"They're Homeless in a Home": Retaining Homeless-Experienced Consumers in Supported Housing
"They're Homeless in a Home": Retaining Homeless-Experienced Consumers in Supported Housing
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DOI：
10.1037/ser0000119
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发表时间：
2017-05-01
影响因子：
2.3
通讯作者：
Young, Alexander S.
中科院分区：
文献类型：
--
作者：
Gabrielian, Sonya;Hamilton, Alison B.;Young, Alexander S.
具有支持性服务的永久性社区住房(“支持性住房”)对无家可归的有经验的消费者来说有许多有利的结果。然而，人们对获得住房但随后失去住房的消费者知之甚少。使用混合方法，我们比较了保留其支持住房至少1年的人(“留守者”)和那些在搬入后1年内失去支持住房的人(“退出者”)。在2011至2012年间，通过退伍军人事务部支持的住房(VASH)计划在退伍军人事务部大洛杉矶居住的人中，我们查询了退伍军人无家可归者登记数据，以确定留下来的人(n=1,558)和退出者(n=85)。我们回顾了随机选择的85名留守人员和所有85名退出人员的医疗记录，以比较人口统计数据、无家可归的长期性、服务年限、收入、是否患有严重精神疾病以及卫生服务利用情况。从这个子样本中，我们有目的地选择了20名留守人员和20名退出人员，进行半结构的定性访谈和更详细的病历审查。我们还对VASH员工/领导层(n=15)进行了定性访谈和焦点小组。递归划分确定了最能区分留在者和退出者的量化变量。对定性数据进行了专题分析。与退出支持住房相关的因素有：长期无家可归；内在动力不足；对精神卫生保健、药物滥用治疗和独立生活技能的需求未得到满足；初级保健参与度低；频繁使用急诊室；以及最近的精神健康住院治疗。这些发现表明，解决这些因素的临床干预措施的价值--例如，激励性访谈或社交技能培训--适应于支持住房的背景和背景。
Permanent, community-based housing with supportive services ("supported housing") has numerous favorable outcomes for homeless-experienced consumers. Little is known, however, about consumers who attain but subsequently lose their supported housing. Using mixed methods, we compared persons who retained their supported housing for at least 1 year ("stayers") with those who lost their supported housing within 1 year of move-in ("exiters"). Among persons housed through the VA Supported Housing (VASH) program at the VA Greater Los Angeles between 2011 and 2012, we queried VA homeless registry data to identify stayers (n = 1,558) and exiters (n = 85). We reviewed the medical records of 85 randomly selected stayers and all 85 exiters to compare demographics, homelessness chronicity, era of service, income, presence or absence of a serious mental illness, and health service utilization. From this subsample, we purposively selected 20 stayers and 20 exiters for semistructured, qualitative interviews, and more detailed medical record review. We also performed qualitative interviews and focus groups with VASH staff/leadership (n = 15). Recursive partitioning identified quantitative variables that best-differentiated stayers from exiters. Thematic analyses were performed on qualitative data. Interrelated factors were associated with exiting supported housing: chronic homelessness; low intrinsic motivation; unmet needs for mental health care, substance abuse treatment, and independent living skills; poor primary care engagement; frequent emergency department use; and recent mental health hospitalizations. These findings suggest the value of clinical interventions that address these factors-for example, motivational interviewing or social skills training-adapted to the setting and context of supported housing.