Benefits of Supported Housing for People with Psychiatric Disabilities

1. Benefits of Supported Housing for People with Psychiatric Disabilities Conclusions based on a systematic review of published research studies 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)

2. Learning Objective: Increased Understanding About…. • Characteristics and principles of supported housing • Factors that contribute to positive supported housing outcomes • Positive outcomes for people with psychiatric disabilities who receive supported housing services

3. Learning Activities • Review of Trainee Supported Housing Knowledge and Experiences • Presentation & Exercise: Supported Housing Principles • Presentation and Exercise: Factors that Positively Effect Supported Housing Outcomes • Presentation and Exercise: Supported Housing Benefits to the Individual

4. Review of Supported Housing Knowledge and Experiences • Successes and Challenges • Experiences with Supported Housing • Characteristics of Supported Housing

5. Supported Housing Principles

6. Supported Housing Principles • Housing is permanent. • Individuals either own their homes or have a lease in their own name. • Permanence has the same meaning as it does for anyone else renting a house or apartment in the community. Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.

7. Supported Housing Principles • Housing is distinct and separate from other services. • Housing and service agencies are legally and functionally separate. Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.

8. Supported Housing Principles • Housing is integrated into the community. • Apartments or houses are located among other houses and apartments that one would find in the community. Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.

9. Supported Housing Principles • Housing is affordable. • No more than 40% of the individuals adjusted gross income is required for rent or mortgage payments. Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.

10. Supported Housing Principles • Mental health services are offered, not mandated. • The individual does not have to avail her/himself of any services, including medication, in order to participate in the program. • Services are flexible, individualized, and voluntary that come and go depending on the individual’s needs and preferences. Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.

11. Supported Housing Principles • The individual chooses the housing and mental health services. • Individuals are offered options about where s/he wants to live and from whom s/he wants services, if any. • Although the person’s ideal choice can’t be guaranteed, the place that s/he lives in must be based on whether s/he chooses to live there or not. Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.

12. Supported Housing Principles • Services are community based. • There are no live in staff. Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.

13. Supported Housing Principles • Crises services are available. • Crises services are available 24 hours per day, 7 days a week. Rog, Debra J., (2004). The Evidence of Supported Housing. Psychiatric Rehabilitation Journal, 27 (4), 334-343.

14. Factors that Positively Impact Supported Housing Outcomes

15. Factors that Appear to Positively Impact Supported Housing Outcomes • Choice of housing • Having more than one housing option increases the individual’s desire to stay and leads to a better functional match between the person and the housing. (Srebnik et al, 1995) • Greater information about housing options during the process of choosing housing is related to desire to stay in residence.(Srebnik et al, 1995) 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)

16. Factors that Appear to Positively Impact Supported Housing Outcomes • Rapid entry into housing • Facilitating entry into housing quickly increases the likelihood that the individual will stick with services and achieve independent housing. (Mares, Kasprow, & Rosenheck, 2004) 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)

17. Factors that Appear to Positively Impact Supported Housing Outcomes • Housing subsidies and vouchers • When housing is affordable, there is a more direct and quicker exit from homelessness and stable independent living is more likely. (Hurlburt, et al., 1996) • Subsidies and vouchers enable individuals access to higher quality housing, which positively impacts keeping people housed and satisfied with their housing. (Hurlburt, et al., 1996) 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)

18. Factors that Appear to Positively Impact Supported Housing Outcomes • Intensive services • Regular case management is no better than services as usual – intensive services are needed. (Rosenheck, et al., 2003) • ACT case management leads to greater satisfaction, greater contact with service providers, reduced symptoms, and greater stability in the community. (Morse, et al., 1997; Fletcher, et al., 2008) • Individuals receiving intensive case management are less likely to terminate services, which can lead to better housing outcomes. (Clark & Rick, 2003) 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)

19. Factors that Appear to Positively Impact Supported Housing Outcomes • Integrated services • A nine site, four year study found that agencies with improved inter-organization integration of services had greater improvement in housing status outcomes than those that did not.. (Rosenheck, 2002) 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)

20. Factors that Appear to Positively Impact Supported Housing Outcomes • Practical services • Help with day to day tasks, e.g., house keeping, shopping, budgeting, is needed to increase housing stability. 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)

21. Supported Housing Benefits for the Individual

22. Supported Housing Benefits to the Individual • Residential status can be significantly improved. • Living situations for individuals who are psychiatrically disabled, with a psychiatric disability and homeless (or at risk of becoming homeless) and with substance abuse problems can be significantly improved. (Tsemberis, et al., 2004; Gulcur, et al., 2003; Shern et al., 1997; Rosenheck, et al., 2003; Goldfinger, et al., 1999; Morse, et al., 2006) • Experimental studies have found that the proportion of individuals who were housed in a community setting (not the streets, a shelter, or an institution) was higher by an average of 15% than those in control groups. (Tsemberis, et al., 2004; Gulcur, et al., 2003; Shern et al., 1997; Rosenheck, et al., 2003; Goldfinger, et al., 1999; Morse, et al., 2006). • Studies have shown significantly faster decreases in homelessness for individuals participating in supported housing. (Tsemberis, et al., 2004) 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)

23. Supported Housing Benefits to the Individual • Housing stability can be improved to rates of 80% or more. (Goldfinger, et al., 1999) • Individuals in supported housing tend to have significantly fewer moves and thus less disruption in their lives. • More than one controlled study measuring the % of time individuals remained housed during follow-up attained the 80% rate. • Follow-up periods ranged from 90 days to over 1 year , in one case, 5 years. 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)

24. Supported Housing Benefits to the Individual • Quality of life can be increased. (O’Connell, et al., 2008) • Living in a place of preference is correlated with the individual’s rating of quality of life. (Nelson, et al., 1998) • Individuals with psychiatric disabilities report wanting independent housing, in non-congregate settings by a wide margin. (Middelboe, et al., 1998) • Clinicians are more likely to recommend settings with higher levels of supervision than individual’s prefer, e.g., group homes versus independent housing. (Goldfinger & Schutt, 1996) 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)

25. Supported Housing Benefits to the Individual • Psychiatric hospitalizations are less likely. • Several studies show a reduction of hospitalization while individuals were housed even though clinical outcomes are more difficult to affect than housing outcomes. (Lipton, et al., 1988; Culhane et al., 2002) 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)

26. Other Conclusions • Provision of supported housing services may reduce other service-related costs. (Culhane, et al., 2002) • Supported housing approaches may be more expensive than other residential service delivery, but the cost offsets may make the cost benefit equation more palatable when compared to other options. (Culhane, et al., 2002) • Substance abuse, unsuccessful housing history, and criminal arrests are associated with poorer housing outcomes. (Hurlbert, et al, 1996; Kenny, et al., 2004) 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)

27. Other Conclusions • It is unclear whether substance abuse and psychiatric symptoms are positively effected by successful supported housing outcomes. (O’Connell, 2008) • Some studies suggest that psychiatric diagnosis is not a factor in residential stability and some suggest that it is(Rosenheck, et al., 2003, Hurlbert, et al., 1996). 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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