title: A wraparound treatment engagement intervention for homeless veterans with co-occurring disorders.
abstract: This article reports the results of a low-intensity wraparound intervention, Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION), to augment Treatment as Usual (TAU) and engage and retain homeless veterans with a co-occurring disorder (COD) in care. Using a quasi-experimental design, 333 homeless veterans were enrolled, 218 who received MISSION along with TAU and 115 who received TAU alone. Group assignment was based on MISSION treatment slot availability at time of enrollment. Compared with TAU alone, individuals receiving MISSION demonstrated greater outpatient session attendance within the 30 days before the 12-month follow up assessment and a larger decline from baseline in the number of psychiatric hospitalization nights. Individuals in the MISSION and TAU-only groups both showed statistically significant improvements in substance use and related problems at 12 months, with those in MISSION less likely to drink to intoxication and experience serious tension or anxiety. Although this study confirmed that compared with TAU alone, MISSION along with TAU is effective in augmenting usual care and engaging and retaining homeless veterans in treatment, some caution is warranted as this study did not involve random assignment. These results, however, are similar to a recent study involving a briefer version of the intervention which included random assignment. Based on these findings, MISSION is being further studied in the joint Department of Housing and Urban Development (HUD) - Department of Veterans Affairs (VA) Supportive Housing (HUD-VASH) program, which offers rapid housing placement and case management to aid in housing maintenance.
authors.affiliation: Edith Nourse Rogers Memorial VA Medical Center, Bedford, and University of Massachusetts Medical School, Worcester, MA, USA. david.smelson@umassmed.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Smelson
authors.forename: Anna
authors.initials: A
authors.lastname: Kline
authors.forename: John
authors.initials: J
authors.lastname: Kuhn
authors.forename: Stephanie
authors.initials: S
authors.lastname: Rodrigues
authors.forename: Kathryn
authors.initials: K
authors.lastname: O'Connor
authors.forename: William
authors.initials: W
authors.lastname: Fisher
authors.forename: Leon
authors.initials: L
authors.lastname: Sawh
authors.forename: Vincent
authors.initials: V
authors.lastname: Kane
mesh_terms: D000328:Adult; D015897:Comorbidity; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D008605:Mental Health Services; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology; D016896:Treatment Outcome; D014481:United States; D014728:Veterans / Q000523:psychology*