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The Neuropsychological Functioning of Men Residing in a Homeless Shelter

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Marquette University e-Publications@Marquette Dissertations, Theses, and Professional Dissertations (1934 -) Projects The Neuropsychological Functioning of Men Residing in a Homeless Shelter Sara Murray Hegerty Marquette University Follow this and additional works at: https://epublications.marquette.edu/dissertations_mu Part of the Psychiatry and Psychology Commons Recommended Citation Hegerty, Sara Murray, "The Neuropsychological Functioning of Men Residing in a Homeless Shelter" (2009). Dissertations (1934 -). 3. https://epublications.marquette.edu/dissertations_mu/3 THE NEUROPSYCHOLOGICAL FUNCTIONING OF MEN RESIDING IN A HOMELESS SHELTER by Sara Murray Hegerty, M.A. A Dissertation submitted to the Faculty of the Graduate School, Marquette University, in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Milwaukee, Wisconsin August 2010 ABSTRACT THE NEUROPSYCHOLOGICAL FUNCTIONING OF MEN RESIDING IN A HOMELESS SHELTER Sara Murray Hegerty, M.A. Marquette University, 2010 The number of homeless individuals in the U.S. has continued to increase, with men comprising the majority of this population. These men are at substantial risk for neuropsychological impairment due to several factors, such as substance misuse, severe mental illness, untreated medical conditions (e.g., diabetes, liver disease, HIV/AIDS), poor nutrition, and the increased likelihood of suffering a traumatic brain injury. Impairments in attention, memory, executive functioning, and other neuropsychological domains can result in poor daily functioning and difficulty engaging in psychological, medical, or educational services. Thus, knowledge of the neuropsychological functioning of homeless men is critical for those who work with this population. Yet data in this area are limited. This study aimed to describe the functioning of men residing in an urban homeless shelter across the domains of attention/concentration, memory, executive functions, language, sensory-motor abilities, general intelligence, and reading ability. Particular areas of impairment included attention, visual memory, cognitive flexibility, balance/coordination, and fine motor control. Correlational analyses found that educational background and ethnicity were linked to test performance, and the results of cluster analysis found two distinct subgroups based on neuropsychological functioning: an “average” group and a “low average/impaired” group. Caveats in interpreting test scores, particularly in the domain of language, are discussed, along with possible explanations for differences between African American and non-African American participants. Based on the findings of this study, it is recommended that clinicians and other service providers working with men residing in homeless shelters consider the possibility of neuropsychological impairment when developing treatment plans. Specific recommendations for each subgroup are discussed. Future research in this area might also explore the utility of offering skill-enhancing interventions within homeless shelters, such as workshops to improve organizational and planning skills. Further, the development of adequate norms for neuropsychological tests that are to be used with homeless individuals is recommended, given the possibility of low educational attainments and below average reading skills in this population. i ACKNOWLEDGMENTS Sara Murray Hegerty, M.A. The completion of this project would not have been possible without the guidance, support, and encouragement of many people. I would like to thank the members of my committee for their invaluable advice and feedback over the course of this project and over the past several years in general. I am grateful to Dr. Todd Campbell for his generosity in backing this study, and, more importantly, for being an adviser who had faith in my ability to figure some things out on my own. This has made me a more confident researcher and (future) psychologist. Many, many thanks are also owed to Dr. Terry Young for his guidance on anything and everything related to neuropsychology. I also greatly appreciated Dr. Timothy Melchert’s input on so many crucial aspects of the research process, as well as his supportive comments along the way. Thanks are also due to Abby Bernett, Chasidy Faith, Ryan Mattek, and Amanda Schmitt for assisting with data collection, and to Dr. Mike Brondino for data analysis assistance. I am also very grateful to the Guest House of Milwaukee for allowing me to stick around for so many months collecting data – they made me feel like part of the GHOM family. I also want to thank my friend and colleague, Rose Lucey, who has seen me through the ups and downs of this process and always knew just what to say. I am so grateful for our friendship. Thanks also to my parents, Tom and Ann Murray, and sister, Malisa Murray, for their support and encouragement – and for understanding why I wanted to keep going to school all these years! Finally, I am extremely thankful for the support of my husband, Scott. I loved your “words of wisdom” along the way! More ii importantly, you kept me grounded. Thank you for letting me talk for hours about psychology stuff, for dragging me away from the computer after too many hours, and for believing in me. You are the best. A final thank you – and perhaps the most important one – goes to the men at the Guest House. I learned so much from you, above and beyond my research goals. Thank you for your kindness and trust. I wish the best for all of you. iii TABLE OF CONTENTS ACKNOWLEDGMENTS ......................................................................................... i LIST OF TABLES ..................................................................................................... v LIST OF FIGURES ................................................................................................... ix CHAPTER I. INTRODUCTION ..................................................................................... 1 Statement of the Problem ................................................................... 3 Purpose of the Study .......................................................................... 4 Definition of Terms ............................................................................ 5 Importance of the Study ..................................................................... 7 Note Regarding Person-First Language ............................................. 7 II. REVIEW OF THE LITERATURE .......................................................... 8 Homeless Individuals in the United States ........................................ 8 Factors Affecting the Neurobehavioral Status of Homeless Individuals .......................................................................................... 17 Cognitive Functioning of Homeless Individuals ............................... 36 Neuropsychological Functioning of Homeless Individuals ............... 44 Conclusion ......................................................................................... 94 III. METHOD ............................................................................................... 100 Research Design ................................................................................. 100 Participants ......................................................................................... 101 Instruments ......................................................................................... 139 Procedure ........................................................................................... 175 iv IV. RESULTS ............................................................................................... 186 Cognitive and Neuropsychological Test Performance ....................... 186 Post-Hoc Comparisons ....................................................................... 248 Relationships Among Test Variables ................................................. 250 Cluster Analysis ................................................................................. 255 V. DISCUSSION .......................................................................................... 270 Summary of Results ........................................................................... 271 Interpretation of Results ..................................................................... 275 Limitations ......................................................................................... 292 Implications and Recommendations .................................................. 296 Recommendations for Shelter-Based Research ................................. 305 Future Research ................................................................................. 307 Conclusion ......................................................................................... 308 BIBLIOGRAPHY ...................................................................................................... 310 APPENDIX A ............................................................................................................ 327 APPENDIX B ............................................................................................................ 334 APPENDIX C ............................................................................................................ 336 APPENDIX D ............................................................................................................ 337 v LIST OF TABLES Table 3.1: Participant Demographic Characteristics (N = 51)...................................
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