Lea Vella

The U.S. Department of Housing and Urban Development estimates that, on a single night in 2021, more than 326,000 individuals experienced sheltered homelessness, 23% of whom were considered chronic...

Adults who are homeless experience high rates of health conditions and psychological distress, including low IQ and functional status. Resources are available to help these individuals, but provision of support is often contingent upon the identification of a known disability. In this context, we examined case managers' (CMs') subjective estimates of IQ and functional status in 77 adult residents of an urban homeless shelter. Participants completed objective measures of IQ and functional capacity. CMs overestimated IQs of lower IQ (IQ < 90) participants, correctly estimated IQs of average IQ (IQ = 90-110) participants, and underestimated IQs of higher IQ (IQ > 110) participants. CMs correctly identified 2 out of 8 participants meeting criteria for intellectual disability and 4 out of 16 participants with impaired functional status. These findings suggest that subjective evaluations of IQ and functional status are prone to a central tendency bias, leading CMs to overlook clients who are in need of assistance. Consequently, the objective measurement of IQ and functional status in homeless shelters is highly recommended.

Aims: To examine the prevalence of and factors associated with unmet need for mental health and substance use treatment in older homeless adults.Methods: Among 350 homeless adults aged ≥50, we examined prevalence of mental health and substance use problems and treatment. Using logistic regression, we examined factors associated with unmet treatment need.Results: Among those with a mental health problem, being aged ≥65 was associated with an increased odds, while having a regular healthcare provider and case manager were associated with a decreased odds of having unmet need for mental health treatment. A first homelessness episode at age ≥50 was associated with increased, while spending time in jail/prison or having a case manager was associated with decreased odds of unmet needs for substance use treatment.Conclusion: Older homeless adults have a high prevalence of unmet behavioral health treatment need. There is a need for targeted services for this population.

Enhancing cognitive performance to improve functioning in schizophrenia is a fundamental research priority. Previous investigations have demonstrated that various types of cognitive training (CT) can improve neuropsychological performance, psychosocial functioning, and psychiatric symptom severity. However, there is limited information about individual differences that may predict CT response and adherence to treatment. The purpose of this study was to identify who is likely to drop out of this type of study as well as this type of intervention and to explore individual factors predicting treatment outcome. Participants included 89 outpatients diagnosed with a primary psychotic disorder who enrolled in a randomized controlled trial of compensatory CT and were assessed at baseline, 3 months (posttest), and 6 months (follow-up). Study completers had more formal education and lower daily doses of antipsychotic medications than did dropouts with no CT exposure, but the groups did not otherwise differ. There were no significant differences between participants who completed CT and those who began CT but later dropped out. CT-associated improvement was correlated with worse baseline scores on measures of cognitive performance, symptom severity, functional capacity, and self-rated quality of life, cognitive problems, and strategy use. These results suggest that those with lower baseline functioning may have more room to improve following CT. The pattern of correlations in this sample indicated that many types of individuals can improve with CT treatment, including older patients.