Factors Related to Rapidity of Housing Placement in Housing and Urban Development-Department of Veterans Affairs Supportive Housing Program of 1990s

By Tsai, Jack; O'Connell, Maria et al. | Journal of Rehabilitation Research & Development, July 2011 | Go to article overview

Factors Related to Rapidity of Housing Placement in Housing and Urban Development-Department of Veterans Affairs Supportive Housing Program of 1990s


Tsai, Jack, O'Connell, Maria, Kasprow, Wesley J., Rosenheck, Robert A., Journal of Rehabilitation Research & Development


INTRODUCTION

A central goal of permanent supported housing programs is rapid exit from homelessness and prolonged program participation. Yet few studies have examined the actual length of time it takes for clients to be screened, admitted, and placed into independent housing or reported the duration of participation among those housed. Supported housing programs have different methods of providing clients with various services that may affect how fast clients enter community housing. Some programs have partnerships with housing providers that keep apartments available for clients [1], other programs own or hold the lease to apartments that they then rent to clients [2-3], while others provide rental subsidies and case management assistance to help clients obtain community housing [4-5]. One of the largest supported housing programs in the United States is the Housing and Urban Development-Department of Veterans Affairs Supportive Housing (HUD-VASH) program, which serves chronically homeless veterans with disabilities. HUD-VASH was originally implemented in 1992 and has provided thousands of veterans with Section 8 vouchers along with supportive case management services. Initially implemented at 19 Department of Veterans Affairs (VA) medical centers, HUDVASH has recently expanded dramatically and is now serving more than 20,000 veterans at 132 VA medical centers [6].

Timely housing entry, while desirable, can be challenging because clients must complete numerous processes before entering housing. These processes can be broken down into four stages: time from intake in the community to specific referral to HUD-VASH, time from referral to signed treatment contract, time from signed contract to receipt of voucher, and finally, time from receipt of voucher to moving into housing. In each of these processes, different factors may be involved in facilitating client progress. From intake to referral, the referring clinician may be central; from referral to signed treatment contract, the HUD-VASH case manager is central; from signed contract to receipt of voucher, both the HUD-VASH case manager and the public housing authority are involved; and from receipt of voucher to housed, the HUD-VASH case manager, the veteran, and landlords of prospective apartments are all extensively involved.

Only one previous study has examined the time it takes for clients in HUD-VASH or any other supported housing program to enter housing [7]. That study found that although HUD-VASH was intended to provide rapid access to independent housing, the actual progression through the various processes was apparently slow, taking several months, and many clients did not stay in the program for the full 5-year period of potential data collection. Administrative data from 2,925 HUD-VASH clients at 36 sites showed the average time from program entry to housing placement was 110 days and that clients remained in the program for an average of 2.6 years in a 5-year follow-up period. Regression analyses found that African-American clients took longer to enter housing after receiving a voucher, while clients who had a mental illness and comorbid substance use disorder obtained housing faster, but site accounted for the greatest proportion of variance in process times.

In the current study, we extend these findings [7] by combining administrative data with further clinical information available on a subset of program participants to examine factors beyond basic sociodemographic characteristics that may be related to the rapidity of placement and duration of participation. More specifically, measures of psychiatric and substance abuse symptoms, along with work and criminal histories, were examined as additional predictors of process times. We hypothesized that clients with more psychiatric and substance abuse symptoms and more extensive criminal histories would be more difficult to house and would accordingly have longer process times. …

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