By Thomas Coyne; Sean Quitzau; and Joseph W. Arnett

This publication of Zero Returns to Homelessness, the Bureau of Justice Assistance (BJA), and the Justice Center of the Council of State Governments, provides a reference guide on housing access for practitioners, including state leaders working to address homelessness as part of their Reentry 2030 goals. It details best practices and strategies around reentry housing, building from four essential steps that have worked in neighborhoods around the country as leaders have expanded housing opportunities for people reentering their communities: Collaborate, Assess, Connect, and Expand. Every year, tens of thousands of people experience homelessness as they return to their communities from incarceration. Gaps and barriers, such as housing policies that bar people with conviction histories from renting, persist that reduce even the limited amount of housing people can access when returning. Because of this, people returning from incarceration are almost 10 times more likely to experience homelessness and more often cycle through public systems designed to respond to emergencies and not provide long-term solutions. However, in states such as Ohio, Connecticut, and Utah, communities are making strides in preventing homelessness when people return from incarceration. These communities are working toward a bold, new vision—Zero Returns to Homelessness—which aims to ensure that all returning residents have access to a safe, permanent place to call home.

New York: The Council of State Governments (CSG) Justice Center, 2024. 65p.

By Chris O'Leary, Rob Ralphs, Jennifer Stevenson, Andrew Smith, Jordan Harrison, Zsolt Kiss, Harry Armitage

Background

Homelessness is a traumatic experience, and can have a devastating effect on those experiencing it. People who are homeless often face significant barriers when accessing public services, and have often experienced adverse childhood events, extreme social disadvantage, physical, emotional and sexual abuse, neglect, low self-esteem, poor physical and mental health, and much lower life expectancy compared to the general population. Rates of problematic substance use are disproportionately high, with many using drugs and alcohol to deal with the stress of living on the street, to keep warm, or to block out memories of previous abuse or trauma. Substance dependency can also create barriers to successful transition to stable housing.

Objectives

To understand the effectiveness of different substance use interventions for adults experiencing homelessness.

Search Methods

The primary source of studies for was the 4th edition of the Homelessness Effectiveness Studies Evidence and Gaps Maps (EGM). Searches for the EGM were completed in September 2021. Other potential studies were identified through a call for grey evidence, hand-searching key journals, and unpacking relevant systematic reviews.

Selection Criteria

Eligible studies were impact evaluations that involved some comparison group. We included studies that tested the effectiveness of substance use interventions, and measured substance use outcomes, for adults experiencing homelessness in high income countries.

Data Collection and Analysis

Descriptive characteristics and statistical information in included studies were coded and checked by at least two members of the review team. Studies selected for the review were assessed for confidence in the findings. Standardised effect sizes were calculated and, if a study did not provide sufficient raw data for the calculation of an effect size, author(s) were contacted to obtain these data. We used random-effects meta-analysis and robust-variance estimation procedures to synthesise effect sizes. If a study included multiple effects, we carried out a critical assessment to determine (even if only theoretically) whether the effects are likely to be dependent. Where dependent effects were identified, we used robust variance estimation to determine whether we can account for these. Where effect sizes were converted from a binary to continuous measure (or vice versa), we undertook a sensitivity analysis by running an additional analysis with these studies omitted. We also assessed the sensitivity of results to inclusion of non-randomised studies and studies classified as low confidence in findings. All included an assessment of statistical heterogeneity. Finally, we undertook analysis to assess whether publication bias was likely to be a factor in our findings. For those studies that we were unable to include in meta-analysis, we have provided a narrative synthesis of the study and its findings.

Main Results

We included 48 individual papers covering 34 unique studies. The studies covered 15, 255 participants, with all but one of the studies being from the United States and Canada. Most papers were rated as low confidence (n = 25, or 52%). By far the most common reason for studies being rated as low confidence was high rates of attrition and/or differential attrition of study participants, that fell below the What Works Clearinghouse liberal attrition standard. Eleven of the included studies were rated as medium confidence and 12 studies as high confidence. The interventions included in our analysis were more effective in reducing substance use than treatment as usual, with an overall effect size of –0.11 SD (95% confidence interval [CI], −0.27, 0.05). There was substantial heterogeneity across studies, and the results were sensitive to the removal of low confidence studies (−0.21 SD, 95% CI [−0.59, 0.17] − 6 studies, 17 effect sizes), the removal of quasi-experimental studies (−0.14 SD, 95% CI [−0.30, 0.02] − 14 studies, 41 effect sizes) and the removal of studies where an effect size had been converted from a binary to a continuous outcome (−0.08 SD, 95% CI [−0.31, 0.15] − 10 studies, 31 effect sizes). This suggests that the findings are sensitive to the inclusion of lower quality studies, although unusually the average effect increases when we removed low confidence studies. The average effect for abstinence-based interventions compared to treatment-as-usual (TAU) service provision was –0.28 SD (95% CI, −0.65, 0.09) (6 studies, 15 effect sizes), and for harm reduction interventions compared to a TAU service provision is close to 0 at 0.03 SD (95% CI, −0.08, 0.14) (9 studies, 30 effect sizes). The confidence intervals for both estimates are wide and crossing zero. For both, the comparison groups are primarily abstinence-based, with the exception of two studies where the comparison group condition was unclear. We found that both Assertative Community Treatment and Intensive Case Management were no better than treatment as usual, with average effect on substance use of 0.03 SD, 95% CI [−0.07, 0.13] and –0.47 SD, 95% CI [−0.72, −0.21] 0.05 SD, 95% CI [−0.28, 0.39] respectively. These findings are consistent with wider research, and it is important to note that we only examined the effect on substance use outcomes (these interventions can be effective in terms of other outcomes). We found that CM interventions can be effective in reducing substance use compared to treatment as usual, with an average effect of –0.47 SD, 95% CI (−0.72, −0.21). All of these results need to be considered in light of the quality of the underlying evidence. There were six further interventions where we undertook narrative synthesis. These syntheses suggest that Group Work, Harm Reduction Psychotherapy, and Therapeutic Communities are effective in reducing substance use, with mixed results found for Motivational Interviewing and Talking Therapies (including Cognitive Behavioural Therapy). The narrative synthesis suggested that Residential Rehabilitation was no better than treatment as usual in terms of reducing substance use for our population of interest.

Authors' Conclusions

Although our analysis of harm reduction versus treatment as usual, abstinence versus treatment as usual, and harm reduction versus abstinence suggests that these different approaches make little real difference to the outcomes achieved in comparison to treatment as usual. The findings suggest that some individual interventions are more effective than others. The overall low quality of the primary studies suggests that further primary impact research could be beneficial.

Campbell Systematic Reviews, Volume 20, Issue , June 2024, 65 pages

By Miguel A. Martínez López

To date, there has been no comprehensive analysis of the disperse research on the squatters’ movement in Europe. In Squatters in the Capitalist City, Miguel A. Martínez López presents a critical review of the current research on squatting and of the historical development of the movements in European cities according to their major social, political and spatial dimensions.　

Comparing cities, contexts, and the achievements of the squatters’ movements, this book presents the view that squatting is not simply a set of isolated, illegal and marginal practices, but is a long-lasting urban and transnational movement with significant and broad implications. While intersecting with different housing struggles, squatters face various aspects of urban politics and enhance the content of the movements claiming for a ‘right to the city.’ Squatters in the Capitalist City seeks to understand both the socio-spatial and political conditions favourable to the emergence and development of squatting, and the nature of the interactions between squatters, authorities and property owners by discussing the trajectory, features and limitations of squatting as a potential radicalisation of urban democracy.

London; New York: Routledge, 2019. 294p.

Edited by A. L. Beier and Paul Ocobock

Throughout history, those arrested for vagrancy have generally been poor men and women, often young, able-bodied, unemployed, and homeless. Most histories of vagrancy have focused on the European and American experiences. This is the first book to consider global laws, homelessness, and the historical processes they accompanied. Vagrancy and homelessness are used to examine the migration of labor, social and governmental responses, poverty through charity, welfare, and prosecution. Cast Out includes discussions of the lives of the underclass, strategies for surviving and escaping poverty, the criminalization of poverty by the state, the rise of welfare and development programs, the relationship between imperial powers and colonized peoples, and the struggle to achieve independence after colonial rule.

Athens, OH: Ohio University Press, 2008. 409p.

By Randall Amster

Amster studies the social and spatial implications of homelessness in America. Increasingly, commentators have lamented the erosion of public space, charting its decline along with the rise of commercialization and privatization. A result is the criminalization of homelessness, a phenomenon revealed here through participant observations, informal conversations, and in-depth interviews with street people, city officials, and social service providers. Amster explores the interconnections among: (i) the impetus of development and gentrification; (ii) the enactment of anti-homeless ordinances and regulations; (iii) the material and ideological erosion of public space; (iv) emerging forces of resistance to these trends; and (v) the continuing viability of anti-systemic movements.

New York: LFB Scholarly Publishing, 2004. 235p.

By S. Giora Shoham.

This continuation of Shoham's unique psychoanalytic personality theory of deviance applies its principles and insights to understanding social deviance in a deeper cultural and religious sense. Mining the works of Rank, Ferenzi, Stack Sullivan and many other great personality theorists of the twentieth century, Shoham effortlessly blends them into a deep understanding of existentialist thought to explain the social deviance in others and in ourselves. Shoham's obvious adoration of the Judeo-Christian ethic, linking it directly to internal family relationships and the external cultural and physical world both reassures and threatens.This is a monumental work, as challenging as it is informative and will remain a classic for the ages.

NY. Harrow and Heston Publishers. 2012.

By Catherine Robinson.

This book reveals the ways in which intense chains of disadvantage, incorporating homelessness, are triggered by very early experiences of violence. Drawing on biographic interviews with six men and six women, the book bears witness not only to horrendous repeated experiences of physical and sexual violence, but discusses what may be understood as related multi-dimensional vulnerability in areas such as physical and mental health, education, employment and social connectedness. A picture of the long-term cycles of violent victimisation and homelessness, and their compounding traumatising effects, are made clear and the importance of trauma-informed service delivery is outlined as a key way forward Sydney:

UTS ePress, 2010. 70p.

Edited by A.L. Beier and Paul Ocobock.

Throughout history, those arrested for vagrancy have generally been poor men and women, often young, able-bodied, unemployed, and homeless. Most histories of vagrancy have focused on the European and American experiences. This is the first book to consider global laws, homelessness, and the historical processes they accompanied. Vagrancy and homelessness are used to examine the migration of labor, social and governmental responses, poverty through charity, welfare, and prosecution. Cast Out includes discussions of the lives of the underclass, strategies for surviving and escaping poverty, the criminalization of poverty by the state, the rise of welfare and development programs, the relationship between imperial powers and colonized peoples, and the struggle to achieve independence after colonial rule.

Athens, OH : Ohio University Press, 2008 409p.