Top

16-04-2024 | Original Paper

Multicomponent Co-Occurring Disorders Treatment and Wraparound Services for Individuals Experiencing Chronic Homelessness

Authors: Abigail F. Helm, Michael A. Andre, Paige M. Shaffer, Kathryn E. Bruzios, Sarah Marcus, Jennifer Harter, David Smelson

Published in: Community Mental Health Journal

Abstract

Individuals experiencing chronic homelessness have high rates of persistent co-occurring mental health and substance use disorders (COD), and they often have difficulty with service engagement and retention, resulting in symptom exacerbation and housing loss. This study pilot tested Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking (MISSION), a multicomponent wraparound treatment approach to improve COD symptoms and housing stability among individuals experiencing chronic homelessness and persistent COD. This open pilot study enrolled and assessed 109 individuals with a COD experiencing chronic homelessness and offered one year of MISSION. Statistically significant improvements were observed in behavioral health symptoms and functioning, days of illicit drug use, and housing stability. By treatment completion, 85% of participants were referred to social and behavioral supports. This pilot study demonstrates that MISSION helped to successfully engage participants in treatment, reduce substance use and mental health symptoms, and improve housing outcomes.

One participant from the original sample of 109 was excluded as an outlier as they were 91 years old.

Breslow, N. R., & Clayton, D. G. (1993). Approximate inference in generalized linear mixed models. Journal of the American Statistical Association, 88, 9–25. https://doi.org/10.2307/2290687.CrossRef

Caputo, D., Le, M., & Reid, M. (2023). US loses 8% of affordable housing units during the pandemic, Capital Investors Eye Entry into the Sector. Moody’s Analytics, Inc.

CDC/ATSDR Social Vulnerability Index. (2022). C. f. D. C. a. Prevention.

Data, U. S. A., & Springfield (2020)., MA. Census Place https://datausa.io/profile/geo/springfield-ma#:text=In%202020%2C%20Springfield%2C%20MA%20had,%2441%2C571%2C%20a%205.42%25%20increase.

Eisen, S. V., & Youngman, D. (1994). Instruction manual for BASIS-32.

Eisen, S. V., Wilcox, M., Leff, H. S., Schaefer, E., & Culhane, M. A. (1999). Assessing behavioral health outcomes in outpatient programs: Reliability and validity of the BASIS-32. The Journal of Behavioral Health Services & Research, 26, 5–17.CrossRef

Herman, D. B., & Mandiberg, J. M. (2010). Critical time intervention: Model description and implications for the significance of timing in social work interventions. Research on Social Work Practice, 20(5), 502–508. https://doi.org/10.1177/1049731509360667.CrossRef

Klein, A. R., Cnaan, R. A., & Whitecraft, J. (1998). Significance of peer social support with dually diagnosed clients: Findings from a pilot study. Research on Social Work Practice, 8(5), 529–551.CrossRef

Lawless, M., & Corr, C. (2005). Drug use among the homeless population in Ireland: A report for the National Advisory Committee on Drugs. Merchants Quay Project.

McLellan, A. T., Grissom, G. R., Zanis, D., Randall, M., Brill, P., & O’Brien, C. P. (1997). Problem-service matching in addiction treatment: A prospective study in 4 programs. Archives of General Psychiatry, 54(8), 730–735.CrossRefPubMed

Montgomery, A. E., Cusack, M., Szymkowiak, D., Fargo, J., & O’Toole, T. (2017). Factors contributing to eviction from permanent supportive housing: Lessons from HUDVASH. Evaluation and Program Planning, 61, 55–63.CrossRefPubMed

Moulin, A., Evans, E. J., Xing, G., & Melnikow, J. (2018). Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A set-up for high Emergency Department utilization. West J Emerg Med, 19(6), 902–906.CrossRefPubMedPubMedCentral

Nilsson, S., Nordentoft, M., & Hjorthoj, C. (2019). Individual-level predictors for becoming homeless and exiting homelessness: A systematic review and Meta-analysis. Journal of Urban Health, 96(5), 741–750. https://doi.org/10.1007/s11524-019-00377-x.CrossRefPubMedPubMedCentral

Polcin, D. L. (2016). Co-occurring substance abuse and mental health problems among homeless persons: Suggestions for research and practice. Journal of Social Distress and the Homeless, 25, 1–10. https://doi.org/10.1179/1573658X15Y.0000000004.CrossRefPubMed

Rog, D. J., Marshall, T., Dougherty, R. H., George, P., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Permanent supportive housing: Assessing the evidence. Psychiatric Services, 65, 287–294. https://doi.org/10.1176/appi.ps.201300261.CrossRefPubMed

SAS Institute Inc. (2023). SAS/STAT® 15.3 user’s guide. SAS Institute Inc.

Smelson, D. A., Losonczy, M. F., Castles-Fonseca, K., Sussner, B. D., Rodrigues, S., Kaune, M., & Ziedonis, D. (2005). 2005/06/07). Preliminary outcomes from a Community Linkage Intervention for Individuals with co-occurring substance abuse and Serious Mental illness. Journal of Dual Diagnosis, 1(3), 47–59. https://doi.org/10.1300/J374v01n03_05.CrossRef

Smelson, D., Losonczy, M., Ziedonis, D., Castles-Fonseca, K., & Kaune, M. (2007). Six month outcomes from a booster case management program for individuals with a cooccurring substance abuse and a persistent psychiatric disorder. Eur J Psychiatry Clin Neurosci, 21, 143–152.

Smelson, D., Kalman, D., Losonczy, M., Kline, A., Sambamoorthi, U., Hill, S., Castles-Fonseca, L., K., & Ziedonis, D. (2012). A brief treatment engagement intervention for individuals with co-occurring mental illness and substance use disorders: Results of a randomized clinical trial. Community Mental Health Journal, 48(2), 127–132.CrossRefPubMed

Smelson, D. A., Zaykowski, H., Guevermont, N., Siegfriedt, J., Sawh, L., Modzelewski, D., Tsemberis, S., & Kane, V. (2016). 2016/04/02). Integrating Permanent supportive housing and Co-occurring disorders treatment for individuals who are homeless. Journal of Dual Diagnosis, 12(2), 193–201. https://doi.org/10.1080/15504263.2016.1174010.CrossRefPubMed

Smelson, D. A., Chinman, M., Hannah, G., Byrne, T., & McCarthy, S. (2018, May 5). An evidence-based co-occurring disorder intervention in VA homeless programs: outcomes from a hybrid III trial. BMC Health Serv Res, 18(1), 332. https://doi.org/10.1186/s12913-018-3123-9.

Sousa, T., Andrichik, A., Cuellar, M., Marson, J., Prestera, E., & Rush, K. (2022). The 2022 Annual Homelessness Assessment Report (AHAR) to Congress. The U.S. Department of Housing and Urban Development.

Springfield (2021)., Massachusetts Quick Facts. United States Census Bureau https://www.census.gov/quickfacts/fact/table/springfieldcitymassachusetts/PST045221#PST045221.

Substance Abuse Mental Health Services Administration (2011). Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings.

Substance Abuse Mental Health Services Administration (2015). CSAT GPRA Modernization Act Data Collection Tools.

The gap: A shortage of affordable rental homes. (2023). National Low Income Housing Coalition.

The (2016). Annual Homelessness Assessment Report (AHAR). (2016). U. S. D. o. H. a. U. D. O. o. C. P. a. Development. https://www.hudexchange.info/programs/hdx/guides/ahar/#reports.

Tsemberis, S. (2010). Housing First. The pathways model to end homelessness for people with mental illness And addiction manual. European Journal of Homelessness, 5(2).

Ware, N. C., Hopper, K., Tugenberg, T., Dickey, B., & Fisher, D. (2007). Connectedness and citizenship: Redefining social integration. Psychiatric Services, 58, 469–474. https://doi.org/10.1176/ps.2007.58.4.469.CrossRefPubMed

Wilson, M. E., Flanagan, S., & Rynders, C. (1999). The FRIENDS program: A peer support group model for individuals with a psychiatric disability. Psychiatric Rehabilitation Journal, 22(3), 239.CrossRef

Ziedonis, D. M., & Stern, R. (2001). Dual recovery therapy for schizophrenia and substance abuse. Psychiatric Annals, 31(4), 255–264.CrossRef

Title: Multicomponent Co-Occurring Disorders Treatment and Wraparound Services for Individuals Experiencing Chronic Homelessness
Authors: Abigail F. Helm
Michael A. Andre
Paige M. Shaffer
Kathryn E. Bruzios
Sarah Marcus
Jennifer Harter
David Smelson
Publication date: 16-04-2024
Publisher: Springer US
Published in: Community Mental Health Journal
Print ISSN: 0010-3853
Electronic ISSN: 1573-2789
DOI: https://doi.org/10.1007/s10597-024-01271-w

At a glance: The STEP trials

Springer Medicine

Multicomponent Co-Occurring Disorders Treatment and Wraparound Services for Individuals Experiencing Chronic Homelessness

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content