Bridge Housing: Key Insights from Focus Groups

Bridge Housing: Key Insights from Focus Groups

Conducted by NorthStar Advocates

“NorthStar Advocates-building a state behavioral health system that is culturally and developmentally responsive to young people”

Title:
SAFE HOUSING POST-INPATIENT BEHAVIORAL HEALTH TREATMENT FACILITY

Executive Summary:

This report presents key insights from four focus groups conducted by NorthStar Advocates, engaging a total of 46 participants. These groups included the Bridge Coalition, the Commerce Youth Action Board (Y4Y), the Whatcom County Youth Action Board (YAB), and a Lived/Professional Experience group comprising representatives from organizations across Washington State. The participants, representing individuals with lived experience, professionals, family members, and other key stakeholders, shared their perspectives to help guide the planning and implementation of the Bridge Housing programs. Bridge Housing is a result of SHB 1929. SHB 1929 draws inspiration from the RDA report, which revealed that 80% of young people who experience homelessness within three to twelve months of exiting a state system of care (foster care, juvenile rehabilitation, inpatient behavioral health) are coming from an inpatient behavioral health treatment facility. Behavioral health is defined as mental health, substance use or both. You can access the RDA report (here). The concept and advocacy for SHB 1929 during the 2024 legislative session was led by NorthStar Advocates including young people with lived experience.  SHB 1929 establishes two 6-10 bed housing models, one on each side of Washington state, designed to provide safe, recovery-based housing for young people ages 18-24 who are exiting an inpatient behavioral health treatment facility with no safe housing option available at the time of discharge.  Referred to as Bridge Housing, this program is for up to 90 days, is voluntary and includes onsite and community based behavioral health support.  The focus groups were led by young people and team members of NorthStar Advocates to receive the insights, ideas and thoughts of young people across the state who have experienced homelessness and/or behavioral health treatment.  All young people who participated received a stipend of $75.00 per hour from NorthStar Advocates.

Key Findings:

• Barriers to Treatment: Participants faced challenges such as stigma, lack of access to services, poor provider support, and post-treatment homelessness.
• Clean and Sober Environment: 80% of participants agreed that maintaining a clean and sober environment in the housing programs is crucial for recovery.
• Early Exit from Programs: A majority of participants believe relapse should not result in automatic exit, while aggressive behavior or refusal to engage in treatment are valid reasons for early exit.
• Necessary Services: Job support, life skills training, mental health care, and enrichment activities were identified as critical for successful reintegration.
• Return to Community Plan: Housing stability, peer and community support, life skills training, and individualized care plans are key for a successful transition back to the community.

Acknowledgment:

NorthStar Advocates extends heartfelt gratitude to the 46 participants who generously shared their experiences and insights during the focus groups. We believe your voices will be instrumental in shaping the Bridge Housing programs, ensuring that it directly addresses the real challenges and unmet needs of young people. At NorthStar Advocates, we firmly believe that sustainable system change happens when those most impacted by homelessness and behavioral health challenges are involved in program development. Your contributions not only highlight gaps in current services but also inspire practical solutions that promote recovery, stability, and long-term success. With your insights at the core, we are committed to building authentic and impactful programs—creating a future where young people have the support they need to not just survive, but to thrive.

1. Personal Experience – Barriers to Treatment

This question asked respondents about the biggest challenges they or someone they know faced when seeking and completing treatment for behavioral health conditions. Here are the key barriers that emerged:

Challenges When Seeking Treatment:

• Stigma: Multiple respondents mentioned the stigma around seeking treatment, which discouraged them from pursuing care.
  “The biggest problem I’ve faced is the courage and shame that comes with asking for help.”
• Access to Services: Several respondents reported issues with a lack of access to mental health care, including inadequate availability of services, long waitlists, and lack of insurance coverage. Respondents with Medicaid noted particular difficulty navigating the small network of providers.
  “No access to health care—I didn’t get help until crisis, with police arresting me/taking me to the hospital involuntarily.”
• Lack of Resources and Information: Many individuals did not know where to find resources or how to navigate the system to access services. Some also pointed to an overall lack of post-care support.
  “It’s difficult to get information about treatment and where you can go for help to prevent trauma.”
• Provider Issues: There were concerns about untrained or incompetent providers, with some mentioning that treatment programs were not trauma-informed. Others noted poor clinical fits or miscommunication with providers, leading to feelings of frustration or being unheard.
  “Incompetent providers, in multiple facets. One, with the basic treatment that was promised for my time in inpatient care; it was not trauma-informed like it was said to be.”

Challenges After Completing Treatment:

• Homelessness: Multiple respondents cited homelessness or unstable living situations after treatment, which significantly hindered their recovery. Many were discharged back into toxic environments, making it hard to maintain their progress.
  “After treatment, I didn’t have housing and went back into an abusive situation.”
• Lack of Ongoing Support: Some noted that there was no ongoing support after they completed treatment. Others faced difficulty accessing continued care, such as peer support or step-down programs, to help them transition.
  “There’s no follow-up or post-care resources. They send you home with no support.”
• Relapse Risk: Several respondents discussed struggles with maintaining sobriety and feeling unprepared to cope with real-life pressures after treatment, with some mentioning relapse as a significant post-treatment challenge.
  “Relapsing after treatment without long-term care—there was no help staying sober after completing treatment.”

 

2. Clean and Sober Environment & Terminology

This section focused on the importance of having a clean and sober environment after treatment and whether respondents found the terminology “Clean” and/or “Sober” offensive or off-putting.

Importance of a Clean and Sober Environment:

• The overwhelming majority of respondents across the four groups agreed that maintaining a clean and sober environment for at least three months after inpatient treatment is crucial for successful recovery.
• Strongly Agree/Agree: 80% of respondents (in total) supported the importance of this environment for recovery, emphasizing stability and a safe space to focus on healing.
  “Maintaining a clean and sober environment is key to feeling safe and supported during recovery.”

Terminology Preferences – Clean/Sober:

• Mixed Reactions: Respondents were divided on the use of the terms “clean” and “sober.” Some respondents found the term “clean” judgmental and stigmatizing, while others were comfortable with both terms.
  “I’d say perhaps just sober and not ‘clean’. Clean gives off purity culture vibes.”
• Most respondents across the focus groups were comfortable using “clean” and “sober.”
• However, many suggested alternative terms including “drug and alcohol-free,” “recovery-focused,” “living in sobriety,” and “active recovery.”
  “Recovery-focused feels less judgmental and more supportive.”

 

3. Reasons for Early Exits from Housing Programs

This question asked respondents whether an individual should be exited from a housing program if they relapse and what behaviors should prompt early exit.

Views on Exiting After Relapse:

• Approximately 60% of respondents believed that relapse should not automatically result in an early exit from housing programs, as relapse is often part of the recovery process.
  “Relapse is part of the process. Don’t kick them out just because they relapse.”
• Over 20% of respondents strongly agreed that individuals should be allowed to stay in the program after relapse if they are showing progress or commitment to recovery.
  “They should only be exited if they are harming others or refuse to try.”

Behaviors That Should Prompt Early Exit:

• Aggression and Violence: Many respondents mentioned that aggressive behavior, such as physical violence, verbal harassment, or threatening others, should result in an exit.
  “Aggressive behavior, thievery, and being harmfully closed-minded (e.g., racist, homophobic, etc.) should be reasons for early exit.”
• Drug Use: Some respondents agreed that bringing drugs into the housing program, particularly substances other than marijuana, should lead to an early exit. Repeated drug use without any attempt to stop was also mentioned as a reason for exiting.
  “Bringing drugs into the housing, especially repeated offenses, should be grounds for early exit.”
• Refusal to Engage: Another common response was the refusal to engage in programming or follow treatment plans as a valid reason for being asked to leave.
  “If they’re not engaging with the program and refusing help, they shouldn’t stay.”
• Harming Others: Behaviors that put others at risk—physically or emotionally—were frequently cited as reasons for early exits.
  “If they’re consistently harming others or making the environment unsafe, they should exit.”

 

4. Beneficial Services for Young Adults in Housing Programs

Respondents were asked to review a list of services (Peer Support, Behavioral Health Support, Medication-Assisted Treatment, Housing Support, Flexible Funding Opportunities) and suggest additional services that would benefit young adults in housing programs.

Additional Services Suggested:

• Job Support and Educational Assistance: Many respondents emphasized the importance of job placement programs, job coaching, and educational training as key services for long-term success.
  “We need job support, job coaching, and educational opportunities to keep moving forward.”
• Life Skills Training: Several respondents pointed out that skills such as financial literacy, managing checking accounts, and applying for jobs were critical to sustaining independence after leaving treatment programs.
  “Learning how to manage finances and basic life skills would help us stay independent.”
• Mental Health Support: Continued access to behavioral health counseling and trauma-informed care was a priority for many, especially for individuals transitioning out of care.
  “Ongoing mental health support is necessary—it’s not just about staying sober.”
• Resource Navigation: Some respondents suggested having resource navigators or case managers to help young adults access essential resources like food, clothing, and transportation.
  “Having resource navigators would help us know where to go for food, clothing, and other necessities.”
• Enrichment Activities: Respondents suggested offering enrichment activities, such as art or sports, to help individuals explore passions and build a sense of community.
  “Providing creative outlets and sports could help us connect and stay engaged.”

5. Areas for Success in a Return to Community Plan

In designing a Return to Community Plan, respondents were asked to highlight critical areas they believed were essential for a successful transition from inpatient care to stable housing.

Critical Areas for Success:

• Housing Stability: Nearly all respondents agreed that stable housing should be the cornerstone of any return to community plan. Respondents mentioned the need for safe, affordable housing where individuals could focus on rebuilding their lives.
  “Housing is the foundation of everything. Without it, we can’t rebuild our lives.”
• Peer and Community Support: Respondents highlighted the importance of having a support system in place, whether through peers, community groups, or family. Continued engagement from caseworkers or peer counselors was considered vital for success.
  “We need a strong support system to keep us on track—peers and community are key.”
• Life Skills and Employment: Life skills training—such as budgeting, grocery shopping, meal prepping, and finding employment—was mentioned as critical to reintegrating successfully. Meaningful employment and financial stability were also noted as essential components.
  “Learning basic life skills like budgeting and meal prepping is essential for success.”
• Individualized Plans: Some respondents suggested that each individual should have a personalized plan tailored to their unique needs, goals, and challenges. This would help them feel more confident and prepared to return to their community.
  “Each person needs a plan that fits their situation—one size doesn’t work for everyone.”
• Safety and Well-being: Respondents emphasized the importance of having safety planning and mental health care built into the plan, ensuring that individuals have the resources to maintain their well-being.
  “Safety and mental health care should be part of every plan—it’s key to staying well.”

6. 6. Demographic Information

• Age Groups:
  • 12-18 years: 7%
  • 18-26 years: 45%
  • 26-35 years: 35%
  • 35-50 years: 10%
  • 50-65 years: 3%
• Pronouns:
  • He/Him: 40%
  • She/Her: 45%
  • They/Them: 10%
  • Other/No Preference: 5%
• Lived Experience:
  • Lived Behavioral Health Experience: 80%
  • Family or Friend of Someone with Behavioral Health Experience: 75%
  • Professional within the Behavioral Health System: 60%
  • Interested in the Topic: 55%
  • These figures account for participants identifying with more than one category.
• Geographic Locations:
  • Respondents were primarily located in counties across Washington, including Whatcom, King, Spokane, Pend Oreille, Yakima, Thurston, Kitsap, Benton, and Cowlitz counties.

Call to Action/Next Steps

Current System Perceived as More Harmful Than Helpful:
A recurring theme across all focus groups was a profound sense that the current system often causes more harm than good. Participants expressed frustration with systemic failures, citing inadequate care, mismanagement, and a lack of genuine support. This, in turn, has fostered deep distrust toward standard providers and institutions, further discouraging engagement and perpetuating barriers to recovery.

However, participants expressed hope and optimism about the Bridge Housing initiative, driven by the fact that individuals with lived experience are leading its design and development. This participatory approach has inspired excitement among participants, who believe the program has the potential to fill critical gaps and offer meaningful, person-centered support for long-term recovery and stability.

Recommendations for the Bridge Housing Program Implementation

Based on the findings from the focus groups, NorthStar Advocates would like to advocate for the following next steps to ensure the successful implementation of the Bridge Housing program:

1. Review and Implement Critical Services: Prioritize job support, life skills training, and mental health counseling as core services for individuals transitioning into stable housing.
2. Tailor Programs for Relapse Support: Develop protocols that focus on relapse prevention without immediately exiting individuals from the program, focusing instead on support and progress tracking.
3. Expand Access to Safe, Stable Housing: Partner with community housing programs and expand access to affordable, safe housing options for individuals after leaving the program.
4. Personalized Community Plans: Ensure that each individual has an individualized return-to-community plan that addresses their unique needs and challenges, with a strong focus on ongoing support and resources.
5. Ensure Drug- and Alcohol-Free Environments: Implement clear guidelines to maintain drug- and alcohol-free environments within the housing programs, creating a safe and supportive space for recovery.
6. Enhance Provider Training: Collaborate with behavioral health professionals to ensure that trauma-informed, culturally responsive care is at the forefront of all treatment services.
7. Ongoing Focus Group Feedback: Conduct additional focus groups after the initial launch of the housing program to gather feedback on the effectiveness of the services and to identify any emerging gaps or areas for improvement.