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Chronic homelessness is a highly complex social problem of national importance. The problem has elicited a variety of societal and public policy responses over the years, concomitant with fluctuations in the economy and changes in the demographics of and attitudes toward poor and disenfranchised citizens. In recent decades, federal agencies, nonprofit organizations, and the philanthropic community have worked hard to develop and implement programs to solve the challenges of homelessness, and progress has been made. However, much more remains to be done. Importantly, the results of various efforts, and especially the efforts to reduce homelessness among veterans in recent years, have shown that the problem of homelessness can be successfully addressed. Although a number of programs have been developed to meet the needs of persons experiencing homelessness, this report focuses on one particular type of intervention: permanent supportive housing (PSH). Permanent Supportive Housing focuses on the impact of PSH on health care outcomes and its cost-effectiveness. The report also addresses policy and program barriers that affect the ability to bring the PSH and other housing models to scale to address housing and health care needs.
There have always been homeless people in the United States, but their plight has only recently stirred widespread public reaction and concern. Part of this new recognition stems from the problem's prevalence: the number of homeless individuals, while hard to pin down exactly, is rising. In light of this, Congress asked the Institute of Medicine to find out whether existing health care programs were ignoring the homeless or delivering care to them inefficiently. This book is the report prepared by a committee of experts who examined these problems through visits to city slums and impoverished rural areas, and through an analysis of papers written by leading scholars in the field.
In the devastation that follows a major disaster, there is a need for multiple sectors to unite and devote new resources to support the rebuilding of infrastructure, the provision of health and social services, the restoration of care delivery systems, and other critical recovery needs. In some cases, billions of dollars from public, private and charitable sources are invested to help communities recover. National rhetoric often characterizes these efforts as a "return to normal." But for many American communities, pre-disaster conditions are far from optimal. Large segments of the U.S. population suffer from preventable health problems, experience inequitable access to services, and rely on overburdened health systems. A return to pre-event conditions in such cases may be short-sighted given the high costs - both economic and social - of poor health. Instead, it is important to understand that the disaster recovery process offers a series of unique and valuable opportunities to improve on the status quo. Capitalizing on these opportunities can advance the long-term health, resilience, and sustainability of communities - thereby better preparing them for future challenges. Healthy, Resilient, and Sustainable Communities After Disasters identifies and recommends recovery practices and novel programs most likely to impact overall community public health and contribute to resiliency for future incidents. This book makes the case that disaster recovery should be guided by a healthy community vision, where health considerations are integrated into all aspects of recovery planning before and after a disaster, and funding streams are leveraged in a coordinated manner and applied to health improvement priorities in order to meet human recovery needs and create healthy built and natural environments. The conceptual framework presented in Healthy, Resilient, and Sustainable Communities After Disasters lays the groundwork to achieve this goal and provides operational guidance for multiple sectors involved in community planning and disaster recovery. Healthy, Resilient, and Sustainable Communities After Disasters calls for actions at multiple levels to facilitate recovery strategies that optimize community health. With a shared healthy community vision, strategic planning that prioritizes health, and coordinated implementation, disaster recovery can result in a communities that are healthier, more livable places for current and future generations to grow and thrive - communities that are better prepared for future adversities.
Housing for Special Groups contains the proceedings of an international seminar held in the Netherlands on November 8-13, 1976 under the auspices of the Committee on Housing, Building and Planning of the United Nations Economic Commission for Europe. The seminar provided a forum for discussing the special housing requirements of certain groups, including the elderly and the handicapped. The emphasis is on the scope and size of special housing problems and their likely future evolution, as well as the general lines of approach adopted by various countries to tackle these problems. The discussions are organized around three themes: specific housing needs in relation to overall housing policy; social principles, including financial aid; and architectural, planning, and technical aspects. The issues covered include the right to housing and the integration of such housing into the community and the avoidance of segregation; the possibility of housing choice; the relationship between the life-cycle of households and housing needs; and the architecture, planning, and technical aspects of housing for special groups in western Europe and eastern Europe. The possibilities offered both by new production and by alterations to existing buildings are considered. This monograph will be of interest to housing officials and policymakers.
Accessible and affordable housing can enable community living, maximize independence, and promote health for vulnerable populations. However, the United States faces a shortage of affordable and accessible housing for low-income older adults and individuals living with disabilities. This shortage is expected to grow over the coming years given the population shifts leading to greater numbers of older adults and of individuals living with disabilities. Housing is a social determinant of health and has direct effects on health outcomes, but this relationship has not been thoroughly investigated. In December 2016, the National Academies of Sciences, Engineering, and Medicine convened a public workshop to better understand the importance of affordable and accessible housing for older adults and people with disabilities, the barriers to providing this housing, the design principles for making housing accessible for these individuals, and the features of programs and policies that successfully provide affordable and accessible housing that supports community living for older adults and people with disabilities. This publication summarizes the presentations and discussions from the workshop.
This handbook is the definitive resource for understanding current mental health policy controversies, options, and implementation strategies. It offers a thorough review of major issues in mental health policy to inform the policy-making process, presenting the pros and cons of controversial, significant issues through close analyses of data. Some of the topics covered are the effectiveness of various biomedical and psychosocial interventions, the role of mental illness in violence, and the effectiveness of coercive strategies. The handbook presents cases for conditions in which specialized mental health services are needed and those in which it might be better to deliver mental health treatment in mainstream health and social services settings. It also examines the balance between federal, state, and local authority, and the financing models for delivery of efficient and effective mental health services. It is aimed for an audience of policy-makers, researchers, and informed citizens that can contribute to future policy deliberations.
As an evidence-based practice, Housing First has not only been proven to be successful in ending homelessness, but is also embraced as the most cost-effective solution. Today, the Housing First model is being implemented in hundreds of communities across the United States, Canada and Europe. As the model evolves one thing remains constant: Housing First ends homelessness. Housing First is simple: provide housing first, and then combine that housing with supportive treatment services in mental and physical health, substance abuse, education, and employment.Housing First details:solid, actionable information about the program's philosophy, operations, and administrationthe composition, staffing structures, and day-to-day operations of the clinical and support servicespractices in client assessment and engagementproperty management operationsthe best protocols for assisting clients with the search for housing, relationships with landlords, and the overall "settling in" processthe research evidence for the effectiveness of the Pathways modelThe Pathways model has been remarkably successful in ending chronic homelessness. Since its founding, housing retention rates have remained at 85 – 90 percent even among individuals who have not succeeded in other programs. Not only is Housing First effective at keeping people housed and working toward recovery, it has also proven to be incredibly cost-effective.