Running head: CASE MANAGEMENT PRACTICE 1

Critical Analysis of Case Management Practice for Homelessness

Name

Institution
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Critical Analysis of Case Management Practice for Homelessness

Introduction

Despite its indefinite definition and vagueness, case management now functions as the

backbone of the efforts to take care of the plight of homeless people. Health providers and

researchers have always recommended case management practice to the policy-makers (de Vet et

al., 2013). In the United States, where the problem of homelessness is a teething issue, the

Congress has been encouraging the use of case management through legislative initiatives. This

paper presents a critical analysis of case management practices for the homeless people.

Homelessness: Key Historical and Contemporary Issues

The issue of homelessness is a very huge social crisis in the United States of America.

The McKinney-Vento Homeless Assistance Act describes the homeless people as those who do

not have fixed regular and enough residence for night-time use. It is vital to note that the issue of

homelessness started rising in the United States of America during the 1870s. During this time, a

lot of people resided in the emerging urban cities like New York City. However, the Great

Depression that happened in the 20th century led to a huge level of poverty in the country

(Gronda, 2009). Consequently, people could not even afford to have residences and food. The

state of homelessness became an epidemic issue in the United States of America. In fact, people

started migrating from the United States of America as a result of the worst state of the economy

and hardships in life. The problem of homelessness in the U.S. was then increased by the de-

institutionalization of the patients from state psychiatric healthcare centers. This move led to an

increased population of the homeless people in the United States of America. With the increase

in the housing as well as social service cuts increase, the problem of homelessness increased
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exponentially. Later on, the McKinney-Vento Homeless Assistance Act was signed into law in

the year 1987. Its intended purpose was to oversee the funding of direct services to the homeless

population in the nation (Morse, 1999).

The issue of homelessness has become a huge public health problem. The estimation for

the lifetime prevalence of homelessness is between 5% and 14% in the United States of America

and Europe. In Europe, the prevalence of homelessness was affected by the global financial

crisis, which made the prices of houses rise reaching unaffordable levels. Many people who lived

in the sub-urban and rural areas became vulnerable to homelessness. It is vital to note that the

austerity measures implemented in Europe in the aftermath of the global crisis enhanced the

problem of poverty and homelessness (Durham, 2014). The worst happened because of the time

lag effect in terms of the impact of the austerity measures implemented in Europe.

The homeless people also experience other related problems. Their quality of life is

always low. The quality of a life of person only improves when he or she gets housing.

Moreover, a lot of the homeless people are forced stay on the periphery of the societal issues

since they are unemployed. Most of them also experience limited social network and lack

income. It is also important to note that the homeless people are always at a very high risk of

being arrested because of the circumstances in which they live (Black & Zanatta, 2014). Their

living conditions expose them to bad habits and crime activities. Studies indicate that 40% of the

homeless people depend on alcohol while 25% abuse drugs. Moreover, a lot of them suffer from

mental disorders like psychotic illness and depression. Over 70% of the homeless people do have

access to their health needs.

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In the year 2015, statistics indicated that 564,708 people experienced homelessness every

night in the U.S. The implication of this statement is that these people slept outside a house,

stayed in emergency shelters or were under a transitional housing program. Data for the year

2015 indicate that 33 states and the District of Columbia (D.C.) had an overall decrease in

homelessness. However, 16 states reported an increase in the level of homelessness. It is vital to

note that the states, which reported high levels of homelessness, were concentrated in the South

and Midwest. The total number of people who currently experience homelessness in the United

States of America is over 3 million (Cornes et al., 2014). The level of homelessness decreased in

the year 2015 when compared to one of 2014. It has been established that poor people are the

ones who are at the highest risk of becoming homeless. Most of them find it very difficult to

afford housing.  

Various factors lead to the high size of homeless population in the U.S. The primary

reason for homelessness is poverty. People who are poor are the ones who are always at the

highest risk of becoming homeless (Netting et al., 2016). Poverty means one has no money to

afford the highly-priced houses in the United States. In this case, people are always left

homeless. Some end up staying in emergency shelters during the nights.

The second reason for homelessness in the United States of America is failure of the

federal urban housing projects. These projects are the ones that have to provide safe, secure and

very affordable housing to the poor people. Moreover, a lot of employees in the U.S. are not able

to stay where they work overnight. Therefore, they depend on the public housing facilities,

which the state and federal governments have to provide for them.
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The other reason for homelessness in the United States of America is the

deinstitutionalization movement that started from the 1950s. This deinstitutionalization

movement chose to take the mentally ill people from hospitals to community-based treatment

programs. Therefore, the long-term commitment of the mentally ill people in the healthcare

institutions was stopped as they were taken out into the community. This move has led to a very

high level of homeless mentally ill patients, who mostly stayed on the streets of urban areas.

Most towns in the United States of America have the mentally diseased people who throng the

streets and sleep outside in the cold at nights. In fact, the mentally ill people make up the largest

share of the homeless patients.

Homelessness in the United States of America is also caused by redevelopment and

gentrification activities, which are normally instituted by the cities all over the country. During

the construction of these projects, the low-income neighborhoods are normally demolished in

order to create space for the buildings. Such projects are preferred over the low-income

neighborhoods because they normally generate higher property taxes as well as revenues. This

move usually creates the problem of housing shortage for the low-income working families who

cannot afford the new highly-priced real-estate properties.

It is understandable that many veterans are also homeless in the United States of

America. The reason for the homelessness of the U.S. veterans is failure of the Department of

Veterans Affairs to give them effective mental health care as well as good training for jobs. Most

of the homeless veterans are the ones who participated in the Vietnam War. This federal

department has left the task to the related non-governmental organizations whose capacity is not

sufficient enough to deal with the needs of the veterans.

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Another issue is connected with the people who are deprived normal childhood. The

foster children become homeless when they are released at the age of 18 years old. Such children

usually have no direction to go and no place to call home. It is important to note that when they

are released at the age of 18, the common thing is that they do not even seek for the means of

getting a job or securing a rented house. They end up staying outside.

Many reasons still exist and can be cited as the causes of the high rate of homelessness in

the United States of America. The lack of parents is also another reason for the lack of homes for

many children. There are children who lose parents through accidents or natural death. They are

left with no one to take care of them, and this factor makes them end up homeless. Some children

are born to divorced parents who eventually deny them (Vissing, 2015). They are thrown away

and left to survive independently at the tender ages. The outcome of this situation is a high

number of children who are homeless. These incidents commonly happen in various parts of the

U.S.

The other reasons for the presence of high rate of homelessness in the United States of

America include people hiding from incarceration on accounts of criminal offenses and evictions

from the rented house property.

Case Management Practice in the Field of Homelessness

Case management practice has got increased relevance in the field of homelessness. The

focus of the policy-makers in efforts to reduce homelessness has changed significantly. The

Homeless Emergency and Rapid Transition to Housing Act, an amendment to the McKinney-

Vento Homeless Assistance Act, was enacted in 2009 to modernize the US Department of
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Housing and Urban Development’s homelessness assistance programs. In the year 2010, a road

map for solving the problem of homelessness within the European Union was given as part of the

recommendations of the jury of the European Consensus Conference on Homelessness. It is

important to note that there is a significant shift away from the "staircase" approach that demands

the victims of homelessness to prove their readiness for housing while transferring through the

shelters and the housing situation on transitional terms before they are considered eligible for

independent housing (Coldwell & Bender, 2007). Today, there is a rising trend towards rapid-

rehousing approach. This new approach focuses on providing access to the permanent

independent housing as the very first response to solving the issue of homelessness. To prevent

the issue of recurrent homelessness, this new approach also gives flexible aid services according

to the requirements of the people who are rehoused.

Case management practice has been identified as a very effective and important strategy

in supporting this new rapid rehousing approach. It is of great relevance particularly for those

with special and complex needs (Rubin, 1992). What is not sufficiently known is information

about the specific services that are most suitable in supporting housing for the different sub-

groups of homeless people.

It is important to note that since the 1980s a lot of the models of case management

practice have been developed and implemented in the field of the homelessness (Toro et al.,

2007). These models of case management practice are meant to provide basic functions like

outreach, planning, linkage, monitoring, advocacy and assessment. Some of the specific services

delivered by the case managers include practical aid, development of the independent living

skills for the victims of homelessness and acute care during the crisis circumstances (Herman &

Mandiberg, 2010). Moreover, the case managers who practice in this field of homelessness also
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do provide support with the medical and psychiatric treatment. Additionally, they also offer

assistance with the contracts between clients and people in their social and professional support

systems.

There are four models of case management practice which have been recommended and

widely implemented for the homeless people. These models include standard case management,

intensive case management, assertive community treatment, and the critical time intervention

(Borg, 2014). The distinction among these case management practice models is based on the

functions that they emphasize.

SCM is a coordinated and integrated approach to service delivery with the goal to provide

ongoing supportive care. ICM is typically targeted to individuals with the greatest service needs

and prescribes more intensive services, more frequent client contact, and smaller individual

caseloads than SCM does. ACT is closely related to ICM; however, in ACT the responsibility for

providing services to clients is shared by a multidisciplinary team that is accessible 24 hours a

day, 7 days a week (Vanderplasschen et al., 2004). CTI is an intensive time-limited case

management approach to enhance continuity of care by bridging the gap between services and

strengthening clients’ social and professional networks. CTI is designed to be deployed at critical

moments in the lives of clients, for instance, when a person is about to make a transition from a

shelter to independent housing (Milbourne & Cloke, 2013).

Conclusion

The number of case management practice programs for the homeless people have

increased across the world in the modern days. This increase in the case management practices is

an outcome of the high number of people who are homeless across the world. However, many
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continue to question the meaning and effectiveness of these case management practices for the

homeless people. It is vital to note that the concept of case management continues to be loosely

understood because of its indefinite definition.

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References

Black, C., & Zanatta, P. (2014). Case management: a snapshot literature review. Parity, 27(3), 6.

Borg, M. B. (2014). Homelessness during adulthood. Encyclopedia of Primary Prevention and

Health Promotion, 1705-1715.

Coldwell, C. M., & Bender, W. S. (2007). The effectiveness of assertive community treatment

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Cornes, M., Manthorpe, J., Joly, L., & O'halloran, S. (2014). Reconciling recovery,

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exclusion homelessness. Health & Social Care in the Community, 22(2), 134-143.

de Vet, R., van Luijtelaar, M. J., Brilleslijper-Kater, S. N., Vanderplasschen, W., Beijersbergen,

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Durham, S. (2014). J2SI case management achieving positive outcomes for clients experiencing

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