Homeless SMI Consumers Thrive with Housing, Work Support
Mental Health Weekly March 19, 2012
A new study examining the impact of a federally-funded housing and employment demonstration program for homeless adults with serious mental illness finds that this population fared better at job and work experience at rates significantly higher than the members of the study’s comparison group. The findings appear in the March issue of Psychiatric Services.
The study, “Impact of Housing and Work Supports on Outcomes for Chronically Homeless Adults with Mental Illness: LA’s HOPE,” helps dispel a common misperception that consumers with serious mental illness can work only in sheltered workshops and set-aside jobs and can live only
in groups homes, said researchers. Research for the study was part of a federal initiative that funded five demonstration projects to combine these housing and employment practices through ambitious interagency cooperation agreements, the study noted.
LA HOPE (Los Angeles’ Homeless Opportunity Providing Employments) was part of a major demonstration project in 2003 launched by the U.S. Department of Housing and Urban Development (HUD) and various federal partners. HUD and the U.S. Department of Labor (DOL) provided five-year funding for LA HOPE and other HUD demonstration projects. The demonstration project was a collaboration of four public agencies: the City of Los Angeles Community Development Department; the Los Angeles County Department of Mental Health; the Housing Authority of the City of Los Angeles; and the VA Medical Center
The study groups included 56 LA HOPE participants who enrolled between July 1, 2004 and May 17, 2005, in three AB2034 programs – a state-funded program to reduce homelessness among people with serious mental illness – and 415 clients who enrolled in the remaining 15 AB2034 programs in the county during the same period.
The target populations came largely from the streets of the Skid Row area of Los Angeles, and inclusion criteria included having a major mental illness, being unattached to the mental health system, having co-occurring substance use and chronic medical conditions, and having long histories of homelessness, the study stated.
Program enrollment involved Los Angeles’ Community Development Department (CDD) case managers housed at Goodwill Industries, one of CDD’s workforce development centers. Candidates were referred to the Los Angeles County Department of Mental Health for eligibility determination. All participants qualified for county mental health services usually with an axis I diagnosis of schizophrenia or affective disorder. All were homeless at enrollment or at extremely high risk of homelessness. Additionally, all participants were about equally likely to have a co-occurring substance use disorder, the study stated.
The study found that with respect to employment, 57 percent of LA HOPE clients were employed (27 percent in competitive employment) at some time during the demonstration period – rates more than double those of the comparison group (22 percent attaining any employment; 13 percent competitive employment).
Tenancy in permanent supportive housing was the housing goal for LA HOPE’s clients; housing stability was also a primary goal of all AB2034 program participants. Among LA HOPE clients, 50 percent had lived in permanent supportive housing since enrollment, whereas only 1 percent in the comparison group had done so.
AB2034 programs had resources that could be used for transitional housing situations, but LA HOPE had permanent rental assistance to offer in the form of Shelter Plus Care certificates, according to the study. Participants in the LA HOPE demonstration project received substantially greater assistance with housing, including long-term rental assistance, and employment than clients of other AB2034 programs.
“The participants of the LA HOPE program had hands-on support to make it all happen,” Martha R. Burt, Ph.D., lead study author and affiliate scholar with the Urban Institute, told MHW. Case managers housed at the City of Los Angeles Community Development Department’s workforce development
centers helped LA HOPE participants with every stage in the process, she said.
“Case managers assisted [participants] with their resumes and GED prep work,” Burt said. They asked about previous employment, helped assess their skill levels, and inquired about their interests, she said. The AB2034 program had no housing resources and far less employment supports for the comparison group, said Burt.
Burt noted that program participants also received assistance searching through newspaper employment ads, and they received uniforms and equipment if needed. “Their job is to help people get to work,” she said. “If you’re not trying to help people reach difficult goals, then they won’t reach those goals.”
The attitudes of those affiliated with the AB2034 program toward the participants were more like ‘We’ll see how you do’ regarding employment and housing opportunities whereas LA HOPE participants were told “Yes, you can do this,” said Burt. The study noted that LA HOPE had the structure and resources to promote the outcomes in greater degree than the programs serving the comparison group. AB2034 had resources that could be used for traditional housing situations, but LA HOPE had permanent rental assistance to offer in the form of Shelter Plus Care certificates.
According to the study, LA HOPE operated on a “housing first” basis, moving people with active substance abuse issues and mental illnesses uncontrolled by medications into housing and working on those issues once clients were stably housed, in contrast to common practice for many AB2034 programs where clients must be “housing ready” – with stabilized symptoms and drug free.
The LA HOPE program has since ended due to loss of funding, said Burt. People who had received rental and housing vouchers have been able to keep those vouchers she said. Overall, “the results were what we were hoping for,” said Burt. Although the LA Hope program ended once the five-year grant ended in 2008, some parts of the program continued, said Maria Funk, Ph.D., mental health clinical district chief of adult justice, housing, employment and education services at the Los Angeles County Department of Mental Health.
“We learned from the AB2034 program the importance of providing housing and we vigorously applied for grants to allow for more affordable housing for our clients,” Funk told MHW. While the department has been unable to secure grants specifically for employment support for the homeless, it has received funding to continue assisting them with housing support, said Funk whose administrative unit oversees housing and employment resources.
Funk added, “The LA Hope program introduced us to the workforce centers. We’re making sure our providers in LA County continue to connect with the program. •