Service Delivery for Vulnerable Populations: New Directions in Behavioral Health

487 Pages·2011·4.579 MB·English

by  Steven A. Estrine, Robert T. Hettenbach, Heidi Arthur, Maria Messina

Service Delivery for Vulnerable Populations
New Directions in Behavioral Health
StevenA.Estrine,PhD,isthefounderandPresidentofSAE&Associates.Hehasover35years
ofexperienceasahigh-leveladministrator,strategicplanner,andprogramdeveloperin
mentalhealthandsubstanceabuseforthemostvulnerable,at-riskpopulationacrossthe
lifespan.EstrinehasheldpositionsasDirectorofAdultPsychiatricServicesoftheNewYork
StateOfficeofMentalHealth,DirectorofPublicSectorPsychiatryatNewYorkPresbyterian
Hospital,andDirectorofProgramDevelopmentatNorthShore-LongIslandJewishHealth
Systems.Dr.Estrine’sprimaryinterestsareinprogramsthataddresstheneedsofvulnerable,
at-riskpopulationsacrossthelifespan.
RobertT.Hettenbach,MPS,isSeniorVicePresidentforBusinessDevelopmentatPSCHin
theGreaterNewYorkArea.Hehasover36yearsofexperienceinhealth,mentalhealth,and
managedcare.AsasenioradministratorwithintheNorthShore/LongIslandJewishHealth
CareSystem,Hettenbachhelpeddeveloptheirmanagedcarenetwork,hasbeentheExecutive
Directorofalocalcommunityhospitalresponsibleforqualitycare,finances,andregulatory
compliance.Accordingly,hehasdevelopedauniqueunderstandingoftheintegrationof
behavioralhealthwithprimarycare,andtheimpactofmentalillnessonthemanagementof
chronicandacutemedicalconditions.HettenbachalsodirectedNewYorkState’sOfficeof
MentalHealth’sNewYorkCityRegionalOffice,withoversightofeightstatehospitals,and
responsibilityforthelicensureofallinpatientandoutpatientprogramsandthedistribution
ofmillionsofdollarsinfundingforcommunity-basedprogramsservingtheseriously
mentallyill.
HeidiArthur,LMSW,isVicePresidentforProgramDevelopmentandGrantWritingatSAE&
Associates.Arthurhasover15yearsofexperienceinhumanservicesprojectdesign,
implementation,andadministration.AtSAE,herworkhasyieldedmorethan$25millionfor
programsbenefitingchildrenfamilies,andadultpopulations.Arthurhaspreviouslyheld
grantsmanagementpositionsforboththeNewYorkCityDepartmentofHealthandMental
HygieneandtheNewYorkStateOfficeofMentalHealth.Shehasalsodevelopedand
implementedacommunity-basedoutreachinitiativeforpregnantandparentingsubstance
abusers,achildwelfaretrainingcurriculumforworkersservingthosewhoarepregnant,anda
school-basedcurriculumforacquaintancerapeeducation.
MariaMessina,PhD,isaconsultantandprogramevaluatoratSAE&Associates.Messinaisa
medicalanthropologistwithmorethan16yearsofexperienceinpublichealth,specializingin
ethnographicandethno-epidemiologicalresearchincludingHIVriskenvironments,
behaviors,andsero-sorting/sero-disclosurepracticesamongmenhavingsexwithmen(MSM)
inNewYorkCity(NYC);crystalmethamphetamineuseandHIVriskamongMSMinfiveU.S.
cities;crackinjectionpracticesandhealthrisksamonghomelessstreetyouthinNYC;riskand
protectivefactorsfordruguseamongyouthinthebarriosofCaracas,Venezuela;residential
therapeuticcommunitydrugtreatmentamongmaleandfemalehomelessorformerly
incarceratedadultsintheNYCpublicsheltersystemandadjudicatedandnonadjudicated
adolescentsintheUnitedStatesandCanada;andHIVpreventionamongYMSMandMSMin
theHouse/BallandKikicommunities.MessinaspeaksFrenchandArabicandisaFulbright
scholarandaSocialScienceResearchCouncilFellowforherresearchinNorthAfricaon
gender,sexuality,andIslam.
Service Delivery for
Vulnerable Populations
New Directions in Behavioral Health
Steven A. Estrine, PhD
Robert T. Hettenbach, MPS
Heidi Arthur, LMSW
Maria Messina, PhD
Editors
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Morton Wallach, MD
Robert N. Butler, MD
Myrna I. Lewis, PhD

Contents
Contributors xv
Foreword MarkR.Novick,MD xix
Preface xxi
Acknowledgments xxvii
SECTIONI.NEWDIRECTIONSINTHETREATMENTOFPERSONSWITH
PSYCHIATRICDISABILITIES
1. DefiningSeverePersistentMentalIllness:Implicationsfor
Knowledge,Needs,andServices 1
DeniseTorres
Introduction 1
CompetingDefinitionsofSMI 2
ImplicationsofOperationalizingSMI 5
RecoveryinContext 14
Recovery-OrientedSystemsofCare 19
Conclusion 24
References 25
2. InnovativeProgramsforConsumerswithPsychiatric
Disabilities 39
PhyllisSolomon,LisaSchmidt,PeggySwarbrick,and
EdieMannion
Introduction 39
Evidence-BasedPsychiatricRehabilitationPractices 40
EmergingBestPsychiatricRehabilitationPractices 54
FutureDirections 62
References 63

vii
viii Contents
SECTIONII.NEWDIRECTIONSINSERVICESFORCHILDREN,YOUTH,ANDFAMILIES
3. Children,Youth,andFamilies:NeedsandIssues 71
HeidiArthur,SusanBowler,andNinaRoseFisher
Introduction 71
Co-OccurringNeeds 72
Stigma 74
CulturalFactors 74
FamilyandYouthInvolvement 76
DevelopmentalIssues 77
FragmentedSystems 78
ConvergingNeedswithintheJuvenileJusticeandChildWelfare
Systems 79
Conclusion 82
References 82
FurtherReading 85
4. ModelApproachesforChildrenandYouthwithSerious
EmotionalDisturbance:SystemsofCareandWraparound 87
NinaRoseFischer
Introduction 87
HistoryofSystemsofCare 87
WraparoundService 89
Conclusion 103
References 104
SECTIONIII.NEWDIRECTIONSINSERVICESFORLGBTQINDIVIDUALS
5. SexualMinorityandGender-VariantYouth:TheHeterogeneityof
Health-CareNeeds 107
MariaMessina,SelL.Hwahng,andAnthonyVavasis
Introduction 107
StigmaandSocialIsolation 112
SubstanceUse 113
AbuseandVictimization 114
HomelessYouth 120
TeenPregnancy 121
SexualOrientationandMentalHealth 121
Contents ix
SexualOrientationandPhysicalHealth 123
InnovationinHealth-CareParadigms 125
Callen–LordeCommunityHealthCenter:HOTT 127
VerticalandHorizontalKnowledge 131
Conclusion 132
References 132
6. SexualMinorityandGender-VariantAdults:Resiliencies
andVulnerabilitiesinHealthCare 145
MariaMessinaandSelL.Hwahng
Introduction 145
DefinitionofTerms:SexualMinorityNomenclature 149
Challenges 153
Stigma 154
EthnicCommunities,Resiliency,andCulturalBuffers 156
AbuseandVictimization 157
MentalHealth 159
PhysicalHealth 162
Conclusion 168
References 168
SECTIONIV.NEWDIRECTIONSINHOUSINGANDHOMELESSNESS
7. Pathways’HousingFirst:AConsumer-Driven
ApproachtoEndingHomelessnessand
PromotingRecovery 183
SamTsemberisandBenHenwood
Introduction 183
Conclusion 198
References 199
8. HomelessVeterans:TheBigPictureandtheNewYork
Experience 205
HenriettaFishman
Introduction 205
History 206
TheNewYorkExperience 210
Conclusion:WhereAreWeNow? 215
References 216
FurtherReading 216