1. Supported Housing: Research and Best Practices The Transformation Center Boston, MA. Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

2. Outline of Presentation 1. Description and Types of Supported Housing 2. Role in Community Integration 3. Benefits & Challenges 4. Review of the Research 5. Advocacy & Resources 6. Conclusions Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

3. What is Supported Housing?  Supported housing helps individuals acquire and maintain independent housing that is integrated into the community.  The consumer has choice and control over his/her services and supports.  The consumer is in a long term housing situation but the supports may change over time as needed. Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

4. Some Models of Supported Housing As Described in the Research 1. Supported Housing Program which helps consumer to acquire and maintain housing of their choice - the housing is the intervention (or part of it.) 2. Case Management Program which provides support to individuals who are in their own living situations; program helps to acquire subsidized or affordable housing by partnering with community agencies. Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

5. Supported Housing: Benefits  Gives consumers more control over the supports and services  Supports can decrease, increase or change according to the needs and wishes of the individual  Eliminates multiple moves, provides stability  Can reduce hospitalizations and improve the quality of life. Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

6. Supported Housing: Challenges  Obtaining enough subsidized housing is very challenging when the demand is so great.  Typically there are long waiting lists.  The field would benefit from better cost-benefit studies (usually SH costs more but may decrease some other costs such as treatment. Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

7. Research Review by Boston University Center for Psychiatric Rehabilitation (and Panel of 10 Experts)  Rationale for the Review: People in the field of rehabilitation needed the information on supported housing research, even though many studies did not have randomized trials.  Reviewed and Rated: 15 years of research including studies in which housing was an intervention, those where housing was the outcome and those where housing was both. Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

8. Supported Housing: Research Findings 1. Supported housing can improve housing status and increase the quality of life of residents who have psychiatric disabilities, are homeless, at risk of homelessness and/or may be substance abusing. 2. Consumers frequently prefer independent housing rather than group/congregate living. 3. Higher quality housing may lead to better quality outcomes. Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

9. Supported Housing: Research Findings 4. When housing is affordable, there is a more direct and quicker exit from homelessness and stable independent living is more likely. 5. When consumers go directly to supported housing (vs. group home), they are more likely to remain in their housing for a longer time. (Housing stability rates have been found to be 63% - 81%.) Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

10. Supported Housing: Research Findings 6. Housing subsidies lead to greater success in getting and keeping housing. 7. SH costs are greater than group living but may offer some savings in other services such as treatment. 8. Traditional case management is not sufficient to effect stable housing; intensive supports need to be available for those who need it, including practical supports such as laundry, shopping, and cleaning. Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

11. Supported Housing: Research Findings 9. There is some evidence that women fare better in supported housing than men. 10. Studying residential options using a randomized design is possible, but the attrition of participants presents a challenge. Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

12. Supported Housing: Research (continued) Supported housing does not guarantee: Social integration Improvement of symptoms Solving of practical problems When services promote social integration with the community, housing outcomes are improved, (but not necessarily clinical outcomes). Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

13. Need for Further Investigation  What is the relationship between housing, mental health outcomes and satisfaction?  What role do housing types have in relation to therapeutic benefits to individuals (unrelated to services)?  How should we define “housing stability” for research purposes so studies can be compared? Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

14. Supported Housing: Conclusions  Integrated, long term independent housing with supports is critically important to rehabilitation and recovery.  Supported housing in combination with subsidies can significantly improve the quality of life of residents.  Programs need to assist consumers in their community integration and prevent isolation. Compiled by the Supported Housing Study Group at Boston University Center for Psychiatric Rehabilitation. Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)