Co-Occurring Disorders and Homelessness

Training Practitioners to Work with Individuals with Co-occurring Disorders who are Homeless

Practitioners working with individuals experiencing homelessness benefit from specialized training in co-occurring disorders, and practitioners who work with individuals with co-occurring disorders benefit from training about the challenges of homelessness. Training may take a range of forms, from web-based training and lunch talks, to more in-depth advanced training, perhaps working towards a certification.

Basic training for homeless staff

As a place to start, some training resources that explain the special circumstances for serving an individual with co-occurring disorders who is homeless include:

• Addressing Co-occurring Disorders in Non-Traditional Service Settings (PDF) — This overview paper describes some strategies and concepts related to providing services for co-occurring disorders in corrections facilities, community settings, and social welfare settings.
• Health Care for the Homeless Models of Integrated Care  (webinar/PDF) — This webinar profiles how three communities, Salt Lake City, Houston, and Orlando, provide integrated mental health, substance abuse, and physical health services for person experiencing homelessness.
• Integration of SBIRT in Health Care for the Homeless Clinics  (PPT) — This PowerPoint discusses risks associated with alcohol use and related terms, describes the Screening, Brief Intervention, and Referral to Treatment (SBIRT) modalities for alcohol and other drug use disorders, and discusses how to implement SBIRT with homeless individuals.
• Meeting the Challenges of Comorbid Mental Illness and Substance-Related Disorders  (PDF) — This pamphlet is a brief but detailed overview of the prevalence, consequences, and treatment of co-occurring disorders as well as information about applying evidence-based initiatives.

Basic training for behavioral health staff

Standard clinical practice guidelines often fail to take into consideration the unique challenges faced by persons experiencing homelessness. Practitioners with extensive experience caring for individuals who are homeless routinely adapt their practice to foster better outcomes for these patients. Those with less experience working with people who are homeless can increase their "homeless cultural competency" with resources such as:

• Adapting Your Practice: Recommendations for the Care of Homeless Patients  describes clinical practice adaptations for the care of persons experiencing homelessness.

Because of the reluctance of many homeless people to seek treatment for co-occurring disorders, outreach is essential in order to engage those who otherwise might not get care.

• Outreach to People Experiencing Homelessness: A Curriculum for Training Health Care for the Homeless Outreach Workers  - This is an online curriculum about outreaching to people experiencing homelessness for Health Care for the Homeless workers.
  • http://www.samhsa.gov/co-occurring/topics/homelessness/training_subone.aspx
  • http://www.samhsa.gov/co-occurring/topics/homelessness/training_subtwo.aspx
  • http://www.samhsa.gov/co-occurring/topics/homelessness/training_subthree.aspx
• Outreach to People Experiencing Homelessness  (website)- Additional resources about outreaching to people experiencing homelessness can be found at this website, including videos and articles.

For more resources, see below.

Motivational interviewing is a key competency for staff working with homeless individuals with co-occurring disorders. Motivational interviewing is a complex clinical skill that often takes considerable practice to master. In addition to training, ongoing consultations will help practitioners more effectively learn and implement motivational interviewing.

• Motivational Interviewing (website) 
• Motivational Interviewing Training Video: A Tool for Learners (3 DVD set) 
• Motivational Interviewing for Medical Providers: Preparing People for Change (PPT) 
• Video Assessment of Simulated Encounters (VASE-R) (website/PDF/video) 

Another evidence-based practice for individuals with co-occurring disorders who experience homelessness is critical time intervention. Critical Time Intervention provides emotional and practical support during transitions from institutional to community care. Practitioners work with individuals with co-occurring disorders to strengthen their social and service support network. Read more about Critical Time Intervention by clicking here.

Resources and Links

• Poverty, Health Care and Homelessness

  Links to curricula, books, articles, and more.

• Disaster Planning for People Experiencing Homelessness

  Discusses co-occurring disorders within the context of disaster situations.

• Training and Technical Assistance

  Links to regional and national training, onsite training and technical assistance, online learning opportunities, and CME/CEU.