Transitional Housing Programs Research Articles

How Can Transitional Housing Be Improved? Insights from Residents' Experiences and Perceptions in New York City.

Homelessness, affecting over half a million Americans, significantly elevates the risks of mental and physical health issues, consequently diminishing life expectancy when compared with the general population. Homelessness is a critical public health issue, and efforts are needed to address lack of housing as a social determinant of health. Transitional housing (TH) programs emerge as vital interventions, offering a place to stay with various support services to facilitate the transition to permanent residency. Nearly half of the unhoused population in the country and over 90% in New York live in TH or shelters. Despite the high utilization rates of TH, engagement with support services and opportunities for improvement remain poorly understood. This study aimed to fill this gap by examining the factors influencing support service usage and opportunities for enhancement through semi-structured interviews with TH residents in New York City to capture their lived experiences and perspectives. Analysis of the interviews (n = 20) revealed five main factors affecting service engagement that aligned with constructs of the socioecological model: intrapersonal (self-efficacy, chronic health conditions, mental health), interpersonal (parenthood and well-being of children with special needs, individual staff interactions, and communication), institutional (bureaucratic challenges, administrative burden, and living facilities), community (social isolation and educational opportunity), and policy (challenge meeting basic needs and undocumented status). Recommendations for bridging service gaps primarily arose at the institutional and community levels, offering critical insights for administrators to tailor services more effectively to TH residents' needs, thus contributing to the broader goal of advancing health equity among the unhoused.

Hospital-based transitional housing and care at discharge for persons experiencing homelessness

ABSTRACT People identifying as homeless in high income countries are becoming older and more medically complex. Previous studies have demonstrated the health and social benefits of various housing interventions for people who are homeless after hospital discharge. In this pre-/post-intervention cohort study, we recruited 57 participants from two transitional housing programs on the grounds of a single inner-city tertiary care center. In comparison to the 12 months prior to attending the transitional housing program, the number of hospital admissions decreased by 45% in the 12 months thereafter from an average of 2.0 to 1.1 admissions (p = 0.01). The number of inpatient days decreased by 64% from an average of 23.2 to 8.3 days (p < 0.01). Housing status at 12 months after baseline interviews had improved for 42% of our participants. Through our qualitative interviews with participants, key strengths of the programs included the trauma-informed approach and social service navigation provided by staff members, as well as the stable physical environment with proximity to comprehensive healthcare and social resources. Among hospitalized individuals facing homelessness, our study demonstrates that participation in a hospital-based transitional housing program can be associated with reductions in hospitalizations and hospital length of stay, and improved housing status.

Resident Perspectives on Modular Housing: The Need for Progression, Collaboration, and Autonomy

Modular housing is a temporary and transitional housing program in British Columbia. This qualitative study gathered the perceived needs of residents at modular housing sites to determine how service delivery impacts care continuity and well-being. Twenty-five residents at four modular housing sites in an urban setting participated in focus groups and semi-structured interviews. Thematic content analysis was used to summarize key findings. Themes highlight the need for flexible, person-centred, and tailored supports. Participants also voiced the importance of communication during times of transition into modular housing, as well as the impact of the environment on safety and autonomy.

A Sanctioned Encampment as a Strategy for Increasing Homeless Veterans' Access to Housing and Healthcare During the COVID-19 Pandemic.

The COVID-19 pandemic intersected with a housing crisis for unsheltered Veterans experiencing homelessness (VEHs); congregate settings became high risk for viral spread. The VA Greater Los Angeles responded by creating the Care, Treatment, and Rehabilitation Service (CTRS), an outdoor, low-barrier-to-entry transitional housing program on VA grounds. This novel emergency initiative offered a protected outdoor environment ("sanctioned encampment") where VEHs lived in tents and had access to three meals a day, hygiene resources, and health and social services. To identify contextual factors that supported and impeded CTRS participants' access to healthcare and housing services. Multi-method, ethnographic data collection. VEHs residing at CTRS, CTRS staff. Over 150hours of participant observation were conducted at CTRS and at eight town hall meetings; semi-structured interviews were conducted with 21 VEHs and 11 staff. Rapid turn-around qualitative analysis was used to synthesize data, engaging stakeholders in iterative participant validation. Content analysis techniques were used to identify key factors that impacted access to housing and health services among VEHs residing in CTRS. Staff varied in their interpretation of CTRS' mission. Some conceptualized access to health services as a central tenet, while others viewed CTRS as an emergency shelter only. Regardless, staff burnout was prevalent, which lead to low morale, high turnover, and worsened access to and quality of care. VEHs endorsed trusting, long-term relationships with CTRS staff as paramount for facilitating access to services. Though CTRS addressed basic priorities (food, shelter, etc.) that traditionally compete with access to healthcare, some VEHs needed on-site healthcare services, at their tents, to access care. CTRS provided VEHs access to basic needs and health and housing services. To improve access to healthcare services within encampments, our data suggest the value of longitudinal trusting relationships, adequate staff support, and on-site health services.

The contribution of replicated follow-up studies to improving transitional housing programs for youths aging out of care in Israel

Evaluation research on transitional housing programs (THP) for youths aging out of care resulted in recommendations on how to improve the programs to ensure a more effective response to the needs of care leavers. The aim of the present study was to examine whether implementing the recommendations indeed improved the experiences of care leavers during their participation in the THPs, and their outcomes two to three years after discharge from the program. Study participants were young adults from two cohorts of the same national transitional housing program who participated in two follow-up studies conducted after their discharge from the transitional apartment. We harnessed data from two mixed-methods follow-up studies. The first follow-up comprised young adults who had graduated from the program prior to the implementation of the recommendations, while the second consisted of young adults who graduated from the program after said implementation. The questions addressed the participants’ retrospective evaluations of the program, their experiences of transition to independent living, and outcome measures such as life skills, leisure time activities, satisfaction with social relations, self-reported health (SRH), and life satisfaction. Results revealed that participants in the second cohort evaluated both their experience in the program and the outcomes measures more positively than did their counterparts in the first cohort. In addition, a positive association was found between evaluation of the program’s assistance, relationship with an apartment counselor, life skills, and life satisfaction. We conclude that repeated follow-ups of transitional housing program leavers following the implementation of evaluation recommendations can contribute to significantly improving users’ experiences and outcomes.

COVID-19 Vaccine Hesitancy among U.S. Veterans Experiencing Homelessness in Transitional Housing.

Little is known about COVID-19 vaccine hesitancy and acceptance among individuals experiencing homelessness, despite their higher risk for morbidity and mortality from SARS-CoV-2. This study examines COVID-19 vaccination attitudes and uptake among U.S. military Veterans experiencing homelessness enrolled in transitional housing programs funded by the U.S. Department of Veterans Affairs (VA). Telephone interviews were conducted with 20 Veterans in California, Florida, Iowa, Kentucky, and Massachusetts, USA (January-April 2021). A rapid analysis approach was used to identify and enumerate commonly occurring themes. Although 60% of interviewed Veterans either received the COVID-19 vaccine or were willing to do so, one-third expressed hesitancy to get vaccinated. COVID-19 vaccination attitudes (e.g., belief that the vaccines were inadequately tested), military experience, beliefs about influenza and other vaccines, and sources of information emerged as influential factors for COVID-19 vaccination uptake or hesitancy. Veterans in VA-funded homeless transitional housing programs are generally willing to be vaccinated. However, a substantial minority is reluctant to take the vaccine due to concerns about the COVID-19 vaccine and distrust of authority. Recommendations for increasing uptake include utilizing Veteran peers, homeless service providers, and healthcare providers as trusted messengers to improve confidence in the vaccine.

Aging in the Right Place for Older Adults Experiencing Housing Insecurity: An Environmental Assessment of Temporary Housing Program.

Research on programs offering senior-specific housing supports and enabling "aging in the right place" (AIRP) for "older persons with experiences of homelessness" (OPEH) is limited. This paper presents an environmental assessment of a "transitional housing program" (THP) in Metro Vancouver, Canada, for OPEH to AIRP. Data were collected using Aging in the Right Place Environmental (AIRP-ENV) and Secondary Observation (AIRP-ENV-SO) audit tools designed to evaluate multi-unit housing for OPEH. The 241-item AIRP-ENV tool was used to assess the built environmental features of four multi-unit buildings of the THP. The AIRP-ENV-SO tool was used to collect contextual data on the function, safety, and land use of the surrounding neighborhood. Findings identified built environment and urban design features that support THP residents' safety, security, accessibility, functionality, social activity, autonomy, and identity. The THP buildings were rated 'Good' for accessibility, functionality, autonomy and identity, while 'Satisfactory' or 'Poor' for safety, security, and social activity. Findings point to the built environmental features (e.g., size and layout of spaces) required in the THP to create opportunities for increased social engagement among residents and enhanced safety and security. The AIRP-ENV and AIRP-ENV-SO audit tools can help inform programs across the housing continuum to develop supportive built environments that promote AIRP for OPEH.

Vaccines, Military Culture, and Cynicism: Exploring COVID-19 Vaccination Attitudes among Veterans in Homeless Transitional Housing

Veterans experiencing homelessness are particularly at risk from infection and transmission from COVID-19, and vaccines offer a promising avenue toward reducing that risk. However, little is understood about vaccine acceptance within the homeless population, particularly Veterans experiencing homelessness, who comprise a disproportionate share of that population. The cultural roots of vaccine hesitancy among active-duty military members and Veterans are even less understood. This study used semi-structured interviews to explore the role of military identity in shaping the vaccination attitudes of 20 Veterans experiencing homelessness enrolled in U.S. Department of Veterans Affairs’ (VA) transitional housing programs. Over half of the Veteran respondents mentioned their military experience during interviews about the COVID-19 vaccines. In these discussions, they cited mandatory vaccines in the military, military identity, and distrust of the military or government. Distrust was cited by most refusing the vaccine, while mandatory vaccines in the military were cited by most accepting the vaccine. Military identity, culture, and experience influence the risk-benefit reasoning that man Veterans in VA homeless programs undertake when deciding whether to accept the COVID-19 vaccine. A more nuanced understanding of military culture’s effect on Veterans experiencing homelessness is vital in designing messages and strategies that encourage vaccine uptake.

Centering Our Voices: Experiences of Violence Among Homeless African American Women.

Women experiencing homelessness who are also survivors of violence require uniquely tailored programs to accommodate complex needs. To understand how violence shaped the lives of formerly homeless African American women, an instrumental case study design and community-based participatory research approach was utilized in this qualitative study. Focus group interviews with graduates (N = 40) from a long-term transitional housing program were conducted. Using thematic analysis, identified themes included: cycles of violence, violence in the community, relationships with children, and coping with violence. These themes illustrated survivors' growth through supportive programming and highlighted services dedicated to empowering women who have experienced violence.

Developing Evaluation Approaches for an Anti-Human Trafficking Housing Program

The increasing number of anti-trafficking organizations and funding for anti-trafficking services have greatly out-paced evaluative efforts resulting in critical knowledge gaps, which have been underscored by recent recommendations for the development of greater evaluation capacity in the anti-trafficking field. In response to these calls, this paper reports on the development and feasibility testing of an evaluation protocol to generate practice-based evidence for an anti-trafficking transitional housing program. Guided by formative evaluation and evaluability frameworks, our practitioner-researcher team had two aims: (1) develop an evaluation protocol, and (2) test the protocol with a feasibility trial. To the best of our knowledge, this is one of only a few reports concerning anti-trafficking housing program evaluations, particularly one with many foreign-national survivors as evaluation participants. In addition to presenting evaluation findings, the team herein documented decisions and strategies related to conceptualizing, designing, and conducting the evaluation to offer approaches for future evaluations.

Vaccinating Veterans Experiencing Homelessness for COVID-19: Healthcare and Housing Service Providers’ Perspectives

This study examines challenges experienced during COVID-19 vaccination efforts, facilitating factors that increased vaccination, and lessons learned from healthcare providers and housing program staff who delivered healthcare and services to Veterans experiencing homelessness during the SARS-CoV-2 pandemic. Qualitative, semi-structured interviews were conducted with seven transitional housing program staff in northern California, southern California, Florida, Iowa, Kentucky, Massachusetts, and New Jersey (January-April 2021) and six primary care providers serving Veterans experiencing homelessness, four from clinics in California and two from a clinic in North Dakota (July-August 2021). Interviews were transcribed and analyzed using a rapid analysis approach. COVID-19 vaccination rates were between 40 and 60% among Veterans who received care from the primary care providers and between 20 and 90% among Veterans who were enrolled in the transitional housing programs. Barriers that providers and housing staff encountered when getting Veterans vaccinated for COVID-19 included lack of eligibility, the vaccine appointment scheduling process, transportation and communication challenges, Veterans’ distrust in the government, vaccine mandates, and vaccine hesitancy among organization staff. Recommendations to increase COVID-19 vaccine uptake included making vaccination more convenient, using trusted sources such as homeless program staff or Veteran peers to provide educational information about the safety and efficacy of COVID-19 vaccines, and encouraging rather than mandating vaccination. These lessons will enable entities providing care to people experiencing homelessness to develop more effective policies and educational campaigns to improve vaccine acceptance and uptake among this vulnerable population.

Implications of the COVID-19 Pandemic for Youth Housing and Homelessness Services.

Youth homelessness is a growing crisis in the United States that is associated with a range of adverse outcomes. A variety of social service programs exist to address youth homelessness and its consequences, such as street outreach and diversion services, emergency shelters, transitional housing programs, and rapid rehousing services, among others. The coronavirus disease 2019 (COVID-19) pandemic reached the United States in early 2020, altering nearly every facet of daily life, including the way social service organizations structure and deliver their programming. To understand the implications of the pandemic on housing and homelessness services for youth, the current study examines data from interviews conducted with staff from a large non-profit in Austin, Texas, serving vulnerable transition-age youth. Through these interviews, programmatic changes that occurred as a result of COVID-19—as well as challenges and facilitators to service delivery—were identified. This article provides an overview of these key learnings, as well as recommendations derived from these key learnings, for other organizations adapting their housing and homelessness services in response to the COVID-19 pandemic.

Innovation and partnerships: Meeting the health care needs of a houseless population.

Achieving health equity in the houseless population will take innovation, collaboration, and forward-thinking alternative models of health care. Using a foundation of disruptive innovation and an evidence-based care model, a group of nurses drew upon established partnerships to create Oregon's first nurse-owned and fully nurse-operated clinic serving the houseless population. The Harrington Health Clinic offers primary care, mental and behavioral health care, health and wellness, palliative care, and telemedicine services to men in a transitional housing program. Since its launch in January 2021, the clinic has served over 100 men spanning nearly 400 visits. The clinic attributes much of its success to registered nurses and nurse practitioners operating at the top of their scope, an academic affiliation that promotes learning-centered practices, and partnership with organizations similarly committed to just and equitable care. Through high quality, equitable primary care, this nurse managed and owned clinic has created a replicable solution that can impact houseless populations across the country.

Environmental Assessment of Housing for Older Adults Facing Housing Insecurity

The Aging in the Right Place Environmental Audit (AIRP-ENV) and Secondary Observation (AIRP-ENV-SO) tools were developed to conduct observation-based audit of the built environment in shelters, transitional housing, independent housing with offsite/onsite supports, and permanent supportive housing with onsite medical and/or specialized services for older adults experiencing (or at risk of) homelessness. The 241 item AIRP-ENV tool is used to audit the presence/absence of exterior and interior built environmental features that support housing stability. The seven open-ended questions in the AIRP-ENV-SO tool is used to collect contextual data on function, safety and land-use of surrounding neighborhood. Data were collected at four sites of a transitional housing program in Vancouver, Canada as part of a multi-year, multi-city partnership project on aging and homelessness. Preliminary results demonstrate that built environment and urban design features (e.g., access, privacy, flexible and supportive spaces) contribute towards tenants’ residential resiliency and aging in place.

The Importance of Positive Social Support During Reentry From Prison: Examining the Role of Volunteer Mentoring.

Social support appears to be important in improving outcomes for incarcerated individuals during the reentry process not only in terms of general wellbeing but also in gaining employment and avoiding recidivism. Mentoring programs have become increasingly popular interventions that are intended to provide such support during reentry. However, research on mentoring programs is limited and tends to focus solely on the programs' impact on recidivism, a distal outcome. Through the use of semi-structured, in-depth interviews, this qualitative study focuses on more proximal outcomes, exploring how reentering individuals who are receiving volunteer mentoring through a transitional housing program define successful reentry and perceive the value of different types of support they received from their mentors. Participants identified several indicators of successful reentry and discussed the types of support that were helpful, harmful, or absent. Implications for practice and areas for future research are discussed.

Rural Families Experiencing Homelessness: Demographics, Program Design, Outcome of High Barrier Transitional Housing and Rehabilitation Program

Rural Families Experiencing Homelessness: Demographics, Program Design, Outcome of High Barrier Transitional Housing and Rehabilitation Program

Leveraging research to inform prevention and intervention efforts: Identifying risk and protective factors for rural and urban homeless families within transitional housing programs.

This mixed method study spotlights hardships and supportive factors for unhoused families led by single mothers who have successfully graduated from two transitional housing programs, one rural and one urban. Data collection consisted of entry and exit surveys (n = 241) as well as qualitative interviews (n = 11). Binary logistic regression results indicated education and social support as significant predictors of successful program completion. Qualitative findings further illustrate narratives surrounding supportive factors and program supports (i.e., assistance securing employment, education courses, sense of community), as well as policy implications. Implications stress the need for enhancing supportive factors (i.e., education and social capital) in early prevention efforts (e.g., schools and community centers), as well as an intentional integration of addressing socio-emotional needs and resources within housing programs and services unique to rural and urban communities.

Program Effectiveness of Life Skills Classes for Homeless Veterans

Abstract Date Presented 03/28/20 This quasiexperimental study determined whether four homeless male veterans who partook in life-skills classes in a transitional housing program reported increased satisfaction and improved life skills according to the Canadian Occupational Performance Measure (COPM). Results of paired t-tests indicated no statistically significant change; however, all participants reported a self-perceived change of two or more points, which is clinically significant and could inform future programs and OT practice. Primary Author and Speaker: David LeVan Contributing Authors: Allison Blatt, Colleen Cummings, Morgan Demyanovich, Emily Tomer, Jennifer Weightman

Voluntary, Survivor-Centered Advocacy in Domestic Violence Agencies

Voluntary, survivor-centered advocacy is a model of practice used in domestic violence organizations; however, more information is needed from the perspective of survivors on how to best facilitate survivor-centered approaches in a voluntary service format. This qualitative study used a thematic analysis to uncover core advocacy approaches from 25 female-identified survivors dwelling in domestic violence emergency shelter and transitional housing programs in two states. Themes revealed that three core approaches aid a voluntary, survivor-centered advocacy model: 1) Establishing a safe base for support, 2) Facilitating access and connection, and 3) Collaboration. Advocacy approaches that emphasize safety, mutuality, and availability of support best engage survivors in voluntary services to address needs and meet goals. Use of a strengths-based approach, psychoeducation, and resource-building contributes to the social and emotional well-being of survivors. Findings indicate community DV advocates should use adaptable advocacy models aimed at service access, connection, and collaborative resource acquisition. Voluntary, survivor-centered models use principals of trauma-informed care, though more widespread use of trauma-informed care (TIC) in voluntary services are needed. Advocates need organizational support to meet survivor needs. Implications for research include the need for fidelity studies and longitudinal research.

Needs Assessment for a Comprehensive Reemployment Program Among Residents of a Work Rehabilitation Program for Individuals With Unstable or Lack of Housing.

Individuals in transitional housing programs often have a goal of reaching stable employment, but the unique needs and barriers for achieving this warrants further study. A structured interview guide was administered orally and descriptive data analysis was done for this exploratory mixed-methods study. Commonly reported reemployment challenges included legal barriers and unmet transportation, housing, and financial needs. More than two-thirds of residents reported no place to live after the program regardless of if they had previous precarious housing. Emerging themes included challenges regarding sufficient time for the transition to being employed, fear of relapse, and lack of long-term goals and planning. Findings suggest that residential rehabilitation programs are an important resource. While these programs tend to focus on reemployment, their services could be enhanced by assessing individual needs and allowing for variation in reemployment preparation.