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Pages 1-11

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From page 1...
... , serious traumatic injuries, drug overdoses, violence, death due to exposure to extreme heat or cold, and death due to chronic alcoholism. Persons experiencing homelessness are more likely than housed persons to use hospital emergency departments for health care and to be admitted to the hospital because they are less likely to have health insurance and a usual source of health care and because their conditions cannot be appropriately cared for without safe and secure housing.
From page 2...
... COMMITTEE'S STATEMENT OF TASK The Committee on an Evaluation of Permanent Supportive Housing Programs for Homeless Individuals was charged to address a fundamental question: To what extent have permanent supportive housing programs improved health outcomes and affected health care costs in people experiencing chronic homelessness? To answer this question, the committee focused on more specific questions, including the following: • What is the evidence that permanent supportive housing improves health-related utilization and outcomes in homeless persons with serious, chronic, or disabling conditions (e.g., substance use disorders, serious mental illness, physical disabilities, chronic conditions such as diabetes, etc.)
From page 3...
... . To respond to the last question on "key policy barriers and research gaps associated with developing programs to address the housing and health needs of homeless populations," the committee looked primarily at barriers to the PSH program and what would be needed to bring it to scale to meet the needs of those experiencing chronic homelessness.
From page 4...
... CONCLUSIONS AND RECOMMENDATIONS Overall, except for some evidence that PSH improves health outcomes among individuals with HIV/AIDS, the committee finds that there is no substantial published evidence as yet to demonstrate that PSH improves health outcomes or reduces health care costs. However, while this was the inescapable finding based on an impartial review of the evidence available at the time of this assessment, the committee believes that housing in general improves health, and notes that PSH is important in increasing the ability of some individuals to become and remain housed.
From page 5...
... Based on studies conducted over a 1- to 2-year period, PSH effectively maintains housing stability for most people experiencing chronic homelessness. Whether PSH can reduce chronic homelessness for these individuals for longer periods of time will only be known once the results of longer term studies are available.
From page 6...
... The committee does not believe policy makers and others should expect that permanent supportive housing programs would yield net cost savings, although some cost savings could be identified in specific studies such as those that exclusively focus on persons who are persistently high utilizers of emergency medical services systems. To address these problems, the committee recommends: Recommendation 4-1: Incorporating current recommendations on cost effectiveness analysis in health and medicine (Sanders et al., 2016)
From page 7...
... Recommendation 4-2: Additional research should be undertaken to ad dress current research gaps in cost-effectiveness analysis and the health ben efits of permanent supportive housing. Assessing Individual and Program Characteristics of PSH There is some evidence that individual characteristics of the people using PSH programs have a modest impact on the outcomes achieved with PSH.
From page 8...
... Given this, it is unclear whether other, less intensive interventions might do as well, or how subpopulations who might benefit from PSH should be identified. Key Policy and Program Barriers As part of its charge, the committee was asked to identify the "key policy barriers and research gaps associated with developing programs to address the housing and health needs of homeless populations." Based on its position that PSH holds potential for improving the health outcomes of individuals experiencing homelessness, the committee describes below the key policy and program barriers to bringing PSH and other housing models to scale to meet the needs of those experiencing chronic homelessness.
From page 9...
... . Focusing specifically on individuals experiencing chronic homelessness, individuals with disabilities, and older adults needing longterm support services, the bulletin describes how "certain housing-related activities" can be reimbursed via Medicaid.
From page 10...
... As described above, in studies ranging up to 2 years, PSH has been shown to be effective in maintaining housing stability for most people experiencing chronic homelessness. This evidence of the effectiveness of PSH in allowing people to become stably housed indicates that it is possible to reduce chronic homelessness, given sufficient will and a commitment of adequate resources.
From page 11...
... In addition, to eliminate barriers to the use of housing vouchers for scatter-site PSH, federal, state, and local governments could proactively use their anti-discriminatory enforcement authorities and their leverage over the terms of federal grants to incentivize grantees to eliminate barriers that make the programs less effective and efficient. Overall, based on its assessment, the committee finds that PSH holds potential not only for reducing the number of persons experiencing chronic homelessness but also for improving their health outcomes, although much additional research is needed to determine the effectiveness of PSH and to clarify for whom and in which circumstances it is most beneficial.


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