Is System Integration Associated with Client Outcomes?

Tables

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Contents

Tables:

  1. Baseline characteristics of national evaluation subjects across sites
  2. CICH client changes in service use and outcome measures during first 12 months in treatment
  3. Descriptive characteristics of "baseline" network measures examined in this report by clients and across sites
  4. Client characteristics bivariately associated with network measures (i.e., baseline covariates)
  5. Association of "baseline" network measures and 12-month client service use and outcomes

Table 1.
Baseline characteristics of national evaluation subjects across sites
  TOTAL
(N=736)
Mean/% SD/N
Client Eligibility
% Homeless greater than 1 year 86% 630
% Homeless 4 or more periods 69% 510
% With substance abuse problem 72% 532
% With alcohol problem 52% 385
% With drug problem 52% 381
% With mental health problem 77% 564
% With schizophrenia 19% 137
% With depression 28% 206
% With bipolar 19% 139
% With post traumatic stress disorder 7% 53
% With other psychiatric disorder 3% 22
% Ever hospitalized for psych. 51% 373
>% Ever taken meds for psych 68% 503
% Ever SA & MH problem 52% 386
% With medical problem 65% 476
% With developmental disability 10% 73
% Parent/guard. minor child 0% 1
Mean no. minor children 0 0
Demographics
Mean age 46 9
% Male 76% 556
% Minority (non-Caucasian) 62% 458
% Single (never married) 48% 351
% Married 2% 12
% Divorced/separated/ widowed 33% 243
% Veterans 30% 220
Mean years homeless (lifetime) 8 6
Use of Outpatient Services
Mean number of mental health visits 4 11
Mean number of substance abuse visits 6 18
Mean number of medical care visits 3 8
Treatment Outcomes
Housing
% Living in own place 28% 205
% Living alone 27% 196
% Receiving rental subsidy 27% 200
Mean no. days housed (past 90) 5 14
Mean no. days homeless(past90) 57 37
Employment (past 30 days)
% Worked for pay 16% 121
Income (past 30 days)
Mean employment income 319 362
% receiving employment income 14% 103
Mean public assistance income 397 268
% receiving public assistance 70% 515
Mean total income 460 316
Physical Health
Mean SF-12 physical health 45 10
Mental Health    
Mean SF-12 mental health 38 12
Mean BSI symptom score 1.7 3.7
Substance Abuse (past 30 days)
Mean no. days drunk 2.1 6.6
% Used illicit drugs 39% 284
Mean ASI-alcohol score 0.15 0.27
Mean ASI-drug score 0.08 0.20
Incarceration (past 30 days)
Mean no. days in jail 1.5 8.8
Subjective Quality of Life
Mean QOLI overall score (1-7) 4.5 3.9
Observed Psychotic Behavior
Mean rating of psychosis (0-3) 0.22 0.30
Services integration
% Living in own place 28% 205
% Has case manager(s) 89% 652
% Received SA treatment. for SA problem 44% 324
% Received MH services for MH problems. 53% 392
% Received medical care for medical problems. 52% 386
% Received Veterans Health Administration-eligible services 19% 138
Mean % overall integration 64% 23
Source:  CICH client outcomes report, Table 4 (Mares & Rosenheck, 2007).

Table 2.
CICH client changes in service use and outcome measures during first 12 months in treatment (N=736)
(Least square means from mixed regression analyses examining main effect of time, covarying for site and following baseline characteristics:  homeless greater than 1 yr. and/or homeless 4+ episodes prior to entering program;  presence of medical problem, substance abuse problem, mental health problem, and/or dual mental health & substance abuse problems;  age;  minority;  single;  veteran;  and, yrs. homeless in lifetime)
    Type III test of
fixed effect of time
Baseline 3-mo 6-mo 9-mo 12-mo Num df Den df F p
Service use
Primary health care
Has usual health care provider 36% 45% 48% 52% 49% 4 2221 12 ***
No. preventive procedures administered during past year. 7.4 8.0 8.2 8.4 8.4 4 2259 12 ***
No. health behaviors discussed with doctor for those with unhealthy behaviors 3.3 3.5 3.7 3.8 3.9 4 2228 9 ***
No. OP medical visits (past 90) 2.8 3.1 2.8 2.5 2.3 4 2188 1 n.s.
Uninsured 21% 15% 12% 12% 12% 4 2170 13 ***
Mental health/SA treatment
Has primary mh/sa treater 54% 70% 69% 67% 67% 4 2132 20 ***
No. OP mental health visits (past 90) 3.5 4.1 3.8 3.2 2.9 4 2195 3 *
No. OP substance abuse visits (past 90) 5.0 4.9 3.7 2.9 3.5 4 2192 3 **
Participated in AA/NA (past 90) 39% 34% 32% 30% 30% 4 2206 5 **
Therapeutic alliance 4.5 4.5 4.5 4.4 4.4 4 1425 1 n.s.
Consumer choice scale 4.1 4.1 4.0 4.0 3.9 4 1240 3 *
Case management
Has primary case manager 30% 33% 25% 25% 21% 4 2169 7 ***
Visited by case mgr in commun (past 90) 45% 72% 70% 71% 67% 4 2017 68 ***
Has money manager 19% 25% 26% 29% 31% 4 2279 13 ***
Any contact with landlord (past 90) 70% 73% 72% 73% 75% 4 1750 1 n.s.
Total service integration
Total no. OP health visits (all kinds) 11.2 12.1 10.4 8.6 8.8 4 2202 5 **
Number of service providers 4.1 4.5 4.1 4.0 4.0 4 2161 3 *
Coordination of services scale 1.1 1.3 1.3 1.3 1.3 4 1678 14 ***
Overall services integration 64% 81% 81% 79% 78% 4 2121 105 ***
Client outcomes
Housing
Days housed 18 68 81 82 83 4 2127 913 ***
Housed (own place, else's place or hotel) 38% 91% 94% 94% 95% 4 1934 449 ***
Homeless 16% 2% 1% 1% 2% 4 1669 70 ***
Housing satisfaction (1-5) 4.1 4.1 4.0 4.0 4.0 4 1721 4 **
Community adjustment
Community integration 6.8 7.1 7.3 7.2 7.3 4 2236 3 **
Knows any neighbors well 38% 67% 76% 77% 77% 4 1697 36 ***
Social support 1.4 1.4 1.4 1.3 1.3 4 2220 1 n.s.
Days in jail 1.5 0.7 0.9 1.2 0.8 4 1811 2 n.s.
QOL 4.3 4.6 4.6 4.6 4.6 4 2171 5 ***
Income/Support
Any employment (past 30) 17% 16% 14% 19% 15% 4 2201 3 *
Employment income $43 $60 $50 $73 $58 4 2225 3 *
Any public support (past 30) 70% 81% 84% 85% 83% 4 2205 20 ***
Public support income $316 $390 $454 $460 $478 4 2270 25 ***
Total income $380 $472 $523 $577 $579 4 2236 30 ***
Mental health
SF-12 mental 38.8 39.9 40.3 40.6 40.3 4 2161 5 ***
BSI 1.53 1.39 1.35 1.31 1.29 4 2267 12 ***
Observed psychotic behavior 0.22 0.20 0.22 0.23 0.23 4 2166 1 n.s.
Satisfaction with primary treater 5.2 5.1 5.2 5.1 5.1 4 1374 1 n.s.
Substance abuse                
Days intoxicated 2.1 1.6 1.7 1.8 2.1 4 2188 2 n.s.
Any drugs 38% 35% 34% 35% 38% 4 2241 2 n.s.
ASI alcohol 0.13 0.11 0.10 0.11 0.12 4 2238 4 **
ASI drug 0.05 0.05 0.04 0.05 0.05 4 2234 1 n.s.
Physical health
SF-12 physical 45.2 45.2 44.8 44.5 44.8 4 2224 1 n.s.
Trust in physician (1-5) 3.8 3.9 3.9 3.9 3.9 4 984 3 *
Treatment costs
Cost of medical/dental treatment $3,219 $2,500 $1,961 $1,608 $1,512 4 1977 3 *
Cost of mental health services $2,303 $1,949 $1,525 $1,037 $1,138 4 2154 4 **
Cost of substance abuse treatment $1,310 $526 $388 $576 $734 4 1891 10 ***
Total health care cost $6,832 $4,969 $3,869 $3,214 $3,376 4 2040 8 ***
Inpatient care costs $5,776 $3,904 $2,984 $2,400 $2,677 4 2038 7 ***
Outpatient care costs $1,056 $1,060 $883 $808 $698 4 2221 8 ***
Source:  CICH client outcomes report, Table 7 (Mares & Rosenheck, 2007)
  * p<.05   ** p<.01   *** p<.001

Table 3.
Descriptive characteristics of "baseline" network measures examined in this report by clients and across sites
Site N
(informants)		 Best practices
(scale range:  0-3)		 Services planning
(scale range:  0-3)		 Trust
(scale range:  0-3)		 Exchange of resources
(scale range:  0-1)
mean (sd) range mean (sd) range mean (sd) range mean (sd) range
Chattanooga, TN 50 2.08 (0.40) 1.67-2.47 1.57 (0.11) 1.46-1.68 2.73 (0.14) 2.58-2.87 0.05 (0.01) 0.04-0.06
Chicago, IL 55 2.24 (0.23) 1.99-2.48 1.31 (0.04) 1.28-1.35 2.45 (0.10) 2.21-2.51 0.19 (0.01) 0.16-0.19
Columbus, OH 80 2.42 (0.09) 2.30-2.48 2.09 (0.35) 1.63-2.36 2.75 (0.11) 2.61-2.83 0.39 (0.04) 0.36-0.45
Denver, CO 89 2.27 (0.09) 2.18-2.40 1.82 (0.07) 1.76-2.04 2.57 (0.01) 2.56-2.62 0.39 (0.08) 0.31-0.48
Ft. Lauderdale, FL 47 2.23 (0.12) 2.05-2.31 1.69 (0.07) 1.58-1.74 2.80 (0.03) 2.75-2.82 0.38 (0.03) 0.37-0.43
Los Angeles, CA 62 2.08 (0.17) 1.93-2.28 1.65 (0.23) 1.45-1.91 2.61 (0.03) 2.58-2.64 0.33 (0.04) 0.30-0.38
Martinez, CA 48 2.18 (0.05) 2.13-2.36 2.01 (0.04) 1.98-2.16 2.62 (0.00) 2.62-2.64 0.39 (0.03) 0.36-0.47
New York, NY 49 2.08 (0.17) 1.94-2.54 1.97 (0.24) 1.83-2.47 2.72 (0.04) 2.70-2.81 0.24 (0.15) 0.18-0.63
Philadelphia, PA 67 2.30 (0.01) 2.29-2.30 1.84 (0.06) 1.74-1.88 2.78 (0.12) 2.59-2.86 0.29 (0.03) 0.25-0.31
Portland, OR 68 2.34 (0.10) 2.23-2.42 1.79 (0.17) 1.59-1.92 2.73 (0.05) 2.68-2.78 0.34 (0.05) 0.30-0.40
San Francisco, CA 85 2.63 (0.01) 2.60-2.63 2.07 (0.05) 2.05-2.21 2.72 (0.03) 2.64-2.73 0.21 (0.00) 0.21-0.21
Total 700 2.29 (0.23) 1.67-2.63 1.82 (0.28) 1.28-2.47 2.68 (0.12) 2.21-2.87 0.30 (0.11) 0.04-0.63
One-way ANOVA stats: p<.000;  df=10;  F=77 p<.000;  df=10;  F=119 p<.000;  df=10;  F=121 p<.000;  df=10;  F=216
Note:  "baseline" defined as the network interview wave assigned to clients based on date of baseline assessment.

Table 4.
Client characteristics bivariately associated with network measures (i.e., baseline covariates)
(Pearson correlation coefficients)
  Best
practices		 Services
planning		 Trust Exchange
of resources
Program eligibility
 % homeless > 1 year n.s. -.11 ** n.s. n.s.
 % homeless 4+ periods n.s. -.15 *** n.s. -.08 *
 % with substance abuse problem n.s. n.s. -.15 *** n.s.
 % with alcohol problem n.s. n.s. -.14 *** n.s.
 % with drug problem n.s. n.s. -.08 * -.11 **
 % mental health problem n.s. n.s. .17 *** n.s.
 % with medical problem n.s. n.s. -.09 * n.s.
 % with developmental disability n.s. n.s. n.s. -.17 ***
Demographics
Age n.s. .08 * n.s. n.s.
Minority -.09 * n.s. -.12 ** n.s.
Divorced -.07 * n.s. n.s. n.s.
Housing
No. days housed (own, else’s, hotel) (past 90)  .15 *** .11 ** n.s. -.15 ***
No. days in residential treatment n.s. n.s. n.s. .08 *
No. days in hospital .09 * .08 * .10 ** n.s.
No. days in prison/jail n.s. n.s. .11 ** n.s.
   No. days in an institution n.s. n.s. n.s. .08 *
No. days homeless (shelter/outdoors) -.16 *** n.s. n.s. n.s.
% housed at baseline .14 *** n.s. -.09 * -.15 ***
Employment
Work history (past 3 yrs.)
   Regular job (part-time or full-time) n.s. .08 * .16 *** n.s.
   Unemployed n.s. -.14 *** -.16 *** n.s.
   Other n.s. n.s. n.s. -.09 *
Hrs worked per wk (past 30) -.08 * n.s. n.s. n.s.
% volunteered (past 30) n.s. -.09 * n.s. n.s.
Hrs volunteered per wk (past 30) n.s. -.11 ** n.s. n.s.
Income
Ever recvd SSI/SSDI/GA n.s. .13 *** n.s. n.s.
% recvd any public support (SSI/SSDI/GA/food stamps/VA sc disab) (past 30) n.s. n.s. n.s. -.11 **
% recvd SSI/SSDI/GA (past 30 days) n.s. .12 ** n.s. n.s.
Public support income (past 30 days) .13 *** .15 *** n.s. n.s.
Total income (past 30) .14 *** .19 *** n.s. n.s.
% having money manager .33 *** .23 *** .09 * -.15 ***
Physical health
No. medical problems (0-27) n.s. n.s. n.s. -.09 *
No. med problems treated (past 90) n.s. n.s. n.s. -.15 ***
Body mass index (BMI) n.s. n.s. .08 * n.s.
% HIV positive n.s. n.s. n.s. -.07 *
% Hepatitis C positive n.s. n.s. n.s. .08 *
% TB positive n.s. n.s. n.s. -.11 **
% pregnant -.07 * -.08 * n.s. n.s.
Access to care
% uninsured (past 90 .16 *** n.s. n.s. -.10 **
% having usual source care – medical n.s. -.10 * -.13 ** n.s.
% having usual place care – medical n.s. .24 *** .08 * .20 ***
Healthcare providers
% having usual treater - medical n.s. .10 ** .10 ** n.s.
Trust in physician scale (1-5) n.s. .14 * n.s. n.s.
No. preventive procedures (past yr) (0-14/16) n.s. n.s. n.s. -.10 **
% of preventive procs recv’d. (past yr) (0-1) n.s. n.s. n.s. -.10 **
Health behaviors
Eating fatty foods (1-3) n.s. n.s. -.12 ** n.s.
Exercising (1-4) .09 * .10 ** .12 ** .11 **
Breast self-examination (1-3) n.s. -.25 ** n.s. -.25 **
Mental health
BSI - depression, anxiety & psychotic sub-scales (0-4)   n.s. n.s. .13 ** n.s.
% ever told has schizophrenia n.s. n.s. .18 *** n.s.
% ever told has other psychotic disorder n.s. -.09 * n.s. n.s.
% ever told has major depression n.s. -.08 * n.s. n.s.
% ever told has bipolar disorder n.s. -.09 * n.s. n.s.
% ever told has anxiety disorder n.s. -.09 * n.s. -.09 *
% ever told has other mental health problem n.s. n.s. n.s. .08 *
Sum of mental health diagnoses (ever told) n.s. -.12 ** n.s. n.s.
% of mental health dx treated (past 90) (0-1) n.s. -.11 * n.s. n.s.
SF12 - mental (0-100) n.s. -.08 * -.08 * n.s.
% ever hospitalized for psychiatric problem .08 * n.s. .10 ** n.s.
% ever taken meds for psychiatric problem n.s. n.s. .10 ** n.s.
Substance use
% treated for alcohol dependency (past 90) n.s. n.s. .12 * n.s.
% treated for drug dependency (past 90) n.s. n.s. .11 * n.s.
No. days drunk (0-30) n.s. n.s. n.s. .11 **
% used any illicit drugs n.s. n.s. n.s. -.10 **
ASI – drug n.s. n.s. n.s. -.09 *
% has primary treater for mh or sa problems n.s. n.s. n.s. .12 **
Sum mh & sa diagnoses (0-11) n.s. -.10 ** n.s. n.s.
% with mh or sa problem having primary treater n.s. n.s. n.s. .11 **
Use of services
No. mh outpatient visits (past 90) .09 * n.s. .11 ** n.s.
No. total outpatient visits (all kinds) n.s. n.s. .11 ** n.s.
% recvd vocational rehabilitation (past 90) n.s. -.10 ** -.11 ** n.s.
% recvd housing services (past 90) n.s. n.s. -.08 * n.s.
% recvd educational services (past 90) n.s. -.08 * n.s. -.08 *
% recvd crisis intervention services (past 90) n.s. n.s. .12 ** -.16 ***
Sum of supportive svcs recvd (past 90) (0-7) n.s. -.09 * n.s. -.11 **
% recvd food from soup kitchen, food pantry .08 * n.s. n.s. n.s.
Service use costs (quarterly)
Medical/dental services .08 * n.s. n.s. n.s.
Mental health/SA services n.s. n.s. .12 ** n.s.
Total costs .07 * n.s. .08 * n.s.
   Inpatient costs n.s. n.s. .07 * n.s.
   Outpatient costs n.s. n.s. .09 * n.s.
Case management
No case managers (4-level) (past 90) n.s. -.08 * n.s. -.09 *
% having primary case manager n.s. n.s. .09 * -.12 **
% received community visit by c/m (past 90) -.13 ** -.18 *** n.s. -.12 **
% recvd c/m for housing (past 90) n.s. n.s. -.09 * n.s.
% recvd c/m for physical health (past 90) n.s. n.s. .11 ** -.12 **
% recvd c/m for mental health (past 90) n.s. n.s. .11 ** n.s.
% recvd c/m for substance abuse (past 90) n.s. n.s. .10 ** -.08 *
Total no. service providers (past 90) .12 ** n.s. .09 * n.s.
Coordination of services scale (past 90) (0-2) n.s. n.s. n.s. .14 **
Community adjustment
No. days in jail (past 90) n.s. n.s. .11 ** n.s.
Social support (0-10) n.s. -.18 *** n.s. -.12 **
Religious faith scale (0-3) -.08 * -.12 ** n.s. n.s.
% living in own place (apart, room, house) .18 *** .08 * .14 *** -.13 ***
% with SA problem recvd any SA treatment n.s. .10 * .22 *** n.s.
% with mh problem recvd any mh treatment n.s. n.s. n.s. -.13 **
Fidelity
Overall services integration (0-1) .10 ** .10 ** n.s. -.09 *
* p<.05     ** p<.01     *** p<.001

Table 5.
Association of "baseline" network measures and 12-month client service use and outcomes
     (Mixed model coefficients;  BL value of DV, time, network measure, and BL covariates specified below)
  Best
practices		 Services
planning		 Trust Exchange
of resources
Client service use measures
   Usual treater – medical n.s. 1.5 * n.s. n.s.
   No. preventive procedures (past yr) (0-14) -1.1 ** n.s. n.s. n.s.
   No. health behaviors discussed with pcp (past yr) (0-6) -.53 ** n.s. n.s. n.s.
   Uninsured (past 90) n.s. n.s. -.31 * n.s.
   Participants having primary treater for mh n.s. 2.5 ** n.s. .59 *
   No. mental health outpatient visits n.s. n.s. n.s. n.s.
   No. substance abuse outpatient visits n.s. n.s. n.s. n.s.
   Substance abuse AA n.s. n.s. n.s. n.s.
   Consumer choice scale (1-5) n.s. n.s. n.s. n.s.
   Has primary case mgr n.s. n.s. n.s. n.s.
   Case mgmnt visit in commun (home or elsewhere) -.12 ** n.s. n.s. -.60 *
   Has money manager .20 *** n.s. n.s. n.s.
   Total outpatient visits (all kinds) n.s. n.s. n.s. n.s.
   No. service providers -.74 * n.s. n.s. n.s.
   Coordination of services scale (0-2) n.s. n.s. n.s. n.s.
   Overall services integration (0-1) n.s. n.s. n.s. n.s.
Client outcome measures
   Housed (own or else’s place, hotel) n.s. n.s. n.s. n.s.
   Housing satisfaction (1-5) n.s. n.s. n.s. n.s.
   No. commun integration activities (0-16) (past 14) n.s. n.s. n.s. n.s.
   Knows 1+ neighbors well n.s. n.s. n.s. n.s.
   Subjective quality of life (1-7) n.s. n.s. n.s. n.s.
   Any work (past 30) n.s. n.s. n.s. n.s.
   Employ inc among all (with 0s) (past 30) n.s. n.s. n.s. n.s.
   Recvd any public support (SSI, SSDI, GA, FS, vap & vad) n.s. n.s. n.s. n.s.
   Public support income (with 0s) (past 30) n.s. n.s. n.s. n.s.
   Total income (with 0s) (past 30) n.s. n.s. n.s. n.s.
   Mean SF-12 mental score n.s. n.s. n.s. n.s.
   BSI (dep, anx & psy sub-scales) (0-4) n.s. n.s. n.s. n.s.
   ASI alcohol sub-scale (0-1) n.s. n.s. n.s. n.s.
   Trust in physician scale (1-5) .24 * n.s. n.s. n.s.
   Total medical & dental (A) n.s. n.s. n.s. n.s.
   Total mental health (B) n.s. n.s. n.s. n.s.
   Total substance abuse (C ) n.s. n.s. n.s. n.s.
   Total (A+B+C) -2260 * n.s. n.s. n.s.
* p<.05     ** p<.01     *** p<.001

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