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HSR&D 2004 National Meeting Abstracts

1057. Effectiveness of Assertive Community Treatment for Homeless Mental Illness
Craig M Coldwell, MD, White River Junction VAMC

Objectives: Treatment of persons with severe mental illness (SMI) is a tremendous challenge for public mental health systems. Evidence supports the effectiveness of Assertive Community Treatment (ACT), however, there is some controversy regarding its effectiveness in SMI subpopulations. This meta-analysis compares ACT to other community-based treatments for homeless persons with SMI and tests the hypothesis that ACT will be superior in reducing homelessness, hospitalization and symptom severity.

Methods: A structured literature search was followed by a standardized data abstraction of included studies. We used published changes in homelessness, hospitalization and symptom rating scales to determine effect sizes and confidence intervals for each study using ?2 or t-tests. We then calculated summary effects across randomized trials and observational studies.

Results: Nine out of 52 studies (17%) met inclusion criteria, including six randomized controlled trials and three observational studies with a total of 5716 subjects. In randomized trials, ACT produced a 41% (95%CI: 28% to 55%) improvement in homelessness, a 27% (95%CI: 8% to 45%) improvement in psychiatric symptom ratings, and a nonsignificant 11% (95%CI: -7% to 27%) reduction in hospitalization compared to other treatments. In observational studies, ACT subjects experienced greater improvement in all outcomes.

Conclusions: Current evidence supports a moderate advantage in housing and clinical outcomes for ACT over usual treatments. Engaging homeless clients in treatment may lead to a short-term increase in hospitalization across all treatment models.

Impact: Conclusions support the use of ACT-based treatments, such as MHICM, to achieve improved psychosocial outcomes for the homeless mentally ill.