Common ground, complementary approaches: adapting the Housing First model for domestic violence survivors

Females and Housing First: An analysis of 18-month outcomes in a randomized controlled trial

The main objective of this research was to qualitatively examine the impacts of Housing First (HF) specifically on those participants who identified themselves as female in response to question asking what their gender was. The data analyzed are from a larger, muti-site, randomized controlled trial. χ2 analysis was used to compare the life changes (coded as positive, neutral, or negative) experienced by 64 females (42 HF and 22 TAU). An in-depth qualitative analysis was conducted on 45 of these participants (23 HF and 22 TAU). Significantly more female HF participants reported making positive life changes from baseline to 18-month than those in TAU. Relative to females in TAU, female HF participants reported a number of specific positive changes, including enhanced safety, improved recovery in mental illness, greater reductions in drug use, and individual changes. The implications of findings for strengthening HF programs to meet the unique needs of female participants are discussed.

Domestic Violence Housing First Model and Association With Survivors' Housing Stability, Safety, and Well-being Over 2 Years

Importance

Intimate partner violence (IPV) is a leading cause of homelessness and a serious threat to public health and well-being.

Objective

To determine whether the Domestic Violence Housing First (DVHF) model improves safety, housing stability, and mental health over 2 years.

Design, Setting, and Participants

This longitudinal comparative effectiveness study interviewed IPV survivors and reviewed their agency records. All unstably housed or homeless IPV survivors entering domestic violence (DV) services were eligible to participate in the study, ensuring capture of typical variability in service delivery (eg, some survivors would enter services when agencies had the capacity to provide DVHF and others would receive services as usual [SAU]). Clients from 5 DV agencies (3 rural and 2 urban) referred by agency staff in a Pacific Northwest state of the United States were assessed between July 17, 2017, and July 16, 2021. Interviews were conducted in English or Spanish at entry into services (baseline) and at 6-, 12-, 18-, and 24-month follow-up visits. The DVHF model was compared with SAU. The baseline sample included 406 survivors (92.7% of 438 eligible). Of the 375 participants retained at the 6-month follow-up (92.4% retention), 344 had received services and had complete data across all outcomes. Three hundred sixty-three participants (89.4%) were retained at the 24-month follow-up.

Intervention

The DVHF model has 2 components: housing-inclusive advocacy and flexible funding.

Main Outcomes and Measures

Main outcomes included housing stability, safety, and mental health, which were assessed using standardized measures.

Results

Of the 344 participants (mean [SD] age, 34.6 [9.0] years) included in the analyses, 219 (63.7%) received DVHF and 125 (36.3%) received SAU. Most participants identified as female (334 [97.1%]) and heterosexual (299 [86.9%]). Two hundred twenty-one participants (64.2%) were from a racial and ethnic minority group. Longitudinal linear mixed-effects models showed that receiving SAU was associated with greater housing instability (mean difference, 0.78 [95% CI, 0.42-1.14]), DV exposure (mean difference, 0.15 [95% CI, 0.05-0.26]), depression (mean difference, 1.35 [95% CI, 0.27-2.43]), anxiety (mean difference, 1.15 [95% CI, 0.11-2.19]), and posttraumatic stress disorder (mean difference, 0.54 [95% CI, 0.04-1.04]) compared with receiving the DVHF model.

Conclusions and Relevance

Evidence in this comparative effectiveness study suggests that the DVHF model was more effective than SAU in improving the housing stability, safety, and mental health of survivors of IPV. The DVHF's amelioration of all of these interconnected public health issues-relatively quickly and with long-term continuance-will be of substantial interest to DV agencies and others working to support unstably housed IPV survivors.

Domestic violence survivors' housing stability, safety, and well-being over time: Examining the role of domestic violence housing first, social support, and material hardship

Intimate partner violence remains a significant public health issue and survivors often need various forms of support to achieve safety. The increased likelihood of experiencing housing instability and homelessness among survivors has led to an uptake in domestic violence agencies implementing housing-based interventions, such as Domestic Violence Housing First (DVHF), to address survivors' needs. The present study expands on prior research supporting the effectiveness of DVHF to examine situational factors that moderate the outcomes associated with this model among 406 survivors seeking services from domestic violence agencies located in the Pacific Northwestern region of the United States. Using latent profile analysis, participants were grouped into three latent classes: (a) "high abuse/instability," (b) "still affected," and (c) "doing better." Latent transition analysis was used to estimate the probability that participants would transition into a different latent class over time with social support (SS), material hardship, and receipt of DVHF services included as model predictors. Receipt of DVHF predicted improvements in survivors' safety, housing stability, mental health, and well-being, such that receiving DVHF was associated with higher odds of survivors transitioning into the "doing better" class. Social support and material hardship also emerged as significant factors predicting class membership, such that higher levels of social support and financial stability predicted membership in the "doing better" class. Additionally, social support and financial stability appeared to augment receipt of DVHF services, with DVHF being more strongly associated with positive outcomes among participants who also had high levels of social support and lower levels of material hardship. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impact of the Domestic Violence Housing First Model on Survivors' Safety and Housing Stability: Six Month Findings

Intimate partner violence (IPV) is a leading cause of homelessness, yet little evidence exists about effective strategies to assist IPV survivors as they work to avoid homelessness while freeing themselves from abuse. An ongoing demonstration evaluation is examining if and how one promising model assists IPV survivors in obtaining safe and stable housing over time. The Domestic Violence Housing First (DVHF) model involves providing IPV survivors with mobile advocacy and/or flexible funding, depending on individual needs, in order to attain these goals. We hypothesized that those receiving DVHF would experience greater housing stability and less re-abuse compared to survivors receiving services as usual. The current study evaluated the short-term efficacy of the DVHF model with a sample of 345 homeless or unstably housed survivors who sought services and who completed in-person interviews shortly after contacting the DV agency, as well as six months later. Those who received the DVHF model showed greater improvement in their housing stability compared to those receiving services as usual, as well as decreased economic abuse. Both groups experienced a sharp decline in all forms of abuse. The Domestic Violence Housing First model shows promise in helping unstably housed DV survivors achieve safe and stable housing. Study findings have implications for DV agencies as well as those funding such services. Understanding which interventions work best for which survivors is critical to ensuring that service providers are effectively working toward long-term housing stability and well-being for IPV survivors and their children.

Impact of the Domestic Violence Housing First Model on Survivors' Safety and Housing Stability: 12-Month Findings

Intimate partner violence (IPV) is a widespread and devastating phenomenon resulting in a myriad of long-term consequences for survivors and their children. IPV victimization not only has negative health and economic consequences, it has also been linked to homelessness and housing instability. In response, the Domestic Violence Housing First (DVHF) model is being used in some domestic violence (DV) agencies to help survivors attain safe and stable housing. The model includes using individualized advocacy and/or flexible funding to help survivors meet these goals. Using a longitudinal, quasi-experimental design, the current study involved conducting interviews with survivors and examining agency records to investigate the effectiveness of this model. We hypothesized that survivors who received DVHF would experience less re-abuse and greater housing stability over 12 months compared to those who received services as usual (SAU). The sample included 345 IPV survivors who had been homeless or unstably housed when they approached one of five DV programs for help. Interviews were spaced 6 months apart (when survivors first sought services as well as 6 months and 12 months later). Longitudinal analyses showed that survivors who received the DVHF model reported greater improvements in housing stability at both the 6-month and 12-month time points compared to those receiving SAU. At the 12-month time point, survivors who had received DVHF reported decreased physical, psychological, and economic abuse, as well as the use of their children against them as a form of abuse. This study adds to a growing body of evidence supporting this model's effectiveness and adds to our understanding of factors impacting the long-term housing stability and safety for IPV survivors.

From Philosophy to Practice: Designing a Multi-Method, Multi-Stage Program Evaluation of the Wisconsin Domestic Violence Housing First Pilot Program

Safe and secure housing is a pressing concern for survivors of domestic violence (DV). Domestic Violence Housing First (DVHF) is a policy that serves DV survivors' needs by removing barriers to housing stability via flexible financial assistance, mobile advocacy, trauma-informed practice, and partnerships with community housing providers. In this paper, we outline a study protocol developed to evaluate the efficacy of the Wisconsin Domestic Violence Housing First Pilot Program (WI-DVHF). Funding was provided to 9 social service programs across the state and implemented in novel ways. We develop a multi-site, multi-level, longitudinal analysis of WI-DVHF at the individual, site, and community levels. WI-DVHF includes 4 elements differentiating it from previous studies, including analysis of DVHF in rural and urban locations, unique implementation across different sites, and access to a WI rental education program. We also include data from comparable non-WI-DVHF sites and clients served during the study period. This will address concerns about comparing survivors within a site as DVHF funding may free up funds that can benefit other survivors at that site and to better understand the general challenges and trends these organizations face during the study period. The US housing crisis emphasizes the importance of identifying unique and flexible ways to meet the housing needs of DV survivors. This study highlights the potential for DVHF to improve the lives of survivors, and its adaptability to previously understudied cultural groups and across the rural-urban divide. Further, WI-DVHF funds may positively benefit other programs and participants within a site by freeing up valuable space in DV shelters and other resources.

"I Felt Better When I Moved Into My Own Place": Needs and Experiences of Intimate Partner Violence Survivors in Rapid Rehousing

Accessing stable housing is a basic need for intimate partner violence (IPV) survivors, and rapid rehousing programs are a critical way to address homelessness. However, little is known about survivor experiences, needs, and outcomes in rapid rehousing services within IPV agencies. This study uses an exploratory approach to understand the needs and experiences of 31 survivors using vouchers facilitated by an IPV program in the U.S. Southwest. Thematic analysis of structured interviews resulted in four summary themes: getting to housing, managing multiple needs, accessing support, and facing barriers. Practice and evaluation implications are discussed.

The impact of COVID-19 on the safety, housing stability, and mental health of unstably housed domestic violence survivors

Using data from an ongoing longitudinal study, we examined the impact of the COVID-19 stay-at-home orders on a racially diverse population of unstably housed domestic violence (DV) survivors over time. Specifically, we examined survivors' safety, housing stability, and mental health before, during, and after the onset of COVID-19, and how demographic, social, and familial factors attenuated or exacerbated the effect of the stay-at-home orders. Approximately 300 participants were initially interviewed after they sought services from a DV agency, and then again, every 6 months over 2 years. COVID-19 stay-at-home orders occurred midway through the completion of this multi-year study. Longitudinal mixed effects models were estimated to examine the impact of COVID-19 on the safety, housing stability, and mental health of survivors over time. We also examined models with several time-varying (e.g., employment, income, social support, and number of children) and time-invariant (baseline outcome scores, racial/ethnic identity, education, and disability status) control variables. Results revealed that safety, housing stability and mental health were improving for study participants before the onset of the COVID-19 pandemic but plateaued after the stay-at-home orders were issued. Experiences of abuse, housing instability, and mental health symptomatology did not worsen as a result of the COVID-19 stay-at-home orders. Notably, social support and housing services emerged as important predictors of outcomes, such that participants who received housing-related services and greater social support reported less abuse, less housing instability, and lower mental health distress. COVID-19 temporarily disrupted the positive trajectory unstably housed DV survivors were experiencing in regard to safety, housing stability and mental health. These findings provide critical insight into the importance of service access during and after global catastrophes. Additional resources and support may be helpful in assisting survivors to return to their pre-pandemic recovery and growth trajectories.

Safe and Stable Housing for Intimate Partner Violence Survivors, Maryland, 2019‒2020

House of Ruth Maryland is a comprehensive intimate partner violence (IPV) service provider. Our academic‒practitioner partnership conducted a prospective, quasi-experimental evaluation (n = 70) of on-site transitional housing and community-based rapid rehousing to meet the safety and stability needs of individuals made homeless because of IPV. By 6-month follow-up, both IPV revictimization and housing instability significantly improved (P < .001). Housing supports through an IPV service provider advanced the dual goals of safety and housing stability for IPV survivors. Safe, affordable housing is an IPV prevention strategy. (Am J Public Health. 2022;112(6):865-870. https://doi.org/10.2105/AJPH.2022.306728).

Examining contextual influences on the service needs of homeless and unstably housed domestic violence survivors

Domestic violence (DV) is a leading cause of homelessness for women, yet many DV agencies are just beginning to focus on helping clients stabilize their housing situations. The purpose of this study was to better understand the contexts and service needs of unstably housed and homeless DV survivors, to promote more efficient and successful service matching from DV agencies. We examined whether DV survivors could be grouped by particular features, histories, and contextual factors, and how these group differences impacted what they needed from DV agencies. The sample included 406 homeless and unstably housed DV survivors who had recently sought DV services. Latent class analysis supported the identification of four distinct classes: (1) highest disadvantages service seeker, (2) moderate disadvantages-criminal legal system service seeker, (3) moderate disadvantages service seeker, and (4) lower disadvantages service seeker. Additionally, we were able to profile each class, and test the types of services survivors in each class needed from agencies.

From Isolation to Connection: The Practices and Promise of Open Domestic Violence Shelters

Antidomestic violence advocates have begun to question two essential policies that have long defined domestic violence shelters-strict secrecy regarding shelter location and prohibitions on shelter access to all except staff and residents-both of which serve to increase survivors' social isolation and entail coercive rules that resonate painfully with broader oppressive dynamics. In response a growing number of communities have begun experimenting with open shelters, which break from tradition by making their locations public, and allowing visitors. Although this innovation is a sharp departure from tradition, virtually no research exists to explore its philosophical underpinnings, benefits, and challenges. This study addresses this gap. Study Questions: We used a qualitative descriptive approach to explore the experiences and perspectives of open shelter directors. Participants included 14 open shelter directors from 11 states. We conducted semistructured phone interviews with each participant, focusing on their shelter's (a) nature and history; (b) rationale; (c) policies and programs related to secrecy and openness; (d) benefits and challenges; (e) effects on specific survivor subgroups; and (f) practices used to build or strengthen survivors' relationships. Open shelters: (a) promote physical safety using a broad array of measures; (b) adopt a range of policies that promote varying degrees of location disclosure and visitor accessibility; (c) face challenges, such as the need to gain buy-in from multiple constituents; and (d) Improve survivor outcomes, including decreased shame; improved advocacy relationships; increased access to services and community involvement in shelter life; and deepened relationships with network members; in turn increasing prospects for physical and psychological well-being long after survivors' shelter stays are over. Findings suggest a new path for shelters interested in promoting survivor safety and healing in the context of a web of meaningful relationships.

Identifying and Responding to the Complex Needs of Domestic Violence Housing Practitioners at the Onset of the COVID-19 Pandemic

The social, financial, and emotional repercussions of the COVID-19 pandemic has left many organizations that support survivors of intimate partner violence questioning how to maintain core services while addressing compounding individual, organizational, and public health issues. Stay-at-home orders and other COVID-19 mitigation strategies have resulted in reduced shelter availability and increased intimate partner violence rates. Coupled with the economic impact of the pandemic, these factors have threatened financial and housing stability. To better understand these challenges and provide immediate support, The National Alliance for Safe Housing (NASH) co-hosted a peer support call to provide a virtual platform for practitioners to ask questions, discuss challenges, and share strategies for quality service provision during the COVID-19 pandemic. Over 800 practitioners from across the United States participated in the NASH call, most of whom were advocates, program directors, and managers. NASH gathered data on practitioners' needs from a brief survey from the registration form analyzed using conventional inductive content analysis. Practitioners' primary concerns were situated within eight questions, which we categorized into four meta-categories: (1) managing residential housing programs; (2) getting survivors materials resources; (3) keeping staff safe; and (4) maintaining organizational operations. The paper concludes with community-grounded and empirically supported practice recommendations aligned with practitioners' expressed needs.

Working With Marginalized Populations

This Eleanor Clarke Slagle lecture describes the author's work with marginalized populations, including homeless adults with mental illness, premature aging conditions, and poor literacy; women who became homeless as a result of domestic violence; children in impoverished, urban school systems reading below grade level; and adults with severe and chronic mental illness that impeded their ability to secure employment, housing, and independent community living. The author illustrates how and why occupational therapy practitioners should become part of the primary care team that evaluates the impact of multiple disorders on marginalized populations' daily life activities, provides services to optimize community participation, and provides environmental modifications to enhance safety and function.

Unlocking the Door to Safety and Stability: Housing Barriers for Survivors of Intimate Partner Violence

Housing has been identified as critical for survivors of intimate partner violence (IPV) to achieve long-term stability, but both individual- and system-level barriers hinder its obtainment. The purpose of this research study was to assess the challenges to service access and service delivery for survivors in Utah. In-depth, semistructured interviews and focus groups were conducted with 102 participants, including 43 survivors and 59 service providers. Data analysis consisted of line-by-line coding, identifying themes, coding categories, and developing matrices to uncover relationships between themes and categories. Overwhelmingly, participants communicated an immense need for emergency shelter upon exit from an abusive relationship, yet reported limited shelter space. Service providers reported that scarce funding coupled with grantor-imposed expectations impede their ability to serve all survivors in need. When turned away from shelter, survivors resorted to staying in a motel, car, homeless shelter, or even returning to the perpetrator. Barriers to obtaining permanent housing included unaffordability, landlord discrimination, and insufficient documentation. Indigenous and immigrant survivors encountered amplified barriers to housing stability. Despite the prominence of Housing First in Utah, survivors were unable to access much needed housing resources. Housing First programs can and should be tailored to meet the unique housing needs of survivors of IPV. Therefore, Housing First eligibility requirements should be adjusted, and a specific number of placements should be reserved for survivors and their children. IPV-related trauma must be understood as multifaceted, and services for survivors should simultaneously target this trauma while meeting basic needs. Future research should examine interventions such as rapid rehousing and permanent supportive housing on survivors' safety and stability in the long-term.

Aging in place among older adults with histories of traumatic experiences: A scoping review

BACKGROUND AND OBJECTIVES

Adverse childhood and adult experiences can have far-reaching impacts, and when coupled with typical aging-related changes, may impede achievement of a suitable person-environment fit for aging adults. The objective of our study was to determine if extant literature connects older adults with trauma history to successfully aging in place.

RESEARCH DESIGN AND METHODS

We proposed a conceptual model regarding trauma history, adaptive capacity of aging adults, and trauma-informed supports for aging in place. We conducted a scoping review using six databases [key words older adult(s), aging in place, housing, trauma], with a full review of 32 articles.

RESULTS

Insights included: 1) Aging in place does not have to mean living in the same house over time. 2) The uncertainty of the aging process can be traumatic and can be exacerbated by previous traumatic experiences. 3) Environmental sensitivities can result from previous traumatic experiences and cause further trauma. 4) Housing precarity is a traumatic experience. 5) Permanent supportive housing is an important resource for people in crisis. 6) Community supports are critical to aging in place.

DISCUSSION AND IMPLICATIONS

Our review revealed insights about aging in place and trauma, but did not connect the vulnerabilities specific to aging adults with personal trauma histories to aging in place. Research is needed that confirms the relationship between history of traumatic experiences and difficulties with aging in place as well as trauma-informed approaches that can mitigate housing-related stressors and foster community living environments that provide equitable access to aging in place.

Evaluation in the Real World: Decision Points and Rationales in Creating A Rigorous Study Designed to Convey Ecologically Valid Findings

Rigorously evaluating community-based interventions for multiply marginalized populations is fraught with challenges under the best of circumstances. This manuscript describes the methodology chosen to evaluate an innovative model designed to help survivors of intimate partner violence obtain safe and stable housing. We justify the choice of evaluation design from a community psychology perspective and detail why we believe the multi-method, multi-source design, that also focuses on social context, will maximize ecological validity and, therefore, propel the scale-up of the intervention if it is found to be effective. Longitudinal data are being collected from program recipients over time, the advocates who worked with them, agency service records, and monthly documentation of agency resources on hand that can impact services provided. Special attention is focused on capturing contextual information that can impact program success. While randomized control trials are still too often heralded as "the gold standard" for measuring intervention effectiveness, we maintain that the current design, which was developed in partnership with key community stakeholders, holds more promise when evaluating many community-based programs.

Survivors Achieving Stable Housing: Implementation, Challenges, and Lessons Learned

There is a movement toward permanent housing as an alternative to emergency shelter for survivors of intimate partner violence (IPV). Through a case study, this article illuminates the challenges survivors encountered at multiple levels after being offered one of 25 permanent housing choice vouchers (HCVs) as part of the Survivors Achieving Stable Housing project. Obtaining an HCV is a complicated and lengthy process; survivors transitioning from emergency shelter may face time limits on shelter stays while awaiting this permanent housing option. This article identifies challenges, such as difficulties with landlords, moving costs, and a lack of affordable housing, similar to issues reported in previous research. However, specific to IPV survivors, intersecting U.S. Department of Housing and Urban Development and Violence Against Women Reauthorization Act of 2013 (S. 47) policies led to challenges in implementing and interpreting rules and guidance for IPV survivors. Survivor safety from an abusive partner and across other aspects of their lives is of particular concern to survivors as they consider housing options. Given the overlap of homelessness and IPV, social workers in both systems must be knowledgeable about the intersecting issues survivors face as well as the policies affecting them so they can advocate effectively for their clients.

Housing Interventions for Intimate Partner Violence Survivors: A Systematic Review

Intimate partner violence (IPV) survivors are much more likely to experience housing insecurity or homelessness than those who have not experienced IPV. However, little comprehensive research has evaluated the effectiveness of interventions used to address IPV survivors' housing insecurity. To address this knowledge gap, our team conducted a systematic review guided by three questions: (a) What are current interventions for addressing IPV survivors' housing needs? (b) What are the methodological strengths and limitations of the research evaluating those interventions? (c) How effective are the identified interventions? We identified potentially relevant peer-reviewed and gray literature using variations of predetermined search terms and four search methods. Twelve articles met inclusion criteria. Accordingly, this study showed that there is an overall dearth of research concerning interventions that address IPV survivors' housing insecurity and needs. Shelter is the most commonly assessed and available housing intervention for IPV survivors, but only limited empirical evaluation is available of shelter effectiveness. In addition, findings indicate both traditional shelter services and innovative interventions (e.g., rapid rehousing, flexible funding) would benefit from rigorous evaluation including examining survivor and situation characteristics contributing to housing strategy effectiveness.

Recent Intimate Partner Violence and Housing Instability Among Women Veterans

INTRODUCTION

Women Veterans are at increased risk of both housing instability and intimate partner violence compared with their non-Veteran counterparts. The objectives of the present study were (1) to assess the relationship between women Veterans' experience of intimate partner violence and various indicators of housing instability, and (2) to assess what correlates help to explain experiences of housing instability among women Veterans who experienced past-year intimate partner violence.

METHODS

Data were collected from U.S. Department of Veterans Affairs electronic medical records for 8,427 women Veterans who were screened for past-year intimate partner violence between April 2014 and April 2016 at 13 Veterans Affairs' facilities. Logistic regressions performed during 2017 assessed the relationship between past-year intimate partner violence and housing instability.

RESULTS

A total of 8.4% of the sample screened positive for intimate partner violence and 11.3% for housing instability. Controlling for age and race, a positive intimate partner violence screen increased odds of housing instability by a factor of 3. Women Veterans with past-year intimate partner violence were more likely to have an indicator of housing instability if they identified as African American, had screened positive for military sexual trauma, or had a substance use disorder; receiving compensation for a disability incurred during military service and being married were protective.

CONCLUSIONS

For women Veterans, intimate partner violence interventions should assess for both physical and psychological housing needs, and housing interventions should coordinate with intimate partner violence programs to address common barriers to resources.