Journal of General Internal Medicine

, Volume 34, Issue 9, pp 1703–1708 | Cite as

Changes in Physical Health After Supported Housing: Results from the Collaborative Initiative to End Chronic Homelessness

  • Jack TsaiEmail author
  • Lillian Gelberg
  • Robert A. Rosenheck
Original Research



The permanent supported housing model is known to improve housing outcomes, but there has been sparse research on the effects of supported housing on physical health. Various organizations including the National Academy of Sciences have called for research in this area.


This observational multi-site outcome study examined changes in physical health among chronically homeless adults participating in a comprehensive supported housing program and the associations between changes in physical health, housing status, and trust in primary care providers.


Data are presented from an observational outcome study analyzed with mixed linear modeling and regression analyses.


A total of 756 chronically homeless adults across 11 sites were assessed every 3 months for 1 year.


The Collaborative Initiative to End Chronic Homelessness provided adults who were chronically homeless with permanent housing and supportive primary healthcare and mental health services.

Main Measures

Days housed, physical health-related quality of life (HRQOL) measured by the Short Form-12 health survey, number of medical conditions, number of treated medical conditions, and number of preventive medical procedures received.

Key Results

Participants showed reduced number of medical problems and receipt of more preventive procedures over time, but there was no statistically significant change in physical HRQOL. Changes in housing were not significantly associated with changes in any physical health outcomes. Over time, participants’ trust in primary care providers was positively associated with increased numbers of reported medical problems and preventive procedures received but not with physical HRQOL.


Entry into supported housing with linked primary care services was not associated with improvements in physical HRQOL. Improvement in other medical outcome measures was not specifically associated with improved housing status.


homelessness public health primary care physical health supported housing 


Compliance with Ethical Standards

Conflict of Interest

J. Tsai, L. Gelberg, and R. Rosenheck both do not report any conflicts of interest with this work.


  1. 1.
    National Academies of Sciences E, and Medicine. Permanent supportive housing: Evaluating the evidence for improving health outcomes among people experiencing chronic homelessness. Washington, DC: The National Academies Press 2018.Google Scholar
  2. 2.
    Tsemberis S, Kent D, Respress C. Housing stability and recovery among chronically homeless people with co-occurring disorders in Washington, DC. Am J Public Health 2012;102(1):13–6.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Rosenheck RA, Kasprow W, Frisman L, Liu-Mares W. Cost-effectiveness of supported housing for homeless persons with mental illness. Arch Gen Psychiatry 2003;60(9):940–51.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Stergiopoulos V, Hwang SW, Gozdzik A, Nisenbaum R, Latimer E, Rabouin D, et al. Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: A randomized trial. JAMA. 2015;313(9):905–15.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Cheng AL, Lin H, Kasprow WJ, Rosenheck RA. Impact of supported housing on clinical outcomes: Analysis of a randomized trial using multiple imputation technique. J Nerv Ment Dis 2007;195(1):83–8.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Kertesz SG, Crouch K, Milby JB, Cusimano RE, Schumacher JE. Housing First for homeless persons with active addiction: Are we overreaching? Milbank Q 2009;87(2):495–534.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Tsai J, Kasprow WJ, Rosenheck RA. Alcohol and drug use disorders among homeless veterans: Prevalence and association with supported housing outcomes. Addict Behav 2014;39(2):455–60.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Tsai J, Rosenheck RA. Does housing chronically homeless adults lead to social integration? Psychiatr Serv 2012;63(5):427–34.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Kelly JT. Trauma: With the example of San Francisco’s shelter programs. In: Brickher PW, Scharer LK, editors. Health Care of Homeless People. New York: Springer-Verlag; 1985. p. 77–91.Google Scholar
  10. 10.
    McAdam JM, Brickner PW, Scharer LL, Crocco JA, Duff AE. The spectrum of tuberculosis in a New York City men’s shelter clinic (1982-1988). Chest Surg Clin N Am 1990;97(4):798–805.Google Scholar
  11. 11.
    Zlotnick C, Zerger S, Wolfe PB. Health care for the homeless: What we have learned in the past 30 years and what’s next. Am J Public Health 2013;103(Suppl 2):S199-S205.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Zlotnick C, Zerger S. Survey findings on characteristics and health status of clients treated by the federally funded (US) Health Care for the Homeless Programs. Health Soc Care Community 2008;17(1):18–26.PubMedPubMedCentralGoogle Scholar
  13. 13.
    O’Connell JJ. Premature mortality in homeless population: A review of the literature. Nashville: National Health Care for the Homeless Council, Inc.; 2005.Google Scholar
  14. 14.
    Baggett TP, Hwang SW, O’connell JJ, Porneala BC, Stringfellow EJ, Orav EJ, et al. Mortality among homeless adults in Boston: Shifts in causes of death over a 15-year period. JAMA Intern Med 2013;173(3):189–95.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, et al. Housing status, medical care, and health outcomes among people living with HIV/AIDS: A systematic review. Am J Public Health 2016;106(1):e1-e23.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Mares AS, Rosenheck RA. Twelve-month client outcomes and service use in a multisite project for chronically homelessness adults. J Behav Health Serv Res 2010;37:167–83.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Ware JE, Kosinski M, Keller SE. How to score the SF-12 physical and mental health summary scales. 3rd ed. Lincoln: Quality Metric, Inc.; 1998.Google Scholar
  18. 18.
    Larson CO. Use of the SF-12 instrument for measuring the health of homeless persons. Health Serv Res 2002;37:733–50.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Anderson LA, Dedrick RF. Development of the Trust in Physician scale: A measure to assess interpersonal trust in patient-physician relationships. Psychol. Rep. 1990;67(3, Part 2):1091–100.Google Scholar
  20. 20.
    Derogatis LR, Spencer N. The brief symptom index: Administration, scoring, and procedure manual. Baltimore: Johns Hopkins; 1982.Google Scholar
  21. 21.
    McLellan AT, Luborsky L, Woody GE, O’Brien CP. An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. J Nerv Ment Dis 1980;168:26–33.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Neale MS, Rosenheck RA. Therapeutic alliance and outcome in a VA intensive case management program. Psychiatr Serv 1995;46:719–23.PubMedPubMedCentralGoogle Scholar
  23. 23.
    O’Toole TP, Johnson EE, Aiello R, Kane V, Pape L. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program. Prev Chronic Dis 2015;30(7):886–98.Google Scholar
  24. 24.
    O’Toole TP, Johnson EE, Borgia ML, Rose J. Tailoring outreach efforts to increase primary care use among homeless veterans: Results of a randomized controlled trial. J Gen Intern Med 2015;30(7):886–98.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Thom DH, Hall MA, Pawlson LG. Measuring patients’ trust in physicians when assessing quality of care. Health Aff (Millwood) 2004;23(4):124–32.Google Scholar
  26. 26.
    O’Connell JJ, Oppenheimer SC, Judge CM, Taube RL, Blanchfield BB, Swain SE, et al. The Boston Health Care for the Homeless Program: A public health framework. Am J Public Health 2010;100(8):1400–8.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Jezewski MA. Staying connected: The core of facilitating health care for homeless persons. Public Health Nurs 1995;12(3):203–10.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Thompson SJ, McManus H, Lantry J, Windsor L, Flynn P. Insights from the street: Perceptions of services and providers by homeless young adults. Eval Program Plann 2006;29(1):34–43.Google Scholar
  29. 29.
    Hudson AL, Nyamathi A, Greengold B, Slagle A, Koniak-Griffin D, Khalilifard F, et al. Health-seeking challenges among homeless youth. Nurs Res 2010;59(3):212–8.PubMedPubMedCentralGoogle Scholar

Copyright information

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2019

Authors and Affiliations

  • Jack Tsai
    • 1
    • 2
    Email author
  • Lillian Gelberg
    • 3
    • 4
  • Robert A. Rosenheck
    • 2
  1. 1.National Center on Homelessness Among Veterans U.S. Department of Veterans AffairsWest HavenUSA
  2. 2.Department of PsychiatryYale University School of MedicineNew HavenUSA
  3. 3.David Geffen School of MedicineUniversity of CaliforniaLos AngelesUSA
  4. 4.Greater Los Angeles Healthcare SystemU.S. Department of Veterans AffairsWest HavenUSA

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