CBHCM Housing Stability and Social Determinants of Health — Questions and Answers
Question 1: The 'Housing First' model in behavioral health is based on which core principle?
- Clients must demonstrate sobriety and medication compliance before receiving permanent housing
- Permanent, stable housing is a basic right and should be provided without treatment compliance prerequisites (Correct answer)
- Transitional housing programs are more cost-effective than permanent supportive housing
- Family reunification should be the first housing option explored before independent placement
Correct answer: Permanent, stable housing is a basic right and should be provided without treatment compliance prerequisites
Housing First holds that stable housing is a fundamental need. Research shows providing immediate permanent housing — without preconditions like sobriety or treatment participation — improves housing retention, mental health outcomes, and ultimately increases voluntary treatment engagement.
Question 2: Social determinants of health (SDOH) most directly associated with poor behavioral health outcomes include:
- Access to recreational facilities and green spaces
- Geographic proximity to a hospital emergency department
- Poverty, housing instability, food insecurity, and lack of social support (Correct answer)
- Distance from the nearest pharmacy
Correct answer: Poverty, housing instability, food insecurity, and lack of social support
SDOH are the non-medical conditions in which people live, work, and age. Poverty, housing instability, food insecurity, unemployment, and social isolation are strongly and consistently associated with higher rates of mental health disorders and substance use disorders.
Question 3: A case manager is working with a chronically homeless client with schizophrenia who refuses all psychiatric treatment. The BEST initial approach is to:
- Require psychiatric stabilization before initiating housing placement
- Prioritize securing stable housing while continuing to build rapport around mental health treatment (Correct answer)
- File for involuntary commitment to ensure the client receives needed treatment
- Refer the client only to emergency shelters until he expresses willingness to engage in treatment
Correct answer: Prioritize securing stable housing while continuing to build rapport around mental health treatment
Consistent with the Housing First model, securing stable housing first provides the foundation from which treatment engagement can develop over time. Requiring treatment compliance as a housing prerequisite is both ineffective and ethically problematic for this population.
Question 4: Supportive housing is BEST defined as:
- Temporary emergency shelter with on-site security staff
- Permanent, affordable housing linked to voluntary and flexible support services (Correct answer)
- A residential treatment program with 24-hour clinical supervision
- Shared transitional housing with mandatory attendance at group therapy
Correct answer: Permanent, affordable housing linked to voluntary and flexible support services
Supportive housing combines permanent, affordable housing with voluntary support services (case management, mental health, substance use treatment) that tenants may choose to use. It is not a treatment program — tenants have standard tenant rights and services are not conditions of tenancy.
Question 5: When conducting a housing assessment for a client with serious mental illness, the case manager should assess all of the following EXCEPT:
- Current living situation and history of housing instability
- History of evictions and any criminal justice involvement that may affect housing eligibility
- The client's preferred neighborhood and cultural community ties
- Whether the client's family members have criminal records (Correct answer)
Correct answer: Whether the client's family members have criminal records
Housing assessments should focus on the client's own history, preferences, and barriers. Running background checks on family members who are not part of the housing application is outside the case manager's scope and could constitute an unjustified privacy violation.
Question 6: The ACE (Adverse Childhood Experiences) study is most relevant to behavioral health case management because it demonstrated:
- That childhood poverty is the single most reliable predictor of adult mental illness
- A dose-response relationship between the number of childhood adversities and risk of mental health, substance use, and physical health problems in adulthood (Correct answer)
- That genetic factors are more significant than environmental factors in determining behavioral health outcomes
- That residential stability in childhood fully protects against adult behavioral health disorders
Correct answer: A dose-response relationship between the number of childhood adversities and risk of mental health, substance use, and physical health problems in adulthood
The ACE study found a dose-response relationship: the more adverse childhood experiences (abuse, neglect, household dysfunction) a person had, the greater their risk of mental health disorders, substance use, chronic disease, and early death in adulthood. This underscores the importance of addressing social determinants and trauma.
CBHCM Housing Stability and Social Determinants of Health
The 'Housing First' model in behavioral health is based on which core principle?