Evaluation of an Integrated Cluster Care and Supportive Housing Model for Unstably Housed Persons Using the Shelter System.

Purpose: To evaluate the feasibility of an integrated cluster care and supportive housing model.

Primary Practice Setting(s): Community shelters.

Methodology And Sample: The Inner City Access Program (ICAP) is a new service delivery model employed by the Toronto Central Community Care Access Centre, which combines supportive housing services and health care for homeless, underhoused, and marginalized populations using the shelter system. We evaluated the effectiveness of the ICAP in facilitating access to health services, supporting goal-setting, and promoting interprofessional case management. Client interviews examined care goals, goal achievement, and satisfaction; staff interviews determined client-centeredness of staff-identified care goals/planning; document reviews were conducted to obtain service utilization and process data.

Results: Twenty clients received service during a 15-month period before implementation. This increased to 147 clients during a 16-month period post-implementation at a 60% reduction in cost/client. Results indicated that regular interdisciplinary team meetings promoted greater service delivery efficiency; greater client satisfaction was associated with goal achievement (p < .01); and a trend toward greater perceived goal achievement (as reported separately by clients and staff) and client satisfaction when staff- and client-stated goals were more closely aligned.

Implications For Case Management Practice: The ICAP proved an efficient and cost-effective model in engaging marginalized populations. There was a trend toward greater client satisfaction when clients perceived success related to "education, employment, activities, and programs" goals.