EmBRACE the Journey

By: SUE IRWIN, MA (Education), PGCE, BSc (Physics – Hons) 

Within the UK and across the World more people are becoming aware of Adverse Childhood Experiences (ACEs), how common they are and the impact they can have on behaviour and health. So many people have been able to resonate with the subject within their own lives, whether that is on a personal or professional level or both. Having this realisation and an awareness of ACEs is important, but this is just the starting point. As a society it is paramount that we weave the ACEs science through our communities, address the impact of ACEs and understand how to make the necessary changes needed. However, it is evident from the question ‘how do we take the research and put it into practice?’, which I am very often asked, people do not always know how to do this. In response to the emerging evidence on ACEs, and to address such a poignant question, I founded a new and dynamic cultural change and  

leadership programme. Initially focussed within an educational setting, the programme has evolved to enable multi-agency programmes to adopt the approach and become Trauma-Informed. The cultural change programme is called ‘Emotionally and Brain Resilient to Adverse Childhood Experiences’, or EmBRACE for short. The strength of EmBRACE is that it is implemented over a period of time to embed and consider how the organisation becomes ACE Aware and ACE and Trauma Informed. EmBRACE also challenges resistance to change and recognises that each establishment is different. To achieve this various change management tools are implemented.

The use of language and buy in from staff have been two critical components which have provided the foundations for cultural change within the organisations I have worked with. Staff need to be given the time and: supported with their thinking; opportunities to reflect. Subsequently, they have been able to recognise that EmBRACE is not an initiative and identify already trauma informed good practice, which is empowering for practitioners. Staff need to feel confident with the trauma informed language and any new practices they may implement. Building this into procedures and policies must be addressed and led by the senior management team to ensure capacity building and sustainability. 

Inspire Blackburn with Darwen (BwD), UK is an integrated Prevention and Drug Recovery Service. As an organisation they recognised the prevalence of ACEs for clients/service users and wanted to explore how they could make the necessary changes to become ACE and Trauma Informed to support further their service users. Subsequently, I was commissioned to work with them to implement EmBRACE. Recovery Support Coordinator from Inspire (BwD), and now lead ACE Champion, James Houghton, also recognised ‘There are reasons underpinning peoples’ negative behaviours, which are because of something else. All services e.g. substance mis-use, social services, dealing with depression, in general, are geared up to manage the symptoms. A high percentage of the causes and conditions of negative behaviours are based in the person’s thinking, often being that they have a negative perception of life in general, including the perception they have of themselves. This can lead to a manifestation of not only ACEs but adversity in adulthood too, which can come in various forms. The common denominator is perception and how this manifests within the thought process e.g. “I’m not as good” or “I’ll never be able to achieve what they have” The negative thoughts are then displayed in the behaviour. As a result of this, someone won’t then engage in activities they want to go to or apply for a job etc. For society in general, these negative thought patterns don’t manifest into something major. However, for the extremes, which are a minority of society, there are organisations like Inspire who deal with them. Because of an adverse experience people find coping strategies and display a variety of behaviours. The more adversity somebody experiences, the more susceptible they become to more negative behaviours. When this happens, what people do is mummify themselves. They protect themselves with a ‘bandage’ which enables them to manage, a process which will have no doubt taken years for them to do. Then as ‘Services’ we unwrap them without dealing with the issues as to why they are doing this’.  

A number of key components when supporting Inspire (BwD) with their Trauma Informed Journey was for them as an organisation to strategically: realise the science and impact of ACEs; know how to weave this into practice, procedures and policies.

Working with James Houghton, these key components have been addressed through the delivery of the EmBRACE Workshops, which have also provided a platform for clients to reflect through an ACE lens. Below are the aims and objectives for the EmBRACE Workshops:

  • show how identifying causes and conditions of negative behaviours opposed to finding solutions to address the by-product of those. This has provided clients with the ownership and confidence to have control of their own recovery
  • Explain the brain’s structure and operation so that clients can relate to this within their own life
  • Provide opportunity for discussion and examples of how thoughts, feelings, behaviours and consequences can dictate decision made/choices which ultimately affect behaviours 
  • Provide opportunities for reflections so that breaking the cycle can be achieved and managed by the client during recovery
  • To educate around the physical health complications trauma can cause

The quotes below demonstrate the impact the EmBRACE Workshops have had on the clients/service users and the significance of understanding about ACEs, particularly in relation to their own lives and behaviours, breaking the cycle and looking at addiction from a different perspective: 

‘I found the subject matter really interesting and a new way to look at addiction’

 ‘The workshops have helped me understand a lot about ACEs and helped put things into perspective’

 ‘ACEs are a major key part of the recovery process’ which highlights the need for ACE and Trauma Informed Practice to be an integral part of the culture within the organisation rather than a bolt on.

‘Understanding about ACEs has impacted on my decision making as well. My whole thought process on making a decision has been influenced through an ACE Lens. It has helped me to rationalise my thoughts rather than act on impulse’.

‘The focus in service has really shifted with the ACEs definitely’.

 ‘Being ACE Aware has affected more than just me. I have been able to reflect on the fact that my own children will have ACEs and how to address this. Breaking the Cycle has been a big part of this. The relationship with my siblings and mum has improved (now reconciled). In addition to this other people have cascaded their knowledge about ACEs which is a fantastic testament to the ACEs movement’.

James Houghton stresses “The EmBRACE Workshops explain that you have a drug solution, you don’t have a drug problem”. Looking at the bigger picture, James continues “Street homelessness is a big by-product of substance mis-use. The negative thought process of ‘I’m ok on the streets’ becomes part of someone’s belief system. People in this situation can’t function in society. Paying the bills or caring for their children is of secondary importance. The brain overrides this”. He nicely summarises “EmBRACE Workshops look at the root cause and are set up to educate around this. EmBRACE empowers the person to take responsibilitywhich is a fantastic testament to the ACEs movement and a key part of Cultural Change through an ACE Lens.

—Sue Irwin is a very experienced consultant, with over 24 years in education and learning. As a national lead in England, UK, on Adverse Childhood Experiences (ACEs) and founder of EmBRACE, Sue effectively leads other professionals to reflect and develop their practice, provide change management through an ACE Lens and build trauma-informed cultures. 

“Addressing Homelessness and Housing Insecurity in Higher Education”

This book helps educational leaders provide support for students who face significant barriers to college access, success, and retention. The authors offer research-based, practical guidance to allow readers to evaluate these issues within their local context, create and implement a plan of action, and sustain those efforts over time. Vignettes based on interviews with students experiencing homelessness and housing insecurity and contributions from practitioners are woven throughout the text to illustrate promising-practice recommendations. Topics include trauma-informed frameworks, policies affecting homelessness and housing insecurity, transitioning students to college, supporting college retention, collaborations and partnerships, and life after college. This practical resource can be used as a professional development tool for student affairs, academic affairs, health and wellness centers, and other campus-based support services.

Book Features:

  • Guidance for evaluating food and housing insecurity in a local context.
  • Practical ideas for designing and implementing solutions.
  • Useful strategies for building a team and securing resources.
  • Case studies that include voices of students and higher education practitioners. 

The Authors

Ronald E. Hallett is a professor of organizational leadership in the LaFetra College of Education at the University of La Verne, a research associate in the Pullias Center for Higher Education at the University of Southern California, and coauthor of Serving Students Who Are HomelessRashida M. Crutchfield is an associate professor in the School of Social Work at California State University, Long Beach.  Jennifer J. Maguire is an associate professor in the Department of Social Work at Humboldt State University.

Research Round-Up: The Latest in Homelessness Scholarship

This blog post features 10 recently published, peer-reviewed journal articles on homelessness – some written by faculty from our partner schools. These publications cover a range of topics related to homeless youth and adults, permanent supportive housing, homeless service provision, and service learning. Consider adding one of these to your course syllabi next semester or citing one in your next article. And, if you’re looking for additional readings to include in your classes, check out our curriculum resource page.

  1. Aparicio, E. M., Birmingham, A., Rodrigues, E. N., & Houser, C. (2019). Dual experiences of teenage parenting and homelessness among Native Hawaiian youth: A critical interpretive phenomenological analysis. Child and Family Social Work, 24(2), 330-339. Read more here.
  2. Byrne, T., Montgomery, A. E., & Fargo, J. D. (2019). Predictive modeling of housing instability and homelessness in the Veterans Health Administration. Health Services Research, 54(1), 75-85. Read more here.
  3. De Marco, A. C., & Kretzschmar, J. (2019). The impact of cocurricular community service on student learning perceptions of poverty and homelessness. Journal of Poverty, 23(1), 21-43. Read more here.
  4. Burns, V. F., & Sussman, T. (2019). Homeless for the first time in later life: Uncovering more than one pathway. Gerontologist, 59(2), 251-259. Read more here.
  5. Lee, W., & Ferguson, K. M. (2019). The role of local businesses in addressing multidimensional needs of homeless populations. Journal of Human Behavior in the Social Environment, 29(3), 398-402. Read more here.
  6. Marie, D. S., Gallardo, K. R., Narendorf, S., Petering, R., Barman-Adhikari, A., Flash, C., Hsun-Ta, H., Shelton, J., Ferguson, K., & Bender, K. (2019). Implications for PeEP uptake in young adults experiencing homelessness: A mixed methods study. AIDS Education and Prevention, 31(1), 63-81. Read more here.
  7. Metzger, M. W., Bender, A., Flowers, A., Murugan, V., & Ravindranath, D. (2019). Step by step: Tenant accounts of securing and maintaining quality housing with a housing choice voucher. Journal of Community Practice, 27(1), 31-44. Read more here.
  8. Waegemakers Schiff, J., & Lane, A. M. (2019). PTSD symptoms, vicarious traumatization, and burnout in front line workers in the homeless sector. Community Mental Health Journal, 55(3), 454-462. Read more here.
  9. Travis, R., Rodwin, A. H., & Allcorn, A. (2019). Hip hop, empowerment, and clinical practice for homeless adults with severe mental illness. Social Work with Groups, 42(2), 83-100. Read more here.
  10. Gwadz, M., Freeman, R., Leonard, N. R., Kutnick, A., Silverman, E., Ritchie, A., Bolas, J., Cleland, C. M., Tabac, L., Hirsch, M., & Powlovich, J. (2019). Understanding organizations serving runaway and homeless youth: A multi-setting, multi-perspective qualitative exploration. Child and Adolescent Social Work, 36(2), 201-217. Read more here.

Making a Class Count: Incorporating the PIT Count into an MSW Research Course

Most of us who work in the field of homelessness are familiar with the point-in-time (PIT) count, which entails using volunteers to attempt a census of people experiencing homelessness within a community. These homeless counts are a federal funding requirement from the Department of Housing and Urban Development (HUD), but they also provide valuable information and insight about the prevalence, incidence, and scope of homelessness in a community.

Beyond these explicit and pragmatic purposes, however, homeless counts are also a community engagement event. A broad spectrum of community members concerned about homelessness comes together to engage with the lived reality of homelessness in their community. While some volunteers, like service providers or advocates, may already be familiar with these realities, for many other volunteers, participating in the count is one of the few experiences they will have conversing and engaging with individuals experiencing homelessness. Indeed, some research suggests that participating in a homeless count, and the resulting direct contact volunteers have with individuals on the street, can dispel and mitigate some of the common misconceptions and stigma toward people experiencing homelessness or housing instability. And so, as educators and researchers concerned about the growing distrust and lack of empathy toward people experiencing homelessness, we feel there is great potential to leverage the homeless count as an opportunity for the broader community, including students, to learn about and engage with homelessness.

Balancing Our Roles as Researchers and Educators

During the last couple of years, we have become increasingly involved in the homeless count in our community of Sacramento, California. In 2017, we worked with our community partners to improve the methodology of how the count is conducted— for example, helping design a more rigorous sampling and survey method to increase the reliability of the count. And in 2018, we continued this work to introduce various innovations to improve the accuracy of the 2019 count, from using mobile apps to conduct surveys to improving sampling strategies.

One of the innovations we are most proud of this year has been incorporating our Sacramento State students in the implementation of the homeless count. This past January, over 200 of the 900 volunteers deployed were students. To give a little context, in 2017, only 230 volunteers participated in the Sacramento homeless count, which had been typical for Sacramento since PIT counts began in the region. As such, this year was by far the largest homeless count that Sacramento has ever had—reflecting the sad reality of growing homelessness in our community (and California more broadly), as well as greater engagement from the community, stakeholders, and our university. From our lens that the PIT count is also a community engagement event, the larger turn-out of volunteers and increased community engagement this year represents in some respects a point of success and progress.

Recruiting More Volunteers and Our Students

One of the key points we advocated for this year was the need to seek a broad spectrum of volunteers to participate in the count and to do strategic outreach targeting volunteers who have social service backgrounds (e.g., direct-service providers, social workers, nurses, etc.). We emphasized the importance of having specific volunteers designated as team leads who could leverage their social services experience and expertise to ensure the count was conducted with respect, cultural humility, and professionalism. We encouraged the organizers to recruit and establish teams of volunteers with a variety of experiences and perspectives, with team leads who would use their expertise to help guide the team during the night of the count. We also argued that the team lead should be the key point person to initiate conversations with individuals on the street and to conduct the formal in-person surveys, which are used to estimate the demographic composition of the homeless population in Sacramento. We believed having experienced team leads, and providing them additional training on engagement and interviewing techniques, would increase the response rate of the survey and ensure that conversations were initiated appropriately. We also encouraged organizers to recruit volunteers from our social work program, as well as the broader university.

Incorporating the PIT Count into a Research Course

In our department, students can engage in research through a capstone course. To encourage student involvement in the count, we created a year-long capstone course centered on homelessness and the homeless count. In the spring of 2018, we announced this new capstone course. Traditionally, the capstone course resembles a structured thesis, where students work closely with faculty to develop and implement empirical research throughout their last year of the MSW program. For the 2018-2019 academic year, we pitched two capstone course opportunities—one on quantitative research and one on qualitative research. Students would spend the first semester doing literature reviews about an aspect of homelessness and learning about survey techniques and engagement strategies used in the homeless count. The second semester would entail participating in the count itself, as well as analyzing previously collected data to inform students’ respective empirical projects. The goal was to engage students in a capstone research project that directly reflects and impacts the community.

Approximately 60 graduate students expressed interest in the first semester capstone course. Due to class size constraints, we enrolled 40 students in two course sections. In collaboration with our Community Engagement Center, we also set up the homeless count as a service-learning activity open to all students and used funding from the National Homelessness Social Work Initiative to hold informational sessions to spark student and faculty interest in the count. One of these was a panel on myths about homelessness.

Student Perspectives Regarding the Experience

As the video above highlights, our students played an integral role on the night of the homeless count. Many of them expressed that they gained a deeper understanding of community-based research and a greater understanding of homelessness through this experience. We asked students what participating in the count meant for them. Below are some of their responses.

Student #1

I had never heard of the PIT project until my capstone. Initially, the thought of being sent out at night to the streets of Sacramento County to count homeless scared me. I was concerned about safety. Coming to volunteer, I was also fearful about conducting interviews just because I did not know how people were going to respond and because of my own bias. I was also a little nervous about going out with people I did not know to a place I was unfamiliar with. While we only counted five individuals in our route, and in the end were unable to do a single interview, I still enjoyed participating in the PIT. The experience gave me a new perspective and awareness of the homelessness issue here in Sacramento and how there are many people without a shelter suffering different adversities and in need of help. I can see that there is a need for services and support to help decrease homelessness. Finally, it was surprising to me seeing all these different people coming out to volunteer and give their time to go out to count and interview homeless people. It was nice to see how the community supported this event. I am looking forward to knowing the results of the count and seeing what services will be created or provided (if any) to support the homeless population.

Student #2

My understanding of community-based research was expanded through participation in training, volunteer registration, the count itself, and independent processing time with fellow MSW student volunteers. From the experience, I gained a critical, yet small, understanding of what is needed to implement such a project in a region like Sacramento. Key factors include organization, adaptable leaders, and volunteers who demonstrate respect for the integrity of the project and the value of the findings. Additionally, access to reliable and user-friendly technology appeared to contribute to the ease of data collection.

Student #3

To read about homelessness is one thing, but to hear the stories of those experiencing homelessness is quite another. With all my training as a graduate student of social work, my own lived experience with homelessness as a child, and a son of a mother suffering from severe and persistent mental illness, I should be free from all judgement and bias. But even burgeoning professionals in the field, and seasoned experts alike, are not free from the cultural context that surrounds them. We’re inundated by messages from the media and national discourses that attribute the causes of homelessness to a lack of morality or a desire to avail oneself to the resources that we, as the domiciled population, believe exist in plenty. But my interaction while interviewing individuals and families during the count challenged these internal biases. Maybe it is true that contact reduces stigma.

Given student feedback about how volunteering for the PIT count impacted their understanding of the realities of research and the experience of homelessness, we hope to consider additional opportunities for students to engage in practical, action-based homelessness research in our community. Further, as we consider the successes and lessons learned from our experience of building student community research experiences into our curriculum, we invite others who have engaged students in PIT counts to share their experience with us.

Blog Post Authors: Arturo Baiocchi, PhD and Susanna Curry, PhD – both Assistant Professors of Social Work at Sacramento State 

The Future of Homelessness

The Y-Foundation (Finland) recently published a series of essays from experts on homelessness, social policy, and poverty from around the world. The series, Homelessness in 2030, tackles ideas, hopes, and fears for the future of homelessness. The essays are brief, easy to read, and present a variety of perspectives on policy and practice, as well as case studies of specific countries. Capture

We highlight a couple essays below to illustrate the people and perspectives featured in the series:

Julien Damon’s “No One is Homeless. What is Missing” explores the often-unrecognized economic, social, and political functions of homelessness and how future homeless-free cities may or may not adjust for their absence.

Dennis Culhane’s “A Professional Service for Housing Stabilization” contemplates the emergence of a new sector for social work practice, what he calls The Housing Stabilization Service, which provides a range of services related to homelessness prevention and rehousing.

Suzanne Fitzpatrick’s “Great Britain in 2030” argues that the data, analytic abilities, and statistical models needed to make accurate predictions about homelessness exist and should be used to explore the future of homelessness under a range of possible policy scenarios.

Volker Busch-Geertsema’s “Germany in 2030: Utopia or Dystopia” considers two extremes for the future of homelessness in Germany – a positive vision where homelessness is rare, brief, and non-recurrent and a negative vision where an economic depression causes increased housing insecurity and homelessness and a domino-effect of poor policy decisions.

Mary Shinn’s “A Tale of Three Futures” imagines three futures: one in which no major policy or political shift occurs and homelessness goes unsolved and ignored; one in which wealthy countries apply what’s been learned from previous efforts and other countries to increase housing affordability, bolster incomes, and quickly house those sleeping rough; and one in which visible and invisible homelessness are equally targeted by housing and policy interventions.

You can download a pdf of all of the essays here:

The 2018 Annual Homelessness Assessment Report to Congress

With the U.S. Department of Housing and Urban Development closed as a result of the current government shutdown, the effects for people experiencing homelessness and people living in government subsidized housing have been far reaching. Communities across the country rely on funds from HUD to provide crucial outreach, emergency shelter, housing, case management, and support services to people experiencing or at risk of homelessness. The impacts of these efforts can sometimes be hard to see or quantify.

Last month, HUD released the first part of the 2018 Annual Homelessness Assessment Report (AHAR) to Congress. For those unfamiliar with this report, it’s an annual summary of point-in-time and housing inventory counts conducted during the previous January. It includes national, state, and continuum of care (CoC)-level estimates of homelessness, with specific breakdowns for chronically homeless persons, homeless veterans, and homeless children and youth, as a well as information abocaptureut housing units.

Nearly 553,000 people were homeless on a single night in January of 2018. This number is a very slight (.3%) increase from 2017, and this is the second year in a row that an increase has been observed. Much like the 2% increase between 2016 and 2017, this year’s change was the result of an increase in people living unsheltered in cities across the country. Approximately 35% of people were living unsheltered, such as on the street, in abandoned buildings, or in other places not meant for human habitation. The states with the highest rates of unsheltered people experiencing homelessness were California, Oregon, Nevada, Hawaii, and Washington. The number of people experiencing chronic homelessness also increased slightly between 2017 and 2018.

Of the roughly 553,000 people experiencing homelessness captured in last year’s point-in-time counts, more than 36,000 were unaccompanied youth (individuals under the age of 25). Compared to the overall homeless population and compared to homeless single adults, unaccompanied homeless youth were more likely to be living unsheltered – just over half (51%) of youth were unsheltered. States with the highest rates of homeless youth were Nevada, California, Hawaii, Washington, and Oregon. In general, CoCs are new to the process of conducting point-in-time counts of unaccompanied homeless youth, which can require innovative approaches to ensure estimates are as accurate as possible. The Voices of Youth Count project offers some guidance for youth count methods and has published a series of briefs from their own study of the prevalence and characteristics of homeless youth across the country.

Overall, homelessness has declined by more than 84,000 people since 2010, a 13% reduction. In fact, family homelessness has declined by 23% since 2007, chronic homelessness has declined by 26% since 2017, and veteran homelessness has declined by 48% since 2009. States that have seen the largest decreases in homelessness between 2007 and 2018 are Florida, Texas, Georgia, California, and New Jersey.

While the increase in the number of people experiencing homelessness over the past two years is relatively small, it’s worth paying attention to as an indicator of what may be a gradual reversal of the positive trends of the last decade. Perhaps it is a clarion call to the federal government and local jurisdictions to take action to prevent larger upticks in years to come. Further, the fact that the increase continues to be entirely driven by more individuals experiencing unsheltered homelessness in cities, rather than being evenly spread across groups and homeless experiences, suggests there are distinct place-based factors at play in urban areas, including a widespread lack of affordable housing and inadequate emergency shelter in urban areas. More than 50% of unsheltered people were living in CoCs that encompass the nation’s 50 largest cities. The states that saw the largest increases in homelessness between 2017 and 2018 were Massachusetts, New York, Texas, Washington, and Arizona.

While the point-in-time count data upon which the AHAR is based likely under-counts the actual number of people experiencing homelessness, the report is a useful tool for framing homelessness at the national, state, and local levels. It’s a valuable resource for community agencies, researchers, and academics for writing grant applications, advocating for funding or programmatic changes, and providing background for research and evaluation write-ups.

Communities across the country are conducting their overall and youth counts this month, with the help of a range of community partners and volunteers. The data from these counts will be the basis for the 2019 Annual Homelessness Assessment Report to Congress.

Blog Post Author: Amanda Aykanian, MA, Research and Project Lead at the National Center for Excellence in Homeless Services



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.


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.