Raymond J. Kotwicki, MD, assistant professor in the Department of Psychiatry and Behavioral Sciences at the Emory University 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 the Education and Community Services Engagement Linkage (ECSEL) research study, which began last month.
The ECSEL study will compare two similar groups of patients who are randomized into either a 'usual care' group or the experimental group. Half the participants will receive the same care they are currently getting through Grady, 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," says Dr. Kotwicki, principal investigator of the study and medical director of the Community Outreach Services Program at Grady Memorial Hospital. "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."
The model for the ECSEL program is based on a 2000 demonstration project in Harris County, Texas, in which there was some success, but several outcome data including economic variables 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 'usual care' group who will receive care as it is currently provided through Grady Health System'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 the ECSEL program are some of the leading users of expensive tertiary care such as psychiatric emergency services, hospitals, and jails," explains Dr. Kotwicki. "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."
Dr. Kotwicki plans to publish the data from the study once the project is completed. He hopes that 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, the individuals who are part of the program will continue receiving services, either less acute services if they are better or services similar to those to be provided through ECSEL.