Factors Associated with Finding Housing Among Homeless Individuals Recommended for Permanent Supportive Housing

Background and Purpose

Homelessness is a persistent social and public health challenge in the US and Texas. In 2020, an estimated 27,229 people experienced homelessness, a 5.3% increase since 2019. In Texas, the state-funded Healthy Community Collaborative (HCC) program provides housing and wraparound services for individuals experiencing homelessness and mental health or co-occurring disorders. A standard risk assessment tool, the Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT), is administered to HCC participants to determine risk and prioritization when aiding homeless individuals. Despite recommendations for Permanent Supportive Housing (PSH) from the VI-SPDAT, scarce resources and limited availability persist in obtaining housing for many. Additionally, despite its common use, this is the first study at HCC to use the VI-SPDAT to examine the factors associated with finding housing and its’ applicability in prioritizing the most vulnerable in finding housing has not been assessed in detail. This study identifies factors associated with finding housing among PSH-recommended HCC participants by comparing participants who found housing (n=166) to participants who are currently waiting for housing (n=81).

Methods

The study sample of 247 participants (ages 23-75) in Austin, Texas, was drawn from PSH recommended HCC participants from the VI-SPDAT (2017-2020). The outcome variable, housing status (Y/N), was measured by housing status after receiving the VI-SPDAT recommendation for PSH (average of 270.28 days from VI-SPDAT to housing). Independent variables included demographics and VI-SPDAT subitems—history of chronic homelessness, emergency room use, inpatient psychiatric hospitalization, crisis service use, and criminal justice involvement, risk of harm, risk of exploitation, money management, meaningful daily activity, self-care, social relationships, and history of abuse and trauma. Additionally, the total VI-SPDAT score was included in the analysis. Logistic regression was conducted to identify factors associated with housing status.

Results

An increase in the odds of finding housing is found among participants with more significant mental health needs (OR=1.37, p<.05), greater inpatient hospitalizations (OR=1.34, 0<.05), better self-care (OR=2.97, p<.01), a history of abuse or trauma (OR=.02, p<.01), and greater VISDPAT scores (OR=1.45, p<.01). Additionally, participants with decreased substance use needs (OR=.59, p<.05) and fewer emergency room use (OR=.77, p<.001) were more likely to find housing.

Conclusion and Implications

The findings indicate that participants prioritized for housing were recommended for PSH, had more significant mental health needs, greater inpatient hospitalizations, and better self-care. Additionally, participants prioritized for housing had less substance use needs and fewer emergency room visits. It appears that the higher VI-SPDAT scores, indicating more need, the VI-SPDAT is appropriately placing those participants in housing. The ability for self-care and less substance use treatment needs also emerged as a factor associated with greater odds of obtaining housing, indicating that participant independence and substance use treatment may be an indicator for “housing prioritization.” Further evaluation is needed to understand factors that promote housing for individuals seeking housing. Practice and policymakers may focus on identifying and targeting factors that promote housing readiness to aid in obtaining housing, particularly for individuals deemed in need for PSH.