A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness

Abstract

Background: Homelessness has emerged as a public health priority, with growing numbers of vulnerable populations despite advances in social welfare. In February 2020, the United Nations passed a historic resolution, identifying the need to adopt social-protection systems and ensure access to safe and affordable housing for all.The establishment of housing stability is a critical outcome that intersects with other social inequities. Prior research has shown that in comparison to the general population, people experiencing homelessness have higher rates of infectious diseases, chronic illnesses, and mental-health disorders, along with disproportionately poorer outcomes. Hence, there is an urgent need to identify effective interventions to improve the lives of people living with homelessness.Objectives: The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness.Search Methods: In consultation with an information scientist, we searched nine bibliographic databases, including Medline, EMBASE, and Cochrane CENTRAL, from database inception to February 10, 2020 using keywords and MeSH terms. We conducted a focused grey literature search and consulted experts for additional studies.Selection Criteria: Teams of two reviewers independently screened studies against our inclusion criteria. We included randomised control trials (RCTs) and quasi-experimental studies conducted among populations experiencing homelessness in high-income countries. Eligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid

Nurse‐led mental and physical healthcare for the homeless community: A qualitative evaluation

“…Assertive community treatment approaches are characterised by multi‐disciplinary working and low caseloads offering community‐based, intensive support (Coldwell & Bender, 2007 ). Evidence has supported this approach for homeless individuals because of improved housing stability, mental health and psychiatric outcomes (Moledina et al., 2021 ). Advances in nurse‐led homeless healthcare must therefore adopt structures that support professionals with diverse roles and responsibilities, and facilitate intensive and multi‐agency support to clients (Parsell et al., 2020 ).…”

PROTOCOL: The effectiveness of abstinence‐based and harm reduction‐based interventions in reducing problematic substance use in adults who are experiencing severe and multiple disadvantage homelessness: A systematic review and meta‐analysis

“…The second relevant review is that by Aliza Moledina and colleagues, published in June 2021 (Moledina et al, 2021). This…”

“…The second relevant review is that by Aliza Moledina and colleagues, published in June 2021 (Moledina et al, 2021). This review examined a range of different interventions aimed at people experiencing homelessness, including housing, income assistance, case management, mental ill health, and problematic substance use interventions.…”

Substance use and posttraumatic stress disorder: 12‐month outcomes among adults experiencing chronic homelessness in Australia

“…Permanent supportive housing interventions, such as Housing First, provide rapid access to non‐abstinence‐based housing and coordinated case management, health, mental health and other support services [ 6 , 7 ]. Two recent meta‐analyses found that permanent supportive housing increases housing stability but has no measurable effect on psychiatric symptom severity or substance use compared with usual services [ 6 , 8 ]. These studies informed the development of a Canadian clinical guideline for people who are vulnerably housed or with experience of homelessness aimed at preventing homelessness and improving health, mental health and social outcomes [ 9 ].…”

“…Specialist homelessness services typically provide case managed support, crisis and transitional accommodation, time‐limited supportive housing and advocacy to enter housing [ 21 ]. In standard case management, the average worker‐to‐client ratio is 1:35 [ 8 ].…”