Empowering destitute people towards transforming communities

3.2“Outside-in” missions as the fostering of residential stability

Rossi (1989:13) notes: “what is striking is that destituteness today is a more severe condition of housing deprivation than in decades past”. In the past, those who were considered destitute were able to find some shelter in flophouses, SROs, or cubicle hotels. By contrast, many destitute people today are apt to be found in public places (such as building lobbies or train stations), shelters, or on the street (Rog & Halupka, 1998:5).

Much has been learned in recent years about how to reconnect destitute people with housing. For instance, PCM in Pretoria undertakes a strong drive to reconnect people to housing, with exemplary successes. Outreach and engagement efforts are sometimes critical in beginning the reconnection process, especially for individuals who have been destitute for long periods of time and are experiencing severe mental illness and/or chronic substance abuse (Barrow, Hellman, Lovell, Plapinger, & Struening, 1991:35).

Developing trust by means of efforts such as the provision of food and clothing, over long periods of time, often represents the key to a person’s transition from destituteness to housing, as was discussed under “outreach and engagement” (Chapter 6).

3.2.1Fostering residential stability requires the availability of different housing options

Moving people off the streets and out of shelters, and keeping them in the community, requires that various housing options be made available to meet their different shelter and support needs.

3.2.1.1Supportive housing: housing combined with services

Housing combined with services characterizes many of the interventions that have been developed and tested to improve residential stability, particularly for individuals with specific needs, such as mental health problems or substance abuse issues (Fosburg, Locke, Peck, & Finkel, 1997; Emerson & Twersky, 1996).

The term “supportive housing” is used broadly in order to define housing designed to help individuals reduce their need for more restrictive services and remain residentially stable, and in turn improve their quality of life and functioning (Newman, 1992:4).

Supportive housing (also called services-enriched housing and special needs housing) describes a wide range of housing interventions. For example, supportive housing can be transitional or permanent. Transitional housing typically takes the form of congregated housing with considerable services and supports provided on-site where a person can live a for predetermined period of time. Permanent supportive housing sets no time limits, and typically includes access to services available in the community. Permanent housing options include single room occupancy (SRO) hotels, multi- and single-family rental housing, scattered-site apartments, and even home ownership. Community differences in the housing stock, together with the funding that may be available, often result in differences in the types of supportive housing that are developed.

In supportive housing, housing is combined with access to services and supports in order to address the needs of destitute individuals so that they may live independently in the community rather than on the street or in institutional settings such as mental institutions, jails, shelters and hospitals. Supportive housing is generally considered an option for individuals or families who have either lived on the streets or shelters for long periods of time and/or who have needs that may best be served by services that can be accessed through their housing. It is important to note, however, that not all destitute individuals require supportive housing to regain stability. Many, especially those who have experienced short-term destituteness due to a fire, loss of job, or temporary separation from family, may only need assistance in finding housing that is affordable, rather than ongoing services.

A great variation is evident in the meaning of services within supportive housing. Services may be provided on site or offsite, and may be available for restricted hours or on a 24-hour basis. Supports can be limited to basic security and individual case management services, or can include a host of health, mental health, and daily living services. In some instances, the housing case manager facilitates the linkages with the mainstream service system. In other instances, especially when the needs of the residents are specialized and/or the system exhibits gaps in certain service areas, some services may be provided directly on site.

The types and intensity of services and supports are generally influenced by many factors, such as the amount of funds available, staff-to-resident ratios, needs of the population being served (some buildings are intended to cater for individuals with a specific set of needs, such as severe and persistent mental illness or HIV/AIDS; others are open to a broad population of individuals with varying levels of service needs), and so forth.

3.2.1.2Transitional housing

Transitional housing is designed as temporary housing (ranging from 3 months to 24 months or longer) typically with a high intensity of services. It is predicated on the notion that when destitute individuals initially make the transition into housing, they need a more structured setting with a range of services being readily available, including employment readiness and education, mental health, substance abuse, health, and others. However, as the individual or family stabilizes, the concept is that the services will be needed less and the individual will be ready to move into more independent, permanent housing.

Transitional housing is considered a large component of the continuum of housing options, but it is not a necessary step for all destitute people.

3.2.1.3Towards various types of permanent housing

Several studies (Center for Mental Health Services, 1994; Rog & Gutman, 1997) have indicated that some destitute people can move directly from the streets and shelters to various types of permanent housing, including SROs and multi/single family rental housing, and remain stable for considerable periods of time. There may be instances, however, especially with individuals who have been destitute for long periods of time, when transitional and interim housing may be needed as a preliminary step (Fosburg et al., 1997; Barrow & Soto, 1996). In some instances, the housing may be needed as a critical bridge for people who are ready to leave destituteness but do not yet enjoy access to permanent housing.

3.2.2Conclusion

Overall, research indicates that the residential stability of destitute individuals and families can be fostered, largely by providing some combination of housing (or access to housing) and services and supports (Fosburg et al., 1997; Barrow & Soto, 1996). Residential stability has been defined and measured in a variety of ways. Most studies have measured stability as accessing community-based housing and living stably (i.e., without moving residences) in that housing for a period of time (generally measured at 12 to 18 months after initially entering the particular housing).

Reconnecting with housing is often the first step in reconnecting individuals with the community. In fact, becoming stably housed is increasingly being recognized as a prerequisite to other steps in reconnecting with the community: that is, moving back into the job market, being linked with needed services, and reestablishing or initially establishing ties with family and other sources of support. Therefore, identifying interventions that are effective in fostering residential stability is critical to understanding how community reintegration can begin. Conclusions regarding the fostering of residential stability can be summarized in the words of Rog et al. (1996:80-81):

1. 
   Once in housing—generally with supports—the majority of destitute people stay housed
   
2. 
   Rental subsidies improve residential stability
   
3. 
   Providing housing is often not enough; other assistance can help
   
4. 
   Provide housing first, before tackling other issues
   
5. 
   A range of options may be needed to meet the range of needs and preferences.
   

These authors also identified the need to consider barriers to reconnecting destitute people to housing. It would appear that the following are the most common:

1. 
   Lack of affordable housing and limited supply of subsidies (e.g., vouchers)
   
2. 
   Community opposition
   
3. 
   Substance abuse.