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.     

Predictors of Living in Precarious Housing Among Immigrants Accessing Housing Support Services

The purpose of this study was to identify factors that explain immigrant housing vulnerability, thereby contributing to the growth of a more substantial knowledge base on the intersection between immigration, housing and homelessness. Administrative data on housing support service recipients (n?=?4168) in Alberta, Canada, were analysed to determine the varied demographic, socio-economic and health-related factors that contribute to living in a precarious housing situation (such as homelessness, couch surfing, staying with friends or family etc.). Logistic regression analysis shows that being an immigrant is a protective factor from living in a precarious housing situation. For the immigrant subsample (n?=?525), logistic regression analysis demonstrates that living in a larger city, having a mental illness and being married were protective factors from living in a precarious housing situation. However, having an addiction and being precariously employed (such as only working part-time, having temporary employment or being unemployed) were risk factors for living in a precarious housing situation. Shared and distinctive vulnerabilities among the immigrant subsample and the full study sample are discussed, along with implications for specific policy and programmes that aim to address the housing needs of immigrants.     

Finding Home: A Qualitative Approach to Understanding Adolescent Mothers’ Housing Instability

Many low‐income Latina adolescent mothers face instability in their housing circumstances, which has implications for their long‐term prospects and that of their children. This study used longitudinal, ethnographic data from Welfare, Children, and Families: A Three‐City Study to explore experiences of low‐income, Latina adolescent mothers (N = 15) with unstable housing who primarily rely on their families or the families of their significant others for housing support. Results of analysis employing grounded theory and narrative approaches suggested two types of instability: “Horizontal moves” between family homes and “vertical moves” between family homes and independent living. Although family support often was fundamental in allowing for participants’ pursuit of independent housing (i.e., vertical moves), it also was associated with greater residential mobility (i.e., horizontal moves), most often in the context of intrafamilial conflict and family instability. These results are discussed with respect to inconsistencies in policies to address this vulnerable population.     

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.     

The Effects of Assisted Housing on Child Well‐Being

The most rigorous research on the causal effects of assisted housing on children's outcomes finds no such effects. The present study uses rich longitudinal data from the Panel Study of Income Dynamics, augmented with Census, American Community Survey and U.S. Department of Housing and Urban Development administrative data, to unpack these nil effects. Analyses include 194 children ( age = 6.2 years) living in assisted housing in 1995 or later who were 13–17 years old in 2002 or 2007, and an unassisted comparison group of 215 children who were income‐eligible for, but never received, housing assistance. Results suggested no mean effects of living in assisted housing during childhood on adolescent cognitive, behavior, and health outcomes, addressing selection through propensity score matching and instrumental variables. However, quantile regressions suggest assisted housing provides an added boost for children with the best cognitive performance and fewest behavior problems but has opposite effects on children with the lowest cognitive scores and most behavior problems. Further tests indicate that these differences are not explained either by neighborhood effects or housing quality. A potentially fruitful avenue for future research investigates differences in how parents take advantage of the housing affordability provided by assisted housing to benefit their children.     

Housing First and Photovoice: Transforming Lives,Communities, and Systems

This article presents findings from a community‐based participatory evaluation of a Housing First program on the Island of O'ahu. In this study, clients in a Housing First program used Photovoice to evaluate the program and to advocate for progressive housing policies. Written together by members of the Housing First Photovoice group, this collaborative article describes the outcomes from both the Housing First program and the Photovoice project and demonstrates the ways in which participatory program evaluations can interact with client‐driven programs like Housing First to produce a cumulative, transformative impact. Findings suggest that community psychologists hoping to re‐engage with community mental health systems through enacting transformative change should consider taking a community‐based participatory approach to program evaluation because increased client voice in community mental health programs and their evaluations can have far‐reaching, transformative impacts for research, practice, and policy.     

A Social Ecological Approach to Investigating Relationships Between Housing and Adaptive Functioning for Persons with Serious Mental Illness

This paper seeks to advance mental health—housing research regarding which factors of housing and neighborhood environments are critical for adaptive functioning, health, and recovery for persons with serious mental illness (SMI). Housing and neighborhood environments are particularly important for persons with SMI because of the prevalence of poor housing conditions among this population. Most mental health—housing research has been limited by a focus on problems in environments and functioning. The paper seeks to expand the mental health—housing research agenda to consider protective factors that promote community integration and adaptive functioning. We provide an account of how social ecology theory transformed a research program, from examining individual risk factors to investigating the functioning of persons in the contexts of their housing and neighborhood experiences. The resulting housing environment framework—physical aspects of housing and neighborhoods, social environment of neighborhoods, and interpersonal relationships tied to housing—allows for identification of opportunities for health promotion and facilitation of participation in community-based settings. This program of research draws upon several methods to understand the social experience of persons with SMI living in community settings—survey research, qualitative interviews, Geographic Information Systems, participatory research, and visual ethnography. In this paper, we present how social ecology theory was instrumental in the development of new housing environment measures, the selection of appropriate research methods, and framing research questions that are building a new empirical base of knowledge about promoting adaptive functioning, health, and recovery for persons with SMI living in community settings.     

Suicidality Among Chronically Homeless People with Alcohol Problems Attenuates Following Exposure to Housing First

This study is the first to document suicidality among chronically homeless people with alcohol problems (N = 134) and examine its trajectory following exposure to immediate, permanent, low‐barrier housing (i.e., Housing First). Suicidal ideation, intent, plans, and prior attempts were assessed at baseline and during a 2‐year follow‐up. Baseline suicidal ideation was over four times higher than in the general population. Two‐year, within‐subjects, longitudinal analyses indicated severity of suicidal ideation decreased by 43% from baseline to follow‐up. Significant decreases were also found for intent and clinical significance of ideation. No participants died by suicide during the 2‐year follow‐up.     

Adverse Housing Conditions and Early‐Onset Delinquency

Housing constitutes an important health resource for children. Research has revealed that, when housing conditions are unfavorable, they can interfere with child health, academic performance, and cognition. Little to no research, however, has considered whether adverse housing conditions and early‐onset delinquency are significantly associated with one another. This study explores the associations between structural and non‐structural housing conditions and delinquent involvement during childhood. Data from the Fragile Families and Child Wellbeing Study (FFCWS) were employed in this study. Each adverse housing condition was significantly associated with early‐onset delinquency. Even so, disarray and deterioration were only significantly linked to early delinquent involvement in the presence of health/safety hazards. The predicted probability of early‐onset delinquency among children exposed to housing risks in the presence of health/safety hazards was nearly three times as large as the predicted probability of early‐onset delinquency among children exposed only to disarray and/or deterioration, and nearly four times as large as the predicted probability of early‐onset delinquency among children exposed to none of the adverse housing conditions. The findings suggest that minimizing housing‐related health/safety hazards among at‐risk subsets of the population may help to alleviate other important public health concerns—particularly early‐onset delinquency. Addressing household health/safety hazards may represent a fruitful avenue for public health programs aimed at the prevention of early‐onset delinquency.     

Perceptions of Private Market Landlords Who Rent to Tenants of a Housing First Program

The rental of housing units by landlords to participants in Housing First (HF) programs is critical to the success of these programs. Therefore, it is important to understand the experiences of landlords with having these individuals as tenants. The paper presents findings of qualitative interviews with 23 landlords who rented to tenants from a HF program located in a small city and adjoining rural area in eastern Canada and in which approximately 75 % of tenants had been housed for at least six consecutive months at 2 years in the program. Findings showed that landlords are motivated to rent to HF tenants for financial and pro‐social reasons. They reported holding a range of positive, neutral, and negative perceptions of these tenants. They identified problems encountered with some HF tenants that included disruptive visitors, conflict with other tenants, constant presence in their apartments, and poor upkeep of units. On the other hand, landlords perceived HF tenants as being mostly good tenants who are similar to their other tenants. Implications for practice in the context of HF programs are discussed.     

The Impact of Family Unification Housing Vouchers on Child Welfare Outcomes

This study addresses whether providing housing vouchers through the Family Unification Program (FUP) to families involved in the child welfare system reduces child maltreatment and the need for child welfare services. The study uses child welfare administrative data on 326 children in Portland, Oregon, and 502 children in San Diego, California from the point at which their families were referred to the program through 18 months post‐referral. Using a quasi‐experimental waitlist comparison design, probit regressions show little impact of FUP on preventing child removal from home, but some positive impact on reunification among children already placed out of home. Hazard estimations show receipt of FUP speeds up child welfare case closure. Impacts on new reports of abuse and neglect are mixed, but point toward reduced reports. Low rates of removal among intact comparison families and high rates of reunification for children in out‐of‐home care suggest poor targeting of housing resources. Housing vouchers are being given to families not bearing the risks the program is intended to address. The presence of some positive findings suggests that housing vouchers might help reduce child welfare involvement if better targeting were practiced by child welfare agencies.     

Comparing the Housing Trajectories of Different Classes Within a Diverse Homeless Population

The paper presents findings from a longitudinal study identifying different classes of homeless individuals in a mid‐size Canadian city based on health‐related characteristics and comparing the housing trajectories of these classes 2 years later. Using data collected through in‐person interviews with a sample of 329 single persons who have experienced homelessness, the paper presents results of a latent class analysis. Results found four distinct latent classes characterized by different levels of severity of health problems—i.e., a class of individuals who are “Higher Functioning” (28.7%), a second class with “Substance Abuse Problems” (27.1%), a third class with “Mental Health Substance Abuse Problems” (22.6%), and a fourth class with “Complex Physical and Mental Health Problems” (21.6%) that included having diminished physical functioning, multiple chronic physical health conditions, mental health difficulties, and in some cases substance abuse problems. Follow‐up interviews with 197 of these individuals (59.9%) 2 years later showed the class of individuals with substance abuse problems experiencing the greatest difficulty in exiting homelessness and achieving housing stability. Implications of these findings for social policy development and program planning are discussed.     

In Their Own Words: Mental Health and Quality of Life of West African Refugees in Nigeria

Refugees are exposed to extreme stressors and are therefore at risk of mental health and social problems. Other issues refugees have to cope with include the loss of their country, culture, language, profession, family, friends, and future plans. Much of the studies that have been done on refugee mental health have not attempted to explain what these experiences mean to these individuals. Thus, this study provides explorative data on the mental health and quality of life of West African refugees living in Nigeria in order to understand their views and perspectives. This study carried out in 2010 employed qualitative methods; a total of four focus group discussions (FGDs) were conducted among adult male and female refugees purposively selected at the Oru Refugee Camp, Ogun State, Nigeria. Respondents described quality of life as a major determinant of mental health status. Most of the participants believed that women were more predisposed to mental ill health due to their sensitive emotional make-up. Factors identified by respondents as affecting mental health and quality of life among refugees included poverty, unemployment, physical health, housing and environment, discrimination, stigmatization, and insecurity. Refugees rated their mental health and quality of life as poor due to the aforementioned factors. Recommendations were made to the international community, national and local governments to invest more on education, provision of vocational and entrepreneurial skills as well as adequate housing in order to improve the mental health and quality of life of refugees.     

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.     

Gaining Institutional Permission: Researching Precarious Legal Status in Canada

There is limited research into the situations of people living with precarious status in Canada, which includes people whose legal status is in-process, undocumented, or unauthorized, many of whom entered the country with a temporary resident visa, through family sponsorship arrangements, or as refugee claimants. In 2005, a community-university alliance sought to carry out a research study of the lived experiences of people living with precarious status. In this paper, we describe our negotiation of the ethics review process at a Canadian university and the ethical, legal, and methodological issues that emerged. Although being able to guarantee our participants complete confidentiality was essential to the viability of the project due to their vulnerability to detention or deportation, we discovered that the Canadian legal framework limited us to being able to offer them confidentiality “to the fullest extent possible by law.” One way to overcome this conflict would have been through the construction of a Wigmore defence, in which we would document that the research would not be possible without assurance of our participants’ confidentiality. Such a defence would be tested in court if our research records were subpoenaed by immigration enforcement authorities. Rather than take the risk that this defence would not be successful and would result in our participants being deported, we altered the research methods from using multiple interviews to establish trust (which would have required that we store participants’ contact information) to meeting participants only once to discuss their experiences of living with precarious legal status in Canada. Our encounter with the ‘myth of confidentiality’ raised questions about the policing of knowledge production.     

Do We Know Where We Stand? Neighborhood Relative Income,Subjective Social Status,and Health

Bridging research on relative income and subjective social status (SSS), this study examines how neighborhood relative income is related to ones' SSS, and in turn, physical and mental health. Using a survey sample of 1807 U.S. adults, we find that neighborhood median income significantly moderates the relationship between household income and self‐reported physical and mental health. Low‐income individuals living in high‐income neighborhoods (i.e., relative disadvantage) report better physical and mental health than low‐income individuals living in low‐income neighborhoods. In addition, high‐income individuals living in low‐income neighborhoods (i.e., relative advantage) report higher SSS (relative to neighbors), whereas low‐income individuals living in high‐income neighborhoods (i.e., relative disadvantage) also report higher SSS. We draw from social comparison theory to interpret these results positing that downward comparisons may serve an evaluative function while upward comparisons may result in affiliation with better‐off others. Finally, we demonstrate that SSS explains the relationship between neighborhood relative income and health outcomes, providing empirical support for the underlying influence of perceived social position.     

Emotional Reactions to Health Status Changes and Emotional Well-Being Among HIV-Positive Persons with Limited Reading Literacy

People living with HIV-AIDS experience emotional distress in response to negative changes in their health status. The current study hypothesized that individuals with poorer health literacy skills would evidence greater emotional distress in response to negative changes in health status compared to persons with higher health literacy skills. HIV positive persons (N = 294) completed anonymous surveys that included measures of depression and social support and a subset of 98 participants completed two experimental vignettes depicting a person receiving test results showing an increase in HIV viral load (negative health changes) followed by a vignette suggesting decreased viral load (improved health changes). Responses to affective reactions and coping strategies indicated that persons with lower health literacy skills more strongly endorsed negative affective states and maladaptive coping strategies compared to persons with higher health literacy skills. In addition, lower health literacy was associated with greater symptoms of affective depression and poorer social support, whereas higher literacy was associated with greater negativistic thinking. Findings suggest the need for patient education and counseling regarding changes in health status among people living with HIV-AIDS, particularly persons with limited health literacy skills.     

Housing design and people with severe mental illness: An observational approach to the investigation of supported housing facilities

An observational approach was employed to investigate the role played by architectural characteristics of supported housing facilities (SHF) in sustaining interactional behavior among people with severe mental illness (SMI) (N = 29) and staff (N = 27). The observations were carried out in dining areas, corridors and outdoor environments of SHF (N = 4). In order to test differences in the observed behaviors two SHFs with high physical‐environment quality (HQ) and two with low physical‐environment quality (LQ) according to the perception of people with SMI were chosen. Results showed that the dining areas of HQ better support social interactions between SHF users. No differences between the housing facilities were found concerning corridors areas, while housing facilities that provided proximity and accessibility to outdoor environments, such as those with HQ, were significantly more supportive for social interactional behavior than LQ housing. These results corroborate previous findings from this project and suggest that the characteristics of the housing design have a significant impact on the use of the environment and on the behavior patterns in the setting.     

Housing insecurity and intersecting social determinants of health among transgender people in the USA: A targeted ethnography

Abstract

Background: Housing is an important social determinant of health (SDOH). Transgender people face a unique blend of discrimination and compromised social services, putting them at risk for housing insecurity and associated public health concerns.

Aims: This targeted ethnography explores housing insecurity as a SDOH among transgender people in the U.S.

Methods: In-depth interviews were conducted with transgender people (n?=?41) throughout the U.S.A., identified through purposive sampling. A semi-structured guide was used to elicit personal stories and peer accounts of insecure housing experiences and coping strategies. Interviews were audio recorded and transcribed. Data was coded, sorted, and analyzed for key themes.

Results: Responses revealed pervasive housing insecurity and inter-related challenges. Respondents discussed how intersecting identities create unique constellations of vulnerability, which “intersect like a star.” Financial insecurity and interpersonal rejection were lead housing insecurity causes, often resulting in psychological strain, which was sometimes addressed with substances and sexual risk-taking. These factors were cyclically accompanied by financial and employment insecurity and a cascade of unmet social needs. Social support facilitated coping.

Discussion: Findings support increasing transgender housing security intervention resources that address intersecting and cyclical discrimination, trauma, housing, employment, and health issues.     

Designing a behavioral program for a barrio in Tegucigalpa, Honduras

Health in Housing initiated a behavioral program of education and skills training for children and adults in a community of 30,000 persons living in substandard conditions in Tegucigalpa, Honduras. To measure achievement in the long-range project, 21 families of Flor del Campo participated in a preliminary three-part survey of their (a) health, (b) housing and the environment, and (c) family history. Doctors, designers, and educators worked with Honduran personnel in the first survey. Following functional analyses of the home and surrounding environment and the physical status of the individuals living there, procedures provide the family with treatment and training for home and environment improvement. Graphic, verbal, and numerical data, incorporated into a master computerized system, record events of each family member: training programs experienced, health care delivery courses taken, medical treatments, growth of children, literacy changes, educational courses completed, kinds and amounts of foods eaten, household and building materials purchased. Ongoing functional analysis and a long-range evaluation are made of the progress of each participating individual in a family. Teams revisit each house to observe and record any changes in the physical and environmental facility and the health and life-styles, and to report any indications of new health problems or recurrences.