Long-term effectiveness of the ACCESS program in linking community mental health services to homeless persons with serious mental illness
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
This study examined the long-term effectiveness of the ACCESS (Access to Community Care and Effective Services and Supports) project on service utilization and continuity of care among homeless persons with serious mental illness. A 3-year longitudinal analysis, using Medicaid claims data, tracked behavioral health service utilization among 146 Medicaid-eligible participants in the Pennsylvania ACCESS program. Utilization patterns of inpatient, outpatient, and emergency department services for psychiatric and substance abuse treatment were examined during the year prior to, during, and one year after the implementation of the ACCESS project. Use of psychiatric ambulatory care significantly increased among intervention participants and remained greater following ACCESS intervention. Better continuity of care following hospitalization was achieved during and after the intervention. The number of days spent hospitalized significantly decreased during the intervention. These results suggest that the ACCESS intervention was effective in linking hard-to-reach homeless persons with serious mental illness to the community mental health service system, and that this effect was maintained after termination of the intervention.
- Randolph FL. Improving service systems through systems integration: the ACCESS program.American Rehabilitation. 1995;21(1):36–38.
- Randolph F, Blasinsky M, Leginski W, et al. Creating integrated service systems for homeless persons with mental illness: the ACCESS program.Psychiatric Services. 1997;48(3):369–373.
- Morrissey J, Calloway M, Johnsen M, et al. Service system performance and integration: a baseline profile of the ACCESS demonstration sites.Psychiatric Services. 1997;48(3):374–380.
- Rosenheck R, Lam JA. Homeless mentally ill clients' and providers' perceptions of service needs and clients' use of services.Psychiatric Services. 1997;48(3):381–386.
- Rosenheck R, Lam JA. Client and site characteristics as barriers to service use by homeless persons with serious mental illness.Psychiatric Services. 1997;48(3):387–390.
- Rosenheck R, Morrissey J, Lam J, et al. Service system integration, access to services, and housing outcomes in a program for homeless person with severe mental illness.American Journal of Public Health. 1998;88(11):1610–1615.
- Rosenheck RA, Lam J, Morrissey JP, et al. Service systems integration and outcomes for mentally ill homeless persons in the ACCESS program.Psychiatric Services. 2002;53(8):958–966.
- Lam J, Rosenheck R. Correlates of improvement in quality of life among homeless persons with serious mental illness.Psychiatric Services. 2000;51(1):116–118.
- Chinman MJ, Rosenheck R, Lam JA. The development of relationships between people who are homeless and have a mental disability and their case managers.Psychiatric Rehabilitation Journal. 1999;23(1):47–55.
- Chinman MJ, Rosenheck R, Lam JA. The case management relationship and outcomes of homeless persons with serious mental illness.Psychiatric Services. 2000;51(9):1142–1147.
- Appleby L, Desai, P. Residential instability: a perspective on system imbalance.American Journal of Orthopsychiatry. 1987;57(4):515–524.
- Breakey WR, Fischer PJ. Mental illness and the continuum of residential stability.Social Psychiatry and Psychiatric Epidemiology. 1995;30:147–151.
- Culhane DP, Averyt J, Hadley TR. The rate of public shelter admission among Medicaid reimbursed users of behavioral health services.Psychiatric Services. 1997;48(3):390–392.
- Susser E, Valencia E, Conover S, et al. Preventing recurrent homelessness among mentally ill men: a “critical time” intervention after discharge from a shelter.American Journal of Public Health. 1997;87(2):256–262.
- Federal Task Force on Homelessness and Severe Mental Illness.Outcasts on Main Street: A Report of the Federal Task Force on Homelessness and Severe Mental Illness. Washington, DC: US Dept of Health & Human Services; 1992. US DHHS publication ADM 92-1904.
- Barrow SM, Hellman F, Lovell A, et al. Evaluating outreach services: lessons from a study of five programs.New Directions for Mental Health Services. 1991;52:29–45.
- Asmussen SM, Romano J, Beatty P, et al. Old answers for today's problems: helping integrated individuals who are homeless with mental illnesses into exiting community-based programs.Psychosocial Rehabilitation Journal. 1994;17:17–34.
- Tsemberis S, Elfenbein C. A perspective on voluntary and involuntary outreach services for the homeless mentally ill.New Directions for Mental Health Services. 1999;82:9–19.
- Morse G, Calsyn RJ. Mentally disturbed homeless people in St. Louis: needy, willing, but underserved.International Journal of Mental Health. 1986;14:74–94.
- North CS, Smith EM. A systematic study of mental health services utilization by homeless men and women.Social Psychiatry and Psychiatric Epidemiology. 1993;28:77–83.
- Padgett D, Struening EL, Andrews H. Factors affecting the use of medical, mental health, alcohol, and drug treatment services by homeless adults.Medical Care. 1990;289:805–821.
- Stovall J, Flaherty JA, Bowden B, et al. Use of psychiatric services by homeless veterans.The Journal of Mental Health Administration. 1997;24(1):98–102.
- Dickey B, Gonzalez O, Latimer E, et al. Use of mental health services by formerly homeless adults residing in group and independent housing.Psychiatric Services. 1996;47:152–158.
- Padgett DK, Struening EL, Andrews H, et al. Predictors of emergency room use by homeless adults in New York City: the influence of predisposing, enabling and need factors.Social Science and Medicine. 1995;41(4):547–556.
- Bybee D, Mowbray CT, Cohen E. Short versus and longer term effectiveness of an outreach program for the homeless mentally ill.American Journal of Community Psychology. 1994;22(2):181–209.
- Shern DL, Felton CJ, Hough RL, et al. Housing outcomes for homeless adults with mental illness: results from the second-round McKinney program.Psychiatric Services. 1997;48(2):239–241.
- Johnsen M, Samberg L, Calsyn R, et al. Case management models for persons who are homeless and mentally ill: the ACCESS demonstration project.Community Mental Health Journal. 1999;35:325–346.
- Morrissey JP, Calloway MO, Thakur N, et al. Integration of service systems for homeless persons with serious mental illness through the ACCESS program.Psychiatric Services. 2002;53(8):949–957.
- Rothbard AB, Schinnar AP, Adams K. The utilization of Medicaid mental health services.Administration and Policy in Mental Health. 1996;24(2):117–128.
- Rothbard AB, Metruax S, Blank MB. Cost of care for Medicaid recipients with serious mental illness and HIV infection or AIDS.Psychiatric Services. 2003;54(9):1240–1246.
- Popkin MK, Lurie N, Manning W, et al. Changes in the process of care for Medicaid patients with schizophrenia in Utah's prepaid mental health plan.Psychiatric Services. 1998;49(4):518–523.
- McLellan T, Luborsky L, Woody G, et al. An improved diagnostic evaluation instrument for substance abuse patients: the Addiction Severity Index.Journal of Nervous and Mental Disease. 1980;168(1):26–33.
- Stoner T, Manning W, Christianson J, et al. Expenditures for mental health services in the Utah prepaid mental health plan.Health Care Financing Review. 1997;18:73–93.
- Chandler DJM, Hu TW, McGowen M, et al. Client outcomes in a three-year controlled study of an integrated service agency model.Psychiatric Services. 1996;47(12):1337–1343.
- Dickey B, Normand SL, Norton EC, et al. Managing the care of schizophrenia: lessons from a 4-year Massachusetts Medicaid study.Archives of General Psychiatry. 1996;53(10):945–952.
- Frank RG, McGuire TG. Savings from a Medicaid carve-out for mental health and substance abuse services in Massachusetts.Psychiatric Services. 1997;48(9):1147–1152.
- Long-term effectiveness of the ACCESS program in linking community mental health services to homeless persons with serious mental illness
The Journal of Behavioral Health Services & Research
Volume 31, Issue 4 , pp 441-449
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Author Affiliations
- 1. School of Social Work, Department of Psychiatry, Center for Mental Health Policy and Services Research, Medical Center, University of Pennsylvania, 3535 Market St, Room 3014, 19104, Philadelphia, PA
- 2. the Department of Social Welfare at Kyungsung University, Busan, Korea