A protocol to develop and study the effectiveness and implementation of social skills training that improves supported housing retention for persons with serious mental illness

Abstract

IntroductionSupported housing−which offers permanent, community-based housing and supportive services−effectively addresses homelessness. Yet, many persons with serious mental illness (SMI) struggle to retain housing in these programs. Social skills−which facilitate social interactions and instrumental tasks−predict premature exits from supported housing. Though social skills training effectively improves social skills and functioning for persons with SMI, this intervention is essentially absent from supported housing initiatives.MethodsThis study will use literature review, key informant interviews and an expert panel to adapt social skills training for supported housing, aiming to improve housing retention among SMI persons in these programs. In the Department of Housing and Urban Development-VA Supported Housing program (HUD-VASH) at VA Greater Los Angeles, we will conduct an effectiveness-implementation hybrid type I trial of the adapted intervention. Baseline and 6-month assessments (measuring social skills, mental health status, healthcare utilization, social networks, money management, and housing outcomes) will be conducted with intervention participants (n = 30) and a usual care control group (n = 20). We will use the generalized linear mixed model (GLMM) to compare change over 6 months between groups, capturing the intervention's effectiveness on factors strongly associated with housing retention. Qualitative data and surveys with staff, leadership, and participants will gather data on factors relevant to the intervention's future implementation in routine care.DiscussionFew effective psychosocial interventions for persons with SMI have been adapted or studied in supported housing initiatives. To our knowledge, this is the first study to adapt and study the effectiveness and implementation of social skills training in supported housing programs.

Stakeholder perspectives on sustainment of Housing First in a VA permanent supportive housing program

“…A key component of HF is the absence of mandates for sobriety or mental health treatment, in contrast to traditional approaches to homelessness, which operationalize housing readiness via treatment compliance and/or sobriety 2 . Additional key components of HF include the delivery of voluntary, community‐based, and recovery‐oriented services at a pace and intensity determined by clients, 2 and the prioritization of housing for chronically homeless persons, including those with high psychosocial or biomedical vulnerabilities 3–5 . Table 1 details the key components of HF, which are often used to measure fidelity to this practice.…”

“…At present, HUD‐VASH serves 7500 veterans in metropolitan Los Angeles 21 . HUD‐VASH teams, composed of social workers, nurses, and peer support specialists, provide supportive services in the field, including eligibility assessments, home visits, care coordination, and transportation to services 5 …”

“…2 Additional key components of HF include the delivery of voluntary, community-based, and recovery-oriented services at a pace and intensity determined by clients, 2 and the prioritization of housing for chronically homeless persons, including those with high psychosocial or biomedical vulnerabilities. [3][4][5] Table 1 details the key components of HF, which are often used to measure fidelity to this practice. A substantial body of research shows that HF increases access to housing, [6][7][8] reduces the use of costly emergency services, [9][10][11] heightens perceived autonomy, and improves housing outcomes.…”

“…21 HUD-VASH teams, composed of social workers, nurses, and peer support specialists, provide supportive services in the field, including eligibility assessments, home visits, care coordination, and transportation to services. 5 As a part of HF's widespread implementation within and outside VA, practice adaptations have been made to fit varying settings and contexts. [22][23][24][25] As intensive HF implementation efforts have largely ceased at VA Greater Los Angeles (VAGLA), additional research is needed to characterize practice sustainment and factors associated with sustainment.…”