Housing Stability Among Homeless Individuals with Serious Mental

Illness Participating in Housing First Programs

Coalition on Homelessness and

Housing in Ohio

2008 Annual Conference

Context

• Evidence that permanent supportive housing reduces homelessness of chronically homeless people, many with psychiatric or substance abuse issues

• Increasing popularity of approaches emphasizing access to housing without service requirements for “hard to serve”

• Evidence (including this study) that Housing First may be an effective approach to meet the needs of homeless people with SMI

Purpose of the Study

• Exploratory look at program features and client outcomes in three Housing First programs serving homeless individuals with serious mental illness

Research Questions

• What are the participants’ characteristics?

• What are the features of the programs—target population, housing options, and service models?

• How long do the participants remain in housing?

• Why do some participants leave the program within 12 months of placement?

What is Housing First?

• Direct, or nearly direct, placement into housing

• No requirement that participants use supportive services

• Assertive outreach and use of a low demand approach

• Provision of services and housing during temporary leaves

Housing First Programs

• Downtown Emergency Services Center (DESC): Seattle, WA

• Pathways to Housing: New York City

• Reaching Out and Engaging to Achieve Consumer Health (REACH): San Diego, CA

Housing First Programs

Feature DESC Pathways REACH

Established 1993 1992 2000

Units 306 450 250

Housing types

Owned by DESC:

3 SRO buildings,

1 Safehaven

Scattered-site apartments in private buildings

SRO, Safehaven, Independent Living Facilities, scattered-site apartments

Colocation of housing, services

Yes—on-site staff provide property and case management

No—ACT team members visit clients in home

No—case managers visit clients in home

ACT team Modified Yes Modified

Data Collection

• Administrative interviews with program staff (program features)

• Structured data collection by program staff to track program participation and outcomes over a 12-month period

• Focus groups with program participants (program experience and satisfaction)

Study Participants

• Chronically homeless (88%)

• Co-occurring mental illness and substance-related disorders (69%)

• Prior living situations immediately prior to Housing First Program entry varied:– 39% streets– 28% shelter– 18% psychiatric hospitals– 17% other or unknown

Housing Tenure

• Overall programs had similar outcomes, but findings reveal nuances to housing stability

• 84% of participants were still housed in Housing First program at the end of 12 months– 43% stayers (n = 34)– 41% intermittent stayers (n = 33)– 16% leavers (n = 13)

Level of Housing Stability

40%

62%

28%31%

52%

20%

8%

21%

40%

0%

10%

20%

30%

40%

50%

60%

70%

DESC Pathways REACH

Stayers Intermittent Leavers

Prior Living Situation by Housing Stability

69%

30%

23%

8%

18% 18%

0%

36%

29% 26%

15%

26%

0%

10%

20%

30%

40%

50%

60%

70%

Stayers Intermittent Stayers Leavers

Streets Shelter Psych/Jail Other/Unknown

Impairment from Mental Illness and Substance Abuse

• Little change in level of impairment from mental illness over 12 months but considerable fluctuations for individual study participants

• No overall improvement

• Changes in level of impairment may be the result of better clinical information over time

Issues with Methodology

• No basis for comparison with other PSH options

• Inability to track beyond 12 months

• Small sample size precluded measuring relative impact of service v. housing features on client outcomes

Funding

• This study was funded by the U.S. Department of Housing and Urban Development (HUD)

• The full report may be found at:

http://www.huduser.org/Publications/pdf/hsgfirst.pdf

For More Information

• Carol Pearson, PhD

Walter R. McDonald & Associates, Inc.

cpearson@WRMA.com

• Paul Dornan, PhD

Office of Policy Development and Research

U.S. Department of Housing and Urban Development (HUD)

Paul_Dornan@HUD.gov