Abstract
: Individuals experiencing chronic homelessness are highly marginalized and frequently access acute healthcare services. This program evaluation used secondary data collected from adults experiencing chronic homelessness (n=133) who participated in a Housing First program offering in-home behavioral health services within a large Midwestern city. Participant demographics (e.g., gender, race, age) and data on health factors (e.g., substance misuse and mental health symptoms, and ER visits and inpatient hospitalizations) were collected at program enrollment and at 6-month and 12-month follow-ups. High proportions of missing data led the evaluators to exclude 12-month follow-up and in-home behavioral health data from the analyses. Neither inpatient nights nor ER visits changed significantly between enrollment and 6-months. Males were disproportionately hospitalized throughout the study, suggesting a need for gender-targeted services. Higher rates of hospitalization among African Americans at enrollment subsided by follow-up. Future evaluation should examine if in-home behavioral health services reduced racial health disparities. Acute care use was low overall, likely because of the stabilizing impact of housing. Data limitations suggest a need for more robust study designs to identify causal factors and to enrich our understanding of the role of behavioral health intervention within the Housing First paradigm. Results underscore the importance of using empirically-supported assessment tools to evaluate consumers' individualized needs and responsively allocate supportive services.
Highlights
Individuals experiencing chronic homelessness are highly marginalized and frequently access acute healthcare services
This study aimed to address this gap by evaluating outcomes from a novel in-home behavioral health program for Housing First residents with chronic health conditions
This evaluation examined data from Access to Wellness (ATW), an evidence-based, in-home behavioral health program developed by the AIDS Foundation of Chicago and funded by the Substance Abuse and Mental Health Services Administration (SAMHSA)
Summary
Individuals experiencing chronic homelessness are highly marginalized and frequently access acute healthcare services. This program evaluation used secondary data collected from adults experiencing chronic homelessness (n=133) who participated in a Housing First program offering in-home behavioral health services within a large Midwestern city. Under HUD's current definition, individuals considered chronically homeless must possess a disabling mental or physical health condition and experience either a continuous period of homelessness exceeding one year, or four or more discrete episodes of homelessness in the preceding three years, totaling 12 months or more (U.S Department of Housing and Urban Development, 2015). Compared to usual care (outpatient mental health and substance misuse services, sobering services, and shelters), Housing First recipients spend less time homeless or psychiatrically hospitalized (Brown et al, 2016). Several landmark studies challenge the assumptions inherent to treatmentcontingent (Continuum of Care) models, with treatment-non-contingent (Housing First) program participants demonstrating either comparable or reduced mental health and substance misuse severity relative to Continuum of Care participants (Groton, 2013), as measured by the Addiction Severity Index (McLellan et al, 1980), Colorado Symptom Index (Boothroyd & Chen, 2008), Alcohol Use Quantity Form (Sobell & Sobell, 1992), Short Inventory of Problems (Blanchard et al, 2003), DSM-IV Alcohol Dependence
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