A Review of Case Management for People Who Are Homeless: Implications for Practice, Policy, and Research

Case management programs for homeless people have proliferated since the 1980s but some have questioned the meaning and clarity of the term case management while others have questioned its effectiveness for serving clients. This paper first attends to conceptual issues, identifying primary functions and process variables for understanding and describing case management services. The paper next describes models and approaches to case management for various client subgroups and specialty areas. The paper also reviews the empirical literature on homelessness and case management, especially as it relates to treatment effectiveness and critical factors. Several conclusions are postulated, including that some case management approaches, especially assertive community treatment (ACT), are effective for helping people who are homeless with severe mental illness; frequent service contact is a critical ingredient leading to positive treatment retention and housing outcomes; case management is more effective with some clients than others. A number of gaps in our knowledge of case management are also identified. The final section of the paper presents recommendations on exemplary practices. These include recommendations related to critical staff skills and abilities, service principles, case management models, and organizational practices. Lessons for Practitioners, Policy Makers, and Researchers Recommendations for homeless case management practitioners include focusing service delivery efforts upon: • Conducting assertive, community-based outreach; • Nurturing trusting, caring relationships with clients; • Respecting client autonomy; • Prioritizing client self-determined needs; • Providing clients with active assistance to obtain needed resources; • Maintaining small case loads; and • Implementing ACT approaches. The federal government is also encouraged to promote exemplary practices through knowledge dissemination, advocacy, and financing actions and to promote new research and knowledge on case management services for people who are homeless.