Academic journal article Social Work

Helping Homeless Individuals with Co-Occurring Disorders: The Four Components

Academic journal article Social Work

Helping Homeless Individuals with Co-Occurring Disorders: The Four Components

Article excerpt

Helping vulnerable client populations has long been a major mission of the social work profession (National Association of Social Workers, 2008). Homeless individuals with co-occurring disorders (CODs) of severe mental illness (SMI) and substance use disorder (SUD) are one of the most vulnerable client populations. Compared with homeless individuals without CODs, SMI, or SUD, who often are just transitionally homeless, individuals with CODs are more likely to experience chronic homelessness (Caton, Wilkins & Anderson, 2007; Kuhn & Culhane, 1998). Compared with individuals with CODs, SMI, or SUD who are not homeless, Homeless individuals with CODs, SMI, or SUD are less likely to engage in treatment and to recover from their diseases. Social workers may come across chronically homeless clients in various practice fields. During 2008, among the 642,000 positions held by social workers, 46 percent were in family, school, and child social work; 22 percent were in public health and medical social work; 21 percent were in substance abuse and mental health social work; and 11 percent were in other types of social work (Bureau of Labor Statistics, n.d.). Practitioners in all four fields, though particularly the public health and medical field and the mental health and substance abuse field, are likely to encounter, directly or indirectly, homeless clients with CODs and related challenges. It is critical that both social work students and practitioners be equipped with knowledge and skills to help this client population.

This article discusses strategies for helping homeless individuals with CODs on the basis of a literature review. Relevant articles were located via database searches of PubMed, PsycINFO, and Social Work Abstracts, using the key words "homeless individuals," "homelessness," "housing," "co-occurring disorders," "dual diagnosis," "mental disorders," "schizophrenia," "bipolar," "substance abuse," "substance dependence," "substance use disorders," and "treatment," plus the reference lists of located articles. Because research on the homeless population with CODs and SMI using randomized controlled trials (RCTs) is still very limited (Caton et al., 2007), all relevant located studies on the homeless population with CODs that used various levels of designs--for example, RCTs; meta-analyses; quasi-experimental designs; observational studies; qualitative studies; the 'consensus of expert clinicians,' in a few sources in which research evidence was combined with consistent expert opinion (Burt et al., 2004; Caton et al., 2007; Center for Substance Abuse Treatment [CSAT], 2005; Ziedonis et al., 2005)--were adopted. Rog (cited in Caton et al., 2007, p. 4-12) stated that although studies may fall short of the most rigorous standard, "when [they] produce a consistent pattern of findings, may also be considered as additional evidence to determine whether an intervention is considered evidence based." Four components emerged from the review of the study findings: (1) ensuring effective transition, (2) increasing resources via government entitlements and supported employment (SE), (3) providing linkages to housing, and (4) offering COD treatment.


Reducing the flow of at-risk individuals being released from institutions (for example, psychiatric hospitals, substance abuse treatment programs, correctional facilities, foster care) into the community without receiving proper transitional services is critical to reducing homelessness among individuals with CODs (Burt et al., 2004). The literature contains six strategies for more effective transitions, with the enhancement of continuity of care being common feature (Compton et al., 2003).

Establishing Rules Regarding Discharge Planning

State and local agencies should establish rules to ensure a well-executed discharge plan that links an institution that discharges an individual with the community that takes in the individual (Burt et al. …

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