Permanent Supportive Housing Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness (2018) / Chapter Skim
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5 Effect of Individual and Program Characteristics on Outcomes in Permanent Supportive Housing
5 Effect of Individual and Program Characteristics on Outcomes in Permanent Supportive Housing
Pages 81-94
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From page 81... ...
Individual characteristics that have been examined using these techniques include age and substance use. In addition to subgroup analyses described in the previous paragraph, another possible source of data that may be obtained on the association between individual characteristics and outcomes is the assessment tool used to collect a wide range of information on the characteristics and needs of individuals experiencing homelessness when they first come into contact with a service provider (HUD, 2015a)
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From page 82... ...
Data from the At Home/Chez Soi study, conducted in five cities in Canada, randomized persons with serious mental illness experiencing homelessness to receive usual care or permanent supportive housing using the Housing First model (Stergiopoulos et al., 2015)
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From page 83... ...
. Across the United States, the modal age of single adults experiencing homelessness increased from 34–36 years in 1990 to 49–51 years in 2010, with people in the last half of the Baby Boom cohort at highest risk.
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From page 84... ...
This finding suggests that among substanceusing individuals experiencing homelessness in PSH, housing stability is more easily attained for persons whose substance of choice is alcohol rather than drugs, but it is not clear whether the same finding would hold for individuals who did not receive PSH. Overall, it is not clear whether PSH is differentially effective for people who use different substances.
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From page 85... ...
the level of resources available for housing and supportive services. Ideally, the assessment of the effect of program characteristics on outcomes would be based on data from controlled trials in which individuals experiencing homelessness were randomized to different PSH programs.
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From page 86... ...
. TABLE 5-1 Features of Single-Site Versus Scattered-Site PSH Single Site Scattered Site Model Housing at a single dedicated site Housing in existing private (through new purpose-built market rental units dispersed construction, purchase of existing throughout the community building, or master lease of existing building)
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From page 87... ...
Neighborhood opposition ("NIMBY") Neighborhood opposition usually phenomenon can pose barrier to site not a factor selection and construction permits Can create new affordable housing Does not create new affordable stock in the community housing stock in the community Housing Units at the housing site include Proportion of residents at the environment persons with a history of homelessness, housing site with a history of mental illness, and/or substance use homelessness, mental illness, and/or substance use reflects that of the general population in the community Program can create common spaces for Building may or may not provide clients within building common spaces for residents Building rules and eviction decisions Building rules and eviction are under control of supportive housing decisions are under control of provider private market landlord Support Support services are usually attached to Support services are provided by services the housing site (located in the same mobile case managers or teams building or in close proximity)
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From page 88... ...
As noted earlier, under the Pathways Housing First model, individuals choose their own residence. Scattered-site housing typically involves working with individual landlords to secure agreements to rent to individuals experiencing chronic homelessness, which may not be easy.
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From page 89... ...
As a result, it is not possible to draw conclusions from this study regarding outcomes in scatteredsite versus congregate-site housing. In an assessment of 125 individuals experiencing chronic homelessness with mental illness in a PSH program that provided a modified ACT services and primary care to meet health needs, Henwood et al.
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From page 90... ...
In regression models, housing quality was significantly associated with housing stability at 24 months of follow-up, even after adjustment for city, housing characteristics, participant ethnicity, community functioning, and social support. The study demonstrates that average individuals considered the unit condition to be most important, then the neighborhood, then the building; however, additional research is needed to assess the impact of the environment on housing retention, including individual choice as well as family and community circumstances (Adair et al., 2016)
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From page 91... ...
However, no studies have directly compared the provision of supportive services of different intensities to a group of individuals experiencing homelessness with a defined level of need to assess for differences in effects on housing and health outcomes. In the At Home/Chez Soi study, individuals experiencing homelessness with a current mental health disorder were classified as having either high needs or moderate needs for treatment using a complex algorithm based on psychiatric and substance use diagnoses, community functioning score, and previous pattern of hospitalizations or incarceration (Stergiopoulos, 2015)
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From page 92... ...
Based on the available data, definitive claims cannot be made regarding the relative effectiveness of single-site versus scattered-site PSH with respect to outcomes other than housing stability. There is evidence that the Housing First model of immediate housing in scattered-site units with ACT support results in better housing outcomes and possibly fewer days in hospital compared to a treatment-first approach that uses transitional housing and treatment for psychiatric illness and substance use to help
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From page 93... ...
The positive association between housing quality and housing stability suggests the need to ensure good housing quality in the selection of scattered-site buildings and the construction and management of single-site buildings. Careful attention is needed to ensure that PSH programs receive funding that is sufficient to achieve this goal.
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From page 94... ...
94 Permanent Supportive Housing Recommendation 5-2: Based on what is currently known about services and housing approaches in permanent supportive housing, federal agencies, in particular the Department of Housing and Urban De velopment, should develop and adopt standards related to best prac tices in implementing permanent supportive housing. These standards can be used to improve practice at the program level and guide funding decisions.
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