Housing Placement Research Articles

Taking the High Ground:FEMATrailer Siting after Hurricane Katrina

Using data on more than 300 census blocks from across New Orleans, Louisiana, this article investigates two steps in the placement of temporary housing after Hurricane Katrina. First, the authors seek to understand the factors that determined whether census blocks were selected for Federal Emergency Management Agency (FEMA) trailers. Then, in light of the widespread resistance to the trailers, they focus on variables that influenced whether trailers were successfully placed on those sites. Despite past research arguing that race, collective action potential, and political factors are the primary determinants of facility placement and the success or failure of the attempt, these data show that technocratic criteria dominated. Interestingly, although census blocks in less vulnerable areas were more likely to be selected as locations forFEMAtrailer parks than ones in more vulnerable areas, it was precisely the former areas where siting success was less likely. Flood‐resistant areas that decision makers chose for housing were less willing to accept such projects than more flood‐prone ones.

HOUSING CHRONICALLY HOMELESS VETERANS: EVALUATING THE EFFICACY OF A HOUSING FIRST APPROACH TO HUD‐VASH

Rapidly placing homeless Veterans with severe mental illness into permanent housing is one important goal of the U.S. Department of Housing and Urban Development‐Veterans Affairs Supportive Housing (HUD‐VASH) program; however, no research has tested whether an explicit organizational alignment of this goal with revised practices could improve outcomes. A demonstration project initiated in 2010 to reform housing placement practices in a metropolitan area enabled researchers to compare an explicit “Housing First” program—offering immediate permanent housing without requiring treatment compliance, abstinence, or “housing readiness”—with a treatment‐first program for 177 homeless Veterans. The Housing First initiative successfully reduced time to housing placement, from 223 to 35 days, housing retention rates were significantly higher among Housing First tenants, and emergency room use declined significantly among the Housing First cohort. The results suggest that a national Housing First model for the VA would be associated with improved outcomes for Veterans experiencing homelessness.

The impact of current alcohol and drug use on outcomes among homeless veterans entering supported housing.

Permanent supported housing has increasingly been identified as a central approach to helping homeless individuals with disabilities exit from homelessness. Given that one third or more of homeless individuals actively use substances, it is important to determine the extent to which individuals who report using alcohol and/or drugs at the time of housing benefit from such programs. The current study examines data from the evaluation of the United States Department of Housing and Urban Development-Veterans Affairs (HUD-VA) Supported Housing (HUD-VASH) program to determine differences in housing and clinical outcomes among participants with two different levels of active alcohol or drug use at time of housing entry. Whereas veterans with 1-15 days of active use and 15-30 days of active use had significantly more days homeless than abstainers, albeit with small effect sizes (.06 and .19, respectively), there were no significant differences in days housed or days in institutions. Interaction analysis suggests that the highest frequency substance users who spent time in residential treatment prior to housing had the poorest housing outcomes, while those who were not in residential treatment had outcomes comparable to abstainers. Although active substance users clearly benefit from supportive housing with small differences in outcomes from abstainers, high frequency substance users who were admitted to residential treatment before housing placement, may be an especially vulnerable population.

A wraparound treatment engagement intervention for homeless veterans with co-occurring disorders.

This article reports the results of a low-intensity wraparound intervention, Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking (MISSION), to augment Treatment as Usual (TAU) and engage and retain homeless veterans with a co-occurring disorder (COD) in care. Using a quasi-experimental design, 333 homeless veterans were enrolled, 218 who received MISSION along with TAU and 115 who received TAU alone. Group assignment was based on MISSION treatment slot availability at time of enrollment. Compared with TAU alone, individuals receiving MISSION demonstrated greater outpatient session attendance within the 30 days before the 12-month follow up assessment and a larger decline from baseline in the number of psychiatric hospitalization nights. Individuals in the MISSION and TAU-only groups both showed statistically significant improvements in substance use and related problems at 12 months, with those in MISSION less likely to drink to intoxication and experience serious tension or anxiety. Although this study confirmed that compared with TAU alone, MISSION along with TAU is effective in augmenting usual care and engaging and retaining homeless veterans in treatment, some caution is warranted as this study did not involve random assignment. These results, however, are similar to a recent study involving a briefer version of the intervention which included random assignment. Based on these findings, MISSION is being further studied in the joint Department of Housing and Urban Development (HUD) - Department of Veterans Affairs (VA) Supportive Housing (HUD-VASH) program, which offers rapid housing placement and case management to aid in housing maintenance.

The Impact of Shelter Use and Housing Placement on Mortality Hazard for Unaccompanied Adults and Adults in Family Households Entering New York City Shelters: 1990–2002

This study examines mortality among New York City (NYC) homeless shelter users, assessing the relationships between mortality hazard and time in shelter, patterns of homelessness, and subsequent housing exits for both adults in families and single adults. Administrative records from the NYC shelter system were matched with death records from the Social Security Administration for 160,525 persons. Crude mortality rates and life tables were calculated, and survival analyses were undertaken using these data. Life expectancy was 64.2 and 68.6 years for single adult males and single adult females, respectively, and among adults in families, life expectancy was 67.2 and 70.1 years for males and females, respectively. For both groups, exits to stable housing (subsidized or non-subsidized) were associated with reduced mortality hazard. And while mortality hazard was substantially reduced for the time adults were in shelters, extended shelter use patterns were associated with increased mortality hazard. Differences between single homelessness and family homelessness extend to disparities in mortality rates. Although causal links cannot be established here, results suggest that, for both subgroups of the homeless population, prompt resolution of homelessness and availability of housing interventions may contribute to reduced mortality.

Factors related to rapidity of housing placement in Housing and Urban Development-Department of Veterans Affairs Supportive Housing program of 1990s

The Housing and Urban Development-Department of Veterans Affairs Supportive Housing (HUD-VASH) program is the largest supported housing program in the country for homeless veterans who are seeking rapid entry into permanent independent housing. This study examined factors related to how rapidly clients were housed in the early years of the program and how long they stayed in the program. Mental health, substance abuse, work/income, criminal history, and site were examined as predictors of process times. Regression analyses based on 627 HUD-VASH clients who entered the program between 1992 and 2003 showed that client characteristics were not rate-limiting factors for obtaining HUD-VASH housing; i.e., clients who had greater substance abuse problems or more extensive criminal histories did not take longer to obtain housing. The large differences associated with site of entry partly reflected a curvilinear relationship between the duration of operation of the HUD-VASH program and process times; i.e., at relatively younger and older programs, clients entered housing slightly faster than at programs in the middle range. Lastly, HUD-VASH clients whose case managers reported good therapeutic alliances stayed in the program longer. These findings have implications for the continued expansion of the HUD-VASH program.

Street to Home

This article presents findings from in-depth qualitative interviews conducted with 20 long-term unsheltered homeless adults who had recently been placed into housing by Street to Home (S2H), a housing-focused outreach program in New York City. S2H places individuals directly into transitional and permanent housing, breaking from the prevailing linear treatment and housing models that require a demonstration of ‘housing readiness’ via sobriety and psychiatric stability prior to permanent housing placements. The major themes identified were: (1) negative perceptions of homeless services and service resistance; (2) readiness to leave the street; (3) believable housing options as triggers for change; (4) adapting to new surroundings and discovering benefits; and (5) the importance of knowing supports are in place. Fulfilling promises in the wake of past disappointments and providing an ongoing sense of support appear to be the key elements that have enabled the program to engage and maintain clients.

National dissemination of supported housing in the VA: Model adherence versus model modification.

The continuing development and dissemination of emerging evidence-based practices may be facilitated by the availability of descriptive information on the actual delivery of the service, and its variability, across sites. This paper presents data on the participation of 2,925 homeless veterans in the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program at 36 sites across the country, for up to five years. While most conceptual models emphasize rapid placement, sustained intensive case management, rehabilitation services, and "permanent" housing, no program has yet presented empirical data on the actual delivery of such services over an extended period of time. Using extensive longitudinal data from the VA's national homeless outreach program, the Health Care for Homeless Veterans (HCHV) program, a quantitative portrait presents what happens in supported housing in a large real-world dissemination effort. Program entry to HUD-VASH was generally slow with 108 days (sd = 92 days) on average passing between program entry and housing placement. Total program participation lasted 2.6 years on average (sd = 1.6 years)-just half of the possible 5 years. Service delivery became substantially less intensive over time by several measures, and three-fourths of the veterans terminated within five years, although the vast majority (82%) were housed at the time. Few veterans received rehabilitation services (6%) or employment assistance (17%) and most service delivery focused on obtaining housing. These data suggest that real-world supported housing programs may not adhere to the prevalent model descriptions either because of implementation failure or because veteran needs and preferences differ from those suggested by that model.

Effect of a Housing and Case Management Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults

Homeless adults, especially those with chronic medical illnesses, are frequent users of costly medical services, especially emergency department and hospital services. To assess the effectiveness of a case management and housing program in reducing use of urgent medical services among homeless adults with chronic medical illnesses. Randomized controlled trial conducted at a public teaching hospital and a private, nonprofit hospital in Chicago, Illinois. Participants were 407 social worker-referred homeless adults with chronic medical illnesses (89% of referrals) from September 2003 until May 2006, with follow-up through December 2007. Analysis was by intention-to-treat. Housing offered as transitional housing after hospitalization discharge, followed by placement in long-term housing; case management offered on-site at primary study sites, transitional housing, and stable housing sites. Usual care participants received standard discharge planning from hospital social workers. Hospitalizations, hospital days, and emergency department visits measured using electronic surveillance, medical records, and interviews. Models were adjusted for baseline differences in demographics, insurance status, prior hospitalization or emergency department visit, human immunodeficiency virus infection, current use of alcohol or other drugs, mental health symptoms, and other factors. The analytic sample (n = 405 [n = 201 for the intervention group, n = 204 for the usual care group]) was 78% men and 78% African American, with a median duration of homelessness of 30 months. After 18 months, 73% of participants had at least 1 hospitalization or emergency department visit. Compared with the usual care group, the intervention group had unadjusted annualized mean reductions of 0.5 hospitalizations (95% confidence interval [CI], -1.2 to 0.2), 2.7 fewer hospital days (95% CI, -5.6 to 0.2), and 1.2 fewer emergency department visits (95% CI, -2.4 to 0.03). Adjusting for baseline covariates, compared with the usual care group, the intervention group had a relative reduction of 29% in hospitalizations (95% CI, 10% to 44%), 29% in hospital days (95% CI, 8% to 45%), and 24% in emergency department visits (95% CI, 3% to 40%). After adjustment, offering housing and case management to a population of homeless adults with chronic medical illnesses resulted in fewer hospital days and emergency department visits, compared with usual care. clinicaltrials.gov Identifier: NCT00490581.

Using housing estates as conservation tools: A case study in KwaZulu-Natal, South Africa

Increasing transformation and fragmentation of rural landscapes for economic reasons is causing concern to conservationists worldwide. With this trend likely to continue, perhaps conservation agencies and development corporations need to co-operate and plan housing developments that are environmentally and ecologically sustainable and can serve as refuges for endangered species. In KwaZulu-Natal, South Africa, grasslands are particularly threatened by land transformation for housing developments. A case study is presented of a housing development, Wedgewood Estate in KwaZulu-Natal that has been developed and managed for conserving grassland habitat and associated species, particularly the endangered oribi ( Ourebia ourebi). Feedback from the Estate's managers about the development and ecological impact were obtained. Wedgewood is an example of the viability of housing estates as refuges for endangered species and shows that the density and placement of housing and management of the natural habitat are important. It emphasizes the need for reviewing the types and amount of housing development, management of natural habitat, and the rules and regulations they put in place to assure the integrity of the conservancy is preserved. This case study also shows the potential of such ecologically sensitive housing developments as sources of surplus game for translocation, especially in the case of endangered species such as oribi.

Suitable Housing Placement: A GIS-Based Approach

The intent of this paper is to operationalize some aspects of local sustainability in a suitable development scenario and to compare its energy-use and environmental impacts to trend development. After a discussion of suburban sprawl, local sustainability, and the current state of the Pennypack Creek Watershed in the Philadelphia metro region, these residential location scenarios are presented. The latter were created using geographic information systems software and are based on projections from the Delaware Valley Regional Planning Commission. The impacts of the scenarios on energy use, air emissions, greenhouse gas emissions, water quality, and biological integrity were estimated with very few data, and the effect on the value of generic ecosystem services was assessed. The suitable development scenario was 29% better in terms of energy use and air and greenhouse gas emissions, 2.4% worse on water quality, and 2.6% better with respect to biological integrity. Given its net beneficial results, recommendations for policies to engender suitable development are made, and an outline of an implementation plan is proposed. Thoughts regarding refinements of the present work and the applicability of the methods used here to other watersheds conclude the work.

Deconcentrating Poverty With Housing Programs

Problem: Housing programs of the past have exacerbated the problems of concentrated poverty. Current housing programs serving very low-income households, including homebuyers as well as renters, should be examined to determine the extent to which they help households make entry into neighborhoods with low concentrations of poverty. Purpose: This research is designed to assist planners in understanding how well various approaches to resolving housing affordability problems can facilitate the poverty deconcentration process. Methods: Administrative data from the Department of Housing and Urban Development are used to assess the degree to which federal housing programs help lowincome homebuyers and renters locate in neighborhoods where less than 10% of the population is below poverty. Results and conclusions: Subsidizing households ought to be more effective than subsidizing housing units at helping lowincome households locate in low-poverty areas, and whether a household rents or buys should not matter to whether a program succeeds at deconcentration of the poor. Yet, analysis of national datasets across several housing programs finds neither of the previous propositions to be true. Housing vouchers suppliedto households are not helping renters locate in low-poverty areas any more effectively than are current project-based subsidies. It also turns out that tenure matters; a disproportionately higher share of low-income homebuyers are locating in low-poverty neighborhoods than are lowincome renters. Takeaway for practice: I recommend that housing planners seeking to make poverty deconcentration more effective use housing placement counselors, administer programs at the metropolitan scale, lease and broker market-rate housing directly, promote mixed-income LIHTC developments, practice inclusionary zoning, and monitor the impacts of these efforts. Research support: U.S. Department of Housing and Urban Development.

Midden formation and intrasite chemical patterning in Kalinga, Philippines

AbstractMiddens are surprisingly fluid entities in occupied communities, as shown by ethnoarchaeological research in Dalupa, Kalinga Province, northern Luzon, the Philippines. This study combines ethnoarchaeological observations of midden formation and disturbance in Dalupa with data from soils and sediments in natural, habitation, and midden contexts, including elemental data for 80 samples collected using inductively coupled plasma‐atomic emission spectroscopy. Most surface samples from habitation areas cluster with midden samples, although samples from the lower parts of theses profiles resemble samples from natural contexts around Dalupa. One explanation is a changing spatial distribution of active middens due to changes in house placement and occupation in Dalupa's history. Some habitation areas that chemically resemble middens may once have held middens, as suggested by the periodic changes in midden location from the cleaning and management of extramural space. Surface scatters of human and animal refuse throughout the habitation area may also contribute to this pattern. © 2007 Wiley Periodicals, Inc.

Implementation of Supported Employment for Homeless Veterans With Psychiatric or Addiction Disorders: Two-Year Outcomes

There has been growing interest in the dissemination of supported employment, but few studies have used a control group to examine the benefits of multisite dissemination efforts for clients or have addressed the needs of homeless persons with psychiatric disorders, addiction disorders, or both. This study examined a low-intensity training approach for implementing the individual placement and support (IPS) model at nine Department of Veterans Affairs (VA) programs and compared client outcomes before (phase 1) and after (phase 2) the program was implemented (phase 1). Special funds and sustained training, which was based primarily on teleconferencing, were used to support implementation of the IPS model of supported employment at nine VA programs for homeless veterans. A comparison cohort (phase 1) (N=308) was recruited from the nine sites before IPS was implemented. A postimplementation cohort (phase 2) (N=321) was recruited at the same sites and offered IPS. Mixed models were used to compare quarterly employment outcomes over two years in phase 1 and phase 2, adjusting for significant baseline differences (N=629). Measures of both client-level service delivery and site-level fidelity to IPS suggest that implementation was successful at most, but not all, sites. Overall, compared with veterans in the phase 1 group, those in the phase 2 group had a better long-term work history at the time of program entry. When the analyses controlled for baseline differences, the mean number of competitive employment days per month over the two-year follow-up period was 15% higher for veterans in phase 2 (8.4 days compared with 7.3 days; p<.001) and the mean number of days housed during follow-up was also higher in phase 2 (34.1 days compared with 29.8 days; p=.04), but there were no differences for other outcome measures. A sustained training program can be used to implement IPS in systems that have had little past experience with this approach. This effort was associated with improved employment outcomes and more rapid housing placement.

Impact of Permanent Supportive Housing on the Use of Acute Care Health Services by Homeless Adults

Impact of Permanent Supportive Housing on the Use of Acute Care Health Services by Homeless Adults

Impact of Permanent Supportive Housing on the Use of Acute Care Health Services by Homeless Adults

This analysis examined the impact of permanent supportive housing on the use of acute care public health services by homeless people with mental illness, substance use disorder, and other disabilities. The sample consisted of 236 single adults who entered supportive housing at two San Francisco sites, Canon Kip Community House and the Lyric Hotel, between October 10, 1994, and June 30, 1998. Eighty percent had a diagnosis of dual psychiatric and substance use disorders. Administrative data from the city's public health system were used to construct a retrospective, longitudinal history of service use. Analyses compared service use during the two years before entry into supportive housing with service use during the two years after entry. Eighty-one percent of residents remained in permanent supportive housing for at least one year. Housing placement significantly reduced the percentage of residents with an emergency department visit (53 to 37 percent), the average number of visits per person (1.94 to .86), and the total number of emergency department visits (56 percent decrease, from 457 to 202) for the sample as a whole. For hospitalizations, permanent supportive housing placement significantly reduced the likelihood of being hospitalized (19 to 11 percent) and the mean number of admissions per person (.34 to .19 admissions per resident). Providing permanent supportive housing to homeless people with psychiatric and substance use disorders reduced their use of costly hospital emergency department and inpatient services, which are publicly provided.

Change in neurocognition by housing type and substance abuse among formerly homeless seriously mentally ill persons

Objective To test the effect of living in group housing rather than independent apartments on executive functioning, verbal memory and sustained attention among formerly homeless persons with serious mental illness and to determine whether substance abuse modifies this effect. Method In metropolitan Boston, 112 persons in Department of Mental Health shelters were randomly assigned to group homes (“Evolving Consumer Households”, with project facilitator, group meetings, resident decision-making) or independent apartments. All were case managed. A neuropsychological test battery was administered at baseline, at 18 months (Time 2), with an 81% follow-up rate, and at 48 months (Time 3), with a 59% follow-up rate. Hierarchical Linear Modeling was applied to executive functioning—assessed with the Wisconsin Card Sorting Test (Perseverations)—Logical Memory story recall, and an auditory Continuous Performance Test (CPT) for sustained attention. Subject characteristics were controlled. Results When moved to group homes, subjects without a lifetime substance abuse history improved on Perseverations, while those who moved to independent apartments deteriorated on Perseverations. Across the two housing conditions, subjects showed no change in Perseverations, but improved on Logical Memory story recall and the CPT. Conclusions Type of housing placement can influence cognitive functioning; notably, socially isolating housing is associated with weakened executive functioning. Substance abuse significantly diminishes environmental effects. These are important factors to consider in housing placement and subsequent treatment.

Adolescent Homelessness, Nursing, and Public Health Policy

Homelessness among American adolescents is not a new phenomenon. The United States has a long history of youth who are runaways and/or homeless. The majority of adolescents who are homeless believe that they have no acceptable housing placement options. The foster care system often fails to help youth deal with problems. The impact of homelessness on youth's social functioning and health status should be raised at the community level, particularly by community nurses and other health professions who interact with adolescents who are homeless. By using Kingdon's multiple streams model, nurses can advocate for homeless youth by accurately defining and reframing adolescent homelessness for policy makers and including provision of shelter as a policy priority.

A comparison of patients relapsing to addictive drug use with non-relapsing patients following residential addiction treatment in Antigua

The outcome of a 29-day residential addiction treatment programme for persons from Antigua and Barbuda with addiction to drugs or alcohol was assessed. All 100 patients entering the drug and alcohol treatment programme at Crossroads Centre Antigua between November 1998 and October 2002 were included. All patients were assessed with regards to drug or alcohol use or abstinence in November 2002 using telephone and mail follow-up as well as informal follow-up with families and other community contacts. Crossroads Centre Antigua is a 35 bed, 29-day residential treatment centre for drug and alcohol addiction serving patients from developed countries (85%) and from the Caribbean region (15%). Patients records were also reviewed to obtain age, gender, ethnicity, drug of choice, years of problematic use, completion of the 29 day programme, family member participation at Crossroads Centre Antigua (a four-day programme) and acceptance of halfway house placement. Of the 100 Antiguan patients admitted, 46 (46%) were abstinent (non-relapsers) at average 20.7+/-14.7 months after treatment. Abstinence did not have to be continuous. Forty-nine were known to be using drug or alcohol (49%) and five (5%) were lost to follow-up and considered to be using drugs (relapsers). Age (37.5 vs 41.1 years), gender (28% vs 22% female), ethnicity (87% vs 87% Afro-Caribbean), years of harmful use (12.7 vs 12.5 years) did not differ significantly between relapsers and non-relapsers. Crack cocaine use (67% vs 65%) and alcohol use (26% vs 31%) as primary addiction did not differ significantly between relapsers and non-relapsers. Relapsers were significantly less likely to complete the 29- day programme (81% vs 100%, p < 0.01), have family members participate at Crossroads (32% vs 54%, p < 0.05) or accept halfway house placement (4% vs 54%, p < 0.001). In conclusion, abstinence was achieved in 46% of those entering treatment, in 51% completing treatment, in 60% whose families participated and in 92% of those accepting halfway house placement.

Mitigating apprehension about section 8 vouchers: The positive role of housing specialists in search and placement

The U.S. Department of Housing and Urban Development has found that Section 8 voucher recipients are often unable to secure apartments outside of high‐poverty areas in tight urban rental markets. However, intensive housing placement services greatly improve the success and mobility of voucher holders. Drawing on ethnographic research in the housing placement department of a private, nonprofit community‐based organization, I first describe how fundamental problems in implementing the public subsidy program in a tight private rental market generate apprehension among landlords and voucher recipients that can prevent the successful use of vouchers. Second, I demonstrate how housing placement specialists can dispel and overcome this apprehension through a variety of tactics that require extensive soft skills and a deep commitment to the mission of housing poor families. These findings provide support for the increased use of housing placement services to improve success and mobility rates for Section 8 vouchers.