Homelessness,

Housing, and Social Support: Preliminary Results from a Housing First Pilot Evaluation
Ricca Prasad, MPH1, Manik Chhabra, MD2, Dawn Wiest, PhD1, Laura Buckley, LSW1
1Camden Coalition of Healthcare Providers, 2University of Pennsylvania, Perelman School of Medicine

November, 2017
Background Survey Results Interview Results
• Social support protects against mortality Figure 1: Average score per individual social support survey Figure 2: Number of interviewees that 23
and morbidity.1 question and variation among question scores (n = 35) Housing First Care Team 9
made positive and/or negative references
• Homeless patients face challenges • Highest Score: Frequency of having addiction social to sources of support (n = 25)
integrating into their new communities support (Q1) Family 21
• Patients discussed 3 groups of intimate 19
when they receive housing through • Lowest Scores: Frequency of having material support personal relationships (partners,
supportive programs. 2,3,4,5 (Q6) and an emergency caretaker (Q7). Other Social and Medical Service 12
friends, family) and 2 groups of
Providers 12
• The Camden Coalition of Healthcare Q1. How often is there someone you could professional relationships (Housing First
Providers launched an interagency housing care team and other social and medical 10
count on to help you stay away from drugs or 3.05 Friends
initiative (Housing First) in Camden, NJ in service providers) as sources of social 8
drinking too much?
November, 2015 to improve health support and stress. 3
outcomes and reduce healthcare costs of Q2. How often is there someone who would be (Ex-)Partners 11
• The Housing First care team and family
the city’s sickest homeless residents. available for you to talk to when you have an 2.56 were the most frequently discussed,
• Housing First entails a fifteen-year housing important decision to make? but interviewers also probed about 0 5 10 15 20 25
voucher for rent, utility assistance, and Q3. How often is there someone you could talk those specific topics. Positive Reference Negative Reference
optional wrap-around support services from to if you feel just a bit down or depressed, and 2.53 Figure 3. Positive and negative themes associated with social
a specialized care team. Interview Themes
you wanted to talk about it? support groups Relationship Positive Negative
• The Coalition began gathering data to • Two positive themes that described patients’ attitudes
evaluate Housing First one year post- Q4. How often is there someone you could talk toward their Housing First care team (genuine interactions Intimate + Instrumental - Rejection
implementation. 2.50
to about personal worries and concerns? and positive regard for the patients) relate to the Coalition’s support - Concern
Objectives care philosophy of using authentic relationships as a tool for (Ex-) + Emotional - Abuse
healing. Partners support - Danger
• Understand the impact of Housing First on Q5. How often is there someone you could get
2.30 + Companionship - Absence
patients’ social support system together with just for fun? Family Themes
• Frequency of positive references to specific relationships: Friends + Consistency - Geographic
• Identify areas of success and areas for
Q6. How often is there someone you could • Children: 52% + Trust barriers
improvement
count on for everyday favors like getting a ride, 1.80 • Siblings: 36% Family + Protection - Tension due to
Methods borrowing a little money, or running errands? • Parents: 28% + Motivation drug use
• Program Eligibility: Patients must be • Extended Family: 12%
Q7. How often is there someone you could Professional + Instrumental - Rejection
chronically homeless, permanently disabled, • Some patients said housing enabled them to reconnect with
count on to take care of you if you were 1.71 support - Unclear
super-utilizers of the hospital system, Camden family (ex. increased family members’ trust in them, gave
confined to bed for several weeks? Housing First + Emotional communication
residents, and Medicaid recipients. Once them a safe place to reunite). Care Team support - Inconsistent
enrolled, there are no clinical health
0 2 4 + Companionship - Unreliable
requirements (ex. abstinence from Never Always “I’ve been seeing my sister. Once a month, we go out to dinner
Other Social + Consistency - Superficial
substances). Other Survey Results and stuff. But I never seen her for years until I moved in here.”
and Medical + Transitional - Inadequate
• Study Eligibility: All program participants can • The average combined scores for the full social support
Housing First Feedback Service support - Interrupted
participate in ongoing surveys administered at assessment did not change much when segmented by
• 88% of interviewees noted at least one way in which Housing Providers + Genuine relationships
move-in, six months post move-in, and twelve time point.
First has improved their life, including positive impact on interactions
months post. Data included in this poster • Move-in: 2.77 (n=16)
support, relationships, addiction, peace of mind, + Persistence
were collected between November 2016 and • 6 months post move-in: 2.25 (n=14)
independence, and health. + Positive regard
October 2017. All program participants • 12 months post move-in: 2.71 (n=15).
• Most patients did not suggest ways to improve Housing First, (for patients)
enrolled between February and July 2017 • The range of change in full assessment raw scores for
but there were 2 recommendations to increase the + Gratitude
were also eligible to be interviewed on a first- patients with two completed surveys varied widely (max
come-first serve basis until themes were total 28 points). communal aspect (holiday parties, weekly group meetings) “When you’re not doing too good, no one wants to
exhausted. Survey and interview participants • Move-in to 6 months post move-in: +5 to +9
received Visa gift cards for their time. points (n=7)
Conclusion have nothing to do with you.”

• Analysis: This poster includes data from the • 6 months post move-in to 12 months post • Housing First helps socially stabilize patients through supporting family reconnections, removing addiction triggers, and
survey section assessing social support, which move-in: -4 to +7 points (n=3) increasing safety.
• 25.71% of patients expressed a desire for more social • Patients are ambivalent about social relationships, and Housing First may increase social isolation for some patients.
was a revised version of the scale used in the
connections in at least one survey encounter. Day programs may be one mechanism to increase positive socialization.
New York City FUSE Initiative.6 Interview
46.88% of surveyed patients were enrolled in a medical • Areas of program excellence: unconditional positive regard (suspending judgement) and creating safe relationships in
transcripts were reviewed in entirety for •
themes, with specific attention paid to the or behavioral day program that includes a social which patients feel they can turn to care team members for advice and emotional support
section explicitly probing on social support. component, and 86.67% of enrolled patients positively • Areas for program improvement: socialization among Housing First patients, communication of program roles and
rated their program. responsibilities, support for patients’ material needs.
References
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2. Golembiewski E, Watson DP, Robinson L, et al. Social Network Decay as Potential Recovery from Homelessness: A Mixed Methods Study in Housing First Programming. Soc Sci. 2017; 6(3), 96-119. 5. Tsai J, Mares AS, Rosenheck RA. Does Housing Chronically Homeless Adults Lead to Social Integration? Psychiatr Serv. 2012; 63(5), 427-34.
3. O’Campo P, Stergiopoulos V, Nir P, et al. How did a Housing First Intervention Improve Health and Social Outcomes among Homeless Adults with Mental Illness in Toronto? Two-year Outcomes from a 6. Aidala AA, McAllister W, Yomogida M, et al. Frequent Users Service Enhancement “FUSE” Initiative: Evaluation Report. Columbia University Mailman School of Public Helath. 2014. http://www.csh.org/wp-
Randomised Trial. BMJ Open. 2016; 6(9), e010581. content/uploads/2014/01/FUSE-Eval-Report-Final_Linked.pdf.