Placement into Scattered-Site or Place-Based Permanent Supportive Housing in Los Angeles County, CA, During the COVID-19 Pandemic

Benjamin F Henwood; Randall Kuhn; Amanda Landrian Gonzalez; Jessie Chien; Yue Tu; Ricky Bluthenthal; Michael Cousineau; Howard Padwa; Roya Ijadi-Maghsoodi; Melissa Chinchilla; Bikki Tran Smith; Lillian Gelberg

doi:10.1007/s10488-024-01359-1

Placement into Scattered-Site or Place-Based Permanent Supportive Housing in Los Angeles County, CA, During the COVID-19 Pandemic

Adm Policy Ment Health. 2024 Mar 14. doi: 10.1007/s10488-024-01359-1. Online ahead of print.

Authors

Benjamin F Henwood¹, Randall Kuhn², Amanda Landrian Gonzalez³, Jessie Chien², Yue Tu⁴, Ricky Bluthenthal⁴, Michael Cousineau⁴, Howard Padwa⁵, Roya Ijadi-Maghsoodi^{5

6}, Melissa Chinchilla^{6

7

8}, Bikki Tran Smith⁹, Lillian Gelberg^{10

11}

Affiliations

¹ Suzanne Dworak-Peck School of Social Work, University of Southern California (USC), 669 W. 34th Street, Montgomery Ross Fisher Building, Los Angeles, CA, 90089, USA. bhenwood@usc.edu.
² Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
³ Suzanne Dworak-Peck School of Social Work, University of Southern California (USC), 669 W. 34th Street, Montgomery Ross Fisher Building, Los Angeles, CA, 90089, USA.
⁴ Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA.
⁵ Semel Institute of Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA.
⁶ Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
⁷ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
⁸ VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA.
⁹ Department of Biomedical & Health Sciences, University of Vermont, Burlington, VT, USA.
¹⁰ Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
¹¹ Department of Health Policy & Management, Fielding School of Public Health, UCLA, Los Angeles, CA, USA.

PMID: 38483751
DOI: 10.1007/s10488-024-01359-1

Abstract

There are two dominant approaches to implementing permanent supportive housing (PSH), namely place-based (PB) and scattered-site (SS). Formal guidance does not distinguish between these two models and only specifies that PSH should be reserved for those who are most vulnerable with complex health needs. To consider both system- and self-selection factors that may affect housing assignment, this study applied the Gelberg-Anderson behavioral model for vulnerable populations to compare predisposing, enabling, and need factors among people experiencing homelessness (PE) by whether they were assigned to PB-PSH (n = 272) or SS-PSH (n = 185) in Los Angeles County during the COVID-19 pandemic. This exploratory, observational study also included those who were approved but did not receive PSH (n = 94). Results show that there are notable differences between (a) those who received PSH versus those who did not, and (b) those in PB-PSH versus SS-PSH. Specifically, PEH who received PSH were more likely to be white, US-born, have any physical health condition, and have lower health activation scores. PEH who received PB- versus SS-PSH were more likely to be older, Black, have any alcohol use disorder, and have higher health activation scores. These findings suggest that homeless service systems may consider PB-PSH more appropriate for PEH with higher needs but also raises important questions about how race may be a factor in the type of PSH that PEH receive and whether PSH is received at all.

Keywords: Gelberg-Anderson Model; Homelessness; Housing First; Place-based Housing; Racial Disparities; Scattered-site Housing; Single-site Housing; Vulnerability.