Emory Report
December 5, 2005
Volume 58, Number 13


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December 5 , 2005
Grant funds mental-health service study for homeless

By Alicia Sands Lurry

Raymond Kotwicki, assistant professor of psychiatry and behavioral sciences in the School of Medicine, has received a $250,000 from the United Way to reach out to metro Atlanta’s homeless population. The grant will fund Kotwicki’s Education and Community Services Engagement Linkage (ECSEL) research study, which began last month.

The study will compare two similar groups of patients, one experimental and one control. Half the participants will receive the same care they are currently getting through Grady Hospital, but individuals in the experimental group will receive enhanced levels of case management and services.

“The overall goal of this project is to combine intensive case management, education and coordination of services for individuals with serious mental illnesses who frequently use costly safety-net services. We hope to demonstrate that enhanced, coordinated care will prevent them from going back to the streets,” said Kotwicki, principal investigator of the study and medical director of the Community Outreach Services Program at Grady. “This grant is an effort to provide competent, timely and appropriate mental health services to people who face multiple significant legal, housing and treatment challenges in the Atlanta area.”

ECSEL is based on a 2000 demonstration project in Harris County, Texas, in which there was some success, but several outcome data—including economic and some clinical variables—were not measured.

Patients participating in the study will be identified through the court system, the psychiatric emergency care system or jails. A total of 30 individuals will be randomized into the control group and will receive normal care through Grady’s Behavioral Health Services. They will have access to a primary social worker to coordinate mental health services, as well as case management and nursing services.

Another 30 individuals will be randomly assigned to the ECSEL program team. They will receive intensive clinical team intervention from case managers, social workers and a psychiatrist, as well as placement in permanent housing, financial management and assistance, resource assistance and support, vocational training and education, supportive counseling, psychiatric evaluation, and medication administration and monitoring.

“The individuals receiving care through ECSEL are some of the leading users of expensive tertiary care such as psychiatric emergency services, hospitals and jails,” Kotwicki said. “We hypothesize that the life-support and case-management services provided to homeless individuals will cost taxpayers less than safety net health services and jail.”

Kotwicki plans to publish the data from ECSEL once the project is completed and hopes mental health advocates will find his study helpful in their continuing efforts to improve mental health services in Georgia and the United States.

Pending continued funding, participating individuals will continue receiving services following the study’s conclusion, either less acute services (if they show improvement) or services similar to those provided through ECSEL.