Comparison of Housing Alternatives for SMI in NYC

Principal Investigator: Carole Siegel, Ph.D. Co-Investigators: Judith Samuels, Ph.D., Kim Hopper, Ph.D., Sue Barrow, Ph.D., Kristine Jones, Ph.D., Dei-In Tang, Ph.D., Ilyssa Berg, BS, Frank Lipton, MD (New York City Human Resources Administration), Anthony Hannigan, MSW (Center for Urban Community Services), Sam Tsemberis, Ph.D. (Pathways to Housing).

PROJECT GOALS

To describe the characteristics and costs of two housing models for PSMD – supported housing (SH: separation of housing and services, autonomous living) and community residences (CR: structured housing with bundled services);
To compare the outcomes of propensity score “matched” PSMD in these models over an 18-month period.

This project is a collaboration with the New York City Office of Health and Mental Health Services of the Human Resources Administration, the agency responsible for reviewing housing applications and tracking placement outcomes for individuals with SMI; the Center for Urban Community Services, an agency offering services through several sites and providing housing consultation services; and Pathways to Housing, a supported housing project serving homeless persons with SMI and other disorders. The project is an out-growth of the NY/NY Housing: An Examination of Tenure project conducted by this Center.

RESEARCH ACTIVITIES AND RESULTS

Method: The study compares different types of housing (supported housing vs. a housing continuum) for individuals with SMI by studying housing programs and consumer outcomes in two phases:

Phase I, a process evaluation, examined the operations and ecology of five prototypical housing approaches: two that meet the SAMHSA definition for Supported Housing and three that collectively represent a housing continuum. Within two models of supported housing, distinctive differences in definition of the problem to be solved, target clientele, potential supporters, and neighborhood development strategy were observed and are expected to impact housing outcomes. A paper is under preparation on the "genealogies" of these sites.

In Phase 2, we conducted fidelity assessments of the housing models according to the guidelines and procedures developed by the coordinating center. We completed data collection for our quasi-experimental study testing the hypothesis that there is a difference in outcomes among tenants in supported housing in comparison to those in community residences.

Results: Data collection for the study is complete and extensive data cleaning and data set preparation were ongoing during the year, especially reconciliation of the two data sets on residential history, one from the cross site study, the other from the site specific cost-effectiveness study. The final analyzable sample is comprised of 157 individuals; 76 (48%) who were placed in supported housing (SH), and 81 (52%) who were placed in community residences (CR). However, the analysis sample is comprised of the 138 individuals who had more than a baseline interview. Interim findings based on an intent to treat analysis show overall group differences (weighted over propensity stratum) for housing satisfaction (more satisfaction in SH than in CRs for most time points), Basis 32 measurement of psychotic symptoms (lower in SH than in CR at 12 months) and empowerment (higher in CR than in SH at 18 months). There were other housing group differences for outcome variables that varied by time and assigned propensity stratum for isolation, community integration, quality of life. At 12 months, those in propensity stratum 1 (those least likely to be assigned to SH) who were in SH had a significantly higher number of days appropriately housed (not in jails, shelter, street or on long visits) than those in CRs. Depression/anxiety as measured by the Basis-32 at baseline has an overall significant impact on measures of isolation, community integration, empowerment, housing satisfaction, and overall quality. Residential stability patterns are more favorable (p<.10) for persons in propensity one stratum who start out in supported housing. This particular subgroup also exhibits fewer days in jails/prisons in the street/shelters than their counterparts in CRs.

SIGNIFICANCE OF FINDINGS/POLICY IMPLICATIONS

Knowing the types of housing that work best for which types of people can lead to more informed decision making in the development and support of specific housing types. Interim analysis suggest that persons least likely to be considered for placement in SH (propensity one persons) can do well in SH, and better than their counterparts as measured by several variables. In general there is greater satisfaction with SH than CRs.

INCLUSION OF GENDER AND MINORITY SUBJECTS: SAMHSA Housing Study

	American Indian or Alaskan Native	Asian or Pacific Islander	Black, not of Hispanic Origin	Hispanic	White, not of Hispanic Origin	Other of Unknown Origin	TOTAL
Female	1	2	24	9	16	4	55
Male	1	1	35	30	19	15	106
Unknown	0	0	0	0	0	0	0
TOTAL	2	3	59	39	35	19	167

PLANS

The intent to treat data analysis is complete and efficacy analyses is being conducted based on a definition of “stayers” motivated by the philosophical view of Donald Rubin on examining efficacy. Stayers have been defined as those who receive a minimum dose of the housing (>180 days) and who essentially are in the housing for the course of the study (they exit the study from the housing without having excessive time outside of the housing except for treatment)). They must also be predicted to be stayers if they would have been assigned to the CRs. More detailed analyses are being conducted on residential histories. Cross-site specific studies will be completed in the next year.

Presentation:

Best Practice Conference, NYS OMH, 2001

Publication:

Siegel C, Samuels J, Tan D, Berg I, Jones K, Hopper K. (2004). Supported housing for persons with serious mental illness. (In preparation).

Entered: 4/5/1999
Updated: 7/8/03

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