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Co-Occurring Disorders and Homelessness

Using Data: Co-Occurring and Homelessness

Collecting accurate data on the number and characteristics of individuals with co-occurring mental and substance use disorders who are experiencing homelessness is an essential part of program planning and service delivery. Outcomes data also helps to determine and demonstrate the effectiveness of programs or what's working and what's not. Programs use data to:

  • Determine services
  • Set goals and measurable objectives
  • Prioritize activities
  • Measure progress

Practitioners who work with people who have co-occurring disorders and are homeless agree on the need to measure positive changes in both the consumer and in the service system. Generally, this means collecting and analyzing data on two levels:

  • Systems level. These data can be used as baseline measures of capacity and also to guide and verify quality improvement efforts by systems and agencies.
  • Consumer level. For co-occurring disorders, several domains of outcome are important to assess the health of the whole person.

System-Level Data and Outcomes

At the system-level, most programs that serve people with co-occurring disorders who are homeless will measure access to services, quality of care, and cost-effectiveness. Other system-level outcomes for programs that provide health care services to people who are homeless may include availability of comprehensive services, continuity of care, prevention activities, and degree of consumer involvement.

Consumer-Level Data and Outcomes

Ultimately, the goal of co-occurring disorder services is to improve outcomes for the individuals being served. For people with co-occurring disorders who are homeless, this means improvements in mental symptoms, substance use, housing status, and quality of life.

There are numerous benefits for collecting and sharing consumer-level data. Collecting consumer-level information can:

  • Streamline services
  • Coordinate case management
  • Reduce duplication of effort
  • Improve access to services
  • Inform public policy

Sharing client-level data facilitates a comprehensive rather than piecemeal understanding of the care that each individual needs. It allows practitioners in different systems to communicate and collaborate to provide the full range of care. It enables policy makers to make decisions on resource allocation based on an overall understanding of co-occurring disorders prevalence, service utilization, and program performance.

Federal Information Management Systems

Department of Housing and Urban Development (HUD)-funded homeless service providers can track the effectiveness of co-occurring disorders services in homeless programs in their Homeless Information Management Systems (HMIS). The Department of Health and Human Services (HHS) and the Veteran's Administration (VA) are also starting to use HMIS as a standardized data collection and reporting tool for the homeless programs administered by these agencies. SAMHSA-funded providers can also collect and report performance data through the Government Performance and Results Act (GPRA)/National Outcome Measure tool. In either of these systems, the effectiveness of co-occurring disorder services can be measured by looking at consumer-level outcomes such as:

  • Mental health functioning
  • Substance use
  • Housing status
  • Permanent housing retention
  • Quality of life

Agencies need to ensure that data collection and sharing of data is done in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). To be compliant with HIPAA, any sharing of health information must be done with the client consent, and individuals must be informed of what information is being shared and why.


Resources and Links

  • A brief, practical guide to conducting a five-step assessment to identify the needs, strengths, gaps, and resources of the community. Data gathered during the assessment can identify priorities, guide intervention planning and implementation, and help build consensus among stakeholders.

  • Download the Annual Homeless Assessment Report and AHAR local reports, access information on using HMIS to help identify individuals who are chronically homeless, tap into resources on increasing HMIS participation among Projects for Assistance in Transition from Homelessness (PATH) providers, and learn how to interpret and use AHAR data locally.

  • This report presents results pertaining to mental health from the 2009 National Survey on Drug Use and Health. It includes information specific to the co-occurrence of mental illness and substance use. Although unsheltered homeless people are not included in the survey, findings do include those who are staying in homeless shelters.

  • This site includes links to significant research conducted on homelessness over the past decade. Examples of studies include the characteristics and needs of families and children; risk factors and determinants for homelessness; and characteristics of homeless and impoverished people in substance abuse treatment.

  • Public data access and online analysis for important substance abuse and mental health data collections. The project offers variable-level searching, an archive of survey instruments, related literature for data collections, a listserv, disclosure analysis, and traditional data products.