Peer-led Treatment for Homeless MICA's

Peer-Led Treatment for Homeless MICA's

Principal Investigator: Marc Galanter, M.D., Co-Principal Investigator: Susan Egelko, Ph.D., with Eva Jurewicz, B.A.

Peer-led treatment, although a mainstay of substance abuse treatment, has yet to be employed widely for dual diagnosed patients or studied in a treatment comparison trial. In this follow-up study, assessments are being conducted on patients completing a modified residential therapeutic program where peer leadership is integrated with professional supervision. A control group of patients referred for traditional residential treatment is also being assessed.

PROJECT GOALS

This project lays the ground work for a comparative study of an innovative, professionally recognized residential program for homeless PSMD who have substance abuse disorders (PSMD-D). The program integrates peer leadership and professional supervision, employing modified techniques derived from drug-free therapeutic communities (TCs).

The specific aims of the project are to:

Conduct one- and six-month follow-up assessments on 35 patients completing the six-month modified TC residential program for homeless PSMD-D (the Greenhouse) to determine their status after community transition and to use client satisfaction measures to ways to improve the program.

Determine the rates and predictors of completion of the Greenhouse treatment program, based on 128 patients who began treatment.

Identify predictors of outcome at one and six months following discharge in a subgroup of 35 patients who completed treatment.

Collect pilot data on 30 homeless PSMD-D from Bellevue Hospital Center’s general psychiatric inpatient services who are referred to non-TC-oriented residential treatment at intake, one month into treatment, and at one and six months following treatment completion, in order to perform pilot comparisons with the 35 Greenhouse completers.

Prepare an R01 grant submission based on findings from this proposal, which will allow for a full one year follow-up of a cohort with sufficient power to detect an effect of the treatment.

RESEARCH ACTIVITIES AND RESULTS

The project’s pilot year has been completed and program feasibility established. We initated a system of data collection, tracking and entry, as well as a targeted functional assessment measure of aftercare status. A locator system was refined, whereby we could make contact with program completers following discharge. This system of tracking will ultimately permit us to identify factors instrumental to successful community transition when an adequate sample of clients has been accumulated.

To date a total of 67 subjects have been assessed at intake (entry to the residential DDHP program), using the following information:

basic demographic status (e.g., age, race, history of homelessness, etc.);
level and type of psychiatric symptomatology, including a DSM-IVR diagnosis from the unit chief/psychiatrist, as well as a self-report of symptoms from the Brief Symptom Inventory;
treatment history for psychiatric disorder and/or substance abuse (from Addiction Severity Index [ASI]);
history of suicidality, based on 5 items from the ECA Suicide Questions; and
self-report of drug cravings. As originally planned a one month reassessment was conducted during treatment on 55 clients, based on a Client Satisfaction Questionnaire.

For clients completing the six-month treatment program, a three-month followup assessment in the community had initially been planned. However, this single follow-up assessment time point was replaced by two time points of greater clinical relevance:

a one-month post-completion follow-up telephone functional assessment, and
a more complete 6-month post-completion assessment conducted face-to-face in the community. Both assessment periods cover general psychiatric, substance use and housing stability functions. As originally proposed, the range of behavioral functioning includes:

Brief Symptom Inventory rating of psychiatric symptomatology;
compliance with psychiatric medication, based on the community residence staff;
number of rehospitalizations;
drug/alcohol use (ASI scale);
stability of housing (whether client stayed with initial placement); and
post-discharge client satisfaction with the residential DDHP treatment program. To date a total of 7 program completers have been assessed at 1-month post-discharge and 9 program completers at 6-month post-discharge.

INCLUSION OF GENDER AND MINORITY SUBJECTS

The program site is a male residence and all subjects are dually disordered MICA patients referred from psychiatric and homeless facilities. Ethnic/racial representation is as follows: Black: 55%; White: 24%; and Hispanic: 19%.

SIGNIFICANCE OF FINDINGS/POLICY IMPLICATIONS

Peer-led treatment, although a mainstay of substance abuse treatment, has yet to be employed widely for PSMD-D or studied in a treatment comparison trial. This study will shed light on effective treatment for homeless MICA patients in hospitals and identify factors associated with outcome during the aftercare post-discharge period. In addition, by including patient-consumer ratings of treatment components and clinical concerns both during and after treatment, the study has the potential for developing more targeted treatment for this refractory patient population.

PLANS

With continued funding, assessment interviews will be conducted at all time points, as planned, and data analyses/preparation of preliminary profile reports initiated.

Publications:

Westreich L, Galanter M, Lifshutz H, Metzger EJ, Silberstein C., A modified therapeutic community for the dually diagnosed. J Substance Abuse Treatment 13:1-4, 1997.

Taylor SM, Galanter M, Dermatis H, Spivak N, Egelko S., Dual diagnosis patients in the modified therapeutic community: Does a criminal history compromise adjustment to treatment? J Addictive Dis 16:32-38, 1997.

Mierlak D, Galanter M, Spivak N, Dermatis H, Jurewicz E, De Leon G., Modified therapeutic community treatment for homeless dually diagnosed men: Who completes treatment? J Substance Abuse Treatment 15: 117-122, 1998.

Entered: 3/18/99

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