Adopting Best Practices: Lessons Learned in the Collaborative Initiative to Help End Chronic Homelessness (CICH)

  • Sarah A. McGraw
  • Mary Jo Larson
  • Susan E. Foster
  • Marilyn Kresky-Wolff
  • Elizabeth M. Botelho
  • Emily A. Elstad
  • Ana Stefancic
  • Sam Tsemberis


The Collaborative Initiative to Help End Chronic Homelessness (CICH) was established to provide housing and supportive services for individuals experiencing chronic homelessness. As part of this initiative, 11 projects across the country received funding to apply models of best practices to support their clients in housing. This paper reports on the experiences of the CICH projects in their use of Assertive Community Treatment (ACT) and Motivational Interviewing (MI), clinical practice models commonly used by CICH projects. A qualitative analysis identified five areas of challenge for the projects: (1) Incomplete and underdeveloped staff teams; (2) Incomplete understanding of the practice models; (3) Using the elements of the practice models; (4) Interagency teaming; and (5) Competing expectations of multiple federal agencies. The paper describes the specific challenges in each of the five areas as well as training approaches and gaps in training and the perceived benefits of the practice models as reported by project staff.


homeless practice models ACT motivational interviewing 


  1. 1.
    Rickards LD, McGraw SA, Araki L, et al. Collaborative initiative to help end chronic homelessness: introduction. 2009. doi:10.1007/s11414-009-9175-1.
  2. 2.
    Notice of funding availability for the collaborative initiative to Help End Chronic Homelessness. Federal Register; p. 4037, 2003.Google Scholar
  3. 3.
    Kresky-Wolff M, Larson MJ, O’Brien R. Supportive housing approaches in the collaborative initiative to help end chronic homelessness. Under review.Google Scholar
  4. 4.
    Tsemberis S, Gulcur L, Nakae M. Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health. 2004;94(4):651–656. doi:10.2105/AJPH.94.4.651.CrossRefPubMedGoogle Scholar
  5. 5.
    Stefancic A, Tsemberis S. Housing first for long-term shelter dwellers with psychiatric disabilities in a suburban county: a four-year study of housing access and retention. Journal of Primary Prevention. 2007;28:265–279. doi:10.1007/s10935-007-0093-9.CrossRefPubMedGoogle Scholar
  6. 6.
    Bond GR, Drake RE, Mueser KT, et al. Assertive community treatment for people with severe mental illness: critical ingredients and impact on patients. Disease Management & Health Outcomes. 2001;9(3):141–159 (119).CrossRefGoogle Scholar
  7. 7.
    Drake RE, McHugo GJ, Clark RE, et al. Assertive Community Treatment for patients with co-occurring severe mental illness and substance use disorder: a clinical trial. American Journal of Orthopsychiatry. 1998;68:201–215. doi:10.1037/h0080330.CrossRefPubMedGoogle Scholar
  8. 8.
    Miller WR, Rollnick S. Motivational Interviewing: Preparing People For Change. 2nd edn. New York, NY: Guilford Press; 2002.Google Scholar
  9. 9.
    Marshall M, Lockwood A. Assertive Community Treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews, Issue 3. 2007.Google Scholar
  10. 10.
    Greenwood RM, Schaefer-McDaniel N, Winkel G, et al. Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. American Journal of Community Psychology. 2005;36(34):223–238. doi:10.1007/s10464–005–8617-z.CrossRefPubMedGoogle Scholar
  11. 11.
    Coldwell CM, Bender WS. The effectiveness of assertive community treatment for homeless populations with severe mental illness: a meta-analysis. American Journal of Psychiatry. 2007;164(3):393–399. doi:10.1176/appi.ajp.164.3.393.CrossRefPubMedGoogle Scholar
  12. 12.
    Herdelin AC, Scott DL. Experimental studies of the Program of Assertive Community Treatment (PACT): a meta-analysis. Journal of Disability Policy Studies. 1999;10(1):53–89.Google Scholar
  13. 13.
    Burns BJ, Santos AB. Assertive community treatment: an update of randomized trials. Psychiatric Services. 1995;46(7):669–675.PubMedGoogle Scholar
  14. 14.
    Dixon L, Friedman N, Lehman A. Housing patterns of homeless mentally ill persons receiving assertive treatment services. Hospital & Community Psychiatry. 1993;44(3):286–288.Google Scholar
  15. 15.
    Dixon LB, Krauss N, Kernan E, et al. Modifying the PACT model to serve homeless persons with severe mental illness. Psychiatric Services. 1995;46(7):684–688.PubMedGoogle Scholar
  16. 16.
    Dixon L, Weiden P, Torres M, Lehman A. Assertive Community Treatment and medication compliance in the homeless mentally ill. American Journal of Psychiatry. 1997;154(9):1302–1304.PubMedGoogle Scholar
  17. 17.
    Gulcur L, Stefancic A, Shinn M, et al. Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities participating in continuum of care and housing first programmes. Journal of Community & Applied Social Psychology. 2003;13:171–186. doi:10.1002/casp.723.CrossRefGoogle Scholar
  18. 18.
    Hirsch E, Glasser I (2007) Rhode Island’s Housing First Program: First year evaluation. Providence, RI: United Way of Rhode Island. Full pdf available at: Accessed July 16, 2008.
  19. 19.
    Perlman J, Parvensky J. Denver Housing First Collaborative. Cost benefit analysis and program outcomes report. Denver, CO: Colorado Coalition for the Homeless; 2006.Google Scholar
  20. 20.
    Essock SM, Mueser KT, Drake RE, et al. Comparison of ACT and standard case management for delivering integrated treatment for co-occurring disorders. Psychiatric Services. 2006;57(2):185–196. doi:10.1176/ Scholar
  21. 21.
    Schaedle R, McGrew JH, Bond GR, et al. A comparison of experts’ perspectives on assertive community treatment and intensive case management. Psychiatric Services. 2002;53(2):207–210. doi:10.1176/ Scholar
  22. 22.
    Dixon L. Assertive community treatment: twenty-five years of gold. Psychiatric Services. 2000;51(6):759–765. doi:10.1176/ Scholar
  23. 23.
    McHugo GJ, Drake RE, Teague GB, et al. Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatric Services. 1999;50(6):818–824.PubMedGoogle Scholar
  24. 24.
    Allness DJ, Knoedler WH. A Manual for ACT Start-Up. Arlington, VA: National Alliance for the Mentally Ill; 2003.Google Scholar
  25. 25.
    Moser LL, Deluca NL, Bond GR, et al. Implementing evidence-based psychosocial practices: lessons learned from statewide implementation of two practices. CNS Spectrums. 2004;9(12):926–936 942.PubMedGoogle Scholar
  26. 26.
    Miller WR, Rollnick S. What is Motivational Interviewing Chapter 4. Motivational Interviewing: Preparing People to Change Addictive Behaviour. 2nd edn. New York, NY: Guilford Press; 2002:33–42.Google Scholar
  27. 27.
    Resnicow K, DiIorio C, Soet JE, et al. Motivational Interviewing in medical and public health settings. In: Miller WR, Rollnick S, eds. 2nd edn. Motivational Interviewing: Preparing People for Change. New York: Guildford; 2002:251–269.Google Scholar
  28. 28.
    Ball S, Martino S, Corvino J, et al. Motivational Interviewing to Improve Treatment Engagement and Outcome in Individuals Seeking Treatment for Substance Abuse. NIDA/SAMHSA Blending Initiative. Available at: Accessed June 10, 2008.
  29. 29.
    Vansteenkiste M, Sheldon KM. There’s nothing more practical than a good theory: integrating motivational interviewing and self-determination theory. British Journal of Clinical Psychology. 2006;45:63–82. doi:10.1348/014466505X34192.CrossRefPubMedGoogle Scholar
  30. 30.
    Rubak S, Sandbæk A, Lauritzen T, et al. Motivational interviewing: a systematic review and meta-analysis. British Journal of General Practice. 2005;55:305–312.PubMedGoogle Scholar
  31. 31.
    Mueser KB, Bond GR, Drake RE, et al. Models of community care for severe mental illness: a review of research on case management. Schizophrenia Bulletin. 1998;24(1):37–74.PubMedGoogle Scholar
  32. 32.
    Miller WR, Moyers TB, Arciniega L, et al. Training, supervision and quality monitoring of the COMBINE Study behavioral interventions. Journal of Studies on Alcohol Supplement. 2005(15):188–195; discussion 168–189.Google Scholar
  33. 33.
    Rollnick S, Miller WR. What is motivational interviewing? Behavioural and Cognitive Psychotherapy. 1995;23(4):325–334.CrossRefGoogle Scholar
  34. 34.
    Salyers MP, Tsemberis S. ACT and recovery: integrating evidence-based practice and recovery orientation on Assertive Community Treatment teams. Community Mental Health Journal. 2007;43(6):619–641. doi:10.1007/s10597-007-9088-5.CrossRefPubMedGoogle Scholar
  35. 35.
    Rogers EM. Diffusion of Innovations. 5th edn. New York: Free; 2003.Google Scholar
  36. 36.
    Gotham HJ. Diffusion of mental health and substance abuse treatments: Development, dissemination, and implementation. Clinical Psychology: Science and Practice. 2004;11(2):160–176. doi:10.1093/clipsy/bph067.CrossRefGoogle Scholar
  37. 37.
    Stirman SW, Crits-Christoph P, De Rubeis RJ. Achieving successful dissemination of empirically supported psychotherapies: a synthesis of dissemination theory. Clinical Psychology: Science and Practice. 2004;11(4):343–359. doi:10.1093/clipsy/bph091.CrossRefGoogle Scholar
  38. 38.
    McCarty D, Edmundson Jr. E, Hartnett T. Charting a path between research and practice in alcoholism treatment. Alcohol Research & Health. 2006;29(1):5–10.Google Scholar
  39. 39.
    Corrigan PW, Steiner L, McCracken SG, et al. Strategies for disseminating evidence-based practices to staff who treat people with serious mental illness. Psychiatric Services. 2001;52(12):1598–1606. doi:10.1176/ Scholar
  40. 40.
    Torrey WC, Drake R, Dixon L, et al. Implementing evidence-based practices for persons with severe mental illnesses. Psychiatric Services. 2001;52(1):45–50. doi:10.1176/ Scholar
  41. 41.
    Greenhalgh T, Robert G, Macfarlane F, et al. Diffusion of innovations in services organizations: systematic review and recommendations. The Milbank Quarterly. 2004;82(4):881–629. doi:10.1111/j.0887-378X.2004.00325.x.CrossRefGoogle Scholar
  42. 42.
    Simpson DD. Conceptual framework for transferring research to practice. Journal of Substance Abuse Treatment. 2001;22:171–182. doi:10.1016/S0740-5472(02)00231-3.CrossRefGoogle Scholar
  43. 43.
    Sloboda J, Schildhaus S. A discussion of the concept of technology transfer of research-based drug “Abuse” prevention and treatment interventions. Substance Use & Misuse. 2002;37(8–10):1079–1087. doi:10.1081/JA-120004167.CrossRefGoogle Scholar
  44. 44.
    McGrew JH, Pescosolido B, Wright E. Case managers’ perspectives on critical ingredients of assertive community treatment and on its implementation. Psychiatric Services. 2003;54(3):370–376. doi:10.1176/ Scholar
  45. 45.
    Phillips SD, Burns BJ, Edgar ER, et al. Moving assertive community treatment into standard practice. Psychiatric Services. 2001;52(6):771–779. doi:10.1176/ Scholar
  46. 46.
    Allness DJ, Knoedler WH. A Manual for ACT Start-Up, Chapter 6-A. Arlington, VA: National Alliance for the Mentally Ill; 2003.Google Scholar
  47. 47.
    Krupa T, Eastabrook S, Beattie P, et al. Challenges faced by service providers in the delivery of Assertive Community Treatment. Canadian Journal of Community Mental Health. 2004;23(1):115–127.PubMedGoogle Scholar
  48. 48.
    McGrew JH, Bond GR. Critical ingredients of Assertive Community Treatment: judgments of the experts. Journal of Mental Health Administration. 1995;22(2):113–125. doi:10.1007/BF02518752.CrossRefPubMedGoogle Scholar
  49. 49.
    ATLAS.ti. Qualitative Data Analysis Software: Scientific Software Development GmbH. Available Accessed July 9, 2008.
  50. 50.
    Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Service Research. 2007;42(4):1758–1772. doi:10.1111/j.1475-6773.2006.00684.x.CrossRefGoogle Scholar
  51. 51.
    Miles MB, Huberman AM. Qualitative Data Analysis: An Expanded Sourcebook. 2nd edn. Thousand Oaks, CA: Sage; 1994.Google Scholar
  52. 52.
    Strauss A, Corbin J. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Newbury Park: Sage; 1990.Google Scholar
  53. 53.
    Mares AS, Rosenheck RA. Twelve-month client outcomes and service use in a multi-site project for chronically homelessness adults. 2009.Google Scholar
  54. 54.
    Olivet J, McGraw S, Grandin M, et al. Staffing Challenges and Strategies for Organizations Serving Individuals Who Have Experienced Chronic Homelessness. Under review.Google Scholar

Copyright information

© National Council for Community Behavioral Healthcare 2009

Authors and Affiliations

  • Sarah A. McGraw
    • 1
  • Mary Jo Larson
    • 1
  • Susan E. Foster
    • 2
  • Marilyn Kresky-Wolff
    • 3
  • Elizabeth M. Botelho
    • 1
  • Emily A. Elstad
    • 1
  • Ana Stefancic
    • 4
  • Sam Tsemberis
    • 5
  1. 1.New England Research InstitutesWatertownUSA
  2. 2.National Center on Family HomelessnessNewtonUSA
  3. 3.The CDM Group, Inc.BethesdaUSA
  4. 4.Columbia UniversityNew YorkUSA
  5. 5.Pathways to HousingNew YorkUSA

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