article Case Study: Delivering Innovation in Supportive Housing

Delivering Innovation in Supportive Housing

Peer-led, Community-Based Overdose Prevention in Supportive Housing

Challenges and Interventions

When tenants transition to private housing, this shift often reduces natural peer monitoring and community support that exists in unsheltered environments, increasing the risk of isolation and fatal overdose. This risk is compounded by a reluctance to disclose drug use or ask for help due to negative attitudes or past experiences with judgment, which hinders engagement with traditional services. Because DISH operates as a property manager, not a service provider, it must rely on coordination with external service providers, which can result in gaps in communication and delayed responses. Traditional case management models often focus on crisis management rather than long-term healing and community building, limiting their effectiveness. Additionally, since participation in services is voluntary, DISH has had to find creative, trust-building strategies to connect with tenants in meaningful, non-coercive ways.

Brave Button 

In response to these challenges, DISH has implemented a series of innovative interventions that prioritize harm reduction, peer leadership, and community engagement. Most notably, DISH has implemented a peer-led overdose prevention initiative, which is a multi-faceted approach at Minna Lee, a 50-unit Single Resident Occupancy (SRO) on 6th Street. As part of this pilot, nasal naloxone sprays are available at the front desk and mounted in dispensers throughout the property. DISH also implemented the Brave Button system, an overdose detection device in each unit, which allows residents to alert the front desk that they need help or would like to be checked on post-use. This technology was co-designed with resident peers and has become a vital tool in overdose prevention.

Peer Overdose Response Network 

To encourage peer engagement in overdose prevention, DISH developed a Peer Overdose Response Network, where tenants with lived experience are trained and compensated to provide overdose reversal, distribute Narcan, and educate their peers. These peer responders are essential in fostering trust and engagement among residents who might otherwise avoid formal services. DISH staff and Peer Overdose Specialists are trained in overdose reversal with nasal naloxone and are available to support tenants around the clock. In partnership with Drug-Overdose Prevention Education (DOPE), DISH staff and peer specialists were trained on the fundamentals of overdose prevention and response, including foundations of harm reduction training (harm reduction 101, stigma, conflict management/de-escalation) and overdose response/Narcan training, with a particular focus on evening/overnight staff. 

Peer overdose specialists earn stipends to support the integration of the Brave Buttons into the community, provide low-barrier access to Narcan, and train on safer use. As an additional preventative measure, all tenants are informed about the services and the use of the buttons as they view the unit and again during lease signing.

Holistic Support

Finally, DISH hosts healing-focused programming onsite to support residents’ holistic needs. Through partnerships with local organizations, tenants can access art classes, yoga, cooking groups, and civic engagement training. These offerings are designed to help tenants recover from trauma, foster connections, and feel a sense of belonging in their new homes. The organization also facilitates access to mobile mental health services, therapy, and public health screenings to reduce barriers to care.

Implementation and Best Practices

DISH’s model is rooted in: 

• strong cross-sector collaboration,
• deep community engagement, and
• commitment to holistic wellness. 

From the start, DISH emphasized resident participation in the design, development, and implementation of their overdose prevention strategy. By working alongside the Department of Public Health, the DOPE Project, and Brave Button developers, they have built a program that reflects the needs and realities of their tenants. This collaborative, co-creative approach has proven effective in building resident buy-in and trust. DISH also ensures that staff are well-trained and supported, recognizing the emotional and psychological demands of working with highly marginalized populations. 

Restorative justice practices are being piloted as alternatives to punitive responses, focusing instead on accountability and repair when harm occurs in the community. When harm occurs, such as a conflict, an overdose, or a breach of community trust, DISH does not respond with eviction threats or disciplinary measures. Instead, they engage in restorative conversations that prioritize listening, mutual accountability, and access to continued support with onsite case management services. For example, when a resident feels harmed or disconnected after an emergency response, staff and peer specialists work together to understand what happened, acknowledge the impact, and collaboratively develop a path forward. This ensures that residents are not pushed back into homelessness but instead are supported in maintaining and sustaining their housing with dignity and care.

By embedding restorative justice into the fabric of supportive housing, DISH models how safety, accountability, and healing can coexist, keeping people housed while nurturing community resilience. 

Positive Outcomes and Other Benefits

DISH’s interventions have yielded positive outcomes for over 800 individuals and families, with an 87% tenant satisfaction rate. Many residents have reported feeling a stronger sense of safety, connection, and hope since engaging with the program, with 97% of residents remaining housed each year with an average tenancy length of 5.6 years. For some, these supports have facilitated major life changes, including achieving sobriety after years of use and moving into independent housing. The peer-based model has also empowered tenants to see themselves as leaders and caregivers in their community, reinforcing their self-worth and strengthening community bonds. Furthermore, DISH’s programs have helped break down stigma, increase civic participation, and support residents in reclaiming their roles as engaged citizens. By centering resident voice and experience, the organization has created a culture of safety, autonomy, and mutual support that has led to lower eviction rates and improved housing retention, which includes a 50% reduction in vacancy rate across all nine sites. 

Lessons Learned

Peer Leadership is Transformative: DISH has learned that people with lived experience bring credibility and trust that traditional models often lack. Peer responders are often the bridge to services, engagement, and healing.

Relationships Build Recovery: Voluntary services mean success hinges on trust. DISH focuses on authentic, non-coercive relationships, recognizing that consistent presence and shared community space are healing in themselves.

Punitive Approaches Fall Short: Restorative justice provides a more effective response to conflict than punitive measures. Residents and staff alike benefit from a culture that emphasizes accountability over punishment.

Staff Support is Critical: Effective harm reduction strategies require strong staff support systems—including training, mental health resources, and sustainable workloads. Leadership buy-in is essential.

This case study was written in partnership with the Corporation for Supportive Housing (CSH).