Homeless Recovery Research

Welcome to the Homeless Recovery Research Project.

The Homeless Recovery Research Project is based in part on the Favors Life Recovery Series Curriculum and Overcoming Setback Series Curriculum.

This research project began as an idea to address personal homelessness due to job loss and the impact of the financial recession. The planning around the initial thinking of this project grew to enrolling in a second master’s program in psychology through The Chicago School of Professional Psychology where the ideas could be developed further into a research plan.

Completing graduate psychology coursework provided the best opportunity to understand the factors leading to chronic homelessness, the reasons surrounding why people prematurely exit permanent supported housing (PSH), and the solutions necessary for addressing behaviors of chronically homeless people.

The coursework allowed me to process my thinking about personal biases, tackling chronic homelessness as a cultural phenomenon, and considering racial and/or cultural influences. How the personality is structured, how parenting styles influence adult decision-making, and how cultural identity affects our perception of equality and equity are all considerations for this research project.

Additional series topics will always include the Big Five personality traits, goal orientation, mindset, parenting styles, mate value, and mate switching as factors that might influence our understanding of chronic homelessness. This means that the research will consider John Bowlby’s concepts of secure base, attachment theory, and maternal deprivation theory as well as concepts related to psychopathology, psychoanalysis, and cognitive behavior theory. The list is not exhaustive.

A unique aspect of the Homeless Recovery Research Project will center on adapting motivational interviewing (MI) as an intervention to reduce PSH premature exits. In addition, understanding the role of birth order, context and culture as ecological, cognitive development, identity, fragmented care as a hindrance to recovery, and ethical decision-making are necessary for thinking analytically about the various angles, personal and institutional, affecting the movement or lack of movement of chronically homeless people.

Papers written during my graduate studies will form the basis of building research. The last paper written on the topic of chronic homelessness is available in the next sections, as it outlines preliminary thinking (graded submission).

The Homeless Recovery Research Project will review tentative research questions, the brief annotated bibliography, and the development of various concepts related to the project. The project will also consider the development of vision and mission statements, core values, and related institutional and policy content.

It is not clear if audio lectures that apply psychology concepts to the project will be necessary, but such audio lectures might be central for processing the information when considering moving people from homeless setback to life recovery.

The development of content is tentative and subject to change due to redundancy and policy updates. Consider this research project as draft form until ideas are finalized. I will continue to write books to develop understanding of the topic. New topics will be added as research and content development continues.

BOOK TITLE(S)

The following book title(s) is available on Amazon. Click the links to access the title.

Sample Life Plan Workbook

Favors Sample Life Plan Workbook: A Case Study for Addressing Chronic Homelessness

MISSION STATEMENT

The mission of the Homeless Recovery Research Project is to review and continue the study of chronic homelessness, revise research questions, create additional research questions, design a survey/measure, and develop a comprehensive annotated bibliography. The project will lead to a learning website, which may begin during the planning phases.

TENTATIVE DESCRIPTION

The Homeless Recovery Research Project outlines preliminary considerations for helping chronically homeless individuals overcome homeless setback and sustain homeless recovery by designing both prevention and intervention programming.

GAP ASSESSMENT

The gap assessment is a strategy typically used in business, and I have added it to one or more books, especially the one titled Favors Sample Life Plan: Using Psychology, SWOT, & SMART to Measure Financial Progress. The book is available on Amazon. You can find links for each book under the tabs “Books” and “About.” The use of the gap assessment strategy in the book references finances and financial management.

Conducting a gap assessment for research purposes is always important. I also believe that getting chronically homeless people to conduct a gap assessment, whether they are in the frame of mind or not, might also be significant to point them in a direction towards exiting chronic homelessness. The following content is wholly adapted from the book referenced. Consider the questions as informative.

Why is it important to conduct a gap assessment?

It is important to conduct a gap assessment in your thinking about where you are and where you want to be long-term. The gap assessment usually reveals what is going on in your present day and what you want to happen in your future.

The gap assessment is significant because it is useful for all areas of your life, including academic, professional, personal, and financial. The last category is likely more important than any other area because if you do not have discipline over your finances, the knowledge gap will affect every other area of your life. Your finances matter, and how you manage your finances matters!

What is a gap assessment?

A gap assessment, or in industry terms, gap analysis, is a technique business leaders use to determine the steps needed to move from a current state to a desired state.

A gap analysis includes the following steps:

  • Listing characteristics of the present situation (attributes, competencies, performance)
  • Listing characteristics needed to achieve a future situation (what should be)
  • Highlighting gaps that exist and that need to be filled

It is the difference between “what is” and “what should be.”

Where are you today?

This question encourages you to assess areas of your life that might reflect a knowledge gap or that might reflect a knowledge assurance. Review the following categories and provide responses based on your concerns.

Financially

Financially refers to whether your debt outweighs your income. Do you have a knowledge gap between your debt and income?

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Economically

Economically refers to status and poverty level, or little above poverty level, or thriving. Are you at the poverty level? Are you above the poverty level? Do you know your economic status?

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Emotionally

Emotionally refers to mood regulation and whether you know how to handle conflict. Do you have an emotional conflict with your money? Do you spend emotionally or logically? With whom do you have an emotional conflict with your money?

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Psychologically

Psychologically refers to stress management and whether you have taken on too much. Are you stressed or distressed in some area of your life, especially with finances? What or who is contributing to the stress?

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Spiritually

Spiritually refers to your understanding about sex in marriage and sex out of marriage. What are your views on sex? Is there a gap in your understanding about game playing in relationships that include sex?

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Skill Development

Skill development refers to whether it is time for you to begin upgrading skills or developing a skill to move you forward. What are your current skills? Do they need updating?

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Where should you be?

Where you should be is predicated on who you think you are, your capacity and capability, and your future contribution. It is up to you to ensure you have what you need in the present for the future. There are some things you know. There are some things you do not know. However, not everyone is patient with what you do not know. In other words, if you are plagued with a current distress resulting from a job loss, financial loss, death, etc., not everyone is patient with your re-learning process.

Even if you have been patient with someone in your past, there is no guarantee that the same person will be patient with you in the present. You might have accepted someone into your home because that person lost their home. However, you might also expect that same person to take you in when you are financially down only to realize that the same courtesy is not extended to you. It is important to plan for the unexpected loss. Think about these issues as you provide responses to the following questions.

What are your financial plans?

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What is your financial vision?

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What is your financial purpose?

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To where do you want to take yourself financially?

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The gap assessment and the questions serve as guides for future plans to help chronically homeless people reflect and plan their exit out of chronically homelessness. I am not certain that this will work, but it will definitely work in assessing the gaps in the current literature on chronic homelessness. Conducting a gap assessment might be one of those gaps. This assumption might apply to homeless shelters, advocacy organizations, and federal legislation. The research and development of assumptions is ongoing.

FINAL PAPER

The final paper was submitted in a graduate psychology course. It reflects preliminary considerations surrounding the need to reduce PSH premature exits by adapting motivational interviewing to address housing guilt. It considers reviewing the diverse beliefs of the adult homeless population.

The personal belief (argument) that permanent supported housing is inadequate long-term in addressing chronic homelessness because of their non-abstinence features should be challenged.

Title

The Problem with PSH & Housing First Models: The Case for Relapse Reduction through Community Empowerment

Introduction

Permanent supportive housing (PSH) and Housing First models as housing intervention programming are inadequate long-term in addressing chronic homelessness because of their low-barrier entry, non-abstinence features where residents are not expected to meet milestones, creating a danger for relapse and return to homelessness (Collins, Malone, & Cliasefi, 2013), ultimately failing to address unsheltered homelessness (Smith, 2016).

At the micro level, homeless mentally ill placed in PSH leave before two years of residence. Many clients believe that it is not permanent and often return to sheltered or unsheltered living. “In fact, many permanent housing residents do not expect that their residency in permanent housing will be permanent” (Wong, Hadley, Culhane, Poulin, & Davis et al., 2006, p. x).

Although PSH emphasizes client choice and control over housing, at the meso level, homeless mentally ill placed in PSH do not often utilize supportive services from the immediate provider; supportive services are available to those with a serious mental illness (SMI), substance abuse disorder, physical disability, or chronic disease (Byrne, Fargo, Montgomery, Munley, & Culhane, 2014, p. 235).

In addition, emergency housing planning for the chronically homeless in affluent cities has been met with opposition. “The houses [in San Jose near Silicon Valley] are intended as a stopgap until permanent housing becomes available,” but neighbors are opposed to housing settlements (Gee, 2017).

Further, hoteliers in cities such as San Diego have teamed with city officials to support an increase on hotel-room tax so the homeless people sleeping on the street in front of their businesses will not have an impact on their bottom line (Davis, 2017).

Lastly, at the macro level, lack of attention to community investment into ending chronic homelessness has prompted researchers to study the relationship between PSH and chronic homelessness to help policymakers set accurate targets (Byrne et al., 2014, p. 235). “In short, research on the relationship between PSH and chronic homelessness using community-level data has the potential to provide valuable information for macro-level resource allocation decisions and planning processes that cannot be obtained from individual-level studies” (Byrne et l., 2014, p. 238).

Research at the community level might explain why PSH residents view permanent supportive housing as “not the end of their distress because they leave and go to unstable or less positive housing settings or return to the street” (Wong et al., 2006, p. x).

With these ideas in mind, the following sections provide an overview of the problem and current efforts implemented to address it; an ecological analysis; and proposal for empowerment through creating a pseudo-government that aids in reducing relapse and ushers the homeless into self-sufficiency through community empowerment.

Chapter 1: Overview

Populations Affected

Chronic homelessness is defined as an adult individual experiencing homelessness continuously for one year or more or experiencing homelessness a minimum of four episodes within the last three years (Annual Homeless Assessment Report to Congress, 2012, p. 5-2). Although chronic homelessness may include families, this paper only considers adult individuals and demographic information and includes statistics created between 2007 and 2012.

In 2012, almost half of the chronically homeless within the United States were concentrated in three states: California at 33% (33,422 people), Florida at 8.7% (8,682 people), and Texas at 6.1% (6,115 people) (Annual Homeless Assessment Report to Congress, 2012, p. 5-2). One-night, or point-in-time (PIT) estimates of individuals as homeless, accounted for 62.2 percent, or 394,379, of the total homeless population (Annual Homeless Assessment Report to Congress, 2012, p. 2-3).

“The PIT estimates are one-night counts of both sheltered and unsheltered homeless populations” (Annual Homeless Assessment Report to Congress, 2012, p. 2-3). Of this number, some lived in unsheltered locations (80.1 percent) and some lived in sheltered locations (51 percent) (Annual Homeless Assessment Report to Congress, 2012, p. 2-3).

In addressing the nation’s homelessness problem, two challenges continue to exist: 1) some experts believe that chronic homelessness is manageable through transitional housing and 2) other experts believe that recognizing homelessness as a solvable social ill is achievable through permanent supportive housing and Housing first models (Henwood, Wenzel, Mangano, Hombs, Padgett, Byrne, Rice, Butts, & Uretsky, n.d.).

“The notion that homelessness in the United States can be ended, rather than managed, represents a fundamental shift in expectations that has occurred over the past three decades” (Henwood et al., n.d., p. 3). Shifts in U.S. policy lean towards permanent supportive housing (PSH) over transitional housing (Henwood, Cabassa, Craig, & Padgett, 2013).

Henwood et al. (n.d.) argue that the staggering costs of homelessness prompted studies to document the costs to the taxpayer. In fact, “[s]uch studies support new economic arguments that support the goal of ending chronic homelessness by revealing how the cost of maintaining a person in homelessness is more expensive than solving the problem itself” (Henwood et al., n.d., p. 5). The cost to maintain a homeless adult individual living on the streets or shelters, and processed through the health and law enforcement systems, ranges from $35,000 to $150,000 (Henwood et al., n.d., p. 5).

Yet the cost is low, roughly $13,000 to $25,000, to provide permanent housing (Henwood et al., n.d.). Although these estimates support the argument for PSH and Housing First, scaling up the practice presents challenges, requiring innovation and further study (Henwood, et al., n.d.). In addition, moving homeless individuals out of shelters into permanent housing poses a challenge in which the “PIT count fall but the annual prevalence estimate rises” (Henwood et al., n.d., p. 12). This means that one-night estimates may fall, data collection efforts might not track families that live together, and it would make it difficult to measure the effectiveness of the programming.

Statistics on adult homeless individuals are sub-divided by gender. Men are 2.6 times (72.3%) more likely to reside in shelters than women (27.7%), but less than half (46.8%) are in poverty (Annual Homeless Assessment Report to Congress, 2012, p. 2-8). Most individuals living in a shelter range in age from 18 to 50 (Annual Homeless Assessment Report to Congress, 2012, p. 2-8). Lastly, individuals who are living in shelters are 1.3 times more likely to be Hispanic (13.6% versus 10.2% of the U.S. population), but “[m]ore than half (54.8% of people in shelter as individuals were in a minority group, comprised of African Americans (36.1%) (Annual Homeless Assessment Report to Congress, 2012, p. 2-9).

If measurement is difficult for the larger population, assessing for gender differences could prove to be equally difficult especially given the objective that housing and supportive services are usually tailored to the individual within a PSH environment. Winetrobe, Wenzel, Rhoades, Henwood, Rice, and Harris (2017) report that homeless women may be more vulnerable than their male counterparts (p. 289).

The study population totaled 421 homeless adults were women comprised 28% of the study sample, were less likely than men to have a high school education, reported less income than men, and “2.5 times as likely as men to have any chronic mental health condition and also were diagnosed with more chronic mental health conditions than men” (Wientrobe et al., 2017, p. 289). Homeless women entering PSH seemed less healthy than their homeless male counterparts (Weintrobe et al., 2017). Men, on the other hand, tended to have less access to supportive familial ties than women (Weintrobe et al., 2017).

These results are significant because clients entering PSH often reported feeling lonely and isolated in their new housing unit “where they were unaccustomed to being by themselves for long periods of time, closed in by the quiet, . . . bored because their day no longer involved a constant search for food, . . . and isolated from both the general public and their former acquaintances” (National Health Care for the Homeless Council, 2011, p. 6).

The response to feeling isolated prompted some clients to leave their PSH housing units and return to familiar places, or return to homelessness (National Health Care for the Homeless Council, 2011).

Current Efforts

The feelings of housing guilt and the tendency to relapse are two clinical challenges the provider faces. Providers often reported that helping the PSH client remain in housing was a daily task that consisted of changing the homeless individual’s “culture of living,” especially for clients who had been living on the streets for 10 to 20 years (National Health Care for the Homeless Council, 2011). For low-barrier, non-abstinence Housing First sites, Collins, Malone, and Clifasefi (2013) reported that “46.5% [of the 111study sample], did not feel they would be able to maintain abstinence-based housing had they accepted it” (p. S272).

Twenty-three percent of the participants returned to homelessness at the two-year follow-up; “[n]one of the hypothesized risk factors, including demographic characteristics, alcohol or other drug use, history of homelessness, illness burden, or psychiatric symptoms, were significant predictors of a return to homelessness” (Collins, Malone, & Clifasefi, 2013, p. S273).

Even though Housing First does not require individuals experiencing homelessness to address their behavioral health problems or mandate participation in programming (National Alliance to End Homelessness, 2016), PSH clients were still inclined to return to homelessness. Because of efforts to divert funding to PSH and Housing First models, this put unsheltered homeless at greater risk, increasing the PIT rates and length of stay for emergency shelters, the average stay being 47 nights and 91.6 percent emergency beds covered (Annual Homeless Assessment Report to Congress, 2012, p. 2-15).

“This indicates that it is likely that permanent housing alone is not sufficient to address unsheltered homelessness among individuals and that some attention must be paid to the level of temporary housing available for this population” (National Alliance to End Homelessness, 2016).

Transitional housing programming offers shelter for up to 24 months and it has barrier to entry and long-term recovery objectives that require individuals to meet milestones. The transitional housing program is much better suited to substance abusers and mental health clients because it requires clients to abstain from substance use.

Collins, Malone, and Clifasefi concluded that when asked if they would accept abstinence-based housing, “67.3 (70 of 104) of participants reported they would have accepted housing even if it had been abstinence-based” (p. S271). Transition housing, then, would be an appropriate environment for creating a pseudo-government within the sheltered environment, and it would encourage both those living in PSH and those entering emergency housing.

Chapter 2: Ecological Analysis

Levels of Analysis

Evaluation of a PSH program will require understanding the social environment and the physical setting within which adult homeless individuals operate. This means that we will need an ecological context of the environment, individuals, and the role the community psychologist, or in this case provider, plays. The following four ecological principles serve to examine social environments and their physical settings. Definitions of each and examples help to illuminate how each influences life overall for the adult homeless individual.

Interdependence

First, with interdependence, the social system has multiple, interrelated parts. These parts include the PSH setting, which consists of multiple clients with substance use and mental health issues; leavers and stayers; and ongoing supportive and behavioral health services providers, or licensed counselors.

General real estate market conditions that contribute to the higher rates of homelessness also represent parts because they affect the individual who loses his or her primary dwelling because of gentrification. “ ‘There is a direct association between how fast rents are growing and how much homelessness there is in cities,’ said Svenja Gudell, Zillow’s chief economist,” (Waters, 2017).

Lastly, the setting is affected by local actions against chronic homelessness and steps city councilmembers and the mayor take to resolve the issue. A PSH client who relapses within this environment undoubtedly affects the progress and contribute to the recidivism of homeless people returning to the streets.

Cycling of Resources

Second, with cycling of resources, the social system reflects how resources are used, distributed, and conserved. PSH clients who are leavers are less likely to utilize vocational and social rehabilitation services. Resources are typically used by stayers. However, “[p]rogram staff assessments revealed that voluntary leavers overall had a higher level of functioning and lower need of assistance than stayers” (Wong et al., 2006, p. xiii). This supports the objective in arguing that PSH and Housing First models are not sufficient long-term.

Adaptation

Third, with adaptation, the social system reflects how individuals learn how to adapt to their environment and how the environment adapts to the individual. PSH clients who relapse often have trouble adapting to their environment because of exposure to activities that hinder recovery. Likewise, the PSH program offers clients choice and independence; for a PSH client with a drug or alcohol program, who has problems with self-control, the PSH environment is a mismatch. For these clients, a stringent program is sufficient to decrease rates of recidivism.

Succession

Lastly, with succession, the social system changes over time, and settings are usually examined before intervention is planned. The current PSH system has not changed from its main objective of providing housing choice before addressing mental health or substance issues as a secondary goal. Therefore, part of the succession plan for a PSH provider should include studying risk factors at the micro, meso, and macro levels to PSH client perspectives on “permanent housing.” Only then would succession come into clearer view.

Chapter 3: Prevention or Empowerment

Although prevention of relapse and recidivism might be appropriate for PSH programming, prevention, like the Housing First model, is not suitable for long-term self-sufficiency. It works well as one part of a larger empowerment initiative. Empowerment would help adult homeless individuals become aware of their own homelessness and work towards resolving it through knowledge and responsibility.

With this in mind, empowerment is an active, participatory process by which individuals, organizations, and communities pursue control, efficacy, and social justice (Peterson & Zimmerman, 2004). “Empowerment at the community level of analysis—community empowerment—includes efforts to deter community threats, improve quality of life, and facilitate citizen participation” (Peterson & Zimmerman, 2004, p. 130).

Part of the challenges in providing permanent supportive housing is the belief that the homeless are being rewarded for less or no effort. “Although some conservative commentators have derided [PSH programs] as the ‘bunks for drunks’ policy, proponents have couched their arguments in terms of cost-effectiveness and safety/sanitation issues” (van Wormer & van Wormer, 2009, p. 155).

At the heart of policy debates and organizational initiatives is making the programming less punitive, moving it towards a pragmatic approach leading to non-abstinence-based. However, without some initiative on the PSH client to pursue recovery, through abstinence-based programming, i.e., meeting milestones and/or contributing to his or her development, this will likely increase recidivism, or a return to homelessness, rather than reduce relapse.

Relapse from drug abuse, substance use, and mental illness, and exit from the permanent supportive housing programming, are both risk factors most program providers face. Because HUD adds a disability criterion to its definition of chronic homelessness (Annual Homeless Assessment Report to Congress, 2012, p. 5-2), relapse among leavers might include higher incidence of psychiatric hospitalization and emergency services use after entering PSH.

This could be “indicative of the deteriorating status of mental health among leavers [and experiences] of relapses may be an important factor contributing to the inability of some permanent housing residents to continue their tenure in permanent housing” (Wong et al., 2006, p. xi).

Therefore, policy-based encouragement to create, join, and advocate on behalf of a peer-supported group within the sheltered environment will undoubtedly instill motivation to remain in recovery (Boisvert et al., 2008). In a peer-supported community programme, “[s]ignificant reduction of risk of relapse was found in clients who participated in the programme” (Boisvert et al., 2008, p. 205).

Participating in the community by taking an empowerment approach would allow clients of a PSH program to achieve sustained recovery and gain overall wellness, as Fisk et al. (2006) suggests (as qtd. in Boisvert, Martin, Grosek, & Clarie, 2008, p. 207). “Evidence suggests that a peer-supported community programme focused on self-determination can have a significant positive impact on recovery from substance addictions and homelessness” (Boisvert et al., 2008).

Creating a pseudo-government in which clients form the equivalent of a college-based, student-directed corporation (i.e., student government) comprised of elected members and that reflects the development of a board and committees might contribute positively to reducing relapse. Creating a member-run, independent organization, within the recovery community, would promote learning (micro), planning (meso), and collaboration (macro) at multiple social and political levels.

Micro-Level Intervention

The micro-level intervention supports the rationale for learning. At the micro level, homeless mentally ill placed in PSH leave before two years of residence. “More than ten percent, in fact, left within six months, and nearly a quarter left within the first year after entry” (Wong, Hadley, Culhane, Poulin, & Davis et al., 2006, p. x). Leavers, more than stayers, have used inpatient mental hospital, community residential, and emergency services during their tenure in permanent supportive housing (Wong et al., 2006, p. xi).

Leaving occurred among those considered as “most stably housed,” staying in PSH for many years (Wong et al., 2006). Leavers are also categorized as having no extended familial support as well as struggling with emotion regulation. Without some incentive to remain in the program, clients are more inclined to leave due to boredom.

At the micro level, then, the first task for the initial facilitator, or staff member of the shelter provider, who is also the program designer, is to create an environment for learning. Bandura’s (1977) earlier work in social learning emphasized modeling and observational learning; today, his “theory stresses the importance of cognition, or thinking” (as qtd. in Berk, 2014, p. 18).

Much of what the homeless person knows is his or her beliefs about injustice and possibly their own mental illness. Homeless people have been separated from the main social climate that thinking about advocacy is a foreign concept, but part of learning is understanding the problem. Small group work requires some contemplation (Nelson & Prilleltensky, 2010).

In a study conducted by Boisvert et al. (2008) on a peer-supported community, the occupational therapist designed the programme using occupational therapy guidelines “involving the use of occupation as a primary focus. . . . Meetings were arranged with the PSH community in which the occupational therapist presented and residents discussed the principles of a peer-support recovery community or peer-driven community” (p. 210).

The therapist gave out handouts and readings to inform clients about leadership roles and how to schedule support meetings (Boisvert et al., 2008). “Group interventions focused on training in organizational leadership, group communication and group facilitation skills” (Boisvert et al., 2008, p. 210).

In creating an environment for learning, the occupational therapist empowers the PSH clients so they can be empowered at the next level of intervention. Likewise, by introducing the principles of governing through training, PSH clients will feel equipped to move to the next level.

Meso-Level Intervention

The meso-level intervention supports the rationale for planning. At the meso level, the homeless mentally ill do not take part in supportive services such as vocational and social rehabilitation. “Leavers are less likely than stayers to use such services both before and during permanent housing stays” (Wong et al., 2006, p. xiii). Because PSH requires independent living skills, leavers often relapse into substance use and deteriorate mentally without higher level supervision and structure (Wong et al., 2006, p. xvi).

In addition, some involuntary leavers who relapse are found to be non-compliant; however, other PSH clients who fall under the category of involuntary leavers report “drug activity in their buildings and neighborhoods as a factor aggravating their substance use problems, leading to a downward spiral of relapse and, eventually, to discharge from permanent housing program” (Wong et al., 2006, p. xiv).

PSH clients and providers find that there is a mismatch between the expectations of independence and the lack of self-regulation in permanent supportive housing settings (Wong et al., 2006, p. xiv), suggesting that the lack of stringency with the PSH program, and Housing First model overall, might not work with every client accepted without having to meet traditional entry obstacles to deem the client ready for placement in permanent housing (Byrne et al., 2014).

Therefore, planning at the meso-level must be qualitative. In Boisvert’s et al. (2008) study, “participants were asked to identify what they proposed would be the purpose of their community, what each member had to give or bring to the community, what they thought were the common goals identified during the group discussion, [and] what they thought the community’s values would be” (p. 212). The facilitator also asked what they thought the mission statement should be for their group (Boisvert et al., 2008).

These questions foster participation in gauging the larger group about values and expectations. Without this planning process, it would be difficult to collaborate with social systems to pursue equality and justice and demand humane treatment at the macro level. Van Wormer and van Wormer (2009) oppose the belief that PSH is a reward; “housing should be regarded not as a privilege or a reward for desirable behavior but as a fundamental human right” (p. 155).

Pursuing equality and justice require initial planning. It is in the planning phases where PSH clients develop values, purpose, and a mission statement; clients also create positions for elected officers, i.e., chairperson, vice chairperson, secretary, treasurer, and mayor; formulate rules of order and assignment of duties; and ultimately create bylaws (Boisvert et al., 2008).

These standards, not guidelines, would be mandatory (APA, 2014). The client-run corporation proposed would have access to such resources at the meso level. They will create policies for collaboration at both the meso and macro levels.

Macro-Level Intervention

The macro-level intervention supports the rationale for collaboration. At the macro level, the belief systems about the chronically homeless are difficult to resolve, even if the larger government requires implementation of housing programming. The Stewart B. McKinney Act, the Shelter Plus Care program under the National Affordable Housing Act of 1990, and the HUD McKinney-Vento Act permanent housing alternative program reflect guidance for creating permanent housing and providing ongoing supportive services for difficult-to-serve populations (Wong et al., 2006, p. viii). These directives do nothing for the people who have their views about the homeless.

For example, Ross (2017) believed that his brother, who was homeless for 25 years and now has an apartment, was “lazy, a computer nerd, a stoner” (p. 2). Ross’s beliefs typically fall under the micro level of analysis, but his beliefs about his brother are typical of local and national belief systems about homeless people in general: that it is a choice.

Although homelessness is inherently a choice, this does not solve the greater issue with it being a humanitarian crisis, as Jesse Arreguin, Berkeley’s mayor said to a reporter (Waters, 2017). “Places such as Seattle and Portland have declared states of emergency to deal with the crisis as they would a natural disaster” (Homelessness Editor, 2017).

To deal with the chronic homelessness crisis at the government level, the Federal Emergency Management Agency (FEMA) created the Emergency Food and Shelter National Board Program (ESP) to “supplement and expand the ongoing work of local social service organizations, both non-profit and governmental, to provide shelter, food and supportive services to individuals and families who have economic emergencies” (2017). Funds are not to be used for homelessness due to an immediate disaster circumstance.

At the macro level, he mayor at the local level in Boisvert’s et al. (2008) study represents the community at neighborhood watch meetings and reports back to the group. Most college-based student government systems do not have a mayor, but a president instead. As a mini government, the group could create a position for a mayor or a president; however, when directing their attention to national issues, the community could create a chief executive.

Depending on the goals and purpose of the organization, this would be decided at the meso level and this formulation is central to what will be needed at the macro level. Regardless, development at the meso level allows for action at the macro level.

For example, in considering the proposed organization of this paper, a member of the group, or a larger committee, sends a representative to clinical and management meetings held by the shelter and reports back to the group about concerns and center-based issues (Boisvert et al., 2008).

Another representative from a second committee sends a representative to national organizations to voice concerns about chronic homelessness and shelter issues and presents research at various conferences. Further, another committee might send a representative to local, state, and federal officials and voice concerns of the group as well as the voiceless, i.e., the homeless still living out on the street. There might be a committee that creates a voter drive and registers people; this could create an economic opportunity for PSH clients who do not work.

Lastly, there might be a committee responsible for conducting town meetings concerning opposition to permanent supportive housing in middle-class or upper-class neighborhoods. These are examples, but they reflect how much change is needed at the macro level (Nelson & Prilleltensky, 2010).

As indicated in the study, the occupational therapist would no longer need to attend meetings or group sessions after a significant time has passed, but he or she may continue to offer support when asked (Boisvert et al., 2008). The therapist, or community psychologist, would serve as a consultant.

Reflection

There is personal bias with this topic. Between 2008 and 2013, I was personally homeless, on-again and off-again. I do not and have never been diagnosed with a mental disorder or with substance use. In many cases, I do not fit the criteria of the homeless people I will study.

Most homeless people suffer with some disability and studies are typically conducted on veterans, people suffering suicidal ideation, and mental and substance use issues. They may also represent people who are parolees.

Therefore, the fact that I became homeless due to loss of employment may not garner much research on the topic of chronic homelessness. In addition, people suffering with mental illness or substance use might find my background to be insufficient because I was homeless and I am also college-educated. People often make comparisons and put forth the thinking that one’s struggle is not the same as another person’s struggle.

My college background might be hindrance for someone who sees me as a possible model for moving forward. The general consensus might be, “If you went to college and became homeless, then what does that say about me?” To answer this question, I would have to begin tapping in my skill sets as well as their skill sets and getting them to see what we both can offer to further the larger cause.

In other words, I would point out the fact that I did overcome homelessness, obtained a job, and remained in housing. These are also factors that I can use to encourage clients to remain in housing and participate in the pseudo-government proposed in this paper.

Lastly, the fact that education, or some semblance of knowledge is needed to plan at the meso level, this would also be a tool I could utilize to assign responsibilities/tasks and evaluate their contribution. Clients who might be familiar with homelessness might interview other homeless individuals and write a report. This, too, could be a useful tool for encouraging responsibility and getting clients to remain in housing. This assignment of tasks might be useful for people who are detail-oriented and who love to write.

Conclusion

Permanent supportive housing (PSH) and Housing First models that are non-abstinence-based create opportunities of relapse among the chronically homeless. “Simply securing a roof overhead is not an adequate solution for a chronically homeless individual” (Collard, Lewinson, & Watkins, 2014, p. 469). Single homeless adults need more than a sheltered environment; they need empowerment that moves them out of a state of merely receiving food and shelter into personal, social, and economic self-sufficiency.

Further Direction

Further study is needed to explore the belief systems about chronic homelessness by surveying adult homeless individuals. What they believe about homelessness is equally important as what the researcher suggests. Surveying this information would allow us to delve into their worlds and communities in a personal sense and tailor approaches in an organizational sense. Their viewpoints are needed.

Assessing the homeless population with numbers is not enough to get a sense of what they actually need. We often struggle with remaining in expert status, forgetting that listening is a larger part of the process. Gutierrez-Mayka and Contreras-Neira (1998) state, “Researchers as outsiders need to come into communities as learners and facilitators rather than teachers and overseers” (as qtd. in Rudkin, 2003, p. 142).

Part of the cultural learning process must include the community psychologist considering the impact of his or her expert status and gaining a true understanding of marginalized groups. Recognition of diversity requires attending to the dimensions of inequality and discrimination (Nelson & Prilleltensky, 2010, p. 399). It requires understanding the diverse beliefs of the adult homeless population.

ANNOTATED BIBLIOGRAPHY

This annotated bibliography explores novel approaches to understanding chronic homelessness. It reflects implications for study of homelessness across the lifespan. The annotated bibliography is tentative and subject to change. A comprehensive bibliography will follow.

Entries

Adair, C. E., Holland, A. C., Patterson, M. L., Mason, K. S., Goering, P. N., & Hwang, S. W. (2011). Cognitive interviewing methods for questionnaire pre-testing in homeless persons with mental disorders. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 89, 36-52. Retrieved from https://thechicagoschool-chi.worldcat.org/title/cognitive-interviewing-methods-for-questionnaire-pre-testing-in-homeless-persons-with-mental-disorders/oclc/5659969986&referer=brief_results

Adair et al. (2011) used cognitive interviewing methods to interview homeless individuals with mental disorders. Thirty participants were recruited from multiple service agencies in Canadian cities. The goal of the research was to test relevance, comprehension, recall, and sensitivity/acceptability. The authors define “homeless” to mean social dislocation, extreme poverty, itinerant work, and marginalized ways of living.

The authors reference the use of a cognitive interviewing method to test for the appropriateness of questionnaire items, but they conclude that there has not been a study that tested for the utility and relevance of items, particularly for homeless individuals with mental disorders. An element of a question such as “neighbor” may not be relevant for a homeless individual, especially when neighbor might have a middle-class connotation.

Likewise, visiting parks and museums would have different meanings for a homeless person looking for some place to seek food and shelter; visiting a park is not the same thing as community involvement. The researchers concluded that some questionnaire items created interpretation problems (relevance), some items were poorly understood (comprehension/recall), and some items elicited negative reactions (sensitivity). Homeless individuals preferred “panhandling” to “begging.” This research will be useful for considering the development of a questionnaire.

Aubry, T., Klodawsky, F., & Coulombe, D. (2012). Comparing the housing trajectories of different classes within a diverse homeless population. American Journal of Community Psychology, 49, 142-155. Retrieved from https://thechicagoschool-chi.worldcat.org/title/comparing-the-housing-trajectories-of-different-classes-within-a-diverse-homeless-population/oclc/775592168&referer=brief_results

The research was part of a longitudinal study of homeless individuals living in a mid-size Canadian city. The researchers conducted data on 329 single persons who had experienced homelessness. The goal of the study was to analyze different classes within the homeless population. The authors review research conducted of three classes of homeless people: the transitionally homeless, the episodically homeless, and the chronically homeless.

However, the research produced four classes: those who make up the high levels of physical functioning without substance use, those who report alcohol and/or drug use, those who present with mental problems and substance use, and those who present with complex and multiple health problems that include lower levels in mental health functioning and chronic health conditions, for example.

One of the limitations of the study included questioning the development of latent classes from a sample comprised of homeless youth and adults; the context of homelessness may be different for both sample groups. This research will be useful for exploring the typologies of homeless populations and comparing results of classes distinctions within research.

Bellino, S., Paradiso, E., & Bogetto, F. (2008). Efficacy and tolerability of pharmacotherapies for borderline personality disorder. CNS Drugs, 22, 671-692. Retrieved from https://thechicagoschool-chi.worldcat.org/title/efficacy-and-tolerability-of-pharmacotherapies-for-borderline-personality-disorder/oclc/365978854&referer=brief_results

The authors explore psychopathology dimensions as targets for pharmacotherapy of borderline personality disorder: raffective dysregulation, impulsive-behavioral dyscontrol, and cognitive-perceptual symptoms. The review discusses the clinical trials and meta-analyses of drug efficacy and tolerability in the treatment of borderline personality disorder.

The authors review antidepressant agents, mood stabilizers, and antipsychotics, outlining dosage and their effectiveness for reducing impulsivity, modulating neurotransmitters, and reducing depression and anxiety, respectively. Meta-analysis suggests that antidepressants and mood stabilizers are efficacious in reducing affective instability and anger; and antipsychotics improved interpersonal relationships and global functioning.

Limitations of the study reveal that sponsorship might have led to bias in the sampling and include reference to methodological limitations. This research will be useful for comparing and contrasting different medications and their results and how such drugs affect the chronically homeless. A guiding question might be: Are they useful for reducing chronic homelessness?

De Vet, R., Beijersbergen, M. D., Jonker, I. E., Lako, D. A. M., van Hemert, A. M., Herman, D. B., & Wolf, J. R. L. M. (2017). Critical time intervention for homeless people making the transition to community living: A randomized controlled trial. American Journal of Community Psychology, 60, 175-186. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28872196

The study tested whether critical time intervention (CTI) would be effective outside of the United States for vulnerable people transitioning from Dutch shelter services to independent housing. The primary outcome was number of days rehoused, which was assessed by interviewing participants four times during a 9-month follow-up” (de Vet et al., 2017, p. 175).

Critical time intervention bridges the gap between services, providing both practical and emotional support. The model is useful for helping CIT workers strengthen social and professional support and guide clients through the complex network of health and mental services. The study included 183 participants from 18 shelters of nine organizations.

The researchers hypothesized that CIT would be more effective than “care-as-usual” services in which workers rarely have contact with clients once they are discharged. “Compared to usual services, the structure of CTI allowed CTI workers to spend more time with their clients immediately after the transition to housing, which is often a critical time when clients need the most support” (de Vet et al., 2017, p. 178). The care-as-usual clients represented the control group while the clients receiving CTI represented the experimental group. Results of the study suggest that CTI had a significant effect for clients with less social support but it was not more effective than care-as-usual regarding number of days rehoused (de Vet et al., 2017, p. 182).

Participants did receive services up to 9 months, but those services are in contrast to care-as-usual where participants received services up to 2.5 years. This source will be useful for framing the ideas that Housing First clients in the U.S. need clinical intervention to improve housing stability and housing retention. CTI will be useful for proposing a training program at a later date.

Durbin, C. E., & Hicks, B. M. (2014). Personality and psychopathology: A stagnant field in need of development. European Journal of Personality, 28, 362-386. Retrieved from https://thechicagoschool-chi.worldcat.org/title/personality-and-psychopathology-a-stagnant-field-in-need-of-development/oclc/5615684566&referer=brief_results

Durbin and Hicks (2014) argue that the field of personality research has become stagnant, where much of the research between personality and psychopathology is stuck at the correlate stage. Researchers in the past have simply demonstrated associations between disorders and personality traits, but have disregarded the trajectory of maladjustment across the lifespan.

The authors review limits to structural models and correlational associations and critique different models, subsequently suggesting an alternative approach: developmental psychopathology. Individual differences in adaptation are central for understanding the processes that link traits and disorders across multiple developmental periods. This source will be useful for guiding the development of hypotheses.

Gabrielian, S., Burns, A. V., Nanda, N., Hellemann, G., Kane, V., & Young, A. S. (2016). Factors associated with premature exits from supported housing. Psychiatric Services, 67 (1), 86-93. Retrieved from https://ps-psychiatryonline-org.tcsedsystem.idm.oclc.org/doi/pdf/10.1176/appi.ps.201400311

Gabrielian et al. (2016) conclude that homeless consumers “disengage prematurely” from supported housing before receiving permanent housing (p.86). Supported housing offers health and housing services for a homeless population with “high rates of illness and fragmented health care utilization” (Gabrielian et al., 2016, p. 86).

The researchers studied exiters from the Veterans Affairs Greater Los Angeles supported housing programming (Gabrielian et al., 2016, p. 86), using the VA Homeless Operations Management and Evaluation System for a data set of VA enrollees between 2011 and 2012 (Gabrielian et al., 2016, p. 87). Exiters before the end of 2012 totaled 71 (N=71) and stayers before the end of 2012 totaled 1,772 (N=1,772) (Gabrielian et al., 2016, p. 87).

Factors that contribute to early departure include residence in temporary housing on hospital grounds during program enrollment, substance use disorders, chronic pain, poor adherence to outpatient care, use of emergency room services, and justice involvement (Gabrielian et al., 2016, p. 86). “Moreover, >50% of exiters became street homeless or incarcerated after leaving the program” (Gabrielian et al., 2016, p. 86).

The most important part of the research the authors address is the fact that the Housing First model has greater fidelity to placing the homeless into housing versus designing sobriety mandates (Gabrielian et al., 2016, p. 91). “[T]here is less fidelity to rehabilitation services that could address factors associated with negative exits” (Gabrielian et al., 2016, p. 91). Without designing mandates for homeless consumers with substance abuse issues, for example, the numbers for exiters will increase, thus possibly creating a revolving door of entrants versus stayers.

Gabrielian, S., Hamilton, A. B., Alexandrino, A., Hellemann, G., & Young, A. S. (2017). They’re homeless in a home: Retaining homeless-experienced consumers in supported housing. Psychological Services, 14 (2), 154-166. Retrieved from https://search-proquest-com.tcsedsystem.idm.oclc.org/docview/1896156970?OpenUrlRefId=info:xri/sid:wcdiscovery&accountid=34120

Gabrielian et al. (2017) conclude that clinical interventions such as motivational interviewing or social skills training should be adapted to PSH environments to deter exiters. The authors studied the VA Supported Housing Program (VASH), focusing on homeless consumers who stayed in supported housing for at least 1 year and homeless consumers who left supported housing after 1 year (Gabrielian et al., 2017, p. 154). From a sample of 1558 stayers (N=1558) and 85 exiters (N=85), the authors further “selected 20 stayers and 20 exiters for semistructured, qualitative interviews, and more detailed medical record review” (Gabrielian et al., 2017, p. 154).

Some factors associated with exiters include chronic homelessness, low intrinsic motivation, substance abuse agreement, and poor independent living skills (Gabrielian et al., 2017, p. 154). The researchers also interviewed VASH staff and leadership (Gabrielian et al., 2017, p. 155) to gain insight into unmet needs for homeless consumers of supported housing services. According to O’Connell et al. (2010), “6% of VASH participants return to homelessness each year” (as qtd. in, Gabrielian et al., 2017, p. 155). The goal of the study, then, was to study the experience of losing supported housing and identify factors that produce a negative outcome (Gabrielian et al., 2017, p. 155). The authors postulate that mental health factors are strongly associated with housing loss (Gabrielian et al., 2017, p. 155) and support notions of clinical interventions to improve housing retention (Gabrielian et al., 2017, p. 155).

Clinical interventions such as assertive community treatment (ACT), critical time intervention (CTI), and intensive case management are all useful for lowering exit risk. However, these approaches will not solve the root of the problem, which is the motivation for placing veterans and other PSH consumers under the Housing First model that carries no mandate for adherence.

The authors are focusing on the right goal, which is the experience of loss; however, unless critical intervention addresses the unwillingness of a homeless consumer to let go of the substance use, then the number of exiters will increase and evaluated need may be exaggerated. What is the actual need? Is the need to address housing or the need to address mental health issues? The research does not necessarily address these questions. Instead, the researchers focus on the motivation for exiting and the experiences that follow it. 

Holmes, A., Carlisle, T., Vale, Z., Hatvani, G., Heagney, C., & Jones, S. (2017). Housing first: Permanent supported accommodation for people with psychosis who have experienced homelessness. Australasian Psychiatry, 25 (1), 56-69. Retrieved from http://journals.sagepub.com.tcsedsystem.idm.oclc.org/doi/pdf/10.1177/1039856216669916

The traditional approach to housing, where housing is conditional and behavior-based, offers little incentive for homeless consumers to stay in supported housing. The traditional approach, or continuum of care model where homeless consumers graduate from a series of programs, has not been effective (Holmes et al., 2017, p. 56). Homeless persons have not been able to attain self-sufficiency as a result of programming services (Holmes et al., 2017, p. 56).

According to Holmes et al. (2017), the Housing First model, not available initially in Australia, has become the primary aim for helping Australians maintain housing. “People with psychosis are over represented amongst people experiencing chronic homelessness. Predominantly men, they often use drugs and alcohol, and have histories of childhood trauma and incarceration” (Holmes et al., 2017, p. 56). Adopting a housing first approach allows treatment of homeless persons as consumers able to make choices and entitled to housing as a human right (Holmes et al., 2017, p. 57).

Difficulties with substance use, mental disorder, and behavioral disturbance are all tolerated within the framework of housing first (Holmes et al., 2017, p. 57). The researchers applied a quasi prospective cohort method, studying a population of 162 homeless clients from 2010 to 2015 (Holmes et al., 2017, p. 57). The authors concluded that “supportive accommodation lead to a marked improvement in accommodation stability and client well-being” (Holmes et al., 2017, p. 58).

Stability allowed for client-clinician relationships, tolerance reflected a willingness to accept clients into housing, and collaboration allowed for the “development of complex strategies to deal with challenging behavior. In particular, when difficulties arose, admission or eviction was not seen as the default option . . .” (Holmes et al., 2017, p. 58). In contrast, the continuum of care model would have permitted evictions.

The researchers’ approach to permanent supported housing by focusing on housing stability is useful for determining if homeless persons will exit the program. The housing first model is tolerant. However, people will leave, as the researchers note, permanent housing despite its permanent nature (Holmes et al., 2017, p. 58).

Jones, S. H., Barrowclough, C., Allot, R., Day, C., Earnshaw, P., & Wilson, I. (2011). Integrated motivational interviewing and cognitive-behavioral therapy for bipolar disorder with comorbid substance use. Clinical Psychology and Psychotherapy, 18, 426-437. Retrieved from https://thechicagoschool-chi.worldcat.org/title/integrated-motivational-interviewing-and-cognitive-behavioural-therapy-for-bipolar-disorder-with-comorbid-substance-use/oclc/5152860719&referer=brief_results

Jones et al. (2011) outline comorbid substance use as a common problem for bipolar disorder. Studies to date concentrate primarily on cognitive behavioral approaches which the authors believe are not equipped to measure the ambivalence to change. The authors, therefore, provide the first report of an integrated psychological treatment approach for bipolar disorder comorbid with substance use by combining both motivational interviewing with cognitive-behavioral therapy to address ambivalence and encourage the patient to address substance use.

Using case studies, the researchers help patients confront their cannabis use, explore social and psychological obstacles to recovery, suggest MI and CBT as useful therapeutic tools for improving mood symptoms and impulsiveness. This research will be useful for supporting the idea that reflection leads to recovery.

Melnick, I. (2016). Passageway: A novel approach to success of conditional release – principles and constructs of the model residential program for the forensic mentally ill patient. Behavioral Sciences and the Law, 34, 396-406. Retrieved from https://thechicagoschool-chi.worldcat.org/search?q=Passageway%3A+A+novel+approach+to+success+of+conditional+release+%E2%80%93+principles+and+constructs+of+the+model+residential+program+for+the+forensic+mentally+ill+patient&qt=owc_search&dblist=638&scope=1&oldscope=1&fq=

The author reviews the concept of conditional release and its history, tracing it back to legislation. Due to deinstitutionalization of psychiatry in 1968, mentally ill patients have been prematurely discharged from forensic state hospitals, leaving them homeless and leading to revocation of conditional release. Patients were released back into the community without life skills training. Patients with schizophrenia and bipolar disorder are uniquely vulnerable.

To solve this problem, Tom Mullen created The Passageway Program in 1979, designing and implementing psycho-educational intervention for the patient population, which consists of conditional releases. The author explores the services the program offers, which include case management and comprehensive treatment planning, and related community-based services such as detoxification and financial assistance.

This research will be useful for developing a hypothesis that centers on exploring the idea that long-term community programming, including both residential and aftercare, might aid in reducing chronic homelessness.

Somers, J. M., Moniruzzaman, A., & Palepu, A. (2015). Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to housing first or usual care. Addiction Research Report, Society for the Study of Addiction, 110, 1605-1614. Retrieved from http://web.b.ebscohost.com.tcsedsystem.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=1&sid=7f7239e6-2c93-4bda-9780-b1c688a1d79a%40sessionmgr104   

Somers et al. (2015) compared daily substance use (DSU) between homeless clients receiving support services in Housing First programs and homeless clients receiving support services under treatment as usual (TAU). The participants of the study were homeless comorbid with mental illness. The researchers conducted two “concurrent randomized controlled trials with 24-month follow-up” as part of the Vancouver At Home study (Somers et al., 2015, p. 1605-1606). The setting was a single-building, market rental apartments with support services.

Housing First clients received independent housing with support services, “with an emphasis on promoting client choice and harm reduction in relation to substance use” while treatment as usual clients received existing services and support available for homeless clients with mental illness (Somers et al., 2015, p. 1605). Eight-hundred were assessed for eligibility; 497 underwent need level assessment with 297 with high needs and 200 with moderate needs (Somers et al., 2015, p. 1609).

Daily substance use among the homeless is typically associated with severe psychiatric symptoms as well as chronic physical illness and chronic homelessness (Somers et al., 2015, p. 1605). The researchers concluded that “Housing First, an intervention to support recovery for homeless people who have co-occurring mental illness and substance use disorders, did not reduce daily substance use compared with treatment as usual after 12 or 24 months” (Somers et al., 2015, p. 1605, 1614).

This information is useful for determining which clinical intervention might be appropriate for U.S. Housing First clients with serious mental illness (SMI). Would traditional care be appropriate be appropriate? Or could Housing First organizations design policy to address daily substance use in clients who feel bored?

These are questions that can be answered by comparing this study with the Gabrielian et al. (2017) study on “They’re Homeless in a Home” in which participants report unmet mental health and independent living needs. One participant with a substance use disorder stated, “I had a lot of idle time [in my VASH apartment] and I was depressed . . . people were coming by asking me where they can buy weed. People were drinking when I was going to the store. I was lonely and I was looking for companionship so I started using” (Gabrielian et al., 2017, p. 161).

Comparing studies in which clinical intervention was utilized or necessary might help to provide insight into understanding negative outcomes leading to premature exits in U.S. Housing First programs.

Speer, J. (2017). It’s not like your home: Homeless encampments, housing projects, and the struggle over domestic space. Antipode, 49 (2), 517-535. Retrieved from http://web.a.ebscohost.com.tcsedsystem.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=1&sid=c9861f30-6c3e-4278-84f7-71017580e5bc%40sessionmgr4006

Speer (2017) discusses how anti-homeless policies and policing “constrain homeless people’s expressions of home” (p. 517). The struggle over “domestic space” has become a fixture in contemporary politics (Speer, 2017, p. 517). The struggle is represented as a “clash between competing visions of home” (Speer, 2017, p. 517). Speer (2017) focuses on Fresno, CA homeless encampments in which the homeless assert “alternative notions of home grounded in community rather than family” (p. 517).

As part of a broader effort, the Fresno Housing Authority is pushing homeless people into permanent supportive housing. But the plan only accounts for roughly 10 new housing subsidies, which further perpetuates the necessity of the homeless to maintain self-made shelters. According to Klodawsky (2009), the push towards Housing First ignores the need of homeless people who have created communities among themselves (as qtd. in Speer, 2017, p. 517).

It pushes “unwanted domestic norms onto homeless people while preventing them from creating their own homes” (Speer, 2017, p. 517). Speer interviewed 24 people who consisted of 9 officials involved in homeless management, 8 homeless, and 7 local activists (2017, p. 518). The 8 homeless were living in housing at the time of interviewing, but they had lived in encampments.

Speer is pushing for a holistic approach to politics concerning U.S. homelessness instead of a politics of eviction and demolition. This source will be useful for supporting the notion that chronic homelessness is cultural phenomenon and that homeless individuals feel that they have created a community.

Tobey, M., Manasson, J., Decarlo, K., Ciraldo-Maryniuk, K., Gaeta, J. M., & Wilson, E. (2017). Homeless individuals approaching the end of life: Symptoms and attitudes. Journal of Pain and Symptom Management, 53, 738-744. Retrieved from https://thechicagoschool-chi.worldcat.org/title/homeless-individuals-approaching-the-end-of-life-symptoms-and-attitudes/oclc/7000738695&referer=brief_results Homeless individuals die at a greater rate than their domiciled peers. The study examined symptoms of homeless individuals nearing end of life. The investigators used surveys of homeless individuals living at a respite home. Results revealed that homeless individuals suffered at high rates of substance use disorders and psychiatric diagnoses.

Additional symptoms included previous experiences with death and dying, mistrust of others’ decisions, and concerns about receiving too little care. The median age for this population was 58 years old and individuals complained of pain, fatigue, and depression. The researchers concluded that homeless individuals experience a higher frequency of pain and other symptoms as they reach end of life. Limitations of the study suggests that inclusion of women as a sample might have produced different results.

This research will be useful for tracing the lifespan of the chronically homeless from onset of mental illness to end of life.

Walsh, C. A., Rutherford, G., & Kuzmak, N. (2010). Engaging women who are homeless in community-based research using emerging qualitative data collection techniques. International Journal of Multiple Research Approaches, 4, 192-205. Retrieved from https://thechicagoschool-chi.worldcat.org/title/engaging-women-who-are-homeless-in-community-based-research-using-emerging-qualitative-data-collection-techniques/oclc/4809076718&referer=brief_results

Walsh, Rutherford and Kuzmak (2010) use qualitative research as one part of multiple data collection methods. The authors review multiple methods, but central to this paper is the photovoice, digital storytelling, and poetry. The goal of the research was to help homeless women create their own meaning of “home.” Through digital storytelling and photovoice, homeless women compiled various images of their definition of home and created a digital representation, giving voice by developing emotional reactions.

The researchers also consider poetry as a therapeutic tool. The researchers conducted nine individual interviews during a two-month period which lasted approximately 60 minutes. The research produced ten distinct code families, three sub-categories, and concluded challenges for implementation. Although there were challenges, they also concluded that the qualitative data collection technique was useful.

This source will be useful for supporting the argument that narrative writing might be an effective intervention tool for the chronically homeless because of its value in encouraging reflection.

Winetrobe, H., Wenzel, S., Rhoades, H., Henwood, B., Rice, E., & Harris, T. (2017). Differences in health and social support between homeless men and women entering permanent supportive housing. Women’s Health Issues, 27 (3), 286-293. Retrieved from https://www-sciencedirect-com.tcsedsystem.idm.oclc.org/science/article/pii/S1049386716304066?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb&ccp=y

The authors conclude that there are gender differences in homeless adults receiving mental health and social support within permanent supportive housing environments. The results reveal that compared with men, women (28% of the sample size of 421) were younger, less likely to have a high school diploma, had more chronic mental health issues but had a larger social network than men.

Men reported veteran status and longer duration in homelessness, 2.5 years. Understanding the differences is important “for ensuring that housing and supportive services are appropriately tailored to meet the potentially disparate needs of men and women” (Winetrobe et al., 2017, p. 287).

However, the problem with the article is that it heavily leans on the differences with women and not necessarily on men. Both genders are compared or contrasted, but there is not a balance of each gender’s struggles. The researchers essentially list everything wrong with the homeless women who live in PSH but fail to explore the homeless men except to suggest that X (women) were more likely than Y (men) to report a mental health condition; the discussion does not begin with a Y to X comparison.

Homeless women received more financial benefits, had more contact with relatives, had no high school education, reported less income, and had chronic physical and mental health conditions. In the researchers’ defense, “gender differences in demographic and background characteristics were not a focus of this paper . . .” (Winetrobe et al., 2017, p. 289).

Nevertheless, they conclude that permanent supportive housing cannot be a one-size-fits-all approach. Concerning this topic for my ARP, my approach will be two-part: (study of) program design and (ARP) program evaluation of PSH programming. I am considering those organizations that provide half-way house services, particularly Salvation Army for homeless adults suffering with substance addiction. Study of the clientele might include either the chronically homeless, the recently paroled, or the military in transition, or all three.

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