Supported Housing:
Research and Best Practices
Joseph A. Rogers, Executive Director
National Mental Health Consumers’
Self-Help Clearinghouse
1211 Chestnut Street, 11th Floor, Philadelphia, PA 19107
800-553-4539, ext. 273, jrogers@mhasp.org
Alternatives 2009, Omaha, Nebraska
Oct. 28-Nov. 1, 2009
What Is Supported Housing?

Helps individuals with
mental health challenges
get and keep independent
housing that is integrated
into the community.

Individuals have choice
and control over their
services and supports.

Long-term housing, but
supports may change over
time, as needed.
2
Boston University
Research Review
Summarizes data
on the
effectiveness of,
and predictors
of success in,
this evidencebased practice.
Boston University
3
Some Models of Supported Housing
As Described in the Research (Slides 5-7)
Compiled by the Supported Housing Study Group at Boston University
Center for Psychiatric Rehabilitation. Innovative Knowledge
Dissemination & Utilization
Project for Disability & Professional Stakeholder Organizations/ NIDRR
Grant # (H133A050006)
4
Model 1:
Supported Housing Program
Helps individuals
acquire and maintain
housing of their
choice
 Adjusts the intensity
and types of support
and training they
need/want.
 In this case, the
housing is the
intervention.

5
Model 2:
Case Management Program
Helps individuals maintain
their own housing and
acquire subsidies.
 Provides individuals with:
 support
 skills training
 May be:
 brokered model, or
 more intensive case
management.

6
Model 3: ACT Program



Assertive Community
Treatment
A mobile treatment and
rehabilitation team that
supports individuals in
their own:
 Housing
 Employment
 Social environments
Generally more intensive
services.
7
“Housing First” Is a Model Program

“The treatment for homelessness is
housing. . . . It’s that simple.”
--Dr. Sam Tsemberis of Housing
First (supported housing that offers
apartments to homeless people
who have mental illnesses and who
may have substance abuse
problems, without requiring the
individuals to first become clean
and sober)
http://www.cbsnews.com/stories/2
007/11/23/eveningnews/main3534
623.shtml
8
Housing First Group Develops
Peer-run Program





$2 million SAMHSA “Services in Supportive
Housing” grant
Will integrate peer-run Illness Management and
Recovery (IMR) into Assertive Community
Treatment (ACT)
IMR consists of:
 education
 skills training
 cognitive therapy
Will serve 570 NYC consumers who are
chronically homeless.
Will test innovation of having IMR delivered by
trained peer specialists.
9
Civil disobedience outside Philadelphia Public Housing
Authority to protest proposed discriminatory policies (1985)
10
Philadelphia advocates rally for supported housing, 1/15/08
11
More Housing Advocacy



“Sleep-out” at State Office
Building in Philadelphia (1987)
resulted in more than $4 million
for housing for homeless people
with mental illnesses.
Civil disobedience at Federal
Office Building in Philadelphia
(1988) focused media attention
on plight of people who are
homeless.
“Free 1515” campaign led to
Philadelphia approval of
residence for homeless people
with mental illnesses despite
NIMBY neighbors.
1515 Fairmount
12
Supported Housing: Benefits

Gives individuals more
control over the
supports and services

Improves their
satisfaction with living
arrangements

Supports can decrease,
increase or change
according to the needs
and wishes of the
individual
13
Supported Housing: Benefits
(cont’d)

Eliminates
multiple moves,
provides
stability

Can reduce
hospitalizations
and improve the
quality of life.
14
Challenges
Obtaining subsidized
housing is very challenging
when the demand is so
great.
 Typically there are long
waiting lists.
 Need to address the
isolation and loneliness
reported in several studies.
 Better cost-benefit studies
are needed.

15
Research Review by Boston University
Center for Psychiatric Rehabilitation
(and Panel of Experts)



Rationale for the Review:
The field of rehabilitation needed the
information on supported housing research,
even though many studies to date have not
used randomized trials.
Reviewed and Rated: 15 years of research
including studies in which housing was an
intervention, those where housing was the
outcome and those where housing was both.
Compiled by the Supported Housing Study Group at Boston University
Center for Psychiatric Rehabilitation. Innovative Knowledge
Dissemination & Utilization Project for Disability & Professional
Stakeholder Organizations/ NIDRR
Grant # (H133A050006)
16
Research Finding 1.
Supported Housing can:
1.
2.
3.
improve housing status
lead to residential stability
increase quality of life of
residents who have
psychiatric disabilities, are
homeless, at risk of
homelessness and/or may
be substance abusing.
Research on Slides 17-32 compiled by the Supported Housing
Study Group at Boston University Center for Psychiatric
Rehabilitation. Innovative Knowledge Dissemination &
Utilization Project for Disability & Professional Stakeholder
Organizations/ NIDRR Grant # (H133A050006)
17
Research Finding 2.
Individuals
frequently prefer
independent
housing rather
than
group/congregate
living.
18
Research Finding 3.
Higher-quality housing (in terms of the physical
features of the housing) may lead to better
outcomes.
19
Research Finding 4.
When housing is
affordable,
there is a
more direct
and quicker
exit from
homelessness,
and stable
independent
living is more
likely.
20
Research Finding 5.
Housing stability
rates have
been found to
be 63% - 81%.
21
Research Finding 6.
Housing subsidies and affordable
housing lead to greater success in
getting and keeping housing.
22
Research Finding 7.
Supported housing
costs tend to be
greater than
group living costs
in the short term
but may result in
savings in other
services over
time, such as
treatment and
acute care.
23
Research Finding 8.
At least one study
demonstrated
significant reductions
in a wide array of
services when
individuals who were
homeless are placed
into supportive
housing.
24
Research Finding 9.
Traditional case
management is less
effective in producing
stable housing.
Intensive supports need to
be available for those
who need them. These
include practical
supports:
* laundry
* shopping
* cleaning.
25
Research Finding 10.
There is some
evidence that
women fare
better in
supported
housing than
men.
26
Research Finding 11.
Studying
residential
options using
a randomized
design is
difficult, but
possible.
27
Research Finding 12.
Participants who leave the program
and who are lost to the research
present a challenge.
28
Research Finding 13.
Supported housing
interventions do
not automatically
lead to
improvements in:
 Social
integration
 Symptoms
 Substance
abuse problems
 Solving of
practical
problems
29
Research Finding 14.
Service
integration
leads to
improvements
in housing
outcomes.
30
Need for Further Investigation



What is the relationship
between housing, mental
health outcomes and
satisfaction?
What role do housing types
have in relation to therapeutic
benefits to individuals
(unrelated to services)?
How should we define
“housing stability” for
research purposes so studies
can be compared?
31
Supported Housing: Conclusions

Integrated, long-term independent housing with
supports is critically important to rehabilitation
and recovery.

Supported housing in combination with subsidies
can significantly improve the quality of life of
residents.

Programs need to assist consumers in their
community integration and prevent isolation.
Compiled by the Supported Housing Study Group at Boston University
Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization
Project for Disability & Professional Stakeholder Organizations/ NIDRR
Grant # (H133A050006)
32
Resources for Supported Housing (1)
Boston University Center for Psychiatric
Rehabilitation – Disability Research Right
to Know http://drrk.bu.edu/
 Corporation for Supportive Housing
http://www.csh.org/
 UPenn Collaborative on Community
Integration http://www.upennrrtc.org
 Advocates for Human Potential
http://www.ahpnet.com/HousingHomeless
.html

33
Resources for Supported Housing (2)




New Freedom Initiative . . . to Promote
Community-Based Care
http://www.ahpnet.com/Olmstead.html
Projects for Assistance in Transition from
Homelessness (PATH)
http://www.pathprogram.samhsa.gov
Technical Assistance Collaborative
http://www.tacinc.org
Key Assistance Report on Supported Housing
http://www.mhselfhelp.org/pubs/view.php?public
ation_id=40
34
Resources for Supported Housing (3)
U.S. Department of Housing and Urban
Development http://www.hud.gov and
http://www.huduser.org/index.html
 Pathways to Housing/Housing First
http://www.pathwaystohousing.org/ and
http://www.pathwaystohousing.org/TopMe
nu/ACTServices/HealthandWellness.html
 “Housing First, Consumer Choice, and
Harm Reduction for Homeless Individuals
With a Dual Diagnosis”
http://www.ajph.org/cgi/content/abstract/
94/4/651

35