Case Management Models in Permanent Supported Housing Programs for People With Complex Behavioral Issues Who Are Homeless

ABSTRACT

Objective: The purpose of this article is to examine two evidence-based models of case management for people with co-occurring disorders and histories of chronic homelessness and to better understand their roles in permanent supported housing. Critical Time Intervention and Assertive Community Treatment are examined in terms of key elements, how they assist in ending homelessness, as well as the role they play in an individual's recovery from co-occurring disorders. Methods: Participants in two supported housing programs were interviewed at baseline and 6 months. One program used Critical Time Intervention (n = 144) and the other used Assertive Community Treatment (n = 90). Staff in both programs were interviewed about their experiences and fidelity assessments were conducted for each program. Results: Both programs operated at high levels of fidelity. Despite similar criteria for participation, there were significant differences between groups. Critical Time Intervention participants were older, were more likely to be male, were more likely to be homeless, and reported greater psychiatric symptoms and higher levels of substance use (all p's < .001). Separate outcome analyses suggested that each program was successful in supporting people to transition from homelessness to stable housing; 88.6% of Assertive Community Treatment participants were homeless at baseline, while at 6 months 30% were homeless (p < .001), and 91.3% of those in the Critical Time Intervention were homeless at baseline, while 44.3% were homeless at 6 months (p < .001). Participants in the Critical Time Intervention program also showed significant decreases in alcohol use, drug use, and psychiatric symptoms (all p's < .01). The preliminary results suggest that each case management model is helpful in assisting people with complex behavioral health needs and chronic homelessness to move to stable housing. Conclusions: Permanent supported housing seems to be an effective way to end homelessness among people with co-occurring disorders. Further research is needed to determine which case management models work most effectively with supported housing to help policy makers and program directors make informed decisions in developing these programs.

KEYWORDS:

• Homelessness
• co-occurring disorders
• case management models

Acknowledgments

The authors would like to acknowledge Dr. Autumn Frei and Ymeisa Melendez for their work and involvement in both evaluations. We would also like to thank two agencies, Gracepoint and the Agency for Community Treatment Services.

Disclosures

Dr. Clark is a full-time faculty member at the University of South Florida. She also serves as a consultant to DSG, Inc. as a reviewer of programs for SAMHSA's National Registry of Evidence-Based Programs and Practices. Prior to this year, Dr. Clark was a consultant to MANILA group when they had the contract for this project. The authors have no other financial relationships with commercial interests.

Funding

This report is funded in part by two SAMHSA grants, Treatment for Homeless Program 1 H79 TI16630-01 and Treatment for Homeless Program TI21464. The views expressed in this article are those of the authors and do not necessarily reflect the views of SAMHSA.