Monday, October 24, 2016



Julie Ann Racino, Author of Housing, Support and Community


        By 2012, the National Council on Disability and Harvard University's Joint Center on Housing Studies, published on the State of the Nation's Housing, the former from a disability perspective. These significant reports follow decades of initiatives to guide the development of quality housing for all "in America" from Universal Design to Right to a Decent Home, Right to Ordinary Housing, Housing and Support for All, Accessible and Barrier-Free Housing and Institutional Closures, Consumer-Controlled Housing, and a substantial body of "Fair" Housing Rights and Laws (Racino, 2015, 135-137).

From Residential Segregation to Ordinary Homes and Homelife

      As described by leading advocates (e.g., Gunnar Dybwad of the International League, then of the Handicapped, now with Inclusion International) throughout recent decades, America has a history of residential segregation, even to the extent of being termed apartheid (Steven E. Brown, of Disability Culture) instead of multiculturalism or community integration. The roots of supported housing (critical initiative today) and supportive living are in efforts to move from a facility-based approach to community living (Racino et al, 1993) to Britain's ordinary homes (in Towell, 1988) and to America's stand on home ownership (Klein & Nelson, 2000).

    Ordinary homes and home life, from its religious icons (e.g., Hispanic in America) and family photographs (to social media, 2016), to taken for granted routines from dinners on the go, to daily grind of day or evening jobs, or the joys of successes (e.g., college acceptance, "first steps"), to the meaning of "birth or later in life disability". In 2016, the working, lower and lower half of the middle class have been diverging from the top half of America called "income and social inequality". Homes represented America's family's major asset which increased in equity "for the most part" (annual real estate market values) with a 2008 recession and new housing foreclosures.

Where Are We Today Versus Where Do We Want to Be?

     The US Housing and Urban Development, which concentrates on the use of government funds for housing in America, regularly describes its newest initiatives to "confront poverty" and focus on population groups (e.g., Indian policy), be "big brother" at housing finance and policy, to assure accessibility and integration, and integrate health and housing for better "children's futures" (Evidence Matters, 2013-2016). The disability communities do call for initiatives of their own and supported housing units and their integration was a priority (e.g., Frank Mellville Supportive Housing Investment Act of 2010). 

     US HUD highlights its newest initiatives: Highland's Garden Village, a mixed income, mixed use development in Denver, Colorado choose from for-sale, for-rent, market rate, and affordable units in a pedestrian friendly community with nearby retail, transit, health and outdoor recreation facilities (Spring, 2013). Ordinary citizens often know these as project development (location, sitings) and local hearings; housing and community development planners are the local nexus with the real estate, business and non-profit industries and other "interest groups" (e.g., Policy Link, ethnic groups as equitable development).

      John O'Brien and David Towell in 2010 developed a framework for Building Sustainable and Inclusive Communities with core social and development concepts:
* Reducing carbon footprints
* Social inclusion
* Sustainable prosperity in a globalizing economy
* Social cohesion despite increasing diversity
* Current economic downturn
* Adaptation to changing age and family demographics
* Shaping good places to live
* Meeting rising expectations to public service
* Respecting rights
* Personalization
* Effective response to chronic health conditions
(in Racino, 2015, 126-127). 

      However, the roots in 1989 to 1994 of the leading books in housing were on Homelessness (e.g., ignored homeless families, Seltzer & Miller, 1993; urban poverty and housing crisis, Timmer et al, 1994) which continues to permeate the definition and funding of problems today (e.g., emergency shelters and supported housing). The "housing" solutions continue (e.g., in Seattle, Washington, ASPA, 2016) to fund a non-profit agency to serve a targeted group (e.g. those with alcohol and substance abuse problems). In addition a "surveillaince" versus "supervision" approach, is anticipated to have major effects,  particularly if no publications indicate either and "outpatient, involuntary treatment" is on the rise.

      What is known for decades is not addressed (Racino, 2001, bibliography), and already start with rules that will result on the front end or during the program with exclusion from housing of the targeted population group. Known as "creaming" in the 1970s, the process has begun to both "label the well" (the working classes or managerial classes, without jobs and as clients) and to strip the targeted "disability class" into a poverty or prison-detention class. In part "good intentions" such as McKnight's (leading speaker to professional workers nationwide) were interpreted as "community workers as better than service professionals" in Osborne and Gaebler's Reinventing Government.  

New Initiatives of Government and Non-Profit Sector

    The Housing First and Consumer Choice initiatives (remembering pay $55,000 "public funds" salary for the "choice of homelessness" came in?) are exemplified as tied to "harm reduction for homeless individuals with a dual diagnosis" in New York City (Tsembris, Gulcur, & Nakae, 2004), as the voluntary life sharing group continue their lifelong aspirations for pay. And the "medical and psychiatric class" when asked to "produce a research study" use statistics to bring in positions that it is less stressful for their clients to live in poor surroundings (that is for a federal government housing voucher study for portability to good neighborhoods based upon decades of research findings on quality of life outcomes) (Schmidt, N., Lincoln, A., Nguyen, W., Acevedo-Garcia, D., & Osypuk, T., 2014). Now in the Schmidt study did "we" start "our desired housing option" with tobacco use and"conduct disorder" (boys' behaviors "got worse" or "MTO treatment worsened boys' mental health") in as part of portability vouchers?

      Another is a Supported Housing ("peer-reviewed"article) that begins with housing as an "ubiquitous need" at the "post-deinstitutionalization era" and charts "treatment non-compliance" indicating an "unskilled public administration and community class" (medical and psychiatric taking other people's jobs at housing and community development) now involved (Wong, Filoromo, & Tennille, 2007). 
*Is supported housing in? Yes. 
*Is it now at new opportunities to make the best housing possible to address the "general and mental health populations"? Yes. 
*Are we starting at the right place? To address mental health housing, should be yes. To address the general population needs in mental health? No, never start categorical has always been known. 
*Are we at the right personnel and departments? No. Anyone see the housing departments yet? *What is the new problem? Mental health needs in prisons and jails, increasing. 
*What are time immemorial problems? "Noncompliance" at "forced and illegal medications" reported again.

       In the realm of "Supportive Living" which has remained relatively stable for decades (Braddock et al, 2015; see also, family support on the blogspot),  quality of life outcome studies continue to follow the deinstitutionalization movement from public congregate care to smaller group home-like settings, such as the Hissom court-ordered closure in Oklahoma (Conroy et al, 2003). These community plans have been reported as successful in states as "full conversion" (about 80-90%, Agranoff, 2013) where there is a commitment to ordinary homes and smaller foster or group home versus large residential facilities. However, massive reports of use of behavioral interventions by state and local governments and "its agents" (Mowbray, Grazier & Holter, 2002),  have been reported as increasing in the US. These interventions are associated with "housing" and "homes" (the field of residential services management) and schools with mental health to behavioral health and special education and gender- not inclusive education in ascendancy. 

     While Independent  Living and Supportive Living are supported at federal levels (e.g., Administration on Community Living), in the context of housing (See, Pinterest/Community and Policy Studies), often the studies will be "program categorical" (as, without housing departments, or even separate housing, non-profit broads) or with broader initiatives (e.g., independent living in facility developments). 
Table 4.1 (in Racino, 2015, pp. 82-83) on Services In Supported Housing
Supportive Housing*: intensive rehabilitation and medical, outpatient mental health and substance abuse, educational/ vocational, recovery and rehabilitation (e.g., education on psychotropics, peer counseling, support groups, meal preparation), general (e.g., entitlements, case management), and health and medical.
"Supportive Living": options which include family and individual support, community participation,  communication and specialist services (e.g., sensory ), "leisure and recreation", and independent living or family counseling,  in health programs. 
(*Corporation for Supported Housing and Technical Assistance Collaborative, 2008).

      Housing and Services, as originally conceived in disability and health care, can be found in Pynoos' 2004 book on Linking Housing and Services for Older Adults with Heumann and Racino (1992) and Racino &  O'Connor (1994) attempting to influence future develop-ments. Pynoos is reporting on the proliferation of "residential facility categories" (common governmental programs with assisted and supportive living), Heumann represents an independent living choice approach which includes choice of facilities, and Racino & O'Connor were working with Steven J. Taylor at the federal science industry on facilities to homes (funding under categories, community integration, and later, supportive living). Supported housing, however with mental health roots, claimed regular housing with diversity of services or options (e.g., delivery as different agencies relating to one individual) (Madison Mutual Housing Association, Racino et al, 1993).

     The disability groups in Access and Inclusion can continue at "community integration" to assure the inclusion of critical "disability" issues (e.g., communication access, mobility access) in regular housing developments, including the annual housing surveys and each and every housing and city development (e.g., universal design) (Prieser & Ostroff, 2001). Of course, all modernization is at least go green (Berke, 2008) and sustainable (not just molds and allergies in "sick houses", and now to the forefront, lead in school drinking water), go energy efficient (e.g., furnaces, windows and Energy Star ratings), and inclusive and equitable (which may be 
"hands across the water") with gender-based in political ascendancy. In general, the best books on housing policy are still "generic" (public or general focus, e.g., housing financing) with "weakness" on "disability and integration" (Schwartz, 2010).

References and Bibliography 
Agranoff, R. (2013). The transformation of public sector intellectual/developmental disabilities programming. Public Administration Review, 73: S127.

Berke, P. R. (2008). The evolution of green community planning, scholarship, and practice. American Planning Association, 74(4): 393-407.

Braddock, D., Hemp, Richard, Rizzolo, M.C., Tanis, E. S., Haffer, L., & Wu, J. (2015). The State of the States in Intellectual and Developmental Disabilities: Emerging from the Great Recession. Boulder, CO: University of Colorado, Coleman Institute for Cognitive Disabilities, University of Illinois-Chicago, and American Association on Intellectual and Developmental Disabilities. 

Conroy, J., Spreat, S., Yuskauskas, A., Elks, M. (2003). The Hissom Closure Outcome Study: A report on six years of movement to supported living. Mental Retardation, 41(4): 263-275.

Corporation for Supportive Housing and the Technical Assistance Collaborative. (2008). Leveraging Medicaid: A Guide to Using Medicaid Financing in Supportive Housing. With permission. Boston, MA and Washington, DC: Author. 

Harvard Joint Center on Housing Studies. (2012). The State of the Nation's Housing, 2012. Cambridge, MA: President's and Fellows of Harvard College. 

Heumann, J. & Racino, J. (1992). Independent living and community life: Building coalitions among elders, people with disabilities and our allies. Generations, 16:43-47.

Klein, J. & Nelson, D. (2000). Homeownership for people with disabilities: The state of the states in 1999. Journal of Vocational Rehabilitation, 15(2/3), 67-68.

Mowbray, C., Grazier, K., & Holter, M. (2002). Managed behavioral health care in the public sector: Will it become the third shame of the states? Psychiatric Services, 53(2): 157-170.

O'Brien, J. & Towell, D. (2010). Conversations about Sustainable and Inclusive Communities. London: Center for Inclusive Futures.

National Council on Disability. (2010). The State of Housing in America in the 21st Century. Washington, DC: Author. 

Osborne, D. & Gaebler, T. (1992). Reinventing Government: How the Entrepreneurial Spirit is Transforming the Public Sector. Reading, MA: Addison-Wesley Publishing Co. 

Preiser, W. & Ostroff, E. (2001). Universal Design Handbook. NY, NY: McGraw Hill. 

Racino, J. (2000). Personnel Preparation in Disability and Community Life: Toward Universal Approaches to Support. Springfield, IL: Charles C. Thomas Publishers.

Racino, J. (2001). Housing, Support and Disability: Contextual Literature, 2001 (2015). Rome, NY: Community and Policy Studies. [Bibliography available for $20.00, 69 pp.]

Racino, J. (2015). Housing and disability: Toward inclusive, sustainable, and equitable communities. In J. Racino, Public Administration and Disability: Community Services Administration in the US. (pp. 123-156). Boca Raton, FL, NY, NY and London: CRC Press, Francis and Taylor.

Racino, J. & O'Connor, S. (1994). "A home of our own": Homes, neighborhoods and personal connections. In M. Hayden & B. Abery, Challenges for a Service System in Transition: Ensuring Quality Community Experiences for Persons with Developmental Disabilities. Baltimore, MD: Paul H. Brookes. 

Racino, J., Walker, P., O'Connor, S., & Taylor, S. (1993). Housing, Support and Community. Baltimore, MD: Paul H. Brookes. 

Schmidt, N.M., Lincoln, A.K., Nguyen, Q., Acevedo-Garcia, D., & Osypuk, T. (2014, February). Examining mediators of housing mobility on adolescent asthma: Results from a housing voucher experiments. Social Science Medicine, 107: 136-144. 

Schwartz, A. (2010). Housing Policy in the US. NY, NY: Routledge. 

Seltzer, B. & Miller, D. (1993). Homeless Families. Urbana & Chicago, Illinois: University of Illinois Press. 

Timmer, D.A., Eitzen, D.S., & Talley, K.D. (1994). Paths to Homelessness: Extreme Poverty and the Housing Crisis. Boulder, CO: Westview Press. 

Towell, D. (1988). An Ordinary Life in Practice: Developing Comprehensive Community-Based Services for People with Learning Disabilities. London: King Edward's Hospital Funds. 

Tsemberis, S., Gulcur, L., & Nakae, M. (2004, April). Housing first, consumer choice, and harm reduction for homeless individuals with dual diagnosis.  American Journal of Public Health, 94(4): 651-656.

Wong, Y., Filomoro, M. & Tennille, J. (2007). From principles to practice: A study of implementation of supported housing for psychiatric consumers. Administration of Mental Health and Mental Health Services, 34: 13-28.


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