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Subgroups
From 1988 to 1989, researchers screened 238 individuals experiencing homelessness for participation in the project, and 178 met the following selection criteria: a severe psychiatric disorder, no history of violent behavior, and an intention to stay in the St. Louis area for the duration of the study. Researchers initially assigned 50 participants to each of three conditions, with equal probabilities of assignment (we review two of these conditions here). However, because several participants refused or dropped out between study enrollment and the beginning of the intervention, researchers identified additional eligible participants and randomly assigned them to one of the conditions. Because more clients dropped out in certain conditions than others, the final participant sample varied in size across conditions. Fifty-two participants were ultimately assigned to the intervention condition, and 64 were assigned to the comparison condition, both reviewed here. Sixty-two participants were assigned to a third condition that we do not review.
The intervention was studied over 12 months spanning 1988 to 1989.
Missouri Department of Mental Health and the Community Advocacy and Support Alliance Program.
The intervention condition was a continuous treatment team model for people with a mental illness who were also experiencing homelessness. Services provided included a "no-reject" policy, community-based services for an unlimited amount of time, and an individualized plan to address each client's needs. Clinical case managers worked closely with each client to create the individualized plan and help clients address health needs and access housing, transportation, and money management services.
The comparison condition was traditional outpatient treatment provided by a state mental health clinic. The outpatient clinic provided psychotherapy, psychiatric medication, and assistance in obtaining social services from clinicians and other administrative staff.
None
The study took place in St. Louis, MO. Intervention services were provided by clinical case managers who both visited study participants at emergency shelters and met with clients at the Community Advocacy and Support Alliance Program location. Comparison services were provided at a mental health clinic at the Missouri Department of Mental Health.
Client satisfaction; Days homeless; Psychiatric symptoms; Self esteem; Alienation; Interpersonal adjustment; Alcohol consumption