Fitzpatrick-Lewis et al. BMC Public Health 2011, 11:638 http://www.biomedcentral.com/1471-2458/11/638 Interventions for Homeless Women, Families or Children No new studies that examined interventions for home- less women, families, or children were rated methodolo- gically strong or moderate. Two methodologically weak studies found that cognitive behavioural therapy and ‘education and general support’ were equally effective in decreasing depressive symptomatology among homeless women with mental health concerns and substance use issues [56,94]. Discussion The purpose of this rapid review was to identify new research examining interventions to increase access to health and healthcare for people who are homeless or at risk of homelessness published since the 2005 systematic review by Hwang et al. [6], with an additional focus on the effect of these interventions on housing status. A total of 1546 new and unique articles were identified, however, less than 30% were relevant and the majority of the relevant articles were methodologically weak. As a result < 1% met inclusion criteria for this review. None of the studies were rated to be of strong methodo- logical quality while 10 were of moderate quality. These 10 studies represent new data since the 2005 systematic review of the literature [6]. Concurrent issues of substance abuse, mental illness, and infectious disease make designing interventions to improve the health and housing status of homeless indi- viduals challenging. New data included in this review indicates that provision of housing is associated with decreased substance use, relapses from periods of sub- stance abstinence, health services utilization, and increased housing tenure [87,88]. In addition, absti- nence-contingent housing appears to provide greater impact on sustained abstinence than non-abstinence- contingent housing [87,88]. In the review by Hwang et al. [6], the evidence supporting the effectiveness of case management on substance use was equivocal [104,105], however, interventions that included post-detoxification stabilization [106], abstinence-contingent work therapy [107], or an intensive residential treatment program [108,109] all showed significantly greater reductions in substance use than the usual care groups. These inter- ventions all have a component of abstinence-contin- gency and thus are consistent with the abstinence- contingent housing interventions discussed in the cur- rent review. The recent data included in this review [89-92] sug- gests that for homeless people living with mental illness, provision of housing during discharge planning from hospital is associated with maintaining stable housing. In light of the small sample size for the pilot RCT for homeless people living with mental illness [82], it should be noted that using the validated quality assessment Page 9 of 14 tool, sample size specifically is not a quality assessment criterion but is part of the first criterion that assesses ‘selection bias’. As such, this did impact the global qual- ity rating. It should be noted, however, that despite the small sample size the pilot study was able to detect highly statistically significant differences, which is remarkable given the very limited statistical power. These results from this review are in contrast with Hwang et al. [6] who reported that housing interven- tions did not improve health-related outcomes for homeless people with mental illness. Nevertheless, Hwang et al. found that case management with addi- tional services, such as outreach supports or drop-in centre services, improved health outcomes [110-112]. The integration of intensive case management that includes the provision of housing may be a more effec- tive intervention for improving health-related outcomes in homeless people with mental illness as it targets mul- tiple factors that can affect health and healthcare utilization. This review identified two new studies that both found structured education modules to be effective at reducing risk behaviour in homeless youth with HIV [102,103]. These data are consistent with findings reported by Hwang et al. [6] that attending sessions of an educa- tional program aimed at reducing sexual risk behaviours for HIV was associated with reduced sexual risk beha- viour for HIV in homeless runaway youth when com- pared to usual care [113,114]. As with other homeless sub-populations, case management appears to be an effective intervention with benefits that include improv- ing mental health outcomes, lowering levels of aggres- sion, aiding in social adjustment, and increasing satisfaction with quality of life [113,114]. Unfortunately, research on this sub-population of homeless remains limited and no data exists to indicate what effect, if any, these interventions have on the housing status of home- less youth. It is also of note that, despite a wide litera- ture search, no new methodologically strong or moderate studies were found that examined interven- tions for homeless women, families or children. In the previous review [6], only two studies examined interven- tions for homeless women and these found no impact following educational interventions on HIV risk beha- viours or mental health outcomes [115,116]. The current review identified 4 new studies that examined interventions for homeless people living with HIV [97-99,101]. There does, however, remain a paucity of literature examining interventions on homeless peo- ple with HIV or other infectious diseases (e.g., tubercu- losis and hepatitis-B). The 2005 review by Hwang et al. [6] identified 2 relevant studies that both reported no effect of educational interventions in reducing HIV risk behaviours in homeless women [115,116]. In contrast,