***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We illustrate Fairweather 's approach to Experimental Social Innovation and Dissemination with two experimental studies of programs to reduce homelessness for 168 and 225 people with mental illness and often substance abuse . Literally homeless participants were r and omly assigned to programs that emphasized consumer choice or to the usual continuum of care , in which housing and services are contingent on sobriety and progress in treatment . A drop-in center that eliminated barriers to access to services was more successful than control programs in reducing homelessness , but after 24 months only 38 % of participants had moved to community housing . A subsequent apartment program , in which individuals in the experimental condition moved to subsidized apartments directly from the street , with services under their control , had 79 % in stable housing ( compared to 27 % in the control group ) at the end of 6 months . Groups in this study did not differ on substance abuse or psychosocial outcomes Investigators examined the 6-month impact of three cognitive-behavioral HIV risk-reduction programs on behavioral factors ( substance use and sexual risk behaviors ) and cognitive and psychological re sources of 325 women who resided in emergency or sober-living shelters and their 308 intimate sexual partners . Participants were r and omized by shelter to a peer-mentored , a nurse case-managed , or a st and ard care HIV risk-reduction program . Significant improvements were observed in all groups in all behavioral factors and cognitive and psychological re sources except for self-esteem . Participants in the peer-mentored and nurse case-managed groups did not differ significantly from the st and ard group in self-esteem , life satisfaction , psychological well-being , use of noninjection drugs , sex with multiple partners , and unprotected sex at 6 months ( n = 633 ) . It was concluded that a st and ard approach by health care professionals appears to effectively modify HIV risk behaviors for a majority of homeless participants and may have important economic and policy implication s. Further , the impact of short-term programs that address psychological vulnerabilities of impoverished population s needs to be studied further PURPOSE This exploratory study examined the feasibility of homeless parents ' participation in an intervention to increase use of facilitating language strategies during interactions with their preschool children while residing in family homeless shelters . This study also examined the intervention 's impact on the parents ' use of facilitating language strategies , regardless of parent performance on a single-word receptive vocabulary test . METHOD Using a prospect i ve , pretest/posttest comparison group design , 12 parents were r and omly assigned to a 4-session experimental group training emphasizing use of facilitating language utterances with children following vocabulary testing . Four parents were r and omly assigned to a control group intervention . RESULTS It was feasible for parents to participate in the intervention . Before the intervention , individual experimental group parents with poor test performance demonstrated relatively high use of facilitating language utterances . After the intervention , the experimental group increased use of facilitating language utterances during interactions with their children . CONCLUSIONS This exploratory study provides initial evidence that it is feasible for parents to participate in , and benefit from , a brief language -based group intervention while residing in family homeless shelters . Further study of language -based interventions for these at-risk families and of the possible impact of parent language functioning on intervention benefit is needed A women 's therapeutic community ( TC ) design ed to prevent homelessness was evaluated using a quasi-experimental process . Propensity analysis selected comparable experimental ( E ) and comparison ( C ) participants . Significant improvements were found for the E group at the domain level , both in “ psychological ” dysfunction on symptoms ( e.g. , depression ) , and in “ health , ” including ratings of health and adherence to medication regimens . No significant difference was found at the domain level for “ parenting ” or “ housing stabilization , ” but specific outcomes did differ . For example , a greater number of children resided with the E  group mothers who also assumed financial responsibility for more of their children OBJECTIVES This study tested a psychiatric rehabilitation approach for organizing and delivering services to street-dwelling persons with severe mental illness . METHODS Street-dwelling persons with severe mental illness were r and omly assigned to the experimental program ( called Choices ) or to  st and ard treatment in New York City . We assessed study participants at baseline and at 6-month intervals over 24 months , using measures of service use , quality of life , health , mental health , and social psychological status . The average deviation from baseline summary statistic was employed to assess change . RESULTS Compared with persons in st and ard treatment ( n = 77 ) , members of the experimental group ( n = 91 ) were more likely to attend a day program ( 53 % vs 27 % ) , had less difficulty in meeting their basic needs , spent less time on the streets ( 55 % vs 28 % reduction ) , and spent more time in community housing ( 21 % vs 9 % increase ) . They showed greater improvement in life satisfaction and experienced a greater reduction in psychiatric symptoms . CONCLUSIONS With an appropriate service model , it is possible to engage disaffiliated population s , exp and their use of human services , and improve their housing conditions , quality of life , and mental health status Housing First is an effective intervention that ends and prevents homelessness for individuals with severe mental illness and co-occurring addictions . By providing permanent , independent housing without prerequisites for sobriety and treatment , and by offering support services through consumer-driven Assertive Community Treatment teams , Housing First removes some of the major obstacles to obtaining and maintaining housing for consumers who are chronically homeless . In this study , consumers diagnosed with severe mental illness and who had the longest histories of shelter use in a suburban county were r and omly assigned to either one of two Housing First programs or to a treatment-as-usual control group . Participants assigned to Housing First were placed in permanent housing at higher rates than the treatment-as-usual group and , over the course of four years , the majority of consumers placed by both Housing First agencies were able to maintain permanent , independent housing . Results also highlight that providers new to Housing First must be aware of ways in which their practice s may deviate from the essential features of Housing First , particularly with respect to enrolling eligible consumers on a first-come , first-served basis and separating clinical issues from tenant or housing responsibilities . Finally , other aspects of successfully implementing a Housing First program are discussed BACKGROUND Supported housing , integrating clinical and housing services , is a widely advocated intervention for homeless people with mental illness . In 1992 , the US Department of Housing and Urban Development ( HUD ) and the US Department of Veterans Affairs ( VA ) established the HUD-VA Supported Housing ( HUD-VASH ) program . METHODS Homeless veterans with psychiatric and /or substance abuse disorders or both ( N = 460 ) were r and omly assigned to 1 of 3 groups : ( 1 ) HUD-VASH , with Section 8 vouchers ( rent subsidies ) and intensive case management ( n = 182 ) ; ( 2 ) case management only , without special access to Section 8 vouchers ( n = 90 ) ; and ( 3 )  st and ard VA care  ( n = 188 ) Primary outcomes were days housed and days homeless . Secondary outcomes were mental health status , community adjustment , and costs from 4 perspectives . RESULTS During a 3-year follow-up , HUD-VASH veterans had 16 % more days housed than the case management-only group and 25 % more days housed than the st and ard care group ( P<.001 for both ) . The case management-only group had only 7 % more days housed than the st and ard care group ( P = .29 ) . The HUD-VASH group also experienced 35 % and 36 % fewer days homeless than each of the control groups ( P<.005 for both ) . There were no significant differences on any measures of psychiatric or substance abuse status or community adjustment , although HUD-VASH clients had larger social networks . From the societal perspective , HUD-VASH was 6200 US dollars ( 15 % ) more costly than st and ard care . Incremental cost-effectiveness ratios suggest that HUD-VASH cost 45 US dollars more than st and ard care for each additional day housed ( 95 % confidence interval , -19 US dollars to 108 US dollars ) . CONCLUSIONS Supported housing for homeless people with mental illness results in superior housing outcomes than intensive case management alone or st and ard care and modestly increases societal costs Homelessness and unstable housing have been associated with HIV risk behavior and poorer health among persons living with HIV/AIDS ( PLWHA ) , yet prior research has not tested causal associations . This paper describes the challenges , methods , and baseline sample of the Housing and Health Study , a longitudinal , multi-site , r and omized controlled trial investigating the effects of providing immediate rental housing assistance to PLWHA who were homeless or at severe risk of homelessness . Primary outcomes included HIV disease progression , medical care access and utilization , treatment adherence , mental and physical health , and risks of transmitting HIV .  Across three study sites , 630 participants completed baseline sessions and were r and omized to receive either immediate rental housing assistance ( treatment group ) or assistance finding housing according to local st and ard practice ( comparison group ) . Baseline sessions included a question naire , a two-session HIV risk-reduction counseling intervention , and blood sample collection to measure CD4 counts and viral load levels . Three follow-up visits occurred at 6 , 12 , and 18 months after baseline . Participants were mostly male , Black , unmarried , low-income , and nearly half were between 40 and 49 years old . At 18 months , 84 % of the baseline sample was retained . The retention rates demonstrate the feasibility of conducting scientifically rigorous housing research , and the baseline results provide important information regarding characteristics of this understudied population that can inform future HIV prevention and treatment efforts OBJECTIVE Reductions in runaways ' sexual risk behaviors were evaluated in response to an intensive program to prevent human immunodeficiency virus ( HIV ) infection and the acquired immunodeficiency syndrome ( AIDS ) . DESIGN In a nonr and omized control trial , sexual risk behaviors among 78 runaways at one residential shelter who received up to 30 HIV/AIDS intervention sessions  were compared with 67 runaways at a nonintervention shelter with sexual behaviors assessed at baseline and 3 and 6 months . SETTING Runaways were recruited from the only two publicly funded shelters in New York , NY . PARTICIPANTS The runaways were aged 11 to 18 years , 64 % female , and predominantly black or Hispanic . INTERVENTION The intervention addressed general knowledge about HIV/AIDS , coping skills , access to health care and other re sources , and individual barriers to safer sex . MAIN OUTCOME MEASURES Consistent condom use , a high-risk pattern of sexual behavior , and sexual abstinence over a 3-month time frame were assessed . MAIN RESULTS As the number of intervention sessions increased , runaways ' reports of consistent condom use increased significantly ( at 3 months , unique R2 = .06 , P less than .05 ; at 6 months , unique R2 = .09 , P less than .05 ) , and their reports of engaging in a high-risk pattern of sexual behavior decreased significantly ( at 3 months , unique R2 = .03 , P = .06 ; at 6 months , unique R2 = .04 , P less than .05 ) . Abstinence did not change . CONCLUSIONS The demonstrated effectiveness of the intensive HIV/AIDS program highlights the importance of enlarging the scope of most current HIV/AIDS prevention programs Background : People who are homeless and chronically alcoholic have increased health problems , use of emergency services and police contact , with a low likelihood of rehabilitation . Harm reduction is a policy to decrease the adverse consequences of substance use without requiring abstinence . The shelter-based Managed Alcohol Project ( MAP ) was created to deliver health care to homeless adults with alcoholism and to minimize harm ; its effect upon consumption of alcohol and use of crisis services is described as proof of principle . Methods : Subjects enrolled in MAP were dispensed alcohol on an hourly basis . Hospital charts were review ed for all emergency department ( ED ) visits and admissions during the 3 years before and up to 2 years after program enrolment , and the police data base was accessed for all encounters during the same periods . The results of blood tests were analyzed for trends . A question naire was administered to MAP participants and staff about alcohol use , health and activities of daily living before and during the program . Direct program costs were also recorded . Results : Seventeen adults with an average age of 51 years and a mean duration of alcoholism of 35 years were enrolled in MAP for an average of 16 months . Their monthly mean group total of ED visits decreased from 13.5 to 8 ( p = 0.004 ) ; police encounters , from 18.1 to 8.8 ( p = 0.018 ) . Changes in blood test findings were nonsignificant . All program participants reported less alcohol consumption during MAP , and subjects and staff alike reported improved hygiene , compliance with medical care and health . Interpretation : A managed alcohol program for homeless people with chronic alcoholism can stabilize alcohol intake and significantly decrease ED visits and police encounters This study tests components of Wong and Solomon ’s ( 2002 , Mental Health Services Research , 4(2 ) , 13–28 ) model of community integration , identifying both the dimensions and predictors of integration . It evaluates community integration among adults with psychiatric disabilities assigned r and omly to receive either independent scatter-site apartments with the Housing First approach ( experimental ) or services as usual ( control ) . Factor analysis supported a definition of community integration that includes psychological , physical , and social domains , but 
    Output:
    
For homeless people with mental illness , provision of housing upon hospital discharge was effective in improving sustained housing .
For homeless people with substance abuse issues or concurrent disorders , provision of housing was associated with decreased substance use , relapses from periods of substance abstinence , and health services utilization , and increased housing tenure .
Abstinent dependent housing was more effective in supporting housing status , substance abstinence , and improved psychiatric outcomes than non-abstinence dependent housing or no housing .
Provision of housing also improved health outcomes among homeless population s with HIV .
Health promotion programs can decrease risk behaviours among homeless population s. Conclusions These studies provide important new evidence regarding interventions to improve health , housing status , and access to healthcare for homeless population s. The additional studies included in this current review provide further support for earlier evidence which found that coordinated treatment programs for homeless persons with concurrent mental illness and substance misuse issues usually result in better health and access to healthcare than usual care .
This review also provides a synthesis of existing evidence regarding interventions that specifically support homeless population s with HIV