Inmates Rank Housing First Among
Multiple Needs

The majority of inmates participating in a federally funded needs assessment identified housing as their paramount concern upon release, saying that the need for housing was more important than other concerns such as HIV, mental health and substance abuse treatment. “Housing is one of the foundations for being able to come out in the community and address the other needs that you have,” said Hugh Potter, Team Leader for the Corrections and Substance Abuse Unit at the Centers for Disease Control and Prevention (CDC), which oversaw the study.

The CDC and the Health Resources and Services Administration (HRSA) jointly funded a corrections demonstration project (CDP) in six states and one city during the past five years, a project that provided education, counseling and testing services to nearly 100,000 offenders in prisons, jails and juvenile detention centers. More than 6,000 of these offenders filled out a long and detailed questionnaire and the vast majority cited housing as their major concern even though most have HIV disease, according to Potter. “It is interesting when you look at some of the preliminary data that we have where inmates sort of rank order their needs,” Potter said. “They don’t rank HIV medications and their treatment at the top of the list.” Potter said the results of the study were not surprising. Department of Justice (DOJ) studies repeatedly show that inmates rank housing first on their priority list; many of the inmates participating in the CDP study were homeless after release, making housing a critical and urgent need.

Guy Vandenberg, Director of the Learning Institute at Continuum, a community based organization in San Francisco that works with offenders from the San Francisco County Jail, describes housing as “healthcare,” saying, “imagine yourself coming out of jail and being homeless.” “You are going to think about survival so you are going to think about shelter,” said Vandenberg. “You are going to think about getting some food. You are not going to think about medications or regular primary health. You are going to engage in some survival behaviors that may include fighting, prostitution or commercial sex work. And you are very, very likely to engage in drug use because life on the street is extremely stressful.” Vandenberg said homelessness, even for a few weeks, can cause permanent mental illness among people who were not mentally ill prior to being homeless. Not surprisingly, housing for exoffenders is extremely difficult to obtain in San Francisco and in other parts of the country. As a consultant, Vandenberg has traveled throughout the United States and as he explains, “I thought other places would not have the same kind of problem with housing as San Francisco, but I found out it did not matter if you were in Mississippi or Kansas or Chicago -- housing is extremely hard to get.”

Continuum and the Forensic AIDS Project, which is part of the San Francisco Department of Health, conducted a randomized control study, assigning 150 inmates in the San Francisco Jail to a control group and another 150 to a demonstration arm where they received intensive interventions that included case management, housing, money management and primary medical care. The study, funded by the California Office of AIDS within the Department of Health and known as Homebase, ran from 2000 to 2004 and involved a base line interview with clients while they were incarcerated at the San Francisco Jail and, in the case of inmates enrolled in the demonstration group, bi-weekly meetings and monthly interviews with their case  managers for six months after release. Continuum provided 22 rooms for offenders enrolled in the demonstration project at any given time during the past four years. “That is not a lot,” acknowledged Vandenberg. “But people lived there for only three months and during the time we tried to stabilize them with permanent housing.”

The Forensic AIDS Project provided case management services for inmates participating in the control group on the inside, working with  them to develop a case management plan, the extent of services provided to the control group. Officials are still compiling the data as we go to press but Vandenberg and others are convinced that the offenders who received more intensive services will show better outcomes.“It is a common sense thing,” Vandenberg explained. “If someone is housed and looked after then they are going to do better.” Vandenberg said, “people who stuck with the program and worked with their case manager and engaged in money management components achieved permanent housing without fail.”

The study also looked at risk reduction behaviors among inmates and it is likely to find that a higher percentage of inmates in the demonstration arm engaged in far fewer episodes of risky behavior, according to Vandenberg. The research phase of Homebase ended in late September but the project still continues.“There are no more control groups,” Vandenberg explained. “Everyone in the county jail with an HIV diagnosis is eligible for the program.” Vandenberg pointed out, however, “we do not have enough space to accommodate everyone who comes out of the jail with HIV so we had to establish some other criteria.”