Street to Home: The Experiences of Long-Term Unsheltered ...

Street to Home: The Experiences of Long-Term Unsheltered Homeless Individuals in an Outreach andHousing Placement ProgramJohn Jost*, Aaron Levitt, Leide PorcuAbstractLong-term or “chronically homeless” individuals have been viewed as the most difficult homeless group toengage in services and permanently house. They are often coping with physical ailments and/or co-occurringsubstance abuse and mental health conditions, and recycle through shelter and treatment systems. They alsoface service-related barriers linked to a linear treatment and housing models that often undermine engagementand housing placement. This qualitative study examines the experiences of 20 long-term unsheltered homelessadults who had recently entered Street to Home (STH), a housing-focused outreach program based in New YorkCity that breaks from the linear model by not requiring clients to demonstrate sobriety and psychiatric stability,and by placing them directly into transitional and permanent housing, bypassing stays in drop-in centers andshelters. Participants completed an in-depth qualitative interview focusing on physical and mental health,substance use, homeless experiences, services utilization, reasons for deciding to work with STH, and theirexperiences with STH. Findings revealed: self-descriptions emphasized pride and competence; serviceresistance was related to previous encounters with social services and socio-rational choice; the availability ofbelievable housing options was a trigger for change; the support provided by STH was essential in enablingparticipants to make the transition to permanent housing; and participants preferred minimal programinvolvement after they were housed. The experiences of participants show that it is possible to engage longtermunsheltered homeless adults and place them directly into transitional and permanent housing in thecommunity without the requirements of “housing readiness”. Future challenges for housing service providerswill likely lie in the areas of anticipating and identifying the long-term needs of clients in order to help themremain housed and continue to improve their integration into the community.*Corresponding author: email address jjost@cucs.org1

ReferencesApplewhite, S.L. (1997). Homeless veterans: perspectives on social service use. Social Work, 42, 19-30.Asmussen, S.M., Romano, J., Beatty, P., Gasarch, L., &. Shaughnessey, S. (1994). Oldanswers for today’s problems: helping integrate individuals who are homeless with mental illnesses intoexisting community-based programs. Psychosocial Rehabilitation Journal, 17, 17-34.Bhui, K., Shanahan, L. & Harding, G. (2006). Homelessness and mental illness: aliterature review and a qualitative study of perceptions of the adequacy of care. International Journal ofSocial Psychiatry, 52(2), 152-165.Dickson-Gomez, J., Convey, M., Jilario, H., Corbett, A.M., & Weeks, M. (2007). Unofficial policy: access tohousing, housing information and social services among homeless drug users in Hartford,, Connecticut.Substance Abuse Treatment, Prevention, and Policy, 2:8Fisk, D., Rakfeldt, J., & McDormick, E. (2006). Assertive outreach: An effectivestrategy for engaging homeless persons with substance use disorders into treatment. American Journalof Drug and Alcohol Abuse, 32, 479-486.Geertz, C. (1973). Thick description: Toward an interpretive theory of culture. Theinterpretation of cultures: Selected essays (Chapter 1). New York: Basic Books.Hopper, K., Jost, J., Hay, T., Welber, S., & Haugland, G. (1997). Homelessness, severemental illness and the institutional circuit. Psychiatric Services, 48(10), 659-665.Hopper, K. (2006). Redistribution and its discontents: on the prospects of committedwork in public mental health and like settings. Human Organizations, 65(2), 218-226.Lipsky, M. (1980). Street-level bureaucracy: Dilemmas of the individual in public services. New York, NY:Russell Sage Foundation.Morse, G.A., Calsyn, R.J., Miller, J., Rosenberg, P., West, L., & Gilliland, J. (1996).Outreach to homeless mentally ill people: conceptual and clinical considerations. Community MentalHealth Journal, 32(3), 261-274.Mojtabai, R. (2005). Perceived Reasons for loss of housing and continued homelessnessamong homeless persons with mental illness. Psychiatric Services, 56(2), 172-178.National Registry of Evidence-based Practices and Programs. (2007, November). Retrieved May 15, 2008,from http://www.nrepp.samhsa.gov/programfull details.asp?PROGRAM_ID=195Osher, F. & Drake, R. (1996). Reversing a history of unmet needs: approaches to carefor persons with co-occurring addictive and mental disorders. American Journal of Orthopsychiatry, 66,4-11.Padgett, D. (2007). There’s no place like (a) home: Ontological security among personswith serious mental illness in the United States. Social Science & Medicine, 64, 1925-1936.2

Randall, G. & Brown, S. (2002). Helping rough sleepers off the streets. Office of the Deputy Prime Minister,London, UK.Ridgeway, P. & Zipple, A.M. (1990). The paradigm shift in residential services: From the linear continuum tosupported housing approaches. Psychosocial Rehabilitation Journal, 13, 11-31.Rosenblum, A., Nuttbrock, L., McQuistion, H., Magura, S., & Joseph, H. (2002).Medical outreach to homeless substance users in New York City: preliminary results. Substance Abuse& Misuse, 37(8-10), 1269-1273.Rosenheck, R.A. & Lam, J. (1997). Client and site characteristics as barriers to service use by homelesspersons with serious mental illness. Psychiatric Services, 48(3), 387-390.Rosenheck, R.A., Lam, J., Morrissey, J.P., Calloway, M.O., Stolar, M., Randolph, F., etal. (2002). Service systems integration and outcomes for mentally ill homeless persons in the ACCESSprogram. Psychiatric Services, 53(8), 958-966.Rowe, M., Fisk, D., Frey, J., & Davidson, L. (2002). Engaging persons with substanceuse disorders: Lessons from homeless outreach. Administration and Policy in Mental Health, 29(3),263-273.Schutt, R.K., & Goldfinger, S.M. (1996). Housing preferences and perceptions of healthand functioning among homeless mentally ill persons. Psychiatric Services, 47(4), 381-386.Sosin, M.R., & Bruni, M. (1997). Homelessness and vulnerability among adults withand without alcohol problems. Substance Use & Misuse, 32(7-8), 939-968.Sosin, M.R., & Bruni, M. (2000). Personal and situational perspectives on rejection of ahomelessness and substance abuse program: An exploratory study. Social Work Research, 24(1), 16-27.Sosin, M.R., & Grossman, S.F. (2003). The individual and beyond: a socio-rational choice model of serviceparticipation among homeless adults with substance abuse problems. Substance Use & Misuse, 38(3-6),503-549.Strauss, A.L., & Corbin, J. (1990). Basics of qualitative research: Grounded theoryprocedures and techniques. Newbury Park, CA: Sage.Stefancic, A., & Tsemberis, S. (2007). Housing first for long-term shelter dwellers withpsychiatric disabilities in a suburban county: a four-year study of housing access and retention. Journalof Primary Prevention, 28, 265-279.Susser, E., Valencia, E., Conover, S., Felix, A., Wei-Yann, T., & Wyatt, R.J. (1997).Preventing recurrent homelessness among mentally ill men: A “critical time” intervention afterdischarge from shelter. American Journal of Public Health, 87, 256-262.Tommasello, A.C., Myers, C.P., Gills, L., Treherne, L.L. & Plumhoff, M. (1999).Effectiveness of outreach to homeless substance abusers. Evaluation and Program Planning, 22(3),295-303.Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice, and3

harm reduction for homeless individuals with dual diagnosis. American Journal of Public Health, 94(4),651-656.U.S. Department of Housing and Urban Development. (2006). A Guide to Counting Unsheltered HomelessPeople Revised.Ware, N.C., Tugenberg, T., & Dickey, B. (2004). Practitioner relationships and qualityof care for low-income persons with serious mental illness. Psychiatric Services, 55(5), 555-559.4