Improving Outcomes for Unemployed and Homeless Young People: Findings of the YP⁴ Clinical Controlled Trial of Joined Up Case Management

Are we failing young people not in employment, education or training (NEETs)? A systematic review and meta-analysis of re-engagement interventions

“…Free of serious behavioural and medical problems. 60% males>70% members of racial or ethnic minoritygroups 16–2415, 406 randomised.11,313 analysed.Employment statusEarnings 16 Schochet, Burghardt, & Glazerman [44]2001ExpJob CorpsEducationalVocationalCounsellingPlacements8 months residentialOther services; not Job Corps.As trial 1515, 406 randomised.11,313 analysed.Employment statusEarningsReceipt of welfareReceipt of educationHealth statusCriminal activity 17 Tanner, Purdon, D’Souza, & Finch [32]2009QuasiActivity Agreement pilotsOne-to-one supportIndividually tailored contractFinancial incentives15 weeksStandard service delivery; matched from non-participating areas.England58% males16–17NEET for >20 weeksNot receiving JSA.1018 analysed at F1, 229 analysed at F2.Education and employmentConfidence and independence 18 Grace & Gill [45]2014QuasiYP 4 Case management23 meetings, 2 yearsStandard service deliveryAustralianHomeless (or history of homelessness/disadvantage) Job seekers18–35422 assigned, 370 analysed.EarningsWelfare receiptHousing …”

"Housing First" for Homeless Youth With Mental Illness

“…Although including youth aged 16 to 17 years would have more accurately reflected existing services for homeless youth, differences in legal status for tenancy and, in some jurisdictions, informed consent make "Housing First" more complicated to study and implement in youth <18 years. These findings may not be generalizable to young people 7 CIS, Community Integration Scale psychological integration subscale with possible scores ranging from 4 to 20 (higher scores indicate higher level of integration); CSI, Colorado Symptom Index, a measure of psychiatric symptomatology with possible scores ranging from 5 to 70 (higher scores indicate more severe mental health symptoms); ED, emergency department; EQ-5D, EuroQoL5 Dimensions Visual Analog Scale, a measure of generic quality of life scored from 0 (worst imaginable health state) to 100 (best imaginable health state); GAIN-SPS, Global Assessment of Individual Needs Short Screener-Substance Problem Scale, a measure of substance use problems over the previous month, with possible scores ranging from 0 to 5 (higher scores indicate more symptoms of substance misuse); MCAS, Multnomah Community Ability Scale, a measure of community functioning with possible scores range from 17 to 85 (higher scores indicate a higher level of community functioning); QOLI-20, a measure of condition-specifi c quality of life with total possible scores ranging from 20 to 140 and subscale scores ranging as follows: family (4-28), fi nances (2-14), leisure (5-35), living situation (1-7), safety (4-28), social (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), and overall quality of life (1-7), with higher scores indicating higher quality of life; RAS, Recovery Assessment Scale, a measure refl ecting various components of recovery with possible scores ranging from 22 to 110 (higher scores indicate higher degree of recovery); SF-12, Short Form 12 survey, a measure of physical and mental health status assessed by the physical component summary and mental health component summary, both of which range from 0 to 100 (higher scores indicate better health status). a Models included treatment group (reference: treatment as usual), time (month of visit; reference: baseline), study city (reference: Winnipeg), Aboriginal and ethnoracial status (reference: non-Aboriginal/non-ethnoracial), and treatment × time interaction.…”

“…Case management, a strategy used widely with homeless youth, has demonstrated improvements in housing stability over time, but did not separate from other active treatments 5 or treatment as usual. 6 The Community Reinforcement Approach, an operant-based behavior therapy tested in 2 randomized controlled trials in homeless youth, was associated with a reduction of days homeless 5 and increased social stability (a measure which included housing), 7 but with only the latter trial demonstrating improvement relative to a comparison group, it is not clear that any empirically tested interventions have impacted youth's housing stability beyond general support and the passage of time.…”

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

“…Intensive case management reduced the number of days homeless (pooled standardized mean difference -0.22, 95% CI -0.40 to -0.03), but not the number of days spent in stable housing. 78,80,89 In most studies, there was no major improvement in psychological symptoms between the treatment and control groups. However, 1 trial reported significantly greater reductions in anxiety, depression and thought disturbances after 24 months (mean difference change from baseline -0.32, p = 0.007), as well as improved life satisfaction (mean difference 1.23, p = 0.001) using intensive case management.…”