Panel: The Integration of Supportive Housing and Health Services: Building Evidence for Improved Housing Stability and Health Among Frequent Users of Shelter, Hospital, and Criminal Justice Systems

Saturday, November 9, 2019: 10:15 AM-11:45 AM
I.M Pei Tower: Majestic Level, Majestic Ballroom (Sheraton Denver Downtown)

*Names in bold indicate Presenter

Organizer:  Edith Yang, MDRC
Panel Chair:  Kate Marple-Cantrell, The Cloudburst Group
Discussant:  Ed Stellon, Heartland Alliance Health

For the past 15 years, the “Housing First” approach to addressing homelessness has demonstrated increased housing stability, particularly among people experiencing chronic homelessness. Housing First prioritizes placing people into permanent supportive housing, with no treatment or sobriety conditions for staying in housing. Once housed, residents have access to wraparound services and can decide whether and when to access the supportive services and treatment plans that are available to them. Despite the evidence that Housing First has produced in housing stability, supportive housing programs have yet to show treatment effects for people with substance use disorder. To date, there is limited research focused on Housing First and substance use outcomes. Meanwhile, the past decade has seen the rise of an opioid epidemic that has led to a surge in the unsheltered homeless population, and little is known about whether or how homeless people with opioid use disorder are connecting to housing or getting effective treatment.

This panel features two studies that approach these housing and health needs in different ways. The evaluation of the Denver Supportive Housing Social Impact Bond Initiative is a randomized control trial of supportive housing in Denver. The program is targeted to residents experiencing homelessness and frequent arrests and jail stays, the majority of whom also have psychiatric and/or substance use disorder diagnoses. To better understand the impact of supportive housing on health, the evaluation uses Medicaid claims and jail health records to compare health services and the coordination of care for individuals experiencing a jail-homelessness cycle and those seeking stability in supportive housing.

HomePath is a feasibility study that is piloting an enhanced Housing First model, combining permanent supportive housing with shared medical appointments for people with substance use disorder. Shared medical appointments combine medical treatment, behavioral health treatment, and social work help in weekly group visits. The treatment model is a promising way to save costs and reduce patient wait times by allowing clinicians to treat many patients at once, to reduce the isolation that newly housed residents often feel, and to improve patient care by promoting accountability among the clinicians and practitioners at the appointments.

The first paper examines health care services in Denver jails and how they are coordinated with Medicaid-covered services as people cycle between jail and the community. It also provides a qualitative look at how stability in supportive housing may improve access to care, support a shift to more appropriate health services, and increase coordination of care.

The second paper describes how HomePath operationalized connections between local Continuums of Care, an array of supportive housing providers and housing case managers, and clinical providers to provide coordinated care for those with substance use disorder in Chicago, IL, Philadelphia, PA, and Richmond, VA.

The third paper describes the evolution of the HomePath research design, early findings on housing services, connections to clinical care, and treatment retention, and next steps in scaling up the pilot study.

The Emerging Crisis of Aged Homelessness in New York City: Could Housing Solutions be Funded By Avoidance of Excess Shelter, Hospital, and Nursing Home Costs?
Dennis Culhane1, Dan Treglia1, Kelly Doran2, Randall Kuhn3, Eileen Johns4, Maryanne Schretzman4, Stephen Metraux5 and Thomas Byrne6, (1)University of Pennsylvania, (2)New York University, (3)University of California, Los Angeles, (4)New York City Office of the Deputy Mayor for Health & Human Services, (5)University of Delaware, (6)Boston University

Evolving Housing First + Health Care Coordination with Shared Medical Appointments
Jamie Taylor, LeSar Development Consultants, Cheryl Ho, Valley Homeless Healthcare Program, Ed Stellon, Heartland Alliance Health, Kate Marple-Cantrell, The Cloudburst Group and Lara Weinstein, Pathways to Housing Philadelphia

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