The extent to which non-conditional housing programs improve housing and well-being outcomes: a systematic review

Purpose To reduce rates of homelessness, recent efforts have been directed toward developing non-conditional supported housing programs that prioritize the delivery of housing support and individual services, without tenancy conditions (i.e. maintaining sobriety and adhering to mental health treatment). As promising as these programs are, findings generally show that while housing stability is improved, other individual outcomes remain largely unchanged. No review to date has synthesized the collective evidence base of non-conditional housing programs, rather the focus has been on specific programs of delivery (e.g. Housing First) or on specific population groups (e.g. those with mental illness). The purpose of this paper is to evaluate the extent to which non-conditional housing interventions improve housing and well-being outcomes for all persons. Design/methodology/approach A systematic search of the literature was conducted for randomized controlled studies that evaluated the effectiveness of a non-conditional housing intervention in improving housing and health outcomes among any participant group. Findings A total of 31 studies were included in this review. Non-conditional supported housing programs were found to be most effective in improving housing stability as compared to health and well-being outcomes. Policymakers should consider this when developing non-conditional supported housing programs and ensure that housing and other health-related outcomes are also mutually supported. Originality/value This is the first review, to the authors’ knowledge, to synthesize the collective impact of all non-conditional supported housing programs. The current findings may inform the (re)design and implementation of supported housing models to prioritize the health and well-being of residents.

Environmental Assessment of Housing for Older Adults Facing Housing Insecurity

The Aging in the Right Place Environmental Audit (AIRP-ENV) and Secondary Observation (AIRP-ENV-SO) tools were developed to conduct observation-based audit of the built environment in shelters, transitional housing, independent housing with offsite/onsite supports, and permanent supportive housing with onsite medical and/or specialized services for older adults experiencing (or at risk of) homelessness. The 241 item AIRP-ENV tool is used to audit the presence/absence of exterior and interior built environmental features that support housing stability. The seven open-ended questions in the AIRP-ENV-SO tool is used to collect contextual data on function, safety and land-use of surrounding neighborhood. Data were collected at four sites of a transitional housing program in Vancouver, Canada as part of a multi-year, multi-city partnership project on aging and homelessness. Preliminary results demonstrate that built environment and urban design features (e.g., access, privacy, flexible and supportive spaces) contribute towards tenants’ residential resiliency and aging in place.

Associations between PACS symptoms and risk factors among Long Haulers in the Rutgers Post-COVID Recovery Program

At least 2/3 of people with mild to moderate COVID-19 infection will experience long-haul COVID symptoms that persist for weeks or months, however, risk factors that modify the likelihood that one develops these symptoms are unknown. Patients referred to the Post-COVID Recovery Program at Rutgers in New Brunswick (n= 108) through primary care referral or self-submitted online request and experiencing a wide variety of Post-Acute COVID-19 Syndrome (PACS) symptoms were stratified by those without self-reported cognitive complaints (n=54), those with self-reported cognitive complaints who scored well on cognitive testing (n=29), and those with self-reported cognitive complaints who scored poorly on cognitive testing (n=25). Comparisons between groups were made using ANOVAs and Chi Squared: for COVID-19 disease severity, COVID-19 disease treatment, comorbid COVID-19 symptoms during infection, comorbid PACS symptoms post-infection, pre-existing health conditions, levels of depression and anxiety, level of fatigue, and social determinants of health (access to healthcare, economic stability, housing stability). Preliminary analyses indicated that whereas people without complaints were normally distributed according to age (p>0.200 for Kolmogorov–Smirnov test), people with complaints and deficits were skewed towards the older age group (p<0.001 for K-S test) suggesting age to be a risk factor for cognitive impairment in PACS. Participants that reported cognitive complaints also reported increased symptoms of depression, anxiety, and fatigue, compared to participants without cognitive complaints. These data provide insight into associations between PACS symptoms and risk factors relevant in understanding this novel disease.

Temporary Housing for Older People: Addressing Housing Insecurity to Promote Aging in the Right Place

The Aging in the Right Place (AIRP) project is a multi-year, multi-city partnership grant on aging, housing insecurity and homelessness. This paper presents findings from provider/staff interviews (N=5) at a Temporary Housing Program (THP) serving older people experiencing (or at risk of) homelessness (OPEH) in Vancouver, Canada. The researchers sought to understand the strengths and weaknesses of the program, scale-up (i.e., policies) and/or scale out impacts (i.e., on people and communities), as well as how the program promotes housing security and stability for OPEH. Narrative data reveals the program provided housing stability to OPEH by offering increased access to resources (food, pharmaceutical, transportation, social support and engagement). Additionally, through the promotion of client autonomy, privacy and security in their housing unit, the organization and staff work to support and foster AIRP among their clients and help to transform a temporary housing space into a secure home-type setting.

A Housing First evaluation project for homeless Veterans in Canada: Quantitative findings

LAY SUMMARY This study sought to evaluate a Housing First program for Veterans experiencing homelessness. Housing First is an approach made up of many different aspects of care including peer support and greater access to care resources within the home. These aspects of care are offered in order to address underlying issues and maintain housing stability. The program was implemented across four cities in Canada including London, Toronto, Calgary, and Victoria. To assess the program, interviews with Veterans were conducted at time of enrollment, 3, 9, and 15 months. The Veterans in this study demonstrated a significant reduction in homelessness. As well, a significant reduction in emergency room visits was reported. Other health care interactions and quality-of-life scores remained stable. These findings could, therefore, lead to potential future cost savings in the health care sector. This study demonstrates why this approach to housing for Veterans can be a highly effective and useful way to ensure housing stability.

Qualitative findings from a Housing First evaluation project for homeless Veterans in Canada

LAY SUMMARY This two-year study implemented a Housing First approach among homelessness services for Veterans in four cities across Canada (Victoria, Calgary, London, and Toronto). This approach included peer support and harm reduction resources for Veterans. To obtain a detailed evaluation of personal experiences and opinions, focus groups were held with Veterans, housing staff, and stakeholders at three time points during the study: July-September 2012, May-June 2013, and January 2014. Harm reduction and peer support were regarded as positive aspects of this new approach to housing and homelessness. It was suggested that greater mental health support, support from peers with military experience, and issues regarding roommates should be considered in future implementations of housing services for Veterans. It was also noted that to support personal stabilization, permanent housing is preferred over transitional or temporary housing. Future housing programs serving Veterans experiencing homelessness should consider the addition of harm reduction and peer support to further enhance services and help maintain housing stability.

How Landlords of Small Rental Properties Decide Who Gets Housed and Who Gets Evicted

Scholars and policymakers have long been interested in whether large-scale owners of rental properties have different management practices than smaller-scale owners and whether these differences matter for the housing stability of tenants. This is of particular concern among the 1- to 4-unit small rental properties that comprise half the nation’s rental housing stock. I conducted a nationwide survey supplemented with interviews to understand how owners (i) select their tenants and (ii) react to rent delinquencies. I find that larger-scale owners’ highly routinized property management systems make them much more likely to start the eviction process after a delinquency. However the tenant selection processes of professional owners also appear to result in a tenantry that has a somewhat higher delinquency rate, while the selection process for non-professional landlords raises fair housing concerns. I discuss how the link between the tenant selection and rent delinquency practices of landlords has a number of policy implications.

Brief Note: Exploratory Examination of How Race and Criminal Record Relate to Housing Instability Among Domestic Violence Survivors

Housing instability is a critical concern in the United States, and domestic violence (DV) survivors are a group at high risk for experiencing housing instability or of becoming unhoused. Prior research has also identified having a criminal record (CR) as being a major barrier to obtaining stable housing, and this is truer for Black and Latinx people compared to their White counterparts. No study has examined whether comparable trends exist among survivors of DV, a group also at elevated risk of having a CR, sometimes related to their experience of abuse. The current exploratory study included 305 unhoused or unstably housed female DV survivors who had sought out DV support services. Multivariate regressions explored if survivor race and CR were separately linked to greater housing instability. CR was then explored as a potential moderator in the relation between race and housing instability. Results revealed that DV survivors with a CR faced greater housing instability than those without a CR, Black and Latina survivors experienced greater housing stability than did White survivors, and CR did not moderate the relation between race and housing instability. The racial differences were unexpected and are discussed in light of methodological limitations. This is the first study to date to explore the role of CR possession on housing instability for DV survivors.