OBJECTIVE: Networks of agencies at the 18 demonstration sites in the
Access to Community Care and Effective Services and Supports (ACCESS)
program for homeless persons with serious mental illness were surveyed to
profile baseline levels of systems performance and integration as part of a
longitudinal evaluation of systems change and client outcomes. METHODS:
Interviews were conducted with a representative from each of 875 agencies
in the 18 service networks. Information was obtained about the perceived
performance of the service system and the extent of systems integration as
measured by client referrals, funds exchanges, and information sharing
between agencies. Measures consisted of two multi-item scales assessing the
accessibility and coordination of services for the target population in
each community and four indexes of interagency relationships. RESULTS:
Services at baseline for homeless mentally ill persons at the program sites
were rated as relatively inaccessible, and the coordination of services
between agencies was rated as even more problematic. Interagency ties were
largely based on client referrals and information exchanges, with very few
instances of funding transfers in the form of contracts or grants. On
average, at baseline agencies that had received an ACCESS grant were better
connected to their local service network than were other agencies.
CONCLUSIONS: Consistent with the premise of the ACCESS demonstration,
services for persons who are homeless and mentally ill in urban America are
fragmented and not very accessible. The longitudinal design of the
evaluation will allow for an assessment of efforts to improve services and
systems integration and of the effects of these improvements on client
outcomes.
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