Supported Housing: Research and Best Practices

Supported Housing: Research and Best Practices Joseph A. Rogers, Executive Director National Mental Health Consumers’ Self-Help Clearinghouse 1211 Chestnut Street, 11th Floor, Philadelphia, PA 19107 800-553-4539, ext. 273, jrogers@mhasp.org Alternatives 2009, Omaha, Nebraska Oct. 28-Nov. 1, 2009

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.

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

Some Models of Supported HousingAs 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)

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.

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.

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. ACT

“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

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.

Civil disobedience outside Philadelphia Public Housing Authority to protest proposed discriminatory policies (1985)

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

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

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 Control Satisfaction Flexibility

Supported Housing: Benefits (cont’d) • Eliminates multiple moves, provides stability • Can reduce hospitalizations and improve the quality of life.

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.

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)

Research Finding 1. Supported Housing can: • improve housing status • lead to residential stability • 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)

Research Finding 2. Individuals frequently prefer independent housing rather than group/congregate living.

Research Finding 3. Higher-quality housing (in terms of the physical features of the housing) may lead to better outcomes.

Research Finding 4. When housing is affordable, there is a more direct and quicker exit from homelessness, and stable independent living is more likely.

Research Finding 5. Housing stability rates have been found to be 63% - 81%.

Research Finding 6. Housing subsidies and affordable housing lead to greater success in getting and keeping housing.

Research Finding 7. Supported housing costs tend to be greaterthan group living costs in the short term but may result in savings in other services over time, such as treatment and acute care.

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.

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.

Research Finding 10. There is some evidence that women fare better in supported housing than men.

Research Finding 11. Studying residential options using a randomized design is difficult, but possible.

Research Finding 12. Participants who leave the program and who are lost to the research present a challenge.

Research Finding 13. Supported housing interventions do not automatically lead to improvements in: • Social integration • Symptoms • Substance abuse problems • Solving of practical problems

Research Finding 14. Service integration leads to improvements in housing outcomes.

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?

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)

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

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

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

Supported Housing: Research and Best Practices