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

Author

Listed:
  • David Ponka
  • Eric Agbata
  • Claire Kendall
  • Vicky Stergiopoulos
  • Oreen Mendonca
  • Olivia Magwood
  • Ammar Saad
  • Bonnie Larson
  • Annie Huiru Sun
  • Neil Arya
  • Terry Hannigan
  • Kednapa Thavorn
  • Anne Andermann
  • Peter Tugwell
  • Kevin Pottie

Abstract

Background: Individuals who are homeless or vulnerably housed are at an increased risk for mental illness, other morbidities and premature death. Standard case management interventions as well as more intensive models with practitioner support, such as assertive community treatment, critical time interventions, and intensive case management, may improve healthcare navigation and outcomes. However, the definitions of these models as well as the fidelity and adaptations in real world interventions are highly variable. We conducted a systematic review to examine the effectiveness and cost-effectiveness of case management interventions on health and social outcomes for homeless populations. Methods and findings: We searched Medline, Embase and 7 other electronic databases for trials on case management or care coordination, from the inception of these databases to July 2019. We sought outcomes on housing stability, mental health, quality of life, substance use, hospitalization, income and employment, and cost-effectiveness. We calculated pooled random effects estimates and assessed the certainty of the evidence using the GRADE approach. Our search identified 13,811 citations; and 56 primary studies met our full inclusion criteria. Standard case management had both limited and short-term effects on substance use and housing outcomes and showed potential to increase hostility and depression. Intensive case management substantially reduced the number of days spent homeless (SMD -0.22 95% CI -0.40 to -0.03), as well as substance and alcohol use. Critical time interventions and assertive community treatment were found to have a protective effect in terms of rehospitalizations and a promising effect on housing stability. Assertive community treatment was found to be cost-effective compared to standard case management. Conclusions: Case management approaches were found to improve some if not all of the health and social outcomes that were examined in this study. The important factors were likely delivery intensity, the number and type of caseloads, hospital versus community programs and varying levels of participant needs. More research is needed to fully understand how to continue to obtain the increased benefits inherent in intensive case management, even in community settings where feasibility considerations lead to larger caseloads and less-intensive follow-up.

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  • David Ponka & Eric Agbata & Claire Kendall & Vicky Stergiopoulos & Oreen Mendonca & Olivia Magwood & Ammar Saad & Bonnie Larson & Annie Huiru Sun & Neil Arya & Terry Hannigan & Kednapa Thavorn & Anne , 2020. "The effectiveness of case management interventions for the homeless, vulnerably housed and persons with lived experience: A systematic review," PLOS ONE, Public Library of Science, vol. 15(4), pages 1-21, April.
  • Handle: RePEc:plo:pone00:0230896
    DOI: 10.1371/journal.pone.0230896
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    References listed on IDEAS

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    1. Jonathan Stokes & Maria Panagioti & Rahul Alam & Kath Checkland & Sudeh Cheraghi-Sohi & Peter Bower, 2015. "Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-42, July.
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    4. Lennon, M.C. & McAllister, W. & Kuang, L. & Herman, D.B., 2005. "Capturing intervention effects over time: Reanalysis of a critical time intervention for homeless mentally ill men," American Journal of Public Health, American Public Health Association, vol. 95(10), pages 1760-1766.
    5. Susser, E. & Valencia, E. & Conover, S. & Felix, A. & Tsai, W.-Y. & Wyatt, R.J., 1997. "Preventing recurrent homelessness among mentally ill men: A 'critical time' intervention after discharge from a shelter," American Journal of Public Health, American Public Health Association, vol. 87(2), pages 256-262.
    6. Shern, D.L. & Tsemberis, S. & Anthony, W. & Lovell, A.M. & Richmond, L. & Felton, C.J. & Winarski, J. & Cohen, M., 2000. "Serving street-dwelling individuals with psychiatric disabilities: Outcomes of a psychiatric rehabilitation clinical trial," American Journal of Public Health, American Public Health Association, vol. 90(12), pages 1873-1878.
    7. Kevin Pottie & Christine M. Mathew & Oreen Mendonca & Olivia Magwood & Ammar Saad & Tasnim Abdalla & Vicky Stergiopoulos & Gary Bloch & Vanessa Brcic & Anne Andermann & Tim Aubry & David Ponka & Clair, 2019. "PROTOCOL: A comprehensive review of prioritized interventions to improve the health and wellbeing of persons with lived experience of homelessness," Campbell Systematic Reviews, John Wiley & Sons, vol. 15(3), September.
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    Cited by:

    1. Alison L. Weightman & Mark J. Kelson & Ian Thomas & Mala K. Mann & Lydia Searchfield & Ben Hannigan & Robin J. Smith & Simone Willis & Rhiannon Cordiner, 2022. "PROTOCOL: Exploring the effect of case management in homelessness per components: A systematic review of effectiveness and implementation, with meta‐analysis and thematic synthesis," Campbell Systematic Reviews, John Wiley & Sons, vol. 18(1), March.
    2. Aliza Moledina & Olivia Magwood & Eric Agbata & Jui‐Hsia Hung & Ammar Saad & Kednapa Thavorn & Ginetta Salvalaggio & Gary Bloch & David Ponka & Tim Aubry & Claire Kendall & Kevin Pottie, 2021. "A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness," Campbell Systematic Reviews, John Wiley & Sons, vol. 17(2), June.
    3. Olivia Magwood & Amanda Hanemaayer & Ammar Saad & Ginetta Salvalaggio & Gary Bloch & Aliza Moledina & Nicole Pinto & Layla Ziha & Michael Geurguis & Alexandra Aliferis & Victoire Kpade & Neil Arya & T, 2020. "Determinants of Implementation of a Clinical Practice Guideline for Homeless Health," IJERPH, MDPI, vol. 17(21), pages 1-18, October.

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