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

William N. Elwood, Ph.D. Research and Development Director Guidance Clinic of the Middle Keys, Inc. Marathon and Key West, FL Kathryn Greene, Ph.D. Associate Professor School of Communication, Information, and Library Science Rutgers University New Brunswick, NJ For reprints, visit

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 Phases Phase 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 (5 th 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 = 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)

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).

Age Education.24* Employment Charges $ on drugs Times in treatment Medical problems.32** * Family conflict **.22* Close friends Relationship length.37** * 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 Graduate Clients 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.