The Research Behind Successful
Supportive Housing
September 2016
Overview
We will present research on and policy implications of:
•
Cost of homelessness vs. supportive housing
•
Housing First model
•
The most effective interventions for homeless families
ALBUQUERQUE HEADING HOME
COST STUDY
Albuquerque Heading Home Initiative
•
A private-public initiative to identify and house people in Albuquerque who are
both chronically homeless and medically vulnerable
•
Heading Home leads the initiative in partnership with the City of Albuquerque and
other nonprofit service and housing providers
•
The initiative began in 2011
•
To date, Albuquerque Heading Home has provided permanent supportive housing
to 938 people
What is Permanent Supportive
Housing?
Permanent Supportive Housing =
Long-term assistance paying for housing (i.e. through rental vouchers)
+
Case management services to help participants stabilize, be good tenants and
connect to needed resources and services in the community
Albuquerque Heading Home Cost Study
•
The City of Albuquerque hired the UNM Institute for Social Research to conduct a
rigorous and objective study on the cost effectiveness of providing permanent
supportive housing
•
The study was published in September 2013
AHH Cost Study Participants
•
Any participant who had been housed through AHH for 1 year or more was eligible
to participate in the study
•
Out of the 90 eligible participants, 48 choose to participate in the study
•
Of these 48 study participants:
•
•
60% were male; 40% were female
35% were Hispanic; 35% were White; 13% were Native American and 7% were AfricanAmerican
AHH Cost Study Methodology
The Cost Study compared participants use of these services 1 year before and 1 year after
entering permanent supportive housing:
•
Jail
•
Emergency Shelter
•
Ambulance
•
Outpatient Behavioral Health
•
Mental Health Inpatient
•
Medical Outpatient & Inpatient
•
Emergency Room
•
Cost of providing permanent supportive housing (housing assistance & case management)
AHH Cost Study Results
•
One year post-Heading Home study group member costs were $615,920.49 or
31.6% less than the one year pre-Heading Home study group member costs
•
This amounted to an average savings of $12,831.68 per study group member
AHH Cost Study Results
•
Emergency room costs decreased by 13%
•
Jail costs decreased by 64%
•
Inpatient hospital costs decreased by 84%
•
Outpatient medical costs decreased by 39%
•
Outpatient behavioral health costs decreased by 33%
•
Mental health inpatient increased 148%
•
Social services costs increased 469%
OTHER COST STUDIES
•Emergency room costs decreased by 13%
•Jail costs decreased by 64%
•Inpatient hospital costs decreased by 84%
•Outpatient medical costs decreased by 39%
•Outpatient behavioral health costs decreased by 33%
•Mental health
inpatient increased 148%
•Social services costs increased 469%
New York Cost Study – The First Study
•
Studied 10,000 people and the effect of providing 3,700 units of supportive
housing to some of them.
•
$40,500 cost of homeless people with mental illness not housed
•
$41,500 cost of homeless people with mental illness with housing
•
Net cost of housing was $1,000 per year per person
•
Some costs of being homeless were not captured by the study
Denver Cost Study
•
Compared the cost to society of 19 people before and after being provided
supportive housing in a housing first project over 2 years.
•
34% reduction in emergency room visits and costs
•
66% reduction in hospital inpatient costs
•
84% reduction in detox costs
•
76% reduction in incarceration costs
•
100% reduction in emergency shelter costs
•
Net savings of $4,745 per person (would save $2,434,131 for 513 people)
What Changes in Policy Would You
Recommend?
Policy Implications
•
Cost savings or at least offsets to the cost of housing are one more reason to
house homeless people
•
Moral reasons are of course even stronger: housing provides people a much
improved quality of life
•
The cost savings are realized by several parts of the service system: Medicaid,
hospitals, County jails, emergency shelters, detox programs
•
Each level of government should be encouraged to help fund supportive housing
and realize some of the savings.
RESEARCH ON
HOUSING FIRST
What is Housing First?
•
Prioritizes providing housing as a first step for homeless people
•
Client choice in housing
•
No requirement to address mental health or substance abuse issues prior to
housing
•
No requirement to participate in services to keep housing
•
Participants are offered an array of services that they can take advantage of
including mental health care and substance abuse treatment
•
Target population is homeless people with mental health disabilities
Pathways to Housing Outcomes
•
Sam Tsemberis at Pathways to Housing developed the Housing First model
•
In 2000 Pathways compared 242 housing first participants with 600 people
provided the standard residential treatment
•
88% of housing first participants retained their housing after 5 years
•
47% of those in the residential treatment system remained housed after 5 years
•
Housing first almost twice as effective at keeping people housed
Housing First for Homeless Veterans
•
Compared 177 homeless veterans provided with a housing first program to a
control group
•
Housing first reduced the length of time it took to house the veterans from 223
days on average to 35 days.
•
Also showed better retention among housing first participants and lower
emergency room use
Montgomery, A.E., Hill, L., Kane, V., & Culhane, D. Housing Chronically Homeless Veterans: Evaluating the Efficacy of a Housing First
Approach to HUD-VASH. 2013.
Cost Effectiveness of Housing First
•
Another Pathways study found that a Housing First Program costs $23,000 less per
person per year than a shelter program
Tsemberis, S. & Stefancic, A. Housing First for Long-Term Shelter Dwellers with Psychiatric Disabilities in a Suburban County: A FourYear Study of Housing Access and Retention. 2007.
What Changes in Policy Would You
Recommend?
Policy Implications of Housing First
Research
•
Since housing is cheaper and better than shelter, we should emphasize expanding
housing opportunities.
•
New housing programs for homeless people should be housing first programs.
•
Existing housing programs that are not completely housing first still need to
reduce barriers to entry.
FAMILY OPTIONS STUDY
Study Objectives
The purpose of this study was to compare different interventions for homeless
families with children:
•
Project-based transitional housing
•
Rapid ReHousing
•
Housing subsidy only (no services), i.e. a Housing Choice Section 8 Voucher
•
Usual care (defined as any housing or services that a family accesses in the
absence of immediate referral to the other interventions).
Study Participants & Timeframe
•
Between September 2010 and January 2012, a total of 2,282 families (including
over 5,000 children) were enrolled into the study from emergency shelters across
twelve communities nationwide and were randomly assigned to one of the four
interventions
•
Families are being tracked for a minimum of three years
•
HUD released an interim report in July 2015 that documents the impacts of the
various interventions and their relative costs at the 18-month follow-up period
Housing Stability Outcomes
Housing Stability Outcomes:
•
Those assigned to the Housing Subsidy Only had the fewest returns to
homelessness
•
Those assigned to Rapid ReHousing returned to homelessness at about the same
rate as those assigned to Usual Care
•
Those assigned to Project-Based Transitional Housing returned to homelessness
at a lower rate than those assigned to Usual Care
Family & Child Well Being Outcomes
Family & Child Well Being Outcomes:
•
Families offered housing subsidies experienced many substantial improvements in
adult and child well-being compared to families receiving usual care.
•
Families offered Rapid ReHousing had mixed results compared to families
receiving usual care.
•
Families offered transitional housing did not achieve better outcomes in the
domains of family preservation, adult well-being, child well-being and selfsufficiency compared to families receiving usual care.
Cost Effectiveness Outcomes
Average program cost per stay during follow-up period:
•
Housing Subsidy Only $18,821
•
Rapid ReHousing $6,578
•
Project Based Transitional Housing $32,557
•
Emergency Shelter $16,829
Cost Effectiveness Outcomes
However, the costs changed when the researches included other services that the
participants used outside of the assigned interventions:
•
Housing Subsidy Only $30,832
•
Rapid ReHousing $27,605
•
Project Based Transitional Housing $30,817
•
Usual Care $30,629
Concerns with the Family Options Study
•
HUD and other advocates of Rapid ReHousing have used this initial report to
bolster support for Rapid ReHousing
•
However, other groups have questioned HUD’s interpretation of the study
results, including the Institute for Children, Homelessness & Poverty
Concerns with the Family Options Study
Institute for Children, Homelessness & Poverty points out:
•
Families were not required to accept the intervention that was offered to them
•
Families were not guaranteed admission by the local agency providing that
intervention
•
All interventions were necessarily available
•
All families had the option to changes programs. As a result, many families used
more than one type of intervention
What Changes in Policy Would You
Recommend?
Policy Implications of HUD
Family Options Study
•
The best way to help families exit homelessness permanently is through
affordable permanent housing
•
The results so far do not clearly show that Rapid ReHousing or Project Based
Transitional Housing improve housing outcomes and family well-being, or that
they are more cost effective, than usual care
•
The final study, which will be out in 2017, may provide a clearer picture of the
benefits of Rapid ReHousing and Transitional Housing.