Supportive housing for chronically homeless individuals: Challenges and opportunities for providers in Chicago, USA

Quinn, Katherine; Dickson‐Gómez, Julia; Nowicki, Kelly; Johnson, Amy K.; Bendixen, Arturo

doi:10.1111/hsc.12467

Cited by 21 publications

(32 citation statements)

References 24 publications

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“…There is further evidence that homeless youth may develop a mistrust of services due to previous negative experiences (Garrett et al, ). Concerning permanent housing with supports, studies have found that Housing First was associated with decreased SUD and health care utilisation, including emergency department visits, the number and length of hospitalisations (Poulin, Maguire, Metraux, & Culhane, ; Quinn, Dickson‐Gomez, Nowicki, Johnson, & Bendixen, ; Sadowski, Kee, VanderWeele, & Buchanan, ), and with higher levels of user satisfaction (Robbins, Callahan, & Monahan, ) more generally. Individuals living in permanent housing with supports had greater access to regular sources of care such as a case manager, which may have influenced satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Satisfaction with health and community services among homeless and formerly homeless individuals in Quebec, Canada

Gentil

Grenier

Bamvita

et al. 2019

Health Soc Care Community

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User satisfaction is a crucial quality indicator in health service provision. Few studies have measured user satisfaction among homeless and formerly homeless individuals, despite the high prevalence of mental health disorders (MHD) in this population. The purpose of this study was to assess overall satisfaction among 455 homeless and formerly homeless individuals who were receiving health and community services, and to identify factors associated with user satisfaction. Data collection occurred between January and September 2017. Study participants were 18 years old or over, with experience of homelessness in the current or recent past. They completed a questionnaire eliciting socio‐demographic information, and data on residential history, service use and satisfaction and health profiles. Multivariate linear analysis was performed on overall satisfaction with health and community services in the previous 12 months. Independent variables were organised as predisposing, enabling and needs factors based on the Gelberg–Andersen Behavioral Model. The mean satisfaction score was 4.11 (minimum: 1; maximum: 5). Variables associated with greater user satisfaction included: older age, residence in permanent housing, common MHD (e.g., depression, anxiety), having a family physician, having a case manager, strong social network, good quality of life and, marginally, male sex and having substance use disorders (SUD). By contrast, frequent users of public ambulatory health services were the most dissatisfied. User satisfaction was more strongly associated with enabling factors. Strategies for improving satisfaction include: promoting more tailored primary care programmes (including family physician) adapted to the needs of this population, better integrating primary care with specialised services including SUD integrated treatment and enhancing continuity of care through the reinforcement of case management services. Further efforts aimed at increasing access to permanent housing with supports, and eliciting more active involvement by relatives and friends may also improve user satisfaction with services, and reduce unnecessary service use.

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Section: Discussionmentioning

confidence: 99%

Satisfaction with health and community services among homeless and formerly homeless individuals in Quebec, Canada

Gentil

Grenier

Bamvita

et al. 2019

Health Soc Care Community

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“…Case managers' role in connecting clients to services removed barriers to care that clients had previously found difficult or impossible to overcome, and support from case managers in addressing transportation coordination, food insecurity and criminal justice system involvement was vital. While service participation is voluntary within the Housing First paradigm, research suggests the essential role of case management and other supportive services in improving residents' likelihood of success and stability in permanent housing (Gilmer, Stefancic, Henwood, & Ettner, ; Henwood et al, ; Quinn et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…A few participants discussed having supportive relationships with neighbours or other members of the local community, but only if those individuals were family, friends known previously, or other clients receiving services from the organisation. (Johnson, Hayes, Brown, Hoo, & Ethier, 2014;Kent, 2018 likelihood of success and stability in permanent housing (Gilmer, Stefancic, Henwood, & Ettner, 2015;Henwood et al, 2018;Quinn et al, 2018).…”

Section: (Participant 1)mentioning

confidence: 99%

“…However, a small subset of individuals are “chronically homeless,” defined by the Department of Housing and Urban Development as experiencing homelessness for 1 year or longer, or having had at least four episodes totalling 12 months of homelessness in the past 3 years (United States Department of Housing & Urban Development, ). Compared to the general population, individuals experiencing chronic homelessness have higher mortality rates, higher healthcare costs and acute care utilisation, higher rates of substance use disorders and mental health problems, and lower rates of engagement with supportive services (Kirst, Zerger, Misir, Hwang, & Stergiopoulos, ; Quinn, Dickson‐Gomez, Nowicki, Johnson, & Bendixen, ; Roncarati et al, ). This subset of the population also experiences high rates of uncontrolled chronic diseases compared to the general population, as lack of stable housing makes detection, treatment and management of chronic illness nearly impossible (Brown, Kiely, Bharel, & Mitchell, ; Lebrun‐Harris et al, ; Pribish, Khalil, Mhaskar, Woodard, & Mirza, ).…”

Section: Introductionmentioning

confidence: 99%

“…However, a small subset of individuals are "chronically homeless," defined by the Department of Housing and Urban Development as experiencing homelessness for 1 year or longer, or having had at least four episodes totalling 12 months of homelessness in the past 3 years (United States Department of Housing & Urban Development, 2014). Compared to the general population, individuals experiencing chronic homelessness have higher mortality rates, higher healthcare costs and acute care utilisation, higher rates of substance use disorders and mental health problems, and lower rates of engagement with supportive services (Kirst, Zerger, Misir, Hwang, & Stergiopoulos, 2014;Quinn, Dickson-Gomez, Nowicki, Johnson, & Bendixen, 2018;Roncarati et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

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Assessing the relationship between housing and health among medically complex, chronically homeless individuals experiencing frequent hospital use in the United States

Chhabra

Spector

Demuynck

et al. 2019

Health Soc Care Community

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In the United States and abroad, health systems have begun to address housing insecurity through programs that adhere to the Housing First model. The model provides permanent supportive housing without disqualification due to current mental health problems or substance use, along with optional case management services. This study used qualitative methods to explore how housing stability affected chronic disease management and social and community relationships among individuals with complex health and social needs and patterns of high hospital utilisation who were housed as part of a scattered‐site Housing First program in a mid‐size city in the northeastern United States. 26 individual, semi‐structured interviews were conducted with Housing First clients in their homes or day program sites between March and July 2017. Interviews were digitally recorded and transcripts were analysed using a qualitative descriptive methodology until thematic saturation was reached. Findings suggest that housing provided the physical location to manage the logistical aspects of care for these clients, and an environment where they were better able to focus on their health and wellness. Study participants reported less frequent use of emergency services and more regular interaction with primary care providers. Additionally, case managers' role in connecting clients to behavioural health services removed barriers to care that clients had previously faced. Housing also facilitated reconnection with family and friends whose relationships with participants had become strained or distant. Changes to physical and social communities sometimes resulted in experiences of stigmatisation and exclusion, especially for clients who moved to areas with less racial and socioeconomic diversity, but participation in the program promoted an increased sense of safety and security for many clients.

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Exploring the effect of case management in homelessness per components: A systematic review of effectiveness and implementation, with meta‐analysis and thematic synthesis

Weightman

Kelson

Thomas

et al. 2023

Campbell Systematic Reviews

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Background Adequate housing is a basic human right. The many millions of people experiencing homelessness (PEH) have a lower life expectancy and more physical and mental health problems. Practical and effective interventions to provide appropriate housing are a public health priority. Objectives To summarise the best available evidence relating to the components of case‐management interventions for PEH via a mixed methods review that explored both the effectiveness of interventions and factors that may influence its impact. Search Methods We searched 10 bibliographic databases from 1990 to March 2021. We also included studies from Campbell Collaboration Evidence and Gap Maps and searched 28 web sites. Reference lists of included papers and systematic reviews were examined and experts contacted for additional studies. Selection Criteria We included all randomised and non‐randomised study designs exploring case management interventions where a comparison group was used. The primary outcome of interest was homelessness. Secondary outcomes included health, wellbeing, employment and costs. We also included all studies where data were collected on views and experiences that may impact on implementation. Data Collection and Analysis We assessed risk of bias using tools developed by the Campbell Collaboration. We conducted meta‐analyses of the intervention studies where possible and carried out a framework synthesis of a set of implementation studies identified by purposive sampling to represent the most ‘rich’ and ‘thick’ data. Main Results We included 64 intervention studies and 41 implementation studies. The evidence base was dominated by studies from the USA and Canada. Participants were largely (though not exclusively) people who were literally homeless, that is, living on the streets or in shelters, and who had additional support needs. Many studies were assessed as having a medium or high risk of bias. However, there was some consistency in outcomes across studies that improved confidence in the main findings. Case Management and Housing Outcomes Case management of any description was superior to usual care for homelessness outcomes (standardised mean difference [SMD] = −0.51 [95% confidence interval [CI]: −0.71, −0.30]; p < 0.01). For studies included in the meta‐analyses, Housing First had the largest observed impact, followed by Assertive Community Treatment, Critical Time Intervention and Intensive Case Management. The only statistically significant difference was between Housing First and Intensive Case Management (SMD = −0.6 [–1.1, −0.1]; p = 0.03) at ≥12 months. There was not enough evidence to compare the above approaches with standard case management within the meta‐analyses. A narrative comparison across all studies was inconclusive, though suggestive of a trend in favour of more intensive approaches. Case Management and Mental Health Outcomes The overall evidence suggested that case management of any description was not more or less effective compared to usual care for an individual's mental he...

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Supportive housing for chronically homeless individuals: Challenges and opportunities for providers in Chicago, USA

Cited by 21 publications

References 24 publications

Satisfaction with health and community services among homeless and formerly homeless individuals in Quebec, Canada

Satisfaction with health and community services among homeless and formerly homeless individuals in Quebec, Canada

Assessing the relationship between housing and health among medically complex, chronically homeless individuals experiencing frequent hospital use in the United States

Exploring the effect of case management in homelessness per components: A systematic review of effectiveness and implementation, with meta‐analysis and thematic synthesis

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