Integrating Alternative to Incarceration Programs Into the Housing First Harm Reduction Model: Research Implications for Practice

Background: Persons with mental illness are at greater risk for arrest and incarceration, particularly if they are also experiencing substance use, homelessness, unemployment, and poverty. Alternative to Incarceration initiatives (ATI), designed to divert individuals from the criminal justice system, typically involve mandatory treatment, court-reporting, and abstinence. Few community programs, however, are structured to address the multiple risk factors facing ATI populations using a consumer-driven approach. Many programs also lack integrated mental health and substance use treatment, specifically exclude individuals with histories of incarceration or treatment non-compliance from housing, and limit the pursuit of recovery-oriented activities (e.g., employment) through rigid structures. To eliminate cycles of re-arrest, ATI initiatives can utilize innovative approaches, such as Housing First, to increase the resources needed for successful community integration. This project explored: 1) How do participants define the key elements of the ATI initiative and the Housing First program? 2) How does the Housing First program address factors associated with criminal/jail recidivism? 3) What changes do participants highlight as a result of their participation in the program?

Methods: Twenty formerly homeless individuals with mental illness and histories of criminal justice involvement were interviewed approximately two years after enrolling in an ATI initiative. Participants were receiving permanent independent housing and comprehensive supports built on harm reduction principles through a Housing First program. Participants completed semi-structured qualitative interviews that were digitally recorded and transcribed. Questions covered their life history, experiences with the criminal justice system, and experience with the program. Using a modified grounded theory approach, data analysis included 1) developing initial codes (open coding), 2) validating & using the codes (i.e., coding all transcripts) and 3) clustering and interpreting the codes, coded excerpts, and developing broader themes.

Results: Participants largely viewed the ATI initiative as a structure by whose rules and regulations they had to abide. However, they also recognized and were grateful that even within the ATI system, the courts would give them second chances. Participants identified Housing First program components including permanent housing; non-judgmental, person-oriented and time-unlimited services; consumer choice; flexible limits, harm reduction, and second chances as critical to their success in the program. Participants also distinguished court requirements from the program's requirements. Participants reported an improved quality of life, a better outlook, positive internal shifts (e.g., becoming more trusting, confident), and having new goals (e.g., finding a job, restoring family connections) as a result of program participation.

Conclusions & Implications: This presentation identifies practices that can make the combination of Housing First, a model based on consumer choice, flexible services, and harm reduction, work within the constraints imposed by ATI programs that involve treatment mandates, monitoring, and reporting requirements. Unlike most ATI programs, Housing First was not as closely equated with the criminal justice system and was perceived as honoring consumer choice. Key program features address both personal risk factors and typical treatment system risk factors, resulting in improved outcomes two years post-enrollment and suggesting that Housing First is a viable ATI strategy.