Housing Outcomes & Predictors of Success: The Role of Hospitalization in Street Outreach
SUMMARY:
What
is known on the subject?
- Outreach services are often successful in engaging and
housing street homeless individuals. People experiencing homelessness have
greatly increased rates of mental illness and substance abuse.
What this paper
adds to existing knowledge?
- Given the relative lack of research involving
street homeless individuals, this retrospective chart review examined factors
associated with successful housing by a multidisciplinary street outreach team,
including the use of hospitalization as an intervention within a housing first
framework. The majority of clients were successfully housed by the end of
outreach team involvement. An admission to hospital was strongly associated
with successful housing for those with a psychotic disorder.
What are the
implications for practice?
- Multidisciplinary outreach teams, specifically those
with psychiatric and nursing support, successfully work with and house people
experiencing street homelessness and psychosis. Mental health nurses embedded
in the community are an essential link between inpatient and outpatient care
for highly vulnerable street homeless individuals.
ABSTRACT:
Introduction
Housing-first strategies have helped establish housing as a human right.
However, endemic homelessness persists. Multidisciplinary outreach teams that
include nursing, social and psychiatric services allow for integrative
strategies to engage and support clients on their housing trajectory.
The
following retrospective review focused on the identification of demographic,
clinical, and service characteristics that predicted the obtainment of housing,
and explored the role of psychiatric hospitalization as an intervention, not an
outcome measure, in contrast to previous studies. These have rarely focused on
street homelessness.
Method
A retrospective chart review of 85 homeless,
primarily rough-sleeping, clients was conducted to determine housing outcomes
and the factors associated with obtaining housing through care provided by a
psychiatric street outreach team in Toronto, Canada. Demographics, homelessness
duration, diagnosis, hospitalization and housing status were tracked during
team involvement.
Results
Overall, 46% (36/79) were housed during the study
term. Securing housing at the end of treatment/data collection was
significantly enhanced by hospitalization. It was significantly diminished by psychosis and prior homelessness >36 months . Twenty-three of 31 (74%)
hospitalized clients with psychosis were subsequently housed, compared to 4 of
30 (13%) not hospitalized.
Discussion
Multidisciplinary street outreach teams successfully house long-standing
homeless clients (>12 months without a permanent address) with serious
mental illness and/or substance abuse. Hospitalization can be utilized as a
complimentary intervention, particularly for those with psychosis, in the
continuum of housing first initiatives, and can contribute to securing housing
for those with persistent psychotic disorders.
Implications for nursing
practice Community mental health nurses are uniquely positioned to translate
care between hospital and community settings, ensuring timely assessment,
intervention and treatment of clients who are historically difficult to engage.
- 1Department of Nursing, University of Toronto, Toronto.
- 2Department of Psychiatry, University of Toronto, Toronto.
- 3Department of Economics, University of Toronto, Toronto.
- J Psychiatr Ment Health Nurs. 2016 Mar;23(2):98-107. doi: 10.1111/jpm.12287.
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