What constitutes effective problematic substance use treatment from the perspective of people who are homeless? A systematic review and meta-ethnography

Joanna Miler,Nicola Ring,Hannah Carver,Tessa Parkes

doi:10.1186/s12954-020-0356-9

Joanna Miler, Nicola Ring + Show 2 more

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https://doi.org/10.1186/s12954-020-0356-9

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Abstract

BackgroundPeople experiencing homelessness have higher rates of problematic substance use but difficulty engaging with treatment services. There is limited evidence regarding how problematic substance use treatment should be delivered for these individuals. Previous qualitative research has explored perceptions of effective treatment by people who are homeless, but these individual studies need to be synthesised to generate further practice-relevant insights from the perspective of this group.MethodsMeta-ethnography was conducted to synthesise research reporting views on substance use treatment by people experiencing homelessness. Studies were identified through systematic searching of electronic databases (CINAHL; Criminal Justice s; Health Source; MEDLINE; PsycINFO; SocINDEX; Scopus; and Web of Science) and websites and were quality appraised. Original participant quotes and author interpretations were extracted and coded thematically. Concepts identified were compared to determine similarities and differences between studies. Findings were translated (reciprocally and refutationally) across studies, enabling development of an original over-arching line-of-argument and conceptual model.ResultsTwenty-three papers published since 2002 in three countries, involving 462 participants, were synthesised. Findings broadly related, through personal descriptions of, and views on, the particular intervention components considered effective to people experiencing homelessness. Participants of all types of interventions had a preference for harm reduction-oriented services. Participants considered treatment effective when it provided a facilitative service environment; compassionate and non-judgemental support; time; choices; and opportunities to (re)learn how to live. Interventions that were of longer duration and offered stability to service users were valued, especially by women. From the line-of-argument synthesis, a new model was developed highlighting critical components of effective substance use treatment from the service user’s perspective, including a service context of good relationships, with person-centred care and an understanding of the complexity of people’s lives.ConclusionThis is the first meta-ethnography to examine the components of effective problematic substance use treatment from the perspective of those experiencing homelessness. Critical components of effective problematic substance use treatment are highlighted. The way in which services and treatment are delivered is more important than the type of treatment provided. Substance use interventions should address these components, including prioritising good relationships between staff and those using services, person-centred approaches, and a genuine understanding of individuals’ complex lives.

Highlights

People experiencing homelessness have higher rates of problematic substance use but difficulty engaging with treatment services
Carver et al Harm Reduction Journal (2020) 17:10 (Continued from previous page). This is the first meta-ethnography to examine the components of effective problematic substance use treatment from the perspective of those experiencing homelessness
In phase 1, we identified our ME research question as: What components of problematic substance use treatment are perceived to be effective by adults who are homeless? Preliminary searching was conducted to ensure the availability of a body of literature to be synthesised

Summary

Introduction

People experiencing homelessness have higher rates of problematic substance use but difficulty engaging with treatment services. There is limited evidence regarding how problematic substance use treatment should be delivered for these individuals. Previous qualitative research has explored perceptions of effective treatment by people who are homeless, but these individual studies need to be synthesised to generate further practice-relevant insights from the perspective of this group. Individuals who are homeless are those without suitable, stable and permanent housing, including those who are sleeping rough, living in hostels, with family/ friends or in residential treatment programmes; living in insecure accommodation; and those living in unsuitable housing [4]. The experience of other adverse events, such as traumatic childhood experiences, imprisonment, institutional care, substance use, relationship breakdowns and mental health problems are associated with increased likelihood of homelessness [7–9]. People experiencing homelessness report poorer physical and mental health than the general population [11]. In the UK, this group are four times more likely to die prematurely; on average, aged 37 years for women, and 42 years for men [12]

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