Service-enriched housing
Service-enriched housing is permanent, basic rental housing in which social services are available on-site or by referral through a supportive services program or service coordinator1. Housing and services can be provided by nonprofit, private, or government organizations; housing options can be unsubsidized, government assisted, mixed income, or a combination. Programs often support families with low incomes, older adults, people with disabilities, or veterans1, 2, 3. Some service-enriched housing programs also assist families or individuals experiencing homelessness; programs that support households experiencing homelessness are often referred to as permanent supportive housing4.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced homelessness
Increased housing stability
Reduced hospital utilization
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Improved health outcomes
Improved mental health
What does the research say about effectiveness?
There is some evidence that service-enriched housing reduces homelessness1, 5, 6, 7, increases housing stability1, 4, 5, 6, 7, 8, and reduces hospital utilization for participating individuals and families2, 5, 6, 8, 9. Programs are particularly effective among individuals experiencing homelessness4, 5, 6, 7, 10. Additional evidence is needed to confirm effects.
Participation in service-enriched housing programs can reduce anxiety11. Programs with strong case management can stabilize physical4, 6 and mental health conditions for formerly homeless individuals with HIV6. Long-term supportive housing can reduce HIV risk behaviors, new HIV infections, and the costs associated with managing HIV12. Supportive housing programs for youth aging out of foster care have been shown to increase housing stability and reduce sexually transmitted infections (STIs)13. Service-enriched housing programs may improve the health of older adults by reducing preventable risk factors14 and provide support to allow older adults to age-in-place2. Service-enriched housing may reduce chronic homelessness and improve health outcomes among individuals who are chronically homeless4. Programs which include peer support workers, who have also experienced homelessness, mental illness, or addiction, can improve physical and mental health and reduce psychological distress for participants with serious mental illness15. In one study, service-enriched housing has been associated with increased maintenance of sobriety16.
There is a demonstrated need for service-enriched housing among the elderly2, 17, veterans1, individuals with chronic mental illness and substance abuse problems5, 6, 18, and chronically homeless families and individuals4. Tailoring service-enriched housing to meet the specific needs of older veterans, female veterans with children, or young veterans, can increase effects on housing stability and mental health or substance disorders, and ease the transition from military service to civilian workplaces1.
States may facilitate partnerships between behavioral health and housing providers and provide intensive behavioral health services via Medicaid for supportive housing participants19.
Service-enriched housing may be a cost-effective mechanism to achieve stable housing for vulnerable families and individuals11, 20; additional research is needed to assess cost-effectiveness and potential health care savings4. Decreased emergency care utilization and hospitalizations may offset some program costs2, 3, 6, 7, 9.
Implementation Examples
Service-enriched housing programs for families with low incomes and families or individuals experiencing homelessness are in place throughout the United States. Programs may be implemented across a region, as by the LINC Housing Corporation in California and the Colorado Coalition for the Homeless, or in individual communities as in Bridgeport, CT via the PT Barnum Partnership (PT Partners)21, 22, 23. PATH Making It Home and Mercy Housing are two additional examples of service-enriched housing programs in local communities24, 25. Programs can also be implemented by faith-based non-profits as in Washington, D.C.’s Jubilee Housing26.
There are many veteran-specific service-enriched housing programs. The HUD-VA Supported Housing (HUD-VASH) program, a service-enriched housing program for veterans experiencing homelessness who also have psychiatric or substance abuse disorders, includes rental assistance vouchers from the U.S. Department of Housing and Urban Development (U.S. HUD) with case management and clinical services provided by the U.S. Department of Veteran Affairs (VA); 93,000 vouchers have been awarded and approximately 150,000 veterans have been served by HUD-VASH since 200827, 28. The Mayors Challenge to End Veteran Homelessness, an additional partnership between the VA and U.S. HUD, uses permanent supportive housing with added mental health services along with concepts from rapid re-housing and Housing First to serve veterans experiencing homelessness29.
Some programs also focus on the needs of specific groups. Family Service Communities, for example, provides service-enriched housing to older adults with low and middle incomes in five senior-living complexes in Rochester, NY30. The Road Home Dane County in Madison, WI provides service-enriched housing for families that are chronically homeless and include an adult with disabilities31. In Minnesota, the Volunteers of America provide service-enriched housing in one complex which includes families and older adults in five senior-living complexes32.
Implementation Resources
Housing Hope - Housing Hope. Housing and services.
US HUD-ALCP - U.S. Department of Housing and Urban Development (U.S. HUD). Assisted Living Conversion Program (ALCP): Grant program to convert private, non-profit housing developments to service-enriched housing or assisted living facilities for elderly residents aging in place.
US ICH-Supportive housing - United States Interagency Council on Homelessness (U.S. ICH). Supportive housing: Core components and featured tools. 2018.
Furman Center-Neighborhood conditions - Furman Center for Real Estate and Urban Policy. Research area: Neighborhood conditions. New York University, Furman Center.
Footnotes
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1 Sturtevant 2015 - Sturtevant L, Brennan M, Viveiros J, Handelman E. Housing and services needs of our changing veteran population. Washington, D.C.: National Housing Conference and Center for Housing Policy; 2015.
2 Castle 2016 - Castle N, Resnick N. Service-enriched housing: The staying at home program. Journal of Applied Gerontology. 2016;35(8):857-877.
3 Brown 2013b - Brown RT, Thomas ML, Cutler DF, Hinderlie M. Meeting the housing and care needs of older homeless adults: A permanent supportive housing program targeting homeless elders. Seniors Housing & Care Journal. 2013;21(1):126-135.
4 NASEM 2018 - National Academies of Sciences, Engineering, and Medicine (NASEM). Permanent supportive housing: Evaluating the evidence for improving health outcomes among people experiencing chronic homelessness. Washington, D.C.: The National Academies Press; 2018.
5 Rog 2014 - Rog DJ, Marshall T, Dougherty RH, et al. Permanent supportive housing: Assessing the evidence. Psychiatric Services. 2014;65(3):287-294.
6 Fitzpatrick-Lewis 2011 - Fitzpatrick-Lewis D, Ganann R, Krishnaratne S, et al. Effectiveness of interventions to improve the health and housing status of homeless people: A rapid systematic review. BMC Public Health. 2011;11:638.
7 Montgomery 2013 - Montgomery AE, Hill LL, Kane V, Culhane DP. Housing chronically homeless veterans: Evaluating the efficacy of a Housing First approach to HUD-VASH. Journal of Community Psychology. 2013;41(4):505-514.
8 Lim 2018 - Lim S, Singh TP, Hall G, et al. Impact of a New York City supportive housing program on housing stability and preventable health care among homeless families. Health Services Research. 2018;53(5):3437-3454.
9 Bamberger 2015 - Bamberger JD, Dobbins SK. A research note: Long-term cost effectiveness of placing homeless seniors in permanent supportive housing. Cityscape: A Journal of Policy Development and Research. 2015;17(2):269-277.
10 Gutman 2017 - Gutman SA, Raphael-Greenfield EI. Effectiveness of a supportive housing program for homeless adults with mental illness and substance use: A two-group controlled trial. British Journal of Occupational Therapy. 2017;80(5):286-293.
11 Urban-Popkin 2010 - Popkin SJ, Theodos B, Getsinger L, Parilla J. Supporting vulnerable public housing families: An evaluation of the Chicago Family Case Management Demonstration. Washington, D.C.: Urban Institute; 2010: Brief No. 1.
12 Lee 2018a - Lee CT, Winquist A, Wiewel EW, et al. Long-term supportive housing is associated with decreased risk for new HIV diagnoses among a large cohort of homeless persons in New York City. AIDS and Behavior. 2018;22(9):3083-3090.
13 Lim 2017 - Lim S, Singh TP, Gwynn RC. Impact of a supportive housing program on housing stability and sexually transmitted infections among young adults in New York City who were aging out of foster care. American Journal of Epidemiology. 2017;186(3):297-304.
14 Castle 2008 - Castle NG. Service enriched housing and the senior living enhancement program. Journal of Housing for the Elderly. 2008;22(3):263-278.
15 Crisanti 2017 - Crisanti AS, Duran D, Greene RN, et al. A longitudinal analysis of peer-delivered permanent supportive housing: Impact of housing on mental and overall health in an ethnically diverse population. Psychological Services. 2017;14(2):141-153.
16 Collard 2008 - Collard CS, Larkin R. Supportive housing: Implications for its efficacy as intervention with special needs low-income African Americans. Journal of Public Management & Social Policy. 2008;14(2):69-83.
17 Golant 2010 - Golant SM, Parsons P, Boling PA. Assessing the quality of care found in affordable clustered housing-care arrangements: Key to informing public policy. Cityscape: A Journal of Policy Development and Research. 2010;12(2):5-28.
18 Culhane 2002 - Culhane DP, Metraux S, Hadley T. Public service reductions associated with placement of homeless persons with severe mental illness in supportive housing public service reductions associated with placement of homeless. 2002;13(1):107-163.
19 Mathematica-Kleinman 2017 - Kleinman R, Kehn M, Siegwarth AW, Brown J. State strategies for coordinating Medicaid and housing services. Psychiatric Rehabilitation Journal. 2017;40(2):225-232.
20 Cohen 2004 - Cohen CS, Mulroy E, Tull T, White C, Crowley S. Housing plus services: Supporting vulnerable families in permanent housing. Child Welfare. 2004;83(5):509-528.
21 LINC Cares-Resident services - Limited Income Communities (LINC) Housing Corporation. LINC Cares: Resident services.
22 CCH-Housing - Colorado Coalition for the Homeless (CCH). Housing: Affordable housing and support services for low income or homeless families and individuals.
23 PT Partners 2014 - Partnership for Strong Communities. Affordable housing, community development, supportive housing: Making public housing work for families. Fairfield County Community Foundation and PT Barnum Apartments (PT Partners); 2014.
24 PATH - PATH Making It Home. Find your PATH home: helping individuals, families, and communities end their homelessness.
25 Mercy Housing - Mercy Housing. Transforming lives through affordable housing.
26 Jubilee Housing - Jubilee Housing. Affordable housing and family services in Washington, D.C.
27 US HUD-VASH - U.S. Department of Housing and Urban Development (U.S. HUD). Veterans Affairs Supportive Housing (VASH): HUD-VASH Vouchers.
28 HUD-VASH 2018 - U.S. Department of Housing and Urban Development (U.S. HUD). HUD and VA announce additional support to help homeless veterans find permanent homes: Second round of HUD-VASH vouchers to provide housing for veterans and their families. HUD Public Affairs, press release; December 11, 2018.
29 US ICH-Veteran homelessness - United States Interagency Council on Homelessness (U.S. ICH). Mayors challenge to end veteran homelessness: Criteria and benchmarks for ending veteran homelessness.
30 Family Service Communities - Family Service Communities. About Family Service Communities: Enriched housing & assisted living in Rochester, NY.
31 RHDC-PSH - The Road Home Dane County (RHDC). Permanent supportive housing (PSH).
32 VOA-Service-enriched housing - Volunteers of America, Minnesota and Wisconsin. Service-enriched housing: Affordable apartment living for families and seniors in Minnesota.
Related What Works for Health Strategies
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