Sexuality Research and Social Policy

, Volume 15, Issue 2, pp 163–171 | Cite as

Improving Health While Saving Money: Lessons Learned from a Supportive Housing Program for Young Adults with HIV

  • S. J. Dodd
  • Jeannette Ruffins
  • Denise Arzola


The Bailey House Success Through Accessing Rental Assistance and Support (STARS) Program is a 20-unit scatter-site permanent supportive housing program for homeless or unstably housed HIV-positive young adults ages 18–24. A harm reduction and strength-based approach is utilized to connect HIV+ individuals with medical care and other services while ensuring housing stability. An intensive case management team provides support such as home visits, case monitoring, accompaniment to appointments, and referrals to health and social service resources within the community. This program evaluation used clinical data mining (CDM) to implement a Return-on-Investment (ROI) analysis of the STARS supportive housing program. The evaluation compared program costs to “services as usual” through the NYC shelter system. The STARS program served 27 individuals, achieving 25 successful outcomes, during 3 years. The program’s total value (savings relative to shelter costs) yielded a 1.32 ROI. The results support practice and policy advocacy initiatives promoting supportive housing and housing first initiatives as a viable method to reduce homelessness and as a structural intervention to improve health outcomes for young people with HIV.


Supportive housing Housing first Cost-benefit analysis Young adults HIV Carter-Richmond Program evaluation 


Compliance with Ethical Standards


The program was funded by the Office of Housing and Urban Development as a HOPWA SPNS Project No. NYH080026.

Conflict of Interest

Author A serves as the evaluation consultant for Bailey House, Inc.

Authors B and C serve as vice-presidents for Bailey House, Inc.

Ethical Approval

The University IRB ruled that the retrospective use of data gathered by the agency as part of a program evaluation “does not meet the definition of human subject research as defined by the federal regulations (45 CFR 46.102(d) (f)) and therefore no further IRB review or approval is required.”


  1. Aidala, A. (2005). Homeless, housing instability and housing problems among persons living with HIV/AIDS, Address at the NAHC Research Summit.Google Scholar
  2. Aidala, A., Lee, G., Abramson, D., Messeri, P., & Siegler, A. (2007). Housing need housing assistance, and connection to HIV medical care. AIDS and Behavior, 11(S2), 101–115.CrossRefPubMedGoogle Scholar
  3. AIDS Alliance for Children, Youth & Families. (2005). Finding HIV-positive youth and bringing them into care. Washington, DC: AIDS Alliance.Google Scholar
  4. Altena, A. M., Beijersbergen, M. D., & Wolf, J. R. (2014). Homeless youth’s experiences with shelter and community care services: Differences between service types and the relationship to overall service quality. Children & Youth Services Review, 46, 195–202.CrossRefGoogle Scholar
  5. Aos, S., Mayfield, J., Miller, M., & Yen, W. (2006). Evidence-based treatment of alcohol drug, and mental health disorders: Potential benefits, costs, and fiscal impacts for Washington State. Olympia: Washington State Institute for Public Policy.Google Scholar
  6. Aranti, Y. (2009). Homeless children and youth: Causes and consequences. National Center for Children in Poverty (NCCP). New York: Mailman School of Public Health, Columbia University.Google Scholar
  7. Basu, A., Kee, R., Buchanan, D., & Sadowski, L. (2012). Comparative cost analysis of housing and case management program for chronically ill homeless adults compared to usual care. Services Research, 47, 523–543.CrossRefGoogle Scholar
  8. Bloomberg, M. (2012). Mayor’s management report: New York City. [Data specific to the department of Homeless services].Google Scholar
  9. Buchanan, D., Kee, R., Sadowski, L., & Garcia, D. (2009). The health impact of supportive housing for HIV-positive homeless patients: A randomized controlled trial. American Journal of Public Health, 99(S3), S675–S680.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Burt, M. R. (2015). Serving people with complex health needs: Emerging models, with a focus on people experiencing homelessness or living in permanent supportive housing. American Journal of Psychiatric Rehabilitation, 18(1), 42–64.CrossRefGoogle Scholar
  11. Center for Disease Control and Prevention (CDC). (2017). HIV Among Youth Fact Sheet. retrieved 8 May 2017
  12. Chambers, L. A., Greene, S., Watson, J., Rourke, S. B., Tucker, R., Koornstra, J., et al., Team, T. P. S. H. P. (2014). Not just “a roof over your head”: The meaning of healthy housing for people living with HIV. Housing, Theory and Society, 31(3), 310–333.Google Scholar
  13. Cohen, M. S., McCauley, M., & Gamble, T. R. (2012). HIV treatment as prevention and HPTN 052. Current Opinion in HIV and AIDS, 7(2), 99–105.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Culhane, D. P., Gollub, E., Kuhn, R., & Shpaner, M. (2001). The co-occurrence of AIDS and homelessness: Results from the integration of administrative databases for AIDS surveillance and public shelter utilisation in Philadelphia. Journal of Epidemiology and Community Health, 55(7), 515–520.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Epstein, I. (2010). Clinical data-mining: Integrating practice and research. Oxford: Oxford University Press.Google Scholar
  16. Gilmer, T. (2016). Permanent supportive housing for transition-age youths: Service costs and fidelity to the housing first model. Psychiatric Services, 67(6), 615–621.CrossRefPubMedGoogle Scholar
  17. Holtgrave, D., Wolitski, R., Pals, S., Aidala, A., Kidder, D., Vos, D., Royal, S., Iruka, N., Bridell, K., Stall, R., & Bendixen, A. (2013). Cost-utility analysis of the housing and health intervention for homeless and unstably housed persons living with HIV. AIDS and Behavior, 17(5), 1626–1631.CrossRefPubMedGoogle Scholar
  18. Hopper, K. (2012). The counter-reformation that failed? A commentary on the mixed legacy of supported housing. Psychiatric Services, 63(5), 461–463.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Incardi, J., & Harrison, L. (1999). Harm reduction: National and international perspectives. Thousand Oaks, CA: Sage Publications.Google Scholar
  20. Kidder, D. P., Wolitski, R. J., Pals, S. L., & Campsmith, M. L. (2008). Housing status and HIV risk behaviors among homeless and housed persons with HIV. JAIDS Journal Of Acquired Immune Deficiency Syndromes, 49(4), 451–455.CrossRefPubMedGoogle Scholar
  21. Kisley, S., Parker, J., Campbell, L., Karabanow, J., Hughes, J., & Gahagan, J. (2008). Health impacts of supportive housing for homeless youth: A pilot study. Public Health, 122(10), 1089–1092.CrossRefGoogle Scholar
  22. Legander, S. (2006). Housing first. A program to help people move off the streets and into treatment. Behavioral Healthcare, 26(5), 38.PubMedGoogle Scholar
  23. Milburn, N. G., Iribarren, F. J., Rice, E., Lightfoot, M., Solorio, R., Rotheram-Borus, M. J., et al. (2012). A family intervention to reduce sexual risk behavior, substance use, and delinquency among newly homeless youth. Journal of Adolescent Health, 50(4), 358–364.CrossRefPubMedGoogle Scholar
  24. Morcelle, M. T. (2015). Gimme shelter: Permanent supportive housing is health care for people living with HIV/AIDS. (Unpublished capstone paper). Retrieved from Washington and Lee University Archives. (Identifier no.
  25. Padgett, D. (2013). Choices, consequences and context: Housing first and its critics. European Journal of Homelessness, 7(2), 341–347.Google Scholar
  26. Parashar, S., Chan, K., Milan, D., Grafstein, E., Palmer, A. K., Rhodes, C., ... & Hogg, R. S. (2014). The impact of unstable housing on emergency department use in a cohort of HIV-positive people in a Canadian setting. AIDS care, 26(1), 53–64.Google Scholar
  27. Sadowski, L., Kee, R., VanderWeele, T., & Buchanan, D. (2009). Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: A randomized trial. Journal of the American Medical Association, 301(17), 1771–1778.CrossRefPubMedGoogle Scholar
  28. Saleeby, D. (2002; 2006). The strengths perspective in social work practice. Boston, MA: Pearson/Allyn & Bacon.Google Scholar
  29. Slesnick, N., Dashora, P., Letcher, A., Edrem, G., & Serovich, J. (2009). A review of services and interventions for runaway and homeless youth: Moving forward. Children and Youth Services Review, 31, 732–742.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Slesnick, N., Guo, X., Brakenhoff, B., & Bantchevska, D. (2015). A comparison of three interventions for homeless youth evidencing substance use disorders: Results of a randomized clinical trial. Journal of Substance Abuse Treatment, 541–513.Google Scholar
  31. Tsemberis, S. (2010). Housing first: The pathways model to end homelessness for people with mental illness and addiction. Minneapolis, MN: Hazelden Press.Google Scholar
  32. Tsembris, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. Journal of Public Health, 94(4), 651–656.Google Scholar
  33. Weinstein, M., & Lamy, C. E. (2009). Measuring success: How Robin Hood estimates the impact of grants. New York, NY: Robin Hood Foundation.Google Scholar
  34. Wilkins, C. (2015). Connecting permanent supportive housing to health care delivery and payment systems: Opportunities and challenges. American Journal of Psychiatric Rehabilitation, 18(1), 65–86.CrossRefGoogle Scholar
  35. Wu, E. S., Rothbard, A., Holtgrave, D. R., & Blank, M. B. (2016). Determining the cost-savings threshold for HIV adherence intervention studies for persons with serious mental illness and HIV. Community Mental Health Journal, 52(4), 439–445.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Silberman School of Social Work, Hunter CollegeCUNYNew YorkUSA
  2. 2.Bailey House, Inc.New YorkUSA

Personalised recommendations