The social environment of transitional work and residence programs: Influences on health and functioning

The social environment of service programs-the context for treatment delivery rather than the treatment itself-is often neglected in evaluations of treatment outcomes. This research paper uses Moos's [Moos, R. H. (1997). Evaluating treatment environments: The quality of psychiatric and substance abuse programs (2nd ed.). New Brunswick, NJ: Transaction] measure of level of program involvement to identify variation in the social environment of a multi-site transitional program for homeless veterans that included both work and residential components. The transitional program, the Veterans Health Administration Compensated Work Therapy/Transitional Residence program (CWT/TR) provides a unique opportunity to test the simultaneous influence of the social environment in work and housing. Three hypotheses were tested concerning the impact of the social environment on three health outcomes and three functional outcomes. We find that programs with higher average involvement levels tended to produce more improvement among participants, particularly for those who were more impaired at baseline. Identifying the influence of the social environment within this program required assessment of both the work and residential environments and tests for their conjoint influence, as well multiple tests of person-environment fit with multiple outcomes.