Spring 2009 Research Newsletter

HRI Spring Research Newsletter

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Quarterly Research Newsletter
Focus On Permanent Supportive Housing Studies Spring 2009
In This Issue:
Feature on PSH Studies
2009 Homeless Counts Map
Take Three! Expert Q&A
Policy-Driven Research
By The Numbers 
13
Percent decrease in Medicaid-reimbursable costs (acute and preventive) after enrollment in permanent supportive housing, as reported by the Heartland Alliance. 
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The Alliance's Homelessness Research Institute (HRI) is pleased to send the first issue of the Quarterly Research Newsletter. This newsletter is central to HRI's mission to ensure that policymakers, practitioners, and the caring public have access to the best information about trends in homelessness and emerging solutions.
 
Each issue will present new research on a particular issue in homelessness. This issue focuses on recent studies of the cost and effectiveness of permanent supportive housing for individuals with long histories of homelessness and features an Expert Q&A with Jacquelyn Anderson, Senior Program Manager of Research and Evaluation at the Corporation for Supportive Housing and member of the Alliance's Research Council. You will also find other features that will become regular elements of this newsletter: Interactive Map, Policy-Driven Research, and By The Numbers. 
 
You are receiving this first issue because you are a recipient of the Alliance's weekly newsletter. To continue receiving the Quarterly Research Newsletter newsletter, you will need to add Research Newsletter - Quarterly as one of your Alliance subscriptions. Click here to add Research Newsletter - Quarterly as one of your subscriptions.
 
Feature: Permanent Supportive Housing Studies 
There have been several recent studies published that document the cost savings and effectiveness associated with permanent supportive housing interventions for chronically homeless individuals. 
 
Recent Cost Offset Studies
The April 1, 2009 issue of the Journal of the American Medical Association included the article, "Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons with Severe Alcohol Problems," which reports on the results of a Housing First initiative in Seattle, WA known as "1811 Eastlake". This study compared 95 Housing First participants, with 39 wait-list control members and found cost reductions of over 50 percent for the Housing First group. While it is not the first published evidence of the service use reductions and cost savings that permanent supportive housing interventions can provide, it is worth highlighting because the level of the cost savings - almost $30,000 per person per year after accounting for housing program costs - are greater than some seminal studies that have shown more modest cost offsets through permanent supportive housing. The study is also noteworthy as one of several recent cost offset studies that have been released already this year. For example, a study of permanent supportive housing in Illinois showed a 39 percent decrease in the total cost of service provision, and a study involving 12 homeless service providers across Massachusetts found a 67 percent decrease in Medicaid costs for Housing First participants. 
 
Outcomes of Permanent Supportive Housing
There is also recent research that directly addresses the well-being of permanent supportive housing residents. The April 2009 issue of the Journal of Community Psychology included an article entitled, "Housing Stability among Homeless Individuals with Severe Mental Illness Participating in Housing First Programs." The authors of this article reviewed the outcomes of participants in three different Housing First programs in New York City, San Diego, CA and Seattle, WA and found that 84 percent of participants remained stably housed after 12 months. The authors also evaluated level of impairment related to psychiatric symptoms and substance abuse at baseline and 12 months and found no significant improvement in substance abuse or mental health impairment with permanent supportive housing.
 
See Research in this Newsletter for full citations of all of the above-referenced reports/articles.
Interactive Map: Keeping up with Homeless Counts
2009 Counts Map as JPEGThe current economic crisis and its impact on homelessness and on the homeless services system have increased demand for current data on homelessness. In response to that demand, HRI has created an Interactive Map of media reports of January 2009 point-in-time counts. This map serves as a database of January 2009 point-in-time counts that have been reported in the media or on Continuum of Care websites. While most of the reports to date (63 percent) are of increases, there are many communities that have seen decreases overall or in particular subpopulations.  New reports are added regularly, and links to news stories or Continuum of Care websites are included. Click on the image to view the Interactive Map.
Take Three! Expert Q&A
 Headshot: Jacquie Anderson (CSH)
Jacqueline Anderson is Senior Program Manager at the Corporation for Supportive Housing, a leading creator of permanent supportive housing for ending homelessness, where she leads efforts to disseminate research on supportive housing. She is also a member of the Alliance's Research Council. She joined us for an expert Q&A on cost offset studies. Click here to learn more about CSH's research and evaluation activities.
 
Alliance:  What are the useful take-away messages in the recent cost studies for practitioners and policy advocates?
 
Anderson: These studies provide mounting evidence that supportive housing is a cost effective and humane solution to long-term homelessness that benefits our health care and other publicly funded systems.  Because people experiencing long-term homelessness frequently have complex medical and behavioral health challenges, they use a disproportionately high amount of health care services. When people are homeless, their health care is likely to consist of costly emergency, inpatient, and long-term care services.  Supportive housing provides an essential foundation for access to primary health care and chronic disease management, services that are less expensive than crisis care but are more likely to address underlying health problems.  As these studies demonstrate, this approach saves public dollars and leads to better health outcomes.  
 
Alliance: CSH is coordinating several ongoing studies.  What do you expect to learn from these studies that isn't already known?
 
Anderson: We are working with researchers from the Urban Institute and Columbia University's Center on Homelessness Prevention Studies (CHPS) to evaluate the impact of affordable housing with attached services for people with chronic behavioral health challenges and significant criminal justice and shelter-use histories in three different places:  New York, NY, Chicago, IL, and the State of Ohio.  These three studies will help determine whether supportive housing interrupts the cycle of homelessness and incarceration for the "frequent user" population - people who repeatedly cycle through public systems and use the most public services.  In addition to measuring cost effectiveness and the impact of supportive housing on housing stability and recidivism, researchers at CHPS (who are conducting the study in New York) will track physical and mental health outcomes.  They will use a methodology called "trajectory analysis" to better understand the patterns of service use and institutional involvement for this group. 
 
We are also conducting an evaluation of a supportive housing program in New York City that targets families with long histories of homelessness and involvement in the child welfare system. The research team will be gathering information about the program's impact on reducing family homelessness and increasing family stability. An in-depth survey will collect detailed information about the parents and children and provide information about the role that affordable housing and services play in supporting families in their efforts to reunify or avoid out-of-home placements. 
 
Alliance: Cost studies are a good example of how research can inform public policy.  Can you think of another area of homelessness policy where more research could lead to better-informed policy?
 
Anderson: While cost studies have served as powerful tools for generating support and increasing funding for supportive housing, it is also important that research measure the other positive outcomes of housing.  Research has shown that stable housing improves physical and mental health outcomes and reduces drug and alcohol use and related risk-taking behaviors, but we need to continue to strengthen this body of evidence.  Furthermore, we need to use research to understand the link between stable housing and long-term, intergenerational family stability and child well-being.  Such evidence will help advocates argue that housing does more than just end homelessness - it improves health, keeps families together, and builds stronger communities.  
Policy Driven Research: Housing Affordability
Housing affordability is an important public policy issue and is one that directly affects homelessness. Irrespective of the presence of mental illness, disability or substance abuse status, homelessness is caused by a lack of access to affordable housing. Many policy-focused organizations develop their research strategies around the reality that there is an affordable housing shortage.
 
Each year the National Low Income Housing Coalition (NLIHC) releases Out of Reach, a report on housing affordability among renters in the United States.  Specifically this report examines how much a household must earn to reasonably afford the most modest housing unit; and whether a worker earning the minimum wage could afford housing.  According to NLIHC, in 2009, a household would have to earn at least $37,105 to reasonably afford a two-bedroom apartment at the national average fair market rent.  This translates into a "Housing Wage" of $17.84.  A Housing Wage is the hourly rate that a worker needs to earn to be able to reasonably afford a modest housing unit.  This Housing Wage exceeds the average hourly wage of renters ($14.69), and is more than double the recently-increased national minimum wage ($6.55). Despite recent increases in the minimum wage, there is still no county in the United States where a one-bedroom unit is affordable to a full time worker earning the minimum wage.  
 
Priced Out is a biennial report produced by the Technical Assistance Collaborative that examines the affordability of housing for people who rely solely on disability income.  This report uses monthly Supplemental Security Income (SSI) information for persons with long-term disabilities and compares that to the local fair market rent (FMR) to determine whether a single person household relying on SSI could afford housing.  In 2008, the national average FMR for a one-bedroom unit consumed more than the entire monthly SSI payment.  That is, the SSI monthly income amount did not cover the national average rent for the most modest housing unit.  Further, there is not one place (metropolitan or rural) in the country where housing at the FMR was affordable to someone relying solely on SSI.
 
See Research in this Newsletter for links to both of these reports.
Research In this Newsletter
Pearson, C, Montgomery, A.E., and Locke, G. "Housing Stability among Homeless Individuals with Serious Mental Illness Participating in Housing First Programs," Journal of Community Psychology 37, no. 3 (2009) 404-417.
 
Larimer, M.E., Malone, D.K., Gardner, M.; et al. "Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons with Severe Alcohol Problems," Journal of the American Medical Association 301, no. 13 (2009) 1349-1357.
 
The Heartland Alliance Mid-America Institute on Poverty. 2009. Supportive Housing in Illinois: A Wise Investment. Click here for the report. 
 
Massachusetts Housing and Shelter Alliance. 2009. Home and Healthy for Good: A Statewide Housing First Program. Progress Report March 2009. Click here for the report.
  
National Low Income Housing Coalition. 2009. Out of Reach 2007-2008: Persistent Problems, New Challenges for Renters. Click here for the report.
 
Technical Assistance Collaborative. 2009. Priced Out in 2008. Click here for the report.

 
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