National Academies Releases Report on Supportive Housing

CSH welcomes the observations of the National Academies and their affirmation that supportive housing is a solution for ending chronic homelessness. Their report today reflects much of what we already know: Supportive housing is a stabilizing force that can improve the lives of those who face multiple challenges and complex issues such as debilitating medical illness, mental health recovery, substance use and other barriers to independence, wellness and economic sufficiency. Like the National Academies, CSH is firmly on record supporting more robust, thorough and evidence-based examinations of the impacts supportive housing has on individual health outcomes, systems performance and cost savings. Another federal agency, the Corporation for National and Community Service (CNCS), worked with CSH much earlier this year to release the evaluation of a far-reaching national effort to scrutinize supportive housing and such effects. This evaluation was conducted by a research team at New York University from 2012-2017 and had three components: an implementation evaluation that included site visits; 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. This evaluation is significant because it is the first major national study on these subject matters to rely on the RCT design, ITT and TOT. It intentionally sought to address the limited scope of prior research studies regarding supportive housing offsets to health care and other public expenditures. The focus of the evaluation included the practicality of identifying and serving high-utilization, medically-needy homeless individuals and focused on whether supportive housing could reduce healthcare utilization, as well as use of shelters and jail time; and if such reductions in costs could offset the cost of supportive housing. Overall, the evaluation found supportive housing can reduce utilization of shelters and costly health care in some populations, and these reductions can substantially offset supportive housing costs. While, on average, supportive housing was associated with reduced costs and utilization at some sites, and improvements in self-reported quality of life and access to care across sites were demonstrated, many residents were still experiencing deep and complex health problems one year into their housing. These results led us to call for even more in-depth evaluations of supportive housing impacts, emphasizing uniform measurements of health care outcomes and costs going beyond study timeframes that have been too limiting and simply do not reflect reality. We are gratified the National Academies have joined with us in calling for additional studies that rely more on scientifically-accepted approaches, such as RCT, and examine supportive housing residents over longer periods of time to produce data and evidence we are confident will continue to prove supportive housing works.

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