Benefits and barriers of providing in-home behavioral health services to chronically homeless adults

In-home intensive outpatient behavioral health treatment offers a viable alternative to traditional outpatient services. The Access to Wellness (ATW) project offers in-home substance abuse, mental health and health advocacy treatment services to chronically homeless adults recently housed in permanent supportive housing, many with long term behavioral and physical health problems. By the end of YR2, 34 clients were referred for substance use treatment, 65 clients were referred for mental health treatment, and 58 clients were referred for health advocacy treatment, with 94.1%, 50.8% and 56.9% service utilization rates, respectively.

From May to November 2013, program evaluators conducted a multipronged qualitative study to determine the benefits and barriers of providing in-home treatment services. Evaluators held a focus group with clients enrolled in the ATW program, which was audiotaped, transcribed and coded for analysis. Topic areas included in-home vs. traditional counseling, harm reduction vs. abstinence-only models, treatment readiness, ancillary service opportunities, challenges, recommendations, etc.

Clients reported a greater number of benefits than barriers to receiving treatment in their homes. The only barrier reported was a concern for the clinicians’ safety when traveling through the clients’ neighborhoods. Benefits included convenience, affordability, increased treatment adherence, and maintaining their own personal safety. While clients reported many benefits to receiving in-home treatment services, they also had recommendations to improve similar supportive housing programs in the future, including employment, volunteer and skill-building opportunities. Findings from this qualitative study can inform the development of service delivery models for future supportive housing programs.