Panel Paper: Designing the Homepath Study: Lessons from Piloting an Enhanced Housing First Treatment Model for Homeless Individuals with Substance Use Disorder

Saturday, November 9, 2019
I.M Pei Tower: Majestic Level, Majestic Ballroom (Sheraton Denver Downtown)

*Names in bold indicate Presenter

Edith Yang, MDRC

The recent opioid epidemic has led to a sharp increase in the unsheltered homeless population across the country, and the housing field has not found a consistently effective approach to treating substance use disorder among its most vulnerable residents. The goal of the HomePath study is to build evidence on a scalable treatment model of Housing First and shared medical appointments. Ultimately, the study aims to evaluate whether HomePath can increase housing stability and treatment retention for substance use disorder and reduce use of shelter, hospital, and criminal justice systems.

MDRC is conducting the HomePath feasibility study in Chicago, Illinois; Philadelphia, Pennsylvania; and Richmond, Virginia. The study will assess whether conducting a rigorous, full-scale evaluation of Housing First with shared medical appointments is possible. To do this, MDRC is assessing:

  • the viability of recruiting enough sample members to have the statistical power necessary for a rigorous full-scale evaluation;
  • whether the treatment contrast (that is, differences in services received) between the program and control groups is large enough to warrant further testing for program effects; and
  • whether reliable outcome data can be collected using administrative data sources.

In Philadelphia and Richmond, the study will examine only the implementation of the program. In Chicago, MDRC is piloting a natural experiment design, taking advantage of the inherent randomness of the permanent supportive housing match process through the city’s coordinated entry system for housing. Study participants matched to Housing First providers are in the program group, and those matched to other housing providers are in the control group. MDRC is collecting Homeless Management Information System data from the City of Chicago and clinic data from Heartland Alliance Health for the feasibility study.

This presentation offers an early look at lessons and findings from the HomePath feasibility study. The paper will provide an overview of the theory of change for the treatment model. It will address sample recruitment and buildup, and strengths and challenges in engaging patients in the shared medical appointments across the three jurisdictions. For the Chicago pilot, the paper will provide additional information on the research design process, on whether the treatment model appears to be increasing connections to housing and health services, and on whether available administrative data can capture adequate estimates of longer-term housing stability, health, and healthcare outcomes that HomePath hopes to improve. The paper will also outline recommendations and next steps for scaling up the HomePath evaluation.