• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of amjphAmerican Journal of Public Health Web SiteAmerican Public Health Association Web SiteSubmissionsSubscriptionsAbout Us
Am J Public Health. 2000 December; 90(12): 1873–1878.
PMCID: PMC1446423

Serving street-dwelling individuals with psychiatric disabilities: outcomes of a psychiatric rehabilitation clinical trial.


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 randomly assigned to the experimental program (called Choices) or to standard 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 standard 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 populations, expand their use of human services, and improve their housing conditions, quality of life, and mental health status.

Full Text

The Full Text of this article is available as a PDF (95K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Dennis DL, Buckner JC, Lipton FR, Levine IS. A decade of research and services for homeless mentally ill persons. Where do we stand? Am Psychol. 1991 Nov;46(11):1129–1138. [PubMed]
  • Fischer PJ, Breakey WR. The epidemiology of alcohol, drug, and mental disorders among homeless persons. Am Psychol. 1991 Nov;46(11):1115–1128. [PubMed]
  • Drake RE, Osher FC, Wallach MA. Homelessness and dual diagnosis. Am Psychol. 1991 Nov;46(11):1149–1158. [PubMed]
  • Bachrach LL. Interpreting research on the homeless mentally ill: some caveats. Hosp Community Psychiatry. 1984 Sep;35(9):914–917. [PubMed]
  • Freddolino PP, Moxley DP. Refining an advocacy model for homeless people coping with psychiatric disabilities. Community Ment Health J. 1992 Aug;28(4):337–352. [PubMed]
  • Susser E, Goldfinger SM, White A. Some clinical approaches to the homeless mentally ill. Community Ment Health J. 1990 Oct;26(5):463–480. [PubMed]
  • Morse GA, Calsyn RJ, Miller J, Rosenberg P, West L, Gilliland J. Outreach to homeless mentally ill people: conceptual and clinical considerations. Community Ment Health J. 1996 Jun;32(3):261–274. [PubMed]
  • Anthony WA. Psychiatric rehabilitation: key issues and future policy. Health Aff (Millwood) 1992 Fall;11(3):164–171. [PubMed]
  • Surles RC, Blanch AK, Shern DL, Donahue SA. Case management as a strategy for systems change. Health Aff (Millwood) 1992 Spring;11(1):151–163. [PubMed]
  • Mueser KT, Bond GR, Drake RE, Resnick SG. Models of community care for severe mental illness: a review of research on case management. Schizophr Bull. 1998;24(1):37–74. [PubMed]
  • Shern DL, Felton CJ, Hough RL, Lehman AF, Goldfinger S, Valencia E, Dennis D, Straw R, Wood PA. Housing outcomes for homeless adults with mental illness: results from the second-round McKinney program. Psychiatr Serv. 1997 Feb;48(2):239–241. [PubMed]
  • Schinnar AP, Rothbard AB, Kanter R, Jung YS. An empirical literature review of definitions of severe and persistent mental illness. Am J Psychiatry. 1990 Dec;147(12):1602–1608. [PubMed]
  • Dohrenwend BS, Krasnoff L, Askenasy AR, Dohrenwend BP. Exemplification of a method for scaling life events: the Peri Life Events Scale. J Health Soc Behav. 1978 Jun;19(2):205–229. [PubMed]
  • Susser ES, Struening EL. Diagnosis and screening for psychotic disorders in a study of the homeless. Schizophr Bull. 1990;16(1):133–145. [PubMed]
  • Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Arch Gen Psychiatry. 1981 Apr;38(4):381–389. [PubMed]
  • Spitzer RL, Williams JB, Gibbon M, First MB. The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatry. 1992 Aug;49(8):624–629. [PubMed]
  • Felton CJ, Stastny P, Shern DL, Blanch A, Donahue SA, Knight E, Brown C. Consumers as peer specialists on intensive case management teams: impact on client outcomes. Psychiatr Serv. 1995 Oct;46(10):1037–1044. [PubMed]
  • Shern DL, Wilson NZ, Coen AS, Patrick DC, Foster M, Bartsch DA, Demmler J. Client outcomes II: Longitudinal client data from the Colorado treatment outcome study. Milbank Q. 1994;72(1):123–148. [PubMed]
  • Pearlin LI, Schooler C. The structure of coping. J Health Soc Behav. 1978 Mar;19(1):2–21. [PubMed]
  • Gibbons RD, Hedeker D, Elkin I, Waternaux C, Kraemer HC, Greenhouse JB, Shea MT, Imber SD, Sotsky SM, Watkins JT. Some conceptual and statistical issues in analysis of longitudinal psychiatric data. Application to the NIMH treatment of Depression Collaborative Research Program dataset. Arch Gen Psychiatry. 1993 Sep;50(9):739–750. [PubMed]
  • Dawson JD, Lagakos SW. Size and power of two-sample tests of repeated measures data. Biometrics. 1993 Dec;49(4):1022–1032. [PubMed]
  • Di Bisceglie AM, Martin P, Kassianides C, Lisker-Melman M, Murray L, Waggoner J, Goodman Z, Banks SM, Hoofnagle JH. Recombinant interferon alfa therapy for chronic hepatitis C. A randomized, double-blind, placebo-controlled trial. N Engl J Med. 1989 Nov 30;321(22):1506–1510. [PubMed]
  • Dawson JD. Sample size calculations based on slopes and other summary statistics. Biometrics. 1998 Mar;54(1):323–330. [PubMed]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...