Academic journal article Cityscape

International Commentary: Eliminating Family Homelessness and the Family Options Study

Academic journal article Cityscape

International Commentary: Eliminating Family Homelessness and the Family Options Study

Article excerpt

Introduction

For this commentary, I reviewed the report on the 3-year outcomes of the Family Options Study (Gubits et al., 2016a, 2016b) and two articles (Shinn, Brown, and Gubits, 2016; Shinn et al., 2016) published on this study. In this commentary, I discuss the interventions and their underlying theories of change, the target group, methodological issues, the findings, and the policy implications of the study. The Family Options Study is an evaluation of different program options for families experiencing homelessness. The study was conducted in 12 communities, enrolled 2,282 participants, and used a randomized controlled trial (RCT) design. This study is, by far, the largest, most rigorous comparative evaluation of interventions for homeless families ever conducted anywhere. As such, it has important policy implications for how homeless families are best served.

I come to this commentary as a member of the national research team of the recently completed At Home/Chez Soi (hereafter, At Home) project in Canada. Similar to the Family Options Study, At Home was its nation's largest-scale (5 communities, 13 programs, 2,148 participants) RCT evaluation of housing and service interventions for adults experiencing homelessness and mental illness (Goering et al., 2014). Although the populations and interventions in the Family Options Study and At Home were different, these two research demonstration projects, their findings, and their policy implications have some parallels that I note in this commentary.

Interventions and Theory of Change

The Family Options Study examined the effectiveness and costs of three different options, each with its own underlying theory of change. A theory of change identifies the program components, presumed short-term and long-term outcomes, and the causal mechanisms linking program activities and outcomes (Riemer and Bickman, 2011). First, the subsidized housing option provides participants with a housing voucher (or rent supplement) and assistance finding housing but, importantly, no other support services. The theory of change for this Housing First intervention is that families lack the financial resources to access housing and that providing a housing voucher helps to overcome the problem of housing affordability, enables families to use more of their income for other necessities, and reduces stressors to families related to poverty and housing instability. Second, community-based rapid re-housing provides short-term (up to 18 months) housing vouchers and low-intensity case management. The theory guiding this approach is that of crisis intervention, with services providing immediate, but time-limited, intervention to help families resolve their housing crises. Third, project-based transitional housing emphasizes time-limited (up to 2 years) congregate housing with other homeless families and onsite intensive case management (ICM). This "treatment-first" approach strives to prepare families for housing readiness based on the theory that families must first address other issues (for example, substance use or lack of job skills) before they can achieve stable housing.

The Family Options Study is valuable because it compares these different options and clearly articulates the theories underlying each approach. Similarly, the At Home project had a clear theory of change for its Housing First programs based on several principles, including consumer choice, a recovery orientation, and an emphasis on community integration (Tsemberis, 2015), which is visually depicted in a program logic model that links principles and program components with outcomes (Aubry, Nelson, and Tsemberis, 2015; Nelson and MacLeod, 2017). One of the advantages of having a theory of change is that it then becomes possible to develop methods to assess the implementation of program components and the intended outcomes. Assessing implementation is important to understanding how programs do or do not lead to intended outcomes. …

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