Long-term housing subsidies and SSI/SSDI income: Creating health-promoting contexts for families experiencing housing instability with disabilities

doi:10.1016/j.dhjo.2017.08.006

Disability and Health Journal

Volume 11, Issue 2, April 2018, Pages 214-220

Paper presented at the 2017 Society for Community Research and Action Biennial

https://doi.org/10.1016/j.dhjo.2017.08.006 Get rights and content

Abstract

Background

Though disability and housing instability are discussed separately in public health literature, few studies address families at their intersection. As a result, little is known about families who experience both homelessness and disability, how many receive disability benefits like SSI and SSDI, or the influence of those benefits on health-promoting outcomes like housing stability and self-sufficiency. Moreover, no previous research compares the ability of different housing and service interventions to increase disability benefit access.

Objective

We examine relationships between disabilities and SSI/SSDI income reported when families enter emergency shelters and later health-promoting outcomes (housing stability and self-sufficiency) and how housing interventions affect SSI/SSDI receipt.

Methods

Families in the (name removed) Study (N = 1857) were interviewed in emergency shelters, randomly offered of one of three housing interventions or usual care (i.e., no immediate referral to any intervention beyond shelter), and re-interviewed 20 months later.

Results

A third of families reported a disability at shelter entry. SSI/SSDI coverage of these families increased nearly 10% points over 20 months but never exceeded 40%. Disabilities predicted greater housing instability, food insecurity, and economic stress and less work and income. Among families reporting disabilities, SSI/SSDI receipt predicted fewer returns to emergency shelter, and more income despite less work. Offers of long-term housing subsidies increased SSI/SSDI receipt.

Conclusions

Many families experiencing homelessness have disabilities; those receiving SSI/SSDI benefits have better housing and income outcomes. Providing families experiencing homelessness with long-term housing subsidies and SSI/SSDI could improve public health.

Section snippets

Method

This study uses administrative and survey data collected as part of an experimental evaluation of housing and service interventions for families experiencing homelessness in 12 American communities.³² Families with children under age 16 were enrolled following a one-week stay in emergency shelter between September 2010 and January 2012. After administering a baseline survey, researchers randomly assigned each family to receive referral for long-term housing subsidies, short-term rapid rehousing

Disability status at shelter entry and SSI/SSDI income at shelter entry and 20-month follow-up

At shelter entry, 34.1% (n = 618) of respondents reported some disability in the family, 9.2% (n = 168) reported a non-respondent adult with a disability, and 19.9% (n = 360) reported a child under age 16 with a disability. Among non-respondent adults with disabilities, 20.0% were respondents' adult children, stepchildren, or grandchildren. Also, 26.0% (n = 467) of respondents reported a disability in the family that limited the respondent's ability to work. More specifically, 21.7% (n = 390)

Discussion

Disabilities were common among families sampled in emergency shelters in 12 American communities and were associated with less work. About 34% of families reported a member with a disability, just over 20% of respondents reported that a personal disability limited their ability to work, and nearly 20% reported living with a child with a disability.

However, many families reporting disabilities never received SSI/SSDI income. Twenty months after shelter entry, fewer than 40% of respondents

Conclusions

Disabilities among families experiencing homelessness are an overlooked public health topic. Although this study considered only families who were already homeless, disability and associated low incomes may have contributed to homeless entry in the first place. Also, not receiving disability income was associated with returns to shelter. This finding is important given the effects of children's environments on their neurodevelopmental and mental health.37, 38 Policies designed to reduce time

Funding

The research reported herein was performed pursuant to a grant from Policy Research, Inc. as part of the U.S. Social Security Administration's (SSA's) Improving Disability Determination Process Small Grant Program. The opinions and conclusions expressed are solely those of the author(s) and do not represent the opinions or policy of Policy Research, Inc., SSA or any other agency of the Federal Government. Funding for this paper was also provided by the U.S. Department of Housing and Urban

Conflicts of interest

The authors have no conflicts of interest to report.

Human participant protection

The Institutional Review Boards of both Vanderbilt University and Abt Associates, Inc. approved this study.

References (39)

J. Castellow et al.
Previous homelessness as a risk factor for recovery for serious mental illnesses
Community Ment Health J
(2015)
A.S. Mares et al.
Disability benefits and clinical outcomes among homeless veterans with psychiatric and substance abuse problems
Community Ment Health J
(2007)
R.A. Rosenheck et al.
Outcomes after initial receipt of social security benefits among homeless veterans with mental illness
Psychiatr Serv
(2000)
C.D. Solari et al.
The 2015 Annual Homeless Assessment Report (AHAR) to Congress. Part 2: Estimates of Homelessness in the United States
(2016)
US Department of Housing and Urban Development (HUD)
HEARTH “homeless” Definition Final Rule
(2011)
E.L. Bassuk et al.
Prevalence of mental health and substance use disorders among homeless and low-income housed mothers
Am J Psychiatry
(1998)
L.F. Weinreb et al.
A comparison of the health and mental health status of homeless mothers in Worcester, Mass: 1993 and 2003
Am J Public Health
(2006)
J. Schuster et al.
Trauma exposure and PTSD symptoms among homeless mothers: predicting coping and mental health outcomes
J Soc Clin Psychol
(2011)
B.T. Zima et al.
Emotional and behavioral problems and severe academic delays among sheltered homeless children in Los Angeles County
Am J Public Health
(1994)
J. Samuels et al.
Time-limited case management for homeless mothers with mental health problems: effects on maternal mental health
J Soc Soc Work Res
(2015)

V.L. Banyard et al.

Surviving poverty: stress and coping in the lives of housed and homeless mothers

Am J Orthopsychiatry

(1998)

C.J. Bogard et al.

Homeless mothers and depression: misdirected policy

J Health Soc Behav

(1999)

M. Park et al.

Changes in maternal health and health behaviors as a function of homelessness

Soc Serv Rev

(2011)

M. Shinn et al.

Predictors of homelessness among families in New York City: from shelter request to housing stability

Am J Public Health

(1998)

M.A. Hayes et al.

The SHIFT Study: Final Report

(2013)

M. Shinn et al.

Longitudinal impact of a family critical time intervention on children in high-risk families experiencing homelessness: a randomized trial

Am J Community Psychol

(2015)

A. Irwin et al.

Action on the Social Determinants of Health: Learning from Previous Experiences

(2010)

S.L. Parish et al.

Material hardship in U.S. families raising children with disabilities

Except Child

(2008)

P.W. Newacheck et al.

A national profile of health care utilization and expenditures for children with special health care needs

Arch Pediatr Adolesc Med

(2005)

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Original ArticleLong-term housing subsidies and SSI/SSDI income: Creating health-promoting contexts for families experiencing housing instability with disabilities

Abstract

Background

Objective

Methods

Results

Conclusions

Section snippets

Method

Disability status at shelter entry and SSI/SSDI income at shelter entry and 20-month follow-up

Discussion

Conclusions

Funding

Conflicts of interest

Human participant protection

Previous homelessness as a risk factor for recovery for serious mental illnesses

Community Ment Health J

Disability benefits and clinical outcomes among homeless veterans with psychiatric and substance abuse problems

Community Ment Health J

Outcomes after initial receipt of social security benefits among homeless veterans with mental illness

Psychiatr Serv

The 2015 Annual Homeless Assessment Report (AHAR) to Congress. Part 2: Estimates of Homelessness in the United States

HEARTH “homeless” Definition Final Rule

Prevalence of mental health and substance use disorders among homeless and low-income housed mothers

Am J Psychiatry

A comparison of the health and mental health status of homeless mothers in Worcester, Mass: 1993 and 2003

Am J Public Health

Trauma exposure and PTSD symptoms among homeless mothers: predicting coping and mental health outcomes

J Soc Clin Psychol

Emotional and behavioral problems and severe academic delays among sheltered homeless children in Los Angeles County

Am J Public Health

Time-limited case management for homeless mothers with mental health problems: effects on maternal mental health

J Soc Soc Work Res

Surviving poverty: stress and coping in the lives of housed and homeless mothers

Am J Orthopsychiatry

Homeless mothers and depression: misdirected policy

J Health Soc Behav

Changes in maternal health and health behaviors as a function of homelessness

Soc Serv Rev

Predictors of homelessness among families in New York City: from shelter request to housing stability

Am J Public Health

The SHIFT Study: Final Report

Longitudinal impact of a family critical time intervention on children in high-risk families experiencing homelessness: a randomized trial

Am J Community Psychol

Action on the Social Determinants of Health: Learning from Previous Experiences

Material hardship in U.S. families raising children with disabilities

Except Child

A national profile of health care utilization and expenditures for children with special health care needs

Arch Pediatr Adolesc Med

Original Article
Long-term housing subsidies and SSI/SSDI income: Creating health-promoting contexts for families experiencing housing instability with disabilities