Effectiveness of interventions targeting community integration among individuals with lived experiences of homelessness: A systematic review [2020]

Community integration (CI) has been identified as a key outcome of programs designed to improve the lives of homeless and recently housed individuals (Gaetz, The State of Homelessness in Canada 2016, 2016). Although researchers have explored the extent to which Housing First (HF) impacts on social integration (Quilgars & Pleace, Soc. Incl., 4, 2016), little is known about the range and effectiveness of other interventions on CI more broadly. We conducted a systematic review of experimental studies using Joanna Briggs Institute (JBI) guidelines. Our search strategy was deployed in six databases: EMBASE, CINAHL, PsychINFO, Medline, Sociological Abstracts, and Proquest Dissertations and Theses. Our search was initiated in 2017 and updated on May 5, 2019. Using the definition of CI identified by Wong & Solomon (Ment. Health Serv. Res., 4:13–28, 2002), two independent raters screened 14,158 titles and abstracts after the removal of duplicates. A total of 157 articles were subjected to full‐text review. Studies published in the English language and involving participants of any age were included. We conducted a critical appraisal of 25 studies using the JBI checklists for quasi‐experimental and randomised controlled trials (Tufanaru, Joanna Briggs Institute Reviewers Manual, 2017), and subsequently excluded four studies as they did not meet a pre‐established quality threshold score of 50/100. A total of 21 studies were included in a narrative synthesis. Critical appraisal scores ranged from 53.8–100 (Mdn = 69.2). Interventions evaluated in existing literature included housing and housing support interventions (n = 9), HF (n = 5), psychosocial interventions (n = 5), and employment interventions (n = 2). A meta‐analysis could not be performed due to the heterogeneity of outcomes in included studies. Aspects of CI measured by researchers included social (n = 17), psychological (n = 6), and physical (n = 4) integration. Studies that evaluated HF and housing and housing support interventions demonstrated surprisingly mixed or a lack of effectiveness for promoting CI. Psychosocial interventions were the most promising, specifically those which incorporated an element of peer support. Findings of literature included in this review suggests that there is inconsistency in the extent to which existing interventions are effectively targeting CI as an outcome. Furthermore, we contend that existing systems‐level interventions, including HF and permanent supportive housing alone may not be enough to promote CI among homeless and formerly homeless individuals. Future research should focus on the development and evaluation of interventions that more effectively target this critical construct.

What is known about this topic

  • Community integration (CI) has been identified as a key outcome of programs designed for supporting individuals during and following homelessness.
  • Poverty, the stigma of homelessness, and disability and stigma related to mental health problems all contribute to low levels of CI for homeless individuals.
  • Being integrated in one’s community can support housing stability, health and well‐being for homeless and recently housed individuals.

What this paper adds

  • A summary of the existing state of experimental evidence evaluating interventions for improving CI for homeless and recently housed persons.
  • A range of interventions, including Housing First, housing and housing support interventions, psychosocial and employment interventions have been used to promote CI.
  • Recommendations for future research and practice pertaining to the development and evaluation of interventions that more effectively promote CI for homeless and recently housed persons.

Carrie Anne Marshall PhD, OT Reg.(Ont.) Leonie Boland PhD Lee Ann Westover MS, OTR/L Blair Marcellus MSc.OT Silka Weil MSc.OT Sarah Wickett BA, LLIS
Health and Social Care in the Community, Volume 28, Issue 6, November 2020