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ABSTRACT: Two randomized experiments compared the effectiveness of the assertive community treatment (ACT) team against other treatments (outpatient therapy, drop-in center, and brokered case management) in improving the social relationships of individuals who were both homeless and suffered from severe and persistent mental illness. In both studies clients assigned to ACT teams reported having more professionals in their social networks than clients assigned to the other treatments. Clients did not report significant differences between treatment conditions on most of the other social relationship dimensions. Further attention to developing social skills and network interventions within ACT teams are recommended.
Homelessness affects millions of Americans each year, with approximately one-third of this population suffering from severe mental disorders (Dennis, Buckner, Lipton, & Levine, 1991). Considerable research indicates that people who are homeless and mentally ill also have a number of other important, unmet needs (Ball & Havassay, 1984; Morse & Calsyn, 1986). One important area of need involves social relations, particularly social support. Social support appears to buffer stress and diminish psychiatric symptoms, and may be related to stable housing among people formerly homeless (Cohen & Kochanowicz, 1989; Cohen & Sokolovsky, 1978; Drake, Wallach, & Hoffman, 1989; Drake et al., 1991).
Two studies have found that the social networks of mentally ill individuals who are homeless are smaller than the networks of other homeless people and the general population (Goering et al., 1992; Morse & Calsyn, 1986). In addition, it appears that the social networks of homeless mentally ill people become even smaller the longer that they remain homeless (Calsyn & Morse, 1991; Grigsby, Baumann, Gregorich, & Roberts-Gray, 1990; LaGory, Ritchie, & Mullis, 1990). Some studies on homeless people have also found a negative correlation between the amount of social support and psychiatric symptoms (Calsyn & Morse, 1992; LaGory, et al., 1990), although this result has not occurred in all homeless research (Morse & Calsyn, 1986).
Assertive community treatment (ACT) has become the recommended approach for assisting individuals with severe and persistent mental illness, including those who are homeless (Burns & Santos, 1995). The ACT team provides a more integrated approach to serving people who are homeless and mentally ill than typical service programs. Some of the more essential characteristics of ACT are: 24 hour emergency...