housing stability among homeless individuals with serious mental illness participating in housing...
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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.
• Paul Dornan, PhD
Office of Policy Development and Research
U.S. Department of Housing and Urban Development (HUD)