A multi-site comparison of supported housing for chronically homeless adults: "Housing first" versus "residential treatment first"

Both direct placement in supported community housing and pre-treatment with time-limited residential treatment are used as approaches to helping chronically homeless adults exit from homelessness but relative effectiveness and cost remains untested. The current observational study utilized data from a national, multi-site housing project to determine whether clients who receive residential treatment or transitional housing before being placed into independent housing achieve superior outcomes than clients who are immediately placed into independent housing, and whether they incur greater healthcare costs. A total of 709 participants (131 and 578 participants in the respective groups) were assessed every 3 months for 2 years on housing outcomes, community adjustment, work and income, mental and physical health, and health service costs. Clients who received immediate, independent housing had more days in their own place, less days incarcerated, and reported having more choice over treatment; but no differences on other clinical or community adjustment outcomes. In this observational study, there were no clinical advantages for clients who had residential treatment or transitional housing prior to entry into community housing, but they incurred higher substance abuse service costs. Studies using randomized controlled trials of these conditions are needed to establish causation.     

The Interplay Between Housing Stability and Child Separation: Implications for Practice and Policy

Greater understanding of how residential stability affects child separation and reunification among homeless families can guide both child welfare and homeless policy and practice. This article draws upon two longitudinal studies examining services and housing for homeless families and their relationship to family and housing stability. Both studies were conducted in the same state at roughly the same time with similar instruments. The first study, examining families’ experiences and outcomes following entry into the homeless service system in three counties in Washington State, found that at 18 months following shelter entry, families that are intact with their children were significantly more likely to be housed in their own housing (46%) than families that were separated from one or more of their children (31%). The second study, a quasiexperimental evaluation of a supportive housing program for homeless families with multiple housing barriers, found that the rates of reunification for Child Protective Services (CPS)‐involved families receiving supportive housing was comparable to that for families entering public housing without services, but significantly higher than the rate of reunification for families entering shelter. Taken together, the findings from both studies contribute to the evidence underscoring the importance of housing assistance to homeless families involved in the child welfare system.     

A Longitudinal Study of Predictors of Housing Stability,Housing Quality,and Mental Health Functioning Among Single Homeless Individuals Staying in Emergency Shelters

The current study examined risk and resilience factors at multiple levels that affect homeless individuals' ability to exit homelessness and achieve housing stability. It also examined the relationship between housing status, housing quality and mental health functioning. The methodology is a longitudinal study of single homeless individuals staying in emergency shelters in a medium‐sized Canadian city who were followed for a 2 year period. Data were collected from participants at a baseline interview when they were homeless and at a 2‐year follow‐up. There were 329 participants interviewed at baseline and 197 (59.9%) participants interviewed at follow‐up. Results from a structural equation modelling analysis found that having interpersonal and community resources were predictive of achieving housing stability. Specifically, having a larger social support network, access to subsidized housing, and greater income was related to achieving housing stability. On the other hand, having a substance use problem was a risk factor associated with a failure to achieving housing stability. Being female, feeling personally empowered, having housing that is perceived of being of higher quality were directly predictive of mental health functioning at follow‐up. Findings are discussed in the context of previous research and their policy implications.     

Life Goals Over Time Among Homeless Adults in Permanent Supportive Housing

Permanent supportive housing (PSH) is a widely‐accepted solution to the challenge of chronic homelessness. While housing support and retention, physical health, and healthcare continue to be important for formerly homeless persons in PSH, “higher‐order” and humanistic needs such as thriving have received less attention and as a result are less well understood in this population. One important indicator of thriving is the ability to establish and articulate life goals. This study utilizes longitudinal data from 421 formerly homeless adults prior to their move into PSH, and at 3‐, 6‐ and 12‐months after move‐in (369 respondents completed all four interviews), to examine what life goals are articulated by this population and how those goals change over time. Prior to housing, most respondents articulated housing attainment as their primary life goal, whereas at follow‐up interviews health goals, housing relocation, and financial goals became more prevalent. Aspirational goals (e.g., independence, self‐improvement, artistic pursuits) were also common, but demonstrated a decrease over time in housing. Relationship goals remained common and consistent over time. Findings indicate that housing is a necessary, but perhaps not sufficient, step for improving thriving among formerly homeless adults. Implications for practice and future research are discussed.     

Spirituality and Homelessness: Implications for Pastoral Counseling

This article presents a limited number of findings from a larger research project that explores spiritual themes related to the experience of homelessness as reported by 16 research participants following their residence in a 90-day emergency shelter program in Los Angeles County, California. By utilizing interpretive phenomenological analysis, the study focuses solely on three spiritual themes present in the experience of homelessness. Participants noted experiencing the presence of hope and motivation while homeless, the challenges of coping with the homeless stigma, and times in which they felt (and did not feel) “human.” Implications for pastoral counselors and others offering spiritually-integrated counsel in the context of homelessness are discussed.     

Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data

This study tests a typology of homelessness using administrative data on public shelter use in New York City (1988–1995) and Philadelphia (1991–1995). Cluster analysis is used to produce three groups (transitionally, episodically, and chronically homeless) by number of shelter days and number of shelter episodes. Results show that the transitionally homeless, who constitute approximately 80% of shelter users in both cities, are younger, less likely to have mental health, substance abuse, or medical problems, and to overrepresent Whites relative to the other clusters. The episodically homeless, who constitute 10% of shelter users, are also comparatively young, but are more likely to be non-White, and to have mental health, substance abuse, and medical problems. The chronically homeless, who account for 10% of shelter users, tend to be older, non-White, and to have higher levels of mental health, substance abuse, and medical problems. Differences in health status between the episodically and chronically homeless are smaller, and in some cases the chronically homeless have lower rates (substance abuse in New York; serious mental illness in Philadelphia). Despite their relatively small number, the chronically homeless consume half of the total shelter days. Results suggest that program planning would benefit from application of this typology, possibly targeting the transitionally homeless with preventive and resettlement assistance, the episodically homeless with transitional housing and residential treatment, and the chronically homeless with supported housing and long-term care programs.     

Social integration and social support in a life crisis: Effects of macrosocial change in east Germany

This process evaluation study examined what variables moderate and mediate treatment effects on days in stable housing and client satisfaction for homeless mentally ill clients. In general, demographic characteristics did not moderate either outcome variable. Housing contacts, entitlement contacts, mental health contacts, and supportive services were significant mediators of the treatment effect on days in stable housing. Program contacts, mental health contacts, and supportive services were significant mediators of client satisfaction. The authors thank the National Institute of Mental Health for their financial support (MH43248, MH42357) for this project, Dorothy Gano for word processing and editorial assistance, and Gitry Heydebrand, Melissa Dannelet, Betty Tempelhoff, Ruth Smith, and Laeeq Ahmad for assisting in the interviews of clients. We are also appreciative of the cooperation given to us by the staffs of Malcolm Bliss Mental Health Center, St. Patrick's Center, the Community Advocacy and Support Alliance Program, and the St. Louisemergency shelters. Finally, we thank all of the participants in this study; we hope that their homelessness has now ended. (The conclusions presented in this paper are the sole responsibility of the authors and do not necessarily reflect official National Institute for Mental Health policy.)     

Voices from the Street: How Structural and Individual Factors Influence Homelessness

This study compared structural and individual factors related to persons who are homeless and how these factors affected their ability to utilize and benefit from available services. A qualitative case study design was used to conduct in-depth interviews with two participants receiving hospice care in a residence for the homeless. Results support previous findings that chronic homelessness is the result of multiple structural and individual factors that occur over time. Contrary to the literature on chronic homelessness, however, both participants were unique in their history of employment and strong desire to work, despite having limited work skills. Responses from both participants underscored the value of daily structure and meaningful occupation in residential addiction treatment.     

Individual,Housing, and Neighborhood Predictors of Psychological Integration Among Vulnerably Housed and Homeless Individuals

The current longitudinal study evaluated the individual, housing, and neighborhood characteristics predictive of feeling psychologically integrated within one's neighborhood among a population of homeless and vulnerably housed individuals. Participants were recruited at homeless shelters, meal programs, and rooming houses in Ottawa, Canada and participated in three in‐person interviews, each approximately 1 year apart. Prospective and cross‐sectional predictors of psychological integration at Follow‐up 1 and Follow‐up 2 were examined. There were 397 participants at baseline, 341 at Follow‐up 1 and 320 at Follow‐up 2. A hierarchical multiple regression uncovered several significant predictors of psychological integration. The most salient and common predictors were being older, having greater social support, living in high quality housing, and residing in a neighborhood with a positive impact. Implications for service provision and policy advancements are discussed.     

Employment Clothing for Women in Training Programs

Eighty-one women in social service employment programs were surveyed to determine knowledge of employment clothing. They were compared on demographics, and differences were found in possession of business clothing, resources for clothing, education, income, residence, and homelessness. Based on these differences, they were separated into 3 smaller groups. The comparison showed that women who had interview and employment clothing had never been homeless, had higher incomes and educational levels, and used different resources for obtaining their clothing. These responses indicate a need to educate low-income participants on information about employment clothing and resources.     

Effects of psychosocial and situational variables on substance abuse among homeless adults

Finding direct and indirect influences of salient psychosocial and situational variables on problem substance use among homeless people is important in designing evidence-based, effective, and relevant interventions for this special population. A stress-coping paradigm in conjunction with situational items specialized for homeless people was used to explore predictive relationships in a sample of homeless adults (N = 664) among (a) psychosocial variables of self-esteem, social support, positive and negative coping, and emotional distress, (b) situational variables of homelessness history and quality of recent housing, and (c) outcomes of alcohol use, injection drug use (IDU), and non-IDU. Lower self-esteem predicted greater emotional distress, lower positive coping, greater negative coping, and more alcohol use. Social support predicted less emotional distress and more positive coping. Chronic homelessness predicted more emotional distress, less positive coping, greater alcohol use, and IDU. Poor housing was associated with more alcohol use and IDU. Substance abuse interventions among the homeless should have a dual focus that includes attention to psychological issues and negative coping patterns while also addressing situational, environmental factors, including encouraging provision of permanent supportive housing.     

Re‐building Bridges: Homeless People's Views on the Role of Vocational and Educational Activities in Their Everyday Lives

Homeless people face everyday challenges of marginalisation and stigmatisation. Consequently, they can suffer from low self‐confidence, self‐efficacy and agency. Empirical research in Britain on educational, skill‐building and meaningful activities for homeless people principally emphasises the instrumental value of training and learning as a route to employment rather than the impact of activities on homeless people's everyday lives. Theoretical literature suggests that psychosocial benefits related to the development of self‐efficacy, agency and empowerment can be gained from such activities. Participants' experiences and perceptions of educational and recreational activities were examined through 29 interviews at three homeless day centres in London. Thematic analysis suggests the restorative power of engagement in activities and shows that participants value activities, not only as the foundation for future goals of finding employment and housing, but as an immediate way of restoring a sense of self and finding positive experiences with a focus on the present. The findings underline the importance of viewing these interventions from a ‘bottom‐up’ perspective. The study tentatively concludes that accepting and emphasising the immediate personal benefits as a positive achievement of activities may be a valuable approach to better engage homeless clients. Copyright © 2015 John Wiley & Sons, Ltd.     

Homeless Adults’ Recovery Experiences in Housing First and Traditional Services Programs in Seven European Countries

Across Europe, as governments turn to housing-led strategies in attempts to reverse rising rates of homelessness, increasing numbers of Housing First (HF) programs are being implemented. As HF programs become more widespread, it is important to understand how service users experience them compared to the more prevalent traditional treatment-first approach to addressing long-term homelessness. Although there is a large body of research on service users’ experiences of Housing First compared to treatment-first in North American contexts, comparatively less is known about how these two categories of homeless services are experienced in the European context. In a correlational and cross-sectional study, part of a larger examination of homelessness in Europe, participants (n = 520) engaged with either HF (n = 245) or traditional services (TS; n = 275) programs in seven countries completed measures of their experiences of services (consumer choice, housing quality, and service satisfaction) and recovery (time in independent housing, psychiatric symptoms, and community integration). Across the seven countries, participants engaged with HF programs reported experiencing more consumer choice, better perceived housing quality, and more satisfaction with services than participants engaged in TS programs. Participants in HF programs also reported a greater proportion of time in independent accommodation, fewer psychiatric symptoms, and more community integration. Varying patterns of association between experiences of services and recovery outcomes were observed. Findings indicate HF consistently predicts greater recovery than TS across diverse sociopolitical and economic contexts. Implications of findings for configurations of homeless services and homeless services policy are discussed.     

Living the high life: social status influences real estate decision making

Social status is associated with the vertical spatial dimension, with people conceptualizing higher social status with higher vertical positions. Two experiments tested whether this association influences relatively real‐world decisions about others by asking participants to act as real estate agents, aiding in the relocation of clients who explicitly or implicitly varied in social status. Across experiments, higher status clients were placed into higher elevation housing options. This influence of social status persisted when strategy‐aware participants were removed from analysis, and was not influenced by individual differences in social dominance or locus of control. Abstract concepts of social status are understood through associations with vertical space, and these mapping of abstract concepts to concrete percepts prove influential in guiding daily decisions.     

A Retrospective Examination of Child Protection Involvement Among Young Adults Accessing Homelessness Services

Childhood maltreatment is associated with a variety of young adult adversities including homelessness. This study used linked administrative records to develop a population‐level, epidemiological characterization of the child protection histories of young adults accessing homelessness services. The records of all 17‐ to 24‐year‐olds receiving homeless services between 2011 and 2014 in San Francisco County, California (n = 2241) were probabilistically linked to statewide child protective service (CPS) records. Findings document that 50.0% of young adults had been reported for maltreatment at least once during childhood, yet the prevalence of past CPS involvement varied across demographic and child welfare characteristics. Homeless female youth were significantly more likely to have a CPS history than male youth (58.1% vs. 41.5%). Nearly twice as many Black clients accessing homelessness services had a CPS history as did White clients (59.8% vs. 31.8%). Roughly half (47.3%) of those with a childhood history of reported maltreatment had been last reported for maltreatment in another California county. Targeting services that address past trauma and instability among homeless young adults may be justified given the prevalence of CPS history in this population.     

Loss of Control,Attributions, and Helplessness in the Homeless1

Control has emerged as an important psychological variable. The purpose of this project was to extend the concept of environmental control to the homeless shelter environment. Data from interviews conducted with residents of a homeless shelter supported the hypothesis that perceived loss of control over the shelter environment would be positively related to giving up on finding a home and employment. The hypothesis that the helplessness created by low control environments is consistent with the external, stable attributional style of “universal” helplessness was partially supported. Suggestions for future research are provided. Changes in the shelter environment are recommended for the treatment of helplessness in the homeless though helplessness is expected to persist as long as poverty, expensive housing, and prejudice against the homeless make efforts and outcomes noncontingent.     

Consumer Preference Programs for Individuals Who Are Homeless and Have Psychiatric Disabilities: A Drop-In Center and a Supported Housing Program

We illustrate Fairweather's approach to Experimental Social Innovation and Dissemination with two experimental studies of programs to reduce homelessness for 168 and 225 people with mental illness and often substance abuse. Literally homeless participants were randomly assigned to programs that emphasized consumer choice or to the usual continuum of care, in which housing and services are contingent on sobriety and progress in treatment. A drop-in center that eliminated barriers to access to services was more successful than control programs in reducing homelessness, but after 24 months only 38% of participants had moved to community housing. A subsequent apartment program, in which individuals in the experimental condition moved to subsidized apartments directly from the street, with services under their control, had 79% in stable housing (compared to 27% in the control group) at the end of 6 months. Groups in this study did not differ on substance abuse or psychosocial outcomes.     

Short versus longer term effectiveness of an outreach program for the homeless mentally Ill

Presents 12-month follow-up results from an outreach/linkage intervention with persons who are homeless and mentally ill, contrasting these with results obtained at 4 months. Both sets reflect the success of the program in placing individuals in independent housing. However, longer term data provide useful information regarding client movement patterns and increased tenure in nonhomeless living arrangements beyond the termination of specialized services. Analyses of 12-month residential outcomes identified four variables as significant predictors: recruitment source, project service duration, CMH service duration, and client age. In contrast to 4-month predictors, variables reflecting baseline client functioning were no longer significantly related to outcome, suggesting that the positive effects of the intervention may take longer to achieve with some clients. Discussion focuses on the implications of these effectiveness results for future research designs and measures as well as the utility and limitations of preexperimental approaches for evaluating innovative service models when implementation and efficacy experiences are lacking. This research was supported in part by a grant from the National Institute of Mental Health, #H87 MH44373, to the Michigan Department of Mental Health.     

Experiences of being homeless or at risk of being homeless among Canadian youths

A qualitative study was undertaken with four groups--immigrants, youths, Aboriginal people, and landlords--in order to explore, compare, and contrast diversity issues among the homeless population and those at risk of homelessness in a larger Canadian city (Calgary, Alberta) with a smaller city (Lethbridge, Alberta), to better understand their and to needs make recommendations for improvement in service delivery and policy formation. This paper focuses on the findings from our sample of youths who shared information on a range of factors that contributed to their being homeless or at risk of being homeless. The youths in this study also shared their positive as well as negative experiences with educators, peers, family members, and social service providers. Canada's homeless include growing numbers of young people, families, women, and members of various ethnic communities, including Aboriginal people and immigrants. Today it is no longer possible to articulate a single silhouette of the homeless, but rather a diversity of profiles is needed. It was in the light of this reality that a study, "Diversity Among the Homeless and Those At Risk," was carried out. It was undertaken with four groups--immigrants, youths, Aboriginal people, and landlords.     

The Black Church,Values, and Secular Counseling: Implications for Counselor Education and Practice

There has been a recent increase in the amount of attention given in the counseling literature to addressing clients’ religion and spirituality. However, Black American churchgoers are rarely the target population in the discourse, and little is known about how the Black church shapes their views. This article provides information on values of the Black church and the church's influence on Black American churchgoers regarding secular counseling. Implications for counselor education and practice are discussed.