So Kotwicki was pleasantly surprised when one of his clients shared a more ambitious aim: “He wanted to take a class and study Shakespeare.”

Homelessness isn't synonymous with illiteracy or lack of motivation, says Kotwicki, medical director of Grady's outreach program.

“Many of these folks have substance abuse and other mental health issues, and people are always telling them what they can't do,” he says. “We really focus on the positive with them—what they can do.”

Kotwicki recently received a $250,000 grant from the United Way to fund a research study comparing the clinical and economic outcomes of two similar groups of homeless, mentally ill men and women in Atlanta.

One group will receive the same care they normally would through Grady. The other group will receive enhanced care: intensive intervention from a team of case managers, social workers, and a psychiatrist; placement in permanent housing; financial assistance and vocational training; and careful monitoring of medications.

Participants were identified through the court system, psychiatric emergency care, and jail. Gaining their trust was the first major hurdle, says Kotwicki.

“Some were so paranoid, they felt it was safer to be on the streets,” he says. “We drive around and find them and talk to them, even if they don't want to see us. We hand them a cup of coffee or a hamburger. We try to help in any way we can. It's a slow process, but some of the results have been remarkable.”

Kotwicki plans to use the findings of this study to lobby legislators on behalf of the homeless by showing that social services can be a wise investment for the state.

“We hope to demonstrate that this level of care will prevent them from going back to the streets,” he says, “and that it will end up costing the taxpayers less than expensive safety-net health services or incarceration.”—M.J.L.