Effect of Scattered-Site Housing Using Rent Supplements and Intensive Case Management on Housing Stability Among Homeless Adults With Mental Illness

Stergiopoulos, Vicky; Hwang, Stephen W.; Gozdzik, Agnes; Nisenbaum, Rosane; Latimer, Éric; Rabouin, Daniel; Adair, Carol E.; Bourque, Jimmy; Connelly, Jo; Frankish, James; Katz, Laurence Y.; Mason, Kate; Misir, Vachan; O’Brien, Kristen; Sareen, Jitender; Schütz, Christian; Singer, Arielle; Streiner, David L.; Vasiliadis, Helen‐Maria; Goering, Paula

doi:10.1001/jama.2015.1163

Cited by 233 publications

(260 citation statements)

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“…We identified a total of four studies that used an RCT design to examine the effects of PSH on health services utilization and associated costs. Overall, these studies found that, relative to control groups, the treated groups experienced a decrease in hospital days by 23 to 29 percent and a decline in the number of ER visits by 24 to 33 percent (see Basu et al, 2012;Sadowski et al, 2009;Stergiopoulos et al, 2015). Also, Basu et al (2012) found that the treated group used substance-use residential treatment significantly less frequently than the control group that was subject to a non-Housing First approach.…”

Section: Studies Using Randomized Controlled Trialsmentioning

confidence: 98%

“…For example, a PSH program that targeted individuals experiencing homelessness and serious mental illness demonstrated a 95-percent reduction of postintervention public service costs among those who were housed (Culhane, Metraux, and Hadley, 2002); a program targeting individuals who experienced chronic homelessness, had severe alcohol use disorders, and were high users of crisis centers and hospitals showed a cost reduction of 53 percent (Larimer et al, 2009). However, programs that have enrolled individuals with less serious health conditions have yielded more modest cost reductions (Stergiopoulos et al, 2015). Moreover, smaller (partial) program cost offsets tend to be found in earlier phases of the program (Bamberger and Dobbins, 2014;Basu et al, 2012;Brown et al, 2012;Culhane, Metraux, and Hadley, 2002;Flaming, Burns, and Matsunaga, 2009;Larimer et al, 2009;Mondello et al, 2007;Reaser and Mauerman, 2015;Sadowski et al, 2009;Seligson et al, 2013;Stergiopoulos et al, 2015;Thomas et al, 2014;Toros, Stevens, and Moreno, 2012;Tsemberis, Gulcur, and Nakae, 2004;Wright et al, 2016).…”

Section: Service Utilization and Costs Among Populations Experiencingmentioning

confidence: 99%

“…However, programs that have enrolled individuals with less serious health conditions have yielded more modest cost reductions (Stergiopoulos et al, 2015). Moreover, smaller (partial) program cost offsets tend to be found in earlier phases of the program (Bamberger and Dobbins, 2014;Basu et al, 2012;Brown et al, 2012;Culhane, Metraux, and Hadley, 2002;Flaming, Burns, and Matsunaga, 2009;Larimer et al, 2009;Mondello et al, 2007;Reaser and Mauerman, 2015;Sadowski et al, 2009;Seligson et al, 2013;Stergiopoulos et al, 2015;Thomas et al, 2014;Toros, Stevens, and Moreno, 2012;Tsemberis, Gulcur, and Nakae, 2004;Wright et al, 2016). 2 We organize prior findings by study design and devote a section to describing Los Angeles County-specific results.…”

Section: Service Utilization and Costs Among Populations Experiencingmentioning

confidence: 99%

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Evaluation of Housing for Health Permanent Supportive Housing Program

Hunter¹,

Harvey²,

Briscombe³

et al. 2017

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Limited Print and Electronic Distribution RightsThis document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org For more information on this publication, visit www.rand.org/t/RR1694Published by the RAND Corporation, Santa Monica, Calif. © Copyright 2017 RAND CorporationR® is a registered trademark.iii PrefaceHousing for Health (HFH), a division within the Los Angeles County Department of Health Services (DHS), was established to provide supportive housing to DHS patients with complex medical and behavioral health issues who were experiencing homelessness. HFH goals are to improve patients' health, reduce costs to the public health system, and demonstrate DHS's commitment to addressing homelessness within Los Angeles County. In August 2014, through the generous support of the Conrad N. Hilton Foundation, the RAND Corporation was selected to serve as the evaluator for the HFH permanent supportive housing (PSH) program. RAND conducted a formative evaluation to provide early feedback on program implementation and performed an outcome evaluation examining the effects of the PSH program on county service utilization and service costs. RAND also analyzed data from a survey on health functioning both at housing entry and a year later among a small convenience sample of HFH participants.This report includes an assessment of the program structure and program goals and identifies the effects of PSH on service utilization and cost expenditures from several county departments. In this report, we discuss recommendations regarding future programming and research. This report will be of interest to state and county governments serving populations that experience homelessness; health care organizations; clinical practitioners; homeless services advocacy organizations; health care researchers; social workers; and others responsible for providing individuals experiencing homelessness with supportive housing and related care. The research was conducted by RAND Health, a division of the RAND Corporation. A profile of RAND Health, abstracts of its publications, and ordering information can be...

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Section: Studies Using Randomized Controlled Trialsmentioning

confidence: 98%

Section: Service Utilization and Costs Among Populations Experiencingmentioning

confidence: 99%

Section: Service Utilization and Costs Among Populations Experiencingmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of Housing for Health Permanent Supportive Housing Program

Hunter¹,

Harvey²,

Briscombe³

et al. 2017

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“…Randomized controlled trials have found housing stability and retention for HF participants to be between 73% and 80% as compared to usual care, which, depending on the study consisted of access to existing forms of housing assistance and support in the community or programs following a "treatment first" approach that made access to permanent housing conditional on successful treatment adherence, had rates of approximately 30%. 2,3 Furthermore, there has been remarkable consistency across evaluations of HF programs. In a review of eight published studies of Housing First that reported on housing retention and stability during periods that ranged from 1 to 5 years, rates varied from 73% to 88%.…”

Section: Introductionmentioning

confidence: 99%

Residential Moves Among Housing First Participants

Byrne

Henwood

Scriber

2016

J Behav Health Serv Res

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Research has demonstrated that Housing First (HF) is an effective intervention for improving housing stability among individuals with serious mental illness experiencing chronic homelessness, but efforts to examine residential moves experienced by HF participants remain limited. The present study assessed the extent to which participants in an HF program in Philadelphia experienced residential moves, situational factors related to residential moves, and HF participant characteristics associated with experiencing moves. Roughly half of HF participants in the study cohort experienced a residential move at some point during the study period, which translates into participants experiencing an average of one move every 2.3 years.Moves categorized as due to housing loss were more common than those related to housing fit.Length of time between program admission and initial move-in and older age were positively associated with an increased rate of moves following initial move-in. Study findings have important implications for HF providers and programs.

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“…The trial protocol is provided in detail in Goering et al, 15 and 24-month outcomes are reported elsewhere. 16,17 The cities differed in rental market conditions, so we knew that finding quality rental units would be more challenging in some sites. We also wanted to ensure that housing units procured in the private market with rent supplements from a publicly funded program were of acceptable quality.…”

Section: Introductionmentioning

confidence: 99%

Housing Quality in a Randomized Controlled Trial of Housing First for Homeless Individuals with Mental Illness: Correlates and Associations with Outcomes

et al. 2016

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Housing quality (HQ) is associated with mental health, and may mediate outcomes in housing interventions. However, studies of housing interventions rarely report HQ. The purpose of this study was to describe HQ in a multi-site randomized controlled trial of Housing First (HF) in five Canadian cities and to examine possible differences by treatment group (HF recipients and treatment-as-usual (TAU) participants who were able to find housing through other programs or on their own). We also examined the association between HQ and the primary trial outcome: housing stability. The performance of a new multi-dimensional standardized observer-rated housing quality scale (the OHQS) in a relatively large cross-site sample was also of interest. HQ was rated by trained research assistants for 204 HF participants and 228 TAU participants using the OHQS. General linear regression models were used to examine unit/building quality scores by group and site adjusting for other group differences, and as a predictor of housing stability outcomes after 24 months of follow-up. The OHQS was found to have good reliability and validity, but because most of the neighborhood subscale items were negatively correlated with the overall scale, only unit and building items were included in the total HQ score (possible scores ranging from 13.5 to 135). Unit/building HQ was significantly better for the HF group overall (91.2 (95 % CI = 89.6-92.9) vs. 88.3 (95 % CI = 86.1-90.5); p = .036), and in one site. HQ in the TAU group was much more variable than the HF group overall (W (mean) = 24.7; p G .001) and in four of five sites. Unit/building HQ scores were positively associated with housing stability: 682CI 91.4-94.9)) for those housed all of the time (F = 43.9 p G .001). This association held after adjusting for site, housing characteristics, participant ethnocultural status, community functioning, and social support. This study demonstrates that HQ can be as good or better, and less variable, in HF programs in Canada that systematically and predominantly source housing stock from the private sector compared to housing procured outside of an HF program. HQ is also an important predictor of housing stability outcomes.

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Effect of Scattered-Site Housing Using Rent Supplements and Intensive Case Management on Housing Stability Among Homeless Adults With Mental Illness

Abstract: isrctn.org Identifier: ISRCTN42520374.

Cited by 233 publications

References 35 publications

Evaluation of Housing for Health Permanent Supportive Housing Program

Evaluation of Housing for Health Permanent Supportive Housing Program

Residential Moves Among Housing First Participants

Housing Quality in a Randomized Controlled Trial of Housing First for Homeless Individuals with Mental Illness: Correlates and Associations with Outcomes

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