Integrated Treatment for Persons with Concurrent Disorders
Bibliographic record
Abstract
Objective: Residential outcomes of adults with severe and persistent mental illness (SPMI) and substance use disorders were studied over 18-months, during which participants received integrated concurrent disorders services from two models of community-based intensive case management programs. Of primary interest in this analysis were the risks associated with co-occurring addictions on housing quality and stability, and the relative effectiveness of assertive community treatment (ACT) and intensive case management (ICM) on housing outcomes. Methods: Data for this secondary analysis was drawn from one of six projects organized under the Community Mental Health Evaluation Initiative. Clients who were diagnosed as having SPMI with and without co-morbid substance dependence (N=80) were randomly assigned to two case management programs in Toronto, Canada. All clients with concurrent disorders received integrated mental health and substance abuse treatment, but half were provided more fully integrated services from ACT. Housing was classified in one of three categories to describe the quality and consistency of residential tenure: stable housing, unstable accommodation defined by number of address changes, or homeless. Results: Participants with concurrent disorders were much more likely to be homeless or living in unstable, substandard housing than subjects without substance dependence. ICM clients with co-morbid disorders showed greater improvement on housing outcomes, but both case management groups showed strong gains on subjective measures of community adjustment, including empowerment, social support, and symptom distress. Housing stability was mediated by intensity of service contacts. Conclusion: Integrated treatment is a recent innovation in service delivery for persons with concurrent disorders. The favourable outcomes found for ICM in this study raise questions about the relative effectiveness of different implementation strategies to achieve integrated treatment within individual case management programs. The results provide strong support for the hypothesis that service intensity is a critical component promoting community tenure for this at-risk population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".