Impact of a supported housing prioritization system using vulnerability and high service utilization

ABSTRACT

For people experiencing chronic homelessness, supportive housing with intensive social, health, and behavioral health services reduces the likelihood of re-entering homelessness and the public costs of associated acute medical care, shelter use, and incarceration. Due to a limited supply of supportive housing, it must be allocated to those most in need. This paper examines findings from a unique, region-wide method for prioritizing individuals for supportive housing based on utilization of high-cost public services and vulnerability if left on the street. A sample of 196 individuals were prioritized for housing based on this method, while a comparison group of 102 were housed not using the method. Results showed that those housed under the prioritization method achieved greater reductions in utilization of high-cost public services, but were also less likely to have positive dispositions when exiting the housing programs, suggesting the need for a greater intensity of supports and/or multiple “doses” of supportive housing before stability can be expected. The method described in the paper can provide a starting point for developing regional, comprehensive systems of coordinated, prioritized entry into supportive housing, such as those now required by US Department of Housing and Urban Development.

KEYWORDS:

• Homeless
• supported housing
• homeless housing
• chronic homelessness
• housing policy

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Dr. Srebnik has over 20 years of program evaluation experience and has served as a program evaluator for King County’s Behavioral Health and Recovery Division since 2003. She has conducted program and system-level evaluations related to behavioral health, criminal justice, and housing services. She is also a Clinical Associate Professor within the University of Washington, Department of Psychiatry and Behavioral Sciences. In that capacity she has conducted clinical and services research, and worked with state and local human services departments to develop outcome indicators and performance metrics.

Laurie Sylla manages the work of King County’s Behavioral Health and Recovery Division, System Performance and Evaluation section. She oversees program evaluation and quality improvement initiatives that span behavioral health, housing, health, and criminal justice service sectors. In addition, she is involved in development and evaluation of system-level quality improvement projects and performance metrics.

Marla Hoffman serves as a statistician for King County’s Behavioral Health and Recovery Division. She conducts statistical analyses and provides other technical support for specific staff and external projects and investigates system-wide performance, including clinical care issues: She plans, designs, and executes analysis projects focused on system-wide issue and collaborates with others regarding data management, data development, and maintaining data integrity.

René Franzen has worked for King County Behavioral Health and Recovery Division since 2008. She has more than 30 years of experience in health care, with emphasis in mental health, and in the past 5 years, with housing and homelessness. Her responsibilities for King County include design of a high utilizer database and development of a scoring system to prioritize individuals who frequently use public safety systems and/or are vulnerable.

ORCID

L. Sylla http://orcid.org/0000-0002-3746-7267

M. Hoffman http://orcid.org/0000-0001-6911-6384

R. Franzen http://orcid.org/0000-0002-9590-9924

Additional information

Funding

This work was supported by King County Department of Community and Human Services.