Supported Housing Model Research Articles

Comparing health service use before and after transition to a supported housing model for clients who experience severe and persistent mental illness in southwestern Ontario, Canada

Objective and ApproachBeginning in 2018, a provincially-funded custodial housing model in Ontario, Canada transitioned to a supported housing model that allowed more autonomy for clients who experience severe and persistent mental illness (SPMI). The objective of this study was to compare health service use before and after transition to the new Community Homes for Opportunity (CHO) program in southwestern Ontario between 2017 and 2019. Information about clients who transitioned to the CHO program were obtained from the Ontario Ministry of Health and Long-Term Care and linked to health administrative data at ICES. Rates of emergency department (ED) visits, primary care visits, and specialist visits in the one year before and after implementation of the CHO program were compared using conditional Poisson models. ResultsOf the 368 clients, approximately 40% were female and the mean age was 57 years old. Compared to before the transition, clients had more primary care visits (rate ratio [RR] = 1.21; 95% CI: 1.07-1.37) and specialist visits (RR = 1.33; 95% CI: 1.11-1.60) within the year after transition to the CHO program. There was no significant change in the use of emergency department visits following the transition (RR = 1.20; 95% CI: 0.96-1.50). ConclusionsSupported housing may be associated with greater use of primary and specialist care for clients who experience SPMI. ImplicationsThe new supported housing model may encourage clients to use more personalized health care, according to their specific needs. Such personalized support is crucial for clients with complex health care needs.

Staff perspectives on the successful families program model: Combining supportive housing with wraparound services for teen families

Providing support to address the systemic barriers that teen families face is a logical step toward improving their health and well-being. One area where teen families face multiple obstacles is accessing safe, secure, affordable housing. This paper describes a unique, innovative model of supportive housing developed in combination with wraparound supports, provided to teen parents in Edmonton, Canada. As part of a larger community-based participatory research and evaluation project, we draw on qualitative data to describe the supportive wraparound housing model that was developed. In particular, we conducted individual interviews and focus groups with a total of 27 staff members from the partner agencies, who provided information about the Successful Families program model. Analysis of interview data resulted in five broad categories that have resonated with our community and academic team as a way to conceptualize and share the work of the program. Categories, which are described in terms of associated subcategories, include: Community, Partnership, Program Principles and Values, Successful Families Program Structures, and Skill and Knowledge Development. Through this work, we aim to promote awareness of considerations for service providers seeking to implement similar services, and expand the limited knowledge base regarding methods for supporting the diverse needs of teen families.

‘Moving, moving, moving’: the social forces that perpetuate housing instability for women experiencing intimate partner violence

Housing scholars have demonstrated that intimate partner violence (IPV) is a key driver of housing instability. Contributing to existing housing literature that foregrounds the importance of material and psychological housing instability, our empirical research focuses on a novel programme providing supportive housing for women, the majority of whom are allocated housing to protect them from IPV. Our data includes in-depth interviews with the supportive housing tenants and practitioners, as well as administrative data. Our findings illuminate the close interrelation between material and psychological housing instability, and demonstrate how problems inherent in the private rental market interact with issues caused by perpetrators’ ongoing use of violence in ways that make it impossible for women to achieve either form of stability. The implication for housing scholars is to understand that although affordable housing is a protective measure, supportive housing models that rely on the private rental market, face profound limitations in achieving material and psychological housing stability for women who experience IPV.

Implementation of the Community Homes for Opportunity Program Among Community Mental Health Staff in Southwestern Ontario

Supportive housing programs such as the Community Homes for Opportunity (CHO) that provide combined formal (off-site healthcare providers) and informal (on-site supports are effective in reducing erratic housing and homelessness. This study explored the views of the Community Mental Health Agency staff on their experiences with the CHO and related changes for further improvement of the program. We applied focused ethnographic techniques to recruit 47 agency staff from 28 group homes in Southwestern Ontario, Canada. Focus group discussions were conducted at two-time points (baseline–spring 2018 and post-implementation – winter 2019). Data analysis guided by Leininger’s ethnographic qualitative analysis techniques produced three main themes and 11 subthemes themes. The main themes include facilitators of CHO, challenges to the CHO implementation, and strategies for improving the CHO program. Overall, supportive housing models have been found to constitute an effective pathway to reducing precarious housing and ending chronic homelessness for those in need while enhancing their social integration.

Understanding the Homelessness Crisis and Responses in Bloomington, Indiana

This study addresses the complex challenges of homelessness in Bloomington, Indiana. Beacon, Inc., a nonprofit based in Bloomington, plays a pivotal role in providing support to individuals experiencing homelessness in south-central Indiana. Beacon’s approach prioritizes immediate and barrier-free access to shelter and housing while eliminating stringent entry requirements. Beacon offers three distinct programs: Friend’s Place, an emergency shelter; Rapid Re-Housing, facilitating rapid transitions to stable housing; and Crawford Homes, providing permanent supportive housing. This research, conducted in partnership with Beacon, employs a mixed-methods approach to examine homelessness in the city of Bloomington. It includes a literature review, quantitative data analysis from nationwide counts and Beacon’s programs, and interviews with Beacon staff to gain insights into the housing crisis and its unique dynamics in this community. The results underscore the impact of Beacon’s programs in 2022 on individuals experiencing extreme poverty in Indiana’s Region 10, which consists of six south-central counties. Despite the success of these programs, challenges persist for individuals experiencing homelessness, particularly in combating chronic homelessness. Interviews with Beacon staff highlighted additional barriers to housing, including high rents, inflexible landlords, evictions, and entanglement with the criminal justice system. This study suggests the need for diverse strategies, including expanding Housing First programs and supportive housing models, as well as long-term government housing subsidies for low-income renters. These solutions can reduce reliance on emergency shelters and work to prevent chronic/recurrent homelessness. By employing a mixed-methods research approach, this study offers valuable insights into homelessness and housing assistance programs, providing a foundation for future research aimed at addressing homelessness more comprehensively in Bloomington and similar communities.

Promoting Sustainability in Housing with Services: Insights From the Right Care, Right Place, Right Time Program.

Despite the widely-acknowledged potential of housing with services for improving the lives of low-income older adults, ensuring their financial sustainability has been challenging. This study aimed to address this issue, drawing on 31 key informant interviews and three focus groups with payers, housing providers, and community partners involved in the Boston-area Right Care, Right Place, Right Time Program, which enrolled about 400 older adults. Transcripts were qualitatively analyzed using thematic coding. Participants agreed on the program's value, but there was little consensus on mechanisms for securing ongoing funding. The broadly distributed responsibility for individuals in housing sites, which involves health insurers, hospitals, and community service providers, provides little incentive for investment by these entities. Findings suggest that governmental mechanisms, probably at the federal level, are needed to channel funding toward these supportive services. Without such reliable funding sources, replication of supportive housing models for low-income older people will prove difficult.

Evaluation of a modernized supported housing intervention for individuals who experience severe and persistent mental illness in Ontario, Canada.

Supported housing approaches that include case management and increased opportunities for independence and personal autonomy for people who are living with severe and persistent mental illness (SPMI) have been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. This study uncovered that individuals experiencing SPMI who lived in supported housing used more primary health care and specialist physician services, in the year following transition to this housing arrangement. The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual residents, including increasing access to both primary health care and specialist services. This is important for nursing practice, as the findings of the study show that supported housing arrangements for people experiencing SPMI may assist in better supporting their complex health care needs. INTRODUCTION: Supported housing for people who are living with severe and persistent mental illness (SPMI) has been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. The aim of this study was to compare the use of health services use of individuals with SPMI, before and after transition to the new supported housing program. Using health care administrative databases, a pre-post cohort study was conducted examining the health system use of residents who transitioned from custodial to supported housing arrangements between 2017 and 2019. Individuals with SPMI used more primary health care and specialist physician services after transition to the supported housing model. The results suggest that a supported housing model may be associated with increased usage of outpatient person-centred health services in people experiencing SPMI. The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual. This is important for nursing practice, as the findings of the study show that supported housing arrangements may assist in better supporting complex health care needs of individuals.

Care and Complexity in Emergency Housing: an Examination of the COVID-19 Shelter-in-Place (SIP) Hotel Program to House People Experiencing Homelessness in San Francisco

In this study, we consider the patient, provider, and public health repercussions of San Francisco’s (SF) COVID-related response to homelessness using tourist hotels to house people experiencing homelessness (PEH). We describe the demographics, medical comorbidities, and healthcare utilization patterns of a subset of PEH who accessed the shelter-in-place (SIP) hotel sites during the 2020–2021 pandemic. We focus on how SIP hotels impacted connection to outpatient care and higher-cost emergency utilization. Our mixed methods study integrates qualitative and quantitative data to consider the impact of this temporary housing initiative among a medically complex cohort in a time of increased morbidity and mortality related to substance use. We found that temporary SIP housing increased outpatient care and reduced higher-cost hospital utilization. Our results can inform the future design and implementation of integrated supportive housing models to reduce mortality and promote wellness for PEH.

'The Big Island Model': Resident experiences of a novel permanent supportive housing model for responding to rural homelessness.

Research on rural homelessness focuses primarily on describing the experiences and prevalence of homelessness in rural contexts, with little focus on intervention strategies. We conducted a case study of the 'Big Island Model' (BIM), a novel approach to providing housing and support to individuals experiencing homelessness that has been developed for, and reflects, a rural context. We interviewed 13 participants (n=10 men; n=3 women) supported by the BIM using mixed interviews including qualitative and quantitative components exploring experiences of living within this model and aspects of psychosocial well-being. Descriptive statistics were calculated to represent demographic data and participants' scores on standardised measures. Wilcoxon signed-rank tests were conducted with threshold scores and population norms derived from existing literature to identify any differences between residents' median scores on each standardised scale and scores derived from published literature. Qualitative data were analysed using thematic analysis. On measures of meaningful activity, residents reported significantly lower levels of boredom (p < 0.01) and a greater degree of engagement in productivity (p < 0.01) compared with participants in other studies. Mental well-being was reported to be higher (p < 0.05) and drug use was significantly lower than a low-moderate range (p < 0.01). Community integration scores revealed significantly lower physical integration (p < 0.05) and significantly higher psychological integration than individuals who had transitioned to housing in another study (p < 0.001). Our analysis of qualitative interviews resulted in the identification of a central essence characterising residents' experiences: 'Becoming Through Belonging'. This essence was represented by four distinct themes: (1) the healing qualities of nature; (2) being meaningfully occupied; (3) living in a mutually supportive environment; and (4) this place is here to help.

Primary care embedded within permanent supportive housing for people who use substances: A qualitative study examining healthcare access in Vancouver, Canada.

Marginally housed people who use drugs and alcohol (PWUD/A) face barriers in accessing healthcare services, which may be improved by providing healthcare in housing settings. This case study examines the experiences of healthcare access amongst PWUD/A who live in a permanent supportive housing model in Vancouver, Canada. This model has an embedded multidisciplinary clinic providing in-reach services. Thirty participants were recruited via posters placed throughout the building and semi-structured qualitative interviews were conducted remotely. Interviews were conducted with participants who accessed onsite care regularly (n=15) and those who do not (n=15). Data were analysed to identify both a priori and emerging themes. Participants who accessed the onsite clinic reported benefiting from stigma-free care. Close proximity and convenience of drop-in appointments enabled participants to engage with healthcare services more consistently, though hours of operation and privacy concerns were barriers for others. Participants who did not use the onsite clinic highlighted the importance of continuity of care with their pre-existing primary care team, particularly if their clinic was in close geographic proximity. However, they also described utilising these services for urgent health needs or as an occasional alternative source of care. Shared perspectives across all participants emphasised the importance of low-barrier services, including medication delivery, convenience and positive therapeutic relationships. Our findings suggest that embedding access to primary care within supportive housing benefits PWUD/A who have previously encountered barriers to healthcare access. This model could be implemented to prevent utilisation of acute healthcare resources and improve health outcomes amongst PWUD/A.

The extent to which non-conditional housing programs improve housing and well-being outcomes: a systematic review

PurposeTo reduce rates of homelessness, recent efforts have been directed toward developing non-conditional supported housing programs that prioritize the delivery of housing support and individual services, without tenancy conditions (i.e. maintaining sobriety and adhering to mental health treatment). As promising as these programs are, findings generally show that while housing stability is improved, other individual outcomes remain largely unchanged. No review to date has synthesized the collective evidence base of non-conditional housing programs, rather the focus has been on specific programs of delivery (e.g. Housing First) or on specific population groups (e.g. those with mental illness). The purpose of this paper is to evaluate the extent to which non-conditional housing interventions improve housing and well-being outcomes for all persons.Design/methodology/approachA systematic search of the literature was conducted for randomized controlled studies that evaluated the effectiveness of a non-conditional housing intervention in improving housing and health outcomes among any participant group.FindingsA total of 31 studies were included in this review. Non-conditional supported housing programs were found to be most effective in improving housing stability as compared to health and well-being outcomes. Policymakers should consider this when developing non-conditional supported housing programs and ensure that housing and other health-related outcomes are also mutually supported.Originality/valueThis is the first review, to the authors’ knowledge, to synthesize the collective impact of all non-conditional supported housing programs. The current findings may inform the (re)design and implementation of supported housing models to prioritize the health and well-being of residents.

Massachusetts briefing touts supportive housing for homeless

A Massachusetts supportive housing model that offers an alternative to shelter placement for the homeless was hailed for its success in providing supervised, supportive housing for the hard‐to‐reach homeless population during a legislative briefing last week.

Examining the need profile of supportive housing applicants with and without current justice involvement: A cross-sectional study.

Permanent supportive housing has been identified as a possible intervention which could reduce the risk of criminal justice involvement (CJI) among people with serious mental illness who are experiencing residential instability and homelessness. However, the evidence evaluating the impact of supportive housing on CJI is mixed. Increasing understanding of the specific needs of people with justice involvement entering supportive housing may inform interventions which improve their criminal justice outcomes. Toward this end, this study compared the characteristics and need profiles of applicants to supportive housing with and without current CJI. Secondary analyses were conducted of archival databases of 12,277 individuals applying for supportive housing in Toronto, Canada between 2009 and 2015. The characteristics and support needs of applicants with current CJI were compared to applicants with no current justice involvement. Of the applicants, 2,894 (23.6%) reported having justice involvement at the time of referral to supportive housing services. The strongest predictors of having justice involvement were a history of physical assaults, homelessness, problematic substance use, male gender, and younger age. Criminological factors rather than functional or mental health needs were most predictive of having current justice involvement at referral. Development of justice-focused supportive housing models may be considered which supplement traditional supportive housing approaches with empirically based interventions targeting the criminogenic needs of people with mental illness and justice involvement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Effect of Various Supportive Housing Models on ART Adherence Among Persons Living With HIV in Supportive Housing.

Providing permanent supportive housing to chronically homeless persons living with human immunodeficiency virus (PLH) contributes to improved human immunodeficiency virus (HIV) outcomes, including adherence to antiretroviral therapy (ART). This study seeks to understand whether certain components of housing, namely intensity of case management and specialized HIV housing programs, affects ART adherence for PLH in supportive housing. From 2015 to 2019 we conducted quantitative assessments with 157 PLH in supportive housing at baseline, 6-, 12-, and 18-month postbaseline to identify factors associated with ART adherence. General Estimating Equations for repeated measures were performed to assess bivariate and multivariate measures. Two thirds of PLH in supportive housing reported 95% or greater adherence to ART. Multivariate analyses indicate that neither intensity of case management services nor specialized housing for PLH were associated with greater ART adherence. Greater time since diagnosis was positively associated with ART adherence. Greater depressive symptoms and African American race were negatively associated with ART adherence. Study findings reveal that although prior research has established the importance of receipt of housing for homeless PLH, the type or intensity of case management services associated with that housing may not be as important as simply being housed. Our results highlight the importance of considering mental health and more recent HIV diagnosis when developing treatment and case management plans to enhance residents' ART adherence.

The comparative effectiveness of different models of permanent supportive housing on problematic substance use, depression, and anxiety symptoms over time.

To compare the effectiveness of different models of permanent supportive housing (PSH), housing configuration, and service provision model on substance use, depression, and anxiety symptoms among residents over time. Linear mixed model regression was used with 888 residents of PSH to investigate the relationship between supportive housing type, service model, and housing configuration and change in mental health and substance use at baseline, 6-, 12-, and 18-month follow-up. There were few significant differences in problematic substance use, depression, or anxiety symptoms among those in different PSH types, different housing configuration models, or different service provision models. Similarly, there were no significant differences in PSH type, housing configuration, or service delivery model among those with severe mental illness (SMI), substance use disorder (SUD), or those with dual diagnoses. There is little evidence that different models of PSH result in differences in mental health and substance use outcomes. Future research should consider the number of services clients receive and critical periods in PSH residency in improving mental health and substance use outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Using developmental evaluation and community-based participatory research to develop a model of supportive housing

Community-based participatory research (CBPR) and developmental evaluation (DE) have emerged over recent decades as separate approaches for addressing complex social issues. Current literature offers little with respect to the use of CBPR and DE in combination, although the two approaches are complementary. Through the current paper, we outline how CBPR and DE were used to develop a model of supportive housing for teen families. More specifically, we describe the structures and processes that contributed to this development, including (1) our partnership approach, (2) pooled resources, (3) regular opportunities for collaboration and reflection, (4) integration of multiple data sources, (5) ongoing feedback and knowledge dissemination, and (6) adjustments to program practices. We end by providing insights into the lessons that we learned through this project. Through this paper, we describe how researchers and community partners can collaboratively use CBPR and DE to develop a program model in complex community settings. Insights are offered that will be important for researchers, evaluators, and practitioners seeking to develop programming in response to complex community issues.

Supported Housing as a recovery option for long-stay patients with severe mental illness in a psychiatric hospital in South India: Learning from an innovative de-hospitalization process.

Individuals with severe mental illness have long been segregated from living in communities and participating in socio- cultural life. In recent years, owing to progressive legislations and declarations (in India and globally), there has been a growing movement towards promoting social inclusion and community participation, with emphasis on the need to develop alternative and inclusive care paradigms for persons with severe mental illness. However, transitions from inpatient care to community settings is a complex process involving implications at multiple levels involving diverse stakeholders such as mental health service users, care providers, local communities and policy makers. This article studies how the transition from a hospital setting to a community-based recovery model for personals with severe mental illness can be facilitated. It reflects on the innovative process of creating a Supported Housing model in South India, where 11 MH Service users transitioned from a psychiatric ECRC to independent living facilities. Experiences in various phases of the project development, including care provider- and community level responses and feedback were scrutinised to understand the strategies that were employed in enabling the transition. Qualitative methods (including in-depth interviews and naturalistic observations) were used with residents and staff members to explore the challenges they encountered in stabilizing the model, as well as the psychosocial benefits experienced by residents in the last phase. These were complemented with a Brief Psychiatric Rating Scale (BPRS) and WHO Quality of Life scale to compare baseline and post-assessment results and an increase of quality of life. Results display a significant reduction of psychiatric symptoms in patients (p< 0.5). It also describes the challenges encountered in the current context, and strategies that were used to respond and adapt the model to address these concerns effectively. Positive behavioural and psycho-emotional changes were observed amongst the residents, significant amongst those being enhanced in their mobility and participation. The article concludes by discussing the implications of this study for the development of innovative community-based models in wider contexts.

Health-related quality of life and related factors among chronically homeless adults living in different permanent supportive housing models: a cross-sectional study.

Permanent supportive housing (PSH) is an effective intervention to improve residential stability and reduce the utilization of costlier healthcare services for the chronically homeless. However, there has been little focus on health-related quality of life (HRQL) once they enter PSH, and the potential influence of other factors including the PSH model. Study results can shed light on the HRQL of the PSH population and inform strategies to improve PSH program effectiveness in this area. In this cross-sectional study, survey methods were used to assess the HRQL of PSH residents in the Chicago metropolitan area. The survey also included questions on socio-demographics, health behaviors, housing and neighborhood characteristics, and housing satisfaction. The SF-36 was used to obtain physical (PCS) and mental component summary (MCS) scores for HRQL. Other variables were selected using the Wilson and Cleary HRQL model. Statistical analyses included summary statistics, bivariate analyses, and fully adjusted linear regression models. The study sample included 855 adults currently in PSH. The sample was predominantly African American men with an average age of 53years. Mean scores for PCS and MCS were 39.4 and 46.1, respectively, (out of 100). In adjusted analyses, older age and being on disability were associated with worse PCS. Having HIV was associated with better PCS. Being non-Hispanic Black, living in fixed-sited housing, and being in PSH for longer durations were associated with better MCS. More depressive symptoms was associated with worse PCS and MCS. While both aspects of the PSH model (housing configuration and service provision) were initially associated with HRQL in unadjusted analyses, housing configuration was the only PSH model variable that remained significant once accounting for other factors. Depressive symptomology and the social environment also appear to be important correlates of HRQL and are potential areas to target in PSH programs.

Attempting Randomized Housing First Research in a Community Context: Reflections on Failure.

The Housing First (HF) model of permanent supportive housing for individuals experiencing chronic homelessness has a strong evidence base that has largely been driven by researchers in the field of community psychology in partnership with community-based organizations. However, important gaps in the HF literature remain. Implementing rigorous research designs to further the evidence for HF requires immense resources to fund both the housing intervention and the research activities. In the absence of such resources, university-community partnerships may be established to integrate research within business-as-usual services and utilize existing housing units. This first person account presents a "post-mortem" exploration of an attempt to conduct a randomized trial of scattered-site and single-site approaches to HF within a community context from the perspectives of multiple stakeholders involved in the endeavor. Despite strengths of the research collaborative, the project did not come to completion due to a series of bothinsurmountable and avoidable barriers. Yet, the experience illuminated several potential challenges researchers and housing providers conducting work in this area may encounter, such as ever-changing homeless service system policies that may impact research and organizational procedures. Lessons learned and recommendations for preventing or overcoming systems-level barriers and potential challenges within the university-community partnership are described.

Community in the Permanent Supportive Housing Model: Applications to Survivors of Intimate Partner Violence

ABSTRACT A key aspect of permanent supportive housing (PSH) is the community it forms, providing social supports and a sense of home for residents. Only recently, however, have evaluations of PSH examined community as an integral characteristic. For intimate partner violence (IPV) survivors, a new PSH target population, community and social connections are uniquely important. Using a case study of a PSH program for IPV survivors, we explored residents’ experiences of a community. Based on feminist-grounded theory, we conducted in-depth interviews with 13 survivors over a two-year period. Findings indicate that some residents experience community in terms of shared physical space and shared identity and that positive interactions exist. However, the system of supports was fragile and inconsistent. We discuss strategies to strengthen community within PSH, but also argue for an expanded definition of community that reflects the diverse backgrounds and circumstances of residents.