Not All Housing Is Created Equal

A Mixed Methods Analysis of the Well-Being of Adults in Permanent Supportive Housing in Los Angeles County

by Melissa Francisca Felician

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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.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Literature Review

  • Chapter Three

    Conceptual Framework and Research Design

  • Chapter Four

    Methods - Qualitative Data Collection and Analysis

  • Chapter Five

    Program and Participant Characteristics

  • Chapter Six

    Participant Experiences in PSH

  • Chapter Seven

    Participant Experience by Housing Type and Location

  • Chapter Eight

    Methods for Quantitative Data Collection and Analysis

  • Chapter Nine

    Sample Characteristics and Geographic Distribution

  • Chapter Ten

    Living Environment and Health Service Use

  • Chapter Eleven

    Discussion and Policy Implications

  • Appendix A

    Characteristics and Outcomes for Participants Interviewed

  • Appendix B

    Data Collection Instrument and Protocol for Interview

  • Appendix C

    Instrument and Protocol for Focus Group Discussion

  • Appendix D

    Summary SWB Findings - CH and IH participants compared

  • Appendix E

    Additional Analyses

Research conducted by

This document was submitted as a dissertation in May 2020 in partial fulfillment of the requirements of the doctoral degree in public policy analysis at the Pardee RAND Graduate School. The faculty committee that supervised and approved the dissertation consisted of Sarah Hunter (Chair), Dmitry Khodyakov, Mathew Cefalu, and Bill Pitkin (external member).

Partial funding for this dissertation was provided by the JL Foundation, the Doris Dong Dissertation Award, the David L.J. Wang Dissertation Award, and the Sidney Stern Memorial Trust External Fellowship.

This report is part of the RAND Corporation dissertation series. Pardee RAND dissertations are produced by graduate fellows of the Pardee RAND Graduate School, the world's leading producer of Ph.D.'s in policy analysis. The dissertations are supervised, reviewed, and approved by a Pardee RAND faculty committee overseeing each dissertation.

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