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Does distance matter? Service use and diagnosis in adult homeless

David E. Pollio, PhD, George Warren Brown School of Social Work, Washington University, One Brookings Dr., Box 1196, St. Louis, MO 63130-4899, (314) 935-7516, depollio@gwbmail.wustl.edu, Brian McKean, Washington University, George Warren Brown School of Social Work, Box 1196, St. Louis, MO 63130-4899, Carol S. North, MD, MPE, School of Medicine, Washington University, Department of Psychiatry, 660 S Euclid, CB 8134, Renard Building, Room 2210, St. Louis, MO 63110, and Edward Spitznagel, PhD, Washington University, Campus Box 1196, St. Louis, MO 63130-4899.

Introduction: Research on service use by homeless adults has demonstrated that need factors have small, but significant associations with service use. Clearly, other factors not yet examined influence access of needed services by homeless adults. One conceptually obvious, but untested, relationship is that distance traveled is associated with service use, and this association emerges differentially based on diagnosis. The purpose of this presentation, to test these associations, requires comprehensive data, including current sleeping location, service use, and valid diagnosis. Methods: Homeless individuals (n=400) were randomly recruited from shelters and street locations and diagnostically assessed for depression, schizophrenia, mania, PTSD; alcohol, cocaine, marijuana, amphetamine, opioid abuse/dependence. Service use data for 12 months following recruitment were collected from 35 agencies comprising homeless, mental health, and substance abuse sectors-of-care. Distance traveled to obtain services was established using Geographic Information System software. Generalized Estimating Equation models were developed to examine the ability of diagnosis and volume of service use to predict distance overall and for specific sectors-of-care, controlling for individual effects (age, race, veteran). Results: Persons with diagnoses of schizophrenia, major depression, and amphetamine abuse/dependence, and volume of services, were associated with greater average distance traveled; marijuana and opioid abuse/dependence, and being a veteran were associated with shorter distances. Discussion: Although limited, these results argue for the need to consider distance in understanding service use for this complex-to-treat population. Clearly, diagnosis is differentially associated with distance traveled to service use by homeless populations. Further, agencies need to consider location in offering services.

Learning Objectives:

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Interventions, Evaluations and Research Issues and Findings Among Homeless Populations

The 132nd Annual Meeting (November 6-10, 2004) of APHA