Supportive Housing Works (for most). Don’t Throw the Baby Out with the Bathwater

This post was written by Dr. Emmy Tiderington, Assistant Professor of Social Work at Rutgers, The State University of New Jersey. 

The State of New York’s rush to move mentally ill adult home residents into independent, supportive housing, as detailed in the December 6th New York Times article, “’I Want to Live Like a Human Being’: Where N.Y. Fails Its Mentally Ill”, was in many ways a horrific failure. But, this does not mean that the supportive housing model endangers people and that we should throw the proverbial “baby out with the bathwater”. Supportive housing isn’t to blame—the service system is to blame.

Having worked with people with severe mental illness for years in a New York City supportive housing program and in other community settings, I have seen individuals like those described in this article who struggle to live independently in these settings. But I’ve had many more recipients of these services tell me that this combination of housing and supports saved their lives. Decades of research have shown that supportive housing works for the vast majority of recipients. Housing stability in these programs is high, upwards of 93% in a recent federal demonstration project and far higher when compared with “care as usual” in homeless services. The model is considered a best practice by the federal government and has been employed effectively to end homelessness in many cities across the nation .

There is a small percentage of people who do not succeed in supportive housing and need a higher level of care, as these studies also show. But the U.S. Supreme Court’s 1999 Olmstead v. L.C. decision, which precipitated New York’s and other states’ efforts to move people out of institutional facilities, mandates that communities ensure that people with disabilities are given the chance to live in the “most integrated, least restrictive setting possible” and there is an ethical imperative to give people this opportunity.

States should have taken a lesson from the failures of deinstitutionalization, the period from the 1950s onward during which patients from state psychiatric hospitals were discharged en masse to an inadequate array of community-based services. The poor implementation of this public policy is one of the major contributing factors to the modern era of homelessness, when thousands of people with severe mental illness fell through the cracks and visible street homelessness reemerged as a major social problem in the United States. Deinstitutionalization offers a cautionary tale, whether its 1950 or 2018. Without adequate resources in place, systems cannot keep people safe.

To avoid the tragedies described in the NY Times, New York should have ensured an appropriate array of services existed in the community before transitioning people out of adult homes. While the type of supportive housing used in the adult home transition may not have worked for some, other forms of supportive housing with greater capacity for supervision could have been used to meet the needs of this group. Unlike the scatter-site apartments used in the transition, which scattered people in independent apartments throughout the community, congregate supportive housing buildings with on-site social services are physically set up to allow for more supervision. With robust funding for high-intensity services in this type of setting, people could get the supervision and services they need while living in their own apartment in the community.

For those who cannot make it in any form of community-based housing, available alternatives are necessary. Finding a psychiatric inpatient bed for individuals who meet the legal threshold of being “a danger to themselves or others” in some communities, like New York City, can be extremely challenging. A 2016 Pew report found that the United States is 123,300 psychiatric hospital beds short of what is needed. When there are no beds available, a person is often stuck in a revolving door from a supportive housing apartment to a 48-hour hold in a psychiatric emergency room and then straight back into supporting housing.

To keep people safe in the community and in the “least restrictive, most integrated setting possible”, we need a robust safety net of accessible, appropriate resources. While the adult home transition failed many, and tragically so for some, it did go well for most and should not be a reflection on the quality of care offered by supportive housing. Instead, this failure should shed light on the still inadequate and underfunded social service system for people with severe mental illness. We should use this week’s revelations to illuminate places for improvement rather than blaming a housing approach that has vastly improved the lives of many decades after the injustices of deinstitutionalization.

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Emmy Tiderington, PhD, is an Assistant Professor of Social Work at Rutgers, The State University of New Jersey. She previously worked as a social work supervisor at a New York City-based supportive housing program.

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Syracuse University SSW Hosts Legislative Policy Symposium on Homelessness

Addressing “The Many Faces of Homelessness in New York State” was the focus of the Syracuse University School of Social Work’s 20th Annual James L. Stone Legislative Policy Symposium held Friday, October 26, 2018, at the Onondaga County Legislative Chambers in Syracuse, New York.

As a central feature of our Bachelor of Science in Social Work (BSSW) and Master of Social Work (MSW) curricula, this event is designed to reinforce the importance of, and commitment to, policy practice as a professional responsibility. Each year students and faculty take a day to explore the roles that social workers, advocates, legislators, community leaders, and service providers play as issues affecting vulnerable populations emerge onto the public agenda, move through legislative processes, and as policy and programmatic interventions are implemented. The goal is to further strengthen the commitment of social work students to participate, as professionals and citizens, in advancing the ideas and values of the profession through policy practice. These symposia have been made possible by the generosity of James L. Stone, a distinguished alumnus (MSW ’64) and former Commissioner of the New York State Office of Mental Health. IMG_7131

Dr. Robert L. Okin (pictured right)  recipient of the American Psychiatric Association’s Human Rights Award and author of Silent Voices: People with Mental Disorders on the Streetkeynoted the conference, noting that “when you see homelessness up close and personal, it’s clear that it represents a severe moral problem for society as well as an absolute humanitarian crisis.”

Notwithstanding that “19,000 more people became homeless than stopped being homeless last year,” Andrew Hevesi, New York State Assembly Member and Chair of its Social Services Committee (pictured below with Amanda Aykanian, Research and Project Lead at NCEHS), warned that “the state has been walking away from its responsibility.” Relative to the expenses incurred by counties, New York State is paying a smaller portion of the cost of housing and related services for people who are homeless than it had in the past. Other presenters highlighted how they harness their own homelessness advocacy skills, with and on behalf of persons who are homeless, to educate the public and expand services. Still others, while also discussing how much remains to be done, shared their knowledge of innovative efforts to address homelessness in central New York, including providing “street corner” health interventions, constructing tiny home communities, forming coalitions, and implementing social services.

We invite you to take a look at the following videos of the presentations made over the course of the day. They are available for classroom and other professional usage.

Conference participants learned about the problems facing New Yorkers who are homeless  89,500, according to a point-in-time survey, including 526 in Onondaga County. When “doubling-up” with relatives or friends is counted, frighteningly, the Syracuse School district reported that one-in-ten students, 2,464, were homeless in 2016 a number only exceeded by the New York City school district. We were reminded that the experience of being homeless falls disproportionately on persons with physical and behavioral disabilities, communities of color, LGBTQ youth, people who are impoverished, and children and women, including families experiencing domestic violence. And, many of our presenters discussed the harsh reality of how homeless populations are often marginalized and unseen. They are sometimes criminalized, often experience a loss of personhood, and subject to routine violations of “civil, political, economic, social, and cultural rights, …especially the rights to housing and freedom from non-discrimination and cruel, inhuman, and degrading treatment” (National Law Center on Homelessness and Poverty).

IMG_7183This year’s symposium was well-timed to the Council on Social Work Education’s growing interest in integrating homelessness into social work curricula. We were fortunate to have the advice and presence of Amanda Aykanian (pictured left, with Assembly Member Hevesi), a Ph.D. candidate at the University at Albany (SUNY) School of Social Welfare and Research and Project Lead at the National Center for Excellence in Homeless Services. She and her colleagues are working to strengthen social work education to better address homelessness and to expand field placements for students in homeless settings. According to Ms. Aykanian, it is important that social workers continue to advocate for change at all levels.IMG_7283

The importance of this work to the social work profession, and more importantly to people who are homeless, was driven home by Al-amin Muhammad (pictured right), founder of We Rise Above the Streets Recovery Outreach, a Syracuse organization recognized for its “Sandwich Saturdays.” He regularly engages large numbers of volunteers on Saturdays in directly engaging and providing food to people who are homeless. Here’s what one interaction with a social worker meant to him when he experienced homelessness:

“I was about to commit suicide until a social worker walked up to me. He remembered me when I signed up for the detox center and told me my name was at the top of the list. He’d been looking for me. This social worker saved my life.”

Later in his journey, he says, “I finally told myself I was somebody. All my life people told me I would never amount to anything, and I believed that, until the social worker told me that I was somebody.”

We are a profession that respects the resiliency and strength described above. Our profession’s work embraces the tradition of respecting the worth of humankind.

Syracuse University School of Social Work is pleased to be a part of the National Center’s New York/New Jersey Regional Network. We have many excellent field placements that connect to homeless services. We are currently infusing more content on homelessness into our course offerings. We will continue to maintain a focus on empowerment and ethical adherence associated with homeless populations.

The slide show below features additional pictures of presenters, students, and other attendees.

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Blog Post Authors:

Eric R. Kingson, Ph.D., Professor, Syracuse University School of Social Work, Falk College

Keith A. Alford, Ph.D., M.S.W., Director and Associate Professor, Syracuse University School of Social Work, Falk College

Alexandra Leigh Kerr, M.S.W. Student, Graduate Assistant, and Coordinator of 2018 Legislative Policy Day Symposium, Syracuse University School of Social Work, Falk College

Evaluating the Evidence: Permanent Supportive Housing and Health Outcomes

The faculty at the University of Southern California Suzanne Dworak-Peck School of Social Work, one of the National Center’s regional hub schools, continue to make significant contributions to the field of homelessness research. In September, the Homelessness Policy Research Institute at USC held a research symposium on the impact of permanent supportive housing on health outcomes for people experiencing chronic homelessness. The symposium’s program was built around a recent report from the National Academy of Sciences, which was co-authored by Dr. Suzanne Wenzel, a professor of social work at USC. Dr. Wenzel presented findings and implications from the report at the research symposium. The key takeaways include the following:

  • PSH is effective in keeping people stably and safely housed and has great potential for reducing the number of people experiencing chronic homelessness and improving their health outcomes;
  • Existing data is too limited to demonstrate definitively that PSH contributes to improved health outcomes; and
  • There is a need for more well-designed, high quality research studies to more clearly define the impact of PSH on health outcomes.

You can view highlights of the symposium below or watch a recording of the entire event here.

REALSYT Collaborative Works to End Youth Homelessness

“The best work happens in collaboration, not  in a vacuum.” The origin of this quote is unknown, but it’s more than likely somewhere outside of academia. Researchers and academics, for better or worse, can often feel isolated, covertly competitive, and disconnected. This has contributed to disconnected community-based researchers that are reliant on small samples collected in single localities, limiting the ability to draw connections to a broader experience. In 2016, in spite of these traditional approaches, seven researchers came together in collaboration to overcome inherent challenges in the world of research. All with the shared goal of ending youth homelessness.

The Research, Education, and Advocacy Co-Lab for Youth Stability and Thriving, or REALYST, is a national collaborative of academic and community partners that uses research to inform innovative policies, programs, and services aimed at ending homelessness and housing instability among young people. REALYST members are interdisciplinary, representing a variety of fields and research areas. Some members focus on sexual health, while others examine social media use and opportunities for innovative service outreach. The co-lab holds monthly meetings where members can seek consultation from colleagues and use feedback to build their programs of research. REALYST researchers co-author peer-reviewed papers, using data from the Homeless Youth Risk and Resilience Survey (HYRRS), which to date has surveyed 1,426 young persons experiencing homelessness and housing instability across seven cities. Initial publications include an exploration of sexual health knowledge and access to HIV-prevention medication, service experiences of LGBTQ individuals, and prescription drug misuse. Learn more about the HYRRS here.

REALYST is committed to overcoming another common research challenge – making findings accessible to support service providers and policy makers invested in making evidence-informed decisions. Relationships between researchers and practitioners are integral to REALYST’s approach to advocacy and change. Community agencies assist with the collection of data, and researchers are committed to sharing findings with their community partners. A team of REALYST graduate students works to disseminate findings from recent publications via briefs, blog posts, and social media in order to inform policy makers and service providers, change public perception, and educate young people facing housing instability. In doing so, REALYST contributes to the Grand Challenge of Ending Homelessness by intentionally bridging the gap between research and practice to prevent and eliminate youth and young adult homelessness.

Together, researchers, practitioners, and advocacy groups discuss the data and its implications, brainstorming new approaches to service delivery and new research questions.

Interested in learning more or partnering with REALYST? Contact them here.

The REALYST team includes researchers and graduate students from multiple partners of the National Center for Excellence in Homeless Services. This post was written by Jonah DeChants and Robin Petering.

JonahJonah DeChants is a doctoral candidate at the University of Denver’s Graduate School of Social Work (GSSW). He uses community-based research methods to study the experiences of youth and young adults experiencing homelessness, particularly those who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ).

 

robinRobin Petering, PhD is interested in improving the lives of young people who experience homelessness through community-inclusive research, policy advocacy, and program implementation. Her research agenda includes reducing violence through innovative intervention approaches.

Research Round-Up: Recent Publications from National Center Partner School Faculty

We feature a lot of our partner schools’ community-based collaborations and service learning activities on this blog, but our faculty contacts are also leading homelessness scholars. This blog post features just 10 of the peer-reviewed journal articles published in 2018 by homelessness researchers at our partner schools. These publications cover a range of topics related to homeless youth and adults, permanent supportive housing, and homeless service provision. Consider adding one of these to your course syllabi this semester. And, if you’re looking for additional readings, check out our curriculum resource page.

  1. Aykanian, A. (2018). Service and policy considerations when working with highly mobile homeless youth: Perspectives from the frontlinesChildren and Youth Services Review, 84, 9-16. Read more here.
  2. Bender, K., Begun, S., Dunn, K., Mackay, E., & Dechants, J. (2018). Homeless youths’ interests in social action via photovoice. Journal of Community Practice, 26(1), 107-120. Read more here.
  3. Crutchfield, R. (2018). Under a temporary roof and in the classroom: Service agencies for youth who are homeless while enrolled in community college. Child and Youth Services. Read more here.
  4. Henwood, B., Lahey, J., Harris, T., Rhoades, H., & Wenzel, S. (2018). Understanding risk environments in permanent supportive housing for formerly homeless adults. Qualitative Health Research. Read more here.
  5. Lee, W., & Plitt Donaldson, L. (2018). Street outreach workers’ understanding and experience of working with chronically homeless populations. Journal of Poverty. Read more here.
  6. Piat, M., Sabetti, J., & Padgett, D. (2018). Supported housing for adults with psychiatric disabilities: How tenants confront the problem of loneliness. Health and Social Care in the Community, 26(2), 191-198. Read more here.
  7. Narendorf, S. C., Bowen, E., Santa Maria, D., & Thibaudeau, E. (2018). Risk and resilience among young adults experiencing homelessness: A typology for service planning. Children and Youth Services Review, 86, 157-165. Read more here.
  8. Rhoades, H., La Motte-Kerr, W., Duan, L., Woo, D., Rice, E., Henwood, B., Harris, T., & Wenzel, S. (2018). Social networks and substance use after transitioning into permanent supportive housingDrug and Alcohol Dependence, 191(1), 63-69. Read more here.
  9. Tiderington, E. (2018). “The apartment is for you, it’s not for anyone else”: Managing social recovery and risk on the frontlines of single-adult supportive housingAdministration and Policy in Mental Health and Mental Health Services Research, 45(1), 152-162. Read more here.
  10. Wagamann, M. A., Shelton, J., & Carter, R. (2018). Queering the social work classroom: Strategies for increasing the inclusion of LGBTQ persons and experiences. Journal of Teaching Social Work, 38(2), 166-182. Read more here.

While peer-reviewed articles are typically not publicly available, you can obtain full-text copies of any article by contacting the author(s).

Nazareth College Supports Local Project Homeless Connect

This post was written by Leanne Charlesworth and Jed Metzger, faculty in the Nazareth College Department of Social Work.

Project Homeless Connect Rochester (PHCR) began in 2009 as a volunteer-driven annual event dedicated to connecting homeless individuals and families to housing and other critical resources. Modeled after San Francisco’s Project Homeless Connect (https://www.projecthomelessconnect.org/), the explicit mission of PCHR is to “rally the city to support and create lasting solutions for homeless Rochesterians” (see http://www.homelessconnectrochester.org/about.php).


Homelessness Nationally
According to the National Alliance to End Homelessness, many low-income households face risk of homelessness due to the lack of affordable housing in their communities. Doubling-up with family and friends is one of the most common living situations just prior to experiencing homelessness.

According to nation-wide Point in Time Count data:

Most people experiencing homelessness are living in some form of transitional housing or shelter; approximately one-third are living in a place not meant for human habitation (e.g., outdoors).

Veterans comprise less than 10% of the homeless population. According to the Center for Evidence-Based Solutions to Homelessness, the homeless veteran population in the U.S. has steadily declined over the last few decades.

Chronically homeless adults, homeless families with children, and homeless youth are groups in need of particular attention in terms of meeting housing and service needs.


PHC 2016PHCR entrance interviews conducted by Nazareth College social work student volunteers (pictured right) indicate the one-stop venue serves approximately 700 individuals and families annually. Each year, about half of PHCR guests report they did not sleep in their own home on the night prior to the event; some slept with friends and family members, some slept in shelters, and some slept on the street. And, approximately half of those who slept in their own homes face the threat of eviction within three weeks.

PHCR guests roughly reflect nationwide homelessness figures. The racial and ethnic backgrounds of guests vary widely, and women and men are almost equally represented.

Following is information about the guests served by PHCR in 2017 according to completed entrance interviews:

  • Most were men (57.1%, n=349)
  • More than half were African American (54.7%, n=341)
  • Approximately 1 in 10 identified as Hispanic or Latino (11.4%, n=71)
  • Approximately 1 in 10 identified as a veteran (9.9%, n=58)
  • The average age was 44 (with ages ranging from 15 to 85)
  • Primary reasons for attending PCHR were to obtain identification, winter clothing, and linkages to services, such as housing and employment resources

As guests left PCHR, they reported high levels of satisfaction with the volunteers and the spirit of the event. Approximately 439 individuals completed a voluntary exit survey in 2017. The majority (85%, n=375) found participating in PHCR very helpful and 88% (n=389) stated that the event helped connect them to the services they needed.

As we approach its 10th anniversary, PHCR continues to be organized and implemented by a community-wide team of agency representatives and volunteers. The Nazareth College Department of Social Work plays a critical role within this team. Faculty members Jed Metzger and Leanne Charlesworth attend the PHCR Planning Committee’s monthly meetings, reviewing annual event data, and work collaboratively toward continuous improvement. Current efforts are focused on refining service provider and volunteer training prior to the event and during orientation on the day of the event.

Nazareth College BSW and MSW students comprise the majority of PHCR volunteers, serving as either entrance interviewers or guest escorts. Student roles are tied to diverse service learning assignments specific to distinct social work courses across the curriculum. Observing that many social work students repeatedly volunteer at PCHR during their years in the undergraduate and graduate social work programs, Metzger and Charlesworth have seized this opportunity to initiate scaffolding of student volunteers. During the upcoming fall 2018 event, seasoned social work students will mentor students new to the event, providing shadowing experiences and serving as a mobile help desk during the event.

Although all Nazareth College social work faculty members have supported PCHR since its inception, the role of additional social work faculty in orienting and directing student volunteers has become more integral to successful PCHR implementation in recent years. The scope of Nazareth College student and faculty volunteers has also expanded significantly to address the need for (ASL and Spanish) interpretation services, a stream-lined resource (e.g., coat, toiletry) distribution system, and transportation.

As PCHR grows in scope and presence within the Rochester community, the PHCR Planning Committee is working to ensure all service providers understand the goals of the event. New strategies have been identified to communicate with participating agencies including the design of an online training tool for service providers. The goal is strengthened connections with critical partners, such as county departments, shelter directors, and other academic departments within a range of institutions of higher education.

PHCR offers a few suggestions to other communities considering their own Project Homeless Connect:

  • Collaborate with local government officials
  • A host site at a large central venue is essential
  • Enlist leaders from critical sectors across the local academic, government, and service communities
  • Emphasize same-day service and resource provision rather than referrals

The next PHCR event will be held on September 13, 2018. Stay tuned for Rochester updates via homelessconnectrochester.org. Below are pictures that capture the venue and check-in process.

PHC.3PHC.2 2016

Nazareth College Supports 10th Annual Project Homeless Connect in Rochester, NY

Project Homeless Connect Rochester
Project Homeless Connect Rochester (PHCR) began in 2009 as a volunteer-driven annual event dedicated to connecting homeless individuals and families to housing and other critical resources. Modeled after San Francisco’s Project Homeless Connect, the explicit mission of PCHR is to “rally the city to support and create lasting solutions for homeless Rochesterians”.

PHCR entrance interviews conducted by Nazareth College social work students indicate the “one stop” venue serves approximately 700 individuals and families annually. Each year, about half of PHCR guests report that they did not sleep in their own home on the night prior to the event – some slept with friends and family members, some slept in shelters, and some slept on the street. Approximately half of those who slept in their own homes face the threat of eviction within three weeks.


Homelessness Nationally

  • Many low-income households face risk of homelessness due to the lack of affordable housing in their communities.
  • “Doubling-up” with family and friends is one of the most common living situations just prior to experiencing homelessness.
  • The majority of the population experiencing homelessness is living in some form of transitional housing or shelter; approximately one-third are living in a place not meant for human habitation.
  • Veterans comprise less than 10% of the  homeless population. The homeless veteran population in the U.S. has steadily declined over the last few decades.
  • Chronically homeless individuals and families often have particularly complex needs.

In 2017, PHCR guests roughly reflected nationwide homelessness figures:

  • More men (57%) than women completed entrance interviews.
  • More African-American individuals (55%) than other racial groups completed entrance interviews.
  • Approximately one in ten was Hispanic or Latino.
  • Approximately one in 10 guests was a veteran.
  • Age varied from teens to elderly individuals, with middle-aged adults most heavily represented. The average age of those completing entrance interviews was 44, with self-reported ages ranging from 15 to 85.

PHC FloorPictured right is guests being checked-in to the PHCR event. Guests report their primary reasons for attending PHCR are concrete: to obtain identification, winter clothing, and linkages to services, such as housing and employment resources.

As guests leave PHCR, they report high levels of satisfaction with the volunteers and the spirit of the PHCR event as a whole. Approximately 439 individuals completed a voluntary exit survey in 2017. The vast majority (85%) found participating in PHCR very helpful and 88% stated that the event helped connect them to the services they needed.

Planning for the 10th Annual PHCR
As it approaches its 10th anniversary, PHCR continues to be organized and implemented by a community-wide team of agency representatives and volunteers. The Nazareth College Department of Social Work plays a critical role within this team. Faculty members Jed Metzger and Leanne Charlesworth attend the PHCR Planning Committee’s monthly meetings, reviewing annual event data and working collaboratively toward continuous improvement. Current efforts are focused on refining service provider and volunteer training prior to the event and orientation on the day of the event.

Student conducting entrance interviewPictured left is a PHCR student volunteer. Nazareth College BSW and MSW students comprise the majority of PHCR volunteers, serving as either entrance/exit interviewers or guest escorts. Student roles are tied to diverse service learning assignments specific to distinct social work courses across the curriculum. Observing that many social work students repeatedly volunteer at PCHR during their years in the undergraduate and graduate social work programs, Metzger and Charlesworth have seized this opportunity to initiate scaffolding of student volunteers. During the upcoming fall 2018 event, seasoned social work students will mentor students new to the event, providing shadowing experiences and serving as a mobile “help desk” during the event.

Although all Nazareth College social work faculty members have supported PHCR since its inception, the role of additional social work faculty in orienting and directing student volunteers has become more integral to successful PHCR implementation in recent years. The scope of Nazareth College student and faculty volunteers has also expanded significantly to address the need for (ASL and Spanish) interpretation services, a stream-lined resource (e.g., coats, toiletries) distribution system, and transportation.

As PCHR grows in scope and presence within the Rochester community, the PHCR Planning Committee is working to ensure all service providers understand the goals of the event. New strategies have been identified to communicate with participating agencies including the design of an online training tool for service providers. The goal is strengthened connections to critical partners, such as county departments, shelter directors, and academic departments within other institutions of higher education.

Suggestions for Communities Interested in Hosting a PHC
PHCR offers a few suggestions to others considering development of their own Project Homeless Connect:

  • Collaborate with local government officials.
  • Secure a host site. A large, central venue is essential.
  • Enlist leaders from critical sectors across the local academic, government, and service communities.
  • Emphasize same-day service and resource provision rather than referrals.

The next PHCR event will be held on September 13, 2018. Stay tuned for Rochester updates via homelessconnectrochester.org.

Blog Post Authors: Leanne Charlesworth and Jed Metzger, Professors of Social Work at Nazareth College.