INNOVATIONS IN INTEGRATED CARE FOR INDIVIDUALS EXPERIENCING HOMELESSNESS

ABSTRACT

STATEMENT OF PROBLEM/QUESTION Health care for individuals experiencing homelessness is typically fragmented and passive, and illequipped to meet the complex needs of this population. DESCRIPTION OF PROGRAM/INTERVENTION The Mobile, Medical, and Mental Health Care Team (M3 Team) is a mobile, patient-centered, integrated care model for people experiencing chronic homelessness with a chronic medical condition, serious mental illness, and substance use disorders. M3 innovates in three ways 1) M3 is mobile and patient-centered, meeting people where they are - both geographically and in their readiness for engagement;2) M3 is integrated and holistic, integrating primary care, behavioral health care, and health-related social needs across public medical and mental health systems;3) M3 focuses on racial equity to include provider training, prioritization of Black clients, and data disaggregation by race and ethnicity. MEASURES OF SUCCESS We conducted quarterly assessments of enrolled patients using two standardized scales (1) self-reported functioning and mental health symptoms using the Behavior and Symptom Identification Scale (BASIS-24), and (2) substance use using the Addiction Severity Index (ASI) drug and alcohol use scales. To assess changes in the dependent variables over time, we used repeated measures ANOVA with time, gender, race, ethnicity, number of comorbidities, and an indicator of whether the measurement was taken before or after the start of the COVID-19 pandemic as independent variables. We also evaluated emergency department utilization and hospitalizations, 6 and 12 months pre- and post-enrollment on the M3 Team (unadjusted results presented here, adjusted analyses currently ongoing and will be presented if accepted). We also tracked enrollment in social programs. FINDINGS TO DATE 54 clients were enrolled between August 2019 and December 2022. In the 6 months following the start of M3 enrollment, participants experienced decreases in mean severity of mental health symptoms related to depression and functioning (-0.205, p=0.011) and self-harm (-0.055, p=0.008), as well as alcohol use (-0.120, p=0.007) and drug use (-0.065, p=0.001). In the 18 months following M3 initiation, mean severity of symptoms related to depression and functioning (-0.372, p=0.003), self-harm (-0.073, p=0.019), emotional lability (-0.114, p=0.014), and drug use (-0.080, p=0.005) decreased while other domains were not significantly different from baseline values. On average, ED visits post enrollment were significantly lower than pre-enrollment for the 6-month and 12-month measures by 51% and 43%, respectively. Hospitalizations pre- and post-enrollment were not significantly different. Enrollment in a variety of social service programs increased over the enrollment period. KEY LESSONS FOR DISSEMINATION Delivery models that integrate primary care, behavioral health care, and social services hold promise for improving behavioral health outcomes, reducing ER utilization, and addressing social needs of individuals with complex health needs who are experiencing homelessness.