3:00pm - 3:15pm (CDT) | 4231.0 - Integrating harm reduction principles into case management for homeless individuals experiencing substance use disorders within the United States: A scoping review

Session: Barriers Surrounding Homelessness, Harm Reduction & Physical Needs

Program: Caucus on Homelessness

Presenter: Victoria Bensel, DC, MS, MS

Authors:

Shivesh Shourya

Grace Manes

Meredith Mcgee

Nicole Campbell

Abstract

Background

People experiencing homelessness who have a substance use disorder are a uniquely vulnerable and underserved demographic. With the absence of established best practices that have resulted in a varied landscape of interventions, harm reduction-based case management has emerged as a pivotal strategy in addressing overlapping substance use and housing instability and represents a critical approach for addressing the multifaceted needs of this population. However, the integration of harm reduction principles into case management strategies and interventions remains poorly characterized. This scoping review assesses the existing literature on harm reduction-oriented case management interventions for people experiencing homelessness with substance use disorders.

Methods

We conducted a scoping review utilizing PubMed, employing relevant keywords and MeSH terms about harm reduction-based case management interventions targeting homelessness in the United States. Our search yielded 6,147 studies after the removal of duplicates, which underwent initial screening. Subsequently, 28 studies met the scoping review inclusion criteria and underwent a full-text review, including 15 using quantitative methods, 10 using qualitative methods, and 3 using mixed methods approaches. We utilized a thematic analysis to identify harm reduction principles as outlined by the National Harm Reduction Coalition and analyzed intervention outcomes and feasibility based on outlined study aims.

Results

Our analysis disseminated how harm reduction principles were integrated into case management interventions, and revealed that the included interventions either improved substance use and housing stability program retention or feasibility within healthcare frameworks. Among the eight themes three were the most common: understanding of drug use as a multifaceted phenomenon; acknowledging the influence of past trauma and social inequities on vulnerability to drug-related harms; and prioritizing the improvement of individual well-being over complete cessation of drug use. Furthermore, our scoping review discusses the diverse array of interventions and their feasibility encompasses case management, biomedical interventions, and mental health support.

Conclusion

Our review underscores the potential efficacy and feasibility of integrating harm reduction-based case management for people experiencing homelessness with substance use disorders. Specifically, policymakers should prioritize embedding harm reduction principles within housing stability services, providing comprehensive training for case managers, and fostering synergistic partnerships between healthcare providers and community organizations. While this approach holds promise for enhancing both housing stability and addressing substance use challenges among homeless populations, further evaluations are imperative to refine these interventions and to guide the development of evidence-based policies aimed at improving outcomes for people experiencing homelessness with substance use disorders.