Randomized trial of intensive housing placement and community transition services for episodic and recidivist homeless families.

OBJECTIVES: We compared Home to Stay, a pilot of intensive housing placement and community transition services for episodic and recidivist homeless families, with a standard services approach. METHODS: Using intention-to-treat analyses, we conducted a modified randomized trial of 138 Home to Stay client families and a control group of 192 client families receiving standard shelter services. RESULTS: Home to Stay clients exited shelter more quickly than clients in the control group (Cox regression, P < .001), more commonly exited shelter with housing subsidies (75% vs 56%), stayed out of shelter longer (Cox regression, P = .011), and spent fewer total days in shelter (376 days vs 449 days). Home to Stay performed best with clients who entered shelter within 180 days of the pilot's start date and had less impact on clients entering shelter before that time. CONCLUSIONS: Relative to standard services, Home to Stay services can accelerate exit from shelter and reduce return to shelter and total sheltered days for episodic and recidivist homeless families. Standard shelter services may be able to narrow this performance gap by incentivizing work with all episodic and recidivist homeless families.

Randomized controlled trial of illness management and recovery in multiple-unit supportive housing.

OBJECTIVE: This study evaluated the effects of the illness management and recovery program on mental illness and functional outcomes of persons with serious mental illness who were receiving supportive housing services. METHODS: A randomized controlled trial was conducted with 104 persons with serious mental illness who were assigned either to illness management classes for six months or to a waitlist control group, with follow-up assessments conducted six months posttreatment. Assessments included self-reports, nonblinded clinical ratings, and blinded interview ratings and included the domains of illness management, symptoms, psychosocial functioning, hospitalizations, and substance abuse and dependence. RESULTS: Participants assigned to the program showed significantly greater improvements than the control group in self-reported and clinician ratings of illness management, interview-based ratings of symptoms on the Brief Psychiatric Rating Scale, and interview-based ratings of psychosocial functioning on the abbreviated Quality of Life Scale. Participants in both groups improved in self-ratings of symptom distress and had low rates of hospitalization and substance abuse over the course of the study. CONCLUSIONS: The results suggest that the program was effective at improving illness management and functional outcomes for persons with serious mental illness who were receiving supportive housing services.

Health and social characteristics of homeless adults in Manhattan who were chronically or not chronically unsheltered.

OBJECTIVE: This study compared health and social characteristics of two groups of homeless adults in Manhattan--those who were chronically unsheltered and those who were not. METHODS: Outreach workers conducted brief, structured interviews with 1,093 unsheltered homeless adults. Respondents were later categorized as being chronically unsheltered on the basis of New York City criteria (sleeping without shelter at least nine of the previous 24 months). RESULTS: The sample had high rates of substance abuse (65%), serious medical issues (42%), and repeated trauma (51%) and low rates of medical insurance (47%) and income entitlements (26%) entitlements. Sixty-seven percent were chronically unsheltered, and these respondents had significantly higher rates on several measures, including military service, incarceration, and mental illness. CONCLUSIONS: The sick and aged nature of this population suggests that more aggressive efforts are needed to enroll unsheltered homeless people in income and health benefits and to create adequate housing opportunities with appropriate support services.