0.67; 95% CI = 0.46, 0.99)., Conclusions: The results suggest that PTC is an effective sexual health education intervention that can be implemented with system-involved youths who represent a sexually experienced multiracial youth population.

The article features the panelists in a session at a Chinese American conference who shared their experiences of growing up in Chung Mei and Ming Quong, group homes for Chinese American children in the Bay Area in California. A brief historical background of both homes is presented. The experiences of Lynette Choy Uyeda Gin, Phillip Chan, Richard Mar and Nona Mock Wyman are described.

This section announces that a copy of a bibliography of books and articles pertaining to halfway houses may be obtained free of charge by writing to the Friends Committee on Legislation in San Francisco, California.

The influx of persons with developmental disabilities into community-based programs has required the development, expansion and improved integration of community-based services. The role of caregivers in these community settings has become pivotal. However, with regard to daily activities, oral hygiene is often a low priority. Few attempts have been made to study caregiver participation in oral disease prevention and practices. This study evaluated the effects of an indirect training program, where caregivers were trained but the ultimate effects were demonstrated in adult clients. In addition, these effects were demonstrated in community care settings. A multiple baseline design, across three group homes, included 11 adult clients with developmental disabilities. This study evaluated the effects of training, instruction to use training and coaching on the presence of caregivers during oral hygiene sessions, the duration of toothbrushing and plaque scores of the clients. The results of this investigation demonstrated that there was an increase in caregiver presence and duration of brushing with a concurrent decrease in plaque scores. Caregivers responding to social validation questionnaires believed that 8 out of 11 clients had increased skills. This study demonstrates that caregiver training, combined with specific instructions to use training information and coaching of caregivers, can have a positive impact on the oral health of individuals with developmental disabilities living in community settings.

Assertive community treatment (ACT) programs originated to meet the needs of the severely mentally ill (SMI) for multiple psychosocial supports necessary for community living. Housing has been prominent among these needs and research to date on ACT programs has addressed residential outcomes, principally reduced homelessness and maintenance in some form of stable housing. However, limited studies have examined variables that might predict particular types of residential placements, which range from unsupervised to highly structured environments. The purpose of this study was to identify factors related to residential placement for the subjects in a model ACT program. Of multiple variables assessed, two were significantly related to residential placement. Chronic respiratory illness was strongly associated with placement in supervised group homes. Team assignment was associated with placement, with clients in one of three teams significantly more likely to live more independently. Clients assigned to this team showed higher psychosocial functioning than others in terms of functional ratings on the Multnomah Community Ability Scale. However, higher function alone was not significantly associated with placement, suggesting a role for clinical judgement and a need for future research in this area.

This article reports the results of a study of final discharge outcomes for an exit cohort of 2,653 foster youths in California who were at least 17 years old at exit and had spent at least 18 months in care before their final discharge. A logistic regression model of discharge status was developed that expresses the effect of selected variables on the odds that a child exited foster care via one of three routes: (1) by reaching the age of majority while still in care or being legally emancipated to independent living; (2) by family reunification, placement with a relative or guardian, or adoption; or (3) by an "unsuccessful" exit from care. A youth's number of placements in foster care, time spent in care, and the type of placement the child last resided in were all found to be related to final discharge status. The implications of these findings for efforts to prepare foster youths for independent living are discussed. Of particular interest is the finding that a large proportion of youths who have spent a long time in foster care away from their families nevertheless return to their families at exit from care.

Objective: This longitudinal study examined various dimensions of the lives of patients with chronic mental illness immediately before and again several years after their discharge from a state hospital into well-staffed structured community residential settings., Methods: Fifty-three patients with chronic mental illness and long histories of hospitalization were evaluated shortly before their state hospital discharge using a comprehensive structured assessment of nine dimensions of functioning and symptomatology. A follow-up assessment was undertaken a mean of 7.5 years after discharge into four structured group home settings., Results: At follow-up, 57 percent of the patients continued to live in structured community residential settings, 28 percent had moved on to independent living, and 16 percent had returned to an institutional setting. Fifty-five percent needed hospital readmission, but the total sample spent only 11 percent of the time after discharge in the hospital. At follow-up, patients showed significant improvements in cognitive and social functioning, and 94 percent expressed a preference for life in the community., Conclusions: Many patients discharged to structured community residential settings seem to prefer them to the state hospital, are able to graduate to independent settings, and show improvement in important dimensions of functioning after several years in the community. Other dimensions seem resistant to change despite the structure and support afforded by residential settings.

Crisis residential programs were established by the California legislature in 1978 to provide an alternative to hospitalization for treatment of voluntary acute psychiatric patients. The five crisis residential programs in San Diego County, California, provide high-quality mental health care that is community-based and considerably less expensive than traditional in-hospital programs. Currently, the majority of public-sector, voluntary adult patients in San Diego County receives acute psychiatric inpatient services in these programs. This paper provides a description of the facilities, staff composition, patients, treatment model, and costs.