Adopting Best Practices: Lessons Learned in the Collaborative Initiative to Help End Chronic Homelessness (CICH)

Abstract

The Collaborative Initiative to Help End Chronic Homelessness (CICH) was established to provide housing and supportive services for individuals experiencing chronic homelessness. As part of this initiative, 11 projects across the country received funding to apply models of best practices to support their clients in housing. This paper reports on the experiences of the CICH projects in their use of Assertive Community Treatment (ACT) and Motivational Interviewing (MI), clinical practice models commonly used by CICH projects. A qualitative analysis identified five areas of challenge for the projects: (1) Incomplete and underdeveloped staff teams; (2) Incomplete understanding of the practice models; (3) Using the elements of the practice models; (4) Interagency teaming; and (5) Competing expectations of multiple federal agencies. The paper describes the specific challenges in each of the five areas as well as training approaches and gaps in training and the perceived benefits of the practice models as reported by project staff.

Factors related to rapidity of housing placement in Housing and Urban Development-Department of Veterans Affairs Supportive Housing program of 1990s

“…Supported housing programs have different methods of providing clients with various services that may affect how fast clients enter community housing. Some programs have partnerships with housing providers that keep apartments available for clients [1], other programs own or hold the lease to apartments that they then rent to clients [2][3], while others provide rental subsidies and case management assistance to help clients obtain community housing [4][5]. One of the largest supported housing programs in the United States is the Housing and Urban DevelopmentDepartment of Veterans Affairs Supportive Housing (HUD-VASH) program, which serves chronically homeless veterans with disabilities.…”

Services and Supports for Individuals with Co-occurring Disorders and Long-Term Homelessness

“…Very recently, several studies have been published that have examined Assertive Community Treatment (ACT) as a mechanism for delivering integrated care to persons experiencing homelessness and COD. [24][25][26] In one or more of these studies, ACT was associated with increased housing stability, increased client satisfaction, and high quality relationships with ACT team members (note: a detailed analysis of the application of ACT in the CICH is found in McGraw et al 27 ). The CICH was intended to incorporate promising practices such as ACT and was also built on lessons learned from three previous SAMHSA collaborations that addressed homelessness and mental health/substance use issues: the Collaborative Demonstration Program on Homelessness, the Collaborative Program on Homelessness Prevention, and the Collaborative Program on Homeless Families.…”

“…27 Some team members described motivational techniques as appropriate for their clients in early recovery. They also used motivational techniques with relapsing clients to build their awareness of relapse patterns while encouraging a belief in their ability to change.…”

“…Projects also reported that some staff lacked an understanding and commitment to the client-centered approach that is central to MI. 27 …”

“…However, the teams commonly lacked key elements of ACT teams due to budgetary constraints, difficulty in hiring and retaining staff, and limited availability of some specialists such as psychiatrists and COD experts. 27 Site staff noted that for clients with COD, referring them to treatment by traditional providers was not often feasible because expertise in integrated treatment was either non-existent or nascent in their communities. Therefore, most teams attempted to provide as comprehensive a service array as possible within their teams.…”