Families Will Benefit from Expanding the Evidence Base on Supportive Housing

by Aaron Shroyer

Housing instability among families and children can be detrimental to child welfare, health, economic, and other outcomes. Policymakers and service providers in these fields should consider weaving housing into their approaches. Treating instability at its roots can relieve the trade-offs and stress that emerge when no decent housing is affordable. Evidence indicates that affordable housing can improve a range of outcomes for families and—in combination with short-term or long-term services—help providers tackle complex challenges head-on.

The spectrum of affordable, service-enriched, and supportive housing

When health and human service organizations look toward housing to improve family outcomes, the most effective intervention can range from a simple housing subsidy to permanent supportive housing depending on the program goals and families’ needs.

1. Housing subsidy. A housing subsidy, even without supports, can improve stability, reduce the risk of homelessness, and connect families with better-quality living environments. Families without stable housing face severe rent burdens that crowd out other necessities and can lead to eviction, displacement, or homelessness. Research suggests that families can achieve broad benefits in the short term and the long term from affordability alone.
2. Service-enriched housing. Many affordable housing providers offer optional services as an amenity to help families meet their immediate needs and achieve long-term success. A service coordinator may help families find area programs and resources, or the development may have on-site health care access, child care, after-school programs, financial education, workforce development, and more.
3. Permanent supportive housing for families. Permanent supportive housing for families combines affordable housing with optional but assertive services that focus on keeping vulnerable families stable and housed. This strategy, which is often designed for chronically homeless people, can also benefit families. Although supportive housing programs vary, they share three core principles: they aim to keep tenants housed, the services often involve a range of providers (including physical and mental health, employment, benefits, and others), and tenants do not risk eviction if they refuse services, but providers are persistent in their offers to help.

Knowing the range of housing-based interventions that exist can help social service organizations launch successful partnerships with housing providers that tailor resources and services to fit the level of supports a particular population may need. Likewise, housing organizations can communicate to prospective partners about the spectrum of interventions to create more clarity about the fundamental benefits of different housing approaches.

The added benefits of service-enriched and supportive housing for families

Whether offering a housing subsidy, service-enriched housing, or supportive housing, randomized studies have found that access to a housing subsidy—without an expiration date—is primary. Services don’t yield a strong benefit absent a stable place to call home. But housing with various services and supports can achieve greater benefits to family economic mobility, health, and child welfare.

Family economic mobility

The existing evidence base supports service-enriched housing models, which can help families build economic assets and gain employment with the ultimate goal of increasing their self-sufficiency. Interviews with residents in rapid re-housing programs demonstrate that although residents want to work, many face barriers to employment. Housing contexts offer evidence-based models for finding and retaining employment or making other economic improvements.

The Jobs-Plus initiative by the US Department of Housing and Urban Development (HUD) saturates public housing developments with five years of work supports. This service-enriched program offers job training, amends rent rules to provide greater incentives to work, and provides additional community support for work through outreach and social networking. A review of Jobs-Plus found that where program components were fully implemented, the program produced a 16 percent increase in average annual earnings. This evaluation found that the earnings gains continued during the three years after the program ended. Based on those findings, HUD expanded the program to 24 public housing agencies in 2016.

Another HUD program, the Family Self-Sufficiency (FSS) program, provides incentives to work to families with HUD rental assistance and provides a savings mechanism. FSS combines stable housing with temporary case management services, financial education, and an escrow account. Home Forward, the housing authority for Portland, Oregon, is using its Moving to Work authority to develop high-intensity economic mobility programs that combine elements of Job-Plus and FSS. Humboldt Gardens is one of the developments that engages all residents in setting goals and offering a savings mechanism. The program also provides case management, financial literacy training, and work readiness training.

Health

High-quality affordable housing supports health by reducing lead exposure and providing residents the financial stability to seek medical treatment. Though research shows health benefits of service-enriched housing for older adults and permanent supportive housing for chronically homeless people, the research on service-enriched or supportive housing and the health of families and children is limited. The Chicago Family Case Management Demonstration, an intensive, service-enriched approach, showed that the share of residents indicating fair or poor health fell 15 points during the four years of the demonstration.

The DC Housing Authority’s IMPACT 500 needs assessment underscores the importance of considering housing-based health services for families and children. Thirty percent of adult residents reported fair or poor health. One-third of the families in DC public housing have at least one child with asthma, one-fifth have an overweight child, and 14 percent have a child with a chronic health condition requiring regular, ongoing care. Additional research could demonstrate the value of housing-based health services for families with significant health challenges.

Child welfare

Evidence shows that permanent supportive services improved child welfare outcomes, and additional evaluations of service-enriched models are under way. Keeping Families Together, an initiative of the Corporation for Supportive Housing and the Robert Wood Johnson Foundation, tested the impact of permanent supportive housing for formerly homeless families who had interacted with the child welfare system. Among the 29 families, more than half the child welfare cases that were open at the time they moved into supportive housing closed within 10 months, and all children who were in foster care with a goal of reunification were reunited with their families.

There is emerging evidence on the effectiveness of these programs on child welfare outcomes, but we still need to figure out how best to structure programs, conduct outreach, and quantify results. The Family Unification Program, a specialized housing voucher and supportive services program for families for whom the lack of housing is the primary factor in separation, found that sites struggle to target high-need families, find resources to provide supportive services, and measure results.

A forthcoming evaluation of a multisite supportive housing demonstration will add knowledge about targeting services to high-need families and the efficacy of different models. The evaluation should help child welfare systems better understand the role of supportive housing in reducing out-of-home placement and addressing family instability.

Health and human services systems can better serve and support families in need by using housing as a platform to deliver other services. Because demand for both affordable and supportive housing units outstrips supply, health and human service organizations can partner with housing advocates to seek better access to these essential resources.

Photo by Tomsickova Tatyana/Shutterstock