Real World Implementation of an Adapted ACT Model with Minority and Non-minority Homeless Men

Substance use outcomes among individuals with severe mental illnesses receiving assertive community treatment: A systematic review

Assertive Community Treatment (ACT) is a multidisciplinary treatment approach to support people with severe mental illnesses (SMI) in their recovery. While the majority of ACT recipients report co-morbid substance use issues, limited reviews have evaluated the impact of receiving ACT services on substance use outcomes. The purpose of this systematic review was to evaluate the impact of ACT involvement on substance use outcomes among people with SMI. A systematic literature search was conducted including articles published prior to April 2021. Twenty-nine studies were included in this review. Of them, 15 studies implemented a controlled design (six studies demonstrated high quality) and 14 studies implemented a cohort design. From a synthesis of the reviewed studies, five areas of changes associated with substance use emerged including reduced alcohol and drug use severity, lower prevalence of alcohol and drug use, increased stage of change in substance use treatment, and fewer days of hospitalization and intoxication. Thus, future studies should examine the integration of substance use treatment services as part of ACT interventions for opportunities to enhance recovery outcomes among individuals with SMI.

Barriers and Facilitators to Implementing a Short-Term Transdiagnostic Mental Health Treatment for Homeless Persons

Despite the significant mental health needs and comorbidity in homeless individuals, there is a "science-practice gap" between the available evidence-based treatments (EBTs) and their lack of use in community health centers servicing homeless populations. To address this gap, it is imperative to evaluate and attend to the contextual factors that influence the implementation process of EBTs before their integration into routine care. The study aims to evaluate the barriers and facilitators to implementing a transdiagnostic EBT in a community health center serving homeless individuals. The results of the thematic analyses (7 focus groups, 67 participants) yielded 8 themes for barriers and 10 themes for facilitators to implementation. The findings of the current study highlight common tensions faced by community programs and clinicians when working toward integrating EBTs across different types of populations, and those unique to homeless persons. Results can inform subsequent strategies used in implementing EBTs.

Improving outcomes for homeless people with alcohol disorders: a multi-program community-based approach

Background: Relatively few community-based programs have been found to be helpful for homeless people with alcohol disorders, even though this group represents a high-risk, vulnerable population prone to poor outcomes.Aims: This study sought to implement and evaluate intensive community-based programs for homeless people with alcohol disorders.Method: The project worked closely with a homeless outreach team for referrals, and then provided two different, intensive substance abuse treatment approaches matched to the needs of two subgroups: homeless individuals with alcohol disorders without severe mental illness received community reinforcement approach (CRA) and case management services, while those with alcohol and severe mental illness were assigned to assertive community treatment and integrated dual disorders (ACT/IDDT) services. The study enrolled 322 homeless people with alcohol disorders and outcomes were assessed at six months and program discharge.Results: Participants improved significantly over the first six months in a number of outcome areas, including substance abuse, mental health, housing, employment and health; progress generally remained stable between six months and discharge.Conclusions: Community-based programs that coordinate with mobile outreach teams and then provide CRA and ACT/IDDT appear to be promising approaches for helping individuals with alcohol disorders out of homelessness and into recovery.

Occupation-based practices and homelessness: A scoping review

BACKGROUND

Persons experiencing or at risk of homelessness have occupational needs that are seldom addressed in the Canadian system of care. The lack of documented evidence on occupational therapy practices in this field hinders the development of the profession.

PURPOSE

This article identifies current and potential practices that aim to enable or support the occupations of persons experiencing or at risk of homelessness.

METHOD

A scoping review was conducted, including evidence from both occupational therapy and non-occupational therapy sources.

FINDINGS

One hundred and seventy-eight papers were selected in the areas of occupational performance skills training, enrichment of occupational repertoire, employment/education, physical rehabilitation services, child/family services, community building, occupational transition from homeless to housed, literacy, and disaster relief.

IMPLICATIONS

Occupational therapists can build environments and create opportunities that facilitate occupational engagement of individuals experiencing homelessness. Gaps in knowledge include the evaluation of occupational therapy practices, the Canadian context of family homelessness, and the cultural safety of occupational therapy interventions.