Centre for Addiction and Mental Health, Toronto (Kerman, Kozloff, Stergiopoulos); MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto (Nisenbaum, Durbin, Wang, Hwang); Dalla Lana School of Public Health (Nisenbaum) and Department of Psychiatry (Durbin, Kozloff, Stergiopoulos) and Division of General Internal Medicine (Hwang), Faculty of Medicine, University of Toronto, Toronto.
Psychiatr Serv. 2023 Aug 1;74(8):823-829. doi: 10.1176/appi.ps.20220392. Epub 2023 Feb 23.
Financial incentives can facilitate behavior change and service engagement in health care settings, but research on their use with adults experiencing homelessness is limited. This study examined the effectiveness of financial incentives in improving service engagement and health outcomes among homeless adults with mental illness in Toronto.
The authors of this randomized controlled trial recruited 176 participants receiving brief multidisciplinary case management services for homeless adults with mental illness after hospital discharge. In a 1:1 randomization design, 87 participants received a financial incentive of CAN$20 for every week they remained engaged with the service for up to 6 months. The remaining 89 participants received treatment as usual. The primary outcome was service contact rates for up to 6 months of follow-up. Secondary outcomes included self-reported health status, mental health symptoms, substance use, quality of life, housing stability, acute health service use, and working alliance. Negative binomial regression models, analyses of covariance, generalized estimating equations models, and Wilcoxon rank sum tests were used to examine differences between the financial incentive and treatment-as-usual groups across outcomes of interest.
No significant differences were found between the financial incentive and treatment-as-usual groups in service contact rates or any of the secondary outcomes examined over the 6-month period.
In low-barrier, brief case management programs tailored to the needs of adults experiencing homelessness, financial incentives may not affect service engagement or health outcomes. Further research is needed to identify the effect of financial incentives on engagement in other services, including housing-based interventions.
经济激励可以促进医疗保健环境中的行为改变和服务参与，但关于其在无家可归的成年人中应用的研究有限。本研究旨在探讨经济激励在提高多伦多无家可归的精神病成年人的服务参与度和健康结果方面的效果。
本随机对照试验的作者招募了 176 名在出院后接受针对无家可归的精神病成年人的简短多学科个案管理服务的参与者。采用 1:1 随机设计，87 名参与者每在服务中参与一周就获得 20 加元的经济激励，最长可达 6 个月。其余 89 名参与者接受常规治疗。主要结果是 6 个月随访期间的服务接触率。次要结果包括自我报告的健康状况、心理健康症状、物质使用、生活质量、住房稳定性、急性卫生服务使用和工作联盟。使用负二项式回归模型、协方差分析、广义估计方程模型和 Wilcoxon 秩和检验来检验经济激励组和常规治疗组在感兴趣的结果之间的差异。
在 6 个月期间，经济激励组和常规治疗组在服务接触率或任何其他次要结果方面均未发现显著差异。
在针对无家可归的成年人的需求量身定制的低门槛、简短的个案管理计划中，经济激励可能不会影响服务参与度或健康结果。需要进一步研究以确定经济激励对其他服务（包括基于住房的干预措施）参与度的影响。
