Integration of service systems for homeless persons with serious mental illness through the ACCESS program. Access to Community Care and Effective Services and Supports.
OBJECTIVE
The aim of this study was to evaluate the first of the two core questions around which the ACCESS (Access to Community Care and Effective Services and Supports) evaluation was designed: Does implementation of system-change strategies lead to better integration of service systems?


METHODS
The study was part of the five-year federal ACCESS service demonstration program, which sought to enhance integration of service delivery systems for homeless persons with serious mental illness. Data were gathered from nine randomly selected experimental sites and nine comparison sites in 15 of the nation's largest cities on the degree to which each site implemented a set of systems integration strategies and the degree of systems integration that ensued among community agencies across five service sectors: mental health, substance abuse, primary care, housing, and social welfare and entitlement services. Integration was measured across all interorganizational relationships in the local service networks (overall systems integration) and across relationships involving only the primary ACCESS grantee organization (project-centered integration).


RESULTS
Contrary to expectations, the nine experimental sites did not demonstrate significantly greater overall systems integration than the nine comparison sites. However, the experimental sites demonstrated better project-centered integration than the comparison sites. Moreover, more extensive implementation of strategies for system change was associated with higher levels of overall systems integration as well as project-centered integration at both the experimental sites and the comparison sites.


CONCLUSIONS
The ACCESS demonstration was successful in terms of project-centered integration but not overall system integration.
Morrissey
Joseph P
JP
Cecel G. Sheps Center for Health Services, University of North Carolina, Chapel Hill, 27599-7590, USA. joe_morrisey@unc.edu
Calloway
Michael O
MO
Thakur
Neil
N
Cocozza
Joseph
J
Steadman
Henry J
HJ
Dennis
Deborah
D
D003156:Community Mental Health Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated; D006297:Health Services Accessibility; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D015397:Program Evaluation; D011897:Random Allocation; D012720:Severity of Illness Index; D014481:United States