Cognitive Therapy for Chronic Homelessness


To ensure that individuals experiencing chronic homelessness and mental health issues receive the most comprehensive and efficient services, the Collaborative Initiative to Help End Chronic Homelessness (CICH) has recommended the use of innovative and evidence-based approaches to training staff serving these individuals. In line with the CICH recommendation and in partnership with the City of Philadelphia’s Department of Behavioral Health and disAbility Services (DBHIDS) and the Veterans Affairs (VA) Center on Homelessness Among Veterans, our center is currently training case managers and therapists to implement CBT in agencies that serve individuals experiencing chronic homelessness in Philadelphia and in VA Housing First programs across the country.

Current Projects

Homeless VeteranCognitive Therapy for Individuals Experiencing Chronic Homelessness: Training in CT has been adapted to meet the needs of therapists and case managers working in low-demand shelters—safe havens—and intensive residential facilities—Journey of Hope programs—aimed at promoting recovery from substance use and chronic homelessness.

In the safe havens, over 20 staff to date have been trained to use the cognitive model to understand the behaviors of individuals living in the shelters, develop empathy and understanding for them, and implement cognitively-informed strategies to help these individuals move toward their goals. The majority of safe havens in Philadelphia have been trained, so the project is in a maintenance phase with support provided as needed. Funding for this project was generously provided by both the Beck Initiative and the van Ameringen Foundation.

The Journey of Hope project, initiated in 2007, was implemented to transform six under-utilized substance use treatment programs in Philadelphia to residential facilities that would better meet the needs of the city’s chronically homeless individuals by providing an intensive treatment opportunity for individuals in recovery from substances, mental illness, and chronic homelessness. The City of Philadelphia has been nationally recognized for its efforts to end street homelessness, and the Journey of Hope project has demonstrated a dedication to these endeavors with promising preliminary results. Two Journey of Hope programs have successfully partnered with the Beck Initiative to train their master’s level clinicians in CBT, and a third is slated to begin in summer 2013. Data are being collected to examine the acceptability and feasibility of training therapists working in such settings to implement CBT, as well as the impact of that training on individuals experiencing chronic homelessness, the therapists, the Journey of Hope programs, and the larger behavioral health network in Philadelphia.

Cognitive Behavioral Therapy for Homelessness Prevention in Veterans: The Aaron T. Beck Psychopathology Research Center is collaborating with the VA National Center on Homelessness among Veterans and the VHA Office of Mental Health Services in providing an innovative training program in recovery-oriented Cognitive Behavioral Therapy (CBT) to the Housing First model within HUD- Veterans Affairs Supportive Housing (HUD-VASH). The Housing First approach provides people with housing quickly and then follows with services as needed to sustain permanent housing. This approach is consistent with goals most often articulated by individuals experiencing homelessness. In the CBT model demonstration project, Housing First case managers are trained to provide CBT that targets depression, substance abuse, suicide risk, and enhancing skills of daily living to promote greater housing stability and treatment engagement.

Beginning in 2013, this CBT initiative will include training approximately 70 HUD-VASH case managers on the theoretical foundations of CBT, cognitive case conceptualization, as well as cognitive and behavioral interventions aimed at helping Veterans achieve particular housing stability and treatment goals. Features of the CBT training program include an intensive 3-day workshop that involves academic presentations, demonstrations, and participatory role play to practice CBT skills. Following the workshop, additional training includes weekly, small group conference calls over a 5 month period with an expert in CBT who will provide clinical case consultation on the implementation of CBT with those Veterans who are being served by each therapist. This intensive consultation will work to ensure that each case manager feels confident and competent to deliver this evidence-based psychotherapy to Veterans who struggle with homelessness. Additional features of the program include a comprehensive program evaluation component to assess the effectiveness of the training as evidenced by the case managers’ CBT skill development as well as Veteran outcomes related to both housing stability and treatment engagement.

Relevant publication:

Pontoski, K., Cunningham, A. C., Schultz, L., Jager-Hyman, S., Sposato, R., Creed, T., Evans, A., & Beck, A. T. Using a Cognitive Behavioral Framework to Train Staff Serving Individuals who Experience Chronic Homelessness. Manuscript submitted for publication.

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