HUD/HHS/VA Collaborative Initiative to Help End Chronic Homelessness: Preliminary Client Outcomes Report. Comparison of service use and outcomes across CICH client sub-groups

02/26/2007

Mean service use levels and outcomes (Table 11) during the 12-month follow-up period were compared among the following five client sub-groups defined by critical baseline characteristics: 1) type of psychiatric disability (mental health vs. substance abuse vs. both), 2) age, 3) race/ethnicity, 4) incarceration history, 5) military service, and 6) gender.

Use of services

Psychiatric disability

Clients having both mental health and substance abuse problems (N=367; 52%) (hereafter referred to as "dual problem" clients) generally consumed higher levels of services than clients with substance abuse problems alone (N=137; 20%) (Table 11). Service use patterns of clients with mental health problems (N=170; 24%) and dual problem clients were similar, except that dual problem clients as one would expect, had more outpatient substance abuse visits quarterly (5.3 vs. 1.6 visits), and greater participation in Alcoholics Anonymous and Narcotics Anonymous (45% vs. 10%), than clients with mental health problems alone (Table 11).

Age

Younger clients, i.e. under the age of 50 (N=462; 66%), were greater consumers of mental health services, compared with older clients who made greater use of medical services. Younger clients were also more likely to have a primary mental health/substance abuse treater (67% vs. 62%), had more outpatient mental health visits (3.8 vs. 3.0), and were more likely to have a primary case manager (28% vs. 24%) than older clients. Older clients, however, were more likely to have a usual physical health care provider (49% vs. 44%), had a greater number of preventive medical procedures (8.6 vs. 7.8), and had a greater number of outpatient medical visits (3.3 vs. 2.5) than younger clients (Table 11).

Race/ethnicity

The only statistically significant racial/ethnic difference in service use was that minorities (N=439; 63%) consumed more outpatient medical visits during the 12-month follow-up period than Caucasian, non-Hispanic clients (3.0 vs. 2.3) (Table 11).

Legal

Clients who had been incarcerated in their lifetimes (N=476; 71%) prior to entering CICH used more outpatient health (11.2 vs. 8.0) and substance abuse visits (5.0 vs. 1.9) and participated more in AA/NA (37% vs. 22%) than clients without incarceration histories, who , in turn, were more likely to have a usual health care provider (52% vs. 43%) (Table 11).

Veteran Status

Veterans (N=212; 30%) accessed higher levels of healthcare services than non-veterans. Veterans were less likely to report being uninsured (3% vs. 19%), more likely to have a usual health care provider (55% vs. 42%), received more outpatient visits overall (11.8 vs. 9.5), and had more substance abuse treatment visits (5.5 vs. 3.3), perhaps reflecting their access to VA services, an important component of the CICH initiative (Table 11).

Gender

Female clients (N=171; 24%) were more likely than men to report having a usual health care provider (52% vs. 44%), outpatient mental health visits (4.1 vs 3.3), and a greater number of preventive procedures (8.7 vs. 7.9). Additionally, they were more likely to have a primary mental health/substance abuse treater (69% vs. 64%), a primary case manager (30% vs. 26%), and a money manager (32% vs. 24%) than were male clients (Table 11).

Client outcomes

Psychiatric disability

Significant differences were found among psychiatric disability groups on 27 of 30 outcome measures examined. Compared with clients with substance abuse problems, clients having mental health problems were less satisfied with their housing and with life in general, participated less in community activities, were less likely to know their neighbors well, less likely to work, and more dependent on public assistance. As a result they had higher total incomes, were more disturbed by psychiatric symptoms, and demonstrated more psychotic behaviors.

As expected, clients with substance abuse problems showed greater use and reported more problems with alcohol and drugs, compared with those with mental health problems, including: more days intoxicated during the past 3 months (2.5 vs. 0.4), a higher rate of illicit drug use (35% vs. 24%), and higher ASI alcohol and drug scores (0.13 vs. 0.03 and 0.04 vs. 0.02, respectively) (Table 12).

Clients with dual mental health and substance abuse problems fell somewhere between these other two disability groups in the areas of knowing neighbors well, receipt of public assistance, total income, and observed psychotic behavior. Dual problem clients reported a lower level of mental health functioning, and greater alcohol and drug use problems and a higher rate of illicit drug use (44%) than either of the other two psychiatric disability groups, as well as higher quarterly medical/dental, substance abuse treatment, and total health care treatment costs ($5,422 vs. $3,104-$3,869), including both higher inpatient costs ($4,284 vs. $2,471-$3,216), and higher outpatient costs ($1,151 vs. $636-$653) (Table 12).

Age

Younger clients spent more days in jail (1.3 vs. 0.5), received less public assistance ($392 vs. $475) and total income ($474 vs. $571), had a lower level of mental health functioning (39.3 vs. 41.3), were more distressed by psychiatric symptoms (1.46 vs. 1.21), and were more likely to use illicit drugs (40% vs. 29%) than older clients. As one would expect, younger clients showed a higher level of physical functioning (45.9 vs. 42.8), and relatedly, lower medical/dental treatment costs ($1,799 vs. $2,881) than older clients (Table 12).

Race/ethnicity

Compared with Caucasian (non-Hispanic) clients, minority clients were more likely to be housed (83% vs. 80%) and had been housed for a greater number of days (68 vs. 64) during the previous 3 months. Minority clients also had larger social support networks (1.4 vs. 1.3), were more satisfied with life overall (4.7 vs. 4.4), had a higher level of mental health functioning (40.4 vs. 39.3), lower medical/dental and total health care treatment costs ($3,892 vs. $5,391), and, more specifically, lower inpatient care costs ($2,954 vs. $4,543) than Caucasian clients (Table 12).

Legal

Clients who had been incarcerated during their lifetimes prior to entering CICH were more likely to be homeless at the time of follow-up assessment, spent more days in jail, were more distressed by psychiatric symptoms, had higher rates of illicit drug use and greater alcohol and drug problems, as well as higher substance abuse treatment costs than clients without an incarceration history (Table 12).

Veteran Status

Veterans were more actively involved in the community and had greater public assistance and total incomes than non-veterans, yet were also less likely to be housed at follow-up and were less satisfied with life in general.

Gender

Female clients were more likely to be housed than males and were housed for more days, were more satisfied with life in general, and were more likely to receive public assistance. However, female clients participated less in community activities, were less likely to be employed, presented with more psychotic behavior during interviews, had a lower level of mental health functioning, and had higher mental health services treatment costs (Table 12).

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