UMMS Affiliation

Department of Psychiatry; Implementation Science and Practice Advances Research Center

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Behavioral Medicine | Health Policy | Health Services Administration | Health Services Research | Mental and Social Health | Military and Veterans Studies | Psychiatry and Psychology | Substance Abuse and Addiction


BACKGROUND: The behavioral model of health service use identified health needs, service preferences (predispositions), and service availability (enabling factors) as important predictors, but research has not conceptualized consistently each type of influence nor identified their separate effects on use of substance abuse and mental health services or their value in predicting service outcomes.

OBJECTIVES: To test hypotheses predicting use of substance abuse and mental health services and residential stability and evaluate peer specialists' impact.

RESEARCH DESIGN: Randomized trial of peer support added to standard case management in VA-supported housing program (Housing and Urban Development-VA Supportive Housing program).

SUBJECTS: One hundred sixty-six dually diagnosed Veterans in Housing and Urban Development-VA Supportive Housing program in 2 cities.

MEASURES: Average VA service episodes for substance abuse and mental illness; residential instability; preferences for alcohol, drug, and psychological services; extent of alcohol, drug, and psychological problems; availability of a peer specialist.

RESULTS: Self-assessed health needs, mediated by service preferences, and assignment to a peer specialist predicted use of VA behavioral health services and residential stability, as did chronic medical problems, sex, and race.

CONCLUSIONS: The behavioral model identifies major predictors of health service use and residential stability, but must recognize the mediating role of service preferences, the differing effects of alcohol and drug use, the unique influences of social background, and the importance of clinical judgment in needs assessment. Service availability and residential stability can be increased by proactive efforts involving peer specialists even in a health care system that provides services without a financial barrier.


health services, peer support, supported housing, substance abuse, mental illness

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Copyright © 2021 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Go to:

DOI of Published Version



Schutt RK, Schultz M, Mitchell-Miland C, McCarthy S, Chinman M, Ellison M. Explaining Service Use and Residential Stability in Supported Housing: Problems, Preferences, Peers. Med Care. 2021 Apr 1;59(Suppl 2):S117-S123. doi: 10.1097/MLR.0000000000001498. PMID: 33710083; PMCID: PMC8132893. Link to article on publisher's site

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Medical care

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Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.