Step 2
Assemble Some Evidence
Think Before You Collect
Bardach's assemblage of evidence includes thinking and gathering data that support reasons why we think that substance abuse is a social problem and needs to be addressed (Bardach, 2011). Gathering and assembling evidence is necessary for the political and analytic intent. Along with collecting evidences, it is important to track down some past solutions and hypothetically apply them to the problem at hand.
Factual information has been gathered to help address the reason why substance abuse, mental illness and homelessness are problems. Data sources from SAMHSA (2012), provides census reports, population study and the problem of the study. Data from the research conducted in the past five years indicates that about 30% of people who are chronically homeless have mental health conditions and, about 50% have co-occurring substance use problems.
This study provides census reports, population correlation and defining characteristics of the problem for all sheltered individuals over the course of a year (October 2009-September 2010). The breakdown is as follow: 62% were male, 38% were female, 21.8% are under age 18, 23.5% are 18-30, 37% are 31 to 50, 14.9% are 51 to 61, 2.8% are 62 or older, 41.6% are White Non-Hispanic, 9.7% are White Hispanic, 37% are Black/African-American, 4.5% are other single races; 7.2% are multiple races (SAMHSA, 2012). Part of this study also shows that on a specific night of January 2010, 109,812 individuals were chronically homeless; 26.2% of all sheltered individuals who were homeless had a severe mental illness; 34.7% of all sheltered adults who were homeless had chronic substance use issues (SAMHSA, 2012).
A study conducted in New York City and Philadelphia, indicated that people experiencing chronic homelessness were predominantly black and male. In New York City, 92.9% were black and 82.3% were male. In Philadelphia, 92.9% were black and 71.1% were male. According to analyses data from the 1996 NSHAPC, 60% of those who are chronically homelessness have experienced lifetime mental health problems and, 80% have experienced some lifetime drug problems (SAMHSA, 2012).
Review Available Literature
When reviewing literature, there is a need to review the cause of an issue, what people are saying about the issue, and the issue itself. Baradach (2012), “there hardly exists a problem on whose causes and solutions some academic discipline or professional association is not doing research (p.14).
A study was conducted among incarcerated homeless adults who suffer from mental illness and substance abuse. The data collection and sample size for this study consists of 102 individuals during the first 22 months, ages 18 to 64 years old. Over half of participants (53%) were female and nearly three-quarters 74% were white (Hickert, 2011).
According to that study, the average time in jail decreased from 71 days in the 12 months prior to HARP to 44 days in the 12 months following HARP intake. The study showed that those who are homeless had a high proportion of inmate substance abuse and mental health treatment (Hickert, 2011). Participation in HARP corresponded with a decrease in the use of residential substance abuse treatment facilities. The use of less intensive outpatient services remained relatively stable for individual treatment and increased slightly for group treatment (Hickert, 2011).
Another study by Meschede (2010) addresses the transitions of the homeless population associated with medical and substance abuse. The sample size for this study was 174 participants who were chronically homeless and individuals at risk of death over a 3-year period. Of the 174 homeless individuals classified as high-risk during 2000–2002, 53% were still living on the streets at the end of 2002. Numerous cycles between the streets and programs are due to the lack of programs, capacities and resources, lack of referral options, and program eligibility rules, such as excluding ex offenders from attending long term programs. (Meschede, 2010).
Among the high-risk cohort were 45 women (26%), 131 Caucasians (76%), and 23 African-Americans (13%) ranging in age from 30 to 84 years, with an average age of 50. Homeless individuals were significantly more likely to be Caucasian and older. In addition, 94% had a substance abuse problem. 82% of mental illness and substance abuse were assessed with a major psychiatric disability; 37% had a depressive disorder, followed by 22% with psychotic condition or a 10% bipolar disorder. 9% suffered from anxiety disorders, and 5% with post-traumatic stress disorder (Meschede, 2010).
Best Practice
Research and advocacy support funding for effective treatments in institutional rehabilitation centers in combination with stable housing have been attempted before. Evidence reports shows that in 1992 a supporting housing program was established to provide clinical and housing services to homeless with mental illness and substance abuse disorders (Cheng, Lin, Kasprow, & Rosenheck, 2007).) Clearly this research indicates that we are not the only supporters of increasing housing programs and bringing awareness to this issue.
Start Early and Touch Base
According to Bardach (2012), “it is important to obtain feedback from participants, usually in the iterative process” (p.16). Gathering information, creating goals and outcomes to support substance abuse and homelessness were very important before moving on to the next phase. The early steps taken to achieve this policy analysis included, emails, the exchange of files, texting, phone calls, and meetings.
Since decades of homelessness, researchers and advocacy groups have been working towards ending this issue and the results have proven that a housing based approach can reduce homelessness. Academic research has confirmed long-term housing assistance, and permanent supportive housing combined with vital supportive services for those with mental illness successfully reduces homelessness, provides stability of housing and is cost-effective (Coalition for the Homeless, 2013).
Step 3
Construct the Alternatives
Comprehensive and Focused
In order to find solutions to a “problem” there must be a course of intervention to solve the “problem” (Bardach, 2012). This implies there are one or more policy action that may help in solving the problem along with other alternatives. When creating alternatives it is a good idea to create a list of all the alternatives to use in the analysis (Bardach, 2012).
The alternative according to Bardach, (2012), assumes that many different elements need to be combined into some workable system that would be achieved (p.24). Alternatives that should be enforced for individuals who are released from prison, inpatient treatments, and other institutions, should include opportunities to learn skills which can be useful in obtaining employment that will prevent returning to prison and being homeless again. We will also consider using targets and budgets from the federal budget plan as an effective way to develop these alternatives.
Models
In order to change an issue, it is important to model the cause of the issue. The United States Interagency Council on Homelessness reports that the legislation authorizes federal grants to government agencies and nonprofit organizations to provide support strategies and services designed to reduce recidivism (USICH). The Second Chance Act, introduced in 1986, authorized the grant program for reentry of offenders into the community in the Omnibus Crime Control and Safe Streets Act of 1968. The act was signed into law on April 9, 2008. This act was designed to help ensure that individuals who are incarcerated transition into the community safely and successfully. This Second Chance act is part of our policy change; it emphasized that the reentering population has a much higher risk of homelessness than the general population. It is critical for these individuals to obtain supportive services during their transition back into community life, and this is a complex system according to Bardach, (2012).
Conceptualize Alternatives
According to Bardach, (2012), “the key to conceptualization is to try to sum up the basic strategic thrust of an alternative in a simple sentence or even a phrase” (p.21). As alternatives, funding provides employment assistance, mental health therapy and substance abuse treatment, mentoring, and housing programs to reduce recidivism and help former prisoners gain stability (USICH). The Anti-Drug Abuse Act, was implemented to establish an effective program to prevent the use of drugs and education by establishing an effective drug abuse, prevention and education programs (Anti Drug Abuse Act, 1986). This act supports our alternative for targeting funding that will facilitate solutions to ending homelessness and substance abuse.
Points on Continuum Designs Alternative
Drake, Mueser, & Brunette, (2007), state that “supporting housing” helps many individuals escape from homelessness and become motivated for further goals. Bardach (2012), points out that we should approach this as a two step problem. The approach is to establish a high to low limit of the policy analysis. The one solution to this two-step problem as Bardach states, would be implementation of stable housing which has been known to be cost-effective. The second step would be to decide what is acceptable as an implementation to the solution in making our alternative choices. Part of the design alternative to this issue would be supportive permanent housing, because it meets the objective of the policy alternative implemented. Bardach (2012), reminds us to consider targets and budgets which are important in achieving the goals.
Step 4
Select the Criteria
Commonly Evaluative Criteria
The fourth step, according to Bardach (2012), “is the most important step for introducing values and philosophy into the policy analysis, because some possible criteria are evaluative standards used to judge the goodness of the projected policy outcomes that are associated with each of the alternatives” (p.32). Equality, equity, fairness, and justice are some terms used to oppose these ideas. The evaluation criteria is applied to the projected outcomes.
Equality among those with substance abuse should be address the same way with any other disability. Mental illness is connected with inequality and discrimination within our society and mental health care. Social workers should advocate for living conditions conducive to the fulfillment of basic human rights by, pursuing social change on behalf of vulnerable and oppressed individuals and groups in effort to alleviate unemployment, discrimination, and other forms of social injustice (NASW, 2008).
The equality of substance abuse has prevalence in relation to unemployment, homelessness, and income inequality. These individuals experience a high level of unemployment and face a greater chance of relapse along with all of its associated consequences. Social and economic factors may also serve as barriers to accessing sufficient housing, financial assistance and continued after care. Financial barriers to accessing these services should be removed for these individuals so that they can have equitable access to high quality behavioral healthcare.
Individuals with substance abuse have fair access to health care. Many programs for homeless people with mental illnesses do not accept people with substance abuse problems, and many programs for homeless substance abusers do not treat people with mental illnesses. These individuals should both be treated fairly, because both individuals experience additional obstacles to recovery, such as increased risk for violence and victimization and frequent cycling between the streets, jails, and emergency rooms
Lastly, the principle of justice assumes impartiality and equality. The Anti-Drug Abuse Act Second Chance Act serves as justice for individuals who are re-occurring offenders into the community. Federal and government agencies have provided funds to support the community based drug treatment programs to reduce the chance of this individual becoming involved in the criminal justice system after release from prison. Hoefer (2012), stated that social workers are called upon to assist those who are in need, either physical, mental, social, and or societal and the main purpose of advocacy practice is the pursuit of social justice.
The NASW code of ethics is enough support to help get these policies passed. The ethical responsibility and principle of this criteria is to address issues of homelessness, especially when it comes to advocating for living conditions. The analysis of current policy and understanding is a first step towards assisting those who are affected by this policy. Policy shapes what social workers can do to bring about change and to be able to conduct an effective advocacy (Hoefer, 2012).
Conflicting Evaluative Criteria
Many individuals have ideas and solutions for people with serious mental illnesses receiving effective treatment after discharge from an institution or treatment facility. Decisions about this issue will be made by those in charge, local, state and governments. We can follow Bardach's (2012), idea of modifying the existing act that was already implemented. As much as we consider those whom the act was implemented for, we believe that they will agree with making changes to it.
Logistic Criteria
As stated previously, the evaluate criteria which is applied to this policy analysis is equality, equity, fairness, and justices. The man important aspect to consider when evaluating this-criteria is fairness for implementing a change. As Bardach (2012), stated “it is helpful to focus initially on one primary criterion, a principle objective to be maximized or minimized” (p.44).
Avoid Confusing Alternative and Criteria
Confusing alternatives and criteria can be a dangerous mistake as stated by Bardach (2012); therefore, we must identify our alternatives and criteria carefully. This policy analysis of the problem of the mentally ill homeless who have substance abuse problems has showed the need for housing counseling, financial counseling, and support services through the community assistance.
Assemble Some Evidence
Think Before You Collect
Bardach's assemblage of evidence includes thinking and gathering data that support reasons why we think that substance abuse is a social problem and needs to be addressed (Bardach, 2011). Gathering and assembling evidence is necessary for the political and analytic intent. Along with collecting evidences, it is important to track down some past solutions and hypothetically apply them to the problem at hand.
Factual information has been gathered to help address the reason why substance abuse, mental illness and homelessness are problems. Data sources from SAMHSA (2012), provides census reports, population study and the problem of the study. Data from the research conducted in the past five years indicates that about 30% of people who are chronically homeless have mental health conditions and, about 50% have co-occurring substance use problems.
This study provides census reports, population correlation and defining characteristics of the problem for all sheltered individuals over the course of a year (October 2009-September 2010). The breakdown is as follow: 62% were male, 38% were female, 21.8% are under age 18, 23.5% are 18-30, 37% are 31 to 50, 14.9% are 51 to 61, 2.8% are 62 or older, 41.6% are White Non-Hispanic, 9.7% are White Hispanic, 37% are Black/African-American, 4.5% are other single races; 7.2% are multiple races (SAMHSA, 2012). Part of this study also shows that on a specific night of January 2010, 109,812 individuals were chronically homeless; 26.2% of all sheltered individuals who were homeless had a severe mental illness; 34.7% of all sheltered adults who were homeless had chronic substance use issues (SAMHSA, 2012).
A study conducted in New York City and Philadelphia, indicated that people experiencing chronic homelessness were predominantly black and male. In New York City, 92.9% were black and 82.3% were male. In Philadelphia, 92.9% were black and 71.1% were male. According to analyses data from the 1996 NSHAPC, 60% of those who are chronically homelessness have experienced lifetime mental health problems and, 80% have experienced some lifetime drug problems (SAMHSA, 2012).
Review Available Literature
When reviewing literature, there is a need to review the cause of an issue, what people are saying about the issue, and the issue itself. Baradach (2012), “there hardly exists a problem on whose causes and solutions some academic discipline or professional association is not doing research (p.14).
A study was conducted among incarcerated homeless adults who suffer from mental illness and substance abuse. The data collection and sample size for this study consists of 102 individuals during the first 22 months, ages 18 to 64 years old. Over half of participants (53%) were female and nearly three-quarters 74% were white (Hickert, 2011).
According to that study, the average time in jail decreased from 71 days in the 12 months prior to HARP to 44 days in the 12 months following HARP intake. The study showed that those who are homeless had a high proportion of inmate substance abuse and mental health treatment (Hickert, 2011). Participation in HARP corresponded with a decrease in the use of residential substance abuse treatment facilities. The use of less intensive outpatient services remained relatively stable for individual treatment and increased slightly for group treatment (Hickert, 2011).
Another study by Meschede (2010) addresses the transitions of the homeless population associated with medical and substance abuse. The sample size for this study was 174 participants who were chronically homeless and individuals at risk of death over a 3-year period. Of the 174 homeless individuals classified as high-risk during 2000–2002, 53% were still living on the streets at the end of 2002. Numerous cycles between the streets and programs are due to the lack of programs, capacities and resources, lack of referral options, and program eligibility rules, such as excluding ex offenders from attending long term programs. (Meschede, 2010).
Among the high-risk cohort were 45 women (26%), 131 Caucasians (76%), and 23 African-Americans (13%) ranging in age from 30 to 84 years, with an average age of 50. Homeless individuals were significantly more likely to be Caucasian and older. In addition, 94% had a substance abuse problem. 82% of mental illness and substance abuse were assessed with a major psychiatric disability; 37% had a depressive disorder, followed by 22% with psychotic condition or a 10% bipolar disorder. 9% suffered from anxiety disorders, and 5% with post-traumatic stress disorder (Meschede, 2010).
Best Practice
Research and advocacy support funding for effective treatments in institutional rehabilitation centers in combination with stable housing have been attempted before. Evidence reports shows that in 1992 a supporting housing program was established to provide clinical and housing services to homeless with mental illness and substance abuse disorders (Cheng, Lin, Kasprow, & Rosenheck, 2007).) Clearly this research indicates that we are not the only supporters of increasing housing programs and bringing awareness to this issue.
Start Early and Touch Base
According to Bardach (2012), “it is important to obtain feedback from participants, usually in the iterative process” (p.16). Gathering information, creating goals and outcomes to support substance abuse and homelessness were very important before moving on to the next phase. The early steps taken to achieve this policy analysis included, emails, the exchange of files, texting, phone calls, and meetings.
Since decades of homelessness, researchers and advocacy groups have been working towards ending this issue and the results have proven that a housing based approach can reduce homelessness. Academic research has confirmed long-term housing assistance, and permanent supportive housing combined with vital supportive services for those with mental illness successfully reduces homelessness, provides stability of housing and is cost-effective (Coalition for the Homeless, 2013).
Step 3
Construct the Alternatives
Comprehensive and Focused
In order to find solutions to a “problem” there must be a course of intervention to solve the “problem” (Bardach, 2012). This implies there are one or more policy action that may help in solving the problem along with other alternatives. When creating alternatives it is a good idea to create a list of all the alternatives to use in the analysis (Bardach, 2012).
The alternative according to Bardach, (2012), assumes that many different elements need to be combined into some workable system that would be achieved (p.24). Alternatives that should be enforced for individuals who are released from prison, inpatient treatments, and other institutions, should include opportunities to learn skills which can be useful in obtaining employment that will prevent returning to prison and being homeless again. We will also consider using targets and budgets from the federal budget plan as an effective way to develop these alternatives.
Models
In order to change an issue, it is important to model the cause of the issue. The United States Interagency Council on Homelessness reports that the legislation authorizes federal grants to government agencies and nonprofit organizations to provide support strategies and services designed to reduce recidivism (USICH). The Second Chance Act, introduced in 1986, authorized the grant program for reentry of offenders into the community in the Omnibus Crime Control and Safe Streets Act of 1968. The act was signed into law on April 9, 2008. This act was designed to help ensure that individuals who are incarcerated transition into the community safely and successfully. This Second Chance act is part of our policy change; it emphasized that the reentering population has a much higher risk of homelessness than the general population. It is critical for these individuals to obtain supportive services during their transition back into community life, and this is a complex system according to Bardach, (2012).
Conceptualize Alternatives
According to Bardach, (2012), “the key to conceptualization is to try to sum up the basic strategic thrust of an alternative in a simple sentence or even a phrase” (p.21). As alternatives, funding provides employment assistance, mental health therapy and substance abuse treatment, mentoring, and housing programs to reduce recidivism and help former prisoners gain stability (USICH). The Anti-Drug Abuse Act, was implemented to establish an effective program to prevent the use of drugs and education by establishing an effective drug abuse, prevention and education programs (Anti Drug Abuse Act, 1986). This act supports our alternative for targeting funding that will facilitate solutions to ending homelessness and substance abuse.
Points on Continuum Designs Alternative
Drake, Mueser, & Brunette, (2007), state that “supporting housing” helps many individuals escape from homelessness and become motivated for further goals. Bardach (2012), points out that we should approach this as a two step problem. The approach is to establish a high to low limit of the policy analysis. The one solution to this two-step problem as Bardach states, would be implementation of stable housing which has been known to be cost-effective. The second step would be to decide what is acceptable as an implementation to the solution in making our alternative choices. Part of the design alternative to this issue would be supportive permanent housing, because it meets the objective of the policy alternative implemented. Bardach (2012), reminds us to consider targets and budgets which are important in achieving the goals.
Step 4
Select the Criteria
Commonly Evaluative Criteria
The fourth step, according to Bardach (2012), “is the most important step for introducing values and philosophy into the policy analysis, because some possible criteria are evaluative standards used to judge the goodness of the projected policy outcomes that are associated with each of the alternatives” (p.32). Equality, equity, fairness, and justice are some terms used to oppose these ideas. The evaluation criteria is applied to the projected outcomes.
Equality among those with substance abuse should be address the same way with any other disability. Mental illness is connected with inequality and discrimination within our society and mental health care. Social workers should advocate for living conditions conducive to the fulfillment of basic human rights by, pursuing social change on behalf of vulnerable and oppressed individuals and groups in effort to alleviate unemployment, discrimination, and other forms of social injustice (NASW, 2008).
The equality of substance abuse has prevalence in relation to unemployment, homelessness, and income inequality. These individuals experience a high level of unemployment and face a greater chance of relapse along with all of its associated consequences. Social and economic factors may also serve as barriers to accessing sufficient housing, financial assistance and continued after care. Financial barriers to accessing these services should be removed for these individuals so that they can have equitable access to high quality behavioral healthcare.
Individuals with substance abuse have fair access to health care. Many programs for homeless people with mental illnesses do not accept people with substance abuse problems, and many programs for homeless substance abusers do not treat people with mental illnesses. These individuals should both be treated fairly, because both individuals experience additional obstacles to recovery, such as increased risk for violence and victimization and frequent cycling between the streets, jails, and emergency rooms
Lastly, the principle of justice assumes impartiality and equality. The Anti-Drug Abuse Act Second Chance Act serves as justice for individuals who are re-occurring offenders into the community. Federal and government agencies have provided funds to support the community based drug treatment programs to reduce the chance of this individual becoming involved in the criminal justice system after release from prison. Hoefer (2012), stated that social workers are called upon to assist those who are in need, either physical, mental, social, and or societal and the main purpose of advocacy practice is the pursuit of social justice.
The NASW code of ethics is enough support to help get these policies passed. The ethical responsibility and principle of this criteria is to address issues of homelessness, especially when it comes to advocating for living conditions. The analysis of current policy and understanding is a first step towards assisting those who are affected by this policy. Policy shapes what social workers can do to bring about change and to be able to conduct an effective advocacy (Hoefer, 2012).
Conflicting Evaluative Criteria
Many individuals have ideas and solutions for people with serious mental illnesses receiving effective treatment after discharge from an institution or treatment facility. Decisions about this issue will be made by those in charge, local, state and governments. We can follow Bardach's (2012), idea of modifying the existing act that was already implemented. As much as we consider those whom the act was implemented for, we believe that they will agree with making changes to it.
Logistic Criteria
As stated previously, the evaluate criteria which is applied to this policy analysis is equality, equity, fairness, and justices. The man important aspect to consider when evaluating this-criteria is fairness for implementing a change. As Bardach (2012), stated “it is helpful to focus initially on one primary criterion, a principle objective to be maximized or minimized” (p.44).
Avoid Confusing Alternative and Criteria
Confusing alternatives and criteria can be a dangerous mistake as stated by Bardach (2012); therefore, we must identify our alternatives and criteria carefully. This policy analysis of the problem of the mentally ill homeless who have substance abuse problems has showed the need for housing counseling, financial counseling, and support services through the community assistance.