Service systems integration and outcomes for mentally ill homeless persons in the ACCESS program. Access to Community Care and Effective Services and Supports.

OBJECTIVE The authors evaluated the second of the two core questions around which the ACCESS (Access to Community Care and Effective Services and Supports) evaluation was designed: Does better integration of service systems improve the treatment outcomes of homeless persons with severe mental illness? METHODS The ACCESS program provided technical support and about $250,000 a year for four years to nine sites to implement strategies to promote systems integration. These sites, along with nine comparison sites, also received funds to support outreach and assertive community treatment programs to assist 100 clients a year at each site. Outcome data were obtained at baseline and three and 12 months later from 7,055 clients across four annual cohorts at all sites. RESULTS Clients at all sites demonstrated improvement in outcome measures. However, the clients at the experimental sites showed no greater improvement on measures of mental health or housing outcomes across the four cohorts than those at the comparison sites. More extensive implementation of systems integration strategies was unrelated to these outcomes. However, clients of sites that became more integrated, regardless of the degree of implementation or whether the sites were experimental sites or comparison sites, had progressively better housing outcomes. CONCLUSIONS Interventions designed to increase the level of systems integration in the ACCESS demonstration did not result in better client outcomes.

[1]  L. Stein,et al.  Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. , 1980, Archives of general psychiatry.

[2]  A T McLellan,et al.  An Improved Diagnostic Evaluation Instrument for Substance Abuse Patients: The Addiction Severity Index , 1980, The Journal of nervous and mental disease.

[3]  L. Robins,et al.  National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. , 1981, Archives of general psychiatry.

[4]  The psychiatric epidemiology research interview , 1981 .

[5]  D. Hedeker,et al.  Random regression models: a comprehensive approach to the analysis of longitudinal psychiatric data. , 1988, Psychopharmacology bulletin.

[6]  A. Lehman,et al.  A Quality of Life Interview for the chronically mentally ill. , 1988 .

[7]  D. Mechanic.  Strategies for integrating public mental health services. , 1991, Hospital & community psychiatry.

[8]  Joseph P. Morrissey,et al.  Accuracy and reliability of self-reported data in interorganizational networks , 1993 .

[9]  H. B. Milword.  Integrating Services for Children and Families: Understanding the Past to Shape the Future , 1993 .

[10]  R. Bosker.  Boekbespreking van "A.S. Bryk & S.W. Raudenbusch - Hierarchical linear models: Applications and data analysis methods" : Sage Publications, Newbury Parki, London/New Delhi 1992 , 1995 .

[11]  H. Goldman,et al.  Characteristics and activities of case managers in the RWJ Foundation Program on chronic mental illness. , 1996, Psychiatric services.

[12]  R. Rosenheck,et al.  Individual and community-level variation in intensity and diversity of service utilization by homeless persons with serious mental illness. , 1997, The Journal of nervous and mental disease.

[13]  R. Rosenheck,et al.  Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness. , 1998, American journal of public health.

[14]  R. Drake,et al.  Program fidelity in assertive community treatment: development and use of a measure. , 1998, The American journal of orthopsychiatry.

[15]  Services for mentally ill homeless persons: street-level integration. , 1998, The American journal of orthopsychiatry.

[16]  R. Rosenheck,et al.  Time-limited assertive community treatment for homeless persons with severe mental illness. , 2001, Archives of general psychiatry.

[17]  R. Rosenheck,et al.  Service delivery and community: social capital, service systems integration, and outcomes among homeless persons with severe mental illness. , 2001, Health services research.

[18]  R. Rosenheck,et al.  Overview of the ACCESS Program , 2002 .

[19]  H. Steadman,et al.  Integration of service systems for homeless persons with serious mental illness through the ACCESS program. Access to Community Care and Effective Services and Supports. , 2002, Psychiatric services.

[20]  R. Rosenheck,et al.  Lessons from the evaluation of the ACCESS program. Access to Community Care and Effective Services. , 2002, Psychiatric services.