Outcomes of Homeless Adults With Mental Illness in a Housing Program and in Case Management Only

Clark, Colleen; Rich, Alexander R.

doi:10.1176/appi.ps.54.1.78

Cited by 87 publications

(80 citation statements)

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“…Drake et al (1997) observed modest, yet significant, decreases in alcohol and drug use after 18 months of follow-up among participants who were placed in housing. 18 In their study of homeless veterans with substance use and/or psychiatric disorders, Clark and Rich (2003) found decreased substance use over a 12-month period, but no differences in level of improvement were found when comparing a comprehensive supportive housing program that included case management to case management alone. 16 In contrast to the previous literature, we observed no significant differences in health status, substance use, health care utilization, or residential stability between the two groups over time resulting from our supportive housing program.…”

Section: Discussionmentioning

confidence: 99%

“…Prior research involving homeless and vulnerably housed adults have shown improvements in residential stability and decreases in health care utilization resulting [16][17][18] The effects of supportive housing on substance use are less clear. Drake et al (1997) observed modest, yet significant, decreases in alcohol and drug use after 18 months of follow-up among participants who were placed in housing.…”

Section: Discussionmentioning

confidence: 99%

“…Previous longitudinal research demonstrates that supportive housing can lead to long-term residential stability, improved quality of life, and a reduction in the frequency and length of hospitalizations and length of time in jail. [14][15][16][17][18] However, it is less clear whether the provision of supportive housing has a positive impact on physical health status or whether supportive housing can significantly reduce mental health symptoms or substance use among homeless individuals. [14][15][16][17][18] Moreover, these studies were conducted in the United States, where over half of homeless people lack health insurance.…”

Section: Introductionmentioning

confidence: 99%

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Health Status, Quality of Life, Residential Stability, Substance Use, and Health Care Utilization among Adults Applying to a Supportive Housing Program

et al. 2011

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Supportive housing, defined as subsidized housing in conjunction with sitebased social services, may help improve the health and residential stability of highly disadvantaged individuals. This study examined changes in health status, quality of life, substance use, health care utilization, and residential stability among 112 homeless and vulnerably housed individuals who applied to a supportive housing program in Toronto, Canada, from December 2005 to June 2007. Follow-up interviews were conducted every 6 months for 18 months. Comparisons were made between individuals who were accepted into the program (intervention) and those who were wait-listed (usual care) using repeatedmeasures analyses. Individuals who were accepted into the housing program experienced significantly greater improvements in satisfaction with living situation compared with individuals in the usual care group (time, F 3,3,261 =47.68, pG0.01; group×time, F 3,3,261 = 14.60, pG0.01). There were no significant differences in other quality of life measures, health status, health care utilization, or substance use between the two groups over time. Significant improvement in residential stability occurred over time, independent of assigned housing group (time, F 3,3,261 =9.96, pG0.01; group×time, F 3,3,261 =1.74, p= 0.17). The ability to examine the effects of supportive housing on homeless individuals was limited by the small number of participants who were literally homeless at baseline and by the large number of participants who gained stable housing during the study period regardless of their assigned housing status. Nonetheless, this study shows that highly disadvantaged individuals with a high prevalence of poor physical and mental health and substance use can achieve stable housing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Health Status, Quality of Life, Residential Stability, Substance Use, and Health Care Utilization among Adults Applying to a Supportive Housing Program

et al. 2011

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“…Ces résultats sont aussi rapportés dans les revues systématiques de Nelson et al (2007) et Rog (2004. Clark et Rich (2003) montrent plutôt que ce sont précisément les personnes ayant des troubles mentaux graves et une forte consommation de substances qui ont bénéficié de l'approche « logement d'abord » sur le plan du logement, alors que celles ayant des troubles plus légers n'en ont pas davantage bénéficié (réf. « résultats mitigés » dans le tableau 8).…”

Section: Comparaison Entre L'approche « Logement D'abord » Et Les Intunclassified

“…Les études qui ont mesuré la santé mentale et la consommation de substances ont plutôt montré que l'approche « logement d'abord » n'a pas davantage d'effets sur ces dimensions que les interventions psychosociales traditionnelles (Clark & Rich, 2003 ;Nelson et al, 2007 ;Padgett et al, 2006). Elle ne permettrait pas non plus de diminuer davantage les visites aux urgences hospitalières (Montgomery et al, 2013).…”

Section: Comparaison Entre L'approche « Logement D'abord » Et Les Intunclassified

Efficacité de l’approche « logement d’abord » : une revue systématique

Beaudoin

2016

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Les personnes itinérantes aux prises avec des problèmes de santé mentale et de toxicomanie qui souhaitent obtenir un logement se butent à des programmes dans lesquels l’abstinence et les traitements psychiatriques sont obligatoires. Ce type de programmes se base sur l’approche « traitement d’abord » selon laquelle ces personnes doivent d’abord être traitées avant de pouvoir aller en logement.Cette approche est remise en question et un changement de paradigme s’opère à la suite de l’implantation aux États-Unis du modèle Pathways to Housing. Ce modèle est fondé sur le principe qu’une personne doit être logée avant de pouvoir se concentrer sur ses autres besoins. Les logements privés sont privilégiés dans ce modèle et ceux-ci sont offerts conjointement avec un soutien d’intensité variable ou un suivi intensif dans la communauté.Le modèle Pathways to Housing a influencé la création de plusieurs programmes hybrides basés sur l’approche « logement d’abord » combinée à une offre de services et de logements diversifiés. Cette approche est basée sur la même philosophie d’obligation minimale que le modèle original, voulant que les personnes n’aient pas à être abstinentes ou à suivre un traitement psychiatrique pour accéder à un logement.Au Canada, le gouvernement envisage de subventionner principalement les programmes basés sur cette approche. Cette annonce a mené à un soulèvement au Québec, notamment en raison des logements sociaux qui y sont actuellement priorisés.Cet article présente les résultats d’une revue systématique de la littérature réalisée afin de statuer sur l’efficacité des programmes basés sur l’approche « logement d’abord ».Les résultats de cette revue nous permettent de conclure que la mise en place au Québec de programmes basés sur cette approche devrait être favorisée. Les modalités et interventions offertes dans ces programmes auraient également avantage à être diversifiées.Homeless people diagnosed with substance abuse and mental illnesses often encounter problems in their quest to find housing since sobriety and psychiatric treatments are frequently required to qualify for a housing program. These programs are based on the “treatment first” approach, meaning individuals must first be treated before being admitted in a housing program.The relevancy of this approach is being questioned and change is occurring due to the implantation, in the United States, of the Housing First approach initiated by the Pathways to Housing organisation. The general premise of this model is that homeless people must first be housed before their other needs are taken care of. Private independent apartments are the preferred model of housing while intensive case management (ICM) or assertive community treatment (ACT) constitute the possible interventions.Pathways to Housing model influenced the cr...

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

Moledina

Magwood

Agbata

et al. 2021

Campbell Systematic Reviews

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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

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Outcomes of Homeless Adults With Mental Illness in a Housing Program and in Case Management Only

Abstract: The results suggest that the effectiveness, and ultimately the cost, of homeless services can be improved by matching the type of service to the consumer's level of psychiatric impairment and substance use rather than by treating mentally ill homeless persons as a homogeneous group.

Cited by 87 publications

References 18 publications

Health Status, Quality of Life, Residential Stability, Substance Use, and Health Care Utilization among Adults Applying to a Supportive Housing Program

Health Status, Quality of Life, Residential Stability, Substance Use, and Health Care Utilization among Adults Applying to a Supportive Housing Program

Efficacité de l’approche « logement d’abord » : une revue systématique

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

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