Comparing Two Service Delivery Models for Homeless Individuals With Complex Behavioral Health Needs: Preliminary Data From Two SAMHSA Treatment for Homeless Studies

Abstract

Assertive Community Treatment (ACT) and the Comprehensive, Continuous, Integrated System of Care (CCISC) are two models for delivering services to homeless persons with complex behavioral health needs. This quasi-experimental study presents preliminary data comparing these two programs. The first program was based out of a community mental health center and utilized the ACT model of care with supported housing (ACT-SH), and the second program was based out of a substance abuse treatment agency and used the CCISC model of care in a residential treatment facility (CCISC-RT). Participants completed clinical assessment interviews at baseline before being admitted to the programs and then 6 months later. Measures included the Brief Symptom Inventory (BSI) to measure mental health symptoms; the Treatment Services Needed and Received (TSNR) to assess service needs, utilization, and levels of unmet needs; and a tool assessing employment, housing, and past-month substance use. Results indicated that participants in both interventions reported significant reductions in substance use and mental health symptoms, although the CCISC-RT program was 287 Downloaded by [McMaster University] at 09:45 26 November 2014 288 M. S. Young et al.associated with slightly greater reductions in mental health symptoms. Both programs were also associated with significant improvements in residential stability, although participants in the ACT-SH program were more likely to own or rent their own residence 6 months following program enrollment. This study indicates that both the ACT and CCISC models of care can be successfully implemented to serve homeless individuals with behavioral health needs. Although the CCISC-RT program was based in a residential treatment facility and delivered a greater intensity of behavioral health services than the ACT-SH program, results indicate that either approach can successfully be used to assist homeless individuals in obtaining a variety of needed services, reducing their substance use and mental health symptoms, and attaining a stable residence.

Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience

“…: unpublished data, 2020) identified 14 trials on permanent supportive housing (PSH). [30][31][32][33][34][35][36][37][38][39][40][41][42][43] Several trials across Canada and the United States showed that PSH initiatives house participants more rapidly compared with usual services (73 v. 220 d; adjusted absolute difference 146.4, 95% confidence interval [CI] 118.0 to 174.9); 30 increase the number of people who maintain stable housing at 2 years (pooled odds ratio [OR] 3.58, 95% CI 2.36 to 5.43); 30,40 and significantly increase the percentage of days spent stably housed. 41 No trials showed a sig nificant improvement in mental health symptoms compared with standard care.…”

“…44 No trials showed a significant improvement in substance use compared with standard care. 30,33,[41][42][43] Most trials reported no effect of PSH on acute care outcomes (e.g., number of emergency department visits and percentage of participants admitted to hospital). 30,41 However, 2 trials suggest that PSH participants had lower rates of hospital admission (rate reductions of 29%, 95% CI 10 to 44) and time in hospital (e.g., mean difference -31, 95% CI -48 to -14).…”

Die gesundheitliche Versorgung von wohnungslosen Menschen mit psychischen Problemen

“…Ein aktuelles Review bestätigt diese Effekte (40). Auch bei Wohnungslosen mit psychischen Störungen und komorbider Suchterkrankung verbessert ACT die psychische Gesundheit (58,72,73) oder lindert psychiatrische Symptomatik (39). Auch CTI erweist sich hier als wirksam, während für herkömmliches CM oder ICM kein entsprechender Effekt vorliegt (40).…”

“…So finden sich für ACT keine signifikanten Einflüsse auf Konsummenge oder Missbrauchsschwere (40). Das trifft auch für Wohnungslose mit komplexem Bedarf oder Substanz-Komorbidität zu (72,73). Andere Studien finden mittels ACT in dieser Subgruppe eine deutliche Reduktion der Konsummenge (39,58).…”

Outcomes of Integrated Assertive Community Treatment for Homeless Consumers With Co-occurring Disorders

“…In the years since ACT was developed, it has been evaluated with a wide range of consumers including homeless persons (Coldwell & Bender, 2007;Lehman et al, 1999;Lehman, Dixon, Kernan, Deforge, & Postrado, 1997;Meisler, Blankertz, Santos, & McKay, 1997), mentally ill persons involved in the criminal justice system (Cosden, Ellens, Schnell, & Yamini-Diouf, 2005;Cosden, Ellens, Schnell, Yamini-Diouf, & Wolfe, 2003;McCoy, Roberts, Hanrahan, Clay, & Luchins, 2004;Meisler et al, 1997), and persons with co-occurring mental illness and substance use disorders Meisler et al, 1997). Additionally, studies have been conducted to determine ACT's impact on housing stability (Drake, Yovetich, Bebout, Harris, & McHugo, 1997;Lehman et al, 1997;Meisler et al, 1997), homeless persons with co-occurring mental health and substance use disorders (Young, Clark, Moore, & Barrett, 2009), mental illness symptom reduction (Coldwell & Bender, 2007;Cosden et al, 2005;Lehman et al, 1997), cost-effectiveness compared to traditional models (Essock, Frisman, & Kontos, 1998;Lehman et al, 1999), and drug and alcohol use (Cosden et al, 2005;Drake et al, 1998aDrake et al, ,1998b. Across populations and variables, ACT has consistently performed as well as other models of care, and in many instances it has outperformed other approaches on one or more of the outcomes discussed above.…”