CLINICAL HANDBOOK OF SCHIZOPHRENIA

29. Supported Housing 293findings: People with psychiatric disabilities strongly prefer normal housing and supportsrather than congregate residential services approaches. People want to live alone or withanother person, or persons, of their choice, rather than in groups of people with psychiatricdisabilities. They want a variety of support services to call upon, but they do not wantto live in staffed settings. Consumer preferences are in marked contrast to typical clinicianrecommendations that emphasize placement in much more structured and restrictivesettings. Some research has assessed the impact of preferences on outcomes. Residentialstability and life satisfaction markedly increase when consumers perceive that they havechoices, and when their housing and support preferences are honored.THE EMERGING EVIDENCE BASE ON“BEST-PRACTICE”-SUPPORTED HOUSING SERVICESThis section reviews some of the elements of “best practice” in supported housing. Theseso-called “active ingredients” were identified in a meta-analysis of supported housing literature(Ridgway & Rapp, 1997). This analysis revealed that effective supported housingincludes core elements associated with supportive services and housing assistance. Bestpracticeguidelines for supportive services often includes some form of intensive casemanagement that involves the following:• Workers should carry small caseloads (1:8–1:10) for consumers labeled “most difficultto serve” and up to 1:20 for others with psychiatric disabilities.• There should be the capacity for frequent contacts (up to several times per week,especially during an initial settling in period).• Workers should directly provide support services rather than broker services.• Services should be provided in vivo (in the person’s housing or other natural communitysetting).• Support services delivery may use alternative models (e.g., either a team approachor individual workers who carry a small caseload).• Workers should have explicit goals to increase residential stability, to improvequality of life, and to reduce homelessness and hospitalization.The Importance of the Helping RelationshipSome research on supported housing reconfirms the importance of the helping relationship.A strong alliance with the worker was associated with significant reduction in thenumber of days people spent homeless, to moderate improvements in quality of life andsatisfaction ratings, less isolation, greater housing satisfaction, and greater sense of empowerment.A few studies have found that the strength of the worker–consumer allianceis not related to outcomes.Best-Practice Guidelines for Housing AssistanceThe research shows that effective supported housing combines supportive services withhousing assistance that includes the following elements:• Rental subsidies are provided.• Consumer housing preferences are honored.