Since 1991, Bonita House, Inc. (BHI) has provided supportive services to dually diagnosed adults (i.e., those with serious mentally illness and substance-abuse). In October, 1993, BHI was awarded a Phase 1 grant through the Cooperative Agreements for CMHS/CSAT Collaborative Demonstration Program for Homeless Individuals. The Phase 1 grant supported a manualization of the BHI Residential Treatment Program's intensive early engagement intervention with homeless dually diagnosed adults. As described in the manual, developing methods to use structure as an engagement tool in the first two weeks of treatment, at the same time achieving a balance with individualized treatment, is BHI's contribution to state-of-the-art homeless dual diagnosis service. In the current proposal, BHI applies for a Phase 2 award to formally evaluate the intervention manualized in Phase 1. Evaluation of engagement techniques can be challenging. In this application for Phase 2 funding we propose an evaluation of the impact of intensive early engagement interventions on client length of stay and subsequent treatment outcomes. As proposed, the evaluation will test the impact of the BHI early engagement interventions by comparing outcomes of BHI Residential Treatment Program residents against the outcomes of a like group: dually diagnosed patients discharged from psychiatric inpatient settings into other residential treatment programs or treatment settings. The Evaluation Plan in Section D of this application describes the strategy for documenting how intensive early engagement occurs in the Residential Treatment Program, and it provides a design for evaluation of its impact on resident outcomes. Briefly, short-term (14-day) outcomes include the following: level of integration into the program community, consecutive days in the program, days of abstinence from alcohol and drug use, and completion of expected treatment goals for this period. Intermediate-term (120-day) outcomes include consecutive days in the program, completion of goals of each of four treatment-program levels, days of abstinence from alcohol and drug use, and planning for discharge with a case manager. Long-term outcomes (240 days), which should follow from short and intermediate term outcomes, will be measured by frequency and duration of psychiatric hospitalizations, days of residential stability and homelessness, days of alcohol and drug abstinence, whether or not individuals have structured day activities, and frequency of contact with the criminal justice system. At the end of a 24-month study period, BHI will have completed an evaluation of the Residential Treatment Program intensive early engagement intervention, and will disseminate findings for use by providers nationally. Compliance with 42 CFR Part 2 and 45 CFR Part 6 are addressed in the Evaluation Plan. The procedure to protect the rights of all human subjects will be submitted to an Institutional Review Board (IRB) on June 16, 1994, with approval expected on June 28, 1994.
