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. / Thesis / Master of Social Work (MSW)

Cette thèse vise à vérifier, à partir de données françaises, l’hypothèse d’Oswald selon laquelle la propriété immobilité serait un frein à la flexibilité du marché du travail et entraînerait donc un taux de chômage plus élevé. Le premier chapitre présente une synthèse de la littérature récente s’intéressant à la vérification de cette hypothèse. Le deuxième chapitre analyse l’effet du statut résidentiel sur les taux de retour à l’emploi. Les résultats empiriques montrent que les propriétaires ont plus de chance d’accéder à des emplois locaux, mais plus faible chance d’accéder à des emplois impliquant une mobilité résidentielle. Le troisième chapitre cherche à apporter un éclairage supplémentaire sur le comportement de recherche d’emploi des propriétaires selon qu'ils sont accédants ou non. Les résultats empiriques indiquent que les accédants à la propriété sortent plus vite du chômage tandis que les propriétaires détenant un stock d'actifs financiers élevé restent plus longtemps au chômage. Enfin, le quatrième chapitre propose un modèle théorique à agents hétérogènes afin d'analyser les effets du statut résidentiel et des politiques publiques sur les taux de retour à l'emploi. Nos résultats révèlent que la mobilité des propriétaires et des locataires est affectée par les coûts de mobilité et que le plus faible taux de sortie du chômage des propriétaires s’explique essentiellement par la stratégie d’accession à la propriété et par un effet de richesse. / This thesis seeks to verify, from French data, the Oswald hypothesis, according to which homeownership would be a hindrance to labor market’s flexibility and thus result in a higher unemployment rate. The first chapter presents a synthesis of recent literature seeking to verify this hypothesis. The second chapter analyzes the effect of residential status on rates return-to-employment. Empirical findings show that owners have more likely to access local jobs, but less likely to access jobs involving residential mobility. The second chapter investigates the effect of housing tenure status on unemployment duration. Empirical findings indicate that constrained owners leave faster unemployment, while owners holding a large stock of financial assets remain longer unemployed. Finally, the fourth chapter proposes a model with heterogeneous agents to analyze the effects of residential status and public policies on rates return-to-employment. Our results show that the cost of mobility affects the geographical mobility and the lowest exit rate of unemployment to owners is mainly due to the strategy of homeownership and a wealth effect.

The purpose of this study was to identify risk factors associated with homelessness, assess the relationship between housing status and consumption of costly publicly funded resources, to identify characteristics associated with service retention, and to evaluate whether length of treatment is associated with better outcomes. The target population was homeless and formerly homeless adults with SMI enrolled in community mental health services at the Downtown Emergency Service Center SAGE mental health program located in Seattle. The sample consisted of 380 SAGE patients who had continuous enrollment in 2005. These patients formed the cohort for the study. Agency records for these patients were reviewed for a 3-year period (2005-2007). The study utilized a non-experimental retrospective cohort study design. Multiple logistic regression, hierarchical multiple regression, two-way repeated measures ANOVA, and Cochran's Q test were used to analyze the data. Homelessness was associated with African American race, substance use, lower income, and younger age. Patients who were homeless spent more time in jail and required more mental health staff time compared with patients with stable housing. Patients with schizophrenia were more likely to retain services and African American patients were less likely to retain services. Overall, patients who remained enrolled in services from Year 1 to Year 3 had improved housing stability, fewer days of incarceration, and required less staff support. The overrepresentation of African Americans among patients who experienced homelessness suggests that racism could be a factor contributing to homelessness for this racial group. Further research is needed to assess the relationship between race and homelessness.