Housing-First versus Treatment-First Proposal updated notes ppt (1) (Nancy Kiflemariam) (1)
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The document summarizes a study comparing the Housing-First and Treatment-First models for addressing chronic homelessness. Chronic homeless individuals who are placed in Housing-First programs with supportive services are found to maintain permanent housing for significantly more months on average (10 months) than those in Treatment-First programs (3 months) without supportive services after being housed. The study hypothesizes that Housing-First will lead to better housing outcomes, which is supported by a t-test analysis. However, limitations include potential outliers skewing the averages and longer term outcomes need further research.
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Housing-First versus Treatment-First Proposal updated notes ppt (1) (Nancy Kiflemariam) (1)
- 1. Presented By: Nancy Kiflemariam PSY 550 October 27, 2015
- 2. The cycle of chronic homelessness Acknowledgement: Usish.gov
- 3. Introduction: • Testing two service delivery models for chronically homeless people (CHP): Housing-First vs. Treatment-First. • • CHP account for 10% of homeless population, but use 50% of community resources. Average cost annual per CHP is $40,000 (Donovan-HUD, 2014). • The average cost for the Housing-First model is just over $16,000. • • Clients placed in Housing-First model with supportive services maintain permanent housing for more months on average than clients who are served through the Treatment-First model. • Housing-First is controversial but shows positive results with less drug/alcohol use and behavioral health episodes.(Tsai, et al., 2010) •
- 4. Methodology • Six graduate students from three universities in three large cities. • Two agencies tested in each city – one from each model. • • 33-34 cases will be tested at each agency for a total of 100 client records in each model (200 total). • • All cases will be assigned pseudo numbers and randomly selected by drawing numbers, following HIPAA laws. • • Each case tested first for eligibility – CHP with dual diagnosis ages 18-65 and score of 10+ on Vulnerability Index-Service Prioritization and Decision Assistance Tool (VI- SPDAT). • • Researchers will conduct the same questionnaire interview for each case at all agencies and results will be compiled for each model in all three cities. • • The six agencies will each be paid $1,000 to cover staffing time for the study. •
- 5. Hypothesis • Alternative Ha: Clients under the Housing-First model with supportive services maintain permanent housing for more months on average than clients who are served through the Treatment-First model • • (μ Housing-First > μ Treatment-First). • • Null Ho: The mean number of months of maintaining permanent housing in Housing-First programs is less than or equal to the mean number of months in the Treatment-First programs (μ Housing First < μ Treatment First). •
- 6. Results Results: I. Hypothesis 1: (One Directional t-tail table in Appendix D) Difference in Means/Statistic (μHousingFirst - μTreatmentFirst) Degrees of Freedom (DF) (n=100) Critical t- value Observed t- value p- value 7 months 99 1.66 1.99 .025
- 7. Discussion Hypothesis 1: • The observed t-value (with 99 degrees of freedom) is larger than the critical t-value, producing a significance level of p = .025. • Reject the Ho - null hypothesis that clients in Treatment-First programs do better or equally as good as those in Housing-First programs based on an alpha level of 5%. • • Study shows Housing-First program clients perform significantly better in maintaining permanent housing on a long-term basis (Average 10 months with supportive services versus 3 months for Treatment- first with no support once housed). • Future study needed on long-term success between the two models on health and wellness and long-term self-sufficiency, as well as cost savings. • • Limitations: Outliers alter the mean because they tend to drop out early and pull the averages down. The mode is possibly more accurate with most in housing 12 months. • • No ethical issues, but it is controversial as some feel it is irresponsible to place homeless people in housing without an ability to pay their rent and bills.
- 9. Appendix B 12 month comparison – Average months of stable housing completed 1st column – Housing-First model outcomes versus 2nd column Treatment-First model (Hypothetical Result) based on data on HUD website. M on th s in ho us in g
- 10. References: Department of Housing and Urban Development, July 28, 2014, www.hud.gov/chronichomelessness National Coalition for the Homeless, Executive Summary-Los Angeles, October 11, 2011. http://www.nationalhomeless.org/publications/dyingwithoutdignity/sum mary.html Tsai, J, Mares, A, Rosenheck, R., A multisite comparison of supported housing for chronically homeless adults: Psychological Services, Vol 7(4), November 2010, p. 219-232. http://dx.doi.org/10.1037/a0020460
Editor's Notes
- I am presenting a correlational study for two service delivery models being used in the U.S. for chronically homeless persons (CHP), defined as homeless multiple times and/or over a year, with 2 diagnosed disabling conditions (Mental health and substance abuse). Treatment-First entails shelter- based services and referrals until individuals are stable and able to maintain housing on their own; while Housing-First provides immediate housing with supportive case management services provided after housed until stabilized and able to maintain.
- The cycle of chronic homelessness, as the this chart shows, is moving from streets to jail/prison to hospitals, rehabs, psychiatric hospitals to shelters until they outlast their stays and then go back into the cycle. This often goes on for years, hence not surprising that the average life expectancy for a CHP is 36% lower (age 48.1) than the average adult in the U.S. (National Coalition for the Homeless, 2011).
- The most common service models for the CHP are Treatment-First and more recently, the Housing-First models. The average cost for each CHP is $40,000 per year, with some costing hundreds of thousands in public services. CHPs make up only 10% of the homeless population, but account for over 50% of the costs associated with homelessness. The cost to house and provide support services for a CHP is just over $16,000 on average, hence, the average savings to house and case manage each person is estimated at $24,000 (HUD, 2014). Studies have shown that once housed, substance abuse is reduced and mental health episodes are reduced with increased stabilization. While living in shelter, few people are able to secure and maintain permanent employment. Regulations of the shelter make evening work nearly impossible. Often shelters have hours from 4pm to 6am. Those who arrive late do not get shelter, thus these limiting factors are barriers to employment. (HUD, 2014).
- This study includes 100 cases served in each model, (total of 200), split among three cities: Phoenix, Chicago and Atlanta. The study is conducted in a partnership with Psychology graduate students at Grand Canyon, Northwestern and Emory Universities and are conducted at six different provider agencies (two in each city, one using HF and the other using TF). The agencies replace subject names with pseudo numbers to avoid any HIPAA violations. Randomly selected cases will be tested on eligibility, taking only cases that score higher than 10 on the vulnerability index service prioritization and decision tool, (VI-SPDAT); an assessment tool used to prioritize cases at most risk. Additional criteria is dual diagnoses (substance abuse and a mental disability). Each agency will be interviewed on 33-34 cases each and compensated $1,000 for staff time.
- The alternative hypothesis is that the Housing-First model clients with supportive services will maintain permanent housing for more months on average than the Treatment- First model clients. The null hypothesis is that the mean number of months of Housing-First clients maintaining permanent housing is less than or equal to the mean number of months of Treatment-First model programs.
- The t-test with mean of 3 months for Treatment-First clients and the mean of Housing-First clients being 10, results in a 7 month difference, with degree of freedom (n=100) of 99, a critical t-value of 1.66, and the observed t-value of 1.99. The p-value is .025 hence the null hypothesis is rejected and the alternative hypothesis is accepted.
- As seen in the results, there is a mean difference of 7 months and a rejection of the null hypothesis as Housing-First subjects performed significantly better than the Treatment-First with an alpha level of 5%. Based on these results, it appears that clients do better and remain in permanent housing longer. More studies on successes of Housing-First are needed to further study whether subjects relapse after closure of cases and whether or not the cycling stops with the Housing-First model. The value of the study would show, not only the improved life expectancy and conditions, but the return on investment in millions of dollars of savings in the long-term.
- The results of this study show a one direction tail t-test with a t=value of 1.99 and a .025 significance level rejecting the null hypothesis with a positive result of the alternative hypothesis.
- The bar chart shows results of the compiled data for all Treatment-First assessments, totaling a mean of 3 months. The Housing-First mean stay was 10 months, thus there is a 7 month difference based over a 12 month period. These results are consistent with HUD results in 2014; reported in 2015.
- References used in this study indicate positive outcomes for the Housing-First model of service for CHPs. There are significant differences in the results and less cycling with the Housing First model.