Book Description

BACKGROUND: Permanent Supportive Housing (PSH) is part of a national strategy in the United States to tackle homelessness, but more research is needed to understand how aspects of PSH program implementation support or hinder participants' transition into housing. OBJECTIVE: This dissertation used a mixed-method case study design to explore the relationship between living environment, subjective well-being (SWB) and objective well-being outcomes, for a cohort of participants in the Housing for Health (HFH) PSH program in Los Angeles (LA). METHOD: I analyzed qualitative data from interviews with a sample of 29 HFH participants and compared experiences by housing type - congregate (CH) and independent (IH) - and geographic location. Findings from these analyses were used to generate hypotheses about the relationship between PSH living environment - housing type and location in or out of a Skid-Row Buffer Zone (SRBZ) - and health service use, which were tested using negative binomial regression modeling (NBRM) based on data for a cohort of HFH participants (n = 852). RESULTS: The qualitative and quantitative data provided evidence that participants' subjective- and objective well-being improved post-housing, regardless of the housing type or location, but some living environments were more supportive than others. Interviewed participants reported an improvement in overall SWB, but many continued to experience food- and income insecurity. Participants in IH reported high levels of social isolation and CH participants in Downtown LA reported low levels of community/environment satisfaction. The quantitative analyses provided strong evidence that the SRBZ was not as supportive as other living environments of participant well-being: CH participants within the SRBZ had worse outcomes compared to IH participants outside the SRBZ or CH participants outside the SRBZ; and among CH participants, those outside the SRBZ had better outcomes than CH participants within the SRBZ. CONCLUSIONS: The findings demonstrate that the social and physical environment in PSH is important to participants' subjective- and objective well-being. IH participants may need additional support services to help with social isolation, including assistance to access meaningful activities and culturally appropriate networks. HFH program administrators may need to reconsider whether PSH units located in SRBZ should be assigned as temporary, rather than permanent housing solutions, because of the unfavorable social and physical environment that Skid Row presents.