Case managed residential care for homeless addicted veterans. Results of a true experiment.
OBJECTIVE
The effectiveness of case-managed residential care (CMRC) in reducing substance abuse, increasing employment, decreasing homelessness, and improving health was examined.


METHODS
A five-year prospective experiment included 358 homeless addicted male veterans 3, 6, and 9 months during their enrollment and at 12, 18, and 24 months after the completion of the experimental case-managed residential care program. The customary control condition was a 21-day hospital program with referral to community services.


RESULTS
The experimental group averaged 3.4 months in transitional residential care with ongoing and follow-up case management for a total of up to 1 year of treatment. The experimental group showed significant improvement compared with the control group on the Medical, Alcohol, Employment, and Housing measures during the 2-year period. An examination of the time trends indicated that these group differences tended to occur during the treatment year, however, and to diminish during the follow-up year.


CONCLUSIONS
Within groups, significant improvements were observed with time from baseline to all posttests on the four major outcomes. We learned, however, that veterans had access to and used significant amounts of services even without the special case-managed residential care program. This partially may account for improvements in the control group and may have muted the differences between groups.
Conrad
K J
KJ
Midwest Center for Health Services & Policy Research, Edward Hines, Jr. VA Hospital, IL 60141, USA.
Hultman
C I
CI
Pope
A R
AR
Lyons
J S
JS
Baxter
W C
WC
Daghestani
A N
AN
Lisiecki
J P
JP
Elbaum
P L
PL
McCarthy
M
M
Manheim
L M
LM
D000328:Adult; D000368:Aged; D019090:Case Management / Q000592:standards*; D004651:Employment; D006304:Health Status; D006703:Ill-Housed Persons; D006787:Hospitals, Veterans; D006801:Humans; D007087:Illinois; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D015397:Program Evaluation; D011446:Prospective Studies; D012044:Regression Analysis; D012114:Residential Treatment / Q000592:standards*; D019966:Substance-Related Disorders / Q000517:prevention & control*; D016896:Treatment Outcome; D014728:Veterans