A randomized clinical trial of tailored interventions for health promotion and recidivism reduction among homeless parolees: outcomes and cost analysis

Abstract

Objectives This study conducted a randomized controlled trial with 600 recently released homeless men exiting California jails and prisons. Methods The purpose of this study was to primarily ascertain how different levels of intensity in peer coaching and nurse-partnered intervention programs may impact reentry outcomes; specifically: (a) an intensive peer coach and nurse case managed (PC-NCM) program; (b) an intermediate peer coaching (PC) program with brief nurse counseling; and (c) the usual care (UC) program involving limited peer coaching and brief nurse counseling. Secondary outcomes evaluated the operational cost of each program. Results When compared to baseline, all three groups made progress on key health-related outcomes during the 12-month intervention period; further, 84.5 % of all participants eligible for hepatitis A/B vaccination completed their vaccine series. The results of the detailed operational cost analysis suggest the least costly approach (i.e., UC), which accounted for only 2.11 % of the total project expenditure, was as effective in achieving comparable outcomes for this parolee population as the PC-NCM and PC approaches, which accounted for 53.98 % and 43.91 %, respectively, of the project budget. Conclusions In this study, all three intervention strategies were found to be comparable in achieving a high rate of vaccine completion, which over time will likely produce tremendous savings to the public health system.

The effectiveness of case management interventions for the homeless, vulnerably housed and persons with lived experience: A systematic review

“…Evidence on cost and cost-effectiveness was mixed. The total cost incurred by SCM clients was higher than those receiving usual or standard care [50,79], but lower compared to a US clinical case management program that included housing vouchers and ICM [98]. Cost-effectiveness studies showed that when the benefits gained and costs borne to all payers were considered (also known as a societal perspective) SCM was not cost-effective compared to ACT for persons with serious mental disorders or those with a concurrent substance-use disorder as it was both more expensive [56,94], and was associated with more days in unstable housing [56], and poorer quality of life [94].…”

“…Two additional trials reported no impact on mental health outcomes [44,54]. Two trials reported decreased problematic substance use [44,79], and four others reported no effect on this outcome [48][49][50]53].…”

“…outcomes. One trial reported a significant improvement in employment over 24 months [44], whereas four trials showed no significant difference [48,50,51,54]. While one trial suggests that SCM improves access to income assistance (p<0.05) [51], no trials on SCM measured participant income as an outcome.…”

“…Of 11 trials on SCM, ten evaluated housing stability [44][45][46][47][48][50][51][52][53][54]. Only three reported significant decreases in homelessness [44,51,52]; an effect that diminished over time in one trial of a time-limited residential case management where participants in all groups accessed significant levels of services [44].…”

Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience

“…Twelve publications provided evidence on cost and costeffectiveness of case-management interventions. 44,55,67,69,73,75,88,96,[147][148][149][150] Findings of these studies were mixed; the total cost incurred by clients of standard case management was higher than that of clients receiving usual or standard care 61,88 and assertive commun ity treatment, 67,147 but lower compared with a US clinical case-management program that included housing vouchers and intensive case management. 55 Cost-effectiveness studies using a societal perspective showed that standard case management was not cost effective compared with assertive community treatment for people with serious mental disorders or those with a concurrent substance-use disorder, as it was more expensive.…”