title: A modified therapeutic community for homeless persons with co-occurring disorders of substance abuse and mental illness in a shelter: an outcome study.
abstract: This article reports on a study conducted to determine the effectiveness of a modified therapeutic community (MTC) shelter on client outcomes. The seven-study hypotheses focused on whether greater effectiveness in the MTC would be demonstrated in longer periods of sobriety, fewer days of psychiatric hospitalization, shorter lengths of stay in a shelter, positive discharge from the shelter, medication compliance, housing placement within the first year, and appropriate housing placement according to level of functioning. The study utilized a quasi-experimental design with two groups: 1) an experimental group (E) homeless persons with co-occurring disorders (COD) of substance abuse/dependence and mental illness who reside in a modified therapeutic community (N = 70); and 2) a comparison group (C) of veterans with CODs living in a general shelter (N = 70). The data collection procedures involved a retrospective review of closed case records for subjects in the facilities from September 1, 1998-June 1, 2000 for the MTC shelter, and from June 1, 1999-June 1, 2000 for the general shelter. Baseline differences between the E and C groups were found in age, length of homelessness, years of education, years of work experience, veteran status, marital status, and psychiatric diagnosis; all except for veteran status were unrelated to outcomes and were controlled in subsequent analyses. Significant difference was found on medication compliance when controlled for both groups. Overall, this study showed some promise for the MTC approach. The study also raised a question as to the contribution of veteran status to the differences between groups and to treatment of CODs.
authors.affiliation: Co-Occurring Programs, Gaudenzia Inc., 1306 Spring Garden Street, 5th Floor, Philadelphia, PA, USA. dskinner@gaudenzia.org
authors.forename: Darren C
authors.initials: DC
authors.lastname: Skinner
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003710:Demography; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D016352:Group Homes / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration; D008875:Middle Aged; D011638:Public Housing / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000628:therapy*