Permanent Supportive Housing Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness (2018) / Chapter Skim
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2 Addressing Homelessness in the United States
2 Addressing Homelessness in the United States
Pages 19-37
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From page 19... ...
While our understanding about the causes of homeless and what interventions are most effective has improved, there is still much more we need to learn about this complex issue. This chapter briefly describes what we know about who experiences homelessness, how homelessness can impact health and other outcomes, and current housing interventions and the populations these are intended to serve, including permanent supportive housing.
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From page 20... ...
. In addition, different definitions create challenges in counting individuals experiencing homelessness, tracking the use of homelessness services, and documenting unmet needs (HUD, 2008; Burt et al., 2010)
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. People experiencing chronic homelessness are one of the primary populations that permanent supportive housing (PSH)
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Major strides have been made since 2009 to move veterans from sleeping on the streets to permanent supportive housing (PSH)
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Funded by the VA's Homeless Providers Grant and Per Diem (GPD) program, the bridge housing model provides beds for those veterans who have been accepted into the Supportive Services for Veteran Families program, HUD-VASH, and programs provided by local Housing Coalitions/Continuums of Care (CoC)
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From page 24... ...
While numerous studies have documented health problems associated with the experience of either spending time in a homeless shelter, or being homeless and living on the street, the committee acknowledges that there may be additional methodological challenges in assessing the health outcomes in this population which are not described here. Individuals experiencing homelessness also face overwhelming barriers and obstacles to receiving high-quality, continuous, and coordinated health care.
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The Office of National Drug Control Policy estimates that 30 percent of the population of individuals experiencing chronic homelessness are living with a serious mental illness (SMI)
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(2011) noted that individuals experiencing homelessness have higher prevalence rates of hepatitis C (HCV)
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They found that individuals experiencing homelessness had a higher prevalence of hypertension and smoking, but there was no difference in diabetes and total cholesterol compared to the general population. Other studies have confirmed the higher prevalence of smoking among homeless populations, but have not found a higher prevalence of hypertension or a difference in diabetes and total cholesterol (Lee et al., 2005)
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Housing First clients are selected for the most disabled adults experiencing chronic homelessness. This is a selection bias in that the group with the worst possible health and psychiatric problems is not equivalent to the general population of individuals experiencing homelessness.
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A brief discussion of the financial mechanisms that might be used to support PSH is also provided. Temporary Housing Models Individuals and families experiencing temporary or situational homelessness due to job loss, economic hardship, domestic violence, or other short-term emergencies have very different housing needs from individuals experiencing chronic homelessness.
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. In this traditional model, individuals experiencing chronic homelessness and substance abuse and/or mental illness were required to be treated for their substance abuse or mental health issues prior to being eligible for permanent housing.
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Unlike previous housing programs for individuals experiencing homelessness, Pathways' Housing First model did not require efforts toward sobriety or treatment for mental illness prior to accessing housing. The fact that tenants were not required to participate in substance abuse or mental health services has remained an essential feature of PSH programs.
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6 The program also provides housing for individuals and families with other immediate problems such as domestic violence and substance abuse. Individuals experiencing chronic homelessness who are in need of PSH are not a target population for this program.
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From page 33... ...
The critical components of PSH are the provision of long-term housing and voluntary supportive services for the residents, including access to mental health care and medical services. By providing housing as described above, PSH is designed to provide individuals experiencing chronic homelessness with a place to avoid the extremes of the elements and a stable place for addressing their health needs.
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From page 34... ...
. Given the importance of housing as a social determinant of health, it is critical to find, create, and implement housing for individuals experiencing chronic homelessness.
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The HUD-Veterans Affairs Supportive Housing (HUD-VASH) program, for example, is specifically designed to help meet the needs of veterans who are chronically homeless.
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. SAMHSA SAMHSA provides funds through several grant programs for services for individuals experiencing homelessness, including the Grants for the Benefit of Homeless Individuals–Services in Supportive Housing, a competitive grant program that provides communities with funding for services relating to substance abuse, co-occurring mental health and substance abuse disorders, and other support services.
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From page 37... ...
PSH is designed to provide housing for individuals and families experiencing chronic homelessness, the unstably housed, individuals living with a longterm disability, and individuals and families who face multiple barriers to accessing and maintaining housing. PSH programs have two essential components: the provision of non-time-limited housing, and the provision of an array of voluntary supportive services.
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