Critically review current research on evidence-based and contemporary best practices to improve practice, policy, and programs
Below is an excerpt from “Empowering Change: Addressing Homelessness, Unemployment, and Substance Abuse Among Women in Hamilton County” by Connie Bradshaw, Kaitlyn Deaux, Madison Griswold, and Amy Mejias for SOCW 612: Advanced Administrative Practice: Program Development, representing the review of literature that our group had done for the project using a trauma informed approach. This literature was reviewed using the social work knowledge of advocacy and knowledge of community based interventions. The review of this literature, encompassed many of the social work values including social justice, dignity and respect for individuals, and competence. The cognitive process used was evaluation and the affective process used was receiving.
The full paper can be found here.
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Literature Review
Social Problem
In their investigation of the complex problem of homelessness among adults, Chamberlain and Johnson (2013) identified and classified five separate vectors that ultimately contribute to homelessness. Pathways like this include homelessness, broken families, drug misuse, mental health issues, and coming of age. The variables contributing to different homelessness durations along these routes are also investigated. Notably, those whose homelessness was precipitated by a housing issue or a family breakup had shorter bouts of homelessness because they were less likely to integrate into the homeless community and embrace it as a way of life. However, people on the drug addiction or youth-to-adult transition routes often interact with members of the homeless subculture, making it more difficult for them to overcome their homelessness permanently. Long-term homelessness is a reality for those who pursue a mental health treatment route, but this is not condoned in the research. These results highlight the intricate web of variables contributing to homelessness (Chamberlain and Johnson, 2013).
Substance Abuse & Homelessness
Substance abuse disorders can occur among a variety of individuals, but they tend to increase in the homeless population as there is limited treatment offered in homeless shelters. According to recent research published by American Addiction Centers (2023), there is a strong correlation between homelessness and drug usage. This statement highlights the fact that individuals struggling with homelessness and addiction frequently have a hard time obtaining the treatment they need. Substance misuse often occurs among the homeless population as a coping mechanism against the hardships of being homeless. At the same time, substance abuse is a factor in the foreclosure of many American houses. Many people who are homeless also face the effects of several mental health diagnoses. Individuals experiencing homelessness who have drug use problems do not know where to turn for assistance, and many can not afford the treatment. The article’s data shows that substance abuse is particularly common among the homeless, underscoring the need for comprehensive assistance and intervention programs (American Addiction Centers, 2023).
Lee et al. (2017) studied how homelessness affects people’s mental health, drug misuse, and suicidal thoughts and actions. There is a strong correlation between anxiety and suicidal thoughts and between substance misuse and suicidal ideation. According to their results, in order to lower suicide rates among the homeless, the research emphasizes the need for screening for mental health and drug misuse concerns and offering appropriate treatment options inside homeless shelters (Lee et al., 2017).
Observing 156 adults who had substance abuse issues as well as anxiety, the increase in suicidal ideation was more than their counterparts who were only receiving treatment for drug abuse. The researchers emphasized that case managers should be aware of and offer treatment for co-occurring mental illness and drug abuse disorders. With both mental illness and drug abuse disorders, there was a significant increase in suicidality (Lee et al., 2017).
Many who develop a substance use disorder do so when they are at their most vulnerable. Turning to drugs or alcohol is one way the homeless cope with the stress of the world. A study done before and after the COVID-19 pandemic found that drug and alcohol use was at an all-time high among the homeless population (Scarlett et al., 2022). Despite the lack of data from the United States, a study pooled from France gave insight into the relationship between homeless shelters and substance abuse. The study concluded that out of the 1,564 participants pulled from various shelters around France, 530 participants were on the line of being diagnosed with a substance use disorder (Scarlett et al., 2022). The researchers found this to be an all-time high compared to only 319 participants the year before in the spring of 2019. The numbers are still significant and what Scarlett et al. (2022) also found was a strong correlation between depression and substance abuse.
One unique study by Kelleher (2013) examined the homeless population using libraries as a place to stay in central Michigan. Kelleher (2013) interviewed the population and found that most of the individuals using the libraries were homeless due to losing their homes, and the library was a safe place for them. They could use the computers and read to pass the time. One issue that Kelleher (2013) found with individuals using the libraries was that many of them were drug dependent and unable to get into a shelter due to their drug abuse (Kelleher, 2013). Due to the drug abuse, many of the families that were denied transitional housing did not feel safe staying in the libraries for very long. This study showed the negative effects of not having different types of shelters and how the large homeless population manages the unpredictability of housing (Kelleher, 2013).
Along with substance abuse in the homeless population, the prevalence of substance use disorders (SUD) among women who are homeless and visit Health Care for the Homeless clinics for primary care is investigated in depth by Upshur et al. (2017). Their research shows alarmingly high rates, with alcohol use disorders being four times more common and drug use disorders being twelve times more common than the overall female population (Upshur et al., 2017). The results highlight the critical importance of substance use disorder (SUD) and mental health care for women experiencing homelessness and emphasize the need for better screening, payment, professional training, and de-stigmatization to reduce health inequities among this group.
Miniguide from the European Monitoring Centre for Drugs and Drug Addiction (2023) focused on health and social responses to drug issues among homeless persons. It is a component of a bigger series that discusses how homelessness and substance abuse are related and what factors should be considered while formulating solutions. This resource analyzed the current options and their efficacy in the European setting. The article highlighted the relevance of treating drug use concerns among homeless people in Europe. Possible topics include effective methods and policy implications for helping addicts living on the streets and also highlight the urgent need for extensive assistance programs and initiatives in the United States and Europe to deal with the intertwined problems of homelessness and drug misuse.
Homelessness In Women
Women who are in danger of homelessness are the focus of Rizzo et al.’s (2022) research on why they are underrepresented in addiction treatment facilities. According to the study’s findings, women’s reluctance to seek addiction treatment stems mostly from concerns about shame, stigma, and legal and social implications, such as participation with child protective services. The research also delved into the logistical and practical issues that prevent women experiencing homelessness from actively seeking treatment. The qualitative study conducted by the authors included the perspectives of physicians, care providers, and women who have experienced both addiction and homelessness. Their results highlighted the complexities of barriers to addiction treatment that women at risk of homelessness encounter. The findings of this study have important implications for physicians, service providers, and future research aimed at expanding and increasing this population’s access to addiction treatment (Rizzo et al., 2022).
According to a study by Bassuk and Beardslee (2014), homeless moms had alarmingly high rates of severe depressive illness. This research highlighted the negative effects of parental depression on the health of homeless children. This paper argued that this under-recognized public health risk necessitates preventative and rehabilitative treatments tailored to low-income and homeless moms. To lessen the impact that mother depression has on homeless families, the authors proposed an interdisciplinary strategy that prioritizes trauma-informed services, culturally competent parenting support, and child-centered environments.
The complicated link between spousal abuse and female homelessness is explored by Tutty et al. (2013). The authors interviewed 62 battered women in Canada to show how partner violence leads to homelessness for many of them, even when they try to find safety in shelters. The report emphasized the need of comprehensive support networks for women experiencing homelessness and abuse and underscores the urgent need for legislative changes to address these concerns.
Slesnick and Erdem (2013) looked at the effectiveness of combined treatment of homeless mothers struggling with substance abuse that are caring for their young children. The study found that the mothers who received rental assistance along with supportive services such as substance abuse treatment and regular case management increased their housing stability and provided recovery from using substances. The study showed a decrease in substance use once women were stably housed along with supportive services.
Mental health can also affect homeless mothers specifically as they have a strong desire to protect their family (Bassuk & Beardslee, 2014). Depression is strongly correlated with mothers in shelter due to the stress of not being able to care for their family as they would have liked as well as being unable to care for their children. This depression can make it more difficult for a woman to get out of homelessness as well as receive treatment (Bassak & Beardslee, 2014). Mental Illness in the Homeless Population
The research by Bassuk and Beardslee (2014) brings attention to an underrecognized public health issue: maternal depression among the homeless population. According to the findings, the prevalence of major depressive illness among homeless moms is much higher than in the general population. Homelessness makes it difficult for these women, yet they still have to provide for and care for their children. Researchers found that homeless children were more likely to have mothers who were depressed. The authors advocate for a systemic strategy, recommending that preventative and rehabilitative programs for low-income and homeless women and their children be adapted and evaluated. The proposed recommendations emphasized providing trauma-informed care, providing parents with culturally appropriate assistance, and designing environments with the needs of children in mind. The findings of this study highlighted the need to address maternal depression among the homeless population and highlight the need for specific assistance programs.
The government Collaborative Initiative on Chronic Homelessness (CICH) program provides comprehensive housing and healthcare services, and Mares and Rosenheck (2011) examined the treatment results of individuals receiving these services. The individuals in this research are compared to chronically homeless people who are getting the standard level of care in their area. According to the findings, CICH clients had better housing results than those who did not recieve the program’s services, which included rigorous case management, healthcare, and treatment for mental health and drug misuse. There were no statistically significant differences between the two groups in terms of drug use, community integration, or health status, although CICH clients reported increased utilization of healthcare services such as outpatient visits for medical, mental health, and substance abuse treatment. While the results showed that increased access to housing and healthcare has a good effect on long-term stability for the homeless, they also imply that drug abuse and health status remain difficult concerns to address for this population (Mares & Rosenheck, 2011).
Neale et al. (2022) research shed light on the complex relationship between drug abuse and homelessness. The study, which was conducted during the COVID-19 epidemic, observed how homeless people’s usage of tobacco, alcohol, and illegal narcotics changed over time. As part of the United Kingdom’s policy reaction to the epidemic, 34 people staying in hotels in London were interviewed over the phone for this research.
The results showed that individuals engage in a wide range of drug use behaviors, exhibiting a spectrum of the severity of issues. The elements that influence changes in drug use are also identified, including individual, social, and environmental influences. The findings of this study highlighted the need to address drug use dynamics among the homeless within the framework of homelessness policy and practice and offer insight into the complexity of this problem (Neale et al., 2022).