WEIGHTMAN et al

• Published in: Campbell systematic review 2023-06, Vol.19 (2)
• Main Authors: Weightman, Alison L, Kelson, Mark J, Thomas, Ian, Mann, Mala K, Searchfield, Lydia, Willis, Simone, Hannigan, Ben, Smith, Robin J, Cordiner, Rhiannon
• Format: Article
• Language: English
• Subjects: Analysis; Assertive community treatment; Benefits; Bias; Case management; Caseworker Approach; Clinical outcomes; Community; Cost analysis; Cost Effectiveness; Daily Living Skills; Drug use; Educational Needs; Emotional intelligence; Employment; Evidence; Health education; Health problems; Homeless people; Housing; Implementation; Independent living; Intervention; Life expectancy; Meetings; Mental disorders; Mental health; Meta Analysis; Physical Health; Substance abuse; Systematic review; Well being
• ISSN: 1891-1803
• DOI: 10.1002/cl2.1329

BackgroundAdequate housing is a basic human right. The many millions of people experiencing homelessness (PEH) have a lower life expectancy and more physical and mental health problems. Practical and effective interventions to provide appropriate housing are a public health priority.ObjectivesTo summarise the best available evidence relating to the components of case-management interventions for PEH via a mixed methods review that explored both the effectiveness of interventions and factors that may influence its impact.Search MethodsWe searched 10 bibliographic databases from 1990 to March 2021. We also included studies from Campbell Collaboration Evidence and Gap Maps and searched 28 web sites. Reference lists of included papers and systematic reviews were examined and experts contacted for additional studies.Selection CriteriaWe included all randomised and non-randomised study designs exploring case management interventions where a comparison group was used. The primary outcome of interest was homelessness. Secondary outcomes included health, wellbeing, employment and costs. We also included all studies where data were collected on views and experiences that may impact on implementation.Data Collection and AnalysisWe assessed risk of bias using tools developed by the Campbell Collaboration. We conducted meta-analyses of the intervention studies where possible and carried out a framework synthesis of a set of implementation studies identified by purposive sampling to represent the most ‘rich’ and ‘thick’ data.Main ResultsWe included 64 intervention studies and 41 implementation studies. The evidence base was dominated by studies from the USA and Canada. Participants were largely (though not exclusively) people who were literally homeless, that is, living on the streets or in shelters, and who had additional support needs. Many studies were assessed as having a medium or high risk of bias. However, there was some consistency in outcomes across studies that improved confidence in the main findings.Case Management and Housing OutcomesCase management of any description was superior to usual care for homelessness outcomes (standardised mean difference [SMD] = −0.51 [95% confidence interval [CI]: −0.71, −0.30]; p