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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Appendix E

Studies of Effectiveness of Permanent Supportive Housing

Studies included in this appendix were identified through a literature search, an examination of published systematic reviews on the effectiveness of permanent supportive housing, and published systematic reviews on interventions to improve the health of people experiencing homelessness.

Programs are grouped by study design, then listed in chronological order by year of first publication.

Study Design:

  • RCT: comparison of outcomes among participants randomized to intervention and control groups (RCT) (rows shaded in gray)
  • Quasi-experimental: comparison of outcomes among individuals who were allocated to or entered intervention and comparison groups on a non-randomized basis
  • Single-group before-after studies are excluded from this table.

Homelessness:

  • Information on duration or severity of homelessness among study participants is provided when available.
  • Information on housing status at baseline is provided for studies in which not all participants were literally homeless at the time of entry into the study.

Outcomes:

  • For each outcome, the group(s) with statistically significant better outcomes are identified as Control or Comparison (C), Intervention (I), Intervention 1 (I1), Intervention 2 (I2), etc.
  • = denotes no statistically significant difference between groups for that outcome.
  • For health care utilization, lower use of emergency departments and hospitals and higher use of outpatient services and substance abuse treatment services were defined as better outcomes, unless otherwise specified.

N/A denotes data not available.

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
References Site and Location Study Participants Interventions and Follow-up Housing Outcomes Health Care Utilization Outcomes Physical Health, Mental Health, Quality of Life Outcomes Substance Use, Incarceration, and Other Outcomes
Randomized Controlled Trials
Lipton 1988 Bellevue Hospital Program

New York City

Patients experiencing homelessness with chronic mental illness being discharged from a psychiatric inpatient unit

Enrolled: N=52

Intervention: n=26

Control: n=26

Sex: 65% male

Age: mean 37 years

Intervention: Residential treatment program providing permanent supportive housing, case management, meals, activity therapy, referrals to other programs, and on-site psychiatric care.

Control: Usual care

Follow-up: 94% at 12 months

% Nights in permanent housing: I

% Nights homeless: =

% Nights homeless after discharge: I

% Nights spent in hospital

(including index stay): I

Psychiatric illness severity: =
Hulburt 1996 McKinney Homeless Research Demonstration Project

San Diego

Persons experiencing homelessness and persons at high risk of homelessness with severe and persistent mental illness

Enrolled: N=362

Intervention 1, 2, 3, and 4: n=90 or 91 in each group

Sex: 67% male

Age: 18-29 years 25%, 30-39 years 42%, 40-49 years 24%

Race/ethnicity: white 63%, black 20%, Hispanic 12%

Homelessness: 64% homeless >1week in past 60 days.

Total time homeless: <1 year 32%, 1-3 years 33%, 4+ years 34%

Conditions: schizophrenia 55%, major depression 28%, bipolar disorder 16%. Due to eligibility criteria, many persons with severe alcohol or drug use were excluded.

Intervention 1: Comprehensive case management + Section 8 housing certificate

Intervention 2: Traditional case management + Section 8 housing certificate

Intervention 3: Comprehensive case management only

Intervention 4: Traditional case management only

Follow-up: 83% at 2 years

Time to housing consistency: =

Stable independent housing pattern: I1 & I2

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
References Site and Location Study Participants Interventions and Follow-up Housing Outcomes Health Care Utilization Outcomes Physical Health, Mental Health, Quality of Life Outcomes Substance Use, Incarceration, and Other Outcomes
Dickey 1996;
Goldfinger 1999;
Seidman 2003
Massachusetts Mental Health Center Program

Boston

Adults experiencing homelessness with major mental illness living in shelters

Enrolled: N=118

Intervention 1: n=63

Intervention 2: n=55

Sex: 70% male

Age: mean 37 years

Race/ethnicity: black 41%

Homelessness: N/A Conditions: schizophrenia 45%, schizoaffective 17%, bipolar disorder 14%, major depression 13%, alcohol/drug abuse ~50%

Intervention 1: Case management + Placement in group housing with staff support and gradually increasing self-governance

Intervention 2: Case management + Placement in an independent apartment

Follow-up: 86% at 18 months

Housing stability index: =

Housing at 18 months: =

Days homeless over 18 months: I1

Inpatient mental health services: =

Outpatient mental health services: =

Neuropsychologic al functioning: = (10 of 11 measures), I1 (executive functioning measure)
Rosenheck 2003;

Cheng 2007

HUD-VA Supported Housing (HUD-VASH) Program

San Francisco, San Diego, New Orleans, Cleveland

Veterans experiencing homelessness with major psychiatric disorder and/or substance abuse disorder who were receiving Veterans Affairs services

Enrolled: N=460

Intervention 1: n=182

Intervention 2: n=90

Control: n=188

Sex: 96% male

Age: mean 42 years

Race/ethnicity: N/A Homelessness: homeless >1 month 100%

Conditions: serious psychiatric diagnoses 10%, alcohol or drug disorders 50%, dual diagnoses 35%, other psychiatric disorders 5%

Intervention 1: Intensive case management + voucher providing immediate access to subsidized housing.

Intervention 2: Intensive case management alone

Control: Usual care with short-term broker case management through outreach worker.

Follow-up: 53% at 36 months

Intervention 1=70%

Intervention 2=48%

Controls=40%

Days housed in last 90 days: I1 Outpatient VA mental health visits: I1 & I2 Medical problems: =

Psychiatric problems: =

Psychological distress: =

Quality of life: I1

Alcohol problems: =

Days intoxicated: =

Drug problems: =

Using multiple imputation analysis for missing data:

Alcohol problems: I1

Days intoxicated: I1

Days of alcohol use: I1

Drug problems: I1

Days of drug use: I1

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
Gulcur 2003;
Tsemberis 2004;
Padgett 2006
Pathways to Housing Program

New York City

Persons experiencing chronic homelessness with severe Axis I mental illness

Enrolled: N=225

Intervention 1: n=99

Intervention 2: n=126

Sex: 77% male

Age: mean 41 years

Race/ethnicity: white 28%, black 40%, Hispanic 15%

Homelessness: At enrollment: living on street/public place 51%, living in psychiatric hospital 36%.

Conditions: psychosis 54%, bipolar disorder 13%, major depression 14%, history of alcohol or substance abuse disorder 90%

Intervention 1: “Housing First” program provided immediate housing in an independent apartment without any prerequisite psychiatric treatment or sobriety. Clients were offered ACT and housing support services, but could refuse.

Intervention 2: “Continuum of Care” program provided outreach services, followed by treatment and transitional housing, then permanent supportive housing. Receipt of housing was contingent on sobriety and compliance with psychiatric treatment.

Follow-up: 90% at 24 months, N/A at 48 months

Proportion of time stably housed: I1 Proportion of time hospitalized: I1 Psychiatric symptoms: = Alcohol use: =

Drug use: =

Use of substance abuse treatment programs: I2

McHugo 2004 Integrated Housing Services Program

Washington, DC

Adults with severe mental illness who were homeless or at high risk of homelessness

Enrolled: N=121

Intervention 1: n=60

Intervention 2: n=61

Sex: 48% male

Age: mean 40 years

Race/ethnicity: black 83%

Homelessness: 85% homeless at baseline, mean proportion of time literally homeless in past 6 months 38%

Conditions: schizophrenia spectrum disorders 74%, mood disorders 27%, mean 40 days of alcohol use in past 6 months, mean 25 days illicit drug use in past 6 months

Intervention 1: Parallel Housing Services (PHS) with scattered-site housing owned by community landlords or housing agencies + ACT team services

Intervention 2: Integrated Housing Services (IHS) with congregate-site housing + case management, provided by teams within a single mental health agency

There was substantial cross-over in housing types. Among participants stably housed at 18 months, housing was 53% vs. 47% in own apartment, 28% vs 21% in SROs, and 6% vs. 21% in group homes, in PHS and IHS respectively.

Follow-up: 84% at 18 months

Proportion of days in stable housing: I2

Housing satisfaction: =

Medical or dental care: =

Psychiatric services: =

Psychiatric symptoms: I2

Quality of life: I2

Days of alcohol use: =

Days of drug use: =

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
References Site and Location Study Participants Interventions and Follow-up Housing Outcomes Health Care Utilization Outcomes Physical Health, Mental Health, Quality of Life Outcomes Substance Use, Incarceration, and Other Outcomes
Sadowski 2009;
Buchanan 2009;
Basu 2012
Chicago Housing for Health Partnership

Chicago

Adults experiencing homelessness with at least 1 of 15 specified chronic medical illnesses who were enrolled while admitted to hospital

Enrolled: N=405

Intervention: n=201

Control: n=204

Sex: 77% male

Age: mean 46 years

Race/ethnicity: white 8%, black 78%, Hispanic 8%

Homelessness: median duration of homelessness 30 months

Conditions: HIV-seropositive 36%, major depression 42%, alcohol intoxication in past 30 days 60%, illicit drug use in past 30 days 59%

Intervention: Case management + transitional care at respite facility after discharge from hospital + placement in permanent housing at group living facilities or scattered site apartments using Housing First model

Control: Usual care (routine discharge planning by hospital social worker; case management services as available in the community)

Follow-up: 90% in intervention group and 74% in control group at 18 months

Stable housing: I Unadjusted analysis:

Hospitalizations: =

Hospital days: =

Emergency department visits: =

Analysis adjusted for baseline variables:

Hospitalizations: I

Hospital days: I

Emergency department visits: I

Quality of life: =

Among HIV-seropositive participants (intervention n=47, control n=47):

Alive and with intact immunity (based on CD4 count and viral load) at 12 months: I

Wolitski 2010;
Kidder 2007
Housing and Health Study

Baltimore, Chicago, Los Angeles

HIV-seropositive adults who were experiencing homelessness or at severe risk of homelessness, with income <50% of median area income

Enrolled: N=630

Intervention: n=315

Control: n=315

Sex: 70% male (41% MSM, 29% male non-MSM)

Age: 18-29 years 10%, 30-39 years 27%, 40-49 years 48%, 50+ years 14%

Race/ethnicity: white 8%, black 78%, Hispanic 9%

Homelessness: housing status in past 90 days: homeless 27%, unstably housed and severe risk of homelessness 69%, in own place and severe risk of homelessness 4%

Conditions: AIDS diagnosis 39%.

CD4 count: <200 24%, 200-349 25%, 350-500 20%, >500 30%.

Intervention: Immediate Housing Opportunities for People with AIDS (HOPWA) rental assistance + case management

Control: Customary housing services + case management

Follow-up: 87% in intervention group, 82% in comparison group at 18 months

Housing status: I Any medical care: =

Appropriate medical care: =

Emergency department visits: =

Hospital admissions: =

On HAART: =

Medication adherence: =

CD4 count: =

Viral load: =

Overall physical health: I*

Overall mental health: =

Depression: I*

Perceived stress: I*

*Significant improvements in these outcomes at 6 and 12 months, but differences no longer significant at 18 months

Sexual risk behaviors: =
Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×

CD4 count: <200 24%, 200-349 25%, 350-500 20%, >500 30%.

Aubry 2015;
Aubry 2016
At Home/Chez Soi Study (High Needs stratum)

Vancouver, Winnipeg, Toronto, Montreal, and Moncton, Canada

Adults with a current mental disorder, with or without a concurrent substance use disorder, who were absolutely homeless or precariously housed (≥2 episodes of homelessness in the past year) and not receiving ACT or ICM services; assessed to have high needs for treatment based on factors including psychiatric and substance use diagnoses, community functioning score, and pattern of hospitalizations or incarceration

Enrolled: N=950

Intervention: n=469

Control: n=481

Sex: 68% male

Age: mean 39 years

Race/ethnicity: white 60%, Aboriginal 19%, other racial or ethnic minority 21%

Homelessness: absolutely homeless 82%, >24 months lifetime homelessness 59%, longest period homeless >1 year 51%

Conditions: major depressive episode 43%, PTSD 27%, psychotic disorder 52%, substance-related problems 73%

Intervention: Immediate supportive housing (mostly in private-market scattered-site units) using Housing First model + ACT team services (client required to accept contact at least once per week)

Control: Usual care

Follow-up: 88% in intervention group, 77% in control group at 21-24 months

Percentage of days in stable housing: I

Time to housing: I

Self-reported housing quality: I

Number of days in hospital: =

Emergency department visits: =

Generic Quality of life: =

Condition-specific Quality of life: =

Health status: =

Mental health symptoms: =

Community functioning: =

Substance use problems: =

Number of Arrests: =

Community integration: =

Stergiopoulous 2015;
Kozloff 2016;
Adair 2016;
Somers 2015;
Somers 2017
At Home/Chez Soi Study (Moderate Needs stratum)

Vancouver, Winnipeg, Toronto, and Montreal, Canada

Adults with a current mental disorder, with or without a concurrent substance use disorder, who were absolutely homeless or precariously housed (≥2 episodes of homelessness in the past year) and not receiving ACT or ICM services; assessed to have moderate needs for treatment based on factors including psychiatric and substance use diagnoses, community functioning score, and pattern of hospitalizations or incarceration Intervention: Immediate supportive housing (mostly in private-market scattered-site units) using Housing First model + intensive case management services (client required to accept contact at least once per week)

Control: Usual care

Follow-up: 85% at 24 months

Percentage of days in stable housing: I

Proportion of participants never housed: I

Number of days in hospital: =

Proportion of participants with any hospitalization: =

Emergency department visits: =

Generic Quality of life: =

Condition-specific Quality of life: I

Health status: =

Mental health symptoms: =

Community functioning: =

Substance use problems: =

Number of Arrests: =

Community integration: =

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
References Site and Location Study Participants Interventions and Follow-up Housing Outcomes Health Care Utilization Outcomes Physical Health, Mental Health, Quality of Life Outcomes Substance Use, Incarceration, and Other Outcomes

Enrolled: N=1198

Intervention: n=689

Control: n=509

Sex: 66% male

Age: mean 42 years

Race/ethnicity: white 48%, Aboriginal 24%, other racial or ethnic minority 28%

Homelessness: absolutely homeless 84%, mean lifetime duration of homelessness 4.6 years (median 2.5 years)

Conditions: major depressive episode 59%, PTSD 31%, psychotic disorder 22%, alcohol abuse or dependence 55%, substance abuse or dependence 61%

Shinn 2015;
Samuels 2015
Family Critical Time Intervention (FCTI)

Westchester County, New York

Families entering the homeless shelters system (excluding domestic violence shelters) in which the mother had a diagnosable mental illness or substance abuse problem and care for at least one child aged 1.5–16 years

Enrolled: N=200

Intervention: n=97

Control: n=103

Mothers:

Age: mean 31 years

Race/ethnicity: white 25%, black 65%, American Indian/Alaska Native 10%; Hispanic 26%

Homelessness: N/A

Conditions: N/A

Children (N=311):

Sex: male 51%

Age: 1.5–5 years 32%,

Intervention: Time-limited (9 months) continuous intensive case management services from a single caseworker with 12:1 caseload + move from shelter to permanent scattered site subsidized housing as soon as possible

Control: Routine case management with workers with 24-48:1 caseload + move from shelter to permanent scattered site subsidized housing only after meeting the caseworker’s standards for housing readiness

Follow-up: 24 months

Percentage of time housed in the community (0-9 months): I

Percentage of time housed in the community (9-24 months): =

Mental health:

Children age 1.5-5: Internalizing problems: I Externalizing problems: I

Children age 6-10: Internalizing problems: = Externalizing problems: = Self-reported school troubles: I

Children age 11-16: Internalizing problems: = Externalizing problems: I Self-reported school troubles: I

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
Sosin 1995 Progressive Independence Model

Chicago

Persons experiencing homelessness (or recently homeless) completing short-term substance abuse treatment program

Enrolled: N=419

Intervention 1: n=96

Intervention 2: n=136

Comparison: n=187

Sex: 75% male

Age: mean 35 years

Race/ethnicity: black 90%

Homelessness: mean 26 months total homelessness over adult lifetime

Conditions: alcohol abuse 75%, drug abuse ~75%, mean 18 days alcohol/drug use in past 30 days

Intervention 1: Case management + assistance finding housing in the community

Intervention 2: Case management + provision of supported housing in independent apartments

Comparison: Usual care (referrals to substance abuse agencies and welfare offices)

Follow-up: 74% at 12 months

Days housed in past 60 days: I1>I2>C Days of alcohol use in past 30 days: I1 & I2

Days of drug use in past 30 days: I1 & I2

Culhane 2002 New York/New York (NY/NY) Housing Program

New York City

Intervention group: Persons experiencing homelessness with severe mental illness who received NY/NY intervention

Comparison group: Persons experiencing homelessness who did not receive intervention, matched to persons in intervention group on sex, race, age, indicators of mental illness and substance abuse, and pattern of previous service use.

Intervention group: N=4679 Matched pairs analyzed: n=3338 for days of shelter use (range n=294 to 570 for health care utilization outcomes)

Sex: N/A

Age: N/A

Race/ethnicity: N/A

Homelessness: N/A

Conditions: N/A

Intervention: NY/NY program placement, consisting of (1) independent housing linked to community-based or on-site service support or (2) community residence facilities (including long-term treatment facilities and group homes) providing on-site services, with participation mandated by the residence agreement.

Comparison: No NY/NY program placement

Follow-up: assessment of service utilization 100% at 2 years after placement (service utilization during this period was compared to the 2-year period before placement)

Days of homeless shelter use: I Inpatient days at: Hospitals (Medicaid): I Public hospitals (non-Medicaid): I VA hospitals: I State psychiatric hospitals: I

Outpatient visits and costs (Medicaid): I*

*Lower outpatient visits and costs were defined as better

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
References Site and Location Study Participants Interventions and Follow-up Housing Outcomes Health Care Utilization Outcomes Physical Health, Mental Health, Quality of Life Outcomes Substance Use, Incarceration, and Other Outcomes
Clark 2003 Pinellas County Program

Florida

Individuals with severe mental illness entering one of two service programs

Enrolled: N=152

Intervention 1: n=69

Intervention 2: n=83

Sex: 52% male

Age: mean 38 years

Race/ethnicity: white 77%, black 20% Hispanic 3%

Homelessness: history of homelessness 91%, homeless more than once 69%

Conditions: Axis I diagnosis 100%, psychotic disorder ~50%, mood disorder 45%

Intervention 1: Case management (outreach, counseling, medication management, housing assistance, linkage to other services)

Intervention 2: Case management as above + guaranteed access to housing and housing support services.

Follow-up: 58% at 12 months

Intervention 1: 36%

Intervention 2: 76%

Proportion of time in stable housing: =

Proportion of time in stable housing (in subgroup of subjects with high impairment at baseline): I2

Psychiatric symptoms: = Days of alcohol use in last 6 months: =

Days of illegal drug use in last 6 months: =

Siegel 2006 SAMHSA Study

New York City

Adults with severe mental illness who were experiencing homelessness or at high risk of homelessness and entered one of two housing programs

Enrolled: N=139

Intervention 1: n=67

Intervention 2: n=72

Sex: 65% male

Age: mean 41 years

Race/ethnicity: white 22%, black 39%, Hispanic 26%

Homelessness: N/A

Conditions: schizophrenia 40%, schizoaffective 26%, bipolar 16% major depression 18%, substance abuse 55%

Intervention 1: “Supported housing”: (A) scattered site apartments + ACT team services or (B) residential hotel with 30% of units for persons with mental illness + on-site case management

Intervention 2: “Community residences”: Single or shared rooms in buildings for persons with mental illness, with meal plan and common dining and meeting spaces, mandatory sobriety + case management services on site

Comparison group matched by propensity score

Follow-up: 18 months

Proportion of tenants remaining in initial housing placement: =

Housing satisfaction: I1

Use of crisis services: = Mental health: =

Quality of life: =

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
Martinez 2006 Canon Kip Community House & Lyric Hotel “Low-Demand” Program

San Francisco

Intervention group: Adults experiencing homelessness with qualifying disabilities (substance use disorder, mental illness and/or HIV/AIDS) who applied for supportive housing, received a random rank order, and received housing in the first year of the program

Comparison group: Adults experiencing homelessness with qualifying disabilities (substance use disorder, mental illness and/or HIV) who applied for supportive housing, received a random rank order, and received housing in the second year of the program (wait-list controls)

Enrolled in main study: N=236

Comparison conducted in subset of participants:

Intervention: n=100

Comparison: n=25

Data for main study participants (N=236):

Sex: 73% male

Age: mean 44 years

Race/ethnicity: white 32%, black 53%, Hispanic 8%, Native American 5%, Asian 2%

Homelessness: homeless >8 months at move-in 100%, documented homeless 2-8 years before move-in 59%

Conditions: substance use disorder + mental illness 75%, substance use disorder + HIV 16%, mental illness + HIV 2%, substance use disorder + mental illness+ HIV 5%, substance use disorder only 4%, mental illness only 5%

Intervention: Supportive housing at two single-site buildings (SRO units with rent subsidies) + on-site support services (including case management, psychiatric care, health care, and vocational training)

Comparison group: Usual care

Follow-up: 1 year

Any emergency department visit: I

Number of emergency department visits: I

Any inpatient admission: =

Number of inpatient days: =

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
References Site and Location Study Participants Interventions and Follow-up Housing Outcomes Health Care Utilization Outcomes Physical Health, Mental Health, Quality of Life Outcomes Substance Use, Incarceration, and Other Outcomes
Larimer 2009;
Collins 2013
Eastlake Housing First Program

Seattle

Adults experiencing chronic homelessness with severe alcohol problems and high costs for use of emergency services, sobering center, and jail

Enrolled: N=134

Intervention: n=95

Comparison: n=39

Sex: 94% male

Age: mean 48 years

Race/ethnicity: white 39%, black 10%, Hispanic 6%, American Indian/Alaska Native 28%

Homelessness: mean age 31 years when first became homeless, mean 2 periods of stable housing since first became homeless

Conditions: mean 16 times treated for alcohol abuse in lifetime

Intervention: Single-site housing program with meals provided and on-site health care services + on-site case managers. Residents not required to participate in treatment, and alcohol consumption allowed in residents’ rooms.

Comparison: Wait-listed individuals who were not housed prior to the 3-month assessment point

Follow-up: 100% at 6 months for cost-use analysis

Propensity scores were used in regression analyses to adjust for differences between groups

Nights of homeless shelter use: I Hospital contacts: =

Emergency medical service contacts: =

Detoxification days: =

Sobering center use: I*

*Lower use of sobering center was defined as better

Days incarcerated: =

Jail bookings: =

Total costs: I

Gilmer 2009 REACH Program

San Diego

Intervention group: Adults experiencing homelessness with serious mental illness who entered the REACH program

Comparison group: Adults experiencing homelessness with serious mental illness with demographic and clinical characteristics similar to REACH clients who were initiating services at the same time

Enrolled: N=338

Intervention: n=177

Comparison: n=161

Sex: 48% male

Age: mean 42 years

Intervention: Housing through transitional residential treatment program then SRO units and scattered-site apartments using Section 8 housing vouchers + ACT-team-based case management

Comparison: Usual care

Comparison group matched by propensity score

Follow-up: 1-2 years

Data provided on costs (not utilization):

Case management costs: I>C

Outpatient costs: =

Inpatient or emergency costs: I<C

Data provided on costs (not utilization):

Criminal justice system costs: I<C

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×

Race/ethnicity: white 58%, black 24%, Hispanic 11%, other 7%

Homelessness: N/A

Conditions: schizophrenia 53%, bipolar disorder 18%, major depression 20%, other psychotic disorder 4%

Gilmer 2010 Full Service Partnership (FSP) Program

San Diego

Intervention group: Adults experiencing homelessness with serious mental illness who entered the FSP program

Comparison group: Adults experiencing homelessness with serious mental illness with demographic and clinical characteristics similar to FSP clients who were initiating services at the same time

Enrolled: N=363

Intervention: n=209

Comparison: n=154

Sex: 63% male

Age: mean 44 years

Race/ethnicity: white 61%, black 25%, Hispanic 10%, other 5%

Homelessness: N/A

Conditions: schizophrenia 60%, bipolar disorder 25%, major depression 15%

Intervention: Subsidized permanent housing at scattered sites using Housing First model + ACT team supports

Comparison: Usual care

Comparison group matched by propensity score

Follow-up: 6 months – 1 year

Outpatient mental health service use: I

Inpatient service use: I

Emergency department use: I

Quality of life: I Justice system use: I
Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
References Site and Location Study Participants Interventions and Follow-up Housing Outcomes Health Care Utilization Outcomes Physical Health, Mental Health, Quality of Life Outcomes Substance Use, Incarceration, and Other Outcomes
Tsai 2010 Collaborative Initiative to Help End Chronic Homelessness (CICH)

Chattanooga, Chicago, Columbus, Denver, Fort Lauderdale, Los Angeles, Martinez, New York City, Philadelphia, Portland, San Francisco

Adults experiencing chronic homelessness (unaccompanied individuals with a disabling condition who had been continuously homeless for ≥1 year or had ≥4 episodes of homelessness in the past 3 years) entering CICH-funded homeless services in one of 11 cities

Enrolled: N=709

Intervention 1: n=131

Intervention 2: n=578

Sex: 76% male

Age: mean 46 years

Race/ethnicity: white 37%, black 49%, Hispanic 8%, Asian/Pacific Islander 5%

Homelessness: past year homeless 86%, mean days homeless in past 3 months 59 days

Conditions: schizophrenia 19%, bipolar disorder 19%, depression 29%, alcohol abuse/dependence 53%, drug abuse/dependence 53%

Intervention 1: Residential Treatment First (RTF), defined as participants who stayed in transitional/residential treatment for ≥2 weeks during the 3 months before or after entry into CICH

Intervention 2: Independent Housing First (IHF), defined as participants who had no days of transitional/residential treatment during the 3 months before or after entry into CICH

Follow-up: up to 2 years

Days in own place: =

Days homeless: =

Days hospitalized: = Psychiatric symptoms: =

Overall physical health: =

Overall mental health: =

Quality of life: =

Days incarcerated: I1

Alcohol use problems: =

Drug use problems: =

Hanratty 2011 Heading Home Hennepin Program

Minneapolis, Hennepin County

Intervention group: Individuals who had been homeless for ≥1 year or had ≥4 episodes of homelessness in the past 3 years, and with a disability that limited ability to work for ≥1 month

Comparison group: Individuals in public shelters at the same time as intervention group, but who were not placed into housing

Enrolled: N=528

Intervention: n=264

Comparison: n=264

Intervention: Housing First program with rent subsidies for housing in scattered site apartments + case management services

Comparison: Usual care

Comparison group matched by propensity score

Follow-up: 59% at 18 months

Public shelter use: I Mean number of arrests: I

Mean number of days in prisons or jails: I

Mean days of health insurance coverage: I

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×

Sex: 77% male

Age: mean 46 years

Race/ethnicity: N/A

Homelessness: mean shelter nights in past 3 years 156 nights

Conditions: N/A

Srebnik 2013 Begin at Home Program

Seattle

Intervention group: Adults experiencing chronic homelessness (unaccompanied individuals with a disabling condition who had been continuously homeless for ≥1 year or had ≥4 episodes of homelessness in the past 3 years) who were referred with ≥60 sobering center visits or ≥$10,000 inpatient paid claims within the past year

Comparison group: Individuals who met the above criteria but who did not enter the program

Enrolled: N=60

Intervention: n=29

Comparison: n=31

Sex: 72% male

Age: mean 51 years

Race/ethnicity: white 62%, black 17%, Hispanic 7%, American Indian/Alaska Native 14%

Homelessness: N/A

Conditions: N/A

Intervention: Single-site Housing First supportive housing program + on-site medical, psychiatric, substance use, and case management services

Comparison: Usual care

Follow-up: 1 year

Emergency department visits: I

Sobering center use: I

Number of hospital admissions: =

Number of hospital days: =

Number of jail bookings: =

Number of jail days: =

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×

REFERENCES FOR APPENDIX E

Adair, C. E., B. Kopp, J. Distasio, S. W. Hwang, J. Lavoie, S. Veldhuizen, J. Voronka, A. F. Kaufman, J. M. Somers, S. R. LeBlanc, S. Cote, S. Addorisio, D. Matte, and P. Goering. 2016. Housing Quality in a Randomized Controlled Trial of Housing First for Homeless Individuals with Mental Illness: Correlates and Associations with Outcomes. Journal of Urban Health 93(4):682-697.

Aubry, T., S. Tsemberis, C. E. Adair, S. Veldhuizen, D. Streiner, E. Latimer, J. Sareen, M. Patterson, K. McGarvey, B. Kopp, C. Hume, and P. Goering. 2015. One-year outcomes of a randomized controlled trial of housing first with ACT in five Canadian cities. Psychiatric Services 66(5):463-469.

Aubry, T., P. Goering, S. Veldhuizen, C. E. Adair, J. Bourque, J. Distasio, E. Latimer, V. Stergiopoulos, J. Somers, D. L. Streiner, and S. Tsemberis. 2016. A Multiple-City RCT of Housing First With Assertive Community Treatment for Homeless Canadians With Serious Mental Illness. Psychiatric Services 67(3):275-278.

Basu, A., R. Kee, D. Buchanan, and L. S. Sadowski. 2012. Comparative cost analysis of housing and case management program for chronically ill homeless adults compared to usual care. Health Services Research 47(1 Part 2):523-543.

Buchanan, D., R. Kee, L. S. Sadowski and D. Garcia. 2009. The health impact of supportive housing for HIV-positive homeless patients: a randomized controlled trial. American Journal of Public Health 99 (Suppl 3):S675-680

Cheng, A. L., H. Q. Lin, W. Kasprow, and R. A. Rosenheck. 2007. Impact of supported housing on clinical outcomes - Analysis of a randomized trial using multiple imputation technique. Journal of Nervous and Mental Disease 195(1):83-88.

Clark, C., and A. R. Rich. 2003. Outcomes of homeless adults with mental illness in a housing program and in case management only. Psychiatric Services 54(1):78-83.

Collins, S. E., D. K. Malone, and S. L. Clifasefi. 2013. Housing Retention in Single-Site Housing First for Chronically Homeless Individuals With Severe Alcohol Problems. American Journal of Public Health 103(S2):S269-S274.

Culhane, D. P., S. Metraus, and T. Hardley. 2002. Public service reductions associated with placement of homeless persons with severe mental illness in supportive housing. Housing Policy Debates 13(1):107-163.

Dickey, B., O. Gonzalez, E. Latimer, K. Powers, R. Schutt, and S. Goldfinger. 1996. Use of mental health services by formerly homeless adults residing in group and independent housing. Psychiatric Services 47:152-158.

Gilmer, T. P., W. G. Manning, and S. L. Ettner. 2009. A cost analysis of San Diego County’s REACH program for homeless persons. Psychiatric Services 60(4):445-450

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×

Gilmer, T. P., A. Stefancic, S. L. Ettner, W. G. Manning and S. Tsemberis. 2010. Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness. Archives of General Psychiatry 67(6):645-652.

Goldfinger, S. M., R. K. Schutt, G. S. Tolomiczenko, L. Seidman, W. E. Penk, W. Turner, and B. Caplan. 1999. Housing placement and subsequent days homeless among formerly homeless adults with mental illness. Psychiatric Services 50:674-679.

Gulcur, L., A. Stefancic, M. Shinn, S. Tsemberis, and S. N. Fischer. 2003. Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities participating in continuum of care and housing first programmes. Journal of Community & Applied Social Psychology 13(2):171-186.

Hanratty, M. 2011. Impacts of Heading Home Hennepin’s Housing First programs for long-term homeless adults. Housing Policy Debate 21(3):405-419.

Hurlburt, M. S., P. A. Wood, and R. L. Hough. 1996. Providing independent housing for the homeless mentally ill: A novel approach to evaluating long-term longitudinal housing patterns. Journal of Community Psychology 24(3):291-310.

Kidder, D. P., R. J. Wolitski, S. Royal, A. Aidala, C. Courtenay-Quirk, D. R. Holtgrave, D. Harre, E. Sumartojo, and R. Stall. 2007. Access to housing as a structural intervention for homeless and unstably housed people living with HIV: rationale, methods, and implementation of the housing and health study. AIDS and Behavior 11(6 Suppl):149-161.

Kozloff, N., C. E. Adau, L. P. Lazgare, D. Parenski, A. H. Cheung, R. Sandu, and V. Stergiopoulos. 2016. Housing First” for homeless youth with mental illness. Pediatrics 138(4):1-10.

Larimer, M. E., D. K. Malone, M. D. Garner, D. C. Atkins, B. Burlingham, H. S. Lonczak, K. Tanzer, J. Ginzler, S. L. Clifasefi, W. G. Hobson, and G. A. Marlatt. 2009. Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. The Journal of the American Medical Association 301(13):1349-1357.

Lipton, F. R., S. Nutt, and A. Sabatini. 1988. Housing the homeless mentally ill: a longitudinal study of a treatment approach. Hospital & Community Psychiatry 39(1):40-45.

Martinez, T. E., and M. R. Burt. 2006. Impact of permanent supportive housing on the use of acute care health services by homeless adults. Psychiatric Services 57(7):992-999.

McHugo, G. J., R. R. Bebout, M. Harris, S. Cleghorn, G. Herring, H. Xie, D. Becker, and R. E. Drake. 2004. A randomized controlled trial of integrated versus parallel housing services for homeless adults with severe mental illness. Schizophrenia Bulletin 30(4):969-982.

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×

Padgett, D. K., L. Gulcur, and S. Tsemberis. 2006. Housing First Services for People Who Are Homeless With Co-Occurring Serious Mental Illness and Substance Abuse. Research on Social Work Practice 16(1):74-83.

Rosenheck, R., W. Kasprow, L. Frisman, and W. Liu-Mares. 2003. Cost-effectiveness of supported housing for homeless persons with mental illness. Archives of General Psychiatry 60(9):940-951.

Sadowski, L. S., R. A. Kee, T. J. VanderWeele, and D. Buchanan. 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.

Samuels, J., P. J. Fowler, A. Ault-Brutus, D. Tang, and K. Marcal. 2015. Time-limited case management for homeless mothers with mental health problems: Effects on maternal mental health. Journal of the Society for Social Work & Research 6(4):515-539.

Seidman, L. J., R. K. Schutt, B. Caplan, G. S. Tolomiczenko, W. M. Turner, and S. M. Goldfinger. 2003. The effect of housing interventions on neuropsychological functioning among homeless persons with mental illness. Psychiatric Services 54(6):905-908.

Siegel, C. E., J. Samuels, D. I. Tang, I. Berg, K. Jones, and K. Hopper. 2006. Tenant outcomes in supported housing and community residences in New York City. Psychiatric Services 57(7):982-991.

Shinn, M., J. Samuels, S. N. Fischer, A. Thompkins, and P. J. Fowler. 2015. Longitudinal impact of a Family Critical Time Intervention on children in high-risk families experiencing homelessness: A randomized trial. American Journal of Community Psychology 56:205-216.

Somers, J. M., A. Moniruzzaman, M. Patterson, et al. 2017. A Randomized Trial Examining Housing First in Congregate and Scattered Site Formats. PLoS One 12(1):e0168745.

Somers, J. M., A. Moniruzzaman, and A. Palepu. 2015. Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care. Addiction 110(10):1605-1614.

Sosin, M. R., M. Bruni, and M. Reidy. 1995. Paths and impacts in the progressive independence model: a homelessness and substance abuse intervention in Chicago. Journal of Addictive Diseases 14(4):1-20.

Srebnik, D., T. Connor, and L. Sylla. 2013. A pilot study of the impact of Housing First-supported housing for intensive users of medical hospitalization and sobering services. American Journal of Public Health 103(2):316-321.

Stergiopoulos, V., S. W. Hwang, A. Gozdzik, R. Nisenbaum, E. Latimer, D. Rabouin, C. E. Adair, J. Bourque, J. Connelly, J. Frankish, L. Y. Katz, K. Mason, V. Misir, K. O’Brien, J. Sareen, C. G. Schütz, A. Singer, D. L. Streiner, H-M. Vasiliadis, and P. N. Goering. 2015. Effect of scattered site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: A randomized trial. The Journal of the American Medical Association 313(9):905-915.

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×

Tsai, J., A. S. Mares, and R. A. Rosenheck. 2010. A multisite comparison of supported housing for chronically homeless adults: “Housing first” versus “residential treatment first.” Psychological Services 7(4): 219-232.

Tsemberis, S., L. Gulcur, and M. Nakae. 2004. Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health 94(4):651-656.

Wolitski, R. J., D. P. Kidder, S. L. Pals, S. Royal, A. Aidala, R. Stall, D. R. Holtgrave, D. Harre, and C. Courtenay-Quirk. 2010. Randomized trial of the effects of housing assistance on the health and risk behaviors of homeless and unstably housed people living with HIV. AIDS and Behavior 14(3):493-503.

Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Suggested Citation:"Appendix E Studies of Effectiveness of Permanent Supportive Housing." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness Get This Book
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Chronic homelessness is a highly complex social problem of national importance. The problem has elicited a variety of societal and public policy responses over the years, concomitant with fluctuations in the economy and changes in the demographics of and attitudes toward poor and disenfranchised citizens. In recent decades, federal agencies, nonprofit organizations, and the philanthropic community have worked hard to develop and implement programs to solve the challenges of homelessness, and progress has been made. However, much more remains to be done. Importantly, the results of various efforts, and especially the efforts to reduce homelessness among veterans in recent years, have shown that the problem of homelessness can be successfully addressed.

Although a number of programs have been developed to meet the needs of persons experiencing homelessness, this report focuses on one particular type of intervention: permanent supportive housing (PSH). Permanent Supportive Housing focuses on the impact of PSH on health care outcomes and its cost-effectiveness. The report also addresses policy and program barriers that affect the ability to bring the PSH and other housing models to scale to address housing and health care needs.

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