A Wraparound Treatment Engagement Intervention for Homeless Veterans With Co-Occurring Disorders
A Wraparound Treatment Engagement Intervention for Homeless Veterans With Co-Occurring Disorders
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DOI：
10.1037/a0030948
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发表时间：
2013-05-01
影响因子：
2.3
通讯作者：
Kane, Vincent
中科院分区：
文献类型：
--
作者：
Smelson, David A.;Kline, Anna;Kane, Vincent
本文报告了低强度的概括性干预的结果，通过系统集成，外展和网络（使命）保持独立性和清醒，以增强治疗作为治疗（TAU），并参与和保留无家可归的退伍军人与共同发生的疾病（COD）在照顾。采用准实验设计，333名无家可归的退伍军人参加了研究，其中218人接受了使命沿着TAU，115人单独接受了TAU。组分配基于入组时使命治疗时段的可用性。与单独使用TAU相比，接受使命治疗的患者在12个月随访评估前30天内的门诊就诊率更高，精神病住院夜数较基线下降更大。在12个月时，使命组和TAU组的个体在物质使用和相关问题上都表现出统计学上的显著改善，使命组的个体不太可能饮酒中毒，也不太可能经历严重的紧张或焦虑。虽然这项研究证实，与单独的TAU相比，使命沿着TAU在增加常规护理和吸引和留住无家可归的退伍军人治疗方面是有效的，但由于这项研究不涉及随机分配，因此需要谨慎。然而，这些结果与最近的一项研究相似，该研究涉及一个简短的干预版本，其中包括随机分配。根据这些调查结果，住房和城市发展部（HUD）-退伍军人事务部（VA）联合支持性住房（HUD-VASH）计划正在进一步研究使命，该计划提供快速住房安置和案例管理，以帮助住房维护。
This article reports the results of a low-intensity wraparound intervention, Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION), to augment Treatment as Usual (TAU) and engage and retain homeless veterans with a co-occurring disorder (COD) in care. Using a quasi-experimental design, 333 homeless veterans were enrolled, 218 who received MISSION along with TAU and 115 who received TAU alone. Group assignment was based on MISSION treatment slot availability at time of enrollment. Compared with TAU alone, individuals receiving MISSION demonstrated greater outpatient session attendance within the 30 days before the 12-month follow up assessment and a larger decline from baseline in the number of psychiatric hospitalization nights. Individuals in the MISSION and TAU-only groups both showed statistically significant improvements in substance use and related problems at 12 months, with those in MISSION less likely to drink to intoxication and experience serious tension or anxiety. Although this study confirmed that compared with TAU alone, MISSION along with TAU is effective in augmenting usual care and engaging and retaining homeless veterans in treatment, some caution is warranted as this study did not involve random assignment. These results, however, are similar to a recent study involving a briefer version of the intervention which included random assignment. Based on these findings, MISSION is being further studied in the joint Department of Housing and Urban Development (HUD) - Department of Veterans Affairs (VA) Supportive Housing (HUD-VASH) program, which offers rapid housing placement and case management to aid in housing maintenance.