Homeless Drug Abusers: Service Use, Needs, and
Cost of Drug Abusing Homeless (SUNCODA)

Principal Investigators: Carol North, M.D., M.P.E., David Pollio, Ph.D.
Funder:           National Institute on Drug Abuse (NIDA) (1R01DA10713)
Timeframe:      06/01/98-05/31/03
Affiliation:      Comorbidity and Addictions Center (CAC)
                         Center for Mental Health Services Research (CMHSR)

                           

Project Staff:   David E. Pollio, Ph.D., Co-PI.
                         Mark Schnitzer, Ph.D., Co-PI
                         Enola Proctor, Ph.D., Co-PI
                         Linda Cottler, Ph.D., Investigator
                         Ed Spitznagel, Ph.D., Statistician
                         Brian McKean, Project Coordinator
Participating Organizations:

• Missouri Department of Mental Health
• St. Louis City Department of Human Services
• Medical Directors
• St. Louis State Acute and Chronic Psychiatric inpatient facilities
• The Veterans Administration
• Barnes-Jewish Hospital/BJC Health System
• Black Alcohol Drug Service Information Center (BASIC)
• Christian Service Center
• Grace Hill Neighborhood Health Center
• Places For People
• United Methodist Metro Ministry Shalom House
• YWCA Phylis Weatley Transitional Housing Program

Project Contact:  Carol North, M.D., M.P.E.
                             Washington University Department of Psychiatry
                             (314) 747-2013
                             northc@psychiatry.wustl.edu

Project Update as of  03/07/2008:
Stage:  Implementation concluded. Data analysis continuing.
Forthcoming, In Press, or Published Papers:

Pollio, D.E., Spitznagel, E.L., North, C.S., Thompson, S., & Foster, D.A. (2000).  Service use over time and achieving stable housing in a mentally ill homeless population.  Psychiatric Services, 51(12), 1536-1543.

North, C.S., Pollio, D.E., Smith, E.M., & Spitznagel, E.L. (1998).  Predictors of age of onset and length of homelessness in a large urban homeless population.  Journal of Nervous and Mental Disease, 186(7), 393-400.

North, C.S., Pollio, D.E., Thompson, S., Smith, E.M. &  Spitznagel, E.L. (1998).  The association of psychiatric diagnosis with weather conditions in a large urban homeless sample.  Social Psychiatry and Psychiatric Epidemiology, 33(5), 206-211.

North, C.S., Pollio, D.E., Thompson, S., Smith, E.M., Ricci, D.A., & Spitznagel, E.L. (1997). A comparison of clinical and structured interviews in a homeless mental health clinic. Community Mental Health Journal, 33(6), 531-543.

North, C.S., Thompson, S., Pollio, D.E., Smith, E.M., Ricci, D.A., & Spitznagel, E.L. (1997).  A comparison of homeless and nonhomeless attenders of an urban mental health clinic. Social Psychiatry and Epidemiology, 32, 236-240.

Pollio, D.E., North, C.S., Thompson, S., Paquin, J.W, & Spitznagel, E.L. (1997). Predictors of achieving stable housing in a mentally ill homeless population. Psychiatric Services, 48(4), 258-260.

North, C.S., Smith, E.M., Pollio, D.E., & Spitznagel, E.L. (1996).  Are the mentally ill a distinct homeless subgroup? Annals of Clinical Psychiatry, 8(3), 117-128.

Description:
The SUNCODA Research Project tested a theoretical model that predicted relationships between service use, needs, costs, and consequences for the drug-abusing homeless population. The project studied 400 adult men and women over two years to identify predictors of service use and status changes in the drug-abusing homeless population.

The opportunity to follow a non-drug-abusing homeless comparison group provided evidence about the impact of drug use disorders on homelessness, in terms of relationships between service utilization patterns and status change consequences.  SUNCODA obtained organizational, financing, and management structure data from agencies in St. Louis serving this population to investigate how structural characteristics of services predict actual service use by drug-abusing compared to non-drug-abusing homeless individuals.

Finally, this project compared costs associated with treatment of drug-abusing and non-drug-abusing subjects. The sample was randomly selected from a variety of public settings including overnight shelters and day centers for homeless persons, as well as from street locations.  All subjects were interviewed at baseline and at one-year intervals with an instrument adapted for this study collecting diagnostic, personal history, sociodemographic, and status change data, modified for each wave.  All subjects were asked to provide access to their medical, psychiatric, and substance abuse records so that agencies could provide information of the type and extent of service use over time.   In addition, all subjects participated in quarterly reports to detail changes in functioning and service use.  Exhaustive tracking methods were utilized to maximize subject retention.