Housing Within Reach (HWR) is a project of the Tennessee Department of Mental Health and Developmental Disabilities (TDMHDD). This project was made possible through funding awarded from the Centers for Medicare and Medicaid Services (CMS) Real Choices Systems Change federal grant program. Originally awarded in 2001, the three-year grant project was extended through June of 2006.
This multiphase project included components which build on existing TDMHDD initiatives to address gaps in housing options across the state. TDMHDD’s Creating Homes Initiative (CHI) has successfully generated opportunities through local partnerships that have made an impact on the availability of appropriate permanent housing options in communities across the state. As CHI efforts continue to create new and improved housing options, the HWR project has created additional mechanisms that promote consumer-directed housing choices and support continued housing development efforts.
The HWR project included a consumer-driven longitudinal evaluation study across Tennessee to document consumer perspectives on consumer housing preferences, and the availability, access and barriers to appropriate housing. Consumer involvement began in the design phase. This unique perspective was a key component of the study and was included to capture feedback from individuals with access to permanent housing following psychiatric hospitalization. The general research question was:How well do existing housing options meet consumer-identified needs for individuals in the early stages of recovery?’
In addition to descriptive documentation of housing barriers and preferences, the longitudinal design of the evaluation was intended to examine housing stability and the interaction with housing needs, preferences, and barriers. More specifically, key evaluation questions included the following:
- Does initial access to less restrictive housing predict satisfaction with community-based living arrangements?
- Is initial satisfaction with living situation associated with housing stability over the subsequent six and twelve months?
- Does initial access to less restrictive housing predict future housing stability?
Overall 205 participants were successfully recruited from community-based service providers in the four separate regions across Tennessee with least 50 enrolled from each region. Eligible participants were engaged in community-based professional support services which began within one year following psychiatric hospitalization.
The longitudinal study included face-to-face interviews conducted with each study participant at baseline, and at six- and twelve-months. A brief semi-structured interview format incorporated customized question items along with widely-used assessment instruments to provide a mixture of single-item and scale measures. These variables generally provided measures for utilization of resources, housing needs and preferences, and quality of life. The longitudinal design of this study provided an opportunity to examine changes overtime for key outcomes, such as housing stability.
- Satisfaction and stability
- Access to less restrictive housing was associated with greater housing satisfaction.
- Housing stability was associated with greater housing satisfaction for individuals living in unsupervised private housing. In contrast, housing stability was associated with reduced satisfaction for individuals living in more restrictive settings.
- Social contacts
- Participants in supervised settings were less likely to have moved in the previous six months and indicated they had more social contacts than those in unsupervised settings.
- There was no significant difference in the number of social contacts between participants with high and low levels of financial support.
- There was a noticeable discrepancy between access to full or part time employment and the desire to work
- A large percentage of participants reported history of trauma and abuse
First, this study, in corroboration with other research, shows that consumers can be and should be a vital part of mental health services research. The findings from this evaluation verify that housing is more than just a dwelling place. To understand the role of housing in the lives of consumers, issues such as satisfaction, stability, social contacts and safety need to be taken into account. Residential stability is desirable, yet housing situations that promote stability are not always the most satisfactory for consumers. Living in independent housing, while more satisfying, may also result in few social contacts and the potential for isolation. These finding suggest that a wide range of housing options is necessary for consumers to be able to find the right balance between independence, healthy interdependence, satisfaction and stability. At the same time, the ability of consumers to find real work for real wages’ remained limited at the time of this study. Lastly, the rate of trauma emphasized once more the need for safe’ places in which people with serious mental illnesses may live and prosper.
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