Housing Assistance Research Articles

Housing insecurity and government housing support utilization among a nationally representative sample of transgender and gender non-conforming adults

ABSTRACT Transgender and gender non-conforming (TGNC) individuals experience greater social adversity and negative social determinants of health compared to cisgender people. This study explored housing security and service use within a probability-based, nationally representative sample. Respondents were adults (264 TGNC; 23,096 cisgender) from the U.S. Federal Reserve Survey of Household Economics and Decision-making. Chi-square and multiple logistic regression analyses compared differences between TGNC and cisgender respondents for housing security indicators and government housing support use. Multivariable analyses were weighted for complex sampling design. Despite a large proportion of TGNC respondents reporting inability to pay their bills (27.9%) and not being homeowners (62.0%), utilization rates for government housing assistance were low (10.4%). Adjusting for covariates, TGNC respondents had significantly greater odds of reporting governmental housing assistance (aOR = 2.64, 95%CI = 1.52–4.60) than cisgender respondents. There was no difference in ability to pay bills or homeownership. Findings indicate that government housing services are reaching TGNC adults relative to cisgender results, but utilization rates remain low despite indicators of high need. Factors influencing utilization and efficacy of services should be assessed in future research to support policy implementation.

Interracial couples and intergenerational coresidence: Interracial couples who provide housing assistance to their aging parents

Interracial couples and intergenerational coresidence: Interracial couples who provide housing assistance to their aging parents

Perceived patient navigator services and characteristics to address barriers to linkage to hepatitis C care among people released from provincial prison in Quebec, Canada

BackgroundPatient navigation increases linkage to hepatitis C virus (HCV) care following release from prison; however, little is known about the services patient navigators should provide to maximize linkage to care. We aimed to identify perceived barriers and facilitators to linkage to HCV care post-release, and to determine patient navigator services and characteristics best suited to address barriers to linkage to care among people released from prison. MethodsTen semi-structured interviews were conducted with adult (age ≥ 18 years) men living with chronic HCV, released from the largest Quebec provincial prison, and linked to HCV care by a patient navigator. Interviews were guided by the Socio-Ecological Model (SEM) and aimed to explore the multi-level barriers and facilitators to linkage to HCV care post-release. Interviews were audio-recorded, transcribed, and analyzed using a deductive, thematic approach. ResultsThe median age of participants was 54 years. Barriers to linkage to HCV care included competing priorities post-release (e.g., substance use, mental health issues, unstable housing), stigma (related to HCV, injection drug use, and incarceration), and lack of transportation. Facilitators included social support, established relationships with existing healthcare providers, prior cure with direct-acting antivirals, and HCV-related health literacy and knowledge. Perceived essential patient navigator services to enhance linkage included pre-release discharge appointments, housing assistance, and facilitated transportation to HCV appointments. Ensuring a consistent, non-judgemental, and empathetic patient navigator were considered important characteristics; lived experiences of incarceration and/or HCV were not felt to be essential for a patient navigator. ConclusionsInterventions that seek to improve linkage to HCV care for people following release from prison should address many levels (individual, interpersonal, and policy) of the SEM. While people experience several competing priorities post-release, having an empathetic and consistent patient navigator, regardless of their lived experiences of HCV and/or incarceration, may improve linkage to HCV care post-release.

What barriers do administrators face whilst upgrading their data assemblage?

Built for Zero (BFZ) is a data-driven methodology that some US homeless systems are using to allocate housing assistance. The ‘by-name data’ that BFZ needs is produced by actors within a ‘data assemblage’: a socio-technical system that people re/create to produce, analyse, and use data. Although BFZ is diffusing across the Global North, little research has examined the barriers that local administrators face whilst upgrading their systems’ data assemblage with this methodology. This paper advances housing scholarship by using interview data from 28 US homeless systems to answer the question: what barriers do administrators face whilst upgrading their data assemblage with BFZ? I delineate four barriers that fray the network ties that local administrators need to produce by-name data: disinterest, fragmentation, noncompliance, and incapacity. My analysis shows how data assemblage theory can be used to understand homeless governance, delineates several factors that prevent or complicate data sharing within homeless systems, and identifies new directions for research on homeless datafication.

Material hardship and use of social safety net programs among LGBT adults and their families

AbstractLesbian, gay, bisexual, and transgender (LGBT) people experience higher levels of economic insecurity and poverty compared to non‐LGBT people. Social safety net programs may reduce this disparity, but the uptake of these programs among LGBT adults has rarely been assessed. We conducted a secondary data analysis of the 2018–2020 Well‐Being and Basic Needs Survey to compare differences in material hardship and social safety net program utilization between LGBT and non‐LGBT adults in the United States. LGBT participants were more likely to report lack of an emergency fund, food insecurity, utilities hardship, medical hardship, and multiple material hardships. LGBT adults had higher odds compared to non‐LGBT adults of using SNAP, income‐ or disability‐based insurance, SSI or SSDI, and housing assistance. There were no differences in use of WIC, reduced‐price/free school lunch benefits, or charitable food. Future studies are needed to evaluate the efficacy of the social safety net programs for reducing material hardship.

Is federal housing assistance associated with earlier-stage cancer diagnosis? Evidence from the new SEER-Medicare and US Department of Housing and Urban Development data linkage.

85 Background: Despite growing awareness that stable and affordable housing is a key social determinant of health, little research has examined the role of federal housing assistance in cancer outcomes. This study uses a novel data linkage to examine the association of federal housing assistance (i.e. various rent subsidy programs) on stage at diagnosis for the 4 most common cancers in the US. Methods: Individuals aged 66-95 years newly diagnosed with breast, colorectal, non-small cell lung (NSCLC) or prostate cancer in 2006-2019 with fee-for-service coverage were selected from SEER-Medicare Housing and Urban Development (HUD) administrative data. After identifying individuals with housing assistance at diagnosis, controls without housing assistance at diagnosis were propensity score matched in a 3:1 ratio by cancer site, age, sex, race/ethnicity, marital status, registry, year of diagnosis, area-level Yost socioeconomic status index, dual Medicaid eligibility, rural/urban residence, reason for Medicare entitlement, and pre-diagnosis comorbidity. Associations of housing assistance and diagnosis stage (SEER summary stage: localized vs. regional/distant) were examined with separate logistic regression models by cancer type. Results: A total of 7335 individuals with breast, 5660 with colorectal, 7399 with NSCL and 4309 with prostate cancer received housing assistance at diagnosis (Table). Compared to matched controls, a smaller percentage of individuals with housing assistance were diagnosed with regional/distant breast (36% vs. 33%), colorectal (59% vs. 57%), and NSCL (71% vs. 69%) cancers. Individuals receiving housing assistance were less likely to be diagnosed with later-stage breast (OR: 0.87; 95% CI: 0.83, 0.92) and NSCL (OR: 0.93; 95% CI: 0.88, 0.99) cancers. Housing assistance was not significantly associated with stage for individuals with colorectal or prostate cancers. Conclusions: Federal housing assistance is associated with earlier-stage breast and NSCL cancer diagnosis, highlighting its potential role in mitigating the adverse effects of housing insecurity on cancer outcomes. Housing assistance and cancer diagnosis stage. No Housing Assistance at Dx,N (%) Housing Assistance at Dx,N (%) OR [95% CI], P Breast Localized 14291 (64) 4890 (67) 1.0 (ref) Regional/Distant 8179 (36) 2445 (33) 0.87 [0.83, 0.92] P<0.001 Colorectal Localized 7046 (42) 2422 (43) 1.0 (ref) Regional/Distant 9934 (59) 3238 (57) 0.95 [0.89, 1.01] P=0.09 NSCLC Localized 6572 (30) 2298 (31) 1.0 (ref) Regional/Distant 15625 (71) 5101 (69) 0.93 [0.88, 0.99] P=0.02 Prostate Localized 10293 (80) 3401 (79) 1.0 (ref) Regional/Distant 2634 (20) 908 (21) 1.04 [0.96, 1.14] P=0.33 Dx=Diagnosis; OR=Odds Ratio; CI=Confidence Interval.

Recommendation for Self-Help Housing Stimulus Assistance (BSPS) Recipient Using Multi-Criteria Decision Making Methods

The Housing and Settlement Area Office aims to improve the accuracy and efficiency of selecting beneficiaries for the Self-Help Housing Assistance (BSPS) program by using the Weighted Product (WP) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) methods. This study was conducted in Sungkai Tengah Subdistrict, North Lampung, involving six criteria: land ownership, employment, house condition, income, independence, and household size.The WP method is used to determine the weight of each criterion by calculating the product of the criteria values raised to the power of their respective weights, which helps in ranking the alternatives. TOPSIS is applied to identify the best alternative by comparing the geometric distance of each option to the ideal solution, which is either the maximum or minimum value of each criterion The results indicate that the WP and TOPSIS methods can provide more objective and transparent rankings. The application of these methods resulted in the highest ranking for ID V3 with a vector V score of 0.1317. The decision support system developed from this research is expected to assist the Housing and Settlement Area Office in distributing aid more accurately, fairly, and efficiently, thereby supporting the government's goals in improving housing quality and spatial planning

Logistics planning for direct temporary disaster housing assistance under demand uncertainty

In this paper, we propose and study a framework for disaster housing logistics planning under demand uncertainty. Specifically, we utilize a two-stage chance-constrained stochastic programming model to achieve the balance between logistics operational cost and demand fulfillment especially towards extreme disaster scenarios. To do so, we incorporate two operational modalities, one for the ordinary modality and the other for the emergency modality, and the emergency modality is only allowed to be activated for a certain percentage of scenarios that is specified by the decision maker among all scenarios. The set of scenarios is generated according to a spatial regression model for characterizing the disaster housing demand based on a selected number of independent variables related to both the hazard and socioeconomic factors, which is trained offline from historical data. We conduct a numerical experiment based on Hurricane Ian, and our numerical results show the effectiveness of the proposed approach compared to some standard benchmark approaches. We also highlight the managerial insights for disaster housing logistics planning gained through this numerical experiment.

Center for Advanced Studies in Child Welfare, University of Minnesota

Objective and ApproachPrior research has found that experiences of homelessness are associated with an increased likelihood of child protection involvement, and vice-versa. However, it is not clear how involvement with the child welfare system may impact family housing stability during and after their involvement. The objective of this study was to more deeply understand the housing stability of families involved with child welfare over time. To examine this issue, we linked administrative data from Minnesota’s Homelessness Management Information System with social services data from the Department of Human Services (e.g., receipt of food support, childcare or housing assistance, child welfare), for families involved with child welfare in Minnesota between 2019 and 2021. ResultsApproximately a quarter of child welfare-involved families experienced homelessness during their involvement with the child welfare system. Rates of homelessness were similarly high in the two years prior to and following child welfare involvement. Although a large proportion of families experienced homelessness before and during their child welfare involvement, we saw no increase in the proportion of families receiving housing support after their involvement in the system. Conclusions and ImplicationsOur findings indicate that involvement with the child welfare system and the resources provided through this involvement do not have a significant impact on family’s experiences of homelessness. This suggests the need for closer collaboration between the child welfare system and housing services to identify more effective solutions for housing instability among families within the child welfare system.

Moving Beyond Referrals: Addressing Multilevel Barriers to Substance Use Treatment Engagement Through Police-Led Recovery Management Check-Ups.

The opioid epidemic in the United States (US) has prompted innovative responses from law enforcement agencies including specialized units to refer overdose survivors to substance use treatment following an overdose. However, traditional law enforcement outreach does not address the multilevel barriers to treatment engagement that lead to repeat overdose-related calls for service. The current evaluation explored the process components and outcomes of a Comprehensive Opioid Abuse Program (COAP) initiative within a local law enforcement agency in the Southeast US. COAP funding supported a police-led recovery management team (RMT) to connect overdose survivors to substance use treatment. The RMT also utilized recovery management check-ups (RMCs) to provide sustained support to enhance substance use treatment engagement beyond the initial treatment referral. A mixed-methods approach was employed to examine participant demographic, substance use, mental health, treatment, and criminal justice characteristics (N = 65) and explore perceptions of programmatic strengths and potential areas for improvement (N = 15). The quantitative and qualitative analyses were informed by the Recovery Capital Model. Quantitative analysis revealed that the RMT connected many participants with various support services, notably including housing assistance and health insurance. Qualitative findings highlight program effectiveness in improving social, community, and personal recovery capital. These findings contribute to expanding research on police-led post-overdose initiatives and suggest that police-led RMCs can address multilevel barriers to treatment engagement and minimize law enforcement stigma.

WellNest: A Medical Student-Run Housing Support Program.

Being unhoused and facing housing insecurity contribute to poor health outcomes. Medical school curricula may include social determinants of health (SDOH) topics. However, experiential learning opportunities allow students to better contextualize how SDOH impact patients. The WellNest Housing Support Program (WellNest) was conceived and developed by Duke University medical students to learn from and support community members with a history of housing insecurity. Under the supervision of community organizations providing housing assistance services, WellNest was created in April 2020. Medical student-volunteers (MSVs) call clients, who are referred to WellNest by the community organizations, to plan move-ins. Local experts provide trainings on topics relevant to health care for individuals experiencing loss of housing. MSVs source and move furniture and clients' belongings into the new homes. Following move-in, MSVs are paired with clients to provide longitudinal tenancy support for at least 1 year. Student-volunteers contemplate their experiences and learning takeaways through debriefing sessions and an optional online survey. From fall 2021 to spring 2023, 83 student-volunteers from across the university participated in WellNest. Student-volunteers were generally medical students (37, 45%), and 16 MSVs served on the leadership team. WellNest facilitated 29 move-ins, and 26 clients requested to be paired with MSVs for longitudinal tenancy support. Following participation in WellNest, student-volunteers reported increased comfort, awareness, knowledge, and motivation related to caring for, discussing, and advocating for individuals experiencing housing insecurity. As students from other programs are also interested in WellNest, there is potential for interprofessional education. Student-volunteers will be encouraged to participate in additional opportunities for reflection and advocacy activities. The impact of WellNest on clients will be explored through a questionnaire and narrative interviews. Long-term financial support was secured from community donations and partnering community organizations.

Implementation of the Independent Housing Stimulant Assistance Program in the Provision of Livable Houses in Soloy Agung Village, West Kulisusu District, North Buton Regency

This study aims to determine the implementation of the Independent Housing Stimulant Assistance Program in the provision of livable houses in Soloy Agung Village, West Kulisusu District, North Buton Regency. This research uses a qualitative approach. The informants in this study were selected using a purposive sampling technique, so that the informants in this study consisted of communities receiving uninhabitable housing assistance. The data in this study were obtained through interviews, observations and documentation. The data obtained was then analyzed qualitatively with an interactive model consisting of data reduction, data presentation and conclusion drawn. The results of the study show that there are three steps in the implementation of Self-Help Housing Stimulant Assistance in Soloy Agung Village, West Kulisusu District, first , community preparation, which includes recipient organization, socialization, household needs identification, store services, and proposal writing, is a process designed to enable potential recipients to be ready for the program and to guarantee success and sustainability; Second, Pre-execution activities are a series of arrangements made before the start of construction or restoration activities of the primary house. This regulation includes the identification of aid recipients, the distribution of assistance, and the completion of assistance; and third, the use of BSPS funds is regulated to ensure that the funds are used efficiently and in accordance with the program's objectives, which are to improve housing standards for low-income communities. This includes the creation of DRPBs, shop contracts, hiring handymen, purchasing building materials, performing real work, paying workers' wages, and reporting. BSPS software helps people build and repair livable homes, reduce financial burdens, and create healthy homes with good lighting, sanitation, and durability.

Caritas’s Work for the Goals of Agenda 2030: A Study on the Services Provided in Campania

The United Nations’ Agenda 2030 has established a series of Sustainable Development Goals to address global challenges, including poverty, food insecurity, access to education, and social inequality. In this context, charitable organizations such as Caritas play a crucial role in mitigating the negative effects of these challenges and promoting fair and sustainable development. This study aims to analyze prevalent needs among individuals seeking assistance from Caritas in Campania and examine how the organization contributes to achieving the Agenda 2030 Goals in the region. The statistical investigation techniques considered include tandem analysis a dimension-reduction technique, such as multiple factor analysis, and then a cluster analysis to identify similar groups of individuals. These exploratory data analysis methods have allowed for the identification of common needs, including food assistance, support for education, employment, and housing assistance. Subsequently, Caritas programs and initiatives aimed at meeting these needs and promoting sustainable development are explored. The results indicate that Caritas plays a significant role in addressing the urgent needs of the vulnerable population in Campania and contributes to the goals of Agenda 2030, particularly those related to poverty alleviation, immigration, health promotion, education, employment, and the reduction of social inequalities. This study provides an important perspective on the relevance and effectiveness of Caritas’s work in the context of Agenda 2030.

Immigrants, slums, and housing policy: The spatial dispersal of the Ethiopian population in Israel

Nearly 40 years after the first wave of Ethiopian immigration to Israel, the country’s Ethiopian population still suffers from significant socioeconomic disadvantage: Many of its members live in highly homogeneous poor neighborhoods, which expose them to a variety of negative externalities. This study is the first to examine empirically the impact of Israel’s policy of absorption and spatial distribution on the formation of homogeneous ghettos of Ethiopians, and the contribution of the government’s major housing assistance programs for Ethiopians to solving or exacerbating this problem. The study, structured into four main stages, embraces a mixed-methods research approach drawing on diverse theoretical and methodological frameworks. In the first stage, we use descriptive statistics to introduce the current characteristics of the Ethiopian population in Israel and compare them with those of other marginalized social groups. In the second stage, we analyze the government’s various housingassistance programs for the Ethiopian population, focusing on three flagship programs. The third stage analyzes the spatial outcomes of the primary housing-assistance program, which remains active to date. Lastly, through in-depth interviews with policymakers and Ethiopian leaders, we delve into the underlying considerations that lay behind the policy decisions made. The research findings indicate that Ethiopians experience social and economic disadvantages, yet their spatial situation seems to be better than that of other disadvantaged groups, because a significant part of this population apparently enjoys the advantages of living in the center of the country. The findings further show that while the various government housing-assistance programs have elevated homeownership rates among Ethiopians, they have not prevent the formation and proliferation of spatial concentrations of poverty. Nor have they ever provided both the means and the knowledge needed to enable Ethiopians households to enhance their quality of life by moving out of these neighborhoods. To truly address the problem of homogeneous concentrations of poverty, a holistic but tailor-made housing policy is essential. This policy should not simply mirroring the national housing policy, which focuses almost exclusively on homeownership, but rather incorporate diverse policy measures for different populations. A good and just housing policy must take into account the existing spatial dynamic and the core–periphery relations and ensure an environment that provides quality employment and education opportunities alongside social networks that the residents can leverage to increase their social, economic, and cultural capital. Otherwise, the government housing-assistance programs will continue to be mere lip service and too little, too late.

Cookin’ the Books: How Waitlist Management Biases Data Production in Built for Zero Communities

Built for Zero (BFZ) is a new data-driven approach to allocating housing assistance to homeless households. BFZ implementation includes the production/maintenance of a “by-name list” (BNL). The BNL is a regularly updated spreadsheet with personalised data about everyone who enters and exits a local homeless system (i.e., flow). Local administrators use the BNL to produce “by-name data” (BND). BND lets administrators monitor and manipulate system flow in “real time.” Scholars have not analysed how administrators manage their BNL and produce BND. This paper starts that conservation by answering three questions with interview data that was collected from administrators at 28 “BFZ communities” (i.e., homeless systems implementing BFZ): How do administrators manage their BNL? What factors influence BNL management? How does BNL management affect BND accuracy? Using thematic analysis, the author provides evidence that administrators manage the length of their BNL by removing “inactive” clients who have disengaged from service providers. Administrators try to verify housing status before deeming someone inactive. The verification process is shaped by social policies, network ties, virtual interactions, and administrative discretion. Because those things vary across homeless systems, administrators face different constraints and enablers whilst verifying someone’s housing status. The intersection of contextual factors and subjective processes biases the BND administrators produce from their BNL.

Association Between Social Determinants of Health and Cancer Treatment Delay in an Urban Population.

Delays in oncologic time to treatment initiation (TTI) independently and adversely affect disease-specific mortality. Social Determinants of Health (SDoH) are increasingly recognized as significant contributors to patients' disease management and health outcomes. Our academic center has validated a 10-item SDoH screener, and we elucidated which specific needs may be predictive of delayed TTI. This is a retrospective cohort study at an urban academic center of patients with a SDoH screening and diagnosis of breast, colorectal, endocrine/neuroendocrine, GI, genitourinary, gynecologic, head and neck, hematologic, hepatobiliary, lung, or pancreatic cancer from 2018 to 2022. Variables of interest included household income, tumor stage, and emergency department (ED) or inpatient admission 30 days before diagnosis. Factors associated with delayed TTI ≥45 days were assessed using multivariable logistic regression. Among 2,328 patients (mean [standard deviation] age, 64.0 (12.8) years; 66.6% female), having >1 unmet social need was associated with delayed TTI (odds ratio [OR], 1.68; 95% CI, 1.54 to 1.82). The disparities most associated with delay were legal help, transportation, housing stability, and needing to provide care for others. Those with ED (OR, 0.49; 95% CI, 0.44 to 0.54) or inpatient (OR, 0.54; 95% CI, 0.50 to 0.58) admission 30 days before diagnosis were less likely to experience delay. Delays in oncologic TTI ≥45 days are independently associated with unmet social needs. ED or inpatient admissions before diagnosis increase care coordination, leading to improved TTI. Although limitations included the retrospective nature of the study and self-reporting bias, these findings more precisely identify targets for intervention that may more effectively decrease delay. Patients with SDoH barriers are at higher risk of treatment delay and could especially benefit from legal, transportation, caregiver, and housing assistance.

Allocating Housing Assistance After the Decentring of Social Housing: From Rationing to Social Sorting

ABSTRACT Anglophone countries are diversifying their responses to housing insecurity, decentring social housing and expanding use of market-oriented assistance that aims to promote “housing independence” . Drawing on fieldwork in three Australian jurisdictions, this paper examines the impact of this shift for how housing assistance is allocated. We argue that allocations practices can no longer be understood as centred on the rationing of a single product – social housing. Rather, they nowadays perform a “social sorting” function that mimics those developed in consumer marketing, where personal information is collected to classify and segment consumers to match them to tailored “products”. These practices sort households based on their “capacity for independence”, aiming to maximize market engagement and reserving social housing for those with the most complex needs. We conclude that these sorting practices ignore both the realities of private renting in Australia (as elsewhere) and the self-defined housing needs of low-income households.

Do talent housing policies foster regional innovation? An analysis based on labor force heterogeneity

Human capital plays a crucial role in regional innovation and economic progress, which has increasingly been highlighted in research. However, rising housing costs in cities can push talent away, causing brain drain and hindering local innovation. Within this context, China has seen widespread adoption of talent housing policies (THPs) aimed at providing housing assistance for the high-skilled labor force, although the ramifications of these initiatives remain largely underexplored. Based on labor force heterogeneity, this study investigates the effects of THPs targeted at high-skilled labor on the mobility of both high- and low-skilled workers and their consequent impact on regional innovation. Our findings reveal that while THPs bolster the local pool of highly skilled human capital and attract more low-skilled workforce, enhancing regional innovation through labor–skill complementarities, they concurrently elevate housing costs for low-skilled laborers, reducing their long-term settlement intensions and potentially hindering a city's innovation trajectory.

Getting off the waiting list? Managing housing assistance provision in an era of intensifying social housing shortage

Getting off the waiting list? Managing housing assistance provision in an era of intensifying social housing shortage

Research of assisted housing design for the bedridden elderly and their family caregivers

Abstract Objectives: To explore the housing design strategies based on the needs of the bedridden elderly and their family caregivers to promote the health of the bedridden elderly and reduce the stress of family caregiving. Methods: A descriptive qualitative study, grounded in phenomenological principles, was undertaken to investigate the experiences of 24 bedridden elderly individuals and their respective 24 family caregivers. The interviews were semistructured and supplemented by nonparticipant observations. Results: The needs of the bedridden elderly and their family caregivers for the housing environment were mainly focused on safety guarantees, health promotion, and care assistance. Challenges such as spatial barriers, poor environmental quality, and insufficient adaptability in housing components and aids can greatly reduce the assisted role of housing. Conclusion: This paper emphasizes the importance of tailoring housing design to the specific physical characteristics, sensory needs, and behavioral habits of the bedridden elderly and their family caregivers. Effective layout and design should consider spatial flow, control and regulation of the physical environment, and the careful selection and configuration of accessories and aids.