A Tale of Two Counties: A Cross-Disability Study of Residential Clustering Among Persons Receiving Housing Support Services

Background & purpose: Supporting people with disabilities in integrated housing is a major goal of rehabilitation policy in the United States; therefore, it is important to assess the extent to which publicly-funded housing support services (HSS) are achieving the goal of community inclusion. HSS refer to a collection of programs that couple provision of housing with supportive services to enable persons with psychiatric disabilities (PPD) and persons with intellectual disabilities (PID) to maintain community tenure. HSS are delivered by two distinct service systems with different funding streams, which in turn might affect the residential locations of the two populations.

This study addresses two questions: 1) To what extent do PPD and PID receiving HSS live in integrated housing settings, as indicated by the lack of spatial concentration? 2) Are PPD and PID receiving HSS living in neighborhoods with similar or different socio-demographic characteristics that might affect their quality of community life?

Methods: The departments of behavioral health and intellectual disabilities from two adjoining counties provided address data on HSS locations. One county is an urban area with very low median household income, whereas the other county is a suburban area with very high median household income. Census tract level data from the 2006-2010 American Community Survey Five-Year Summary File were factor-analyzed to capture community conditions including neighborhood disadvantage, residential instability, and race/ethnic diversity.  Hot-spot analysis, a density-based geographic information system spatial clustering technique, was used to analyze the distribution of 4,599 PPD and PID receiving HSS.

Findings: We identified three HSS-PD clusters and three HSS-ID clusters in the urban county, and three HSS-PD clusters and five HSS-ID clusters in the suburban county. HSS-PD clusters are slightly less concentrated than HSS-ID clusters in the urban county; HSS-PD clusters are twice as concentrated as HSS-ID clusters in the suburban county. In both counties, HSS-PD clusters are located in neighborhoods with higher levels of disadvantage and higher levels of instability when compared with HSS-ID clusters. No differences in race/ethnic diversity were found between HHS-PD and HSS-ID clusters in the urban county, whereas HHS-PD clusters were located in neighborhoods with a higher level of race/ethnic diversity than HHS-ID clusters in the suburban county.

Conclusion and implications: The patterns of HSS locations emerged in the findings might be the result of different service philosophies and housing-siting strategies adopted by the service systems for PPD and PID. Higher funding levels of HHS for PID might have provided programs with the option of placing people in neighborhoods that are more residentially stable and less disadvantaged, in both urban and suburban settings. This study demonstrates the value of hot-spot analysis in conjunction with census tract analysis for improving local policy makers’ and administrators’ capacity to monitor the spatial distribution of HSS and to implement housing-siting strategies that can facilitate the community inclusion of persons with disabilities.