Tsai Jack, Mares Alvin S, Rosenheck Robert A
Department of Psychiatry, Yale University, New Haven, CT.
Psychol Serv. 2010;7(4):219-232. doi: 10.1037/a0020460.
Both direct placement in supported community housing and pre-treatment with time-limited residential treatment are used as approaches to helping chronically homeless adults exit from homelessness but relative effectiveness and cost remains untested. The current observational study utilized data from a national, multi-site housing project to determine whether clients who receive residential treatment or transitional housing before being placed into independent housing achieve superior outcomes than clients who are immediately placed into independent housing, and whether they incur greater healthcare costs. A total of 709 participants (131 and 578 participants in the respective groups) were assessed every 3 months for 2 years on housing outcomes, community adjustment, work and income, mental and physical health, and health service costs. Clients who received immediate, independent housing had more days in their own place, less days incarcerated, and reported having more choice over treatment; but no differences on other clinical or community adjustment outcomes. In this observational study, there were no clinical advantages for clients who had residential treatment or transitional housing prior to entry into community housing, but they incurred higher substance abuse service costs. Studies using randomized controlled trials of these conditions are needed to establish causation.
直接安置到支持性社区住房以及采用限时住院治疗进行预处理，都被用作帮助长期无家可归成年人摆脱无家可归状态的方法，但它们的相对有效性和成本仍未经检验。当前的观察性研究利用了一项全国性、多地点住房项目的数据，以确定在被安置到独立住房之前接受住院治疗或过渡性住房的客户，是否比立即被安置到独立住房的客户取得更好的结果，以及他们是否产生更高的医疗费用。在两年的时间里，每三个月对总共709名参与者（两组分别有131名和578名参与者）进行一次评估，评估内容包括住房结果、社区适应、工作和收入、身心健康以及医疗服务成本。直接获得独立住房的客户在自己住所的时间更多，被监禁的天数更少，并且报告称在治疗方面有更多选择；但在其他临床或社区适应结果方面没有差异。在这项观察性研究中，在进入社区住房之前接受住院治疗或过渡性住房的客户没有临床优势，但他们产生了更高的药物滥用服务成本。需要通过对这些情况进行随机对照试验的研究来确定因果关系。
