A Comparison of Treatment Outcomes Among Chronically Homelessness Adults Receiving Comprehensive Housing and Health Care Services Versus Usual Local Care
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Service use and 2-year treatment outcomes were compared between chronically homelessness clients receiving comprehensive housing and healthcare services through the federal Collaborative Initiative on Chronic Homelessness (CICH) program (n = 281) a sample of similarly chronically homeless individuals receiving usual care (n = 104) in the same 5 communities. CICH clients were housed an average of 23 of 90 days (52%) more than comparison group subjects averaging over all assessments over a 2-year follow-up period. CICH clients were significantly more likely to report having a usual mental health/substance abuse treater (55% vs. 23%) or a primary case manager (26% vs. 9%) and to receive community case management visits (64% vs. 14%). They reported receiving more outpatient visits for medical (2.3 vs. 1.7), mental health (2.8 vs. 1.0), substance abuse treatment (6.4 vs. 3.6), and all healthcare services (11.6 vs. 6.1) than comparison subjects. Total quarterly healthcare costs were significantly higher for CICH clients than comparison subjects ($4,544 vs. $3,326) due to increased use of outpatient mental health and substance abuse services. Although CICH clients were also more likely to receive public assistance income (80% vs. 75%), and to have a mental health/substance provider at all, they expressed slightly less satisfaction with their primary mental health/substance abuse provider (satisfaction score of 5.0 vs. 5.4). No significant differences were found between the groups on measures of substance use, community adjustment, or health status. These findings suggest that access to a well funded, comprehensive array of permanent housing, intensive case management, and healthcare services is associated with improved housing outcomes, but not substance use, health status or community adjustment outcomes, among chronically homeless adults.
KeywordsChronic homelessness Supported housing Service use Treatment outcomes
- Burt, M. R. (2007). The Skid Row Collaborative-2003–2007: Process evaluation. Washington, DC: Urban Institute.Google Scholar
- Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., & Iwen, B. (1999). Homelessness: Programs and the people they serve: Findings of the National Survey of Homeless Assistance Providers and Clients. Washington, DC: Urban Institute.Google Scholar
- Burt, M. R., Aron, L. Y., Lee, E., & Valente, J. (2001). Helping America’s homeless: Emergency shelter or affordable housing?. Washington, D.C.: The Urban Institute Press.Google Scholar
- Central City Concern. (2010). Community Engagement Program. Retrieved on 12/15/2010 at http://www.centralcityconcern.org/CEP.htm
- Center for Mental Health Services. (2001). The CMHS housing initiative. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
- Chattanooga Regional Homeless Coalition. (2008). The blueprint to end homelessness in the Chattanooga region. Appendix C. Retrieved on 12/15/2010 at http://www.homelesscoalition.org/pdf/Chattanooga%20Blueprint%202008Revised.pdf.
- Culhane, D. P., Metraux, S., & Hadley, T. (2001). The impact of supportive housing for people who are homeless with severe mental illness on the utilization of the public health, corrections and emergency shelter systems. Washington, D.C.: Fannie Mae Foundation.Google Scholar
- Derogatis, L. R., & Spencer, N. (1982). The brief symptom index; Administration, scoring and procedure manual. Baltimore MD: Johns Hopkins.Google Scholar
- Dohrenwend, B. (1982). Psychiatric Epidemiology Research Interview (PERI). New York: Columbia University Social Psychiatry Unit.Google Scholar
- HomeBase/The Center for Common Concerns. (2005). Responding to Chronic Homelessness Project profile. San Francisco. Retrieved on 12/15/2010 at http://www.homebaseccc.org/PDFs/CATenYearPlan/ProjectProfileProjectComingHome.pdf.
- Mares, A. S., & Rosenheck, R. A. (2007). HUD/HHS/VA Collaborative Initiative to Help End Chronic Homelessness national performance outcomes assessment preliminary client outcomes report. West Haven, CT: Northeast Program Evaluation Center. Retrieved on 12/15/2010 at http://aspe.hhs.gov/hsp/homelessness/CICH07/outcomes07.
- Mares, A. S., & Rosenheck, R. A. (2009). HUD/HHS/VA Collaborative Initiative to Help End Chronic Homelessness national performance outcomes assessment final client outcomes report. West Haven, CT: Northeast Program Evaluation Center.Google Scholar
- McGraw, S. A., Larson, M. J., Foster, S. E., Kresky-Wolff, M., Botelho, E. M., Elstad, E. A., et al. (2010). Adopting best practices: Lessons learned in the Collaborative Initiative to Help End Chronic Homelessness (CICH). The Journal of Behavioral Health Services and Research, 37(2), 197–212.CrossRefGoogle Scholar
- National Technical Assistance Center (NTAC). (2006). Unpublished summary of field notes taken during visits to CICH sites.Google Scholar
- Nelson, G., Aubry, T., & Lafrance, A. (2007). A review of the literature on the effectiveness of housing and support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless. American Journal of Orthopsychiatry, 77(3), 350–361.PubMedCrossRefGoogle Scholar
- NOFA. (2003). Notice of funding availability for the collaborative initiative to help end chronic homelessness. Federal Register, 68(17), January 27, 2003.Google Scholar
- Post, P. A. (2008). Defining and funding the support in permanent supportive housing: Recommendations of Health Centers Serving Homeless People. Washington, DC: Corporation for Supportive Housing.Google Scholar
- Rosenheck, R. A., Leslie, D., Sindelar, J., Miller, E. A., Lin, H., Stroup, S., et al. (2006). Cost-effectiveness of second generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia. American Journal of Psychiatry, 163(12), 2080–2089.PubMedCrossRefGoogle Scholar
- Ware, J. E., Kosinski, M., & Keller, S. E. (1998). How to score the SF-12 physical and mental health summary scales (3rd ed.). Lincoln, Rhode Island: Quality Metric Inc.Google Scholar
- Zerger, S. (2002). Substance abuse treatment: What works for homeless people? A review of the literature. Nashville, TN: National Health Care for the Homeless Council.Google Scholar