Homeless veterans' satisfaction with residential treatment

Objective: Because little is known about homeless individuals' satisfaction viith mental health services or the association between satisfaction and m easures of treatment outcome, the study examined those issues in a group of homeless veterans. Methods: Demographic and clinical data were obtained fi om intake assessments conducted before veterans' admission to residential treatment facilities under contract with the Department of Veterans Affairs Health Care for Homeless Veterans program, a national outreach and case ma nagement program. Clients: completed a satisfaction survey and the Communit y-Oriented Programs Environment Scale, which asks them to rate dimensions o f the treatment environment. Outcome data came from discharge outcome summa ries completed by VA case managers. Results; Overall satisfaction with resi dential treatment sell-ices was high among the 1,048 veterans surveyed. Gre ater satisfaction was associated with more days of drug abuse and more days spent institutionalized in the month before intake and with an intake diag nosis of drug abuse. Regression anal)ses indicated that satisfaction was mo st strongly related to clients' perceptions of several factors in the treat ment environment. Policy clarity clients' involvement in the program, an em phasis on order; a practical orientation, and peer support were positively related to satisfaction; staff control and clients' expression of anger wer e negatively related. Satisfaction was significantly associated with case m anagers' discharge ratings of clinical improvement of drug problems and psy chiatric problems. Conclusions: Homeless veterans are more satisfied in env ironments they perceive to be supportive, orderly and focused on practical solutions. The results indicate that client satisfaction is not related to treatment outcomes strongly enough to serve as a substitute for other outco me measures.