Sobriety as an admission criterion for transitional housing: a multi-site comparison of programs with a sobriety requirement to programs with no sobriety requirement

Housing Outcomes of Adults Who Were Homeless at Admission to Substance Use Disorder Treatment Programs Nationwide

OBJECTIVE

Substance use disorders affect 30%-50% of single homeless adults, and specialized homelessness service programs enable homeless persons to exit homelessness at rates of about 80%. However, many such adults are treated in substance use disorder treatment programs. This study examined housing outcomes in these programs.

METHODS

Data from the Treatment Episode Data Set: Discharges database were used to examine housing status at discharge from substance use disorder treatment programs of adults who were homeless at admission. Associations of outcomes with sociodemographic characteristics, treatment programs and processes, and clinical variables were further evaluated with bivariate and multivariate logistic regressions. Odds ratios of ≥1.5 or ≤0.67 were considered meaningful.

RESULTS

Of 1,200,105 persons admitted to the programs, 192,838 (16.1%) were homeless at admission; 68.7% remained homeless at discharge, 16.3% were discharged to dependent housing, and only 15.0% were discharged to independent housing. Factors associated with remaining homeless included being age ≥55 years, being unemployed, admission for detoxification (vs. rehabilitation or residential treatment or ambulatory treatment), shorter stays, and program noncompletion. Factors associated with discharge to independent versus dependent housing included employment, admission to nonintensive outpatient treatment, and, unexpectedly, shorter stays.

CONCLUSIONS

Most adults experiencing homelessness at admission to substance use disorder treatment programs remained homeless at discharge, and only half of those no longer homeless were independently housed. These outcomes are considerably worse than outcomes typically reported by specialized homelessness service programs. Evidence-based service models that support exit from homelessness could be provided through augmented internal programming or links with specialized programs.

The Cal-DSH diversion guidelines

The Cal-DSH Diversion Guidelines provide 10 general guidelines that jurisdictions should consider when developing diversion programs for individuals with a serious mental illness (SMI) who become involved in the criminal justice system. Screening for SMI in a jail setting is reviewed. In addition, important treatment interventions for SMI and substance use disorders are highlighted with the need to address criminogenic risk factors highlighted.

A 20-Site Comparison of Transition-in-Place Versus Traditional Transitional Housing Programs

Transition-in-Place (TIP) is a housing model being piloted in the veterans affairs transitional housing program, Grant & Per Diem (GPD). This observational 20-site study compares characteristics and outcomes of 488 clients in TIP and 10,388 clients in traditional GPD programs. TIP participants were younger, better educated, healthier, and reported higher employment income than traditional GPD participants. Adjusting for these differences, TIP participants were more likely to have their own housing and reported higher employment and public support income at program exit, although the differences were small. These results inform use of the TIP model as a public health intervention.

Does stimulant use impair housing outcomes in low-demand supportive housing for chronically homeless adults?

BACKGROUND

Recent research suggests low-demand housing (i.e., not contingent upon abstinence) is effective in helping people exit homelessness, even among recent active substance users. Whether active users of illicit drugs and stimulants have worse housing outcomes than primary alcohol users, however, is unknown.

METHODS

A total of 149 participants in a multisite supportive housing program who reported high levels of active substance use at program entry were classified as either (1) predominantly "Alcohol Use" (>10 of 30 days alcohol, but not >10 days of drug use) or (2) "Illicit Drug Use" (>10 of 30 days any single illicit drug use with or without alcohol use). Sub-analysis of the "Illicit Drug Use" group compared participants reporting high levels of "Stimulant Use" (>10 days cocaine, crack, or methamphetamine use) to those with high levels of "Non-stimulant Use" (>10 days marijuana or other non-stimulant drug use). Group differences in housing outcomes were examined with mixed model multivariate regression.

RESULTS

During 24-month follow-up, days housed increased dramatically for both the "Alcohol Use" and the "Illicit Drug Use" groups without significant differences. Sub-analysis of illicit drug users showed stimulant use was associated with fewer days housed (p = .01) and more days homeless (p = .02) over time.

CONCLUSIONS

Among illicit drug users, stimulant users have somewhat less successful housing outcomes than other active drug and alcohol users, though both groups maintained substantial housing improvements in low-demand housing.

National comparison of literally homeless male and female VA service users: entry characteristics, clinical needs, and service patterns

BACKGROUND

Although there are growing numbers of homeless female U.S. veterans, the U.S. Department of Veterans Affairs (VA) has traditionally served a predominantly male population; thus, it is important to examine differences between homeless female and male veterans in their service needs and the current provision of VA homeless services.

METHODS

A national registry of 119,947 users of VA homeless services from 2011 to 2012 was used to 1) estimate the proportion of female veterans among VA homeless service users, 2) examine the proportion of VA homeless service users who are literally homeless by gender, and 3) report differences between female and male VA homeless service users who are literally homeless on sociodemographic and clinical characteristics, as well as on outreach, referral, and admission patterns for an array of specialized VA services.

FINDINGS

Of VA homeless service users, 8% were female compared with 7% among all homeless veterans, 6% among all VA service users, and 7% among all veterans. Of female VA homeless service users, 54% were literally homeless, slightly fewer than the 59% of male VA homeless service users. Comparing literally homeless VA service users, females were younger, 21% more had dependent children, 8% more were diagnosed with non-military-related posttraumatic stress disorder, and 19% to 20% more were referred and admitted to VA's supported housing program than males.

CONCLUSIONS

Female veterans use VA homeless services at a rate similar to their use of general VA services and they have unique needs, especially for child care, which may require additional specialized resources.

Housing first improves residential stability in homeless adults with concurrent substance dependence and mental disorders

OBJECTIVES

We examined the relationship between substance dependence and residential stability in homeless adults with current mental disorders 12 months after randomization to Housing First programs or treatment as usual (no housing or support through the study).

METHODS

The Vancouver At Home study in Canada included 2 randomized controlled trials of Housing First interventions. Eligible participants met the criteria for homelessness or precarious housing, as well as a current mental disorder. Residential stability was defined as the number of days in stable residences 12 months after randomization. We used negative binomial regression modeling to examine the independent association between residential stability and substance dependence.

RESULTS

We recruited 497 participants, and 58% (n = 288) met the criteria for substance dependence. We found no significant association between substance dependence and residential stability (adjusted incidence rate ratio = 0.97; 95% confidence interval = 0.69, 1.35) after adjusting for housing intervention, employment, sociodemographics, chronic health conditions, mental disorder severity, psychiatric symptoms, and lifetime duration of homelessness.

CONCLUSIONS

People with mental disorders might achieve similar levels of housing stability from Housing First regardless of whether they experience concurrent substance dependence.