This study examines individual client- and community-level sources of variation in service use among clients entering 18 community treatment programs for homeless mentally ill persons as part of a national demonstration project. Assessment data on 1,828 clients were used to evaluate the relationship of a) individual client characteristics and b) site of entry, to both the intensity and diversity of service use. Hierarchical multiple regression was used to identify the relative importance of client characteristics and site of entry. Client characteristics explained only 2% to 3% of the variance in service use. Inter-site variation accounted for 2 to 3 times as much of the variance. Inter-site differences account for substantially more of the variance in service use among homeless persons with mental illness than individual client characteristics. Further studies are needed to identify specific community-level factors that account for these variations.
1Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut and Department of Psychiatry, Yale University School of Medicine.
Send reprint requests to Dr. Rosenheck, (182), VA Medical Center, 950 Campbell Avenue, West Haven, Connecticut 06516.
This study was funded under interagency agreement number AM9512200A between the Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services and the Northeast Program Evaluation Center Department of Veterans Affairs.
The evaluation coordinators and research assistants at each site were responsible for the success of this data collection effort. The authors thank the following local evaluation coordinators and their staffs for their invaluable assistance in collecting the data for this project: Simeon Goodwin, Ph.D., Jacob Tebes, Ph.D., Mardi Solomon, M.A., Sue Pickett, Ph.D., Greg Meissen, Ph.D., Robert Calsyn, Ph.D., Cheryl Roberts, M.A., Coleman Poses, M.S.W., Laverne Knezek, Ph.D., Deborah Webb, Ph.D., Marilyn Biggerstaff, D.S.W., and Peter Brissing, M.S.W.