http://archpsyc.jamanetwork.com/ en-us Mon, 12 Nov 2012 00:00:00 GMT Tue, 01 Jan 2013 00:44:58 GMT Silverchair editor@archpsyc.jamanetwork.com webmaster@archpsyc.jamanetwork.com http://archpsyc.jamanetwork.com/article.aspx?articleID=207801 Mon, 01 Sep 2003 00:00:00 GMT Rosenheck R, Kasprow W, Frisman L, et al. <span class="paragraphSection"><div class="boxTitle">Background</div>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.<div class="boxTitle">Methods</div>Homeless veterans with psychiatric and/or substance abuse disorders or both (N = 460) were randomly 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) standard 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.<div class="boxTitle">Results</div>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 standard care group (<span style="font-style:italic;">P</span><.001 for both). The case management– only group had only 7% more days housed than the standard care group (<span style="font-style:italic;">P</span> = .29). The HUD-VASH group also experienced 35% and 36% fewer days homeless than each of the control groups (<span style="font-style:italic;">P</span><.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 (15%) more costly than standard care. Incremental cost-effectiveness ratios suggest that HUD-VASH cost $45 more than standard care for each additional day housed (95% confidence interval, $−19 to $108).<div class="boxTitle">Conclusions</div>Supported housing for homeless people with mental illness results in superior housing outcomes than intensive case management alone or standard care and modestly increases societal costs.</span> 60 9 940 951 10.1001/archpsyc.60.9.940 http://archpsyc.jamanetwork.com/article.aspx?articleID=207801