Association for Public Policy Analysis & Management

Housing instability is associated with emergency department (ED) visits and hospitalizations that might have been prevented with proper primary care. Supportive housing reduces preventable care for single homeless adults; however, the evidence is limited for homeless families due to the lack of longitudinal data. In addition, housing stability was measured by self-reported data or single housing events in previous studies, which might have limited construct validity. In this evaluation, we used administrative data matched across several public service domains to test whether a supportive housing program in New York City improves housing stability and reduces preventable care for heads of homeless families that have mental illness, substance use disorder, or physical disabilities. We obtained data for eligible 926 applicants during 2007-2012. Of these, 300 were placed in supportive housing (‘treatment group’); 626 were not placed in supportive housing (‘comparison group’). Sequence analysis identified 4 housing stability patterns based on duration and order of housing, incarceration, and hospitalization events in 2 years after baseline (i.e., housing eligibility date). Of these patterns, we defined persistent supportive housing placement for ≥75% of 2 years post-baseline as a stable housing pattern. Additional outcomes were ED visits and hospitalizations post-baseline due to ambulatory care sensitive conditions such as asthma, congestive heart failure, diabetes, hypertension, and tuberculosis. Imbalance in baseline characteristics between treatment and comparison groups were addressed via propensity score weighting, and marginal structural models were used to assess the program impact on housing stability and preventable care. Most 926 eligible heads of homeless families were women and aged 35 years on average. Most were placed in homeless shelters during 1 year prior to baseline. After controlling for differences in baseline characteristics between the treatment and comparison groups, 87% percent of supportive housing tenants experienced housing stability in 2 years post-baseline. In contrast, 1% of the comparison group followed the housing stability pattern. Along with improved housing stability, the supportive housing placement was also associated with reduced preventable ED visits when stratified by housing pattern. Compared with unstably-housed heads of families in the comparison group, those in the treatment group were 0.60 times as likely to make preventable ED visits post-baseline (95% CI = 0.38, 0.96). This evaluation demonstrates that a supportive housing program in New York City was associated with improved housing stability and also reduced preventable care for homeless persons with families. These findings provide important evidence for the continuation and expansion of supportive housing programs for homeless families.