Dyadic Case Management as a Strategy for Prevention of Homelessness Among Chronically Debilitated Men and Women with Alcohol and Drug Dependence

Abstract

Background: The PROUD Homelessness Prevention Project of Arapahoe House, Inc. in Denver, Colorado uses a pair or dyad of case managers to address the individualized client needs of a target population characterized chiefly by chronic utilization of public detoxification services. The local political and economic contexts affecting this population include a recent increase in poverty and decreased housing available to seriously debilitated individuals. Created in 1992, PROUD has expanded its housing services to address homelessness more fully. Target Population and Theory of Treatment: PROUD clients exhibit substance dependence, co-occurring mental health disorders, and tend to be homeless or at serious risk of homelessness. Clients are primarily white males with a high-school education and an average age of 39. Based on a Stages of Change model and intensive case management theories, the PROUD dyadic case management model was innovated by Arapahoe House. This model is hypothesized to offer a cost-effective managed-care strategy for reducing overutilization while simultaneously coordinating a more optimal mix of substance-abuse and housing services. Description of the Intervention and Development of the Program: The primary long-term objectives for PROUD clients are stabilized housing and ability to maintain treatment goals. The intervention model focuses on intensive contact with clients. Contact includes recruitment, engagement, relationship- and skills-building, housing stabilization, and advocacy. Individualized treatment and follow-up plans are designed to motivate clients, reduce individual risk factors, and strengthen protective factors. Careful recruitment of case managers and the use of a multidisciplinary team to design, revise, and implement the logic model are essential. Evaluation Design: The research design for evaluating the effectiveness of this strategy in preventing homelessness with the target population calls for random assignment of clients into the PROUD program or into a course of customary services. Data were collected from clients in both groups by trained research interviewers at the point of enrollment and at six and twelve months after enrollment. Preliminary Findings on Program Implementation: Informal evaluations have shown PROUD to be effective in reducing the number of days and the number of episodes of detoxification. The current more rigorous evaluation should provide information about the efficacy of the dyadic case management model to reduce homelessness and increase sobriety. Lessons Learned and Implications: Listening to client feedback and learning to present clear, complete information to them is crucial for the client/case manager relationship. Development of internal housing expertise and options and careful supervision of the dyads also helps to provide sound housing alternatives for clients.