Housing First for Adults with Problematic Substance Use

Cherner, Rebecca; Aubry, Tim; Sylvestre, John; Boyd, Rob; Pettey, Donna

doi:10.1080/15504263.2017.1319586

Cited by 42 publications

(76 citation statements)

References 28 publications

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“…This finding occurred despite modest fidelity to the MISSION-Vet services in the GTO group. Among homeless individuals with co-occurring mental health and substance use in Permanent Supportive Housing, treatment engagement is an important first step in the recovery process, but individuals might need more time and longer term supports to address mental health and substance use [ 31 ]. Furthermore, others have also documented successful treatment engagement through the use of multifactorial treatment interventions like MISSION-Vet as well as the inclusion of the evidence based critical time intervention approach [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

An evidence-based co-occurring disorder intervention in VA homeless programs: outcomes from a hybrid III trial

Smelson

Chinman

Hannah

et al. 2018

BMC Health Serv Res

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BackgroundEvidence-based treatment for co-occurring disorders is needed within programs that serve homeless Veterans to assist with increasing engagement in care and to prevent future housing loss. A specialized co-occurring disorders treatment engagement intervention called Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking - Veterans Edition (MISSION-Vet) was implemented within the Housing and Urban Development - Veterans Affairs Supportive Housing (HUD-VASH) Programs with and without an implementation strategy called Getting To Outcomes (GTO). While implementation was modest for the GTO group, no one adopted MISSION in the non-GTO group. This paper reports Veteran level outcome data on treatment engagement and select behavioral health outcomes for Veterans exposed to the MISSION-Vet model compared to Veterans without access to MISSION-Vet.MethodsThis hybrid Type III trial compared 81 Veterans in the GTO group to a similar group of 87 Veterans with mental health and substance use disorders from the caseload of staff in the non-GTO group. Comparisons were made on treatment engagement, negative housing exits, drug and alcohol abuse, inpatient hospitalizations, emergency department visits and income level over time, using mixed-effect or Cox regression models.ResultsTreatment engagement, as measured by the overall number of case manager contacts with Veterans and others (e.g. family members, health providers), was significantly higher among Veterans in the GTO group (B = 2.30, p = .04). Supplemental exploratory analyses between Veterans who received “higher” and “lower” intensity MISSION-Vet services in the GTO group failed to show differences in alcohol and drug use, inpatient hospitalization and emergency department use.ConclusionsDespite modest MISSION-Vet fidelity among staff treating Veterans in the GTO group, differences were found in treatment engagement. However, this study failed to show differences in alcohol use, drug use, mental health hospitalizations and negative housing exits over time among those Veterans receiving higher intensity MISSION-Vet services versus low intensity services. This project suggests that MISSION-Vet could be used in HUD-VASH to increase engagement among Veterans struggling with homelessness, a group often disconnected from care.Trial registrationClinicaltrials.gov, registration number: NCT01430741, registered July 26, 2011.

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Section: Discussionmentioning

confidence: 99%

An evidence-based co-occurring disorder intervention in VA homeless programs: outcomes from a hybrid III trial

Smelson

Chinman

Hannah

et al. 2018

BMC Health Serv Res

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“…Substance abuse requires integrated, multidisciplinary care. Promoting stable housing through a "housing first" approach also seems to be crucial [ 43 , 44 ]. The results of this study also showed that older patients were more likely to receive DAA treatment than PEG-IFN–based regimens.…”

Section: Discussionmentioning

confidence: 99%

Evolution of patients’ socio-behavioral characteristics in the context of DAA: Results from the French ANRS CO13 HEPAVIH cohort of HIV-HCV co-infected patients

et al. 2018

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BackgroundDirect-acting antivirals (DAA) have dramatically increased HCV cure rates with minimal toxicity in HIV-HCV co-infected patients. This study aimed to compare the socio-behavioral characteristics of patients initiating pegylated-interferon (PEG-IFN)-based HCV treatment with those of patients initiating DAA-based treatment.MethodsANRS CO13 HEPAVIH is a national multicenter prospective cohort started in 2005, which enrolled 1,859 HIV-HCV co-infected patients followed up in French hospital outpatient units. Both clinical/biological and socio-behavioral data were collected during follow-up. We selected patients with socio-behavioral data available before HCV treatment initiation.ResultsA total of 580 patients were included in this analysis. Of these, 347 initiated PEG-IFN-based treatment, and 233 DAA-based treatment. There were significant differences regarding patient mean age (45 years±6 for the PEG-IFN group vs. 52 years±8 for the DAA group, p<0.001), unstable housing (21.4% vs. 11.2%, p = 0.0016), drug use (44.7% vs. 29.6%, p = 0.0003), regular or daily use of cannabis (24.3% vs. 15.6%, p = 0.0002), a history of drug injection (68.9% vs 39.0%, p<0.0001) and significant liver fibrosis (62.4% vs 72.3%, p = 0.0293). In multivariable analysis, patients initiating DAA-based treatment were older than their PEG-IFN-based treatment counterparts (aOR = 1.17; 95%CI [1.13; 1.22]). Patients receiving DAA treatment were less likely to report unstable housing (0.46 [0.24; 0.88]), cannabis use (regular or daily use:0.50 [0.28; 0.91]; non-regular use: 0.41 [0.22; 0.77]), and a history of drug injection (0.19 [0.12; 0.31]).ConclusionIt is possible that a majority of patients who had socio-economic problems and/or a history of drug injection and/or a non-advanced disease stage were already treated for HCV in the PEG-IFN era. Today, patients with unstable housing conditions are prescribed DAA less frequently than other populations. As HCV treatment is prevention, improving access to DAA remains a major clinical and public health strategy, in particular for individuals with high-risk behaviors.

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“…: unpublished data, 2020) identified 14 trials on permanent supportive housing (PSH). [30][31][32][33][34][35][36][37][38][39][40][41][42][43] Several trials across Canada and the United States showed that PSH initiatives house participants more rapidly compared with usual services (73 v. 220 d; adjusted absolute difference 146.4, 95% confidence interval [CI] 118.0 to 174.9); 30 increase the number of people who maintain stable housing at 2 years (pooled odds ratio [OR] 3.58, 95% CI 2.36 to 5.43); 30,40 and significantly increase the percentage of days spent stably housed. 41 No trials showed a sig nificant improvement in mental health symptoms compared with standard care.…”

Section: Evidence Summarymentioning

confidence: 99%

“…30,31,33,34,41,42 Two studies found that the mental health of PSH participants did not improve as much as that of usual care par ticipants (e.g., mean difference -0.49, 95% CI -0.85 to -0.12). 30,31 The At Home/Chez Soi trial showed small improvements in quality of life for high-needs (adjusted standardized mean difference 0.15, 95% CI 0.04 to 0.24) 30 and moderate-needs (mean difference 4.37, 95% CI 1.60 to 7.14) homeless participants in patients receiving PSH. 41 Youth receiving PSH saw larger improvements in their quality of life during the first 6 months (mean difference 9.30, 95% CI 1.35 to 17.24), which diminished over time (mean difference 7.29, 95% CI -1.61 to 16.18).…”

Section: Evidence Summarymentioning

confidence: 99%

Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience

Pottie

Kendall²,

Aubry³

et al. 2020

CMAJ

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H omeless and vulnerably housed populations are heterogeneous 1 and continue to grow in numbers in urban and rural settings as forces of urbanization collide with gentrification and austerity policies. 2 Collectively, they face dangerous living conditions and marginalization within health care systems. 3 However, providers can improve the health of people who are homeless or vulnerably housed, most powerfully by following evidence-based initial steps, and working with communities and adopting anti-oppressive practices. 1,4,5 Broadly speaking, "homelessness" encompasses all individuals without stable, permanent and acceptable housing, or lacking the immediate prospect, means and ability of acquiring it. 6 Under such conditions, individuals and families face intersecting social, mental and physical health risks that significantly increase morbidity and mortality. 7,8 For example, people who are homeless and vulnerably housed experience a significantly higher prevalence of trauma, mental health conditions and substance use disorders than the general population. 7,9 Canadian research reports that people who experience homelessness face life expectancies as low as 42 years for men and 52 years for women. 7 A generation ago, homeless Canadians were largely middleaged, single men in large urban settings. 10 Today, the epidemiology has shifted to include higher proportions of women, youth, Indigenous people (Box 1), immigrants, older adults and people from rural communities. 13,14 For example, family homelessness (and therefore homelessness among dependent children and youth) is a substantial, yet hidden, part of the crisis. 15 In 2014, of the estimated 235 000 homeless people in Canada, 27.3% were women, 18.7% were youth, 6% were recent immigrants or migrants, and a growing number were veterans and seniors. 10

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Housing First for Adults with Problematic Substance Use

Abstract: Adults who are homeless with problematic substance use can successfully be housed using a Housing First approach. However, further targeted services might be required to address other areas of functioning, such as health, substance use, and quality of life.

Cited by 42 publications

References 28 publications

An evidence-based co-occurring disorder intervention in VA homeless programs: outcomes from a hybrid III trial

An evidence-based co-occurring disorder intervention in VA homeless programs: outcomes from a hybrid III trial

Evolution of patients’ socio-behavioral characteristics in the context of DAA: Results from the French ANRS CO13 HEPAVIH cohort of HIV-HCV co-infected patients

Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience

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