Effectiveness of Housing First for Non-chronically Homeless Individuals Who Are High Utilizers of Inpatient Psychiatric Treatment

Abstract

Chronic homelessness refers to a subset of the homeless population that experiences significant, long-term patterns of housing instability and disabling conditions, such as mental illness. Individuals who are chronically homeless are particularly vulnerable to poor physical and psychological health and often over-utilize costly emergency services. Programs providing housing and support services, referred to as Housing First, have been developed to improve housing stability among people who are chronically homeless by offering permanent housing without preconditions of sobriety or psychiatric treatment compliance. Housing First is traditionally provided to individuals with a history of chronic homelessness. However, it may also be an effective community-based housing intervention for individuals with serious mental illness who have extensive histories of inpatient psychiatric treatment. Vulnerable individuals are frequently discharged from psychiatric hospitals into homelessness, placing them at greater risk of experiencing prolonged housing instability. Thus, the implementation of a Housing First intervention as hospital aftercare for homeless patients may be an indicated preventive approach to chronic homelessness for these individuals. Housing First programs have further demonstrated promise in reducing emergency service and psychiatric hospital utilization. The present study implemented a social ecological approach in evaluating the effectiveness of Housing First for preventing chronic homelessness among individuals who were high utilizers of inpatient psychiatric treatment. Ninety-one residents of a Housing First program were subgrouped based on whether they were chronically homeless upon entering housing. Administrative data were used to examine the number of days homeless and inpatient psychiatric treatment during the year prior to housing and the year after housing for Housing First residents compared to a matched control group of 91 participants receiving usual care. Finally, new data collection with 33 Housing First residents was carried out to explore whether physical, social, and interpersonal aspects of the housing environment were perceived differently by chronically homeless versus non-chronically homeless residents. Results revealed that those living in Housing First spent significantly fewer days homeless and in inpatient psychiatric treatment one year after housing compared to those receiving usual care. Homelessness and hospitalization outcomes were not influenced by homelessness history. Overall, 90.1% of Housing First residents did not return to homelessness one year after housing, and chronic homelessness status did not predict the rate at which individuals left the housing program. Finally, perceptions of the housing environment did not differ among chronically and non-chronically homeless residents. Findings from this study suggest that Housing First is effective for individuals with varying homelessness histories. Individuals who were not chronically homeless were successfully housed for one year, suggesting Housing First may be an appropriate indicated chronic homelessness prevention intervention. These findings have important policy implications and provide evidence for broadening the Housing First model to new populations

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