Factors Affecting Exits From Homelessness Among Persons With Serious Mental Illness and Substance Use Disorders (original) (raw)
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Housing Placement and Subsequent Days Homeless Among Formerly Homeless Adults With Mental Illness
Psychiatric Services, 1999
The study examined the influence of group or individual housing placement and consumer characteristics on the number of days subsequently homeless among formerly homeless mentally ill persons. Methods: A total of 303 homeless shelter residents with severe mental illness were screened for dangerousness, 118 were randomly assigned to either independent apartment or staffed group living sites, and 110 were followed for 18 months. Study participants' sociodemographic characteristics, diagnosis, and residential preferences and the residential recommendations made by clinicians were measured at baseline. Results: Overall, 76 percent of the study participants were housed at the end of the 18-month follow-up period, although 27 percent had experienced at least one episode of homelessness during the period. The number of days homeless was greater for individuals assigned to independent apartments than for those placed in staffed group homes, but only for members of minority groups. Substance abuse was the strongest individual-level predictor of days homeless. Individuals whom clinicians identified as needing group living experienced more days homeless, irrespective of the type of housing they received. Consumers who stated a strong preference for independent living had more days homeless than those who were amenable to staffed group homes. Conclusions: Although consumers more frequently prefer independent living, placement in staffed group housing resulted in somewhat fewer days homeless for some groups of consumers. Further experience of homelessness by formerly homeless mentally ill individuals may be reduced by providing effective substance abuse treatment and by paying special attention to consumers identified by clinicians to be at particular risk for housing loss.
Community Mental Health Journal, 2011
The Housing First (HF) approach for homeless adults with serious mental illness has gained support as an alternative to the mainstream "Treatment First" (TF) approach. In this study, group differences were assessed using qualitative data from 27 HF and 48 TF clients. Dichotomous variables for substance use and substance abuse treatment utilization were created and examined using bivariate and logistic regression analyses. The HF group had significantly lower rates of substance use and substance abuse treatment utilization; they were also significantly less likely to leave their program. Housing First's positive impact is contrasted with the difficulties Treatment First programs have in retaining clients and helping them avoid substance use and possible relapse.
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2016
Housing First (HF) has been shown to improve housing stability, on average, for formerly homeless adults with mental illness. However, little is known about patterns of change and characteristics that predict different outcome trajectories over time. This article reports on latent trajectories of housing stability among 2140 participants (84% followed 24 months) of a multisite randomised controlled trial of HF. Data were analyzed using generalised growth mixture modeling for the total cohort. Predictor variables were chosen based on the original program logic model and detailed reviews of other qualitative and quantitative findings. Treatment group assignment and level of need at baseline were included in the model. In total, 73% of HF participants and 43% of treatment-as-usual (TAU) participants were in stable housing after 24 months of follow-up. Six trajectories of housing stability were identified for each of the HF and TAU groups. Variables that distinguished different trajecto...
The residential support staff, case managers and supervisors of the city's permanent housing programs who tirelessly serve the city's homeless and mentally ill populations. • Our advisory team members, Carol Caton and Michale Covone who have contributed their time, knowledge and expertise. • Paul Dornan, our project Government Technical Representative from the U.S. Department of Housing and Urban Development (HUD)'s Office of Policy Development and Research (OPDR), for providing us with indispensable support, insights and encouragement throughout the study. Additionally, Kevin Neary, also from HUD's OPDR, provided invaluable support. We appreciate the significant contributions that the above individuals made to the implementation of the research project and writing of this report. They are not responsible for any errors or omissions. The findings and views herein are those of the contractors and authors. The contents of this report are the views of the contractor and do not necessarily reflect the views or policies of the U.S. Department of Housing and Urban Development or the U.S. Government. Foreword The Permanent Housing component of the Supportive Housing Program, the Department's principal program to meet the needs of homeless people with disabilities, was established to offer homeless people with disabilities, including mental illness, an assurance of permanent housing and appropriate supportive services. The program is designed to provide a structure that counteracts the disruptions of both homelessness and disability. However, while many formerly homeless people remain in permanent supportive housing for many years, substantial numbers leave within months of entry. The questions of why people leave permanent housing and what happens to them constitute the principal focus of this study. This study examines the experience of some 943 residents of permanent supportive housing in Philadelphia during the period from 2001 to 2005. The capability to merge Homeless Management Information System (HMIS) data and administrative data in Philadelphia, Pennsylvania, made possible a viable strategy to track over time a highly elusive population-formerly homeless people with mental illness who had left permanent supportive housing. The study shows that it is not necessarily a bad thing that some people leave "permanent" supportive housing. Those who left and the circumstances of their departure were highly divergent, and who left and how was significantly related to the stability of their housing and the independence of their lives, both in the short-and longer-term. Three-fifths of those who left HUD-supported Permanent Housing in Philadelphia left voluntarily, either to pursue better housing or to move away from problems they were experiencing in the permanent supportive housing. The remaining two-fifths left involuntarily, having been asked to leave because they violated program rules or because they were adjudged by staff incapable of maintaining themselves in the permanent supportive housing environment. Those who left under positive circumstances were far more likely to move to more stable and independent housing, to stay in that housing over time and to use fewer mental health services post-departure than those who left more negatively. The study also found that, based on the variables included, there would have been no way to predict at entry into permanent supportive housing who would stay or leave, either positively or less so. This study makes a valuable contribution to our understanding of how the structure of permanent supportive housing and the use of various means of stabilization at critical junctures in a resident's stay can promote more stability and, thereby, greater health and independence, among those living there, whether they stay or subsequently leave.
Addiction, 2015
Aims Housing First (HF) is an established intervention for people experiencing homelessness and mental illness. We compared daily substance use (DSU) between HF and treatment as usual (TAU). Design Two concurrent randomized controlled trials with 24-month follow-up. Setting Market rental apartments with support provided by Assertive Community Treatment (ACT) or Intensive Case Management (ICM); a single building with on-site supports (CONG); TAU in Vancouver, Canada. Participants Inclusion criteria were current homelessness and mental illness. Participants were assessed as having either 'high needs' (HN; n = 297) or 'moderate needs' (MN; n = 200). MN participants were randomized to ICM (n = 100) or MN-TAU (n = 100). HN participants were randomized to ACT (n = 90), CONG (n = 107) or HN-TAU (n = 100). Interventions and comparators All HF interventions included independent housing with support services, with an emphasis on promoting client choice and harm reduction in relation to substance use. TAU included existing services and support available to homeless adults with mental illness.
Addiction (Abingdon, England), 2017
Evidence supports the effectiveness of Housing First (HF) programmes for people who are experiencing homelessness and mental illness; however, questions remain about its use in people with comorbid substance use disorders (SUD). The aim of this project was to test whether SUD modifies the effectiveness of an HF intervention. Secondary analysis of data from a randomized controlled trial of HF versus treatment-as-usual (TAU) with 24-month follow-up, comparing those with and without SUD at trial entry. Vancouver, Toronto, Winnipeg, Moncton and Montreal, Canada. A total of 2154 participants recruited from 2009 to 2013 and randomized to HF versus TAU (67% male, mean age 40.8 ± 11.2, 25% ethno-cultural minority). All were homeless and had a mental disorder at baseline; 35% reported symptoms consistent with SUD. Housing paired with Intensive Case Management or Assertive Community Treatment. Primary outcomes were days housed and community functioning. Secondary outcomes were general and hea...
British Journal of Occupational Therapy, 2017
Introduction The purpose of this study was to assess the effectiveness of a housing transition program for homeless shelter residents with chronic mental illness and substance use. Method A two-group controlled study design was used to assess the program, with 10 participants in an intervention group and 10 in a control group. Goal attainment scaling and quality of life ratings were used pre- and post-intervention to determine if a statistically significant difference existed between groups at post-intervention. Results A statistically significant difference existed between intervention and control group goal attainment scaling scores ( U = 9.50, p < .03, d = 1.34), and on quality of life scores ( U = 10.50, p < .04, d = 1.30) at post-intervention. At a 6-month follow-up, 57.14% of intervention group participants had transitioned into supportive housing, while only 25% of control group participants had transitioned. Conclusion Findings suggest that intervention participants ma...
Correlates of Protracted Homelessness in a Sample of Dually Diagnosed Psychiatric Inpatients
Journal of Substance Abuse Treatment, 1999
The authors assessed sociodemographic, drug use, and diagnostic correlates of protracted homelessness in a sample of 147 dually diagnosed patients who required admission to the hospital. When 58 patients with protracted homelessness, defined as continuous undomiciled status for over a year, were compared with 74 patients without protracted homelessness, significant differences were found with regard to diagnosis, employment status, criminality, Brief Psychiatric Rating Scale score on admission, and history of injection drug use. The results of a multiple logistic regression analysis confirmed that a history of injection drug use, current unemployment, and a diagnosis of schizophrenia were positively associated with a history of protracted homelessness. No significant relationships were obtained between protracted homelessness and demographics or chronicity of mental illness.