Supported Housing: Research and Best

Practices

Joseph A. Rogers, Executive DirectorNational Mental Health Consumers’

Self-Help Clearinghouse1211 Chestnut Street, 11th Floor,

Philadelphia, PA 19107800-553-4539, ext. 273,

jrogers@mhasp.org

Alternatives 2009, Omaha, NebraskaOct. 28-Nov. 1, 2009

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What Is Supported Housing?

Helps individuals with mental health challenges get and keep independent housing that is integrated into the community.

Individuals have choice and control over their services and supports.

Long-term housing, but supports may change over time, as needed.

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Boston University Research Review

Summarizes data on the effectiveness of, and predictors of success in, this evidence-based practice.

Boston University

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Some Models of Supported Housing

As Described in the Research (Slides 5-7)

Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation.  Innovative Knowledge

Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR

Grant # (H133A050006)

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Model 1: Supported Housing Program Helps individuals

acquire and maintain housing of their choice

Adjusts the intensity and types of support and training they need/want.

In this case, the housing is the intervention.

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Model 2: Case Management Program

Helps individuals maintain their own housing and acquire subsidies.

Provides individuals with: support skills training

May be: brokered model, or more intensive case

management.

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Model 3: ACT Program Assertive Community

Treatment A mobile treatment and

rehabilitation team that supports individuals in their own: Housing Employment Social environments

Generally more intensive services.

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“Housing First” Is a Model Program

“The treatment for homelessness is housing. . . . It’s that simple.”

--Dr. Sam Tsemberis of Housing First (supported housing that offers apartments to homeless people who have mental illnesses and who may have substance abuse problems, without requiring the individuals to first become clean and sober)http://www.cbsnews.com/stories/2007/11/23/eveningnews/main3534623.shtml

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Housing First Group Develops Peer-run Program

$2 million SAMHSA “Services in Supportive Housing” grant

Will integrate peer-run Illness Management and Recovery (IMR) into Assertive Community Treatment (ACT)

IMR consists of: education skills training cognitive therapy

Will serve 570 NYC consumers who are chronically homeless.

Will test innovation of having IMR delivered by trained peer specialists.

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Civil disobedience outside Philadelphia Public Housing Authority to protest proposed

discriminatory policies (1985)

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Philadelphia advocates rally for supported housing, 1/15/08

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More Housing Advocacy “Sleep-out” at State Office

Building in Philadelphia (1987) resulted in more than $4 million for housing for homeless people with mental illnesses.

Civil disobedience at Federal Office Building in Philadelphia (1988) focused media attention on plight of people who are homeless.

“Free 1515” campaign led to Philadelphia approval of residence for homeless people with mental illnesses despite NIMBY neighbors.

1515 Fairmount

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Supported Housing: Benefits

Gives individuals more control over the supports and services

Improves their satisfaction with living arrangements

Supports can decrease, increase or change according to the needs and wishes of the individual

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Supported Housing: Benefits (cont’d)

Eliminates multiple moves, provides stability

Can reduce hospitalizations and improve the quality of life.

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Challenges

Obtaining subsidized housing is very challenging when the demand is so great.

Typically there are long waiting lists.

Need to address the isolation and loneliness reported in several studies.

Better cost-benefit studies are needed.

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Research Review by Boston University

Center for Psychiatric Rehabilitation

(and Panel of Experts)

Rationale for the Review: The field of rehabilitation needed the

information on supported housing research, even though many studies to date have not used randomized trials.

Reviewed and Rated: 15 years of research including studies in which housing was an intervention, those where housing was the outcome and those where housing was both.

Compiled by the Supported Housing Study Group at Boston University

Center for Psychiatric Rehabilitation.  Innovative Knowledge Dissemination & Utilization Project for Disability & Professional

Stakeholder Organizations/ NIDRR Grant # (H133A050006)

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Research Finding 1. Supported Housing can:

1. improve housing status2. lead to residential stability3. increase quality of life of

residents who have psychiatric disabilities, are homeless, at risk of homelessness and/or may be substance abusing.

Research on Slides 17-32 compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

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Research Finding 2.Individuals

frequently prefer independent housing rather than group/congregate living.

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Research Finding 3.

Higher-quality housing (in terms of the physical features of the housing) may lead to better outcomes.

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Research Finding 4. When housing is

affordable, there is a more direct and quicker exit from homelessness, and stable independent living is more likely.

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Research Finding 5.Housing stability

rates have been found to be 63% - 81%.

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Research Finding 6.

Housing subsidies and affordable housing lead to greater success in getting and keeping housing.

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Research Finding 7.Supported housing

costs tend to be greater than group living costs in the short term

but may result in savings in other services over time, such as treatment and acute care.

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Research Finding 8.At least one study

demonstrated significant reductions in a wide array of services when individuals who were homeless are placed into supportive housing.

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Research Finding 9.Traditional case

management is less effective in producing stable housing.

Intensive supports need to be available for those who need them. These include practical supports:

* laundry* shopping* cleaning.

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Research Finding 10.

There is some evidence that women fare better in supported housing than men.

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Research Finding 11.Studying

residential options using a randomized design is difficult, but possible.

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Research Finding 12.

Participants who leave the program and who are lost to the research present a challenge.

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Research Finding 13.

Supported housing interventions do not automatically lead to improvements in: Social integration Symptoms Substance abuse problems Solving of practical problems

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Research Finding 14.Service

integration leads to improvements in housing outcomes.

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Need for Further Investigation

What is the relationship between housing, mental health outcomes and satisfaction?

What role do housing types have in relation to therapeutic benefits to individuals (unrelated to services)?

How should we define “housing stability” for research purposes so studies can be compared?

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Supported Housing: Conclusions

Integrated, long-term independent housing with supports is critically important to rehabilitation and recovery.

Supported housing in combination with subsidies can significantly improve the quality of life of residents.

Programs need to assist consumers in their community integration and prevent isolation.

Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation.  Innovative Knowledge Dissemination & Utilization

Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

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Resources for Supported Housing (1) Boston University Center for Psychiatric

Rehabilitation – Disability Research Right to Know http://drrk.bu.edu/

Corporation for Supportive Housing http://www.csh.org/

UPenn Collaborative on Community Integration http://www.upennrrtc.org

Advocates for Human Potential http://www.ahpnet.com/HousingHomeless.html

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Resources for Supported Housing (2) New Freedom Initiative . . . to Promote

Community-Based Care http://www.ahpnet.com/Olmstead.html

Projects for Assistance in Transition from Homelessness (PATH) http://www.pathprogram.samhsa.gov

Technical Assistance Collaborative http://www.tacinc.org

Key Assistance Report on Supported Housing http://www.mhselfhelp.org/pubs/view.php?publication_id=40

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Resources for Supported Housing (3) U.S. Department of Housing and Urban

Development http://www.hud.gov and http://www.huduser.org/index.html

Pathways to Housing/Housing First http://www.pathwaystohousing.org/ and http://www.pathwaystohousing.org/TopMenu/ACTServices/HealthandWellness.html

“Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals With a Dual Diagnosis” http://www.ajph.org/cgi/content/abstract/94/4/651