***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: Several studies have established that the personal and social consequences of substance abuse are extensive and costly . These consequences are frequently compounded by mental illness . Although interventions that target mentally ill chemical abusers ( MICAs ) present several challenges , the potential benefits of successful interventions are significant . This article presents outcomes and costs of a modified therapeutic community ( TC ) intervention for homeless MICAs . Outcomes at follow-up are compared with those for a control group of homeless MICAs receiving st and ard services in a “ treatment-as-usual ” ( TAU ) condition .  Annual economic costs for the modified TC and the average weekly cost of treating a single client are estimated . Treatment and other health service costs at 12 months postbaseline are compared for modified TC and TAU clients . The results of this study indicate that , suitably modified , the TC approach is an effective treatment alternative for homeless MICAs , with the potential to be highly cost-effective relative to st and ard services OBJECTIVE Housing First with assertive community treatment ( ACT ) is a promising approach to assist people with serious mental illness to exit homelessness . The article presents two-year findings from a multisite trial on the effectiveness of Housing First with ACT . METHODS The study design was a r and omized controlled trial conducted in five Canadian cities . A sample of 950 participants with serious mental illness who were absolutely homeless or precariously housed were r and omly assigned to receive either Housing First with ACT ( N=469 ) or treatment as usual ( N=481 ) . RESULTS Housing First participants spent more time in stable housing than participants in treatment as usual ( 71 % versus 29 % , adjusted absolute difference [AAD]=42 % , p<.01 ) . Compared with treatment-as-usual participants , Housing First participants who entered housing did so more quickly ( 73 versus 220 days , AAD=146.4 , p<.001 ) , had longer housing tenures at the study end-point ( 281 versus 115 days , AAD=161.8 , p<.01 ) , and rated the quality of their housing more positively ( adjusted st and ardized mean difference [ASMD]=.17 , p<.01 ) . Housing First participants reported higher quality of life ( ASMD=.15 , p<.01 ) and were assessed as having better community functioning ( ASMD=.18 , p<.01 ) over the two-year period . Housing First participants showed significantly greater gains in community functioning and quality of life in the first year ; however , differences between the two groups were attenuated by the end of the second year . CONCLUSIONS Housing First with ACT is an effective approach in various context s for assisting individuals with serious mental illness to rapidly exit homelessness 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 This paper describes some of the statistical considerations in the intent-to-treat design and analysis of clinical trials . The pivotal property of a clinical trial is the assignment of treatments to patients at r and om . R and omization alone , however , is not sufficient to provide an unbiased comparison of therapies . An additional requirement is that the set of patients contributing to an analysis provides an unbiased assessment of treatment effects , or that any missing data are ignorable . A sufficient condition to provide an unbiased comparison is to obtain complete data on all r and omized subjects . This can be achieved by an intent-to-treat design wherein all patients are followed until death or the end of the trial , or until the outcome event is reached in a time-to-event trial , irrespective of whether the patient is still receiving or complying with the assigned treatment . The properties of this strategy are contrasted with those of an efficacy subset analysis in which patients and observable patient data are excluded from the analysis on the basis of information obtained postr and omization . I describe the potential bias that can be introduced by such postr and omization exclusions and the pursuant effects on type I error probabilities . Especially in a large study , the inflation in type I error probability can be severe , 0.50 or higher , even when the null hypothesis is true . St and ard statistical methods for the analysis of censored or incomplete observations all require the assumption of missing at r and om to some degree , and none of these methods adjust for the potential bias introduced by post hoc subset selection . Nor is such adjustment possible unless one posits a model that relates the missing observations to other observed information for each subject-models that are inherently untestable . Further , the subset selection bias is confounded with the subset-specific treatment effect , and the two components are not identifiable without additional untestable assumptions . Methods for sensitivity analysis to assess the impact of bias in the efficacy subset analysis are described . It is generally believed that the efficacy subset analysis has greater power than the intent-to-treat analysis . However , even when the efficacy subset analysis is assumed to be unbiased , or have a true type I error probability equal to the desired level alpha , situations are described where the intent-to-treat analysis in fact has greater power than the efficacy subset analysis . The intent-to-treat design , wherein all possible patients continue to be followed , is especially powerful when an effective treatment arrests progression of disease during its administration . Thus , a patient benefits long after the patient becomes noncompliant or the treatment is terminated . In such cases , a l and mark analysis using the observations from the last patient evaluation is likely to prove more powerful than life-table or longitudinal analyses . Examples are described IMPORTANCE Scattered-site housing with Intensive Case Management ( ICM ) may be an appropriate and less-costly option for homeless adults with mental illness who do not require the treatment intensity of Assertive Community Treatment . OBJECTIVE To examine the effect of scattered-site housing with ICM services on housing stability and generic quality of life among homeless adults with mental illness and moderate support needs for mental health services . DESIGN , SETTING , AND PARTICIPANTS The At Home/Chez Soi project was an unblinded , r and omized trial . From October 2009 to July 2011 , participants ( N = 1198 ) were recruited in 4 Canadian cities ( Vancouver , Winnipeg , Toronto , and Montreal ) , r and omized to the intervention group ( n = 689 ) or usual care group ( n = 509 ) , and followed up for 24 months . INTERVENTIONS The intervention consisted of scattered-site housing ( using rent supplements ) and off-site ICM services . The usual care group had access to existing housing and support services in their communities . MAIN OUTCOMES AND MEASURES The primary outcome was the percentage of days stably housed during the 24-month period following r and omization . The secondary outcome was generic quality of life , assessed by a EuroQoL 5 Dimensions ( EQ-5D ) health question naire . RESULTS During the 24 months after r and omization , the adjusted percentage of days stably housed was higher among the intervention group than the usual care group , although adjusted mean differences varied across sites . [ table : see text ] The mean change in EQ-5D score from baseline to 24 months among the intervention group was not statistically different from the usual care group ( 60.5 [ 95%CI , 58.6 to 62.5 ] at baseline and 67.2 [ 95%CI , 65.2 to 69.1 ] at 24 months for the intervention group vs 62.1 [ 95 % CI , 59.9 to 64.4 ] at baseline and 68.6 [ 95%CI , 66.3 to 71.0 ] at 24 months for the usual care group , difference in mean changes , 0.10 [ 95%CI , −2.92 to 3.13 ] , P=.95 ) . CONCLUSIONS AND RELEVANCE Among homeless adults with mental illness in 4 Canadian cities , scattered site housing with ICM services compared with usual access to existing housing and community services result ed in increased housing stability over 24 months , but did not improve generic quality of life . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N42520374 OBJECTIVE To test the influence of neurocognitive functioning on community functioning among formerly homeless persons with serious mental illness and to determine whether that influence varies with social context , independent of individual characteristics . METHODS In metropolitan Boston , 112 persons in Department of Mental Health shelters were administered a neuropsychological test battery and other measures and then r and omly assigned to empowerment-oriented group homes or independent apartments , as part of a longitudinal study of the effects of housing on multiple outcomes . Subjects ' case managers completed Rosen 's 5-dimensional Life Skills Inventory at 3 , 6 , 12 , and 18 months and subjects reported on their social contacts at baseline , 6 , 12 , and 18 months . Subject characteristics are controlled in the analysis . RESULTS Three dimensions of neurocognitive functioning -- executive function , verbal declarative memory , and vigilance -- each predicted community functioning . Better executive function predicted improved self-care and less turbulent behavior among persons living alone , better memory predicted more positive social contacts for those living in a group home , and higher levels of vigilance predicted improved communication in both housing types . CONCLUSION Neurocognition predicts community functioning among homeless persons with severe mental illness , but in a way that varies with the social context in which community functioning occurs OBJECTIVES We examined the longitudinal effects of a Housing First program for homeless , mentally ill individuals ' on those individuals ' consumer choice , housing stability , substance use , treatment utilization , and psychiatric symptoms . METHODS Two hundred twenty-five participants were r and omly assigned to receive housing contingent on treatment and sobriety ( control ) or to receive immediate housing without treatment prerequisites ( experimental ) . Interviews were conducted every 6 months for 24 months . RESULTS The experimental group obtained housing earlier , remained stably housed , and reported higher perceived choice . Utilization of substance abuse treatment was significantly higher for the control group , but no differences were found in substance use or psychiatric symptoms . CONCLUSIONS Participants in the Housing First program  were able to obtain and maintain independent housing without compromising psychiatric or substance abuse symptoms This study compared the outcomes of services provided by  case managers who are mental health system consumers and case managers who were not consumers . The study focused on the first two cohorts that entered the ACCESS program , a 5-year demonstration program funded by the Center for Mental Health Services between 1994 and 1996 . We tested the associations between the type of case manager  and clinical outcomes at three time points ( baseline , 3 months , and 12 months ) . A series of one-way repeated measures of analyses of variance were conducted on clients from ACCESS sites that hired consumer providers . Although there were significant effects of Time for almost every outcome measure ( clients improved over time ) , there were no significant Time x Case Manager Type interactions . Staff age , race , or gender did not significantly alter the pattern of these results . Given that services provided by consumers and nonconsumers were associated with equivalent client outcomes , the present study shows , using a large sample , the ability of consumers to provide mental health services as members of a case management team The main purpose of the study was to determine whether a peer-support community programme would reduce relapse rates among clients recovering from substance addictions and homelessness and result in increased perceived community affiliation , supportive behaviours , self-determination and quality of life . Mixed methods were utilized including semi-structured interviews , participant observation and a pretest/post-test to evaluate changes on the  quality of life rating  , the  Medical Outcomes Study -Social Support Survey  , and the Volitional Question naire . Data from the prior year 's permanent supportive housing programme were used for comparison of relapse rates . Significant reduction of risk of relapse was found in clients who participated in the programme . Significant differences were found on three subscales of the Medical Outcomes Study -Social Support Survey . Improvement that did not reach statistical significance was seen on the quality of life rating . Qualitative evidence supported improvements in perceived community affiliation and supportive behaviours . Evidence suggests that a peer-supported community programme focused on self-determination can have a significant positive impact on recovery from substance addictions and homelessness . Limitations include a small sample size and lack of a r and omized control group The research reported here tested the factor structure of a measure for sense of community in community organizations , and it evaluated sense of community 's potential as an empowering organizational characteristic within an organizational empowerment framework . R and omly selected community organization participants ( N = 561 ) were surveyed as part of a study of a substance abuse prevention initiative located in the northeastern United States . Confirmatory factor analysis verified the putative structure of the sense of community measure tailored to community organizations . Hierarchical regression analyses indicated that community organization  sense of community significantly predicted intrapersonal empowerment after controlling for demographics , participation , alienation , and other empowering organizational characteristic . Findings imply that organizational sense of community should be considered as an empowering organizational characteristic in community-based health education This research examined the impact of including a supportive person on the outcomes of two 
    Output:
    
Interventions that were competency-building effectively improved outcomes aligned with the intrapersonal PE component .
Interventions that were collaborative and competency-building effectively improved outcomes aligned with the behavioral PE component .
Weak evidence suggested that interventions with empowering features may effectively improve outcomes aligned with the interactional PE component .
Interventions that promoted and developed support effectively improved relational antecedents .
Findings align the empirical evidence for homeless interventions with theoretical conceptions of empowering features and processes .
Findings may be applied to the design and implementation of homeless interventions to incorporate empowering features and to facilitate the development of homeless services users ' PE