Integrating co-occurring mental health and substance use disorder wraparound services within a Housing First framework

Objectives: Describe our experiences and lessons learned in integrating Housing Fist (HF) alongside an established co-occurring mental health and substance use disorder (COD) wraparound support intervention.

Methods: Between 2011 and 2014, MISSION, a flexible 12-month, wraparound intervention developed to treat COD among chronically homeless individuals, was delivered to 121 participants.  Baseline assessments included ASI, BASIS-32, and GPRA. Service delivery records were completed throughout the project to measure fidelity to MISSION.  Qualitative interviews are being completed with a subset of clients (n=15), frontline staff and other stakeholders (n=10) to explore barriers and facilitators to integrating HF principles within MISSION.

Results:  Participants had been homeless for an average of 8.16 years, reported long-term alcohol use (mean=13.39 years), and drug use (mean=15.82 years).  Common mental health issues included depression (83%), and anxiety (83%).  More than half had been prescribed psychiatric medications (62%), and nearly ⅓had attempted suicide (31%). After 6 months of services, 71.6% of clients were housed compared to 2.3% at baseline (n=88).  Preliminary qualitative data suggests that clients preferred to receive housing before COD treatment.  Detailed demographic, housing, and treatment needs data, and a summary of the qualitative interviews, will be included in the presentation.

Conclusions: Given the increasing popularity of HF, many programs providing COD treatment to homeless populations might want to consider incorporating HF into their practices.  MISSION augments HF by initiating needed COD treatment support alongside the housing placement process.  This is particularly important as ongoing treatment and wraparound supports are necessary to help sustain housing stability.