Can shelter-based interventions improve treatment engagement in homeless individuals with psychiatric and/or substance misuse disorders?: a randomized controlled trial.
BACKGROUND
High proportions of homeless individuals have mental illness and substance use disorders. Few of these individuals engage in consistent treatment, although they are likely to benefit from it. Shelter-based interventions to help this population engage in treatment have not been studied in a rigorous manner.


OBJECTIVE
We sought to evaluate the effectiveness of a shelter-based intervention, including intensive outreach by a psychiatric social worker and availability of weekly psychiatrist visits with continuity of care to engage homeless individuals with psychiatric and substance use problems.


METHODS
This was a randomized controlled trial.


METHODS
A total of 102 individuals were referred to a shelter-based psychiatric clinic.


METHODS
The primary outcome measure was first appointment attendance at a community mental health center (CMHC). Secondary outcome measures were attendance at second and third CMHC appointments, participation in a substance abuse program, and employment and housing status at shelter exit.


RESULTS
Individuals receiving the intervention were more likely to attend > or =1 CMHC appointment (64.7% versus 37.3%, P = 0.006) and to participate in a substance abuse program (51.4% versus 12.5%, P = 0.0006) than those in the control group. There was a trend towards being more likely to attend 2 CMHC visits (33.3% versus 17.7%, P = 0.083), but no significant differences in attending 3 visits, being employed, or having housing.


CONCLUSIONS
Shelter-based interventions hold promise for improving treatment engagement in homeless populations with psychiatric and substance use problems. Further study should address how to foster care beyond an initial CMHC appointment and clarify key program components using a wider range of outcome measures.
Bradford
Daniel W
DW
Robert Wood Johnson Clinical Scholars Program, Chapel Hill, North Carolina, USA. dbradford@ebradford.org
Gaynes
Bradley N
BN
Kim
Mimi M
MM
Kaufman
Jay S
JS
Weinberger
Morris
M
D000328:Adult; D003155:Community Mental Health Centers / Q000458:organization & administration*; D003158:Community Psychiatry; D005260:Female; D006703:Ill-Housed Persons; D006798:Housing; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000628:therapy*; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome