The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study

Abstract

BackgroundAlthough a growing number of collaborative mental health care models have been developed, targeting specific populations, few studies have utilized such interventions among homeless populations. This quasi-experimental study compared the outcomes of two shelter-based collaborative mental health care models for men experiencing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model.MethodsIn total 142 participants, 70 from IMCC and 72 from SOCC were enrolled and followed for 12 months. Outcome measures included community functioning, residential stability, and health service use. Multivariate regression models were used to compare study arms with respect to change in community functioning, residential stability, and health service use outcomes over time and to identify baseline demographic, clinical or homelessness variables associated with observed changes in these domains.ResultsWe observed improvements in both programs over time on measures of community functioning, residential stability, hospitalizations, emergency department visits and community physician visits, with no significant differences between groups over time on these outcome measures.ConclusionsOur findings suggest that shelter-based collaborative mental health care models may be effective for individuals experiencing homelessness and mental illness. Future studies should seek to confirm these findings and examine the cost effectiveness of collaborative care models for this population.

Improving Health Care Management in Primary Care for Homeless People: A Literature Review

“…The literature search identified 704 articles, and 2 more articles were added with complementary research. After selection process, this literature review included 19 articles [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ] ( Figure 1 ).…”

“…We isolated 13 articles which evaluated primary care organizations for homeless people [ 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ] ( Table 3 ). Most of the articles (9) evaluated tailored organizations for homeless people (pluriprofessional clinics, paramedical clinics and shelter-based clinics).…”

“…Positive effects on experience and satisfaction of care have been described when: the structures were most tailored [ 43 , 44 , 45 ], had a friendly atmosphere [ 34 ], and offered on-site basic needs [ 34 ]. Many studies highlighted favorable outcomes on access to and use of health care [ 37 , 38 , 39 , 40 , 41 , 42 ], with an increasing of health care visits, and a better use of health care services (mental, primary health care, and others). For example, in a homeless primary-care-based medical home and in patient-aligned care teams, the number of homeless patient visits increased from 20 (before inclusion) to 185 (after inclusion) for the 47 patients included [ 37 ].…”

Promoting continuity of care for homeless adults with unmet health needs: The role of brief interventions

“…There is an international push for service hubs and integrated primary and mental health services, often referred to as “integrated” or “collaborative care” models (Kaliebe, ; Woltmann et al., ). For people with mental health conditions that are currently or recently homeless, integrated services have been associated with improvements in community functioning, utilisation of community health services (Stergiopoulos, Schuler et al., ) and treatment adherence (Ho et al., ; Parashar et al., ). When combined with housing, integrated services are generally preferred by people experiencing homelessness and mental health challenges (Corrigan et al., ; Lee, Crowther, Keating, & Kulkarni, ).…”

Die gesundheitliche Versorgung von wohnungslosen Menschen mit psychischen Problemen

“…Die Effekte bei ICM und herkömmlichem CM sind dagegen uneinheitlich (40), wohingegen die Evidenz für CTI derzeit eher gering, aber vielversprechend erscheint (46). Auch "Collaborative care"-Modelle reduzieren die Zeit in Wohnungslosigkeit und erhöhen die Integration in die Gemeinde (67).…”