The Effect of Focused Client Education on Case Management & Readmission Rates in Homeless Individuals with Co-occurring Disorders Admitted to a Jail Diversion Program

Background: Individuals with both mental illness(es) (MI) and substance use disorder (SUD) occurring simultaneously are known as having co-occurring disorders (COD). The rates of COD found among homeless individuals (H-COD) are higher than in the general population. The presence of both conditions prevents H-COD individuals from overcoming their hardships and places them at a higher risk of being involved in the criminal justice system.

Local Problem: Jail diversion programs (JDPs) admit a high rate of H-COD clients nationally and locally at the project site in Knoxville (JDP-K). The Office on Homelessness reported about 80% of those admitted to JDP-K are homeless and 79% have MI. A needs assessment of JDP-K revealed the case management (CM) acceptance rate (CMAR) and the readmission rates (RR) of H-COD clients could be improved. The purpose of the project was to improve these two outcomes.

Methods: The Model for Improvement guided this quality improvement process. The two outcomes were evaluated during the baseline and intervention periods to assess the impact of the intervention, focused client education (FCE), which was developed using the Plan-Do-Study-Act cycle.

Interventions: FCE was delivered by a nurse (a familiar face) at an opportune time when clients were more sober and receptive to engagement. FCE contained a standardized presentation of the services offered by CM, educational material specific to each client’s MI and/or SUD, and a wallet-sized laminated card with relevant information on resources available in the community.

Results: Post-intervention period, the CMAR for H-COD clients increased significantly (p=0.03) by 14.5%, and the RR decreased significantly (p=0.02) by 13.2% compared to the baseline period.

Conclusions: When presented by a nurse, FCE improved the CMAR and RR at JDP-K. This translates to 24 fewer H-COD clients per year revolving through JDP-K, increasing the odds of improving these clients’ social and health outcomes. Continued FCE training is necessary for sustainability.