Placement of chronically homeless into different types of permanent supportive housing before and after a coordinated entry system: The influence of severe mental illness, substance use disorder, and dual diagnosis on housing configuration and intensity of services

Abstract

Aims Permanent supportive housing (PSH) is designed to house people who experience chronic homelessness with one or more of the following: serious mental illness (SMI), substance use disorders (SUD) or human immunodeficiency virus. The Department of Housing and Urban Development has required major metropolitan areas to develop a coordinated entry system (CES) to prioritize access to PSH to those who need it the most. The aim of this paper is to determine whether PSH residents with SMI, SUD, or dual diagnosis were more likely to be housed after implementation of CES and were more likely to be housed in housing models with more intensive services provided. Methods A cross‐sectional survey with 855 residents of different PSH models. Results Those with SMI, SUD, or dual diagnosis were not more likely to be housed using the CES but were more likely to be housed in higher intensity service programs. Conclusions Those with SMI are more likely to be housed in PSH with high‐intensity services.

The comparative effectiveness of different models of permanent supportive housing on problematic substance use, depression, and anxiety symptoms over time.

“…Thus, all high need participants were randomized to Housing First models with ACT or treatment as usual. (Dickson-Gomez et al, 2020) but may be more able to offer counseling and support for those who live with SMI or SUD.…”

“…To our knowledge, no studies have compared the effectiveness of different service delivery models such as the ACT, or ICM on housing or mental and physical health outcomes (Commitee on an Evaluation of Permanent Supportive Housing Programs for Homeless Individuals, Science & Technology for Sustainability Program Policy & Global Affairs, & Board on Population Health & Public Health Practice Health & Medicine Division, 2018). More intense psychological services are more expensive to provide (Dickson-Gomez et al, 2020) but may be more able to offer counseling and support for those who live with SMI or SUD.…”

Operations research and analytics methods to improve equitable access to public services

“…Moreover, studies reveal that CES necessitates improvements related to technology and user education, as well as federal policy modifications [96]. Presently, there is little evidence that coordinated systems improve individual-level outcomes such as length of stay in housing [59,65].…”