title: The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study.
abstract: BACKGROUND
  Although a growing number of collaborative mental health care models have been developed, targeting specific populations, few studies have utilized such interventions among homeless populations. This quasi-experimental study compared the outcomes of two shelter-based collaborative mental health care models for men experiencing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model.
  
  
  METHODS
  In total 142 participants, 70 from IMCC and 72 from SOCC were enrolled and followed for 12 months. Outcome measures included community functioning, residential stability, and health service use. Multivariate regression models were used to compare study arms with respect to change in community functioning, residential stability, and health service use outcomes over time and to identify baseline demographic, clinical or homelessness variables associated with observed changes in these domains.
  
  
  RESULTS
  We observed improvements in both programs over time on measures of community functioning, residential stability, hospitalizations, emergency department visits and community physician visits, with no significant differences between groups over time on these outcome measures.
  
  
  CONCLUSIONS
  Our findings suggest that shelter-based collaborative mental health care models may be effective for individuals experiencing homelessness and mental illness. Future studies should seek to confirm these findings and examine the cost effectiveness of collaborative care models for this population.
authors: Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. stergiopoulosv@smh.ca.|Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada. stergiopoulosv@smh.ca.|Mental Health Services, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. stergiopoulosv@smh.ca.
authors: Vicky
authors: V
authors: Stergiopoulos
authors: Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. schulera@smh.ca.
authors: Andrée
authors: A
authors: Schuler
authors: Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. NisenbaumR@smh.ca.|Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, M5T 3M7, Canada. NisenbaumR@smh.ca.
authors: Rosane
authors: R
authors: Nisenbaum
authors: Centre for Research on Employment and Workplace Health (CREWH), Centre for Addiction and Mental Health, 455 Spadina Avenue, Suite 300, Toronto, Ontario, M5S 2G8, Canada. wayne_deruiter@camh.net.
authors: Wayne
authors: W
authors: deRuiter
authors: Mental Health Services, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. tim.guimond@utoronto.ca.
authors: Tim
authors: T
authors: Guimond
authors: Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada. donald.wasylenki@utoronto.ca.|Mental Health Services, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. donald.wasylenki@utoronto.ca.
authors: Donald
authors: D
authors: Wasylenki
authors: Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. jeffrey.hoch@utoronto.ca.|Centre for Excellence in Economic Analysis Research (CLEAR), Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. jeffrey.hoch@utoronto.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada. jeffrey.hoch@utoronto.ca.
authors: Jeffrey S
authors: JS
authors: Hoch
authors: Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. hwangs@smh.ca.|Division of General Internal Medicine, Department of Medicine, University of Toronto, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. hwangs@smh.ca.
authors: Stephen W
authors: SW
authors: Hwang
authors: Global Health Program, Department of Family and Community Medicine, University of Toronto, 263 McCaul Street, 3rd Floor, Toronto, Ontario, M5T 1W7, Canada. Katherine.Rouleau@utoronto.ca.|Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. Katherine.Rouleau@utoronto.ca.
authors: Katherine
authors: K
authors: Rouleau
authors: Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada. carolyn.dewa@camh.ca.|Centre for Research on Employment and Workplace Health (CREWH), Centre for Addiction and Mental Health, 455 Spadina Avenue, Suite 300, Toronto, Ontario, M5S 2G8, Canada. carolyn.dewa@camh.ca.
authors: Carolyn
authors: C
authors: Dewa
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006760:Hospitalization; D006798:Housing; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D036301:Qualitative Research; D012111:Residence Characteristics