The COVID-19 pandemic hit all of us very hard, but it has hit the most vulnerable among us even harder. Among these, we count the homeless and people who are precariously housed. These people are at increased risk of COVID-19 infection due to risk factors related to underlying medical conditions, but also their difficulty in adhering to public-health guidelines such as physical distancing and confinement due to their housing conditions.(1)
Homelessness and housing insecurity are affecting many people. This is the experience of more than 35,000 people every day in Canada. Each year, it is estimated that more than 235,000 people will experience homelessness in the country. The number of homeless people aged 50 and over continues to increase. They represent 24.4% of homeless shelter users.(2)
Supporting people who are homeless or who are precariously housed remains a complex issue, even more so in the context of a pandemic. Various support strategies could be put in place, including the use of case managers.
According to the Canadian Observatory on Homelessness, case management is a collaborative, planned approach to ensure that a person experiencing homelessness gets the services and supports they need to move forward in life. Case management strategies often come from the mental health and addiction sector. A case manager assesses the needs of their client (and possibly their family) and, when necessary, organizes, coordinates and advocates for the delivery of a range of programs and services designed to meet the needs of their client, and ensures access to them.
Do these case management interventions have beneficial effects for people who are homeless or precariously housed?
What research tells us
A systematic review of 56 studies examined the effectiveness of four types of interventions with homeless or precariously housed people in relation to housing stability, mental health, quality of life, drug addiction, hospitalization , employment and income.(3)
Across the continuum of services, four key models of case management exist: standard case management, intensive case management, critical time intervention, and assertive community treatment. Although these interventions are varied in terms of definition, complexity, target populations, and modes of delivery, the results show that case management must be continuous, community-based and intensive in order to maintain or increase gains obtained.
Let's take a closer look at the four types of case management:
1. Standard case management aims to provide a set of health and social services to help the person maintain good health and social relationships. This approach involves client engagement, assessment, planning, linkage with resources, consultation with their families, collaboration with the various professionals involved and crisis intervention. Studies that have examined such an approach reveal that standard case management can have limited and short-term effects on substance abuse and housing. However, some clients may experience increased hostility and depression.
2. Intensive case management targets people with more complex, serious and persistent health, mental health and addiction problems to help them maintain their housing, access services and achieve a better quality of life, with long-term support of a 24/7 case manager. Studies show that such an approach appears to have positive effects, including a reduction in the number of days spent homeless, reduced substance abuse, and improved income.
3. Critical time intervention allows for continuity of care during times of transition, such as after discharge from hospital. Such services, limited in time, aim to strengthen the support network of the person within the community and to promote his autonomy. Studies have found that such an approach promotes a slight reduction in psychological symptoms and a reduction in the number of emergency room visits and hospital stays, but also appears to have promising effects on housing stability.
4. Assertive community treatment aims to provide care and services tailored to the needs and goals of each person, intensively through a multidisciplinary team of health workers available 24/7 within the community. Studies show that such an approach helps reduce the number of emergency room visits and hospital days, and appears to be efficient for people with complex needs, from an overall cost and benefit perspective to clients. , the health care system and society as a whole.
Homelessness is not an end in itself
Case management experiences show that the success of such programs depends, among other things, on a relationship of trust with their case manager, but also on interventions chosen according to the specific context and needs of the client.(3)
You too can help!
Get involved and share your ideas: It is possible to get involved in order to advocate for the rights of homeless or precariously housed people, but also to share your ideas in order to find solutions. For example, the Canadian Alliance to End Homelessness is a national coalition of individuals, organizations and communities working together to end homelessness in Canada.
Support your local shelters: Call the homeless shelters in your community to find out their exact needs (whether certain types of clothing, food, or other resources).
Volunteer your time: Homeless shelters across the country depend on volunteers to keep their doors open and keep operations running smoothly.
It is possible to help people get out of homelessness and end housing insecurity if we all put our shoulders to the wheel.