兰德-Evaluation-of-Housing-for-Health-Permanent-Supportive-Housing-Program_78页_1mb

Summary of Evaluation of Housing for Health Permanent Supportive Housing Program

Core Content

The Housing for Health (HFH) program, part of the Los Angeles County Department of Health Services (DHS), aims to provide permanent supportive housing (PSH) to individuals experiencing homelessness with complex medical and behavioral health needs. This initiative is designed to improve health outcomes, reduce public service utilization, and lower associated costs. The RAND Corporation was commissioned to evaluate the program's implementation and outcomes, including service use and costs across multiple county departments and changes in health functioning.

Main Findings

• Program Structure and Goals: HFH combines interim housing and permanent supportive housing, offering long-term affordable housing with intensive case management services. The program has created over 3,400 housing placements since its launch in 2012.
• Service Utilization and Costs: After receiving PSH, participants showed a substantial reduction in the use of medical and mental health services, including ER visits, inpatient care, and outpatient visits. Public service costs decreased by nearly 60% in the year following housing, and when including PSH costs, the program achieved a 20% net cost saving.
• Health Functioning: Participants reported improved mental health functioning one year after housing, but physical health remained largely unchanged. Physical health scores were lower than general population norms, aligning with those of older individuals with chronic conditions.
• Chronic Homelessness: Over 83% of HFH PSH recipients were experiencing chronic homelessness, defined by HUD as continuous homelessness for a year or more, or four episodes equaling a year in the last three years.
• Time to Housing: The average time from initial application to PSH placement was 6.9 months, and to case management was 4.3 months. Over 96% of recipients were stably housed for at least one year.

Key Program Components

• Partnerships: The program involves multiple agencies, including DHS, DMH, DPH, DPSS, LAHSA, and Sheriff's and Probation Departments.
• Data Sources: RAND analyzed data from service utilization and cost records across these departments, as well as health functioning survey data from a small convenience sample of HFH participants.
• Evaluation Methods: RAND conducted a formative evaluation to assess program structure and goals, and an outcome evaluation using pre-post design and health functioning surveys.

Limitations and Considerations

• The cost savings were based on six county departments over a two-year period, and did not account for all potential costs and benefits.
• Comparison groups were not included in the evaluation, so the observed changes in service use and costs may not be solely attributable to the HFH PSH program.
• Jail days increased slightly after housing, suggesting a possible trade-off in some areas.

Recommendations

• Program Expansion and Sustainability: Continued monitoring of scaling up and inter-agency collaboration is essential for long-term success.
• Research Needs: More rigorous causal methods (e.g., randomized controlled trials or propensity score matching) are needed to conclusively attribute changes in service use and costs to the program.
• Supportive Services: The program should maintain its focus on intensive case management and supportive services to ensure ongoing health improvements and cost savings.

Conclusion

The HFH PSH program has demonstrated significant success in reducing public service utilization and costs among individuals experiencing homelessness with complex health needs. However, the lack of a comparison group and limited scope of cost analysis suggest that further research is necessary to fully understand the program's impact. The findings highlight the potential cost benefits and improvements in mental health, reinforcing the importance of permanent supportive housing in addressing homelessness and its associated public health challenges.

Key Departments and Their Roles

• DHS: Primary program administrator and provider of housing and case management.
• DMH: Provides mental health services.
• DPH: Offers substance use treatment services.
• DPSS: Administers General Relief assistance.
• LAHSA: Provides shelter services.
• Sheriff's and Probation Departments: Involved in law enforcement and incarceration data.

Key Statistics

• 83% of participants experienced chronic homelessness.
• 88% had co-occurring medical and mental health or substance use conditions.
• 96% were stably housed for at least one year.
• Public service costs dropped from $38,146 to $15,358 per participant.
• Net cost savings of 20% when including PSH costs.
• ER visits decreased by 1.64 on average.
• Inpatient stays decreased by over four days.
• General Relief use declined by 1.38 months.
• Jail days increased by 2.76 days on average.

Implications

The HFH PSH program is a cost-effective intervention for reducing the burden of homelessness on public services, particularly in health and law enforcement. However, sustainability and scalability depend on inter-agency collaboration, adequate oversight, and continued investment in supportive services. The program's success underscores the importance of housing stability in improving health outcomes and reducing public expenditures.