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Administration and Policy in Mental Health and Mental Health Services Research

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01-05-2011 | Original Paper

Patient and Program Predictors of 12-Month Outcomes for Homeless Veterans Following Discharge from Time-Limited Residential Treatment

Authors: James McGuire, Robert A. Rosenheck, Wesley J. Kasprow

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 3/2011

Abstract

The U.S. Department of Veterans Affairs provides transitional residential treatment to homeless veterans through three types of programs: VA-staffed Domiciliary care, and two types of community-based treatment (one funded through locally managed contracts and the other through national grants). This study compared treatment process and outcomes in these three programs and also sought to identify differences in outcome between dually diagnosed veterans, veterans with substance abuse problems or psychiatric problems alone, and those with no psychiatric diagnoses. Altogether, 1,338 veterans admitted to the 3 types of program were recruited to participate in a prospective naturalistic study which evaluated housing, clinical and community adjustment outcomes during the year following discharge. Data on 1,003 veterans for whom psychiatric diagnostic, social climate and length of stay data were available were used to compare participants in the three program types at baseline. Regression models were used to compare outcomes across program and diagnostic types net of baseline differences between study participants, and of differences in social climate and length of stay. The overall follow-up rate across all time points was 72%. Significant differences across programs were observed on only 2 baseline measures as well as on several baseline values of the outcome measures, length of stay and a measure of social climate. Adjusting for veteran baseline differences alone there were no differences in outcomes by program after correction for multiple comparisons. Dually diagnosed veterans had poorer mental health and overall quality of life outcomes. Longer length of stay and more positive social climate were associated with superior outcomes on several measures. The adjusted mean estimate of the proportion of veterans housed at 12 months follow-up was 78%, similar to published outcomes for supported housing. Length of stay, rather than program funding configuration or diagnostic group, was the strongest predictor of outcomes in time-limited residential treatment programs in which 1-year housing was similar to those in direct-placement supported housing programs.

Barrow, S. M., & Soto, G. (1996). Closer to home: An evaluation of interim housing for homeless adults. New York: Corporation for Supportive Housing.

Barrow, S., & Zimmer, R. (1998). Transitional housing and services: A synthesis. In L. B. Fosburg & D. L. Dennis (Eds.), Practical lessons: The 1998 national symposium on homelessness research. Delmar, N.Y.: HUD USER.

Burling, T. A., Seidner, A. L., Salvio, M., & Marshall, G. D. (1994). A cognitive-behavioral therapeutic community for substance dependent and homeless veterans: Treatment outcome. Addictive Behaviors, 19, 621–629.PubMedCrossRef

Burnam, M. A., Morton, S. C., McGlynn, E. A., Petersen, M. S., Stecher, B. M., Hayes, C., et al. (1995). An experimental evaluation of residential and nonresidential treatment for dually diagnosed homeless adults. Journal of Addictive Diseases, 14, 111–134.PubMedCrossRef

Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., & Iwen, B. (1999). Ηomelessness: Programs and the people they serve. Summary report. Findings of the national survey of homeless assistance providers and clients. Washington: Urban Institute.

Burt, M. R. & Spellman, B. E. (2007). Changing homeless and mainstream service systems: Essential approaches to ending homelessness. In Toward understanding homelessness: The 2007 national symposium on homelessness research. http://aspe.hhs.gov/hsp/homelessness/symposium07/burt/index.htm. Accessed 8 May 2010.

Culhane, D. P., Parker, W. D., Poppe, B., Gross, K. S., & Sykes, E. (2007). Accountability, cost-effectiveness, and program performance: Progress since 1998. Toward understanding homelessness: The 2007 national symposium on homelessness research. http://aspe.hhs.gov/hsp/homelessness/symposium07/culhane/index.htm. Accessed 8 May 2010.

Gamache, G., Rosenheck, R., & Tessler, R. (2001). The proportion of veterans among homeless men: A decade later. Social Psychiatry and Psychiatric Epidemiology, 36, 481–485.PubMedCrossRef

Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: Application to medical care use and outcomes for homeless people. Health Services Research, 34, 1273–1302.PubMed

General Accounting Office (1991). Homelessness: Transitional housing shows initial success but long-term effects unknown. Report to the Chairman, Committee on Governmental Affairs. (Rep. No. GAO/RCED-91-200). Washington, D.C.: United States General Accounting Office.

Greenberg, G. A., Rosenheck, R. A., & Seibyl, C. L. (2002). Continuity of care and clinical effectiveness: outcomes following residential treatment for severe substance abuse. Medical Care, 40, 246–259.PubMedCrossRef

Kasprow, W. J., Frisman, L., & Rosenheck, R. (1999). Homeless veterans’ satisfaction with residential treatment. Psychiatric Services, 50, 540–545.PubMed

Kasprow, W. J., Rosenheck, R. A., DiLella, D., Cavallaro, L., & Harelik, N. (2006). Health care for homeless veterans programs: The nineteenth annual report. West Haven, CT: Department of Veterans Affairs Northeast Program Evaluation Center.

Kertesz, S. G., & Weiner, S. J. (2009). Housing the chronically homeless: High hopes, complex realities. JAMA, 301, 1822–1824.PubMedCrossRef

Lam, J. A., Jekel, J. F., Thompson, K. S., Leaf, P. J., Hartwell, S. S., & Florio, L. (1995). Assessing the value of a short-term residential drug treatment program for homeless men. Journal of Addictive Diseases, 14, 21–39.PubMedCrossRef

Larsen, D. L., Attkisson, C. C., Hargreaves, W. A., & Nguyen, T. D. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2, 197–207.PubMedCrossRef

Leda, C., & Rosenheck, R. (1992). Mental health status and community adjustment after treatment in a residential program for homeless veterans. American Journal of Psychiatry, 149, 1219–1224.PubMed

Lehman, A. F. (1988). A quality of life interview for the chronically mentally ill. Evaluation and Program Planning, 11, 51–62.CrossRef

Leichsenring, F. (2004). Randomized controlled versus naturalistic studies: a new research agenda. Bulletin of the Menninger Clinic, 68, 137–151.PubMedCrossRef

Locke, G., Khadduri, J., & O’Hara, A. (2007). Housing models. In Toward understanding homelessness: The 2007 national symposium on homelessness research. http://aspe.hhs.gov/hsp/homelessness/symposium07/locke/index.htm. Accessed 8 May 2010.

McClellan, T., Luborsky, L., Woody, G., & O’Brien, C. P. (1980). An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental Disease, 168, 26–33.CrossRef

Moos, R. H. (1996). Community Oriented Programs Environment Scale Manual: A social climate scale. Redwood City, CA: Mind Garden.

Moos, R., & Otto, J. (1972). The Community-Oriented Programs Environment Scale: A methodology for the facilitation and evaluation of social change. Community Mental Health Journal, 8, 28–37.PubMedCrossRef

Nuttbrock, L. A., Rahav, M., Rivera, J. J., Ng-Mak, D. S., & Link, B. G. (1998). Outcomes of homeless mentally ill chemical abusers in community residences and a therapeutic community. Psychiatric Services, 49, 68–76.PubMed

Osborne, D., & Gaebler, T. (1992). Reinventing government: how the entrepreneurial spirit is transforming the public sector. Reading, MA: Addison-Wesley.

Prabucki, K., Wootton, E., McCormick, R., & Washam, T. (1995). Evaluating the effectiveness of a residential rehabilitation program for homeless veterans. Psychiatric Services, 46, 372–375.PubMed

Resnick, S. G., Rosenheck, R., Medak, S., & Corwel, L. (2006). The seventeenth progress report on the department of veterans affairs domiciliary care for homeless veterans program: Fiscal year 2005. West Haven, CT: U.S. Department of Veterans Affairs Northeast Program Evaluation Center.

Rosenheck, R., Frisman, L., & Chung, A. (1994). The proportion of veterans among homeless men. American Journal of Public Health, 84, 466–469.PubMedCrossRef

Rosenheck, R., Frisman, L., & Gallup, P. (1995). Effectiveness and cost of specific treatment elements in a program for homeless mentally ill veterans. Psychiatric Services, 46, 1131–1139.PubMed

Rosenheck, R., Kasprow, W. J., Frisman, L., & Liu-Mares, W. (2003). Cost-effectiveness of supported housing for homeless person with mental illness. Archives of General Psychiatry, 60, 940–951.PubMedCrossRef

Schutt, R. K., Rosenheck, R. A., Penk, W. E., Drebing, C. E., & Seibyl, C. L. (2005). The social environment of transitional work and residence programs: Influences on health and functioning. Evaluation and Program Planning, 28, 291–300.CrossRef

Tessler, R., Rosenheck, R., & Gamache, G. (2003). Homeless veterans of the All-Volunteer Force: A social selection perspective. Armed Forces and Society, 29, 509–524.CrossRef

Tsemberis, S. (1999). From streets to home: An innovative approach to supported housing for homeless adults with psychiatric disabilities. Journal of Community Psychology, 27, 225–241.CrossRef

Tsemberis, S., Gulchur, L., & Nakae, M. (2004). Housing first, consumer choice, and harm reduction for individuals who are homeless with dual diagnoses: A 24-month clinical trial. American Journal of Public Health, 94, 651–656.PubMedCrossRef

Ware, J. E., Keller, S. D., & Kosinski, M. (1995). How to score the SF-12 physical and mental health summary scales (2nd ed.). Boston: The Health Institute, New England Medical Center.

Ware, J. E., Kosinksi, M., & Keller, S. D. (1994). SF-36 physical and mental health summary scores: A user’s manual. Boston, MA: The Health Institute, New England Medical Center.

Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-item Short-Form Health Survey (SF-12): Construction of scales and preliminary tests of reliability and validity. Medical Care, 32, 220–233.CrossRef

Title: Patient and Program Predictors of 12-Month Outcomes for Homeless Veterans Following Discharge from Time-Limited Residential Treatment
Authors: James McGuire
Robert A. Rosenheck
Wesley J. Kasprow
Publication date: 01-05-2011
Publisher: Springer US
Published in: Administration and Policy in Mental Health and Mental Health Services Research / Issue 3/2011
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-010-0309-9

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Patient and Program Predictors of 12-Month Outcomes for Homeless Veterans Following Discharge from Time-Limited Residential Treatment

Abstract

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