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Research
Research Projects
Completed
New York Housing Study (funded by SAMHSA)
Sam Tsemberis, Ph.D.
Goal: Examine homelessness, residential stability, mental health and substance abuse outcomes among consumers with severe mental illness and histories of homelessness randomly assigned to receive Housing First or services-as-usual.
Findings: Participants assigned to Housing First obtained housing earlier and remained stably housed at higher rates as compared to participants in services-as-usual. Further, participants assigned to Housing First spent significantly less time in psychiatric hospitals and incurred fewer residential costs. Assignment to Housing First was also associated with greater perceived consumer choice, which positively impacted mental health by increasing mastery. The Housing First group also utilitzed fewer substance use treatment services and there were no significant differences in rates of substance use or psychiatric symptoms between the two groups.
Housing First with Chronic Shelter Users (funded by SAMHSA)
Goal: Describe the process of implementing housing first in new locales and to compare housing retention rates among consumers with severe mental illness and extensive histories of shelter use randomly assigned to receive Housing First or services-as-usual.
Findings: Several system-level factors were identified that could influence the swift implementation of a Housing First approach in new locales: the mode of presentation, whether an outside agency will be brought in or whether a local agency will transition to Housing First, and the perceived uniqueness of the Housing First approach among existing providers and policymakers. Two years after two Housing First programs were implemented (one by Pathways, the other by a local consortium of agencies), 84% of consumers in Housing First were still maintaining apartments, with Pathways at 88.5% and the consortium at 79%. The four year housing retention rate for Housing First was 68%, with Pathways at 78.3% and the consortium at 57%. The difference for housing retention rates between the two Housing First programs may speak to the divergent ways in which key elements of Housing First were implemented and the different housing and service philosophies adopted.
Community Integration in the Early Stages of Housing First
Goal: To describe the reactions of participants who received housing either through a Housing First program or through more traditional housing and service providers.
Findings: Participants' reactions to housing were overwhelmingly positive. Challenges to integration included issues of safety, problems fitting in due to a lack of ethnically diverse or safe neighborhoods, a sense of not being truly housed (for traditional housing participants) and isolation (for Housing First participants). Participation in Housing First was associated with greater consumer choice. Participants entering housing from state psychiatric hospitals, as opposed to from street homelessness or drop-in centers, were more likely to report experiencing challenges to integration.
Ongoing
New York Services Study (funded by NIMH)
Goal: To document the life histories of individuals with severe mental illness and co-occurring substance use disorders, and to investigate various housing and treatment systems from consumers' perspectives using qualitative interviews.
Findings: Analysis revealed clear evidence of the markers of ontological security among participants living in their own apartments: constancy, daily routines, and having a secure base for identity construction were all provided. Additionally findings among a subset of participants suggest that formerly homeless mentally ill women need (and want) autonomy, protection from further victimization, and assistance in restoring status and devalued identity. In general, social networks among consumers are particularly small due to premature deaths among network members, consumers creating difficult situations that led to a severing of ties, and network members having few resources to offer consumers due to difficulties of their own. Such depleted social networks hinder opportunities to build and access social capital. With respect to substance use, consumers' self-reported reasons for use most often reflected an attempt to cope with painful feelings in general, as opposed to a narrow focus of self-medicating psychiatric symptoms.
Phase 2
Goal: To describe the experiences of persons with severe mental illness participating in a Housing First program and three more traditional housing and treatment programs, with emphasis on engagement, retention and recovery.
Findings: Data collection ongoing.
Housing First Fidelity Scale Development (Funded by the Center of Homelessness Prevention Studies (CHPS), Mailman School of Public Health, Columbia University)
Peter Messeri, Ph.D., Sam Tsemberis, Ph.D., Robert E. Drake, M.D.
Goal: Develop a scale to assess program fidelity to the Housing First Model along both structural and philosophical dimensions.
Interim Findings: Preliminary interviews with experts in Housing First suggest that critical program ingredients include: no housing readiness requirements, individualized services, a harm reduction approach, participants choosing the type, frequency and sequence of services, and housing that is scatter site and otherwise available to persons without disabilities.
Community Integration Pilot Study
Goal: To explore the impact of program and neighborhood characteristics on consumer outcomes such as sense of belonging, social integration, and recovery among participants of a Housing First program.
Interim Findings: A qualitative study revealed that social isolation most commonly resulted from practical efforts to avoid harms or difficult situations, not from social withdrawal related to psychopathology, such as cognitive or social deficits. Results suggest that the tendency towards isolation speaks to a lack of opportunities for supportive social interactions, an issue that may be more a consequence of cumulative disadvantage than of psychopathology and a need to protect oneself from potential harms arising from neighborhood and intergenerational poverty. Given that consumers express desires for intimate, supportive and reciprocal relationships, providers should consider expanding social opportunities for consumers and assist them with learning to negotiate social boundaries in order to better manage complex relationships. More nuanced and enhanced boundary management may lead to greater empowerment and less utilization for isolation as the main strategy for dealing with challenging interactions.
Mental Health Treatment Study (funded by the Social Security Administration)
William Frey, Ph.D., and Robert Drake, M.D.
Goal: To evaluate the effects of providing mental health treatment and employment support for person diagnosed with schizophrenia or affective disorders and receiving SSDI.
Findings: Participant enrollment ongoing.
Housing First Programs and Money Management
Sue Barrow, Ph.D. & Sam Tsemberis, Ph.D.
Goal: To describe the specific components of money management services provided to Housing First consumers; to assess the impact of these services on consumer outcomes such as housing retention, choice, satisfaction, money management, mental health and substance use; and to determine which components of money management services are effective for particular client profiles.
Findings: Pending IRB approval
Keeping Homes Project Evaluation
Goal: To examine the impact of Housing First services on housing and treatment retention among participants enrolled in methadone maintenence treatment (MMT) who have psychiatric disabilities and histories of homelessness and involvement with the criminal justice system.
Interim Findings: Housing retention rates among consumers in MMT are similar to those without MMT participation. 18 months after program inception, 85% of participants are still in Pathways' housing.
For Publications related to these research projects, please visit the Publications page.
For more information related to Pathways research projects, please contact Ana Stefancic at stefancic@pathwaystohousing.org
Training
Videos
1. ACT in Action
Running Time: 35 minutes
Summary: Follows an ACT team in the office and the community, through check-in meetings, apartment visits, group support meetings, and other daily operations of a Pathways to Housing ACT team.
Price: $50
2. Journeys in Recovery
Running Time: 14 minutes
Summary: Interviews with Pathways to Housing consumers about their experiences in their apartments.
3. Streets to Homes
Running Time: 12 minutes
Summary: Interviews with Pathways to Housing consumers about their experiences in their apartments.
4. Housing First
Running Time: 12 minutes
Summary: Presenting the Pathways to Housing program to prospective landlords and inspecting potential apartments.
Price: $15
5. Reflections on ACT
Running Time: 27 minutes
Summary: Interview with Leonard Stein, M.D., one of the originators of ACT discussing the development and implementation of ACT.
Price: $30
To purchase a video, or for more information, please contact: info@pathwaystohousing.org
New York State Institute for Assertive Community Treatment and Evidence Based Practices
Please visit the NY ACT Institute Website for a description and schedule of trainings.
For more information on trainings related to ACT, please contact:
Pascale Jean-Noel, Director, or Margaret Kaczorowski, Program Assistant
For more information related to Housing First trainings, please contact:
Links
2007
Denver Housing First Collaborate: Cost Benefit Analysis and Program Outcomes Report
Jennifer Perlman, Ph.D. & John Parvensky, Colorado Coalition for the Homeless, 2006
Voices from the Margins: In Pursuit of Recovery in the New York City Homelessness Services System
Deborah Padgett, Ph.D., New York University School of Social Work, 2006
Tatjiana Meschede, Ph.D. The Center for Social Policy, 2006