A randomized trial of permanent supportive housing for chronically homeless persons with high use of publicly funded services

Raven, Maria C.; Niedzwiecki, Matthew J.; Kushel, Margot

doi:10.1111/1475-6773.13553

Cited by 50 publications

(104 citation statements)

References 25 publications

(28 reference statements)

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“…A study of an HF intervention in four French cities among high-need participants similarly found no significant effects on hospitalization or ED visits, but reduced inpatient days [26]. Another a= Based on the DSM-IV criteria using the Mini International Neuropsychiatric Interview [MINI] version 6.0, c=Absolute numbers less than six have been suppressed to reduce the risk of identification randomized study of the effects of permanent supportive housing for chronically homeless high users of multiple systems in Santa Clara County, California (USA) found no effects on ED or inpatient care use [27].…”

Section: Discussionmentioning

confidence: 99%

“…A study of an HF intervention in four French cities among high-need participants similarly found no significant effects on hospitalization or ED visits, but reduced inpatient days [ 26 ]. Another randomized study of the effects of permanent supportive housing for chronically homeless high users of multiple systems in Santa Clara County, California (USA) found no effects on ED or inpatient care use [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

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The Effect of a Housing First Intervention on Acute Health Care Utilization among Homeless Adults with Mental Illness: Long-term Outcomes of the At Home/Chez-Soi Randomized Pragmatic Trial

et al. 2021

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We assessed the effects of the Toronto Site Housing First (HF) intervention on hospitalizations and emergency department (ED) visits among homeless adults with mental illness over 7 years of follow-up. The Toronto Site is part of an unblinded multi-site randomized pragmatic trial of HF for homeless adults with mental illness in Canada, which followed participants up to 7 years. Five hundred seventy-five participants were recruited and classified as having high (HN) or moderate need (MN) for mental health support services. Each group was randomized into intervention (HF) and treatment as usual groups, and 567 (98.6%) consented to link their data to health administrative databases. HF participants received a monthly rent supplement of $600 (Canadian) and assertive community treatment (ACT) support or intensive care management (ICM) support based on need level. Treatment as usual (TAU) participants had access to social, housing, and health services generally available in the community. Outcomes included all-cause and mental health-specific hospitalization, number of days in hospital, and ED visit. We used GEE models to estimate ratio of rate ratios (RRR). The results showed HF with ACT had no significant effect on hospitalization rates among HN participants, but reduced the number of days in hospital (RRR = 0.32, 95% CI 0.16-0.63) and number of ED visits (RRR = 0.57, 95% CI 0.34-0.95). HF with ICM resulted in an increase in the number of hospitalizations (RRR = 1.69, 95% CI 1.09-2.60) and ED visit rates (RRR = 1.42, 95% CI 1.01-2.01) but had no effect in days in hospital for MN participants. Addressing the health needs of this population and reducing acute care utilization remain system priorities. Trial registration: http://www.isrctn.com/identifier: ISRCTN42520374

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Section: Discussionmentioning

confidence: 99%

“…A study of an HF intervention in four French cities among high-need participants similarly found no significant effects on hospitalization or ED visits, but reduced inpatient days [ 26 ]. Another randomized study of the effects of permanent supportive housing for chronically homeless high users of multiple systems in Santa Clara County, California (USA) found no effects on ED or inpatient care use [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

The Effect of a Housing First Intervention on Acute Health Care Utilization among Homeless Adults with Mental Illness: Long-term Outcomes of the At Home/Chez-Soi Randomized Pragmatic Trial

et al. 2021

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“…This may have been explained by police having an increased ability to serve outstanding warrants to people upon rehousing. 61 Given the high rates of substance use, expansion of substance use treatment programs might reduce older homeless adults’ risk of incarceration. Among all variables that we tested, parole and probation (community supervision) had the highest hazard ratio.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Incarceration in Older Adults Experiencing Homelessness: Results from the HOPE HOME Study

et al. 2021

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Background In the US, the median age of adults experiencing homelessness and incarceration is increasing. Little is known about risk factors for incarceration among older adults experiencing homelessness. To develop targeted interventions, there is a need to understand their risk factors for incarceration. Objective To examine the prevalence and risk factors associated with incarceration in a cohort of older adults experiencing homelessness. Design Prospective, longitudinal cohort study with interviews every 6 months for a median of 5.8 years. Participants We recruited adults ≥50 years old and homeless at baseline (n=433) via population-based sampling. Main Measures Our dependent variable was incident incarceration, defined as one night in jail or prison per 6-month follow-up period after study enrollment. Independent variables included socioeconomic status, social, health, housing, and prior criminal justice involvement. Key Results Participants had a median age of 58 years and were predominantly men (75%) and Black (80%). Seventy percent had at least one chronic medical condition, 12% reported heavy drinking, and 38% endorsed moderate-severe use of cocaine, 8% of amphetamines, and 7% of opioids. At baseline, 84% reported a lifetime history of jail stays; 37% reported prior prison stays. During follow-up, 23% spent time in jail or prison. In multivariable models, factors associated with a higher risk of incarceration included the following: having 6 or more confidants (HR=2.13, 95% CI=1.2–3.7, p=0.007), remaining homeless (HR=1.72, 95% CI=1.1–2.8, p=0.02), heavy drinking (HR=2.05, 95% CI=1.4–3.0, p<0.001), moderate-severe amphetamine use (HR=1.89, 95% CI=1.2–3.0, p=0.006), and being on probation (HR=3.61, 95% CI=2.4–5.4, p<0.001) or parole (HR=3.02, 95% CI=1.5–5.9, p=0.001). Conclusions Older adults experiencing homelessness have a high risk of incarceration. There is a need for targeted interventions addressing substance use, homelessness, and reforming parole and probation in order to abate the high ongoing risk of incarceration among older adults experiencing homelessness.

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“…This finding stands at odds with growing enthusiasm in the healthcare sector for such efforts (Gawande, 2011). RCTs for other healthcare organization‐led interventions, such as deployment of community health workers, hospital‐based ride‐share programs, and housing initiatives, have also been conducted in recent years (Chaiyachati et al., 2018; Raven, Niedzwiecki, & Kushel, 2020; Vasan et al., 2020).…”

Section: The Fundamental Value Of Rcts—examples From Health Policymentioning

confidence: 99%

Effective Policymaking Requires Strong Evidence: Randomized Controlled Trials as the Foundation for Evidence‐based Policy

Venkataramani¹

2021

J Policy Anal Manage

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A randomized trial of permanent supportive housing for chronically homeless persons with high use of publicly funded services

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 50 publications

References 25 publications

The Effect of a Housing First Intervention on Acute Health Care Utilization among Homeless Adults with Mental Illness: Long-term Outcomes of the At Home/Chez-Soi Randomized Pragmatic Trial

The Effect of a Housing First Intervention on Acute Health Care Utilization among Homeless Adults with Mental Illness: Long-term Outcomes of the At Home/Chez-Soi Randomized Pragmatic Trial

Factors Associated with Incarceration in Older Adults Experiencing Homelessness: Results from the HOPE HOME Study

Effective Policymaking Requires Strong Evidence: Randomized Controlled Trials as the Foundation for Evidence‐based Policy

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