MODIFIED THERAPEUTIC COMMUNITY FOR HOMELESS MENTALLY ILL

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This application presents a manual and evaluation plan for the treatment of homeless individuals with mental illness and chemical abuse disorders. The manual adapts therapeutic community (TC) principles and methods from the drug treatment field and describes a new model (the modified TC) for the homeless mentally ill chemical abuse (MICA) individual. The manual describes both a modified TC program in a community residence setting (Stages One through Three) and a TC-oriented program in a supported housing setting (Stage Four). The evaluation plan addresses the supported-housing program only. Both programs are part of an evolving comprehensive and integrated service system. This application is part of a systematic plan of work to design, document, and evaluate components of this emerging service delivery system. The modified TC is a recovery-oriented program using the community-as- method. In this approach the community provides both the context and the techniques for change, and the community is the healing agent. The manual describes the principles of program design, launch and implementation, and the modified TC treatment structure and process. It discusses the integration of recovery stage, treatment stage, level of care (i.e., housing), and community. It documents the interventions of the modified TC community residence and the interventions in the TC-oriented supported housing program. It develops a logic model that integrates the modified TC conceptual framework, interventions, and outcomes. It initiates the technology transfer of modified TC programs into the mental health field. The study design evaluates homeless MICA clients from a TC-oriented supported housing program (n=50) and compares them with homeless MICA clients in a community enhanced psychiatric rehabilitation condition (n=50) and with homeless MICA clients in an intensive case management condition (n=50) at baseline (entry into housing), 6 months post-baseline (6 months in treatment), and 12 months post-baseline (6 months post- treatment). The main process evaluation objectives include: a) establishing that the TC-oriented supported-housing program reaches homeless MICA individuals; and b) demonstrating that the delivery of interventions occurs, and is consistent with the program design. The main outcome evaluation objectives include: a) demonstrating the effectiveness of the TC-oriented supported housing program over time; and b) demonstrating the effectiveness of the program in comparison with standard programs. An additional study objective is to examine the relationship between process and outcome, to begin the empirical identification of the active components of TC treatment. The project contributes to the state-of-the-art on the treatment of homeless MICA individuals in the mental health and drug treatment fields. It provides an innovative treatment model (the modified TC for the community residence and the TC-oriented supported-housing program), training (it instructs mental health workers in the TC-oriented approach), research (it provides data on process, outcome and their interrelationship), planning (it disseminates information and begins technology transfer), and policy (it is now one of the recommended models in New York State).