Abstract Objective: Among individuals experiencing chronic homelessness, there is a high rate of co-occurring mental health and substance use, which has traditionally been addressed through the delivery of permanent supportive housing along with substance use and mental health services. However, this population often has difficulty engaging in treatment for co-occurring disorders, which can result in exacerbation of symptoms and housing loss. Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking (MISSION) is a co-occurring mental health and substance use wraparound approach that was pilot-tested alongside Permanent Supportive Housing (PSH) to improve treatment access and engagement. This pilot was part of a state plan to end homelessness in the Boston metro area. Methods: This open pilot study enrolled 136 individuals who were chronically homeless and offered one year of MISSION along with PSH. Program participants also received baseline and 6- and 12-month follow-up assessments. Results: At one-year follow-up, 82.4% of the program participants were housed in PSH. However, due to limited affordable housing in the Boston metro area, it took on average 6.20 months to house the program participants. Furthermore, while MISSION was feasible to implement alongside PSH, fidelity to the MISSION model was lower than expected. This pilot also examined the role of housing status on clinical outcomes and found that the program participants who were housed at the time of discharge displayed a statistically significant improvement in emergency room visits for mental health complaints, the Psychosis subscale of the Behavior and Symptom Identification Scale (BASIS-32), illegal drug use, and pharmacotherapy treatment. Conclusions: This pilot study demonstrated that systematically integrating PSH and MISSION can improve access and engagement in care, housing retention, and mental health outcomes. Despite the preliminary success and while taking into account the limitations of the open single-group pre/post design, this study also identified the lack of affordable housing as a potential barrier to placement as well as the critical role of housing for improved clinical outcomes. Randomized controlled trials are needed to test MISSION with PSH as well as perhaps PSH with and without MISSION to tease apart the effects of integrating both approaches simultaneously.

中文翻译：

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为无家可归者提供的永久性支持性住房和特殊共病综合服务

摘要 目标：在经历长期无家可归的人中，心理健康和药物滥用同时发生的比率很高，传统上通过提供永久性支持性住房以及药物滥用和心理健康服务来解决这一问题。然而，这些人群往往难以接受同时发生的疾病的治疗，这可能导致症状恶化和住房损失。通过系统集成、外展和网络 (MISSION) 保持独立性和清醒性是一种同时发生的心理健康和药物使用环绕方法，该方法与永久支持性住房 (PSH) 一起进行了试点测试，以改善治疗的可及性和参与度。该试点项目是波士顿都市区结束无家可归者计划的一部分。方法：这项开放的试点研究招募了 136 名长期无家可归的人，他们提供了一年的 MISSION 和 PSH。计划参与者还接受了基线以及 6 个月和 12 个月的后续评估。结果：在一年的随访中，82.4% 的计划参与者被安置在 PSH。然而，由于波士顿都会区的经济适用房有限，平均需要 6.20 个月的时间来安置计划参与者。此外，虽然 MISSION 与 PSH 一起实施是可行的，但对 MISSION 模型的保真度低于预期。该试点还检查了住房状况对临床结果的作用，发现出院时入住的计划参与者在因心理健康问题而就诊的急诊室方面表现出统计学上的显着改善，行为和症状识别量表 (BASIS-32) 的精神病分量表、非法药物使用和药物治疗。结论：这项试点研究表明，系统地整合 PSH 和 MISSION 可以改善护理、住房保留和心理健康结果的获取和参与。尽管取得了初步成功，并且考虑到开放式单组前/后设计的局限性，但本研究还确定缺乏经济适用房是安置的潜在障碍，以及住房对改善临床结果的关键作用。需要随机对照试验来测试带有 PSH 的 MISSION 以及可能带有和不带有 MISSION 的 PSH，以梳理同时整合两种方法的效果。和药物治疗。结论：这项试点研究表明，系统地整合 PSH 和 MISSION 可以改善护理、住房保留和心理健康结果的获取和参与。尽管取得了初步成功，并且考虑到开放式单组前/后设计的局限性，但本研究还确定缺乏经济适用房是安置的潜在障碍，以及住房对改善临床结果的关键作用。需要随机对照试验来测试带有 PSH 的 MISSION 以及可能带有和不带有 MISSION 的 PSH，以梳理同时整合两种方法的效果。和药物治疗。结论：这项试点研究表明，系统地整合 PSH 和 MISSION 可以改善护理、住房保留和心理健康结果的获取和参与。尽管取得了初步成功，并且考虑到开放式单组前/后设计的局限性，但本研究还确定缺乏经济适用房是安置的潜在障碍，以及住房对改善临床结果的关键作用。需要随机对照试验来测试带有 PSH 的 MISSION 以及可能带有和不带有 MISSION 的 PSH，以梳理同时整合两种方法的效果。和心理健康结果。尽管取得了初步成功，并且考虑到开放式单组前/后设计的局限性，但本研究还确定缺乏经济适用房是安置的潜在障碍，以及住房对改善临床结果的关键作用。需要随机对照试验来测试带有 PSH 的 MISSION 以及可能带有和不带有 MISSION 的 PSH，以梳理同时整合两种方法的效果。和心理健康结果。尽管取得了初步成功，并且考虑到开放式单组前/后设计的局限性，但本研究还确定缺乏经济适用房是安置的潜在障碍，以及住房对改善临床结果的关键作用。需要随机对照试验来测试带有 PSH 的 MISSION 以及可能带有和不带有 MISSION 的 PSH，以梳理同时整合两种方法的效果。