Health effects of housing improvement: systematic review of intervention studies

OBJECTIVE: To review the evidence on the effects of interventions to improve housing on health. DESIGN: Systematic review of experimental and non-experimental housing intervention studies that measured quantitative health outcomes. DATA SOURCES: Studies dating from 1887, in any language or format, identified from clinical, social science, and grey literature databases, personal collections, expert consultation, and reference lists. MAIN OUTCOME MEASURES: Socioeconomic change and health, illness, and social measures. RESULTS: 18 completed primary intervention studies were identified. 11 studies were prospective, of which six had control groups. Three of the seven retrospective studies used a control group. The interventions included rehousing, refurbishment, and energy efficiency measures. Many studies showed health gains after the intervention, but the small study populations and lack of controlling for confounders limit the generalisability of these findings. CONCLUSIONS: The lack of evidence linking housing and health may be attributable to pragmatic difficulties with housing studies as well as the political climate in the United Kingdom. A holistic approach is needed that recognises the multifactorial and complex nature of poor housing and deprivation. Large scale studies that investigate the wider social context of housing interventions are required. [References: 42

Predictors of Homeless Services Re-Entry within a Sample of Adults Receiving Homeless Prevention and Rapid Re-Housing Program (HPRP) Assistance

Local and national evaluations of the federal Homelessness Prevention and Rapid Re-Housing Program (HPRP) have demonstrated a high rate of placement of program participants in permanent housing. However, there is a paucity of research on the long-term outcomes of HPRP, and research on rehousing and prevention interventions for single adults experiencing homelessness is particularly limited. Using Homeless Management Information System data from 2009 to 2015, this study examined risk of return to homeless services among 370 permanently housed and 71 nonpermanently housed single adult HPRP participants in Indianapolis, Indiana. Kaplan-Meier survival curves were conducted to analyze time-to-service re-entry for the full sample, and the homelessness prevention and rapid rehousing participants separately. With an average follow-up of 4.5 years after HPRP exit, 9.5% of the permanently housed HPRP participants and 16.9% of those nonpermanently housed returned to homeless services. By assistance type, 5.4% of permanently housed and 15.8% of nonpermanently housed homelessness prevention recipients re-entered services, and 12.8% of permanently housed and 18.2% of nonpermanently housed rapid rehousing recipients re-entered during the follow-up period. Overall, veterans, individuals receiving rapid rehousing services, and those whose income did not increase during HPRP had significantly greater risk of returning to homeless services. Veterans were at significantly greater risk of re-entry when prevention and rehousing were examined separately. Findings suggest a need for future controlled studies of prevention and rehousing interventions for single adults, aiming to identify unique service needs among veterans and those currently experiencing homelessness in need of rehousing to inform program refinement

Homelessness and Public Health in Los Angeles

Los Angeles faces a housing crisis of unprecedented scale. After years of underinvestment, in 2016/2017 LA County voters approved Measures H and HHH, which provided an infusion of resources for homeless services, permanent housing, and integrated outreach through the LA County Homeless Initiative (HI). An estimated 58,936 individuals in LA County remain homeless as of January 2019, 75% of them unsheltered and living on streets, in tents, or encampments. Our best estimates suggest that the homeless population has grown since 2017.HI takes a Housing First approach to homelessness, with the largest amount of total funds allocated to housing solutions. However, rehousing is often subject to delays in construction and case management. These delays, combined with persistent market forces driving new homelessness, have left the county well short of its targets. While no forecasts were issued, the initial gap analysis for HI had assumed a 34% reduction in the total homeless count from 2016 to 2019. The count has in fact increased by 26% over that period, meaning 28,000 more homeless clients than anticipated on any night. Whereas cities with comparable homeless crises such as New York have focused on increasing the availability of emergency shelters and safe havens in addition to permanent housing, LA County’s relatively low investment in transitional options has resulted in persistent levels of unsheltered homelessness.Research has shown that homelessness has severe health consequences. Homeless individuals have a high risk of mortality, with a recent LA County Medical Examiner report finding an average age of death of 48 for women and 51 for men. Homeless individuals have much higher risks of mental illness, substance abuse, infectious disease, chronic illness, violence, and reproductive health risks than the general population. Much less is known about the health burdens associated with being unsheltered, but most evidence points to substantially greater health risks given the more intense exposures to violence, weather, pollution, poor sanitation, and behavioral risk. Research is just beginning to quantify the burdens of living on the streets.Our analysis of the LA County homelessness response drew on expert interviews, data analysis, and document review. Beyond the growing numerical gap between HI’s targets and actual trends, we identified five critical service gaps that require immediate attention: Taking a person-centered approach that recognizes both the diversity of client needs and the limitations of existing resources, yet honors the principle that everyone deserves housing; Improving access to emergency shelters by reducing legal and political barriers to construction and adopting “low barrier shelters” that facilitate entry; Delivering comprehensive street medicine and other services to unsheltered homeless populations using evidence-based models that support the path to housing and recovery Adopting more extensive outreach models that engage citizens, empower homeless clients and leverage mobile technology so that case workers can focus on clients most in need; Strengthening data collection and research methods to understand the consequences of unsheltered homelessness, pilot new service models, and evaluate rehousing efforts

Racial Disparities and Homelessness in Western New York

The Homeless Alliance of Western New York analyzed racial disparities among homelessness within Western New York and examined the homeless system’s equity serving different racial/ethnic groups in terms of receiving those services, prioritizing those services, and housing success rate. The ideal model for an unbiased homeless system would distribute assistance such that it is received in equal percentages across racial/ethnic groups as the percent of that racial group experiencing homelessness. One of the consequences of systemic racism is an overrepresentation of people of color among those who experience homelessness. Black people make up 11% of the general population of Western New York but they account for 25% of the people in poverty and 47% of the homeless population. When the number of people who experience homelessness are compared against the number of people who are in poverty, Black people living in poverty are 3 times more likely to experience homelessness compared to White people. These suggest that poverty rates alone do not explain the over-representation, but that systemic racism blunts the ability of people of color to recover from financial catastrophe to avoid homelessness relative to those who are White

Shall We Dance?

Hello readers! The summer at Special collections is flying by and next week will already be my last week here as the Diane Werley Smith intern ’73. Though the weeks are winding down, we still are busy as bees here in Special Collections. As I said in my last post, I finally finished the rehousing of the Dance Card collection, and the next step taken my Alexa and myself was to start scanning and digitizing the cards for a digital collection. We chose to digitize 56 from around 80 dance cards to serve as highlights of the collection, for their aesthetics and unique charm. From that point we went through the tedious task of scanning each card, some just the front and cover, others multiple pages. After that we learned from Catherine how to create metadata for each card and to upload them into a digital collection. [excerpt

Partnering with Public Schools to End Family Homelessness in San Francisco

Hamilton Family Center (HFC) is a nonprofit organization with the mission of ending family homelessness in the San Francisco Bay Area. As part of their initiative to end family homelessness in San Francisco by 2019, HFC partnered with the San Francisco Unified School District (SFUSD) to more effectively assist families of public school students who are experiencing homelessness or housing instability. Google.org provided a $1 million grant to help launch this partnership and serve 100 homeless or at-risk SFUSD families from November 1, 2014 – October 31, 2016.During the first year of the pilot program (Nov. 2014 – Oct. 2015), 51 families received direct services through this partnership. Twenty-two homeless families were placed into permanent housing and 29 at-risk families were able to avoid eviction and probable homelessness. An additional 14 families were seeking housing as of October 31, 2015 and 86 were referred to other services (HFC data). The most significant finding to date is that the 22 families placed into permanent housing were homeless for an average of 8.2 months less than families served outside of this pilot project. Although this is a small sample size, the results from the first year of this pilot project indicate it has great potential to reduce the length of time a family is homeless.The partnership between HFC and the SFUSD is part of a larger effort to end family homelessness in San Francisco that began in late 2014. The result of this initiative has been a reduction in the average waitlist for family shelter by nearly 40% since the spring of 2013 (Connecting Point data). In addition, the number of homeless students decreased by 255 within one school year (SFUSD data). As a result of these successes, the City and County of San Francisco is providing additional public funding to expand the partnership between service providers and the school district.The purpose of this report is to provide information to other communities on the benefit of building similar partnerships to address family homelessness. It provides information based on experiences in San Francisco and highlights the need for further research and improvements to service delivery systems

Boomerang Homeless Families: Aggressive Rehousing Policies in New York City

The opinion brief suggests that the aggressive rehousing policies for New York City's homeless families during the Bloomberg Administration do not work for all homeless families and therefore have destabilized the shelter system by pushing an increasing percentage of families through a revolving door and back into shelter -- at great cost to the City

Homeless population

The aim was to derive and analyze a model for numbers of homeless and non-homeless people in a borough, in particular to see how these figures might be affected by different policies regarding housing various categories of people. Most attention was focused on steady populations although the stability of these and possible timescales of dynamic problems were also discussed. The main outcome of this brief study is the identification of the key role played by the constant k_1 - the constant which fixes the speed at which the homeless are rehoused in permanent council property. Reducing this constant, i.e. making the system "fairer" with less priority to accommodating homeless families, appears to have little effect on the sizes of other categories on the waiting list but there is a marked increase in the number of households in temporary accommodation. The model, indicated by the size of its longest time-scale, should be modified to allow for births etc. It could be varied by allowing people to remove themselves from the register or by allowing the rates at which registered and unregistered people become homeless to differ, but these modifications are unlikely to substantially change the main result. The inclusion of movement from the homeless to the general population would have the effect of limiting the numbers in temporary accommodation. However, it is thought this effect is very small so a great reduction in k_1 would be needed for this flow to become significant