Preventing homelessness in adults with acquired brain injury: a mixed-methods rapid review.

BACKGROUND

Acquired brain injury (ABI) can cause persistent physical, cognitive, psychological, and behavioral impairments that compromise functioning in relationships, employment, and housing, increasing the risk of homelessness. However, no prior review has evaluated homelessness prevention interventions for this population.

OBJECTIVE

To summarize the available evidence of secondary and tertiary homelessness prevention strategies for adults with ABI through a mixed-methods rapid review.

METHODS

We searched MEDLINE, EMBASE, Cochrane Central, and PsycInfo for studies published between 2003 and April 2, 2025, following Cochrane's recommendations for rapid reviews. Studies were eligible if they evaluated secondary or tertiary prevention interventions for adults with ABI who were experiencing or at risk of homelessness and reported outcomes on risk or protective factors of homelessness. We assessed study quality using the Mixed-Methods Appraisal Tool (MMAT) and the Joanna Briggs Institute (JBI) Checklist for case reports. We synthesized the findings narratively using a configurative approach.

RESULTS

A total of 25 studies involving 2292 participants were included. The analysis revealed 4 intervention approaches involving secondary homelessness prevention practices within (1) ABI rehabilitation services; (2) community settings for individuals with ABI accompanied by challenging behaviors and/or mental disorders; (3) judicial and correctional services; and (4) tertiary homelessness prevention practices for individuals with ABI in homelessness community settings. Interventions were either ABI-specific, non-ABI-specific, or service adaptation. Secondary prevention strategies demonstrated promising effects on housing stability, employment, mental health, substance use, legal issues, and service access. Tertiary prevention approaches showed benefits on housing stability, independent living skills, social engagement, substance use, and health and community support.

CONCLUSIONS

This review synthesizes homelessness prevention strategies for individuals with ABI and highlights promising approaches. Despite methodological limitations, including small sample sizes and a lack of control groups, findings can inform future research, clinical practice, and policy to address the complex needs of this underserved population.

REVIEW REGISTRATION: PROSPERO (CRD42024517928).