Research Methods in Social Work

Medical and Emergency MedicalUse by People ExperiencingHomelessness before and afterPlacement in SupportiveHousing

James Petrovich, PhD, LMSW

TCU Department of Social Work

Kwynn Gonzalez-Pons, BS

UNTHSC Department of Behavioral and Community Health

Emily Spence-Almaguer, PhD, MSW

UNTHSC Department of Behavioral and Community Health

Subhash Aryal, PhD

UNTHSC Department of Biostatistics and Epidemiology

Joel Hunt, PA

JPS Health Network Care Connections

Presenter DisclosurePresenter Disclosure

The following personal financial relationships withcommercial interests relevant to this presentationexisted during the past 12 months:

No Relationships to Disclose

This StudyThis Study

Assessed use of services in the 18 month periodsbefore and after provision of supportive housing

ED, Inpatient, outpatient clinic, urgent care, psychED

Examined service charges accrued before andafter housing

A component of the larger evaluation ofDirections Home (directionshome.org)

Provide a perspective on community-levelimpacts of supportive housing

Directions HomeDirections Home

Fort Worth’s ten-year plan to make homelessnessrare, short-term, and non-recurring

Included housing, supportive services, outreach,employment training, and more

Plan adopted in 2008

Programs initiated 2009

Funded at 2.9 million

Largest program – permanent supportive housing

200 PSH units funded

Justified based on the costs of reacting tohomelessness

Research QuestionsResearch Questions

Does the use of health care serviceschange after placement in DirectionsHome supportive housing?

If service use changes are observed, whatare the accompanying fiscal costs /savings of these changes?

MethodsMethods

Purposive sample of 100 individuals residing inDirections Home housing

Out of 154 housed during PY I

Completed demographics questionnaire

Obtained homelessness-related informationfrom local HMIS

Obtained official health care records fromJohn Peter Smith Health Network

SampleSample

100 individuals enrolled in the study

61 males / 39 females

Mean age 51 years old

Almost two-thirds (62%) African-American

3% Hispanic

Mean homelessness 5.8 years

Mean income $687 per month

65 (65%) reported no income

SampleSample

52%

26%

82%

Percentreporting highschool diploma,GED, somecollege

5 peoplereportedmilitaryservice

Percent SSIor SSDI

Percentreporting JPS asprimary sourceof health care

Self-Reported Health ConditionsSelf-Reported Health Conditions

Based on the Vulnerability Index

Self-Reported Behavioral HealthConditionsSelf-Reported Behavioral HealthConditions

72% report a substance abuse problem

68% report receiving mental healthtreatment

54% report receiving substance abusetreatment

31% report injection drug use

18% report being committed for mentalhealth care

Healthcare System Use Healthcare System Use

Healthcare System Use Healthcare System Use

Healthcare ChargesHealthcare Charges

40%Reduction

40%Reduction

M=$26,456

M=$15,907

OutliersOutliers

$1,103,812

N=5

42% of allpre-housingcharges

$1,103,812

N=5

42% of allpre-housingcharges

$605,187

N=5

$38% of allpost-housingcharges

10%

$435,458N=1

Both Pre and Post Housing

Pre-Housing

Post-Housing

Healthcare Service charges – OutliersRemovedHealthcare Service charges – OutliersRemoved

Summary: Service UseSummary: Service Use

Service use changes after housing

Service reductions observed for:

◦ED use (60%)

◦Inpatient admissions (53%)

◦Psychiatric Ed (40%)

◦Urgent care (30%)

◦Overall JPS (24%)

◦Outpatient clinic visits (7%)

Summary: Service ChargesSummary: Service Charges

Total charges accrued post-housingdecreased by $1,044,391(40%)

Mean post-housing charges decreased by$10,549 (40%)

With outliers removed, total chargesdecreased by $545,768 (36%)

Mean post-housing charges decreased by$5,806 (36%)

Cost Offset?Cost Offset?

Cost of Directions Home Housing:

◦Total = $397,500 ($3,975 x 100)

◦Rent = $1,078,200 ($10,782 x 18)

Total program cost = $1,475,700

Service charge reduction = $1,044,391

Net change = +431,309

Net Change= +431,309

(healthcare + housing + services)

Patients diagnosed with chronicconditions increased after housingPatients diagnosed with chronicconditions increased after housing

+100%

+53%

+88%

+26%

+50%

Implications: PolicyImplications: Policy

Services for people who are homeless arecontested

However, Homelessness stresses larger publicservice systems

It is important to understand howinterventions may impact these systems

Study adds to existing knowledge base

Informs local decision making aroundsupportive housing

Implications: PracticeImplications: Practice

Improved screening for chronic healthconditions

Identify and support “frequent-flyers”

Improved, integrated health-care

Facilitate linkage to primary / preventativecare

Support housing placement

Support housing retention

Implications: Future ResearchImplications: Future Research

Much more to be examined

Preliminary examination of diagnosticdata

Outliers?

Additional service use measurements (24,36….)

Predictors of service use?

LimitationsLimitations

Non-probability sampling approach (100/154)

Participants scored high on VI so notconsidered representative of general homelesspopulation

Unable to control for extraneous variablesimpacting service use

Charges typically inflated but true costs notavailable

Only obtained data from JPS, other providersnot included

Questions / Comments?Questions / Comments?