Housing Outcomes for Vulnerable Youth Utilizing Transition Interventions: A Systematic Review

Background/Purpose: Each year over 50,000 youth in the United States age out of child-serving systems such as child welfare and juvenile justice (Opening Doors, 2010). These youth often lack support from family and face multiple challenges as they transition into adulthood, including a high risk of homelessness. Supports have been put in place over the past 25 years including Independent living programs (ILP) for youth aging out of foster care and transitional living (TLP) or transitional housing programs (THP) for at-risk or homeless youth. More recently, supportive transition interventions such as Assertive Community Treatment and the Transition to Independence Process Model (TIP) have been evaluated. However, there is a dearth of literature focused on evaluating housing outcomes for youth who utilize transition interventions. The purpose of this systematic review is to assess the evidence for the effectiveness of transition interventions on housing outcomes for vulnerable youth.

Methods: Electronic databases, grey literature, and reference lists were searched to identify relevant records. All English studies published between 1985 and March 2015 were included if:  1) participants were age 14-27 and homeless or at-risk of homelessness, exiting or previously in foster care, or identified as having mental health needs, 2) interventions were designed to support the transition to adulthood and 3) included an outcome measure for housing/living arrangement, and 4) used at least a pre-post intervention design. Sixteen studies met this criteria. Data on study design, sampling, outcome measurement, attrition, and allegiance bias were extracted to compare interventions and consider methodological quality.

Results: The majority of studies evaluated ILPs (n=7) or TLPs/THPs (n=7). Two evaluated supportive services interventions with no dedicated housing component. Study designs were generally weak with the majority of studies using single group, pre-post intervention designs (n=12) or a non-equivalent comparison group (n=3). Only three studies provided follow-up measures post-intervention. Across studies, a range of measures assessed housing outcomes at the time of intervention completion. Some measures were labeled similarly but defined differently in their operationalization of terms such as “independent living” and “homelessness”.  Every study reviewed reported improved housing outcomes for youth participating in the intervention.

Conclusion/Implications: The effectiveness of transition interventions on improving housing outcomes for vulnerable youth was unable to be determined given the weak study designs, lack of follow-up, and inconsistencies in outcome measurement. While many youth who participate in transition interventions seem to have improved housing outcomes, these measures vary widely and tend to only measure living arrangement at the time of discharge. There is a need to operationalize and measure housing outcomes in a consistent and developmentally appropriate way that accounts for the fact that housing stability is inherently a longitudinal phenomenon.  Measures that only assess the type of living situation youth have at the point of discharge provide limited information about the success of these interventions in relation to housing stability. In the absence of consistent, contextually-relevant, and longitudinal outcome measures and randomized control designs, the ability to determine whether transition interventions improve housing outcomes for vulnerable youth remains limited.