Information Update Archived Issue
Promising Practices for Social Inclusion: Housing and Community Supports Foster Successful Reintegration
August 2011 » Issue 30
Letter from SAMHSA
SAMHSA’s Recovery Support Initiative, one of eight strategic initiatives outlined in Leading Change: A Plan for SAMHSA’s Roles and Actions 2011–2014, discusses the critical role that stable housing and community supports play in preventing homelessness. SAMHSA’s strategic initiatives are designed to provide a roadmap to help communities, public systems, and our nation as a whole move toward becoming a more socially inclusive America.
Social inclusion is a bidirectional process involving change at multiple levels, including broad systems transformation, community-level changes, and personal wellness and recovery.
According to Individuals Experiencing Chronic/Long-Term Homelessness by Kristin Paquette (2010), about 30 percent of people who are chronically homeless have mental disorders and about 50% have co-occurring substance use disorders. Safe and stable housing is part of the foundation for personal recovery and a high-quality, satisfying, self-directed life in the community. Thus, preventing homelessness and providing the needed supports to foster successful reintegration of individuals with mental and substance use disorders are major areas of focus for achieving social inclusion.
This issue of SAMHSA’s ADS Center Information Update will demonstrate social inclusion in action by:
- Sharing innovative community approaches and tools available for homelessness prevention, housing and supportive services, trauma-informed service delivery, and employment programs
- Revealing one man’s journey back from homelessness to a full life
- Promoting the best practices from one community program
- Describing a national model that is changing service delivery to individuals who are homeless
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Teleconference Summary: Housing, Homelessness, and Social Inclusion—Essential Elements of Healthy Communities
The SAMHSA ADS Center sponsored a free training teleconference on February 23, 2011 entitled “Housing, Homelessness, and Social Inclusion: Essential Elements of Healthy Communities.” The teleconference, which featured presentations by Bonnie Milstein, Livia Davis, and Michael Kelly, highlighted the following topics:
- Current trends and practices in the field, including how to prevent homelessness
- Recent precedent-setting court rulings to address violations of the Americans with Disabilities Act and Olmstead and ensure that consumer choice in housing options is respected and preserved
- The importance of understanding social connectedness, social capital, and social inclusion as the foundation for developing programs that not only help people who have been homeless to successfully reenter their community but also foster the health of communities overall
- The story of one person who moved from being homeless to being a homeowner and the lessons that can be learned from his recovery journey
If you were unable to participate in the teleconference, or would like to listen to it or view the slides again, you can access it here.
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In My Experience: An Individual’s Journey from Homelessness and Isolation to Reintegration and a Full Life in the Community
Jeffrey Holland opens up and shares his recovery journey. He states that supportive community mental health center staff helped him take a key step when they invited him to become involved in helping others:
“As I waited on the city bus bench across the street, I studied the man’s disheveled appearance. . . . As I watched the man I reflected on my own past. I have lived a wandering existence leaving a trail of homeless shelters, emergency rooms, and mental health facilities. My experiences taught me to try to isolate myself as much as possible and to be wary of others. . . . However, it wasn’t until . . . my involvement in local community mental health activities, that I realized the necessity of a group-based therapy and recovery program. I, like other consumers, often found myself helping in small ways in client-staff activities. . . . I am sure that various staff members, who allowed me to help at times, knew very well the exciting transformation that takes place when individuals are motivated not by expectation but by the compassion and responsibility they begin to feel for others.”
Read Jeffrey’s story and support others by sharing your own.
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A Community Model: Durham, NC Housing for New Hope
By, Eric Breit, Development Director, Housing for New Hope
For 19 years, Housing for New Hope has taken a leadership role in the transformation of services to members of its community who are experiencing homelessness. Housing for New Hope, whose motto is “Preventing and Ending Homelessness, One Valuable Person at a Time,” was instrumental in establishing a continuum of care, including an increasing stock of permanent supportive housing and improved mental health and homeless outreach services. Its work has been accomplished by being inclusionary and by recognizing the importance of services and housing options to help individuals and families who are homeless successfully reintegrate into the community.
There are 788 individuals experiencing homelessness in Durham and Orange Counties, where Housing for New Hope operates, and 788 different solutions to getting them from their current situation into their own home—whether it is the individual who has a mental or substance use disorder staying at a homeless camp in the woods, or the single mother with kids sleeping in her car in the parking lot of a local church due to job loss. Housing for New Hope reaches out to these families and individuals and provides them with a pathway of services and housing that eventually leads to them getting the homes they need and the improved lives they deserve. In 2010 alone, Housing for New Hope assisted 950 low-wealth families and individuals with housing, financial support, and services, such as obtaining entitlements and benefits, employment, and health care.
Housing for New Hope’s work would not be successful without the participation of those in recovery and those who have experienced homelessness firsthand. One-third of Housing for New Hope’s employees has experienced homelessness. Their past experiences are critical to helping Housing for New Hope successfully connect with and relate to those it works to assist. And the personal satisfaction these “peer specialists” experience through their work is tangible.
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A National Model: Pathways’ Housing First, An Approach that is Changing Service Delivery to Individuals who are Homeless with Co-Occurring Diagnoses
By, Dr. Sam Tsemberis, Executive Director, and Ana Stefancic, Director of Research, Pathways to Housing
Rooted in principles of psychiatric rehabilitation, the Housing First model was the first to provide individuals who are chronically homeless and experiencing mental and substance use disorders immediate access to permanent housing and consumer-driven supports to maximize successful tenancy and recovery. The model separates housing from clinical issues by addressing homelessness first, providing individuals permanent housing without prerequisites for treatment and sobriety, and then supporting them to address clinical or other issues. To facilitate community integration, housing typically consists of scatter-site apartments, or apartments in different sites across a community, not next to one another, and often not in the same building. These apartments also are located in regular (non-program) neighborhood buildings. The program does not rent more than 20 percent of the units in any building, and program participants have the same rights and responsibilities as any tenant with a standard lease.
Support services are based offsite and are typically provided in the participant’s apartment or community by multidisciplinary Assertive Community Treatment (ACT) teams or, when service needs are not as high, by Intensive Case Management (ICM) teams. The ACT and ICM teams have been modified to integrate principles of client choice and recovery; use a harm reduction approach to mental health and addiction treatment as well as evidence-based practices such as Integrated Dual Disorder Treatment and motivational interviewing; and encourage participants to select the type, frequency, and sequence of services. Teams support participants as they address clinical issues as well as the challenges of community integration, including developing and managing neighborhood relations, using community merchants for all their shopping and homemaking needs, managing finances, finding places to worship, maintaining a healthy lifestyle, and developing a sense of community.
The Housing First model also encourages local service enhancements that foster social connectedness and social inclusion. For example, Pathways to Housing Vermont is implementing a telehealth initiative that will provide participants with computers, Internet service, and video communication equipment to bridge the distances that separate them from service providers, peers, and other social opportunities. Pathways to Housing New York has created a resource center that offers participants classes and one-on-one wellness services—this program funded by SAMHSA is staffed solely by peer specialists—that work with program participants to develop skills, knowledge, and resources to access greater opportunities (e.g., employment, college enrollment, peer advocacy).
The manual, Housing First: The Pathways Model to End Homelessness for People with Mental Illness and Addiction 
,summarizes findings on the effectiveness of the Housing First model. Compared to other approaches, Pathways’ Housing First program helps participants obtain housing earlier, remain stably housed at higher rates, and spend significantly less time in psychiatric hospitals. The model is also cost effective. From the participants’ perspective, Housing First is associated with greater residential satisfaction and reduced psychiatric symptoms and alcohol use. Successful program replication in a number of different countries further attests to its effectiveness across a variety of contexts and populations, demonstrating how program design allows for flexible and effective implementation with high fidelity across sites.
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More Information: Social Inclusion Programs, Technical Assistance Tools, and Research
Please note: The descriptions below are pulled from or based upon the language provided on the organizations’ Web sites.
Promoting Systems Transformation
The National Alliance to End Homelessness works with public, private, and nonprofit divisions to enhance State and local capacity for stronger programs and policies with the goal of ending homelessness. Visit http://www.endhomelessness.org to learn more.
The National Coalition for the Homeless is dedicated to creating systemic and attitudinal changes needed to end homelessness by engaging in public education, policy advocacy, and grassroots organizing. To learn more about this organization visit http://www.nationalhomeless.org .
The National Coalition for Homeless Veterans strives to end the homelessness of veterans by influencing public policy, encouraging collaboration, and working to enhance effectiveness of service providers. To learn more visit http://nchv.org .
The Homelessness Resource Center seeks to improve the lives of people with histories of mental and substance use disorders and trauma who have experienced homelessness. It does so by working to integrate consumers into all activities, fostering a trauma-informed recovery system, and encouraging collaboration at all levels. To learn more visit http://homeless.samhsa.gov/Default.aspx.
SAMHSA’s Co-Occurring and Homeless Activities Branch (CHAB) works toward community transformation, promotes a public health approach to systems of care for people with co-occurring disorders and persons who are homeless, and shares information related to these issues. To learn more about SAMHSA’s CHAB please visit http://chab.samhsa.gov/.
The Bazelon Center for Mental Health Law works to promote full integration of individuals with mental and substance use disorders into society by protecting individuals’ rights to exercise their own life choices and promoting access to resources. Visit http://www.bazelon.org to learn more.
The Technical Assistance Collaborative (TAC) strives to achieve systems change through evidence-based approaches in behavioral health, community services, and affordable and permanent supportive housing. To read more about TAC visit http://www.tacinc.org .
The Trauma-Informed Organizational Toolkit for Homeless Services helps providers of services for people experiencing homelessness assess their services and implement changes to ensure appropriate responses to the needs of families who have experienced traumatic stress. To access this toolkit, please visit http://www.familyhomelessness.org/media/90.pdf
[PDF - 2.0 Mb] .
A Housing Toolkit: Information to Help the Public Mental Health Community Meet the Housing Needs of People with Mental Illnesses offers practical, specific direction and information to organizations and individuals interested in expanding housing opportunities. This toolkit is available for download at http://www.nami.org/Content/ContentGroups/Policy/housingtoolkit.pdf
[PDF - 745 Kb] .
Work as a Priority: A Resource for Employing People Who Have Serious Mental Illnesses and Who Are Homeless offers information on promising programs, discusses relevant policies and laws, and reviews literature on increasing employment. Download is available at http://store.samhsa.gov/shin/content//SMA03-3834/SMA03-3834.pdf
[PDF - 1.0 Mb].
Joint Statement of the Department of Housing and Urban Development and the Department of Justice: Reasonable Accommodations Under the Fair Housing Act outlines these agencies' responsibilities in enforcing the Federal Fair Housing Act. To learn more, visit http://www.hud.gov/offices/fheo/library/huddojstatement.pdf
[PDF - 135 Kb].
Report from Barcelona: Fostering Social Inclusion to End Homelessness describes how Barcelona, Spain's city government, charities, and nongovernmental organizations have banded together to launch a social inclusion initiative in support of those impacted by the global economic recession. Read more at http://homeless.samhsa.gov/Resource/
Report-from-Barcelona-Fostering-Social-Inclusion-to-End-Homelessness-50139.aspx.
Changing Community Perceptions and Influencing Local Systems
Main Street Housing works to establish safe, affordable, and independent rental housing for individuals with mental and substance use disorders through the development of strong working relationships with various community resources and State-level administrations. Please visit http://www.mainstreethousing.org/index.html to learn more.
Pathways to Housing uses a Housing First model to advocate for people experiencing mental and substance use disorders and homelessness. In this model, clients are welcomed into housing as the first step toward recovery. Visit http://www.pathwaystohousing.org to learn more.
With funding from SAMHSA, the Center for Social Innovation’s Services in Supportive Housing Technical Assistance Center assists sites providing supportive housing to individuals and families through technical assistance, tailored trainings, and follow-up support as needed. To learn more about this organization, please visit http://www.center4si.com/projects/projects.cfm?project=37d21195-9b6f-4217-a6ae-616f23795836 .
Developing a State Interagency Council on Homelessness: A Step-by-Step Guide describes the practical benefits, functions, and steps involved in developing a State council on homelessness, along with some features of a successful council. To access this guide, visit http://www.usich.gov/resources/uploads/asset_library/
USICH_2011_State_ICH_Toolkit.pdf [PDF - 409 Kb].
The Permanent Supportive Housing Evidence-Based Practices KIT identifies key elements of permanent supportive housing services and discusses ways to develop new evidence-based programs for people with behavioral health problems. To access this toolkit, visit http://store.samhsa.gov/product/SMA10-4510?WT.ac=AD20100918HP_SMA10-4510.
Building Community Support for Housing: Ten Tips on How to Win Support for Your Affordable Housing Projects highlights tips for developing a successful community outreach campaign. To access this fact sheet, visit http://www.vcn.bc.ca/citizens-handbook/gcastrategies/article_ps_2.html .
100,000 Homes works toward a goal of housing 100,000 homeless Americans by July 2013 by providing communities with the tools and connections needed to help end homelessness. To learn more about this organization, visit http://100khomes.org .
Supporting Personal Wellness and Recovery
SAMSHA’s Projects for Assistance in Transition from Homelessness (PATH) offers a broad range of resources to support community-based organizations that provide services to individuals with mental and substance use disorders experiencing homelessness or at risk of becoming homeless. PATH services include community-based outreach, case management, limited housing services, and other supportive services. To learn more, visit http://pathprogram.samhsa.gov.
Housing for New Hope offers affordable housing and structured programs, including crisis assistance and outreach, designed to help consumers experiencing homelessness to regain hope, independence, and stability in their lives. Learn more about this organization by visiting http://housingfornewhope.org .
Back on My Feet engages individuals living in homeless facilities in running as a way to build confidence, self-esteem, and strength and offers participants a chance to take advantage of financial aid, educational, and job training opportunities. To learn more, visit http://www.backonmyfeet.org .
Peer-Run Supportive Housing for Families describes the approach of Housing Options Made Easy, Inc., or HOME, a consumer-run supportive housing program that is helping residents achieve personal recovery. Positive outcomes include fewer and shorter hospital stays and reduced use of crisis services. To read more about this organization, visit http://homeless.samhsa.gov/Resource/Peer-Run-Supportive-Housing-for-Families-50140.aspx.
Beyond the Storms: Reflections on Personal Recovery in Devon is a book of personal stories shared by individuals who have experienced mental and substance use disorders and a broad range of obstacles, including homelessness. To access this book, visit http://www.recoverydevon.co.uk/download/Beyond_the_Storms.pdf
[PDF - 3.3 Mb] .
Stepping Stones to Recovery: A Case Manager’s Manual for Assisting Adults Who Are Homeless, with Social Security Disability and Supplemental Security Income Applications highlights key eligibility and documentation requirements to facilitate applying for the Social Security Administration’s disability programs. To access this manual visit http://www.prainc.com/SOAR/training/manual/SteppingStonesMan.pdf
[PDF - 4.81 Mb] .
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Information and Research
Culhane, D. P., & Byrne, T. (2010). Ending chronic homelessness: Cost-effective opportunities for interagency collaboration. Penn School of Social Policy and Practice Working Paper. Available at: http://works.bepress.com/dennis_culhane/94/
Fleetwood, M. (2010). Homeless services in the U.S.: Looking back, looking forward: An open letter to policymakers, advocates, and providers. [PDF - 367 Kb] The Open Health Services and Policy Journal, 3, 27–29. doi: 10.2174/1874924001003010021.
Homelessness & mental illness [Special issue]. (2007). The Journal of Primary Prevention, 28(3–4).
Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. [PDF - 1.49 Mb] The Open Health Services and Policy Journal, 3, 80–100. doi: 10.2174/1874924001003010080.
Gillis, L. M., Dickerson, G., & Hanson, J. (2010) Recovery and homelessness services: New directions for the field [PDF - 569 Kb]. The Open Health Services and Policy Journal, 3, 71–79. doi: 10.2174/1874924001003010071.
Mullen, J. & Leginski, W. (2010). Building the capacity of the homeless service workforce [PDF - 1.40 Mb. The Open Health Services and Policy Journal, 3, 101–110. doi: 10.2174/1874924001003010101.
Ottmann, G., Dickson, J., & Wright, P. (2006). Social connectedness and health: A literature review . GLADNET Collection. Paper 471.
Thompson, S. J., Pollio, D. E., Eyrich, K., Bradbury, E., & North, C. S. (2004). Successfully exiting homelessness: Experiences of formerly homeless mentally ill individuals . Evaluation and Program Planning, 27(4), 423–431. doi: 10.1016/j.evalprogplan.2004.07.005
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ABOUT SAMHSA ADS CENTER
This update is from the SAMHSA ADS Center (Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health). SAMHSA ADS Center is a program of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services, Office of Consumer Affairs. We encourage you to share this information with others and to post it in your own newsletters or email lists.