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What do homeless transition-age youth want from housing interventions?
Abstract
Housing-led interventions have become recognized as a best practice for addressing homelessness among adults, yet whether and how they apply to transition-age youth (TAY) is less clear. The purpose of the present study is to expand on a burgeoning literature that has provided marginalized TAY an opportunity to voice their perspectives on housing-led program design. The goal of the study it to build on the existing literature that has predominantly used individual qualitative interviewing by using a focus group methodology in which group interaction can generate data and insights that may not emerge in individual interviews. Focus groups (n = 4) were conducted with 18 youth. Thematic analysis of focus group transcripts was conducted using independent and co-coding procedures. Three overarching and interrelated themes emerged from the focus groups: (a) personal responsibility and deservedness, (b) rising and falling together, and (c) needing individualized support. These findings suggest that TAY preferences for housing and services are not necessarily consistent with the homeless adult population and that youth may be looking for a more supportive housing environment.
... Recently, there has been increasing interest in providing PSH to youth (Gaetz, 2014). However, Housing First, like most housing models in which young people access emergency, temporary, or more permanent shelter, was designed for adults (Henwood et al., 2018;Kozloff et al., 2016) and it remains unclear how to implement PSH so it will be developmentally appropriate for youth (Munson et al., 2017). ...
... However, housing stability alone is insufficient because youth need more than shelter to thrive. Some studies have found that YEH need and want more structure and support than adults (De Rosa et al., 1999;Gaetz, 2014), including training in basic skills, like laundry, food shopping, and money management, to successfully maintain housing (Holtschneider, 2016;Henwood et al., 2018). They also need support to attain the education and job training required to transition into independent adulthood (Gaetz & O'Grady, 2013). ...
... At the interpersonal level, social networks both exacerbate and diminish food insecurity. Research has documented the positive and negative influences of YEH peer networks on issues including drug use, motivation, reliance on survival strategies, and successful integration into housing ( Rice et al., 2005;Henwood et al., 2018;Auerswald and Eyre, 2002). This study adds to those findings by describing how peer networks can diminish food insecurity but can also drain resources because youth feel obligated to provide food to fellow residents and to friends without housing. ...
... They conclude that adaptations to address the unique needs of emerging adults is needed in future trials. Indeed, several researchers note that PSH and RRH interventions have not been adapted to the unique needs of youth which is essential given the unique challenges that youth face [18,43,[54][55][56]. ...
... Taken together, the empirical and qualitative evidence leads to the conclusion that housing is not enough for YEH [17,25,56,62]. Youth need more supports than adults including basic living skills, assistance to maintain housing, money management, shopping for food, attaining education, employment and job training to successfully transition to independent adulthood [55,65,66]. Interconnections to functioning across life domains and connections to supportive adults must occur if we are to make progress on ending homelessness and concomitant struggles among youth [17,56]. ...
Background:
Youth, 18 to 24 years, experiencing homelessness (YEH) are recognized as having developmental challenges dissimilar to older adults. Yet, research on efforts to end homelessness and prevent or intervene in drug use and mental health problems among youth have lagged behind that of adults. The Housing First (HF) Model which underlies Permanent Supportive Housing (PSH) and Rapid Re-Housing (RRH) has become preferred over treatment-first models.
Methods and results:
We provide an overview of PSH and RRH studies to date and summarize our current understanding of their utility for use with YEH. Finally, we review our team's current and past randomized trials testing RRH with YEH, providing lessons learned and recommendations.
Conclusion:
Current research efforts to guide best practices are hampered by a lack of fidelity to HF principles, lack of randomized design, and lack of focus on youth. Lessons learned and recommendations from our work are offered to facilitate the future work of those who seek to end homelessness and address drug use and mental health problems among youth.
... For adults who have experienced long-term homelessness, PSH using a housing first approach-or the provision of immediate access to low-barrier, affordable housing along with wrap-around services-has been effective at ending homeless (U.S. Interagency Council on Homelessness, 2010) and providing a secure base for identity construction (Padgett, 2007). PSH has also been advanced as a solution to youth homelessness (Dworsky et al., 2012;Gaetz, 2014), yet there has been relatively limited research on whether such programs promote healthy development, including identity construction (Henwood, Redline, and Rice, 2018;Kozloff et al., 2016aKozloff et al., , 2016bMunson et al., 2017). The transition from youth to young adulthood is an important period for healthy biopsychosocial development, which is disrupted by experiences of homelessness and related adverse childhood experiences (Catalano et al., 2004;Wood et al., 2018) and can have adverse health consequences throughout life (Felitti et al., 1998;Mackelprang et al., 2014). ...
This qualitative study of 29 young adults (aged 18-25) living in permanent supportive housing (PSH) resulted in a grounded theory that shows how PSH generally provides a sense of ontological security for young adults-much like for older adults-who are also experiencing significant developmental change processes. Simply stated, ontological security refers to a concept of well-being in the world that is rooted in a sense of order in one's social and material environment. Thematic analyses indicated that the presence of markers of ontological security (for example, constancy, routine, control) positively affected participants' mental health and well-being, which helped with positive identity construction. An increase in ontological security also related to residents' social environment and participants' ability to improve on social relationships, which supported improved mental health and sense of self. Most young adults in this study regarded living in PSH as "a chance to start my life" and considered the question of "What's next?" within a normative developmental trajectory. Counterexamples that demarcate the limits of these thematic findings are included in the grounded theory model, including some experiences of social isolation and struggles with mental health associated with less positive orientations toward "what's next."
... Developmentally, it is also important that such supports and family involvement complement youth's needs associated with emerging adulthood. This would include individualizing supports, such as employment or mental health needs, in the context of their immediate needs for stable housing (Henwood, Redline & Rice, 2018). In order for families to serve in the important role of an informal support and access to stability for youth experiencing homelessness, they require intensive and sustained supports themselves. ...
Recent scholarship indicates that youth homelessness is a significant problem outside urban areas. However, previous studies have not examined how local contexts shape the experiences of youth who are homeless in rural areas and small towns with high rates of poverty and epidemic drug use. To address this gap, this analysis draws from two components of a large national study of homelessness among youth, using data collected in a small non-urban setting in the Northwest including (1) a subset of 41 (out of 215 nationally) in-depth interviews with youth and (2) a subset of 16 surveys (out of 523 nationally) with service providers. We explored availability of services and how youth navigate housing instability and the service landscape in small communities. We discovered that current or prior addictions sometimes posed risks to the safety of youth and compromised their ability to rely on family supports – a support proving critical in the absence of a formal service infrastructure. Our results suggest that youth experiencing housing instability in the context of high rates of drug use and limited formal services must often choose between meeting competing needs: a place to stay versus sobriety. We discuss the implications for policy, practice, and research.
In response to a growing crisis of homelessness across the State of California, Senate Bill 850 (2018) established the Homeless Emergency Aid Program (HEAP) to provide $500 million for flexible block grants to help communities address the substantial rise in homelessness. The program awarded 54 one- time block grants to 43 Continuums of Care (CoCs)1 and 11 large cities in California.2 HEAP block grants could be allocated to three general funding categories: direct social services (e.g., street outreach, navigation services), rental assistance (e.g., housing subsidies, rapid rehousing programs), or capital improvements (e.g., constructing new shelters or permanent supportive housing units). Moreover, 5% of each grant was required to be spent on programs or services that explicitly address youth homeless- ness, commonly referred to as the “HEAP youth set-aside”.
This report highlights how some communities lever- aged the HEAP youth set-aside funds to specifically support intervention models that increase outreach, engagement, and housing assistance to young people facing homelessness in California.
Supportive housing (SH), largely consisting of Transitional Living Programs (TLPs) and Permanent Supportive Housing (PSH), is the primarly intervention being applied to the one-in-ten young adults that experience homelessness in the United States each year. To date, efforts to understand the perception of these programs among young adult tenants have focused singularly on TLPs or PSH. The current qualitative study builds upon previous evidence through a comparative analysis of young adult perceptions of TLPs and PSH and examines the the physical, social, and service environments associated with each program. Results suggest six themes, including three themes focused on factors associated with location, common to both TLPs and PSH: desired proximity to friends, family, and amenities; wanted distance from negative influences; and increased ability to assimilate. Three additional themes focused on the environment internal to the housing program that differentiated the models: shared space with roommates, the service environment and relationships with SH staff, and the moving on process. Findings indicate that location is an important but complex element of the housing environment for all young SH tenants with both positive and negative factors. Within the housing environment, more TLP residents had roommates and spoke of utilizing the services associated with their housing, but discussed feeling less prepared for life after SH.
Homelessness among youth is a continuing problem in the US as prevalence rates remain high. Youth experiencing homelessness (YEH) endure multiple mental health struggles, trauma and victimization while living on the streets. Research notes that most YEH underutilize available services several barriers to service access have been identified. Although a few studies have been conducted to test services and interventions that address the unique mental health needs of YEH, such as housing first, outreach and drop-in centers, motivational interviewing and substance use treatments, more research to guide mental health providers is sorely needed.
Introduction
This review aims to identify and synthesize literature focused on housing interventions for young adults experiencing homelessness.
Methods
Following a five-stage approach to scoping reviews, a computerized search was conducted between February 4-8, 2019 to include peer-reviewed articles from a total of eight electronic databases: PsychINFO, Google Scholar, PubMed, Web of Science, Social Work Abstracts, Cochrane, Clinicaltrials.gov, and CINAHL. The search was limited to include literature published between January 1, 1987 and December 31, 2018. Search parameters included three domains: homelessness, housing intervention, and age.
Results
Of the initial 7,344 sources identified, 29 articles met the search criteria and were included in the final sample. Housing models discussed in the reviewed literature include Permanent Supportive Housing, Transitional and Independent Housing and Living Programs, the Foyer model, Housing First, and general Supportive Housing. Housing models were discussed in the context of outcome domains including quality of life, education, employment, housing tenure, cost of intervention, systems and service use, HIV, and social network and relationships.
Discussion
Housing interventions for young adults experiencing homelessness remains a relatively new intervention to combat homelessness among younger demographics. While the evidence base continues to grow, there remains a need for quality research to generate empirical evidence in this area, though studies included in this review showed promise for the development of best housing practices with this population.
At a time when homelessness, inequality and poverty plague Canadian society, an organization in Whistler, British Columbia has been working for over 20 years to combat some of the associated issues faced by vulnerable youth. This multi-year research project explored one of the programs offered by the organization with the intent of gaining an understanding of the short- and long-term impact, the future requirements for sustainability and growth, and the alignment of the program to local and regional needs. Through a series of focus groups, qualitative data was collected and, while the focus of the research project fell across the identified program foci of housing, employment, participant experience, and support, this article focuses specifically on the findings related to employment. The five themes that were identified in the data collected included: participants’ context, processes to support accountability, contributors to success, challenges, and participants’ suggestions for improvement. Across these themes and sub-themes, it was clear that stable employment is a necessary component of a comprehensive program that supports youth as they build resilience and combat homelessness.
Objective
Qualitative methods were used to investigate the perspectives of service providers working in Permanent Supportive Housing, Transitional Living Programs, and Rapid Rehousing for young adults who have experienced homelessness. The primary aim was to explore how housing models were designed, implemented, and the extent to which there is variability in how providers approach their work with young adults.
Methods
Data come from 26 housing service providers purposively sampled from supportive housing providers across the United States between October 2017 and July 2018. Interview transcripts were analyzed using a comparative case summary approach, grouped by program model.
Results
Three themes emerged from the qualitative analysis related to how specific housing models were developed (Stranded between systems: “No model to follow”), the strategies that providers took to support residents toward independence and self-sufficiency (Working toward independence and self-sufficiency: “No one-sized approach”), and the various roles that individual providers discussed fulfilling in their work with young adults (Shifting roles: “Whatever type of figure is needed”).
Discussion
While the overarching goals of supportive housing span across housing models, the methods and philosophies of service delivery differ, mirroring the programmatic structure of the model. Results point to a competing philosophies approach to housing as it delivers different philosophically oriented programming models for similar youth through Transitional Living Programs, Permanent Supportive Housing, and Rapid Rehousing models.
A growing body of research indicates that structural interventions to provide permanent supportive housing (PSH) to homeless adults within a Housing First approach can improve their health. However, research is lacking regarding the impact of PSH on youth experiencing homelessness. This article seeks to understand how PSH for youth impacts a basic health need-food security- across multiple levels of the social-ecological environment. In January of 2014, San Francisco, California opened the city's first municipally-funded PSH building exclusively designated for transition-aged youth (ages 18-24). We conducted 20 months of participant observation and in-depth interviews with 39 youth from April 2014 to December 2015. Ethnographic fieldnotes and interview transcripts were analyzed using grounded theory. We present our social-ecological assessment regarding food insecurity for formerly homeless youth in supportive housing. We found that although housing removes some major sources of food insecurity from their lives, it adds others. Many of the participating youth were frequently hungry and went without food for entire days. Mechanisms across multiple levels of the social-ecological model contribute to food insecurity. Mechanisms on the structural level include stigma, neighborhood food resources, and monthly hunger cycles. Mechanisms on the institutional level include the transition into housing and housing policies regarding kitchen use and food storage. Interpersonal level mechanisms include food sharing within social networks. Individual level mechanisms include limited cooking skills, equipment, and coping strategies to manage hunger. Although supportive housing provides shelter to youth, effective implementation of the Housing First/PSH model for youth must ensure their access to an affordable nutritious diet.
The present study focuses on the service-related needs and experiences of formerly homeless emerging adults living in supportive housing programs following a Housing First model. Recent research on services utilized by homeless individuals has indicated that, in supportive housing programs that serve a wide age range, emerging adults may consider themselves different from older adults, with distinct problems and characteristics. The present study applied conventional content analysis to qualitative interviews to investigate how emerging adults in two Housing First supportive housing programs describe and understand their experiences within these programs. Findings are centered on three main domains: social connections, future outlooks, and program experiences. Results highlight the importance of taking developmental considerations into account when formulating services for emerging adults.
Purpose:
Unaccompanied youth homelessness is a serious concern. Response, however, has been constrained by the absence of credible data on the size and characteristics of the population and reliable means to track youth homelessness over time. We sought to address these gaps.
Methods:
Using a nationally representative phone-based survey (N = 26,161), we solicited household and individual reports on different types of youth homelessness. We collected household reports on adolescents aged 13-17 and young adults aged 18-25, as well as self-reports from young adults aged 18-25. Follow-up interviews with a subsample (n = 150) provided additional information on youth experiences and enabled adjustment for inclusion errors.
Results:
Over a 12-month period, approximately 3.0% of households with 13- to 17-year-olds reported explicit youth homelessness (including running away or being asked to leave) and 1.3% reported experiences that solely involved couch surfing, resulting in an overall 4.3% household prevalence of any homelessness, broadly defined. For 18- to 25-year-olds, household prevalence estimates were 5.9% for explicitly reported homelessness, 6.6% for couch surfing only, and 12.5% overall. The 12-month population prevalence estimates, available only for 18- to 25-year-olds, were 5.2%, 4.5%, and 9.7%, respectively. Incidence rates were about half as high as prevalence rates. Prevalence rates were similar across rural and nonrural counties. Higher risk of homelessness was observed among young parents; black, Hispanic, and lesbian, gay, bisexual, or transgender (LGBT) youth; and those who did not complete high school.
Conclusions:
The prevalence and incidence of youth homelessness reveal a significant need for prevention and youth-centric systems and services, as well as strategies to address disproportionate risks of certain subpopulations.
Safe and affordable housing is critical for any young person’s well-being, and yet many youth are without a reliable place to live. Knowledge of the perceptions of housing programs and shelter among homeless young adults ages 18–24 is very limited. Using qualitative methodology, the present study explores the perceptions of homeless young adults on their experiences as residents of a transitional living program (TLP) by asking the following research questions: (1) What are TLP residents’ expectations of themselves and others in the program? and (2) How do residents perceive the rules and structure of the TLP? Sixteen interviews were conducted with residents at a TLP for homeless young adults, with participants ranging in age from 18 to 22. Findings illuminated residents’ strong emphasis on the values of hard work, self-discipline and a good attitude. Results revealed that residents felt that they are overly monitored within the program, particularly around daily living in the residence and felt a lack of flexibility in the rules and regulations. It is important that the structure of a TLP housing program so that rules are not disruptive to healthy development and successful transition from adolescence to adulthood. Further implications for practice are discussed.
Although research has established a high risk of homelessness among young people aging out of foster care, little is known about the experience of these youth who are helped to make the transition to independent living through supportive housing programs. We interview 14 transition-age youth (18 to 24 years) using photo elicitation interviewing to investigate how young people who have aged out of foster care visually and verbally narrate their journeys through transitional housing programs. The participants were drawn from two transitional housing programs in Los Angeles County. Data were collected in 3 stages: (a) a semi-structured initial interview; (b) a 2-week period of participant photography and photo development; and (c) an in-depth follow-up interview focused on understanding the photos. Analysis involves open coding of transcripts and photographs, clustering of codes into families, and thematic abstraction. Participants’ journeys through transitional housing are captured in 4 major themes: (a) changing perspectives; (b) experiencing newfound independence and control; (c) performing a juggling act; and (d) wanting to move forward, yet feeling unprepared. Study findings illustrate how transition-age youth experience their gradual independence and the ways in which transitional housing programs can provide critical support during this important period. In addition, the findings point to the need for further research regarding how young people can optimally balance employment and educational demands in the context of supportive housing.
This study examined the relationship between victimization and mental health functioning in homeless individuals. Homeless populations experience higher levels of victimization than the general population, which in turn have a detrimental effect on their mental health. A sample of 304 homeless adults and youth completed one-on-one interviews, answering questions on mental health, past victimization, and recent victimization experiences. A hierarchical linear regression showed that experiences of childhood sexual abuse predicted lower mental health functioning after controlling for the sex and age of individuals. The study findings are applicable to current support programs for victims in the homeless population and are relevant to future research on homelessness and victimization.
Most young people in the United States are experiencing an increasingly prolonged transition to adulthood. It is no longer assumed that they will automatically become self-sufficient adults on their 18th or even 21st birthdays (Arnett 2000; Wight, Xhau, Aratani, Schwarz, and Thampi 2010; Setterstein and Ray 2010). Rather, young people are gradually taking on the roles and responsibilities traditionally associated with adulthood while they acquire the education and work experience needed to become economically independent (Berlin, Furstenberg, and Waters 2010).In this document, we summarize what is known about the housing needs and outcomes common to young people who age out of foster care. We explore the current landscape of programs and resources available to assist such young adults with housing. In the first section, we review the literature on the characteristics of the young people, their risk of homelessness, and the barriers they face in securing stable housing, along with relevant federal and, to a lesser extent, state policies. In the second section, we describe a wide range of housing programs for young people aging out of foster care, present a program typology, and conclude with the identification of a small group of innovative housing programs that may warrant closer exploration.
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.
The study of resilience has two core characteristics: it is fundamentally applied in nature, seeking to use scientific knowledge to maximize well-being among those at risk, and it draws on expertise from diverse scientific disciplines. Recent advances in biological processes have confirmed the profound deleterious effects of harsh caregiving environments, thereby underscoring the importance of early interventions. What remains to be established at this time is the degree to which insights on particular biological processes (e.g., involving specific brain regions, genes, or hormones) will be applied in the near future to achieve substantial reductions in mental health disparities. Aside from biology, resilience developmental researchers would do well to draw upon relevant evidence from other behavioral sciences as well, notably anthropology as well as family, counseling, and social psychology. Scientists working with adults and with children must remain vigilant to the advances and missteps in each others' work, always ensuring caution in conveying messages about the "innateness" of resilience or its prevalence across different subgroups. Our future research agenda must prioritize reducing abuse and neglect in close relationships; deriving the "critical ingredients" in effective interventions and going to scale with these; working collaboratively to refine theory on the construct; and responsibly, proactively disseminating what we have learned about the nature, limits, and antecedents of resilient adaptation across diverse at-risk groups.
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.
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.
Objective:
Permanent supportive housing (PSH) programs are being implemented nationally and on a large scale. However, little is known about PSH for transition-age youths (ages 18 to 24). This study estimated health services costs associated with participation in PSH among youths and examined the relationship between fidelity to the Housing First model and health service outcomes.
Methods:
Administrative data were used in a quasi-experimental, difference-in-differences design with a propensity score-matched contemporaneous control group to compare health service costs among 2,609 youths in PSH and 2,609 youths with serious mental illness receiving public mental health services in California from January 1, 2004, through June 30, 2010. Data from a survey of PSH program practices were merged with the administrative data to examine changes in service use among 1,299 youths in 63 PSH programs by level of fidelity to the Housing First model.
Results:
Total service costs increased by $13,337 among youths in PSH compared with youths in the matched control group. Youths in higher-fidelity programs had larger declines in use of inpatient services and larger increases in outpatient visits compared with youths in lower-fidelity programs.
Conclusions:
PSH for youths was associated with substantial increases in costs. Higher-fidelity PSH programs may be more effective than lower-fidelity programs in reducing use of inpatient services and increasing use of outpatient services. As substantial investments are made in PSH for youths, it is imperative that these programs are designed and implemented to maximize their effectiveness and their impact on youth outcomes.
In California, the Mental Health Services Act allocated substantial funding to Full Service Partnerships (FSPs): programs that do whatever it takes to improve residential stability and mental health outcomes. The state-guided, but stakeholder-driven, approach to FSPs resulted in a set of programs that share core similarities but vary in their specific approaches. This qualitative study examines FSP variations within the framework of fidelity to the Housing First model. Semistructured interviews with 21 FSP program managers identified through purposeful sampling were coded and analyzed to identify variations across programs in their approaches to housing and services. Through the process of constant comparison, FSP characteristics were condensed into a set of broad themes related to fidelity to the Housing First model. We identified three broad themes: (a) FSPs varied in the degree to which key elements of Housing First were present; (b) program recovery orientation and staff experience were associated with fidelity; and (c) FSPs for older adults, adults exiting the justice system, and transitional age youth made specific adaptations to tailor their programs for the needs of their specific populations. FSPs bring a considerable level of community-based housing and treatment resources to homeless persons with serious mental illness. However, when examined individually, there exists enough variation in approaches to housing and treatment to raise the question whether some programs may be more or less effective than others. An opportunity exists to employ the variation in FSPs implemented under this initiative to analyze the importance of fidelity to HF for client outcomes, program costs, and recovery-oriented care.
Objectives
This study examined whether and how permanent supportive housing (PSH) programs are able to support aging in place among tenants with serious mental illness.DesignInvestigators used a mixed-method approach known as a convergent parallel design in which quantitative and qualitative data are analyzed separately and findings are merged during interpretation. Quantitative analysis compared 1-year pre-residential and post-residential outcomes for PSH program enrollees, comparing adults aged 35–49 years (n = 3990) with those aged 50 years or older (n = 3086). Case study analysis using qualitative interviews with staff of a PSH program that exclusively served older adults identified challenges to providing support services.ResultsSubstantial declines in days spent homeless and in justice system settings were found, along with increases in days living independently in apartments and in congregate settings. Homelessness and justice system involvement declined less for older adults than younger adults. Qualitative themes related to working with older adults included increased attention to medical vulnerability, residual effects of institutional care, and perceived preference for congregate living.ConclusionsPSH is an effective way to end homelessness, yet little is known about how programs can support housing stability among aging populations. Additional support and training for PSH staff will better promote successful aging in place. Copyright © 2014 John Wiley & Sons, Ltd.
Amidst concern about the implications of an aging U.S. population, recent evidence suggests that there is a unique aging trend among the homeless population. Building on this, we use data from New York City and from the last three decennial Census enumerations to assess how the age composition of the homeless population—both single adults and adults in families—has changed over time. Findings show diverging trends in aging patterns for single adults and adults in families over the past 20 years. Among single adults, the bulk of the sheltered population is comprised of persons born during the latter part of the baby boom era whose high risk for homelessness has continued as they have aged. Specifically, the age group in this population facing the highest risk for homelessness was 34–36 (born 1954–1956) in 1990; 37–42 (born 1958–1963) in 2000; and 49–51 (born 1959–1961) in 2010. In contrast, among adults in sheltered families, there is no indication of any progressive aging of the family household heads. The modal age across the study period remains at 21–23 years of age. We consider implications for the health care and social welfare systems, and policy responses to homelessness.
While rates of disengagement from mental health services remain high, the Housing First program has succeeded in engaging those who are hardest-to-reach, people who have experienced long-term homelessness and co-occurring disorders. This study uses ethnographic methods to explore service engagement within Housing First, focusing on how social processes contribute to program effectiveness. Conducting participant observation and interviews, researchers followed 10 clients and 14 case managers from two treatment teams, over the course of a year. The study used symbolic interactionism as its theoretical framework. In data analysis, therefore, the researchers explored meaning-making within social exchanges. The sites and activities of the program provided a context that made it possible for case managers and residents to create shared narratives about residents’ experiences related to housing. The variation of these sites and activities led case managers to permeate many aspects of clients’ lives, playing roles similar to those of friends and family. The quality of the interaction became apparent from how case managers paid attention, listened, and communicated while engaging in these shared activities. This study illustrates that while the structural aspects of Housing First provided the context and opportunities for engagement, the quality of the interaction between the case managers and residents played a key role in engagement.
Homeless emerging adults need the safety and stability of housing programs if they are to avoid the elements and victimization of the streets, however, barriers to obtaining housing are numerous. This study identified factors associated with perspectives of housing services among 29 homeless emerging adults (ages 18-23years) through one-on-one interviews. Data were gathered and analyzed using grounded theory methodology for qualitative information. Major themes of peer support and positive personal and programmatic interactions in the context of emerging adult development were noted as important factors in housing service utilization. These major themes should be taken into consideration for current housing programs, due to homeless emerging adults' oscillation between their desire for formal support and personal independence. Greater emphasis on services that do not require long term commitments and are more flexible in addressing specific barriers to housing for homeless emerging adults may increase use.
The impact of countervailing social network influences (i.e., pro-social, anti-social or HIV risk peers) on problem behaviors (i.e., HIV drug risk, HIV sex risk or anti-social behaviors) among 696 homeless youth was assessed using structural equation modeling. Results revealed that older youth were less likely to report having pro-social peers and were more likely to have HIV risk and anti-social peers. A longer time homeless predicted fewer pro-social peers, more anti-social peers, and more HIV risk peers. Heterosexual youth reported fewer HIV risk peers and more pro-social peers. Youth recruited at agencies were more likely to report pro-social peers. Having pro-social peers predicted less HIV sex risk behavior and less anti-social behavior. Having HIV risk peers predicted all problem behavior outcomes. Anti-social peers predicted more anti-social behavior. Once the association between anti-social and HIV risk peers was accounted for independently, having anti-social peers did not independently predict sex or drug risk behaviors.
Within the mental health system, there are two distinct service models for adults who have severe mental illness and are homeless: one prioritizes treatment before accessing permanent housing (Treatment First) while the other provides permanent housing upfront followed by clinical support (Housing First). Investigating front-line providers working within these two models affords an opportunity to learn more about their implementation from an insider perspective, thus shedding light on whether actual practice is consistent with or contrary to these program models' contrasting philosophical values.
Forty-one providers were recruited from four agencies as part of a NIMH funded qualitative study. Multiple, in-depth interviews lasting 30-45 min were conducted with providers that explored working within these agencies. Thematic analysis was utilized to compare the views of 20 providers working in Housing First versus the 21 providers working in Treatment First programs.
Providers viewed housing as a priority but differences emerged between Treatment First and Housing First providers along three major themes: the centrality of housing, engaging consumers through housing, and (limits to...) a right to housing.
Ironically, this study revealed that providers working within Treatment First programs were consumed with the pursuit of housing, whereas Housing First providers focused more on clinical concerns since consumers already had housing. Clearly, how programs position permanent housing has very different implications for how providers understand their work, the pressures they encounter, and how they prioritize client goals.
We examined the social network composition among newly homeless youth over time and assessed how pro-social and problematic peers affected sexual and drug-using HIV/AIDS risk-behaviours among 183 youth in Los Angeles County, California. The percentage of newly homeless youth who reported that 'most' or 'all' of their friends were attending school, had jobs, and got along with their families was 73%, 24%, and 50% respectively. Logistic regression models indicated that presence of these pro-social peers reduced HIV risk behaviours at two years; odds of HIV-risk were lower with a greater number of peers who attend school, have a job, or have positive family relationships or if networks change over time to include more of these peers. Presence of problematic peers increased the likelihood of HIV risk-taking; odds of HIV risk behaviours increased with a greater number of peers at baseline who steal, have overdosed, have been arrested, or are in a gang, or if networks change to include more of these peers. Interventions should target newly homeless youth in networks that contain problematic peers, but should strive to harness the naturally occurring pro-social peer influences present in these networks.
This article contrasts values associated with the delivery of housing programs for people with serious mental illness with the typical topics pertaining to housing that are studied by researchers. Six values were identified through a search and content analysis of the literature on housing for people with serious mental illness. A second review of the literature was conducted to identify research on housing for this population. A comparison of findings from the two reviews suggested that whereas values concerned with the therapeutic benefits of housing had received considerable research attention, those concerned with a citizenship dimension had received relatively little. The findings are discussed in terms of their implications for the delivery of housing services and for housing research.
More than a roof over their heads: A toolkit for guiding transition age young adults to long-term housing success
- N Aledort
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- S Grundberg
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A toolkit for guiding transition age young adults to long-term housing success.
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A safe and decent place to live: Towards a Housing First framework for youth
- S Gaetz
Gaetz, S. (2014). A safe and decent place to live: Towards a Housing First framework for
youth. Toronto, Canada: Homeless Hub Press.
Health care for homeless youth: Policy options for improving access
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Halley, M., & English, A. (2008). Health care for homeless youth: Policy options for improving
access. Chapel Hill, NC: Center for Adolescent Health & the Law.
The TAY Triage Tool: A tool to identify homeless transition age youth most in need of permanent supportive housing. Retrieved from Corporation for Supportive Housing website
- E Rice
Rice, E. (2014). The TAY Triage Tool: A tool to identify homeless transition age youth
most in need of permanent supportive housing. Retrieved from Corporation for
Supportive Housing website http://www.csh.org/wp-content/uploads/2014/02/
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Assessment tools for prioritizing housing resources for youth who are homeless
- E Rice
Rice, E. (2017). Assessment tools for prioritizing housing resources for youth who are
homeless. Retrieved from West Coast Convening Website http://www.
westcoastconvening.com/.
Housing First in Canada: Supporting communities to end homelessness
- F Scott
- S J Harrison
Scott, F., & Harrison, S. J. (2013). Calgary, Alberta: The Infinity Project. In S. Gaetz, F.
Scott, & T. Gulliver (Eds.). Housing First in Canada: Supporting communities to end
homelessness (pp. 61-75). Toronto, Canada: Canadian Homelessness Research
Network.
Homeless vulnerability to what? Parity
- T Swanborough
Swanborough, T. (2011). Homeless vulnerability to what? Parity, 24(1), 31.