As mentioned earlier, supported housing is a relatively recent residential service strategy that is still being refined. A 1997 literature review on supported housing by Ogilvie concluded that there are still too few outcome studies on supported housing to draw firm conclusions about the efficacy of the approach. A more recent review of the supported housing literature by Debra Rog (2004) found that the evidence on supported housing is still insufficient. Rog identified, for example, only five studies that used "rigorous" scientific designs. Her review found convincing evidence that supported housing residents were less likely to become homeless, less likely to be hospitalized, and fared better than similar residents in other settings. The findings of three studies (Dickey et al., 1996; Dickey, Latimer, Powers, Gonzalez, & Goldfinger, 1997; Goldfinger et al., 1999;) suggest that housing stability is increased by providing supports rather than by a specific program model. Similarly, Tsemberis and Eisenberg (2000) found that the addition of the supports of an assertive community treatment (ACT) team (see Chapter 7) nearly doubled the rate of housing stability compared to typical residential treatment.
Earlier, supported housing demonstration projects in five states (Ohio, Oregon, Rhode Island, Washington, and Wisconsin) found that consumers reported a high level of satisfaction with their lives (Livingston, Gordon, King, & Srebnik, 1991). Although many of the people receiving services had a history of housing instability, most demonstrated a significant increase in stability once they became involved with the projects. Two critical factors were found to predict housing stability: symptoms and how much input a person had in choosing where he or she lived. The results of this study also suggest that along with providing consumers with opportunities to live in decent homes of their own choosing, communities need to focus on expanded social networks and employment opportunities.
Curtis, McCabe, Fleming, and Carling (1993) interviewed consumers, family members, agency staff, and administrators from seven supported housing demonstration projects in Texas. The most frequently mentioned outcomes were decreases in hospital use and increases in community tenure, access to housing, motivation, hope and empowerment, normal role functioning, and overall quality of life. Consumers also expressed a high level of satisfaction with the services they received.
A subsequent study of the Texas demonstration projects confirmed these initial findings (Texas Department of Mental Health and Mental Retardation, 1994). Utilizing participant data from the year prior to project involvement, and comparing these data to information gathered after 1 year in a supported housing program, this study found that there was an increase in housing stability, level of functioning, and quality of life, as well as a decrease in hospital usage.
A supported housing study by Brown, Ridgway, Anthony, and Rogers (1991) compared a group at high risk for rehospitalization and homelessness with a less disabled group that had requested supported housing services. Both groups significantly decreased their hospital usage in the 6 months following entry into the program, although as might be expected the former group utilized more support services. The authors concluded that the supported housing approach is a viable option even for persons who have severe disabilities.
Much more research needs to be done to determine the outcomes of supported housing services. Because there is still a lack of clear evidence for its efficacy, it is currently considered to be a promising practice (Rog, 2004). However, many consumers and providers believe that even without the research studies to back it up, supported housing programs are worthwhile endeavors because helping individuals find and maintain decent affordable housing is not a form of "treatment." It is a basic human need that profoundly affects the quality of a person's life.
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