Outcomes of a life skills intervention for homeless adults with mental illness

Interdisciplinary rehabilitation for the transition out of homelessness with a traumatic brain injury

People experiencing homelessness (PEH) face higher rates of traumatic brain injury (TBI), which is associated with greater unmet healthcare and social needs and increased difficulty transitioning out of homelessness. While efforts have emerged to address this TBI disparity via screening, staff training and case management, gaps exist in the delivery of evidence-based TBI rehabilitation to PEH. This case report describes the delivery of interdisciplinary TBI rehabilitation to a male patient experiencing homelessness within a US context. Physical medicine and rehabilitation and occupational therapy focused on managing cognitive and chronic pain symptoms to improve daily life function across community settings (ie, outdoors, shelter, the transition to stable housing). After 4 months, the patient demonstrated improved daily life function with changes in objective measurements and housing status from unsheltered homelessness to housed. This case demonstrates the feasibility of delivering equitable TBI rehabilitation to PEH to mitigate health and housing disparities.

World Psychiatric Association-Asian Journal of Psychiatry Commission on Public Mental Health

Although there is considerable evidence showing that the prevention of mental illnesses and adverse outcomes and mental health promotion can help people lead better and more functional lives, public mental health remains overlooked in the broader contexts of psychiatry and public health. Likewise, in undergraduate and postgraduate medical curricula, prevention and mental health promotion have often been ignored. However, there has been a recent increase in interest in public mental health, including an emphasis on the prevention of psychiatric disorders and improving individual and community wellbeing to support life trajectories, from childhood through to adulthood and into older age. These lifespan approaches have significant potential to reduce the onset of mental illnesses and the related burdens for the individual and communities, as well as mitigating social, economic, and political costs. Informed by principles of social justice and respect for human rights, this may be especially important for addressing salient problems in communities with distinct vulnerabilities, where prominent disadvantages and barriers for care delivery exist. Therefore, this Commission aims to address these topics, providing a narrative overview of relevant literature and suggesting ways forward. Additionally, proposals for improving mental health and preventing mental illnesses and adverse outcomes are presented, particularly amongst at-risk populations.

Outcomes of psychosocial interventions for homeless individuals with mental illness: A systematic review

BACKGROUND

Homelessness creates a significant social and economic burden in the society. Homelessness and mental illness are two interconnected social issues that poses challenges to individuals and communities across the globe. This systematic review aims to synthesize the existing literature on interventions for the homeless persons with mental illness.

OBJECTIVES

To systematically review the existing literature on psychosocial interventions for homeless persons with mental illness.

SEARCH METHODS

Five databases including PubMed, ProQuest, Cochrane Library, OVID, and Google Scholar were searched using homelessness, psychosocial interventions, mental ill, residential mental health facility, and case management for experimental studies published from January 2000 to December 2022.

STUDY SELECTION

Abstract review was conducted for the screened studies, and full-text review was done for studies which met inclusion exclusion criteria.

DATA EXTRACTION AND ANALYSIS

Among the 6,387 studies screened 20 studies were selected which fulfilled inclusion criteria. The full text review yielded data of 12,174 homeless persons with mental illness who undergone intervention.

RESULTS

The major psychosocial interventions found including critical time intervention, case management, housing support intervention, assertive community treatment, and life skills training. These interventions were helpful in sustaining housing stability, preventing relapse, reducing hospitalizations, and improving quality of life of the homeless persons with mental illness.

CONCLUSION

Targeted and integrated interventions addressing homelessness and mental illness are required to tackle the social problems of homelessness and mental illness. Further research is required to explore the most effective strategies that address homelessness and mental illness.

Exploring Mental Health Services for Youth Experiencing Homelessness in East Asian Pacific Regions: A Systematic Scoping Review

BACKGROUND

Youth experiencing homelessness (YEH) in East Asian Pacific (EAP) regions represent one of the most at-risk populations due to cultural and geographical factors. Effective mental health interventions, primarily researched in Western contexts, may not fully apply to YEH in EAP. Their lack of stable shelter, disrupted social networks, and limited access to mental health services elevate their susceptibility to adverse mental health, making urgent interventions essential to address their needs.

OBJECTIVE

The objective of this study is to explore and systematically search the types of mental health services and interventions available for YEH in EAP and their impact on overall quality of life and wellbeing.

METHODS

Electronic databases (e.g., Medline, PsycINFO, PubMed, Scopus) were systematically searched (publication dates between 1 January 1990 and 13 May 2023), as well as additional online resources specific to homelessness. Articles were screened, and a critical appraisal assessed the quality of the included studies.

RESULTS

Eight studies with different interventions were identified in Indonesia (n = 2), Malaysia (n = 1), South Korea (n = 3), and the Philippines (n = 1). These were thematically clustered into six categories: art, cognitive behavioural therapy, life skills education, resilience enhancement, family strengthening, and government interventions/services.

CONCLUSIONS

This review highlights effective mental health interventions' positive impact on YEH mental health outcomes and quality of life in EAP, stressing the urgent need to implement socio-culturally sensitive services. Future research should address knowledge gaps through comprehensive studies covering diverse EAP regions and populations, prioritising socio-culturally specific psychological measures.

Competencies for occupational therapy practice in homelessness: A Delphi study

BACKGROUND

Homelessness is growing internationally, and resources to guide occupational therapy practice in this area are needed.

OBJECTIVES

To identify competencies needed for occupational therapists to support individuals during and following homelessness.

MATERIAL AND METHODS

We conducted a three-round Delphi study with occupational therapy practitioners and researchers with expertise in homelessness.

RESULTS

Of 35 potential participants, n = 16 participated in Round I, n = 20 participated in Round II, and n = 18 participated in Round III. Participants included occupational therapists and researchers in Canada, United States, Brazil, UK, Ireland and New Zealand. Consensus was achieved on a total of 93 competencies in 10 categories after 15 were eliminated in Rounds II and III. The categories with the greatest number of competencies included occupational knowledge (n = 18), followed by psychosocial competencies (n = 16).

CONCLUSIONS AND SIGNIFICANCE

This study represents the first to identify the competencies needed for occupational therapists working in the area of homelessness. Practitioners and educators are encouraged to view the identified competencies as a guide for the professional development of occupational therapists in this context. Stakeholders consulted for this study were able to communicate in English and situated in middle to high-income countries. As such, the competencies identified in this study only apply to these sociocultural contexts.

Nutrition programmes for individuals living with disadvantage in supported residential settings: a scoping review

OBJECTIVE

Health inequities such as chronic disease are significantly higher among individuals living with disadvantage compared with the general population and many are reported to be attributable to preventable dietary risk factors. This study provides an overview of the current nutrition interventions for individuals living with extreme disadvantage, in supported residential settings, to develop insights into the development and implementation of policies and practices to promote long-term nutritional health and well-being.

DESIGN

A scoping review searched Scopus, ProQuest, CINAHL Plus, MEDLINE, and Web of Science databases using the terms 'resident', 'nutrition', 'disadvantage', 'intervention' and their synonyms, with particular emphasis on interventions in residential settings.

SETTING

Residential services providing nutrition provision and support.

PARTICIPANTS

People experiencing extreme disadvantage.

RESULTS

From 5262 articles, seven were included in final synthesis. Most interventions focused on building food literacy knowledge and skills. Study designs and outcome measures varied; however, all reported descriptive improvements in behaviour and motivation. In addition to food literacy, it was suggested that interventions need to address behaviour and motivations, programme sustainability, long-term social, physical and economic barriers and provide support for participants during transition into independent living. Socio-economic issues remain key barriers to long-term health and well-being.

CONCLUSIONS

In addition to food literacy education, future research and interventions should consider utilising an academic-community partnership, addressing nutrition-related mental health challenges, motivation and behaviour change and a phased approach to improve support for individuals transitioning into independent living.

Unmet service needs and barriers to care of individuals experiencing absolute homelessness in Edmonton, Canada: a cross-sectional survey

PURPOSE

Individuals experiencing absolute homelessness have complex needs but limited access to services, contributing to high rates of morbidity and mortality. The aim of this article is to describe the perceived unmet service needs of individuals experiencing absolute homelessness, identify their barriers to care, and examine factors associated with specific unmet service needs.

METHODS

Using a cross-sectional survey, 150 individuals experiencing absolute homelessness were recruited from Edmonton's inner city and adjoining areas. The majority of participants were male (71.3%) and self-identified as Indigenous (74.0%). An adapted version of the Perceived Need for Care Questionnaire was used to measure past-year unmet needs for 4 types of services: hospital care, counselling, skills training, and harm reduction. Descriptive statistics and bivariate analyses were used; odds ratio and confidence intervals were calculated for statistically significant outcomes.

RESULTS

Overall, 89.3% of participants perceived a need for care for one or more general health and social services during the past year regarding their substance use and/or mental health problems; participants reported the highest levels of unmet need for counselling (42.9%) and skills training (39.2%). Though 73.3% of participants reported receiving any service, only 8.0% of participants reported having their perceived needs fully met.

CONCLUSION

In this study, individuals reported a high percentage of unmet needs. By interacting and engaging with these hard-to-reach individuals, healthcare systems will be more equipped to service them and address their barriers to care. Better patient-centred care, housing and supports for this neglected and underserved population is needed.

Empowering Features and Outcomes of Homeless Interventions: A Systematic Review and Narrative Synthesis

The purpose of this systematic review and narrative synthesis was to identify homeless interventions with empowering features and evaluate their effectiveness for developing the psychological empowerment of services users. To identify and evaluate intervention studies, we combined the theoretical frameworks of empowering settings and psychological empowerment (PE). Our conceptualization of PE included outcomes aligned with the intrapersonal, interactional, and behavioral components. Relational outcomes were also included and conceptualized as antecedents for PE development. After systematic searching and screening, 37 studies were included for review. Interventions with empowering features included supported housing, case management, skills and knowledge acquisition, and mutual support. Interventions that were competency-building effectively improved outcomes aligned with the intrapersonal PE component. Interventions that were collaborative and competency-building effectively improved outcomes aligned with the behavioral PE component. Weak evidence suggested that interventions with empowering features may effectively improve outcomes aligned with the interactional PE component. Interventions that promoted and developed support effectively improved relational antecedents. Findings align the empirical evidence for homeless interventions with theoretical conceptions of empowering features and processes. Findings may be applied to the design and implementation of homeless interventions to incorporate empowering features and to facilitate the development of homeless services users' PE. Highlights Empowerment theory was applied to review homeless interventions literature. Empowering homeless interventions included supported housing and mutual support, for example. Empowering interventions contributed to indicators of emotional and behavioral empowerment. Fewer empowering interventions contributed to indicators of cognitive empowerment. Service user involvement may facilitate improvements in indicators of psychological empowerment.

The Role of Social Skills in the Prevention of Drug Addiction in Adolescents

Background:

Substance abuse has turned into a great problem in the worldwide. Considering the increased prevalence of addiction in this study, we tried to assess the role of social skills aspects in tendency to addiction among the adolescents.

Materials and Methods:

This cross-sectional study was conducted on 600 high school students studying in the Isfahan City, Iran, from 2016 to 2018. The studied population was assessed using addiction tendency questionnaire and Matson's social skills questionnaire. Data were analyzed by Statistical Package for the Social Sciences software and independent t-test, Pearson and Spearman correlation, and linear regression test.

Results:

Social behavior (P = 0.002, r = −0.124), high self-esteem (P < 0.001, r = −0.381), and peer-communication (P < 0.001, r = −0.361) were inversely associated with a tendency to addiction and were independent predictors of it (P < 0.05). Aggression was associated with increased tendency to the addiction (P = 0.01, r = 0.103) but not a predictor.

Conclusion:

We found that appropriate social behaviors, inappropriate assertiveness, and functional communication were factors associated with less tendency to substance abuse in the adolescent.

A systematic review of occupational therapy interventions in the transition from homelessness

BACKGROUND

Although systematic and scoping reviews have identified a range of interventions for persons experiencing homelessness, no known reviews have captured the range and quality of intervention studies aimed at supporting a transition from homelessness.

OBJECTIVES

To capture the range and quality of occupational therapy intervention studies aimed at supporting a transition to housing following homelessness.

METHOD

Using Joanna Briggs Institute (JBI) guidelines, we conducted a systematic review including a critical appraisal and narrative synthesis of experimental studies.

RESULTS

Eleven studies were included. Critical appraisal scores ranged from 33.3 to 88.9 of a possible score of 100 (Mdn = 62.5; IQR = 33.4). The majority of studies evaluated interventions for the development of life skills (n = 9; 81.8%), and all were conducted in the USA. Several of the included studies were exploratory evaluation and feasibility studies, and all were quasi-experimental in design. Only three studies (27.2%) incorporated a control group. Intervention strategies included (1) integrated group and individual life skills interventions (n = 6); (2) group-based life skills interventions (n = 3); and (3) psychosocial and consultative interventions (n = 2).

CONCLUSIONS

Research evaluating occupational therapy interventions aimed at supporting homeless individuals as they transition to housing is in an early stage of development.

SIGNIFICANCE

Implications for research and practice are discussed.

Needs of Transitionally Housed Young People to Promote Occupational Participation

This qualitative descriptive study explored what young people who are transitionally housed need to promote occupational participation. Nine young people and four staff members from a transitional living facility participated in interviews and focus groups. Results suggested that the young people need opportunities to practice independent living skills, develop routines to support employment, housing, and education, and receive more individualized support from service providers. Findings also reveal that service providers experience a range of barriers to meeting young people's needs. This study underscores the importance of occupational therapy practitioners being informed of national and regional policies as well as emerging evidence of innovative approaches with populations, communities, and individuals so as to ultimately develop novel, collaborative, occupation-based programs to help young people set goals and transition out of homelessness.

Social justice considerations for occupational therapy: The role of addressing social determinants of health in unstably housed populations

BACKGROUND

Populations of those experiencing homelessness in the United States expand beyond those living in shelters and on the streets. Many individuals living in poverty experience housing instability, as well as refugee populations who experience deprivation of social resources due to displacement. These populations are significantly affected by social determinants of health (SDOH).

OBJECTIVE

A current policy and literature review was completed to assess prominent SDOH impacting unstably housed populations in the United States, including refugees, encountered in occupational therapy practice. Review of evidence-based practice to address SDOH was completed to provide recommendations for practitioners across healthcare settings.

RESULTS

A review of policy and its impact on those experiencing housing instability or recently resettled identifies several significant barriers to full occupational performance and health management. Several specific occupational therapy interventions exist to address these barriers and are in alignment with current practice.

CONCLUSION

Occupational therapy practitioners across practice settings should consider how current housing status and social determinants of health may impact their clients' occupational performance and ability to manage health conditions.

Participatory food events as collaborative public engagement opportunities

There is an urgent need to ‘get creative’ with the way we tackle social and nutritional inequalities. The Food as a Lifestyle Motivator (FLM) project has explored the use of creative participatory approaches to engage ‘harder to reach’ communities in dialogues to improve their well-being and life skills. Preliminary findings have confirmed that food can be a powerful catalyst for social inclusion with the potential to empower ‘marginalised’ individuals. Part of this exploratory study has involved two participatory food events (November 2015 and November 2016) run in a local day centre for drug and alcohol rehabilitation. The aim of these events was to bring together key stakeholders (from the service user and provider communities) to exchange food-based knowledge, using collaborative and co-creative participatory approaches. Following ethical clearance, a range of data were collected at the events to assess their ‘social impact’. These consisted of (1) audio interviews (service providers and users), (2) oral surveys (service users and key workers) and (3) observations of social cooking and eating engagement, and creative visual arts (photography, collage, food games and quizzes). In this article, we detail how the range of creative approaches used has successfully engaged individuals (average attendance: n = 80, service users: n = 32) to participate in these food-themed events. We reflect on the overarching themes from data capture of the social and therapeutic aspects of food (activities). We also reflect on the collation (and curation) of findings, systematically critiquing the approaches used, including consideration of ethics, and drivers for engagement. Finally, we consider how the utility of such creative approaches can optimise public engagement activities, not only to enhance research impact but also to inform collaborative developments with and between service users, service providers and other stakeholders, with the potential to lead to transformative food-related changes.

Feasibility and Satisfaction of an Apartment Living Program for Homeless Adults With Mental Illness and Substance Use Disorder

OBJECTIVE

We assessed the feasibility and satisfaction of an apartment living program for formerly homeless adults with mental health and substance use disorders.

METHOD

A one-group pretest-posttest design was used with 22 participants who attended a six-week apartment living program.

RESULTS

Sixteen participants completed the study and demonstrated improvement in the performance of and satisfaction with needed daily life skills (performance: Z = -3.56, p ≤ 0.000, d = -1.86; satisfaction: Z = -2.84, p ≤ 0.004, d = -1.85), interpersonal skills (Z = -3.52, p ≤ 0.000, d = -2.98) and quality-of-life scores (Z = -3.52, p ≤ 0.000, d = -1.34). Participants reported high levels of satisfaction with the program.

CONCLUSION

This study demonstrates the feasibility and satisfaction of an apartment living program and warrants further research.

Effectiveness of a supportive housing program for homeless adults with mental illness and substance use: A two-group controlled trial

Introduction

The purpose of this study was to assess the effectiveness of a housing transition program for homeless shelter residents with chronic mental illness and substance use.

Method

A two-group controlled study design was used to assess the program, with 10 participants in an intervention group and 10 in a control group. Goal attainment scaling and quality of life ratings were used pre- and post-intervention to determine if a statistically significant difference existed between groups at post-intervention.

Results

A statistically significant difference existed between intervention and control group goal attainment scaling scores ( U = 9.50, p < .03, d = 1.34), and on quality of life scores ( U = 10.50, p < .04, d = 1.30) at post-intervention. At a 6-month follow-up, 57.14% of intervention group participants had transitioned into supportive housing, while only 25% of control group participants had transitioned.

Conclusion

Findings suggest that intervention participants made greater progress toward desired housing goals and reported higher quality of life ratings than controls at post-intervention. This study provides support for the effectiveness of a housing program for homeless adults with chronic mental illness and substance use histories to achieve housing goals and higher quality of life ratings.

Perception of occupational balance by people with mental illness: A new methodology

Aims The aims were to (i) investigate initial construct validity of a tool for assessment of time allocation in occupational balance, and (ii) describe perceived occupational balance and its relationship with socio-demographics, well-being, and personal recovery among people with mental illness. Methods Satisfaction with Daily Occupations and Occupational Balance (SDO-OB) was administered to 226 persons. SDO-OB reflects balance in five occupational domains: work, leisure, home chores, self-care, and overall occupational balance. Indicators for assessing construct validity were: satisfaction with everyday occupations, occupational value, symptom severity, and psychosocial functioning. For the second aim, the data collection included socio-demographics, life quality, self-esteem, self-mastery, and personal recovery. Results Occupational balance ratings indicated the participants were either under-occupied or in balance. Few were over-occupied. Feeling in balance was related to greater well-being and recovery compared with being under-occupied. Risk factors for under-occupation were younger age (in relation to work), and higher education (in relation to overall balance). Conclusions Associations with the indicators suggest initial construct validity. The SDO-OB is promising for assessment of occupational balance among people with mental illness. Being under-occupied was detrimental to well-being and recovery, and this indicates the importance of offering more occupational opportunities for people with mental illness.

Quality of Life Enhancement Programme for Individuals with Mood Disorder: A Randomized Controlled Pilot Study

Objective/Background

To investigate the efficacy and feasibility of the Quality of Life Enhancement Programme (QOLEP) for individuals with mood disorder.

Methods

Twenty-one individuals with mood disorder were recruited from psychiatric rehabilitation centres in Taipei City and were randomly assigned to either the treatment group (N = 11) or the control group (N = 10). The treatment group received an 8-week QOLEP. The control group received only “phone contact”, which included support for everyday situations pertaining to daily life and emotions. The primary outcome measure was evaluating improvements in quality of life using the World Health Organization Quality of Life-BREF-Taiwan version questionnaire. The feasibility of the intervention was assessed by the recruitment rate, dropout rate of the participants, and by its content and delivery. The content and delivery were assessed by the group satisfaction questionnaire. The mixed-effects linear model was applied to analyze the efficacy of QOLEP.

Results

The individuals who participated in the eight-session QOLEP showed significant improvement in their level of depression compared with the control group [pre vs. post, treatment group: 25.8 (19.2) vs. 17.8 (13.1); control group: 13.3 (17.3) vs. 13.3 (14.4)]. The criteria of feasibility were met in this study. Most of the participants were satisfied with engaging in the QOLEP activities within a supportive environment.

Conclusion

The participants who received the 8-week QOLEP demonstrated significant improvement in the level of depression. Studies with a sample size of at least 104 participants are recommended in the future.

Life Adaptation Skills Training (LAST) for persons with depression: A randomized controlled study

BAKGROUND

To investigate the efficacy of the "Life Adaptation Skills Training (LAST)" program for persons with depression.

METHODS

Sixty-eight subjects with depressive disorder were recruited from psychiatric outpatient clinics in Taipei city and were randomly assigned to either an intervention group (N=33), or a control group (N=35). The intervention group received 24-sessions of the LAST program, as well as phone contact mainly related to support for a total of 24 times. The control group only received phone contact 24 times. The primary outcome measure utilized was the World Health Organization Quality of Life-BREF-Taiwan version. Secondary outcome measures included the Occupational self-assessment, the Mastery scale, the Social support questionnaire, the Beck anxiety inventory, the Beck depression inventory-II, and the Beck scale for suicide ideation. The mixed-effects linear model was applied to analyze the incremental efficacy of the LAST program, and the partial eta squared (ηp(2)) was used to examine the within- and between- group effect size.

RESULTS

The subjects who participated in the LAST program showed significant incremental improvements with moderate to large between-group effect sizes on their level of anxiety (-5.45±2.34, p<0.05; ηp(2)=0.083) and level of suicidal ideation (-3.09±1.11, p<0.01; ηp(2)=0.157) when compared to the control group. The reduction of suicidal ideations had a maintenance effect for three months after the end of intervention (-3.44±1.09, p<0.01), with moderate between-group effect sizes (ηp(2)=0.101). Both groups showed significant improvement on overall QOL, overall health, physical QOL, psychological QOL, level of anxiety, and level of depression. The within-group effect sizes achieved large effects in the intervention group (ηp(2)=0.328-0.544), and were larger than that of the control group.

LIMITATIONS

A small sample size in the study, a high dropout rate, lower compliance rates for the intervention group, and lacking of true control group.

CONCLUSIONS

The occupation-based LAST program, which focuses on lifestyle rearrangement and coping skills enhancement, could significantly improve the level of anxiety and suicidal ideations for persons with depression.

Feasibility and Acceptability of a Pilot Housing Transition Program for Homeless Adults with Mental Illness and Substance Use

The purpose of this study was to determine if a housing transition program was feasible and acceptable to homeless clients with mental illness and substance use histories. Ten male residents of a homeless shelter participated in the 3-week housing intervention. The intervention used a DVD format with instructional videos, graphics, and opportunities for hands-on practice of functional skills in a simulated apartment environment. Outcome measures included goal attainment scale scores (GAS), satisfaction surveys, and case manager reports. Six of the 10 participants completed the program and achieved GAS scores at a greater level than expected at baseline (T > 50). Participants reported the intervention to be engaging and enhanced their knowledge of the housing transition process. The intervention appears to have assisted the participants in the attainment of housing skills and warrants further study.

Psychometric Properties of the Practical Skills Test (PST)

The Practical Skills Test (PST) is a new assessment of individuals' knowledge of life skills. We evaluated the PST's reliability, validity, and sensitivity to change among a homeless population. Participants were 123 homeless persons in a longitudinal experimental study who were assessed before and after intervention with the PST, Allen Cognitive Level Screen-2000 (ACLS-2000), and Impact of Event Scale-Revised (IES-R). The PST showed generally good internal consistency, no floor effects, and limited ceiling effects (<20% on each test). Supportive evidence for the PST's convergent validity was seen in its moderate correlations with the ACLS-2000; we found no significant correlation with the IES-R. Paired t tests indicated that the PST is sensitive to changes in life skills after intervention, but effect sizes were small. The results suggest that the PST has generally good reliability and validity. However, ceiling effects suggest an area for further development.

Readiness-to-change cluster profiles among adults with mental illness who were homeless participating in a life skills intervention

This longitudinal study examined differences in intervention outcomes based on readiness-to-change cluster profiles among 73 adults with a mental illness at risk for homelessness participating in a manualized life skills intervention. Intervention topics included money management, food management, safe community participation, and room- and self-care. Life skill knowledge and readiness-to-change, measured using the University of Rhode Island Change Assessment, was examined at baseline, post-intervention, and 3-6 months later. Two scoring patterns emerged for readiness-to-change at each time point: Pre-Engaged and Engaged. Participants who were Engaged at the time of assessment scored significantly better than Pre-Engaged on post-intervention life skill testing, however group identification changed over time. Baseline readiness-to-change did not predict future performance or attrition, and therefore may not provide accurate indication of client investment for future learning or participation. Further investigation is needed to determine what factors contribute to Engaged membership.

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

BACKGROUND

Research on interventions to positively impact health and housing status of people who are homeless has received substantially increased attention over the past 5 years. This rapid review examines recent evidence regarding interventions that have been shown to improve the health of homeless people, with particular focus on the effect of these interventions on housing status.

METHODS

A total of 1,546 articles were identified by a structured search of five electronic databases, a hand search of grey literature and relevant journals, and contact with experts. Two reviewers independently screened the first 10% of titles and abstracts for relevance. Inter-rater reliability was high and as a result only one reviewer screened the remaining titles and abstracts. Articles were included if they were published between January 2004 and December 2009 and examined the effectiveness of an intervention to improve the health or healthcare utilization of people who were homeless, marginally housed, or at risk of homelessness. Two reviewers independently scored all relevant articles for quality.

RESULTS

Eighty-four relevant studies were identified; none were of strong quality while ten were rated of moderate quality. For homeless people with mental illness, provision of housing upon hospital discharge was effective in improving sustained housing. For homeless people with substance abuse issues or concurrent disorders, provision of housing was associated with decreased substance use, relapses from periods of substance abstinence, and health services utilization, and increased housing tenure. Abstinent dependent housing was more effective in supporting housing status, substance abstinence, and improved psychiatric outcomes than non-abstinence dependent housing or no housing. Provision of housing also improved health outcomes among homeless populations with HIV. Health promotion programs can decrease risk behaviours among homeless populations.

CONCLUSIONS

These studies provide important new evidence regarding interventions to improve health, housing status, and access to healthcare for homeless populations. The additional studies included in this current review provide further support for earlier evidence which found that coordinated treatment programs for homeless persons with concurrent mental illness and substance misuse issues usually result in better health and access to healthcare than usual care. This review also provides a synthesis of existing evidence regarding interventions that specifically support homeless populations with HIV.

Cognitive Predictors of Life Skill Intervention Outcomes for Adults With Mental Illness at Risk for Homelessness

OBJECTIVE. We investigated the effectiveness of a life skills intervention for people with mental illness who have been homeless.

METHOD. In this longitudinal outcomes study, we used Situated Learning Theory (Lave & Wenger, 1991) to provide group and individual sessions to 38 participants from two housing programs after completing baseline Allen Cognitive Level Screen–2000 (ACLS–2000; Allen Conferences, 2000) and Practical Skills Tests (PSTs). Data were analyzed using linear mixed-effects regression models.

RESULTS. The PST scores of participants with higher ACLS–2000 scores significantly increased over time (food management, p = .021; money management, p = .039; safe community participation, p = .02). Participants with lower ACLS–2000 scores demonstrated an even greater change over time.

CONCLUSION. Most participants, including those with lower ACLS–2000 scores, improved and retained life skills knowledge over time, challenging the premise that people with mental illness should be excluded from mixed-level group interventions.

A systematic review of occupational therapy interventions with homeless people

ABSTRACT A systematic review of the occupational therapy literature 1990-2008 was undertaken with the aim to assess the quality of evidence that supports the role of occupational therapy with homeless people. Forty articles were initially identified and critically appraised, including 16 research studies. Seven quantitative articles were included in this review and demonstrated the effectiveness of occupational therapy in providing interventions that increase employment and education prospects, money management, coping skills, and leisure activities. The literature suggests that occupational therapy has an appropriate role with people experiencing homelessness.