The Corporation for National and Community Service Posts Evaluation of CSH’s Social Innovation Fund
Homelessness among the chronically ill drives significantly higher health care costs and exacerbates chronic illnesses by increasing exposure to trauma and high-risk behaviors.
CSH led a five-year national demonstration to create and evaluate supportive housing for healthcare’s highest need, highest cost beneficiaries experiencing homelessness. The evaluation examines the theory that when individuals with significant health costs experiencing homelessness have access to affordable housing and wraparound services, they will experience increased housing stability and improved health, and decrease the use of costly, crisis health care services.
Participating sites provided affordable, stable housing and case management to improve connections to health care services, improve health outcomes, and reduce health care costs. Sites differed in terms of population size, type of jurisdiction, housing market, and policy landscape. A research team at New York University conducted an implementation evaluation that included site visits, a pre-post participant survey, a cost effectiveness study, and analyses of program impacts using a randomized controlled trial (RCT) design and intent to treat (ITT) analyses and a quasi-experimental design with a treatment on the treated (TOT) approach.
Overall, the evaluation found that these programs can reduce utilization of shelters and costly health care in some populations, and these reductions can substantially offset program costs. The findings from the impact and cost analysis were mixed, but reflect the impact of variations in state and local regulations, services, and homeless populations.
It is possible to develop and deliver a medically-oriented supportive housing program targeted at homeless individuals who are high utilizers of health care using a data-driven approach. CSH is working to increase access to supportive housing for high need populations and embed supportive housing as a health care solution.