Neighborhood Outcomes of Formally Homeless Veterans Participating in the HUD-VASH Program

Research regarding how neighborhoods affect the people who live in them has grown in recent years. However, the neighborhood outcomes of formally homeless veterans have not received the attention this group warrants. This article examines the neighborhood outcomes of two groups of housing voucher holders. Using administrative data, this exploratory study finds that U.S. Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) voucher holders receiving comprehensive case management reside in higher quality neighborhoods than those who do not receive these services. Additionally, this effect seems to be a more critical factor for African Americans than Whites. Use of case managers with housing vouchers may improve African American residential outcomes in terms of neighborhood quality.     

Housing plus services: supporting vulnerable families in permanent housing

The importance of integrating services with housing to help low-income families achieve stability is gaining recognition. The variations in types of existing housing and service initiatives have produced a complex language with multiple meanings and overlapping definitions. The National Low Income Housing Coalition proposes the umbrella term housing plus services to refer to these programs. Following a review of the literature on the relationship of housing to child well-being, the article discusses and illustrates the National Low Income Housing Coalition's principles for and typology of housing plus services.     

Changes in the health status of newly housed chronically homeless: the Alaska Housing First program evaluation

The Housing First (HF) model is an evidence-based supportive housing initiative that provides permanent housing for the homeless without preconditions such as sobriety or treatment compliance. This three-year longitudinal study investigated the effects of Alaska's inaugural Housing First projects in Anchorage and Fairbanks on local service usage, costs and tenant quality of life (QoL). A total of 94 tenants participated at baseline in the QoL study and 68 continued to follow-up. Cost data was collected from local municipalities, Alaska Department of Corrections, and local hospitals, health care clinics, behavioral health providers, and detox facilities. Emergency services use by tenants decreased from the year before moving into Housing First to the year after. Changes in health care costs were more variable depending on site and type of service.     

Targeting Services to Those Most at Risk

Abstract

The budget crises facing many state Medicaid programs have increased interest in the goal of linking services and housing as a way to provide more options to people with disabilities at less cost than institutional care. This article examines some of the premises underlying this interest, especially with respect to linking supportive services and federally subsidized housing for older persons. The first section provides a brief history of the activity in this area. The second section examines the risk factors associated with nursing home admission and how those factors match the characteristics of renters receiving subsidies. The third section focuses specifically on the likelihood that subsidized renters will also become eligible for Medicaid. The fourth section explores the capacity of housing programs to meet the challenges associated with service delivery. Finally, the conclusion examines the implications for public policy decision-makers interested in linking services and housing in order to address the long-term care (LTC) needs of older persons with modest incomes.     

Pregnancy in a Brotherhood bin: Housing and drug-treatment options for pregnant young women

The research on which this paper is based is part of an Australian Housing Urban Research Institute (AHURI) project using ethnographic research with people using heroin in the cities of Yarra and Geelong (Victoria), Sydney and Cabramatta (New South Wales). More specifically the article reports on the lives of young drug dependent pregnant women and the importance of housing for those wanting to enter drug treatment programs. This involves asking how critical the provision of appropriate housing are for women who choose to ‘get clean’ or who attempt to limit their drug use. An answer is provided by drawing on interview material from the pregnant women themselves as well as a range of health and welfare service providers.     

Stakeholder perspectives on integrated services for people who experience chronic homelessness

This article concerns a SAMHSA-funded service intervention, Pathways to Independence, that combined the use of SAMHSA’s SSI/SSDI Outreach, Access, and Recovery approach to facilitating disability entitlement claims with financial management classes, mental health assessment and referral, and access to employment and housing for people experiencing chronic homelessness. The purpose of this study was to explore perceptions of this form of service delivery and the benefits and challenges of the program model from the perspective of those who experienced it. Focus groups were conducted with a total of 17 program stakeholders, including program participants, program staff, collaborating case management staff of the parent agency, and a landlord and an employer, with questions to each regarding the program and its impact. Focus groups were analyzed through independent coding followed by discussion to reach consensus on key themes. Five themes were identified across the groups: (a) the importance of relationships, (b) staff specialization and provision of individualized services, (c) an orientation to outcomes, (d) comprehensiveness of services and facilitation of connections to community resources, and (e) systems challenges. The Pathways to Independence program provides a working model for integrated employment, entitlement assessment and application, housing, and behavioral health treatment for persons experiencing chronic homelessness.     

Changing the method of working with homeless people: a photovoice project in Italy

In Italy, many organizations are experimenting with the Housing First (HF) model to promote a change in how they work with homeless people. This change creates some difficulties, especially in promoting freedom of choice in people involved in the HF programs. This study explored the definition of “home” in homeless people’s points of view. The study participants were 5 homeless men involved in a HF program called “The Road Home” implemented in the city of Padua. Data were collected using Photovoice, a photographic method based on participatory action research. During the project, the participants took photographs to illustrate their definitions of “home” and then engaged in a critical dialogue about the images represented in the photographs. The results of the study showed that occupants identified the home as being related to family, friendship, cohabitation, and hope for the future. The Photovoice project provided an opportunity to promote discussions that revealed the true needs of the people involved, and in the meantime, it brought a change to the program and to the community, in addition to promoting the HF model in the community.     

Impact of a supported housing prioritization system using vulnerability and high service utilization

For people experiencing chronic homelessness, supportive housing with intensive social, health, and behavioral health services reduces the likelihood of re-entering homelessness and the public costs of associated acute medical care, shelter use, and incarceration. Due to a limited supply of supportive housing, it must be allocated to those most in need. This paper examines findings from a unique, region-wide method for prioritizing individuals for supportive housing based on utilization of high-cost public services and vulnerability if left on the street. A sample of 196 individuals were prioritized for housing based on this method, while a comparison group of 102 were housed not using the method. Results showed that those housed under the prioritization method achieved greater reductions in utilization of high-cost public services, but were also less likely to have positive dispositions when exiting the housing programs, suggesting the need for a greater intensity of supports and/or multiple “doses” of supportive housing before stability can be expected. The method described in the paper can provide a starting point for developing regional, comprehensive systems of coordinated, prioritized entry into supportive housing, such as those now required by US Department of Housing and Urban Development.     

Housing interventions for homeless,pregnant/parenting women with addictions: a systematic review

Family homelessness is a growing problem in North America with most of these families headed by single women. Homeless women also experience high rates of pregnancy and addiction (drugs and alcohol). Housing interventions have been identified as key to addressing the complex needs of pregnant/early parenting, homeless women with addictions. The aim of this systematic review is to determine what housing models and programs for this population yield the best outcomes. We systematically searched 10 databases and retrieved eight articles describing four distinct studies that met the inclusion criteria for this review. Overall, improved outcomes were found for all intervention groups with the most recent and rigorous studies favoring models combining Housing First and case management. However, methodological limitations, study quality, and varied outcomes made comparison across studies difficult. Further research must be done in this area using standardized outcomes and rigorous designs to develop evidence-based best practice guidelines to address the unique needs of this population.     

Built community: architecture,community, and participation in a permanent supportive housing project

Housing and the social processes that create it are an important part of a better world. The permanent supportive housing movement holds that housing, in addition to a variety of human services, is the most dignified and effective way to help people without homes. But the design of such initiatives matters. This community-based, qualitative research project investigates the connection between space, participation, and community. It draws on the experiences of residents of an innovative housing organization on Skid Row in Los Angeles, California. Residents of the program find community space to be both promising and contested. Their experiences also reveal the way that institutional space can be trauma-informed and impact their overall wellbeing and opportunities for interacting with others. However, their feelings of being a part of the community and their involvement in activities are not always connected, as identity and social context can cause residents to identify or dis-identify with their community despite how involved or uninvolved they are. Intentionally designed community spaces in permanent supportive housing units can respond to trauma and set the stage for interaction, but they cannot solve all problems.     

Family Resilience Predicts Socioeconomic Mobility of HUD Participants

Changing economic times and government policies are reshaping the way the U.S. Department of Housing and Urban Development (HUD) provides services nationwide; there is both a growing demand for housing and a desire to help families become self-sufficient. In this study, the authors examined factors that contribute to increased socioeconomic mobility through the lens of family resilience. Analyzing cross-sectional data from 411 families in the San Bernardino County HUD District using discriminant function analysis, results of this study show strong preliminary evidence that certain components of family resilience predict whether an individual head of household will have full-time employment. The results of this study provide implications for social service programs aimed at socioeconomic mobility.     

“They give you back that dignity”: understanding the intangible resources that make a transitional house a home for homeless families

Approximately 33% of the homeless population in 2017 were families with children. Researchers have argued for interventions and services to employ an ecological perspective to mitigate some of the unintentional harm inherent in existing programs designed to serve homeless families. This paper utilized a case study of a transitional housing program to (1) determine how well the program met recommendations informed by the ecological perspective and (2) explore underlying themes across recommendations. Past and current residents of a transitional housing program participated in semi-structured interviews as part of a program evaluation. Interviews were deductively and inductively coded to meet aims 1 and 2, respectively. Residents identified several aspects of the program that met the ecological perspective recommendations including culturally-responsive services, trauma-based services, and social and community connections. Major underlying themes spanning across recommendations included interpersonal resources (caring, sense of belonging), empowerment resources (advocacy, family preservation), impact on family (family life, positive youth development), and communication. This case study, through the analysis of residents’ perspectives, highlights the important role of transitional housing programs in providing a supportive, empathetic, empowering, and home-like environment that gives residents “back that dignity” so they are emotionally and physically prepared to successfully transition to permanent housing.     

“At times I kinda felt I was in an institution”: Supportive housing for transition age youth and young adults

Housing stability is essential for young adult development. Older youth and young adults transitioning from public systems of care, such as foster care, the public mental health system and residential settings, commonly experience high levels of transience and housing instability. In recent years, supportive housing policies and programs have emerged to address this situation, yet we know little about whether (or not) new programs are meeting the needs of youth in transition, and, if so, how they are addressing the unique developmental, social, and emotional needs of this population. This study is one of the first to speak directly with young adults living in a supportive housing program designed specifically for youth transitioning out of children's systems of care. Study participants spoke about both their overall transition experience and their views on the housing program where they reside. The study conducted four focus groups (N = 26) with transitioning youth and young adults, ages 18 to 25 (Mean age = 22), in order to explore the following three broad research questions: 1) what is it like to make the transition to adulthood from public children's systems of care?; 2) how does the supportive housing model they reside in shape their transition experiences?; and, 3) how do they experience the services and staff who are part of the program? Data analysis included grounded theory coding techniques and constant comparison with four coders. Results suggest that participants feel like they continue to be treated as children, and they receive mixed messages regarding their need to be increasingly autonomous, yet follow the rules. Finally, they reported specific aspects of what they found to be helpful in both staff relationships and overall program components. These themes constitute the results of the study. Findings underscore the importance of both listening directly to service users, and developing young adult supportive housing programming expressly designed to meet the unique needs of marginalized young adults transitioning to increased independence and self-sufficiency.     

The role of eviction in veterans’ homelessness recidivism*

Eviction is one of the leading causes of homelessness in the U.S.A. Though permanent supportive housing (PSH) helps participants maintain housing, some still leave due to eviction. This study aimed to determine whether eviction is an important predictor of recidivism and time to return to homelessness for participants exiting PSH. The characteristics and post-exit service use of 2802 Veteran PSH participants were analyzed based on exit reason. A Cox proportional hazards survival analysis modeled risk factors for returning to homelessness within 360 days of exit. Compared with other exiters, evicted Veterans remained in the program for less time, were less likely to be receiving service-connected compensation, and used more services – particularly mental health and substance use services – following their exit, and those who returned to homelessness did so more quickly. Identifying participants who might benefit from more intensive services, project-based housing, or income supports may prevent evictions and subsequent returns to homelessness.     

Housing affordability among elderly female heads of household in nonmetropolitan areas

This study investigates the extent and nature of housing affordability for elderly nonmetropolitan female heads of household using data from the Panel Study of Income Dynamics. The results indicate that over one-third of elderly nonmetropolitan female heads of household experience housing poverty and that those who rent, who have fair to poor health, and who are minorities are particularly vulnerable. Housing affordability, measured by the concept of housing poverty, identifies households struggling to meet basic needs while the conventional 25% of income for housing expenditures ratio identifies a larger population. The findings suggest the need for multifaceted public policies to address the problem of housing poverty. Her research interests include housing affordability, housing and community vitality, and decision making. She received her Ph.D. from Purdue University. Sooyoun Park is in the same department as a Project Assistant on a USDA-funded research project entitled “Housing Affordability in Rural Areas,” which is a joint project between Nebraska and Wisconsin. Her research interests focus on housing management behavior in relation to housing expenditure burden. She received her Ph.D. from the University of Nebraska-Lincoln.     

Linking Federally Assisted Housing with Services for Frail Older Persons

Advocates of policies designed to link federally assisted housing with social services for the frail elderly have encountered barriers such as the historical separation of housing and services, political and bureaucratic fragmentation, and budget constraints. Over a 20-year period, they have attempted to address these issues by identifying the nature and extent of the problem, creating workable models, and developing a political constituency. Major reform, however, occurred only in 1990 when Congress passed the landmark National Affordable Housing Act (NAHA) which provided an "open policy window" for supportive housing legislation. NAHA's passage, however, still left many issues unresolved (e.g., targeting and funding for services). The future challenge is to develop new models of supportive housing and provide a range of residential settings and portable services to increase the choices for frail older persons.     

Linking federally assisted housing with services for frail older persons

Advocates of policies designed to link federally assisted housing with social services for the frail elderly have encountered barriers such as the historical separation of housing and services, political and bureaucratic fragmentation, and budget constraints. Over a 20-year period, they have attempted to address these issues by identifying the nature and extent of the problem, creating workable models, and developing a political constituency. Major reform, however, occurred only in 1990 when Congress passed the landmark National Affordable Housing Act (NAHA) which provided an "open policy window" for supportive housing legislation. NAHA's passage, however, still left many issues unresolved (e.g., targeting and funding for services). The future challenge is to develop new models of supportive housing and provide a range of residential settings and portable services to increase the choices for frail older persons.     

Housing Implications of Individual Budget Home Care Models for Older Renters: An Australian Case Study

Policies and programs relating to successful aging in place are premised on the fact that older people's housing is stable and suitable. Home-based aged care delivery models such as individual budgets aim to deliver increased service flexibility, choice, and control for consumers. Little attention has been paid to the consequences of such models for older renters, who often have less stable housing and restricted rights to modify their accommodation. This article reports on a project in Australia that explored the delivery and receipt of individual budget style models of home-based aged care services to older renters.     

Federal Welfare and Housing Policy at the Crossroads

Abstract

A time-series design was used to investigate an innovative, rent incentive-based employment initiative in a predominantly African American public housing community. The purpose of the research was to assess the impact of the Welfare-to-Work (W-t-W) program on resident employment levels and on Public Housing Authority (PHA) revenues and costs. Data were collected on a purposive sample of heads of household (N = 313) representing 78.3% of those in the community. Over half of the residents were under 17 years of age, followed by 24.7% who were 18-34, and 15.5% who were 35-54 years of age. Mean annual income for most participants was less than $5,000, and 60% were welfare reliant. Fifty-six percent of the participants in the study (N = 179) received monthly rent credits (discounts) ranging from $23 to $333 (m = $87, s.d. = $38.60). Employment levels in the community increased considerably over the study period and the W-t-W initiative was cost-effective to the PHA. Implications are discussed regarding advantages and limitations of intersected federal welfare and housing policies, the need for formative, evidence-based assessments of W-t-W programs, and the achievement of economic self-sufficiency of public housing residents.     

Chapter 3: Social Services and Bereavement in the Lesbian and Gay Community

Social service programs to address multiple loss in the gay and lesbian community must incorporate an understanding of the relationship between bereavement and the gay and lesbian experience including issues of stigma, homophobia, and the cumulative effects of stress. To address the collective experience of multiple loss, individual, family, and group interventions should be conducted in conjunction with social supports, community rituals, and political activity. Agencies need to prepare by instituting staff education and specific organizational policies to address HIV and bereavement, and provide organizational support to social service staff to facilitate the effective delivery of bereavement services.