Table 4 Approaches to managing high-risk behaviours and challenges in permanent supportive housing
Year | Authors | High-risk issues examined | Risk management approach (type category) | Approach effectiveness and perceptions |
|---|---|---|---|---|
2022 | Ivsins et al. [36] | Overdose | Development and access to an onsite supervised consumption room and safer supply program (clinical and design-based) | Qualitative experiences of residents, including non-use of the consumption room due to interpersonal safety concerns and preference to use alone, and feelings of safety and less use of street-acquired drugs due to access to safer supply |
2022 | Nixon & Burns [37] | Falls caused by alcohol intoxication | Increased monitoring of residents (surveillant) Removal of excess alcohol (restrictive) | Not meaningfully examined |
2022 | Wood et al. [38] | Property damage; interpersonal threats | Liaise and advocate with housing providers about damage debts (relational/educational) Develop safety strategies (clinical) Provide support to apply for restraining orders (legal) | Not examined |
2021 | Bardwell et al. [39] | Overdose; violence | Installation of overdose response button technology in residential units (design-based) | Qualitative experiences of use by residents, including minimal use of the technology as intended, but use for other emergencies, such as gender-based violence |
2021 | Chavez et al. [40] | Suicide attempts | 10-session cognitive therapy for suicide prevention (clinical) | Outcome analyses are planned, but not yet examined |
2021 | Corporation for Supportive Housing [41] | Overdose | Naloxone training for staff (clinical) | Not examined |
2021 | Milburn et al. [42] | Trespassing; uninvited guests; weapons possession | Use of a security team to patrol buildings (surveillant) Possession of weapons for self-protection (self-defence) | Qualitative experiences of residents, including perceptions that patrols were infrequent and inconsistent, yielding minimal effects on trespassing |
2021 | Roebuck et al. [43] | Apartment takeovers | Acquisition of housing units not located on the ground floor (strategic) Case managers support residents to develop healthy support networks and set boundaries with other people (relational/educational) | Not meaningfully examined |
2020 | Vallesi et al. [45] | Threatening neighbours and violent relationships; apartment takeovers | Transfer residents to more suitable accommodations (strategic) Staff intervene with uninvited guests on behalf of residents (relational/educational) | Not meaningfully examined |
2019 | Bardwell et al. [46] | Overdose | Development of a tenant-led overdose response team to provide naloxone training and distribution (clinical) | Qualitative experiences of residents and staff, demonstrating intervention acceptability and empowerment; however, residents also reported increased emotional distress due to the severity of the overdose crisis and need to administer naloxone to friends |
2019 | Brar et al. [47] | Overdose | Implementation of onsite injectable opioid agonist therapy (clinical) | Drug use outcomes over nine months, but no findings specific to overdose |
2019 | Friesinger et al. [48] | Fire | Use of fire detection, alarm, and extinguisher systems (design-based) Staff check-ins (surveillant) Prohibition of lighters for residents with histories of causing fires (restrictive) Automatic timed switches to turn off stoves and temperature sensors (design-based) | Qualitative experiences of staff and residents, including disablement or misuse of fire safety measures (e.g., bringing in unapproved visitors via emergency and fire exit doors), and concerns about surveillance and restrictiveness |
2019 | Katz et al. [49] | Suicide attempts | Use of the MINI Suicidality Subscale as a tool to predict suicide attempts (clinical) | Instrument had high predictive validity of suicide attempts among people experiencing homelessness and mental illness over a 24-month period |
2018 | Addictions & Mental Health Ontario et al. [50] | Hoarding | Use of a hoarding specialist on support teams (clinical) | Not examined |
2018 | Gutman et al. [51] | Falls | Standardized safety assessment conducted during home visits (clinical) | Identification of environmental fall risks |
2018 | Henwood et al. [52] | Guest-based victimization, including violence and stalking; drug selling and availability | Residents’ isolation at home to avoid drug use (restrictive) Enforcement of visitation program rules (restrictive) | Qualitative experiences of residents including risk of loneliness associated with the isolation approach and preference among women to be alone due to past traumas involving violence and stalking |
2018 | Rhenter et al. [53] | Violence | Residents’ engagement in sedentary behaviours to protect against street violence (restrictive) | Not examined |
2018 | Tiderington [54] | Apartment takeovers | Single-use language in occupancy policies (restrictive) Discouragement of social relationships (restrictive) Surveillance of apartment units and use of drop-ins (surveillant) | Not examined |
2017 | Chang [55] | Drug selling and availability | Widespread presence of security cameras in buildings and surrounding neighbourhood (surveillant) | Not meaningfully examined |
2017 | The Dream Team [57] | Apartment takeovers | Police, security, support worker, or family/friend involvement (relational/educational and legal) Use of screening tools to assess risk for apartment takeovers (clinical) | Qualitative experiences of residents, which indicated that police involvement was a last resort due to mistrust, concerns about effectiveness, and fears about housing loss |
2016 | Kriegel et al. [58] | Neighbourhood crime and drug availability; threatening neighbours | Courts exert influence on release decisions based on housing models and location (legal, restrictive, and strategic) Selectiveness by service providers as to where to appropriately house residents (strategic) | Implementation challenges described, such as tension for service providers between court requirements and Housing First principles |
2014 | Distasio et al. [60] | Violence; pedophilia; property damage; hoarding; unwanted visitors | Exclusion policies for applicants with histories of violence and pedophilia (restrictive) Behaviour agreements that outline rules, rights, and consequences (relational/educational) Increased visitation to residents’ homes (surveillant) Eviction notices as a “wakeup call” (strategic) Retention of leaseholder rights by PSH agency, with units sublet to residents, to enable staff to enter units and expel guests (strategic) Peer support focusing on the challenges of visitor management (relational/educational) Transitioning residents to a shelter for respite (strategic) | Not meaningfully examined |
2014 | Silva et al. [61] | Stovetop fires; violence; weapon offences; uninvited guests | Installation of motion detectors on stoves (design-based) Police involvement and pressing charges (legal) Provision of education and mentorship to residents about who should be allowed to enter apartments (relational/educational) | Motion detection technology on stoves decreased stovetop fires; outcomes not examined for other two approaches |
2012 | Krüsi et al. [63] | Violence; rape | Women-only buildings (design-based) One-guest maximum policy and registration logs (restrictive and surveillant) Bad-date reports (strategic) Camera surveillance (surveillant) Staff and police involvement (relational/educational and legal) | Qualitative experiences of residents, with approaches generally being perceived positively and contributing to a sense of safety |
2005 | Campanelli et al. [66] | Violence; arson | Screening assessment for applicants with histories of violence and arson (clinical) | Tenancy outcomes of applicants accepted following the screening assessment were presented, but few details on why residents were no longer housed in the program |
1996 | Sohng [67] | Sexual and verbal aggression | Rehospitalization (clinical) Transition to respite care (clinical) | Not meaningfully examined |