Specialized assertive community treatment intervention for homeless youth with first episode psychosis and substance use disorder: A 2-year follow-up study

Early Interv Psychiatry. 2020 Apr;14(2):203-210. doi: 10.1111/eip.12846. Epub 2019 Jul 5.


Aim: No previous study has investigated interventions for homeless youth suffering from first episode psychosis and comorbid substance use disorder (HYPS). An intensive assertive community intervention team (IACIT) offering outreach interventions, housing support as well as integrated care for early psychosis and substance use disorder (SUD) was created in 2012 at the Centre Hospitalier de l'Université de Montréal (CHUM). To explore the impact of the addition of an IACIT to an early intervention for psychosis service (EIS) on housing stability, functional and symptomatic outcomes and mental health service use.

Methods: A two-year longitudinal study comparing the outcome of HYPS receiving combined EIS and IACIT since 2012, to a historical cohort of HYPS receiving EIS only between 2005 and 2011. Socio-demographic data, housing stability, functioning, illness severity, SUD severity, emergency room visits and hospitalizations were assessed at admission, at 1 month, and every 3 months thereafter.

Results: HYPS receiving EIS + IACIT achieved housing stability more rapidly and spent less time hospitalized than HYPS getting EIS only (RR 2.38, P = .017). HYPS with cocaine misuse were less likely to attain housing stability (RR 0.25, P = .04). No between-group differences were found for psychiatric symptoms, functioning and SUD outcomes.

Conclusion: The addition of IACIT-HYPS to EIS was associated with earlier housing stability and reduced total hospitalization days compared to EIS alone.

Keywords: assertive community treatment; early intervention; first episode psychosis; homelessness; substance use disorder.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Community Mental Health Services / methods*
  • Comorbidity
  • Early Medical Intervention / methods
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Homeless Youth / psychology*
  • Hospitalization / statistics & numerical data
  • Housing / statistics & numerical data
  • Humans
  • Longitudinal Studies
  • Male
  • Patient Acceptance of Health Care / statistics & numerical data
  • Psychotic Disorders / epidemiology*
  • Psychotic Disorders / therapy*
  • Severity of Illness Index
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / therapy*
  • Treatment Outcome
  • Young Adult