Transcript Community Mental Health Evaluation Initiative (CMHEI

Centre de recherche sur les services communautaires
The Centre for Research on Community Services
Risk Factors and Behaviours Among Homeless
Persons: Effectiveness of Intensive Case
Management in Reducing Housing Instability for
Persons with Severe Mental Illness
Tim Aubry
Centre for Research on Community Services,
University of Ottawa
Canadian Conference on Homelessness
York University, May 20, 2005
The Community Mental Health Evaluation
Initiative (CMHEI)
Partners:
– Ontario MOHLTC, CMHA Ontario, Ontario Mental Health
Foundation, CAMH
Goals:
– Contribute knowledge to support evidence-based practice &
system planning through a multi-site study
– Encourage collaboration between providers and
researchers in Ontario.
– Provide training & increase capacity for conducting mental
health evaluation in Ontario
The Community Mental Health Evaluation
Initiative (CMHEI)
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Focus on innovative community programs:
– Case management (ICM / ACT)
– Crisis services
– Self help / peer support
Required to participate in multi-site component
Comprehensive assessment using common
protocol:
• Symptoms, functioning, service use, quality of
life
CMHEI Ottawa – Primary Objective
 To
examine the effectiveness of
intensive case management
services for people who are
homeless and have severe mental
illness
CMHEI Ottawa – Study Design
1.
2.
3.
Prior to entering study, all participants were
receiving outreach services
Random assignment to ICM (treatment) at or
Standard Care (control)
Clients followed for 24 months
CMHEI Ottawa - Criteria for ICM
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Severe & persistent mental illness
High degree of disability
Homeless or at risk of homelessness
Isolated and few resources
CMHEI Ottawa-Treatment Conditions
ICM: Case management based on strengths and
psychosocial rehabilitation approaches; 15:1 client-staff
ratio; individualized service plans with wide scope
possible; access to any other services in community
SC: Standard care can include any services in the
community with the exception of ICM; continuation of
outreach services for varying amounts of time (each
service provider serves 40-50 clients per year)
CMHEI Ottawa - Participants
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97 participants at 24 months (53T / 44C)
60% male / 40% female
Almost half (46%) had spent at least 1 night on
the streets or in shelters in 9mos prior to BL
Over 55% had diagnosis of schizophrenia,
40% with mood disorder
61% had co-occurring disorders (substance
abuse)
CMHEI Ottawa
Housing-Related Outcomes
% with Unstable Housing
(homeless or 3 or more moves in 9mos.)
ICM
% for both
groups
significantly
decrease
with time;
p<.01
N = 43 SC
N = 52 ICM
70
60
50
40
30
20
10
0
Std Care
ICM < SC
p = .05;
61.2
53.7
31.3
16.7
Baseline
9months
28.6
27.3
20.4
10.3
18 months
24 months
% with Unstable Housing
(homeless or 3 or more moves in 9mos.)
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Both groups show improvement in housing
stability over the 24 month period of the study
Intensive case management clients show a
lower level of housing instability at 24 months
than standard care clients
Quality of Life – Living Situation
(Lehman’s QOLI, 1997)
ANOVA
RESULTS:
Significant
Time effect:
F = 3.93;
p<.01.
Scores
increase
with time.
N = 47
N = 34
5
4
3
ICM
Std Care
Baseline
9months
18months
24 mos
4.05
4.06
4.23
4.42
4.57
4.49
4.42
4.66
Quality of Life – Living Situation
(Lehman’s QOLI, 1997)
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Both groups (ICM & SC) show an increase in
satisfaction with their living situation over the
24-month period of the study
Both groups (ICM & SC) report on average
being “satisfied” (i.e., > 4) with their living
situation
Hierarchical Regression: Predicting
Housing Instability at 24 months (N =73)
Variable Clusters
Standardized
Beta
% Variance
Explained
Demographic Vars.
(Age, Sex, Educ.)
None significant
4%
Clinical Vars. (18 mos.)
.40* (Alcohol use)
(Symptoms, glob. funct., .33* (Drug use)
drug use, alcohol use)
34%**
Service Use Vars. (24
mos.) (Hosps., med.
adher., emerg. Use)
46%**
.30* (Med.
Adherence)
*p < .01; **R2 change significant; p<.001
Predictors of Housing Instability
at 24 Months
Higher levels of drug use
 Higher levels of alcohol use
 Lower levels of medication adherence
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Conclusions
1.
2.
Psychosocial support of different levels
of intensity and duration (ICM & SC) is
effective in reducing housing instability
Clients receiving more intensive support
(ICM) experience lower levels of
housing instability over the long term
Conclusions (contd.)
3.
4.
A small subgroup of persons with
severe mental illness experience a
continued pattern of housing instability
Community support programs need to
target substance abuse and medication
adherence problems to more effectively
assist this subgroup
For more information on CMHEI:
WWW.ONTARIO.CMHA.CA/CMHEI