Integration of Service Systems for Homeless Persons With Mental Illness Through the ACCESS Program
Joseph P. Morrissey, Michael O. Calloway, Neil Thakur, Joseph Cocozza, Henry J. Steadman, Deborah Dennis
The aim of this study was to evaluate the first of the two core questions around which the Access to Community Care and Effective Services and Supports (ACCESS) evaluation was designed: does implementation of system-change strategies lead to better integration of service systems? The study was part of the five-year federal ACCESS service demonstration program, which sought to enhance integration of service delivery systems for homeless persons with serious mental illness. Data were gathered from nine randomly selected experimental sites and nine comparison sites in 15 of the nation's largest cities on the degree to which each site implemented a set of systems integration strategies and the degree of systems integration that ensued among community agencies across five service sectors: mental health, substance abuse, primary care, housing, and social welfare and entitlement services. Contrary to expectations, the nine experimental sites did not demonstrate significantly greater overall systems integration than the nine comparison sites. However, the experimental sites demonstrated better project-centered integration than the comparison sites. Moreover, more extensive implementation of strategies for system change was associated with higher levels of overall systems integration as well as project-centered integration at both the experimental sites and the comparison sites.