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Services and supports for individuals with co-occurring disorders and long-term homelessness
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People who experience chronic homelessness typically experience co-occurring mental health and substance use disorders as well. The Federal Collaborative to Help End Chronic Homelessness (CICH) was created to serve people with co-occurring disorders (COD) as they transition from homelessness to permanent-supported housing. Eleven sites across the United States were funded and this paper describes the strategies used by those sites. The findings of the study are based on observations of the program team leaders, administrators, and clients. This paper presents those findings and organizes them around three central themes: characteristics and needs of CICH clients with COD, strategies employed to respond to those needs, and challenges associated with implementing an integrated approach to COD. Some characteristics of clients include histories of untreated or irregularly treated mental health and substance use disorders. These CODs are often further complicated by trauma and chronic illness. Program teams used and approved an assortment of services and supports for their clients with COD and these services included stabilization, motivational techniques, and trauma-informed interventions. Challenges arose and included challenging client behavior, insufficient staffing and community resources, and the extended time needed for change to occur with this population. The paper concludes with recommendations for further research into the effectiveness of various combinations of service strategies for people who are chronically homeless and have COD in non-traditional settings during the earliest stage of recovery. Workforce and system-level barriers to providing integrated care must also be overcome.
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A program of the U.S. Department of Health and Human Services Substance Abuse & Mental Health Services Administration, Center for Mental Health Services