Supporting Stability After Homelessness

Photo by Dušan veverkolog on Unsplash

This week, Social Science & Medicine published Creating Livable Lives: A Qualitative Exploration of Life After Homelessness. The study examines how people rebuild their lives after exiting homelessness.

This blog summarizes key findings from the research, highlights strategies that support housing stability, and considers what these insights could mean for Charlotte-Mecklenburg.

LIFE AFTER HOMELESSNESS

When people exit homelessness to permanent supportive housing, success is often measured by housing retention, health and behavioral health outcomes, and reductions in the use of crisis and institutional systems. While important, these metrics alone are insufficient in evaluating program success. Equally important are outcomes related to quality of life, community integration, and engagement in supportive services. The study, Creating Livable Lives: A Qualitative Exploration of Life After Homelessness used longitudinal interviews and observations with formerly homeless residents in a permanent supportive housing (PSH) program to explore how program participants reconstruct their lives once they have obtained permanent housing. The findings suggest that after becoming permanently housed, individuals undergo a complex social transition that involves establishing safety within their new environment, forming new relationships, and exploring new opportunities while still navigating many of the structural barriers that contributed to their homelessness. To support this transition, strategic investments in trauma-informed services and relational supports are essential. These investments can help ensure that people not only retain their housing, but are also supported in building stable, connected, and meaningful lives.

BUILDING A FOUNDATION FOR STABILITY

Participants in the Social Science & Medicine study described developing personal strategies to help them create a sense of safety and autonomy. These strategies included establishing routines, seeking privacy, and finding emotional comfort through pets or personal objects. Participants also noted that these efforts were often disrupted by violence, community stressors, or substance use in their local environment. These findings are similar to research by Henwood et. al., and Phipps et al. which showed that key factors impacting housing stability in PSH include trauma and a stressful or unstable environments. Proven strategies to mitigate these risks include:

• Trauma-informed case management that focuses on safety and flexibility rather than compliance.
• Evidence-based service models such as like Assertive Community Treatment (ACT) and Critical Time Intervention (CTI) which provide intensive, relationship-centered support during periods of emergent instability.
• Early interventions teams that work to de-escalate crises ensuring that challenges are addressed and responded to well before a person’s housing is at risk.

To ensure PSH programs are effective and sustainable funders should prioritize investments in clinical and peer support specialists that are trained in trauma-informed care and rapid response teams that can provide short-term crisis stabilization services. It is also essential to support this workforce by ensuring staff are paid a livable wage, providing adequate support for crisis staff, and maintaining reasonable and manageable case load sizes.

SOCIAL INTEGRATION

Participants in the Social Science & Medicine study described connection as both necessary and challenging. Many developed relationships with animals or carefully vetted neighbors. Others leaned on cultural and family bonds for stability and connection. Some reported relying on romantic relationships or chosen families as sources of emotional safety in times of uncertainty.

The findings in this study are consistent with findings by Wenzel and La Motte-Kerr which suggest that two key predictors of housing stability and quality of life are community integration and feelings of social belonging. PSH programs can support community integration and feelings of social belonging by offering structured opportunities for connection as a core programmatic component. Examples include community-building activities or peer mentorship programs. To make this type of programming possible, investment in community spaces and programming budgets that support social activities and peer leadership development are essential.

BUILDING COMMUNITY TO SUSTAIN HOUSING

One of the key findings of the Social Science & Medicine study is that meaningful community participation promotes housing stability. Many study participants shared that opportunities for leadership roles or to volunteer within their housing program would make them feel less like clients and more like active community members. Feelings of boredom, isolation, and a lack of purpose were often associated with both relapse and increased likelihood of behavioral health crises.

Tsemberis and colleagues (2022) reported similar findings and highlighted the importance of tenant engagement, peer employment, and opportunities for leadership roles within the community.

To support this type of community building in PSH programs, dedicated funding for peer support roles, compensation for lived experience contributions, and practice shifts that prioritize engagement over eviction are needed. Investing in this type of community-building infrastructure can transform a PSH site from being just a program to being a community where people have a sense of belonging.