Impact of an integrated service system on client outcomes by gender in a national sample of a mentally ill homeless population

Abstract

Homeless populations with concurrent mental illness have a complex array of service needs that are often addressed in a haphazard or uncoordinated manner. Information is lacking about the effectiveness of programs and public policy in women who are both homeless and mentally ill. This study assessed the impact of gender on the outcomes of a multisite public policy intervention that implemented components of an integrated service delivery system to address the needs of mentally ill homeless men and women. A secondary analysis was performed using longitudinal data obtained from homeless men and women in the Access to Community Care and Effective Services and Supports prospective study, which was conducted at 18 sites across the United States. Outcome data from baseline, 3, 12, and 18 months across 5 annual cohorts were analyzed to determine the impact of gender on 6 clinical outcomes, including days of housing, relationships, victimization, social support, alcohol use, and drug use, in homeless men and women with mental illness. The analysis plan included multilevel modeling of longitudinal data. Data were analyzed from a total of 7,229 participants, including 4,502 men (62%)) (mean age, 38.2 years) and 2,727 women (38%) (mean age, 37.2 years). After 18 months of follow-up, women had significantly better outcomes in terms of family relationships (estimated mean score increased 0.100), victimization (score decreased 0.164), and social support (score increased 0.363) than did men (all, P < 0.001). Being accompanied by children was significantly associated with less change in drug use among women compared with men (P < 0.01). These outcomes were the same across all 18 program sites. Although the addition of services for the homeless in conjunction with clinical and support services offered by case managers had generally positive effects in this study's population, a gender-specific substance abuse treatment intervention should also be included in a comprehensive program for homeless women with mental illness.