Barriers to housing in a grass-roots support group of individuals experiencing housing instability and homelessness

ABSTRACT

Secure housing remains unattainable for many experiencing homelessness or housing instability. Research on models like housing first and consumer choice offer options for the chronically homeless, yet evidence shows these models are insufficient for overcoming local community needs. The objective of this study was to use principles of Community-Based Participatory Research (CBPR) to frame the social and structural barriers that prevent many local homeless from finding secure and stable housing. A combination of questionnaire and semi-structured interview formats were used. Seventy-three participants completed questionnaires and 13 interviews were conducted. Participants were predominantly middle-aged, male (90%), and Black or African American (74%). Qualitative analysis yielded four major themes related to chronic homelessness and barriers to secure housing: 1) diverse contributors to homelessness, 2) psychological effects of housing instability that diminish capacity for change, 3) persisting instability despite attainment of housing, and 4) complex interpersonal connections that provide support but also contribute to a network of instability. The personal impact of homelessness coupled with highly nuanced relationships amplified the complexity of targeting supportive measures. The precarious nature of such a network calls for leveraging partnerships with individuals who have experience with homelessness to promote tailored and context-driven interventions.

KEYWORDS:

• Housing instability
• barriers to housing
• homelessness
• qualitative study
• Minnesota
• peer-support group

Acknowledgments

The authors would like to thank the SVoC membership for their participation in the study, assistance with the development of interview and questionnaire materials, and its administrative leadership for their support in creating a forum for participant involvement.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Dr. Shukla received a research fellowship through the University of Minnesota to conduct this research. Drs. Grande and Walsh received no funding to support this work.

Notes on contributors

Dip M. Shukla

Dip M. Shukla is a resident physician within the Department of Anesthesiology at the University of Minnesota. As a Dr. Pete Dehnel Health Advocacy Fellow (2018) through the Twin Cities Medical Society, he worked with local stake holders at the intersection of housing and healthcare to improve understanding of housing barriers faced by the local homeless and housing insecure community.

William E. Walsh

Dr. William E. Walsh is faculty at the University of Medical School and staff at Hennepin Healthcare as a Facial Plastic and Reconstructive surgeon. He served as the Deputy Chief Innovation Officer at Upstream Health Innovations, the innovation team for Hennepin Healthcare that uses human-centered design to improve healthcare for its most vulnerable patients. Dr. Walsh leads the Envision Community initiative, a cross-sector collaborative that has developed intentional micro-communities as a new type of housing for Hennepin County. Through the Envision Community initiative, he empowers people experiencing homelessness to lead the design process, advocacy work, and participate in the development of affordable housing.

Stuart W. Grande

Dr. Stuart W. Grande is a Lecturer in the Division of Health Policy and Management at the University of Minnesota School of Public Health. He is a medical sociologist with post-doctoral training from Geisel School of Medicine at Dartmouth. His research focuses on social and behavioral factors that contribute to health inequities. Specifically, his specialization is in applying principles of community-based participatory research to improve the way clinicians and consumers of medical care engage with health and the healthcare system.