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SAMHSA recently released TIP 55: Behavioral Health Services for People Who Are Homeless. It is intended as a comprehensive protocol for behavioral health professionals who want to effectively treat clients who experience homelessness. Dr. Hunter McQuistion, who led the team that developed the protocol, shares TIP 55’s intent and goals.
Best Practices, Best Outcomes

The Substance Abuse and Mental Health Services Administration (SAMHSA) has just released TIP 55: Behavioral Health Services for People Who Are Homeless. The treatment protocol offers comprehensive support to both service providers and program administrators who want to provide effective behavioral health services to clients who are experiencing homelessness.
Dr. Hunter McQuistion led the team that produced the improved treatment protocol, TIP 55: “This is one of the first real efforts to pull together the science and the craft for behavioral health services providers to work with the homeless population in a comprehensive way. SAMHSA culled experts in the field, both academics and providers, to agree on specific topics and work together in a collegial and supportive way.”
Dr. McQuistion is the Director of the Division of Outpatient & Community Psychiatry in the Department of Psychiatry and Behavioral Health at The St. Luke’s and Roosevelt Hospitals in New York City. He was formerly the Chief Medical Officer for Mental Hygiene Services in the New York City Department of Health and Mental Hygiene and Medical Director of Project Renewal, Inc., a New York City nonprofit offering comprehensive services for homeless adults.
Dr. McQuistion notes that the new protocol has three parts to it: one for service providers to increase their knowledge base and analytical skills, one for program administrators to effectively support their providers and come up with ideas for serving populations in their area, and, finally, a literature review for anyone who wants to gain a deeper knowledge, either generally or specifically.
“I think the part we are proudest of are the case studies we developed for TIP 55. The case studies bridge the gap between the theoretical and the practical, and between administrators and service providers, to provide a deeper understanding of the issues in effectively treating people who are homeless, including co-occurrence of mental health issues and substance abuse,” Dr. McQuistion said. The experts compiling the protocol role-played—based upon their own extensive and specific experiences—and provided proven strategies for dealing with common problems. “We think these case studies may be the most helpful and useful part of TIP 55 for workers providing direct service to homeless populations.”
What the Behavioral Health Service Provider can expect from TIP 55
For the service provider, the information in TIP 55 is both broad and deep. It includes information about homelessness and its common myths; a self-assessment of the provider’s own attitudes about homelessness; a review of the theoretical framework embodying Stages of Change, Critical Stages of Recovery, and Stages of Homelessness Rehabilitation; clinical interventions and strategies; and even advice about how not to get burned out on the job. Above all else, it stresses the need to be flexible, constantly listening to and evaluating the client as a person to best identify their strengths and serve their specific needs at this time, along with the crucial need to collaborate with other service providers to find the most effective solution for a client.
TIP 55 goes into considerable detail about each stage of service, including:
  • Outreach
  • Initial screening and evaluation
  • Early interventions and stabilization
  • Treatment and prevention planning
  • Case management
  • Client retention and maintenance of continuity of care
  • Relapse prevention and recovery management
What the Program Administrator can expect from TIP 55
Many program administrators are knowledgeable and experienced at providing behavioral health services, but want information about the best way to effectively help people who are experiencing homelessness. TIP 55 provides ideas and strategies for program development and implementation that are effective for the homeless population. Providing effective treatment programs for people who are experiencing homelessness can open up opportunities to better serve other client populations these organizations currently serve.
“We really tried to gather together all the best practices in a single document,” said Dr. McQuistion.  “The information in TIP 55 is practical and comprehensive, and it provides real, usable tools for both clinicians and program administrators to effectively support different subpopulations in different stages of change. Plus, the literature review has literally hundreds of citations, so anybody can go as deep as they want to, either in a general sense or for very specific concerns, with the best science available. It is all there.”

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