Judith Wolf

Effective interventions for homeless youth: a systematic review.

CONTEXT To date, there has not been clear evidence regarding interventions that are effective in addressing the specific needs of homeless youth. A systematic and comprehensive international review on effective interventions for homeless youth is presented. This study seeks to provide an accurate and complete picture of effective interventions for homeless youth by collecting, summarizing, categorizing, and evaluating quantitative studies (i.e., those that have assessed treatment outcomes). EVIDENCE ACQUISTION: The following databases were searched in 2008: PsycINFO, ERIC, MEDLINE, and Cochrane were searched from 1985 through 2008 using specific key words: interventions and programs, with homeless youth (s), homeless adolescents, street youth (s), runaways and throwaways. In addition, references of key articles were searched by hand. Eleven studies met pre-established inclusion criteria. To determine study quality, a set of operational parameters was formulated to rate each study as either good, fair, or poor. EVIDENCE SYNTHESIS There is no compelling evidence that specific interventions are effective for homeless youth, owing to moderate study quality and the small number of intervention studies. Conclusions that can be drawn from the studies are limited by the heterogeneity of interventions, participants, methods, and outcome measures. Many interventions focused on reduction of substance abuse, whereas other important outcomes, such as quality of life, have received little attention. No study received a quality rating of good, and four studies were rated as fair. Most convincing, but still marginal, were results of interventions based on cognitive-behavioral approaches, which revealed some positive results on psychological measures. CONCLUSIONS More methodologically sound research is needed to determine what specific interventions are beneficial for subgroups of homeless youth. Implications for future research are discussed.

Effectiveness of different models of case management for substance-abusing populations

Abstract Case management has been implemented in substance abuse treatment to improve (cost-) effectiveness, but controversy exists about its potential to realize this objective. A systematic and comprehensive review of peer-reviewed articles (n = 48) published between 1993 and 2003 is presented, focusing on the effects of different models of case management among various substance-abusing populations. Results show that several studies have reported positive effects, but only some randomized and controlled trials have demonstrated the effectiveness of case management compared with other interventions. Longitudinal effects of this intervention remain unclear. Although no compelling evidence was found for the effectiveness of case management, some evidence is available about the (differential) effectiveness of intensive case management and assertive community treatment for homeless and dually-diagnosed substance abusers. Strengths-based and generalist case management have proven to be relatively effective for substance abusers in general. Most positive effects concern reduced use of inpatient services and increased utilization of community-based services, prolonged treatment retention, improved quality of life, and high client satisfaction. Outcomes concerning drug use and psychosocial functioning are less consistent, but seem to be mediated by retention in treatment and case management. Further research is required to learn more about the extent of the effects of this intervention, how long these are sustained and what specific elements cause particular outcomes.

Effectiveness of Case Management for Homeless Persons: A Systematic Review

We reviewed the literature on standard case management (SCM), intensive case management (ICM), assertive community treatment (ACT), and critical time intervention (CTI) for homeless adults. We searched databases for peer-reviewed English articles published from 1985 to 2011 and found 21 randomized controlled trials or quasi-experimental studies comparing case management to other services. We found little evidence for the effectiveness of ICM. SCM improved housing stability, reduced substance use, and removed employment barriers for substance users. ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons. CTI showed promise for housing, psychopathology, and substance use and was cost-effective for mentally ill persons. More research is needed on how case management can most effectively support rapid-rehousing approaches to homelessness.

A strengths based method for homeless youth: Effectiveness and fidelity of Houvast

BackgroundWhile homelessness among youth is a serious problem, there is little information about evidence-based interventions for homeless youth. In cooperation with professionals and youths, Wolf (2012) developed Houvast (Dutch for ‘grip’): a strengths based method grounded in scientific and practice evidence. The main aim of Houvast is to improve the quality of life of homeless youths by focusing on their strengths, thus stimulating their capacity for autonomy and self-reliance.Method/DesignThe effectiveness and fidelity of Houvast will be tested in ten Dutch services for homeless youth which are randomly allocated to an intervention group (n = 5), or a control group which provides care as usual (n = 5). Measurements of both objective and subjective quality of life and secondary outcomes (mental and physical health, substance use, coping, resilience, psychological needs, care needs, working relationship with the professional and attainment of personal goals) will be conducted among homeless youths (n = 251). Youths in both groups will be interviewed by means of a structured interview at baseline, at time of ending care or after having received care for six months (T1) and at nine months after baseline (T2). Model fidelity will be tested around T1.DiscussionThis study is unique as it includes a large number of homeless youths who are followed for a period of nine months, and because it focuses on a strengths based approach. If the Houvast method proves to be effective in improving quality of life it will be the first evidence-based intervention for homeless youth.Trail registrationNetherlands Trail Register (NTR):NTR3254

The effectiveness of critical time intervention for abused women and homeless people leaving Dutch shelters: study protocol of two randomised controlled trials

BackgroundOne of the main priorities of Dutch organisations providing shelter services is to develop evidence-based interventions in the care for abused women and homeless people. To date, most of these organisations have not used specific intervention models and the interventions which have been implemented rarely have an empirical and theoretical foundation. The present studies aim to examine the effectiveness of critical time intervention (CTI) for abused women and homeless people.MethodsIn two multi-centre randomised controlled trials we investigate whether CTI, a time-limited (nine month) outreach intervention, is more effective than care-as-usual for abused women and homeless people making the transition from shelter facilities to supported or independent housing. Participants were recruited in 19 women’s shelter facilities and 22 homeless shelter facilities across The Netherlands and randomly allocated to the intervention group (CTI) or the control group (care-as-usual). They were interviewed four times in nine months: once before leaving the shelter, and then at three, six and nine months after leaving the shelter. Quality of life (primary outcome for abused women) and recurrent loss of housing (primary outcome for homeless people) as well as secondary outcomes (e.g. care needs, self-esteem, loneliness, social support, substance use, psychological distress and service use) were assessed during the interviews. In addition, the model integrity of CTI was investigated during the data collection period.DiscussionBased on international research CTI is expected to be an appropriate intervention for clients making the transition from institutional to community living. If CTI proves to be effective for abused women and homeless people, shelter services could include this case management model in their professional standards and improve the (quality of) services for clients.Trial registrationNTR3463 and NTR3425

Hostelbewoners in Utrecht

SamenvattingIn 2000 openden in de gemeente Utrecht de eerste hostels voor verslaafde daklozen hun deuren. Deze daklozen maakten deel uit van een open drugsscene en waren voor hun overnachting vooral op straat aangewezen. De missie van de hostels was bescheiden: het bieden van ‘bed, bad en brood’ en de stabilisering van bewoners. In het licht van de destijds zorgwekkende kwaliteit van leven van de verslaafde daklozen was de inzet imposant (Hulsbosch e.a., 2004). Hoe vergaat het de hostelbewoners anno 2009? Hoe is hun gezondheid, wat is hun middelengebruik en hoe ervaren zij hun kwaliteit van leven? Wat zijn hun behoeften aan hulp en wordt hierin ook voorzien? En wat is bij de bewoners de ervaren baat van hun verblijf in de hostels? Zijn er aanwijzingen dat de bewoners er nu beter aan toe zijn dan destijds? In dit artikel worden deze vragen beantwoord, op basis van een door het Onderzoekscentrum maatschappelijke zorg (Omz) uitgevoerd onderzoek naar de hostels in opdracht van de gemeente Utrecht. Het artikel besluit met een beschouwing.

Case management bij drugsverslaafden

SamenvattingCase management biedt een toegevoegde waarde aan de bestaande interventies in de verslavingszorg, daar zijn zowel de (ervarings)deskundigen als de onderzoekers het over eens. In de Verenigde Staten en Canada is inmiddels een jarenlange ervaring opgebouwd met deze ondersteuning bij de behandeling van druggebruikers. Europa volgt, zij het nog enigszins schoorvoetend. Duidelijk is dat alleen een weloverwogen en goed gefaciliteerde implementatie kan leiden tot een succesvolle uitvoering. Maar dan moet wel eerst voldaan zijn aan een flink aantal voorwaarden.