PITFALLS IN EVALUATING THE EFFECTIVENESS OF CASE-MANAGEMENT PROGRAMS FOR HOMELESS PERSONS - LESSONS FROM THE NIAAA COMMUNITY DEMONSTRATION PROGRAM

It is generally believed that homeless individuals-particularly those with substance abuse problems or mental illness-are unable to access t he full range of available benefits and community services on their ow n. In recent years, community service providers have increasingly look ed toward case management as the intervention of choice for solving th is problem. Yet the evaluation findings of the National Institute on A lcohol Abuse and Alcoholism Community Demonstration Program, which inc luded three case management projects, showed few clear indications of case management effectiveness. The results of these studies-which focu sed on homeless clients with alcohol and other drug problems-are consi stent with studies of case management services for the homeless mental ly ill. This article identifies several phenomena that potentially exp lain the apparent lack of positive effects and suggests that the reaso ns for negative findings may lie as much with the evaluations as with the interventions. These phenomena include bias due to differential at trition from measurement, lack of intervention intensity, lack of dist inction between groups, contextual factors, and additional design and measurement issues. Suggestions for improving future evaluations of ca se management effectiveness are offered