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ACCESS
WHAT IS ACCESS?
The Access to Community Care and Effective Services and Supports (ACCESS)
program is an 18-site, five-year demonstration project funded by the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), and the U.S. Department of Health
and Human Services (DHHS). The purpose of ACCESS is to compare two different service conditions in their effectiveness at helping persons with mental illness avoid homelessness and improving their clinical
outcomes, quality of life, and service use. The first condition is systems-level integration in conjunction with outreach and case management. The second is outreach and case management alone.
There are ACCESS programs in nine states: Illinois, Connecticut,
Missouri, North Carolina, Pennsylvania, Texas, Virginia, and Washington. There are two program sites in each state. In Illinois, both program sites are located in Chicago. Each Chicago site works with
100 homeless consumers per year and both sites provide outreach and case management services. However, one site has received extra monies to also work with other providers in the community in order to better
link clients to the additional services that they may need, such as long-term housing and medical care. This site is the systems integration site. Although the other site-the enhancement site-may work with other
providers, their goal is simply to provide "services as usual" to homeless consumers. Chicago Health Outreach, the systems integration site, serves homeless consumers in the Edgewater-Uptown
neighborhood. Thresholds, the enhancement site, serves homeless consumers in the Loop-Near North side neighborhood.
All ACCESS programs are managed by state mental health agencies. In
Illinois, the Office of Mental Health of the Department of Human Services oversees the project. Each ACCESS program also includes an evaluation site which is responsible for collecting all data mandated by
CMHS regarding client outcomes and service use. The UIC MHSRP serves as the evaluation site for the ACCESS Illinois program.
ACCESS has two evaluation components: a client-level evaluation and
a systems-level evaluation.
CLIENT-LEVEL EVALUATION:
The client-level evaluation consists of three interviews with homeless
consumers over a one-year period. Interviews take place at baseline (immediately after the client has been enrolled in the ACCESS program), 3 months post-baseline, and 12 months post-baseline. (An 18 month follow-up
interview is also being conducted with clients who were enrolled in the last year of the program.) Clients are asked a series of questions assessing history of homelessness, housing status, employment, income,
psychiatric symptoms, alcohol and drug use, service needs and use, victimization, social supports, and quality of life.
SYSTEMS-LEVEL EVALUATION:
The systems-level evaluation consists of a series of interviews conducted
every two years with agency representatives at each site who have been identified as key providers of services to homeless consumers. These individuals are asked about the types of services that they provide
to homeless consumers, the number and type of interactions they have with other agencies, and their assessment of the effect the ACCESS program has had on integrating services in the community. The
systems-level interviews are conducted by the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.
PRELIMINARY RESULTS:
The ACCESS Program is in its final year of data collection. Twelve
month follow-up interviews were completed in May of 1999, and 18-month follow-up interviews were completed in November of 1999. The final wave of systems-level interviews began in January 2000. Therefore, all
results are preliminary.
DEMOGRAPHIC CHARACTERISTICS OF ACCESS ILLINOIS PARTICIPANTS (N=800):
- 60% are male
- 58% are African American
- 61% have a diagnosis of schizophrenia
- Average age is 40 years
- At baseline, clients report an average of 6 episodes of homelessness and have an average lifetime duration of homelessness of 3.5 years
- Also at baseline, clients report an average of 9 lifetime hospitalizations
OUTCOMES:
Significant changes in client outcomes from baseline to 12 month
follow-up include:
- Greater number of days spent in stable housing situations
- Fewer number of days spent living on the street
- Fewer psychiatric symptoms
- Increased monthly income
- Greater quality of life
For information about national client-level results,
email Dr. Robert Rosenheck. For information about system-level results,
email Dr. Joseph Morrissey.
PRODUCTS:
- Cook, J.A., Pickett-Schenk, S., Grey, D., Banghart, M., Rosenheck, & R., Randolph (2001). Vocational Outcomes Among Formerly Homeless
Persons with Severe Mental Illness in the ACCESS Program, Psychiatric Services, 52,1075-1080.
 Pickett-Schenk, S., Cook, J.A., Grey, D., Banghart, M.,
Rosenheck, & R., Randolph (In Press). Employment Histories of Persons with Mental Illness, Community Mental Health Journal.
You can order a copy of this paper from our Publications page.
CONTACT INFORMATION:
Access Illinois Evaluation Site:
Judith Cook,
Ph.D., Evaluation Director
Susan
Pickett, Ph.D., Evaluation
Coordinator
Michael Banghart
, B.S., Research Assistant
Thresholds:
Jerry Dincin, Ph.D.,
Executive Director
Debbie Pavick, Enhancement Site Project Director
Peggy Flaherty,
Assistant Program Director
Chicago Health Outreach:
Mary Lynn Everson, M.A.,
Systems Integration Site Project Director
Deborah Kroopkin, M.S.W.
, Systems Integration Coordinator
Ed Stellon, Clinical Administrator
4750 N, Sheridan Road, Suite 500
Chicago, IL 60640
State Office of Mental Health:
Norah Heenan
, M.A.,
State Project Director
Federal Program Officers:
Frances Randolph, Ph.D.,
Director, ACCESS Program, Homeless Programs Branch Center for Mental Health Services, Rockville, MD
Walter Leginski, Ph.D.,
Chief, Homeless Programs Branch, Center for Mental Health Services, Rockville, MD
National Evaluation Team Members:
Joseph Morrissey, Ph.D.,
Director of ACCESS Network Evaluation, Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill
Robert Rosenheck, MD.,
Director, Client Level Evaluation, Northeast Program Evaluation Center, Yale University
Howard Goldman, MD., Ph.D.,
Research Director, R.O.W. Sciences, Inc.
1700 Research Blvd., Suite 400
Rockville, MD 20850
Deborah Dennis,
Director, National Resource Center on Homelessness and Mental Illness, Policy Research Associates, Inc.
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