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Co-Occurring Disorders and Homelessness

Developing the Workforce to Serve Individuals with Co-Occurring Disorders who are Homelessness

Workforce development and training are essential for developing a service system that can provide integrated care for individuals with co-occurring mental and substance use disorders who are experiencing homelessness. Key issues in developing a workforce are:

  • Practitioner attitudes and values
  • Staff support for burnout and compassion fatigue
  • Staff competencies
  • Professional development

Burnout and frustration can be high among the co-occurring disorders and homeless services workforce at the direct-care level. Workers may:

  • Have difficulty engaging individuals in services
  • Work in non-traditional settings
  • Manage relationships with multiple systems in order to meet multiple needs
  • Confront negative public attitudes

Avoid burnout and staff turnover

Factors that influence staff turnover include job autonomy, good internal communication within the agency, recognition and rewards for performance, onsite learning opportunities for skill building, and streamlining paperwork. Recommendations for avoiding staff burnout include:

  • Working in a team structure rather than in isolation
  • Providing formal opportunities to discuss feelings and issues with other staff who handle similar cases
  • Maintaining a manageable caseload
  • Developing and using a support network

Agencies can help decrease staff turnover by:

  • Hiring staff who have familiarity with mental and substance use disorders and have a positive attitude for those they serve
  • Hiring staff who can think independently, remain flexible and open to new ideas, work collaboratively, and engage in creative problem-solving
  • Providing staff with a framework of realistic expectations for progress
  • Providing opportunities for consultation among all staff, including medical providers, who share service delivery to the same individuals
  • Providing structured opportunities for staff input into program design and implementation
  • Providing a desirable work environment through appropriate compensation, incentives for co-occurring disorders expertise, involvement in quality improvement or clinical research, training and career advancement, and efforts to adjust workloads.

Effective Workforce Models

Individuals with co-occurring disorders who are experiencing homelessness have a range of medical and social issues that require services such as life skills development, employment assistance, and housing. As such, multidisciplinary teams have long been a hallmark of the Health Care for the Homeless (HCH) model of care. The HCH workforce that provides treatment, care, and support to individuals who are homeless and have co-occurring disorders is often a team comprised of behavioral health specialists, nurses, social workers, psychiatrists, case managers, housing specialists, outreach workers, peer specialists, and primary care providers & physicians, nurse practitioners, and physician assistants.

Treatment Innovations

The increased prevalence of co-occurring disorders among individuals experiencing homelessness and the need to provide services to this growing population has led to treatment innovations and research on service delivery models. Both systems integration and comprehensive services, such as Assertive Community Treatment (ACT) and Intensive Case Management (ICM), are deemed essential and effective when addressing the needs of this population. In addition, since a major challenge is how to engage individuals experiencing homelessness in treatment, street outreach is an essential service.

Peer Support

Individuals in recovery from co-occurring disorders play an increasingly important role in helping their peers to recover by reaching their peers who are reluctant to seek help. Shared experiences may ease the engagement process. Staff in recovery enhance the sensitivity of the system to the needs of their peers. Unique characteristics of staff in recovery from co-occurring disorders and those who have been homeless include:

  • Their knowledge of the service system
  • Their knowledge of the skills and experiences of individuals who are homeless
  • Their creativity, flexibility, and ability to develop alternative approaches
  • Their ability to establish rapport with individuals experiencing homelessness

Resources and Links

  • This site links to the Consumer Advisory Board Manual, which is intended to strengthen consumer involvement in homeless health services, and invites homeless individuals to become active at the local and national levels. Opportunities include scholarships to attend the annual health care for the homeless conference, participating in consumer-led research projects, joining the National Consumer Advisory Board, and nominating a peer for national recognition for his or her advocacy work.

  • This journal article studies the challenges of work in homeless services, forming a workforce development strategy, and looks at the question of what is the size and qualification of the workforce needed to provide homeless services in the future.