Response to culturally competent drug treatment among homeless persons with different living arrangements

- Tested the relationship between treatment program cultural competence, homeless persons' living arrangements and their drug use at discharge.
- High community engagement and outreach was associated with fewer days of drug use.
- High community linkages were associated with fewer days of drug use among outdoor homeless compared to low linkages and indoor homeless.

This study investigated the association between program cultural competence and homeless individuals' drug use after treatment in Los Angeles County, California. Los Angeles County has the largest and most diverse population of homeless individuals in the nation. We randomly selected for analysis 52 drug-treatment programs and 2158 participants who identified as homeless in the Los Angeles County Participant Reporting System in 2011. We included their living arrangements (indoors and stable, indoors and unstable, and outdoors) and individual and program characteristics (particularly whether their programs used six culturally competent practices) in multilevel regression analyses. The outcome was days of primary drug use at discharge.Results showed that higher levels of staff personal involvement in minority communities (IRR = 0.437; 95% CI = 0.222, 0.861) and outreach to minority communities (IRR  =  0.406; 95% CI = 0.213, 0.771) were associated with fewer days of drug use at discharge. Homeless individuals living outdoors used their primary drug more often than any other group. Yet, compared to individuals with other living arrangements, when outdoor homeless individuals were treated by programs with the highest community resources and linkages (IRR = 0.364; 95% CI = 0.157, 0.844), they reported the fewest days of drug use. We discuss implications for program evaluation and community engagement policies and practices.