Supportive Housing as a Foundation for Recovery: Homelessness, Co-Occurring Disorders, and Housing Laura Gillis, RN, MS

1. Supportive Housing as a Foundation for Recovery: Homelessness, Co-Occurring Disorders, and Housing Laura Gillis, RN, MS HRC Project Director

2. HRC: Homelessness Resource Center • Seeks to improve the daily lives of people affected by homelessness and who have mental health and substance use disorders and trauma histories.  We seek to achieve this mission by:  • Increasing awareness, knowledge of resources, and capacity to help people experiencing homelessness • Integrating and transforming homelessness service systems • Supporting the implementation of the 10-Year Plans to end homelessness • Supporting the Projects for Assistance in Transition from Homelessness (PATH) • Facilitating communication and collaboration among providers, researchers, policy makers, and consumers

3. HRC: Homelessness Resource Center • Our work includes: • Training and technical assistance • Publications • On-line learning opportunities • Networking • www.homeless.samhsa.gov

4. HRC: Homelessness Resource Center • Funded by the Substance Abuse and Mental Health Services Administration • Operated by the Institute on Homelessness and Trauma • Organization of clinicians, social scientists, policy analysts, consumers and educators dedicated to using knowledge to improve the lives of vulnerable populations.  • Our mission is to bring theory onto the streets by applying knowledge of best practices to real world settings.

5. Poems, Pictures, and Other Great Stuff. (1996). Salem-Keizer Public Schools. Salem, Oregon.

6. Family Permanent Supportive Housing • Reviewed characteristics of 13 FPSH programs - quantitative and qualitative data • Profiles of program participants • Progress over time on three outcomes • Housing stability • Family reunification • Self support Corporation for Supportive Housing (2006). Family Permanent Supportive Housing: preliminary research on family characteristics, program models, and outcomes.

7. Family Permanent Supportive Housing: Findings • Characteristics of families varied substantially when compared to families in emergency shelters and transitional housing • Mothers are older, better educated, have a longer and more complex history of homelessness, and may have “special needs” such as mental health and substance use issues • Subgroup of homeless families with more intense needs – characteristics of chronically homeless

8. Family Permanent Supportive Housing: Findings • Programs had many similarities but some significant differences • All offered case management services • Majority offered on-site service options • Services were not family focused • Intensity of services was limited, e.g. one service contact per week

9. Family Permanent Supportive Housing: Findings • Differences in outcomes appear to be related to the control the programs exerted over residents and participants’ difficulties engaging in critical services. • High demand programs more successful at family reunification and increasing employment rates and income • Low demand programs more successful in retaining families in housing

10. Family Permanent Supportive Housing: Findings • The relationship between a client and staff member can become the decisive factor in re-setting the direction of a client’s life. • Provides the leverage necessary to empower clients to access services • May eliminate necessity of creating stringent rules for program participation • Trusting relationships take time • Developing a sustaining relationship rarely occurs in a linear fashion

11. Family Permanent Supportive Housing: Recommendations • Focus on active outreach and engagement • Gather information about exposure to traumatic stress and add trauma informed services to all programs. • Reconsider the brokered model of case management • Account for the needs of the children and their impact on the family.

12. Family Permanent Supportive Housing: Recommendations • Further research should focus on • examining the key ingredients and processes by which FPSH helps (or fails to help) families achieve residential stability, self-sufficiency, and family reunification, • developing a typology of the homeless families population (including homeless children) to better understand differential housing and service needs • determining which families do best in which FPSH programs and then comparing the outcomes of FPSH to other housing models

13. Limitations of Study • Available data were collected by three distinct research efforts • one of which includes five separate studies • one a single study of seven different programs • one a single study of which the family programs were only one part. • each data set has a unique study design employing different data collection and sampling strategies that limit the ability to compare data across programs and to draw conclusions from these comparisons.