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Center for Substance Abuse Treatment (US). Behavioral Health Services for People Who Are Homeless. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013. (Treatment Improvement Protocol (TIP) Series, No. 55.)

Cover of Behavioral Health Services for People Who Are Homeless

Behavioral Health Services for People Who Are Homeless.

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How This TIP Is Organized

This Treatment Improvement Protocol (TIP) is divided into three parts:

  • Part 1: A Practical Guide for the Provision of Behavioral Health Services
  • Part 2: An Implementation Guide for Behavioral Health Program Administrators
  • Part 3: A Review of the Literature

Part 1 is for behavioral health service providers and consists of two chapters. Chapter 1 illustrates typical problems and issues that arise in behavioral health counseling with people who have experienced or currently are experiencing homelessness. It covers:

  • Approaches that address the counselor’s setting, role, and responsibilities.
  • Screening/assessment, client-centered treatment planning, treatment processes, and continuing care.

Part 1, Chapter 2, presents seven vignettes; each describes the setting in which the counselor is providing services, step-by-step instructions for specific counseling techniques, and master clinician comments. A decision tree is also included in the Francis vignette to help counselors manage key points of therapy. The techniques can be applied to and adapted for other settings. Vignettes are based on role-played interactions staged by consensus panelists.

Part 2 is for program administrators and consists of two chapters addressing the following topics about servicing people who are homeless:

  • Collaboration with other service providers to provide comprehensive services
  • Service modifications to meet the individual needs of clients
  • Providing training and staffing programs that serve people who are homeless
  • Providing outreach and engagement, intensive care, and ongoing rehabilitation services
  • Resources for implementation of best practices, including sample policies and procedures

Part 3 is a literature review on the topic of homelessness and behavioral health services and is intended for use by clinical supervisors, interested providers, and administrators. Part 3 has three sections: an analysis of the literature, links to select abstracts of the references most central to the topic, and a general bibliography of the available literature. To facilitate ongoing updates (performed periodically for up to 3 years from first publication), the literature review is only available online at the Knowledge Application Program Web site (http://kap.samhsa.gov).


Substance abuse: Throughout the TIP, the term “substance abuse” has been used to refer to both substance abuse and substance dependence (as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision [DSM-IV-TR] [American Psychiatric Association, 2000]). This term was chosen partly because substance abuse treatment professionals commonly use the term “substance abuse” to describe any excessive use of addictive substances. In this TIP, the term refers to the use of alcohol as well as other substances of abuse. Readers should attend to the context in which the term occurs in order to determine what possible range of meanings it covers; in most cases, however, the term will refer to all varieties of substance use disorders described by DSM-IV-TR.

Behavioral health: Throughout the TIP, the term “behavioral health” is used. Behavioral health refers to a state of mental/emotional being and/or choices and actions that affect wellness. Behavioral health problems include substance abuse or misuse, alcohol and drug addiction, serious psychological distress, suicide, and mental and substance use disorders. This includes a range of problems from unhealthy stress to diagnosable and treatable diseases like serious mental illness and substance use disorders, which are often chronic in nature but from which people can and do recover. The term is also used in this TIP to describe the service systems encompassing the promotion of emotional health, the prevention of mental and substance use disorders, substance use and related problems, treatments and services for mental and substance use disorders, and recovery support. Because behavioral health conditions, taken together, are the leading causes of disability burden in North America, efforts to improve their prevention and treatment will benefit society as a whole. Efforts to reduce the impact of mental and substance use disorders on communities in the United States, such as those described in this TIP, will help achieve nationwide improvements in health.

Recovery: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Major dimensions that support a life in recovery, as defined by the Substance Abuse and Mental Health Services Administration, include:

  • Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way.
  • Home: a stable and safe place to live.
  • Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society.
  • Community: relationships and social networks that provide support, friendship, love, and hope.


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