Nirvana Recovery

5 Evidence-Based Treatments for individuals experiencing homelessness in Arizona?

Estimates of Homelessness in Arizona
Homelessness is a pervasive issue in Arizona, affecting thousands of individuals and families across the state. According to the 2023 Annual Homelessness Assessment Report 19 in every 10,000 people were experiencing sheltered homelessness, there were 14237 individuals experiencing homelessness in Arizona, with 7615 of them unsheltered and 6622 sheltered. Maricopa County, which includes Phoenix, has one of the highest rates of unsheltered homelessness in the nation. Individuals experiencing homelessness often face significant behavioral health challenges. SAMHSA data indicates that 21% of individuals experiencing homelessness have a serious mental illness, and 16%% have a substance use disorder. The combination of homelessness and untreated behavioral health conditions can lead to poor health outcomes, increased healthcare costs, and difficulty achieving housing stability. Fortunately, there are evidence-based treatments that can effectively support individuals experiencing homelessness and behavioral health disorders. This article will explore five such approaches and their applicability to Arizona.

Medication for Opioid Use Disorder (MOUD)

Opioid use disorder is a growing concern among individuals experiencing homelessness. In a study of individuals experiencing homelessness in Boston, 40% reported having an opioid use disorder. MOUD, which includes medications like buprenorphine and methadone, has been shown to reduce opioid use, increase treatment retention, and lower the risk of overdose death.

Expanding Access to MOUD in Arizona

Despite the proven effectiveness of MOUD, access remains limited for individuals experiencing homelessness. Providers in Arizona can work to expand MOUD access by:

  • Establishing partnerships with shelters, outreach teams, and housing providers to identify and engage individuals in need of treatment.
  • Providing MOUD through mobile clinics, street-based services, or shelter-based programs.
  • Offering same-day MOUD induction and low-barrier access to treatment.
  • Addressing stigma and misconceptions about MOUD among staff and clients.

The SAMHSA PDF highlights several programs that have successfully integrated MOUD into services for individuals experiencing homelessness, including a shelter-based opioid treatment program in Massachusetts. These models could be adapted for implementation in Arizona.

Motivational Interviewing (MI)

Motivational interviewing is a client-centered counseling approach that helps individuals build motivation for change. MI has been found to reduce substance use, increase treatment engagement, and improve mental health outcomes among individuals experiencing homelessness.

Implementing MI in Arizona

To effectively implement MI for individuals experiencing homelessness, Arizona providers should:

The Four Fundamental Processes Of Motivational Interviewing
  • Train staff in MI techniques and provide ongoing coaching and supervision.
  • Implement its four fundamental processes: engaging, focusing, planning, and evoking.
  • Use MI to explore individuals’ goals, values, and motivations for change.
  • Integrate MI into outreach, case management, and treatment planning processes.
  • Monitor fidelity to MI principles and gather client feedback to inform practice.

Intensive Case Management

Intensive case management involves providing individualized, comprehensive support to help clients access services, build skills, and achieve their goals. For individuals experiencing chronic homelessness and behavioral health disorders, intensive case management can be a critical intervention.

Case Management Models for Arizona

Effective case management models for individuals experiencing homelessness typically involve:

  • Low client-to-staff ratios (e.g., 15:1).
  • Frequent, proactive client contact (e.g., multiple times per week).
  • Assertive outreach and engagement strategies.
  • Emphasis on building trust and rapport.
  • Assistance with housing, benefits, healthcare, and other needs.
  • Coordination with mental health and substance use treatment providers.

Arizona providers can implement intensive case management by dedicating specialized case management teams, providing staff training and supervision, and establishing data systems to track client progress and outcomes.

Contingency Management

Contingency management (CM) is an approach that provides incentives or rewards for achieving specific behavioral goals, such as abstinence from substances or treatment attendance. CM has strong research support for treating substance use disorders, including among individuals experiencing homelessness.

Using CM in Arizona Homeless Services

To implement CM for individuals experiencing homelessness, Arizona providers should:

  • Identify target behaviors that are meaningful to clients and aligned with their recovery goals.
  • Select incentives that are attractive to participants, such as gift cards, transportation passes, or hygiene kits.
  • Establish clear, achievable criteria for earning incentives and deliver rewards consistently.
  • Combine CM with other evidence-based practices, such as cognitive-behavioral therapy or MOUD.
  • Monitor client progress and adjust CM protocols as needed based on response.

Peer Support Services

Peer support services involve hiring individuals with lived experience of homelessness, mental illness, and/or substance use disorders to provide mentorship, advocacy, and recovery support to clients. Peer specialists can help build trust, increase engagement in services, and serve as role models for recovery.

Integrating Peer Support in Arizona

Integrating Peer Support in Arizona

Arizona providers can effectively integrate peer support services by:

  • Recruiting and hiring peer specialists with diverse backgrounds and experiences.
  • Providing comprehensive training and ongoing supervision to peer specialists.
  • Defining clear roles and expectations for peer specialist positions.
  • Integrating peer specialists into multidisciplinary treatment teams.
  • Gathering feedback from peer specialists and clients to inform program improvements.

Conclusion

Arizona has a significant population of individuals experiencing homelessness, many of whom also face mental health and substance use disorders. By implementing evidence-based practices (discussed in detail in the attached PDF below) like MOUD, motivational interviewing, intensive case management, contingency management, and peer support services, providers in Arizona can more effectively engage and treat this vulnerable population.

Policymakers and funders should prioritize expanding access to these proven interventions across the state. Through collaboration, innovation, and a commitment to evidence-based practice, Arizona can make significant progress in addressing homelessness and supporting individuals on their path to recovery and stability.

author avatar
Nirvana Recovery