Books, Articles and Research
Community-Partnered Cluster-Randomized Comparative Effectiveness Trial of Community Engagement and Planning or Resources for Services to Address Depression Disparities
This study sought to bridge a gap in understanding of outcomes of quality improvement (QI) healthcare programs across diverse health and human services sectors. QI programs in health care involve "systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups" (Health Resources and Services Administration, 2011, http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement). Specifically, this study compared the effectiveness of two programs, Community Engagement and Planning (CEP) and Resources for Services, in supporting implementation of depression QI programs to improve clients' quality of life as it pertains to their mental health and increase their use of services. They found that the CEP programs were more effective in increasing mental health and well-being, physical activity, and use of services while decreasing homelessness risk factors, behavioral health hospitalization rates, and medication visits. These findings support the importance of community engagement for underserved populations in efforts to decrease health disparities.
Social Inclusion of People With Severe Mental Illness Living in Community Housing Programs
As part of a large-scale cross-sectional study seeking to assess institutes for residential care in the Netherlands, this study sought to determine if individuals living in supported independent living versus those in residential care experienced any differences in social inclusion on a variety of measures. Researchers found that while individuals in supported independent living situations were more likely to participate in activities and to have visitors, there was no difference in vocational participation between the groups. Based on these findings, they concluded that it is important that vocational programs be made available for individuals in both types of housing settings. This study's findings also highlight the success of mental health policies often supported across Western Europe that aim to rehabilitate individuals in community-based facilities and support them in being active participants in their communities.
What is needed to deliver collaborative care to address comorbidity more effectively for adults with a severe mental illness?
This paper examines collaborative care services for people with severe mental disorders that have worked to address comorbidity and the relationship of mental disorders to homelessness, substance use disorders, unemployment, and other health issues in Australia. Researchers identified many key program components that help make integration of care most effective: shared treatment plans and client records, promotion of a "housing first approach," education for staff about comorbidity, and cross-sector collaboration among agencies when serving shared clients. Cross-sector collaboration is described as a real benefit for consumers and staff and as an effective strategy to move Australia toward having more holistic, socially inclusive mental health care.
Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems
This study examined whether housing individuals experiencing both chronic homelessness and alcoholism using a Housing First approach would result in a reduction in the use and costs of health care. The Housing First model separates housing from clinical issues by addressing homelessness first, providing individuals with permanent housing without prerequisites for treatment and sobriety, and then supporting them in addressing clinical or other issues. Researchers found that the Housing First intervention not only resulted in significant cost savings per person each month but also helped people remain in housing longer and helped them reduce their alcohol consumption.
Project-based Housing First for chronically homeless individuals with alcohol problems: Within-subjects analyses of 2-year alcohol trajectories
This study examined a Housing First nonabstinence-based program for chronically homeless individuals and its impact on residents' alcohol use. Researchers found a significant decrease in alcohol use and alcohol-related problems over the course of their 2-year study. They attributed this decrease not only to less difficult rules for residents to follow but also to support and encouragement shared between and among program residents.
A permanent home that allows drinking helps homeless drink less
This article discusses the successful approach of one supportive housing program for people who have experienced long-term homelessness. The program allows residents to continue to drink alcohol while working towards their recovery from alcoholism. The author identified several factors which contributed to the program's success, including easier rules to follow, support from fellow residents and staff, and an overall attitude that does not look down on residents for drinking but rather invites them to be more open about it.
Housing for people with mental illness: Update of a report to the President's New Freedom Commission
This article summarizes many of the issues associated with the high rates of homelessness for individuals with mental disorders, all of which were reviewed by the Subcommittee on Housing and Homelessness of the President's New Freedom Commission. The article examines key subcommittee recommendations, as well as other topics related to preventing and responding to the issue of homelessness among people with mental disorders.
Homelessness, poverty and social exclusion in the United States and Europe
This paper examines high rates of homelessness across different nations in the context of various forms of social exclusion: income, wealth, housing, and incarceration. The author goes on to explain the impact that discrimination and societal choices have on homelessness across societies and identifies racial minorities and individuals with mental disorders as having the highest rates of homelessness everywhere.
Policy Responses to Social Exclusion: Towards Inclusion?
This article defines social exclusion and addresses various aspects of life related to the concept including the labor market, education, health, housing, and access to services. This publication goes on to describe policy responses to social exclusion and identifies themes and issues influencing policy initiatives. The ways in which past policy interventions have created or contributed to current issues are discussed as well as recommendations for developing effective policies to reduce exclusionary practices and evaluate these efforts.
Building the capacity of the homeless service workforce
This article discusses the importance of addressing the professional development needs of homeless service providers to strengthen this workforce and thereby facilitate improvement in the delivery of services to individuals who are homeless. Challenges of work in homeless services such as low wage environments and the need to confront negative public attitudes are discussed. Researchers also describe the role of developing supportive organizations, providing competency-based training, and encouraging collaboration among Federal agencies in enhancing and developing careers in homeless services.
Successfully exiting homelessness: Experiences of formerly homeless mentally ill individuals
This study sought to identify and describe the processes of change which contribute to homeless individuals obtaining and maintaining stable housing. The researchers examined the impact of a number of factors including employment difficulties, behavioral health problems, and relationships with family, friends, and service providers. A key finding was that relationships with family, friends and service providers were central to achieving stable housing.
Ending chronic homelessness: Cost-effective opportunities for interagency collaboration
This article explores the opportunity for Federal policies and programs to change the approach to assisting people who are homeless. It discusses both cost savings that could be realized and improved outcomes in maintaining housing stability, outcomes that would benefit both individuals and the community. It suggests new ideas and approaches to directing policies and practices as a means of enhancing the current approach to addressing homelessness.
Long-term care fundamentals No. 5: Implementing Olmstead in California
This brief provides background information on the 1999 U.S. Supreme Court Olmstead decision which found that the unnecessary institutionalization of people with disabilities is a violation of the Americans with Disabilities Act of 1990. Implications of this decision are discussed, as well as States' efforts toward expanding home- and community-based options for individuals with disabilities including a detailed discussion of efforts undertaken within the State of California.
Joint Statement of the Department of Housing and Urban Development and the Department of Justice: Reasonable accommodations under the Fair Housing Act
This statement outlines the responsibilities of the Department of Justice (DOJ) and the Department of Housing and Urban Development (HUD) in enforcing the federal Fair Housing Act, which prohibits housing discrimination based on race, color, religion, sex, national origin, familial status, and disability. It describes some of the common complaints that HUD and DOJ respond to regarding the Fair Housing Act as well as common questions and answers regarding the rights and duties of people with disabilities and housing providers under the Act relating to reasonable accommodations.
Peer-run supportive housing for families
This article describes the approach of Housing Options Made Easy, (HOME) Inc., a consumer-run supportive housing program. The article discusses the service approach HOME's peer providers use to support residents in achieving personal recovery and the positive outcomes experienced by residents including fewer and shorter hospital stays and reduced use of crisis services. The article also discusses system-level benefits realized through this program including cost savings, a reduction in negative attitudes, and improved overall effectiveness of the area's mental health delivery system.
Report from Barcelona: Fostering social inclusion to end homelessness
This article discusses ways in which Barcelona, Spain has responded to the millions of people in the city who have been strongly impacted by the global economic recession. It describes the increased staffing of homeless assistance programs in Barcelona since the recession and the increase in the availability of emergency housing in the city. This article also describes how the city government, charities, and non-governmental organizations have banded together to launch a social inclusion initiative to address the needs of citizens.
Recovery and homelessness services: New directions for the field
This article examines recovery and recovery-oriented care. The authors suggest recommendations for integrating recovery-oriented care into the homeless assistance network while considering how widespread certain behavioral health problems---including substance abuse, mental health problems, and traumatic disorders---are among chronically homeless individuals.
Social Inclusion for the United States
This paper describes ways the concept of social inclusion is used throughout the United Kingdom and how it could be used within the United States. The paper highlights ways in which social inclusion has become a framework for addressing many social policy issues within the UK and the many dimensions of social inclusion including health, education, housing, skills, advancement, and opportunity.
Recognizing work as a priority in preventing or ending homelessness
This report highlights the role of employment in the lives of homeless individuals. It asserts that, in addition to traditional approaches to assisting homeless clients with resources such as affordable housing and other supportive services, employment should also be a primary focus. Researchers suggest that programs that make work a priority have the potential to help instill higher levels of motivation and hope in homeless individuals who are striving to better their lives and that these programs offer an important tool in preventing and ending homelessness. The paper describes principles, practices, and strategies to use to make employment more central to programs for homeless people.
Shelter from the storm: Trauma-informed care in homelessness services settings
As the field of homeless services has advanced, providers have increasingly realized the importance of addressing long-term healing for people who have experienced homelessness, many of whom are trauma survivors. Trauma-Informed Care (TIC) provides a framework that can be used to support trauma survivors in homeless service settings and represents a promising area for increasingly effective and sensitive service approaches for highly vulnerable people. This paper explores the evidence for TIC within homelessness service settings and examines implications for providers, programming, policy, and research.
Homeless services in the U.S.: Looking back, looking forward: An open letter to policymakers, advocates, and providers
In this editorial, the author suggests strategies for developing inclusive, comprehensive approaches to ending homelessness. She emphasizes the importance of incorporating new research findings and program models as well as linking multiple systems of care to effectively meet the needs of individuals who have experienced homelessness.
Preventing homelessness: A consumer perspective
This article written by a consumer who was homeless and who is now the executive director of a supportive housing program describes the isolation, feelings of hopelessness, lack of mental health support, and violence that many homeless individuals face. The author emphasizes that the goal of all homelessness prevention efforts should be safe, stable, affordable housing in mainstream settings with high-quality services. He discusses various homelessness prevention resources and approaches and highlights the importance of involving consumers who have experienced being homeless in homelessness prevention planning and program development. He encourages consumers to work with programs to help develop a relevant foundation where consumers' autonomy is promoted and where people are challenged to reach their potential.
Community integration of adults with psychiatric disabilities and histories of homelessness
"This article describes a study in which researchers evaluated components of community integration among adults with behavioral health problems. Half of the adults in the study were assigned to independent apartments in a Housing First approach, and half to a control group. The researchers found that providing consumers with housing choice positively impacted their psychological well-being and that providing them with independent scatter-site housing had a positive impact on their social integration. They recommended additional research to explore community integration from the perspective of consumers themselves."
Housing first services to people who are homeless with co-occurring and mental illness and substance abuse
This article details a study in which researchers contrasted outcomes for two groups of adults with co-occuring mental and substance use disorders who had been homeless. One group was in a Housing First program, the other in standard care. Housing First provides consumers with permanent, independent housing without requiring them beforehand to attain sobriety and enter treatment. Standard care requires participants to enter treatment before being placed in housing. After 48 months, researchers found no statistically significant differences in alcohol and drug use between the groups.
Housing First for long-term shelter dwellers with psychiatric disabilities in a suburban county: A four-year study of housing access and retention
This article describes a study in which behavioral health consumers with long histories of shelter use were assigned to a Housing First program or a control group. Housing First provides consumers with permanent, independent housing without being required beforehand to attain sobriety and enter into treatment. In the study, outcomes over four years were better for the group in the Housing First program.
The Importance of Community Development For Health and Well-Being
This report examines the key role that environmental and community forces play in promoting health and preventing disease. In addition, the authors assert that social and public works programs will be more successful if people living in impacted neighborhoods are afforded the opportunity to participate in the creation and management of the initiatives that affect them.
Fair society, healthy lives: Strategic review of health inequalities in England post 2010
This paper describes British issues in health equity, social determinants of health, and UK-style societal interventions in both mental health and overall health with mental health playing a critical role.
Mental health, resilience and inequalities
This report explores the evidence that mental health influences a very wide range of outcomes for individuals and communities. These include healthier lifestyles, better physical health, improved recovery from illness, fewer limitations in daily living, and other factors.
Solutions to discrimination in work and housing identified by people with mental illness
This study examines perceived solutions to discrimination in housing and employment situations.
"It's important to be proud of the place you live in": Housing problems and preferences of psychiatric survivors.
This paper reports findings from a series of focus group meetings held with survivors of mental illness to address issues concerning housing preferences and housing needs.