Paths and Impacts in the Progressive Independence Model:

Abstract

In an attempt to reduce homelessness and substance abuse, Chicago graduates of short-term inpatient substance abuse programs who lacked domiciles were placed into one of three conditions: (1) a case management only intervention (n = 96), (2) a case management with supported housing intervention (n = 136), or (3) a control condition (n = 187) that allowed access to normal aftercare in the community. The two treatment interventions used a "progressive independence" approach, which focuses on simultaneously ameliorating tangible needs and clinical problems. Multivariate analyses suggest that subjects in both treatment interventions experienced lower levels of substance abuse and higher levels of residential stability than subjects in the control condition, as measured over the course of a year. Further analysis suggests that retention was improved by the focus on immediate tangible resources, substance abuse was reduced by both the support of outpatient substance abuse treatment and the promulgation of changes in coping styles, and residential stability was increased by both the focus on access to income maintenance benefits and help with location of housing.

The effectiveness of case management interventions for the homeless, vulnerably housed and persons with lived experience: A systematic review

“…Findings suggested that the case management needed to be continuous, community-based and intensive so as to maintain and/or increase the gains achieved. For example, in Sosin and colleague's trial [51], improvements in housing stability were attributed to the case worker's advocacy for access to income benefits and help with locating housing. Not surprisingly, higher intensity case management models, which generally have lower caseloads, also include the provision of services above and beyond care coordination and incorporate outreach services, especially in the case of ICM, which is shown to have greater effects compared to other less intensive case-management models.…”

“…outcomes. One trial reported a significant improvement in employment over 24 months [44], whereas four trials showed no significant difference [48,50,51,54]. While one trial suggests that SCM improves access to income assistance (p<0.05) [51], no trials on SCM measured participant income as an outcome.…”

“…Of 11 trials on SCM, ten evaluated housing stability [44][45][46][47][48][50][51][52][53][54]. Only three reported significant decreases in homelessness [44,51,52]; an effect that diminished over time in one trial of a time-limited residential case management where participants in all groups accessed significant levels of services [44]. A SCM program tailored to women reduced the odds of depression at 3 months (OR 0.38 95% CI 0.14 to 0.99) but did not show improvements in their overall mental health status (MD 4.50; 95% CI -0.98 to 9.98) [53].…”

Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review

“…In addition, abstinence-contingent housing appears to provide greater impact on sustained abstinence than non-abstinence-contingent housing [87,88]. In the review by Hwang et al [6], the evidence supporting the effectiveness of case management on substance use was equivocal [104,105], however, interventions that included post-detoxification stabilization [106], abstinence-contingent work therapy [107], or an intensive residential treatment program [108,109] all showed significantly greater reductions in substance use than the usual care groups. These interventions all have a component of abstinence-contingency and thus are consistent with the abstinence-contingent housing interventions discussed in the current review.…”

Housing First and the Risk of Failure

“…The availability of complete 1-year follow-up data for all 8 comparators raises the question of whether these 8 represent “retained clients” rather than a pseudo-random sample of entrants to more traditional programs. In the literature, retention of homeless clients in treatment programs is low (in a review of 15 different interventions, loss of 2/3 or more was typical) ( Orwin et al, 1999 ), and in the most rigorous scientific trials, addiction treatment outcomes are modest ( Milby et al, 2009 ; Orwin et al, 2005 ; Sosin et al, 1995 ). The near-perfect results among the 8 Minneapolis comparators might be due to analysis focus on persons “retained,” rather than a random sample of program entrants.…”