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The Moving on Program and Supportive Housing Residents with Histories of Homelessness City University of New York (CUNY) CUNY Academic Works All Dissertations, Theses, and Capstone Projects Dissertations, Theses, and Capstone Projects 5-2019 The Moving On Program and Supportive Housing Residents with Histories of Homelessness Kimberly Livingstone The Graduate Center, City University of New York How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/3142 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] THE MOVING ON PROGRAM AND SUPPORTIVE HOUSING RESIDENTS WITH HISTORIES OF HOMELESSNESS by KIMBERLY R. LIVINGSTONE A dissertation submitted to the Graduate Faculty in Social Welfare in partial fulfillment of the requirements for the degree of Doctor of Philosophy, The City University of New York. 2019 © 2019 Kimberly R. Livingstone All Rights Reserved ii The Moving On Program and Supportive Housing Residents with Histories of Homelessness by Kimberly R. Livingstone This manuscript has been read and accepted for the Graduate Faculty in Social Welfare in satisfaction of the dissertation requirement for the degree of Doctor of Philosophy. ____________________________ ____________________________________ Date Daniel Herman Chair of Examining Committee ____________________________ ____________________________________ Date Harriet Goodman Executive Officer Supervisory Committee: Harriet Goodman Alexis Kuerbis THE CITY UNIVERSITY OF NEW YORK iii ABSTRACT The Moving On Program and Supportive Housing Residents with Histories of Homelessness by Kimberly R. Livingstone Advisor: Daniel B. Herman Supportive housing is the main strategy assisting formerly homeless people to live in the least restrictive settings and as independently as possible. There has been a greater focus on efforts towards homelessness prevention and remedies to minimize the experience of homelessness, which have been further fueled by the demand for supportive housing and a drive for cost effectiveness. Meanwhile, there have been attempts to ensure that those living in supportive housing are only those who continue to need comprehensive long-term support to live independently in the community. To accomplish this, and in line with the Recovery Movement, programs assist people currently living in supportive housing, who are interested in and able to move out into independent apartments in the community. On the other hand, there have been minimal efforts to assist those who want to move on and no longer need comprehensive onsite support. Utilizing data on 40 formerly homeless persons preparing to transition from supportive housing to independent housing, a narrative approach was used, guided by interpretive interactionism, to examine the factors that assist and discourage residents to move out of supportive housing. Results suggest that residents sought ontological security through secure benefits, autonomy, and comfort. While residents were unable to reach an optimal level of secure benefits, autonomy, and comfort in staying or moving, they experienced ambivalence in making their decisions and considered satisficing certain conditions while aiming to optimize iv others. Residents in recovery from mental illness and substance abuse identified a unique relationship with autonomy that was grounded in their recoveries and reinforced their supportive housing tenure. These findings suggest certain considerations for programs for supportive housing residents preparing to move on, specifically for those residents in recovery. v ACKNOWLEDGEMENTS I would like to thank the people who participated in this study. Without you this work would not have been possible. I sincerely appreciate the time that you spent and all that you shared with me, so that I could better understand your experience as you planned to move out of supportive housing. I would like to express my sincere gratitude to the members of my dissertation committee. Each of you provided me with guidance and encouragement. I would like to thank Dr. Daniel Herman for your mentorship prior to and as the chair of my committee. Working with you has changed my life and continues to lead to exciting new opportunities. I would also like to thank Dr. Harriet Goodman for your steadfast support, advice, and insight. You have both been boundless advocates for me and my work. For that, I will forever be grateful. I would like to acknowledge the support of Dr. Emmy Tiderington of Rutgers University, Principal investigator of “Moving On From Permanent Supportive Housing: Implementation and Outcomes of the New York City Moving On Initiative.” I would like to acknowledge the financial support from the Graduate Center and Silberman School of Social Work, particularly for the opportunity to serve as a pre-doctoral research fellow with Dr. Daniel Herman from 2013- 2015. To my children, Taylor, Dylan, and Morgan: you are my inspiration; you are the sun, moon, and stars. To my husband, Pat: Thank you for your limitless encouragement and unconditional love. You fuel my efforts to keep going every day and to share love and support with those who feel silenced, ignored, or alone. To my many family, friends, and colleagues who have offered support to my family and to me over the past 7 years, especially in our times of need: Thank you. vi TABLE OF CONTENTS TITLE PAGE i COPYRIGHT PAGE ii APPROVAL PAGE iii ABSTRACT iv ACKNOWLEDGEMENTS vi TABLE OF CONTENTS vii LIST OF TABLES viii LIST OF FIGURES ix I. INTRODUCTION AND PROBLEM STATEMENT 1 Homelessness in the United States 1 Supportive Housing in the US 2 Homelessness Prevention Efficient Use of Supportive Housing 3 The Emergence of Moving On Programs 4 Research Aims and Theoretical Approach 4 II. HISTORICAL AND POLICY REVIEW 7 Historical Review 7 Lack of Affordable Housing 7 Deinstitutionalization of the Mentally Ill 8 Community Service Initiatives 9 Criminalization of the Homeless and Psychiatrically Disabled 11 Recovery Movement 14 Overview of Services for the Homeless 16 vii Evidence-based Practice 18 III. REVIEW OF LITERATURE 20 Review of Theoretical Literature 20 Ecological Systems Theory 20 Social Construction of Target Populations 21 Goffman’s Total Institution and the Mortification of the Self 22 Empirical Literature Review 23 Primary Programs 24 Housing Subsidies 24 Efficiency and Effectiveness in Primary Programs 26 Secondary Programs 27 Critical Time Intervention 28 Rapid Rehousing 29 Tertiary Programs 30 Supportive Housing 31 Housing Stability 31 Recovery Outcomes 32 Housing First 33 Housing Stability 33 Community Integration 35 Recovery Outcomes 36 Efficiency and Effectiveness in Tertiary Programs 38 Transition from Supportive Housing 39 viii Other Housing Transitions 41 Summary 43 IV. METHODOLOGY 45 Research Goals 45 Theoretical Approach: Interpretive Interactionism 46 Research Design 49 Data Collection 49 Moving On Initiative 49 Parent Study 50 Subject Recruitment 50 Sample Description 51 Ethical Considerations 51 Interview Guide Development and Questions 52 Data Analysis 52 V. STASIS 56 Secure Benefit Seeking in Supportive Housing 59 Autonomy and Comfort Seeking in Supportive Housing 63 Independent Enough in Supportive Housing? 63 Ambivalence and Push Factors for Moving On 64 Stasis: Comfortable Enough in Supportive Housing 65 Having a Comfortable Space 66 Absence of Problems: It Wasn’t Torture 68 I Made it a Home 69 ix Great Location and Resources: Convenient for Me 70 Barriers to Autonomy Beyond Supportive Housing 73 Stigma and Discrimination 73 Stuck in the Circle of Poverty and Programs 75 Conclusion 76 VI. MOVING ON 78 Seeking Autonomy in Moving On 79 Leaving the Nest 81 On My Own 83 Freedom from Supervision 85 Freedom from Apartment Visits 87 Freedom to Come and Go 87 Comfort Seeking in Moving On 89 Freedom from Living Among Others 90 Role Dispossession: All My Children Got Taken Away 92 Place to Do Daily Tasks: On My Own Doing Nothing 96 Secure Benefit Seeking in Moving On 98 The Housing Voucher: The Freedom to Move 98 Not Permanent, as Long as Needed 100 Aftercare: They Don’t Just Leave You in the Cold 101 Conclusion 102 VII. RESIDENTS IN RECOVERY 104 Security within the Gates 105 x Optimizing Autonomy 107 Peer Support 108 Risks to Recovery Maintenance in Supportive Housing 110 Freedom and Peace in Recovery 111 Autonomy through Treatment Adherence 111 Absence from Drugs 112 Being a Good Client: In My Business 113 Freedom to Come and Go 115 Peace of Mind 116 Risks to Autonomy in Recovery 117 Conclusion 120 VIII. DISCUSSION AND CONCLUSIONS 122 Discussion 123 Strengths and Limitations of the Study 130 Strengths of the Study 131 Study Limitations 132 Implications for Services and Policy 133 Implications for Research 138 Implications for Social Work 139 Final Thoughts 140 APPENDICES 142 BIBLIOGRAPHY 143 xi LIST OF TABLES Table 1. Participant demographics 53 xii LIST OF FIGURES Figure 1. Framework Analysis 55 xiii 1 CHAPTER I: INTRODUCTION AND PROBLEM STATEMENT Homelessness in the United States Homelessness is a complex and widespread problem in the United States. Recent research indicates clear and alarming trends in homelessness. On any given night in the US, more than half a million individuals seek safety in temporary shelters or sleep in places not meant for residence (U.S. Department of Housing and Urban Development, 2018; HUD). Although homelessness affects diverse populations, certain groups are overrepresented. While African Americans comprise 13% of the US
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