Effectiveness of Case Management for Homeless Persons: A Systematic Review

Abstract

We reviewed the literature on standard case management (SCM), intensive case management (ICM), assertive community treatment (ACT), and critical time intervention (CTI) for homeless adults. We searched databases for peer-reviewed English articles published from 1985 to 2011 and found 21 randomized controlled trials or quasi-experimental studies comparing case management to other services. We found little evidence for the effectiveness of ICM. SCM improved housing stability, reduced substance use, and removed employment barriers for substance users. ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons. CTI showed promise for housing, psychopathology, and substance use and was cost-effective for mentally ill persons. More research is needed on how case management can most effectively support rapid-rehousing approaches to homelessness.

Comparison of Homeless and Non-Homeless Problem Drug Users Recruited from Primary Care Safety-Net Clinics

“…Felony and gross misdemeanors are serious crimes and can include controlled substance charges, robbery, theft, burglary and the like. As such, our result is in contrast with the view of homeless individuals as typically being arrested for relatively minor transgressions such as panhandling, public intoxication, and squatting rather than for more serious crimes (e.g., de Vet et al, 2013). It is possible that the higher likelihood of arrest for serious offences among homeless participants in the present sample may be related to their pattern of drug use, i.e., greater use of stimulants such as cocaine and amphetamines relative to their non-homeless counterparts, and/or a reflection of their attempts to meet their survival needs (Fischer, Shinn, Shrout, & Tsemberis, 2008).…”

Income generation and attitudes towards addiction treatment among people who use illicit drugs in a Canadian setting

“…Socioeconomically vulnerable PWUD often struggle to maintain social integration (De Vet et al 2013) and, as such, may not be effectively supported to seek treatment without the aid of targeted interventions. Our results suggest that the complex health care needs of socioeconomically marginalized PWUD may not be adequately met in this context and that further development of innovative and flexible substance abuse programming that is tailored to meet the needs of unstably housed PWUD is required, potentially through integrated service provision models that incorporate both housing and addiction treatment support.…”

Using mHealth to Increase Treatment Utilization Among Recently Incarcerated Homeless Adults (Link2Care): Protocol for a Randomized Controlled Trial (Preprint)

“…[23,58] Case managers assist homeless adults with: 1) developing care and housing plans; 2) making and maintaining linkages to onand off-site service providers (e.g., mental health and substance abuse treatment providers); 3) obtaining vital documents needed for housing and income (e.g., birth certificates, state identification, social security cards); 4) job readiness training and placement (if appropriate); 5) overcoming barriers related to criminal history; 6) development of and re-connection with support systems; and 7) transitioning from homelessness to appropriate housing. Case managers also advocate on behalf of homeless adults by serving as a connection between all agencies that will be assisting the guest, their families, and any other involved parties.…”

“…In addition, case managers engage in client assessment, practical support, service planning, advocacy, and monitoring of service utilization and progress. [17,22,23] More intensive case management services (often employed with homeless adults) include a multidimensional approach with integrated counseling, independent living skills building, assertive outreach, and crisis intervention. [24] Case management has been shown to be effective in improving housing stability, mental health, quality of life, and social functioning; while reducing substance use, hospitalization stays, and incarceration in at-risk populations [15,[25][26][27] including homeless and recently incarcerated adult populations (see meta-analysis [23]).…”