Three years ago, Jeannette Lewis and her 16-year-old son spent Christmas in a homeless shelter in the Bronx. With a history of chronic substance use and a disability due to a traumatic brain injury, Ms. Lewis struggled to maintain stable housing and care for her family. Her two older sons no longer lived with her. Although she had been sober for almost two years after completing a chemical dependency outpatient program, Ms. Lewis still had a long road to recovery ahead of her. After years of moving from place to place, always on the brink of homelessness, she knew the first step in that journey was to find a home.
Safe and stable housing has long been recognized as fundamental for recovery from mental health and substance use disorders. In 1943, Abraham Maslow’s Hierarchy of Needs theory described five requirements that were essential to achieving wellness and health: physiological needs, safety needs, love and belonging, esteem, and self-actualization (A.H. Maslow, A theory of human motivation, 1943). Proposed as a tiered-pyramid, Maslow believed the needs at the bottom of the hierarchy—physiological (i.e. shelter) and safety—must be satisfied before individuals can attend to needs higher up the pyramid. Today, housing is still considered central to recovery. In 2014, the Substance Abuse and Mental Health Administration included housing as one of the four required dimensions in its mental health recovery paradigm (SAMHSA, Working definition of recovery updated, 2014).
Housing is necessary for recovery, but for people with complex medical, mental health and/or substance use conditions, it is not always sufficient. For them, additional support is needed to maintain stable housing and make progress toward recovery. Permanent supportive housing, an evidenced-based model that pairs affordable, stable housing with voluntary and flexible services, can provide that additional support.
Since its inception in 1966, the Acacia Network, the largest Latino-founded integrated-care organization in New York State, has recognized the critical role that housing plays in a person’s recovery. Acacia’s vision of healthy communities has always been firmly rooted in providing quality housing. Today it provides a full continuum of housing services, including residential services, individual residential alternative group homes, transitional housing, affordable housing, and permanent support housing.
Acacia developed its first supportive housing program in 1993, and over the last three decades has expanded it to meet the needs of people experiencing homelessness who have complex physical or behavioral health conditions. Today, it operates 15 congregate and scattered-site supportive housing programs for some of NYC’s most vulnerable populations. All supportive housing tenants are offered a wide range services to support their recovery both on-site and through Acacia’s Integrated Care Model. Through Acacia- affiliates, tenants have access to primary care, mental health services, and substance use treatment along with an array of wrap-around services, including child care and after-school care for families, parenting skills, nutrition education, employment and job training support, and life skills training. Supportive housing case managers work with tenants to develop a care plan that is tailored to their needs, empowering them to draw on their capabilities to achieve their recovery goals.
Ms. Lewis and her son moved into Acacia’s Continuum of Care Supportive Housing Program for individuals and families with chronic substance use conditions in February 2016. The supportive housing staff helped them make the transition, and taught Ms. Lewis basic skills to help her maintain housing, such as paying bills on time and keeping up with home maintenance. Using a holistic, personalized approach, the supportive housing case manager worked with Ms. Lewis to establish goals and ensure she received the services needed to meet those goals and live independently. She began receiving mental health services at Acacia’s Westchester Center of Excellence and medical services at its La Casa De Salud health center shortly after moving into the residence, and has continued to engage these services while in the housing program.
At their core, permanent supportive housing programs pair affordable, safe housing with voluntary and flexible supportive services, but exemplary programs go far beyond that. Importantly, supportive housing provides a foundation from which tenants can access the services—a foundation that connects the services in an integrated and seamless manner. Tenants are at the center of their recovery, with case managers arranging, coordinating and collaborating with other providers to ensure the appropriate wrap-around care can be provided. Supportive housing case managers are in a unique position, interacting with tenants on a regular basis and cultivating strong relationships with them. Case managers are aware first-hand of the progress tenants make and challenges they face, and have the personal, in-depth knowledge to provide the follow-up support that is needed.
Supportive housing also provides a springboard to community integration. Social connectedness is critical to health, well-being, and recovery, yet many people with mental health and substance use conditions are socially isolated. Acacia’s supportive housing units are located in communities or in buildings where a majority of units are not reserved for people with disabilities, allowing tenants to interact with neighbors who do not have mental health or substance use conditions. Case managers employ strategies to help tenants to make social connections in their communities, such as identifying support networks, facilitating those connections, and providing transportation to visit family or friends. They help tenants find and participate in community activities that are aligned with their interests, and present opportunities to create social connections by arranging recreational activities such as on-site social gatherings or outings to community events.
Today, after almost three years in Acacia’s supportive housing program, Ms. Lewis is thriving. She has been sober for six years, is a model to other tenants who have gone through a similar life experience, and is providing her children with a good life and a stable home. Her son is doing well in school and is running track with his high school team. Ms. Lewis is actively developing her parenting skills and the family’s bonds by taking advantage of the supportive housing resources. In addition to completing an on-site domestic violence workshop as well as classes on parenting and anger management, Ms. Lewis enrolled in Strengthening Families, an evidenced-based prevention program designed to improve family coping skills and strengthen family bonds. She has been involved in this program for over a year now, rising as a leader and being recognized as a peer specialist. She remains engaged with her supportive housing case manager as she continues to work toward her long-term goals. Through Acacia’s supportive housing program Ms. Lewis has found a home, a community, and a promising future.