What Facilitates Positive Transitions from Permanent Supportive Housing?: A Scoping Review and Theoretical Model of Factors Relevant to Positive Exits from Permanent Supportive Housing

Background and Purpose: The U.S. Department of Housing and Urban Development is actively encouraging homeless service sectors nationwide and financially incentivizing them to “graduate” residents from permanent supportive housing (PSH) programs to mainstream affordable housing. By facilitating these positive exits, communities have the potential to increase PSH capacity, house more individuals experiencing homelessness, and get the U.S. that much closer to achieving the Social Work Grand Challenge of ending homelessness. Yet, the research on barriers, facilitators, and outcomes of positive exits from PSH is limited. The study identifies factors specified in the extent literature that are related to positive exits from PSH and presents a theoretical model based on this review that describes the predisposing, enabling, and need-based factors that promote positive PSH exits.

Methods: To achieve these study aims, a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines (Tricco, et al., 2018) was conducted. A total of 145 records from 4 databases, as well as the first 60 of 4140 records identified via Google Scholar, were located and reviewed in the initial search. The screening and inclusion process resulted in a total of 9 studies examining factors related to positive exits from PSH. Given the limited number of records located, analysis included both quantitative and qualitative studies. Therefore, no meta-analytic statistical analyses were conducted. Instead, findings were analyzed using an inductive content analysis approach. Higher order categories were then compared to existing theories that explain positive housing and health outcomes in unhoused populations.

Results: Factors identified through this scoping review fell into three higher-order categories – characteristics of PSH residents, social supports, and resources, which echo and expand upon Gelberg and colleagues’ (2000) Behavioral Model of Vulnerable Populations. The most cited factor relevant to positive exits was support from PSH case managers. Positive exits were generally negatively associated with other types of service utilization for medical, mental health, and substance abuse conditions. Having financial resources (entitlement benefits, employment income, and health insurance) was also found to be related to positive exits. Relevant individual characteristics included being older, female, with no children, and not African American. There were mixed findings on the relevance of health-related characteristics (having a mental illness, substance abuse or medical condition). No macro-level factors were examined in the studies located through this review and only one study documented the relevance of PSH organizational features in relation to positive exits.

Conclusions and Implications: These findings suggest that PSH services may effectively contribute to positive exits from these programs. Race as a significant factor in relation to exits raises questions about how structural forces (e.g., landlord discrimination) may impact individuals’ ability to exit these programs to mainstream affordable housing. Additional research is needed to explicitly examine these macro-level forces. The theoretical model developed through this review provides a starting point for researchers to test and further develop for the purpose of improving homelessness policy, as well as the targeting and implementation of PSH transitional supports.