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PS 1997; 48:497-503
Copyright © 1997 by American Psychiatric Association
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RANDOMIZED CONTROLLED TRIAL |
An experimental comparison of three types of case management for homeless mentally ill persons
GA Morse, RJ Calsyn, WD Klinkenberg, ML Trusty, F Gerber, R Smith, B Tempelhoff and L Ahmad
University of Missouri-St. Louis 63121, USA.
OBJECTIVE: Three types of case management were compared to determine their
relative effectiveness in helping people with severe mental illness who
were homeless or at risk of homelessness. METHODS: Subjects recruited from
a psychiatric emergency room and inpatient units were randomly assigned to
one of the three treatment conditions: broker case management, in which the
client's needs were assessed, services were purchased from multiple
providers, and the client was monitored; assertive community treatment
only, in which comprehensive services were provided for an unlimited
period; and assertive community treatment augmented by support from
community workers, who assisted with activities of daily living and were
available for leisure activities. Of 165 subjects recruited, 135 were
followed for 18 months. RESULTS: Compared with clients assigned to broker
case management, clients assigned to assertive community treatment only and
assertive community treatment with community workers had superior outcomes
on several variables. They were number of contacts with the assigned
treatment program, resource utilization (for example, use of entitlements),
severity of thought disorder, activity level, and client satisfaction.
Clients in the assertive community treatment only condition achieved more
days in stable housing than those in the other two treatment conditions. No
significant treatment group effects were found on income, self-esteem, or
substance abuse. CONCLUSIONS: Assertive community treatment is superior to
broker case management in assisting individuals with serious mental illness
who are at risk of homelessness.
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