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
The CICH Funder’s Group representing HUD (PD&R and SNAPS), HHS (ASPE), and VA provided essential support and guidance to this evaluation. The CICH evaluation has been completed and the Federal Government is no longer involved. The views presented here are those of the authors, alone, and do not represent the position of any federal agency or of the United States Government. We wish to specifically thank the CICH evaluation site coordinators: Joyce Jones and Daniel White (Chattanooga), Eugene Herskovic (Chicago), Juanita Wilson (Columbus), Richard DiBlasio (Denver), Daniel Robbin and Elaine Stein (Ft. Lauderdale), John Nakashima (Los Angeles), Phyllis Larimore (Martinez), Julie Irwin (New York), Vincent Kane and Kimberly Lewis (Philadelphia), Lawrence Brennan (Portland), and Charlene Nason (San Francisco). We would also like to acknowledge Joe Morrissey and Martha Burt for providing assistance with survey construction and study design issues. Brandi Williams coordinated data management at the VA Northeast Program Evaluation Center (NEPEC), and computer programming support was provided by Dennis Thompson. Patricia Mares assisted with editing and proofreading.
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