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Critical Characteristics of Supported Housing

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This presentation provides critical insight on the characteristics of supported housing.

Bonnie Kirsh, PhD
University of Toronto

Rebecca Gewurtz, MSc (OT), PhD Candidate
University of Toronto

Ruth A Bakewell, MSc (OT)
University of Toronto

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Critical Characteristics of Supported Housing

  1. 1. Critical Characteristics of Supported Housing Bonnie Kirsh, PhD. University of Toronto Rebecca Gewurtz, MSc(OT), PhD Candidate University of Toronto Ruth A Bakewell, MSc(OT) University of Toronto 1
  2. 2. Background High proportion of persons with SMI who are homeless. Pressing need for effective SH that improves outcomes Characteristics of SH that are valued and effective are unknown, EG:  Nature and intensity of supports  Organizational structure to deliver supports  Qualities of physical and social envir of SH 2
  3. 3. Purpose To develop an understanding of important components of supported housing (SH) for persons with severe mental illness (SMI). 3
  4. 4. Objectives Identify critical characteristics of SH as perceived by residents and service providers Identify best practice SH characteristics documented in literature Understand influence of characteristics on outcomes These characteristics can be used for quality improvement and to set standards for SH 4
  5. 5. Methods Comprehensive literature review, extraction of characteristics that affect outcomes Qualitative methods – to understand lived experience of SH  Semistructured interviews with residents, SPs  Analysis: Constant comparative method to generate set of characteristics 5
  6. 6. Participants Consumers/Residents, n=25 Type of Participant Agency 1 Agency 2 Rent Geared to Income <1 yr 2 1 >1 yr 6 3 Homeless <1 yr 1 1 >1 yr 5 3 MH & Justice <1 yr N/A 3 >1 yr N/A Total 14 11 6
  7. 7. Participants (cont’d) Service Providers, n=10 Housing support worker 5 Case manager/Rehab worker 5 7
  8. 8. Results: Themes Generated Consumers Service Providers Guiding principles Guiding principles Supports offered in supportive Supports offered in supportive housing housing Housing features Neighbourhood and community Neighbourhood and community Moving forward: impacts of SH Moving forward: impacts of SH Pathways into SH Pathways into SH Program and system issues 8
  9. 9. Consumers: Guiding Principles Being Treated with Dignity  a person with genuine value and worth  confident that SPs were working hard on their behalf Flexibility and Choice  Flexibility and choice in nature and frequency of support  Choice in housing unit 9
  10. 10. “The good thing about that was the housing worker I had, I was given choices…she would come with a list and said okay, this is where we have housing, it’s up to you...” [resident]. 10
  11. 11. Service Providers: Guiding Principles Flexibility and Choice  individualized support  choice (in neighbourhoods, housing type)  range within the system Client- Client-Centredness  client-chosen goals, indep decision-making client- decision-  information necessary  collaboration Managing Stigma  Segregated vs Integrated Housing  Support and education for Landlords 11
  12. 12. Consumers: Supports offered in SH Access to Supports Some felt they needed more support/ greater access Greater need for developing skills for independent living Nature of Supports  Instrumental Support Taking care of house & home, managing finances  Support During a Crisis  Support with Work and School This extended support is key to moving forward  Informal Supports Importance of friendships, family, pets Connections with other consumers 12
  13. 13. “…Well most of the people that I have become really good friends with are the people in the program…you meet these incredible people who have thriving lives…who were exactly where I was…I mean it’s just why it’s so powerful…these are my friends…which is incredible.” 13
  14. 14. SPs: Supports offered in SH Building a Relationship Fostering trust key to relationship -building relationship- Patience & persistence, not ‘giving up’ High SP turnover a challenge to relationship- relationship- building Access Importance of long-term support, often the only long- support Community supports/resources beyond housing Advocacy - Some resources difficult to access Supporting Independent Living Transition to indep living is like “culture-shock” “culture- Importance of routine Support in making apartment into a home Importance of paying attention to needs beyond housing 14
  15. 15. Service Provider: “Having the supports I think is important … like in our case our caseloads are kept low. So that we can have the time to spend with clients.. So we can go in and see them twice a week. You know three times if we absolutely have to.. And we can spend an hour or more with them if we need to.. you know if it’s needed, not to make a habit of it, but if it’s needed we can.. so it’s not a 15, 20 minute visit …And I just, I think that makes a big difference.” 15
  16. 16. SPs: Supporting Independent Living  Instrumental Supports Finances, paying rent, learning budgeting skills Education about financial options (eg. trustee, income support programs) Support when dealing with unpaid rent  Social Supports Combating isolation, establishing a social network  Support with Work and Education  Support During a Crisis Creating ‘crisis plans’, being attuned to client’s life Working closely with landlords/ superintendents important in crisis prevention and management  Support Managing Health Medications, improving physical health, ageing clients 16
  17. 17. “Ultimately trying to get the individual to do most of the stuff their own. To encourage that independence… this is their home, this is their place… it’s not my home. To help them set up, to make it their sanctuary… it’s such an important thing in people’s life, not just to have a roof over their head, but a place that they can have that pride in and that happiness with. And the more control they have over it, the more sense of ownership.” 17
  18. 18. Consumers: Housing Features Independent Living  Living alone fundamental to privacy & dignity  Important for recovery and goal attainment  Sense of safety & control  Pride in making house into a home  Able to organize routine around personal priorities  Reduces stress, provides flexibility, stability, motivation  Drawback - loneliness Important Structural Features  Rent subsidy  Physical space (separate bedroom, appliances, fresh paint, good building maintenance & services)  Opportunities to socialize locally  Stability of arrangement – no maximum length of stay/tenure  Increased comfort, security, stability, reduced stress 18
  19. 19. “when I go back now to my own unit, I’m able to assess and process what took place that day, and what should be happening next. So that gives me my own space to do that.” 19
  20. 20. When you boil it right down, because I’m now living in a clean secure [place],...I’m just in… an overall better frame of mind… and therefore more likely to do the proper things to take care of myself.... I have my own kitchen, my own bathroom, so I don’t have to wait for other people to get out of the shower. I can lay food somewhere without people stealing it…You know, it’s just yeah… the overall ease of living.. psychologically it’s picked me up a fair bit.. 20
  21. 21. Consumers: Neighbourhood & Community Disclosure  Scattered apartments vs clustered housing  Dealing with stigma  Shared understanding and a community of support Community Access  Public transit & amenities (banks, stores, relig cong)  Proximity to supports (family, friends, drs, MH progs) Interactions with Neighbours  Various levels of interaction and support  Increased sense of security and reduced stress Safety: Impact of Drugs and Crime  Communities with high rates of drugs and crime  Social housing vs subsidized units buildings  Participants with histories of addiction require ‘clean’ buildings and communities 21
  22. 22. “When you live in that building and you come out, nobody, there’s not.. there’s nothing on your hat saying, he has a mental illness or he lives in social housing, or anything… you are one of the tenants, nobody know who you are, or whatever illness you have.. and that type of integration, it is very good.. it, it gives you hope...” (M13) 22
  23. 23. “You know when they say, when you’re in Rome do as the Romans do. Well, when you’re in those places and you’re living there, eventually...you can’t fight them forever and then you give in… and you get high, and you drink with them, and before you know it, you’re brought right down to the level that they’re at… I didn’t want to be around that so, they got me a spot in a condominium building and, they got me a beautiful condo, and that got me away from the drugs, and that crowd, you know what I mean.” 23
  24. 24. SPs: Neighbourhood & Community Community Response to SH  Generally positive, some neighbourhoods more accepting of SH than others  Difficulties arise when clients become unwell and are unable to access medical services Fit – Person to Neighbourhood  Finding a good fit is key part of intake assessment  Importance of safe and healthy neighbourhoods  Services and accessibility in neighbourhoods  Neighborhood critical for clients with substance use issues Safe, Comfortable, Clean Housing  Critical to self-esteem and a sense of self-worth – self- self- SPs help maintain  Importance of building maintenance  Good housing is about more than having shelter; it is about creating a home 24
  25. 25. “When we do the assessment, we’re looking for fit. Cause we already know the landlords in the buildings that we have out there. So we want people to feel like they’re being integrated into a community, that they’re fitting in, that they don’t stand out. So someone that might want to live downtown and that would fit into the downtown community, you know we’re not going to stick them out at say Don Mills and Sheppard where they might stand out. And vice versa. So we really look at the building, the make -up of the make- community, where people request that they want to live, and we try to match it that way. Cause at the end of the day we want people to be successful in housing. We want it to work.” 25
  26. 26. Consumers: Moving Forward : Impacts of Supported Housing Impact of good housing  Increased self-esteem self-  Increased motivation: to improve self-care, to self- participate in community life Being productive  Valued being productive, involved in communities, having a schedule, connecting with others  Being able to pursue their goals improved recovery, overall health and QoL  Taking care of the home as productive work  SH provided opportunity and flexibility to pursue goals Hopes for the future  Safe and secure housing allowed participants to process past experiences and begin to think about the future 26
  27. 27. “It’s allowed me to stop worrying about those things that were holding me back. When I was in the rooming houses, I wasn’t able to even think about the things that I’m doing now…because I was so suppressed with all this negative energy and these negative things going on around me. I just felt hopeless and trapped. But due to my housing situation being changed, and I have a beautiful home and I’m happy there, now I’m learning to be happy with me... I’m a good person and I have a good life, things are going good, I’m going to go out today and I’m going to be a nice person, and I’m going to have a good day. And I’m going to do, I’m going to help somebody if I can, and I’m going to make somebody smile, stuff like that…I can focus on more positive things, now.” 27
  28. 28. SPs: Moving Forward: Impacts of SH Housing as a foundation  Foundation for recovery and community integration  A “first step” towards stability and independence  Consistency in housing is necessary for ‘moving on’ to occur Goals of SH  Maintain housing; a “healthy, happy, safe” home environment  Move on to more independent living situations  Participate in social rec and productive roles; work and school  Integrate into broader community  Risk: isolation Increased confidence and stability  demonstrated in ability to access and use resources 28
  29. 29. “It [supported housing] allows people to feel that they’re part of the community and move forward with their life. Whatever that might look like. Move their life with their journey. Be part of the community ... A mental illness is just one piece of the puzzle of a person, who the person is, it’s not they’re whole existence it’s just a little piece, and often people don’t feel that way. Often they’re not led to feel that way… You’re a person first that has all sorts of goals and aspirations and your identity is not the fact that you have a mental illness.” 29
  30. 30. Literature: Characteristics Safety Rules Stigma Integration Independence Isolation Coordination of services Community Choice Medication Privacy Space Financial Assistance Preference Balance Subsidy Neighbourhood Case management Skills Options Substance/drug abuse Flexibility treatment Affordability Social Support Access Staff Sharing Permanency Resources Control 30
  31. 31. Conclusion Housing is a determinant of mental health Foundation for productive, meaningful engagement in life Choice, individualized approach critical Neighbourhood fit, no time limits Awareness and attention to stigma Relationship key, long term support Supports needed: independent living, crisis, work/school, social life, health 31

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