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PubMed1994

[Basic medical care of drug dependent patients and young homeless persons--a report from general practice].

During the last few years there has been an increasing number of reports from the staff in low level acceptance institutions as well as from streetworkers, about poor physical condition among drug addicts and young drifters. In May 1993 this caused the Public Health department of Cologne to set up a mobile medical service. This service offers consultation hours in so called "contact cafes" as well as in an out-of-service ambulance for drug addicts of the open drug scene and young drifters around the central station. Past experience has shown that the affections are by no means trivial ones. Phlegmoneous inflammations, abscesses, parasitosis and pyodermias of any kind as well as lesions of peripheral nerves and different kinds of acute or chronic virus infections are among the diseases. Without medical treatment there will be grave consequences. Difficulties in the treatment of drug addicts and other marginal social groups formed the term of the patient "who resists any medical treatment". As a result of bad experiences with existing medical institutions drug addicts consult the doctor either too late or they break off the treatment too early. In the treatment of drug addicts and young homeless it is absolutely necessary to face them without any prejudice and to create an atmosphere of confidence in order to guarantee an efficient medical care. There traditional medical services are not able to provide medical aid, the public health department is obliged to establish possibilities of complementary treatment. Drug addiction and homelessness cannot mean exclusion from medical care. That would also mean that the health insurances should participate in the costs.

Adolescent↗
PubMed2006

Assessing delayed effects of a multi-site system intervention for homeless persons with serious mental illness.

ACCESS demonstration sites were followed for an additional two years beyond the scheduled four-year evaluation to assess whether any delayed effects had occurred in system and project integration. For system integration, findings indicate that there was a sharp increase between Wave 3 (1998) and Wave 4 (2000), but experimental and comparison sites had identical trends. For project integration, experimental sites at Wave 4 sustained the high level of integration achieved at Wave 3, but the comparison sites achieved the same level as the experimental sites at Wave 4, through an abrupt increase in their scores. The absence of delayed effects is likely due to diffusion of the interventions to comparison sites both in the latter stages of the demonstration and immediately afterwards. Further, aggressive lobbying on the part of ACCESS program managers to generate local and state support to sustain their services following the termination of federal funding, had an integrating effect thereby creating linkages among comparison site agencies. Implications of these findings for policy and further research are highlighted.

Efficiency, Organizational↗
PubMed2000

Comparing consumer and nonconsumer provided case management services for homeless persons with serious mental illness.

This study compared the outcomes of services provided by case managers who are mental health system consumers and case managers who were not consumers. The study focused on the first two cohorts that entered the ACCESS program, a 5-year demonstration program funded by the Center for Mental Health Services between 1994 and 1996. We tested the associations between the type of case manager and clinical outcomes at three time points (baseline, 3 months, and 12 months). A series of one-way repeated measures of analyses of variance were conducted on clients from ACCESS sites that hired consumer providers. Although there were significant effects of Time for almost every outcome measure (clients improved over time), there were no significant Time x Case Manager Type interactions. Staff age, race, or gender did not significantly alter the pattern of these results. Given that services provided by consumers and nonconsumers were associated with equivalent client outcomes, the present study shows, using a large sample, the ability of consumers to provide mental health services as members of a case management team.

Adult↗
PubMed2002

Hispanic client-case manager matching: differences in outcomes and service use in a program for homeless persons with severe mental illness.

Mental health professionals have responded to ethnic and racial disparities in mental health care by advocating increasing cultural relevancy in treatment. A central component of cultural relevancy is ethnic and racial pairing of clients and providers. This study examined the effects of client-case manager ethnic and racial matching among white and Hispanic clients who received assertive community treatment in the Access to Community Care and Effective Services and Supports Program. Twelve-month outcomes and service use were examined among 242 Hispanic and 2333 white clients seen in the first 3 years of the program. Analysis of covariance was used to evaluate the association of client-case manager ethnic and racial matching with changes in health status and service use from baseline to 12 months after program entry. At baseline, Hispanics had more serious problems than whites on several measures of psychiatric and substance abuse domains, and they also showed less improvement than whites over the next year on several measures of psychiatric status and service use. One significant association with ethnic matching was found: when treated by a Hispanic clinician, Hispanic clients showed less improvement in symptoms of psychosis. These results do not support the hypothesis that ethnic and racial matching improves outcomes or service use. Several explanations are offered for the results.

Adult↗