***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: OBJECTIVES Cost-effective programs are needed to assist homeless persons with severe mental illness in their transition from shelters to community living . The authors investigated the cost-effectiveness of the critical time intervention program , a time-limited adaptation of intensive case management , which has been shown to significantly reduce recurrent homelessness among men with severe mental illness . METHOD S : Ninety-six study participants recruited from a psychiatric program in a men 's public shelter from 1991 to 1993 were r and omly assigned to the critical time intervention program or to usual services .  Costs and housing outcomes for the two groups were examined over 18 months . RESULTS Over the study period , the critical time intervention group and the usual services group incurred mean costs of 52,374 dollars and 51,649 dollars , respectively , for acute care services , outpatient services , housing and shelter services , criminal justice services , and transfer income . During the same period , the critical time intervention group experienced significantly fewer homeless nights than the usual care group ( 32 nights versus 90 nights ) . For each willingness-to-pay value -- the additional price society is willing to spend for an additional nonhomeless night -- greater than 152 dollars , the critical time intervention group exhibited a significantly greater net housing stability benefit , indicating cost-effectiveness , compared with usual care . CONCLUSION S : Although difficult to conduct , studies of the cost-effectiveness of community mental health programs can yield rich information for policy makers and program planners . The critical time intervention program is not only an effective method to reduce recurrent homelessness among persons with severe mental illness but also represents a cost-effective alternative to the status quo 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 The present study was design ed to explore the relative efficacy of three types of service delivery intervention models for homeless men with alcohol and /or drug problems :  integrated comprehensive residential services provided at one site ( Group 1 ) ; on-site shelter-based intensive case management with referrals to a community network of services ( Group 2 ) ; and usual care shelter services with case management ( Group 3 ) . In addition to assessing the relative efficacy of these approaches in terms of drug and alcohol use , residential stability , economic and employment status , the project also sought to examine what personal factors best predicted successful outcomes for clients . Clients were assessed at baseline and approximately six months following discharge . All three treatment groups improved significantly over time in terms of reduced alcohol and cocaine use , increased employment , and increased stable housing , but no differential improvement was found among groups . Successful outcomes were predicted by lower recent and lifetime substance use , fewer prior treatment episodes , more stable housing at baseline , fewer incarcerations , and less social isolation OBJECTIVES We analyzed whether a method for identifying latent trajectories -- latent class growth analysis (LCGA)--was useful for underst and ing outcomes for individuals subject to an intervention . METHODS We used LCGA to reanalyze data from a published study of mentally ill homeless men in a critical time intervention ( CTI ) program .  In that study , 96 men leaving a shelter 's on-site psychiatric program were r and omly assigned to experimental and control groups . The former received CTI services and the latter usual services . Each individual 's housing circumstances were observed for 18 months after program initiation . Our outcome measure was monthly homelessness : a person was considered homeless in a month if he was homeless for even 1 night that month . RESULTS Four latent classes were found among the control group , but just 3 among the experimental group . Control , but not experimental , group individuals showed a small class of chronically homeless men . The size of the never-homeless class was 19 percentage points larger for the experimental than for the control group . J- and inverted-U-shaped patterns were also found among both groups , but with important differences in timing of patterns . CONCLUSIONS Our results reveal effects not apparent in the original analysis , suggesting that latent class growth models improve intervention evaluation OBJECTIVE Clients with co-occurring severe mental and substance use disorders are at high risk of institutionalization and other adverse outcomes . Although integrated mental health and substance abuse treatment is becoming a st and ard clinical approach for such clients , the optimal method for delivering integrated treatment remains unclear . METHOD This study compared integrated treatment delivered within two different models of community-based case management ( assertive community treatment and st and ard clinical case management ) .  A total of 198 clients in two urban sites who had co-occurring disorders and were homeless or unstably housed were r and omly assigned to one of two treatment conditions and were followed for three years . RESULTS Participants in both treatment conditions improved over time in multiple outcome domains , and few differences were found between the two models . Decreases in substance use were greater than would be expected given time alone . At the site that had higher rates of institutionalization , clients who received st and ard case management were more likely to be institutionalized . However , in the site that had lower rates of institutionalization , no differences in the rate of institutionalization were found between the two treatment conditions . CONCLUSIONS Integrated treatment can be successfully delivered either by assertive community treatment or by st and ard clinical case management Abstract Detection of current ( past 30 days ) drug use by analysis of hair was examined along with self-reports of current use in a 1994 treatment needs assessment survey ; the sample was 179 homeless/transient adults in New York state . Results of  radioimmunoassay of hair ( RIAH ) were used to eval uate the veracity of self-reports of current cocaine use . Only 26 % of those persons whose hair tested positive for cocaine ( n=115 ) admitted to having used cocaine in the past 30 days . Subjects eligible for treatment , as indicated by a DSM-III-R diagnosis of cocaine dependency , were nearly four times as likely to admit current cocaine use than those who were not dependent . These results are consistent with other studies of population s at high risk for substance use 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 to provide integrated clinical and housing services to homeless veterans with psychiatric and /or substance abuse disorders at 19 sites . At four sites , 460 subjects were r and omly assigned to one of the three groups : ( 1 ) HUD-VASH , with both Section 8 vouchers and intensive case management ; ( 2 ) case management only ; and ( 3 ) st and ard VA care . A previous publication found HUD-VASH result ed in superior housing outcomes but yielded no benefits on clinical outcomes . Since many participants missed prescheduled visits during the follow-up period and follow-up rates were quite different across the groups , we reanalyzed these data using multiple imputation statistical methods to account for the missing observations . Significant benefits were found for HUD-VASH in drug and alcohol abuse outcomes that had not previously been identified BACKGROUND People with severe mental illness and substance use disorders ( dual disorder ) often have considerable contact with the criminal justice system . AIMS To test the effects of client characteristics on six criminal justice outcomes among homeless ( at intake ) people with mental illness and substance misuse disorders . METHODS The sample was of participants in a r and omized controlled trial comparing st and ard treatment , assertive community treatment ( ACT ) and integrated treatment ( IT ) . Data were analysed using hierarchical logistic regression . RESULTS Half the sample was arrested and a quarter incarcerated during the two-year follow-up period . The regression models explained between 22 % and 35 % of the variance of the following criminal justice measures : ( 1 ) major offences , ( 2 ) minor offences , ( 3 ) substance-use-related offences , ( 4 ) incarcerations , ( 5 ) arrests , and ( 6 ) summons . Prior criminal behaviour was the strongest predictor of all of the dependent variables ; in general , demographic and diagnostic variables were not . Similarly , neither the type nor the amount of mental health treatment received predicted subsequent criminal behaviour . CONCLUSION Elsewhere the authors have shown that ACT and IT had advantages for health and stability of accommodation but these analyses suggest that more specialized interventions are needed to reduce criminal behaviour in dual disorder individuals OBJECTIVES This study examined a strategy to prevent homelessness among individuals with severe mental illness by providing a bridge between institutional and community care . METHODS Ninety-six men with severe mental illness who were entering community housing from a shelter institution were r and omized to receive 9 months of a " critical time " intervention plus usual services or usual services only . The primary analysis compared the mean number of homeless nights for the two groups during the 18-month follow-up period . To eluci date time trends , survival curves were used . RESULTS Over the 18-month follow-up period , the average number of homeless nights was 30 for the critical time intervention group and 91 for the usual services group . Survival curves showed that after the 9-month period of active intervention , the difference between the two groups did not diminish . CONCLUSIONS Strategies that focus on a critical time of transition may contribute to the prevention of recurrent homelessness among individuals with mental illness , even after the period of active intervention Case management arose in the USA as a solution to the difficulties of providing community care to people with severe mental disorders . The basic principle of the approach is that a case manager takes responsibility for a client ; arranges an assessment of need , a comprehensive service plan , delivery of suitable services , and monitoring and assessment of services delivered . The case-management approach has been widely accepted , to the extent that recent legislation has made case-management the cornerstone of community care in the UK . We did a r and omised controlled trial to evaluate a social services case-management team for people with long-term mental disorders . Subjects were referred from hostels for the homeless , night shelters , a general-practitioner clinic for the homeless , the Oxford City Council homelessness unit , and local voluntary-sector group homes . Of 103 subjects referred , 80 consented to be r and omised to treatment or control groups . At 14-month follow-up , as assessed by st and ardised interviews , there were no significant differences between groups in number of needs , quality of life , employment status , quality of accommodation , social behaviour , or severity of psychiatric symptoms . In the case-management group there was a significant reduction in deviant behaviour on a st and ardised behaviour rating scale ( REHAB ) ( mean = 0.79 ; 95 % CI 0.26 - 1.32 ) . It is unfortunate , in view of the limited effectiveness we have shown , that social services case-management was not evaluated in r and omised controlled trials before its implementation in the UK OBJECTIVE Three types of case management were compared to determine their relative effectiveness in helping people with severe mental illness who were homeless or at risk of homelessness . METHODS Subjects recruited from a psychiatric emergency room and inpatient units were r and omly assigned to one of the three treatment conditions : broker case management , in which the client 's needs were assessed , services were purchased from multiple providers , and the client was monitored ; assertive community treatment only , in which comprehensive services were provided for an unlimited period ; and assertive community treatment augmented by support from community workers , who assisted with activities of daily living and were available for leisure activities . Of 165 subjects recruited , 135 were followed for 18 months . RESULTS Compared with clients assigned to broker case management , clients assigned to assertive community treatment only and assertive community treatment with community workers had superior outcomes on several variables . They were number of contacts with the assigned treatment program , re source utilization ( for example , use of entitlements ) , severity of thought disorder , activity level , and client satisfaction . Clients in the assertive community treatment only condition achieved more days in stable housing than those in the other two treatment conditions . No significant treatment group effects were found on income , self-esteem , or substance abuse . CONCLUSIONS Assertive community treatment is superior to broker case management in assisting individuals with serious mental illness who are at risk of homelessness We describe the impact of 
    Output:
    
We found little evidence for the effectiveness of  ICM .
SCM  improved housing stability , reduced substance use , and removed employment barriers for substance users .
ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons .
CTI showed promise for housing , psychopathology , and substance use and was cost-effective for mentally ill persons .