Which Variations in Permanent Supportive Housing Programs Produce Better Outcomes?

The United States has adopted permanent supportive housing as a key tool to treat its chronically homeless population. Stemming from the Housing First model, programs across the country are providing services to improve housing stability and health outcomes to this group, which is more likely to suffer from severe mental illness, substance use issues, and chronic and nonchronic diseases. Though little research has been done to show how Housing First is being implemented in practice, some research suggests that a lack of concrete guidelines has led to deviation from the model. The original Housing First project included scattered-site housing, where residents lived in their own free-market rental housing, but now, many permanent supportive housing programs operate project-based models in which all residents live in a single building. Service delivery also varies between sites. Some provide single case managers, while others provide group-intensive peer support. Some provide substance abuse treatment and living skills groups, while others only provide basic services. This new study set out to determine which components lead to better health outcomes. The authors summarize differences in supportive housing programs for chronically homeless adults in the Chicago area and analyzed interviews with supportive housing providers. Their findings suggest that studying individual components to supportive housing programs, rather than using a one-size-fits-all lens, could help better measure effectiveness.

Key findings

• Supportive housing programs in the Chicago metropolitan area varied according to housing configuration (scattered site versus project based) and service provision model (low-intensity case management, intensive case management, behavioral health). This variation could exist because of the broad definition of supportive housing that the US Department of Housing and Urban Development provides.
• Despite the variation, certain components were more likely to be offered together. For example, low-intensity case management was found more often in project-based housing, while intensive case management was most often found in scattered-site housing.
• More supportive housing programs in Chicago used a harm-reduction approach to their clients’ drug and alcohol use and psychiatric symptoms.
• Results show advantages and disadvantages to each of type of housing configuration and service provision model. Further comparative effectiveness research could help identify which program components lead to better health outcomes among different subpopulations of homeless people.