Summary of the Community-Based Rapid

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Chapter 7. Impacts of Community-Based Rapid Re-

7.8 Summary of the Community-Based Rapid

Versus Usual Care (UC) Comparison Across Domains

In the CBRR-versus-UC comparison, 60 percent of families assigned to CBRR and 20 percent of families assigned to UC received CBRR. This contrast in program use did not lead to notable differences in experiences between the CBRR and UC families. The vast majority of the evidence—involving dozens of outcomes in five domains—suggests equivalent results for housing stability, family preservation, and adult and child well-being with or without privileged access to CBRR after 7 days in shelter.

Assignment to CBRR may have had some consequences for children, but the indications to this effect are limited and mixed in direction. Also, priority access to CBRR may have improved family income (annual income for CBRR families was $1,128 higher than for UC families) and food security during the followup period and may have increased the likelihood of receiving SNAP, although these results could be spurious among many self-sufficiency indicators exam-ined. Most strikingly, relative to UC, the study team did not find evidence that priority access to CBRR affected housing stability over the followup period. The reason for the lack of effects on the outcomes that CBRR is intended to affect directly is unclear. Higher participation in other homeless and housing assistance programs among UC families may have diminished the impact of CBRR. Chapter 9 reports on how CBRR compares to the other two active interventions, SUB and PBTH.

Short-Term Impacts of Housing and Services Interventions for Homeless Families 90

CHAPTER 8.

IMPACTS OF PROJECT-BASED TRANSITIONAL HOUSING (PBTH) COMPARED WITH USUAL CARE (UC)

T

his chapter presents estimates of the impact of the project-based transitional housing (PBTH) interven - tion compared with outcomes of families served by the usual care (UC) homeless assistance systems in their communities. The goal is to determine whether offering pri-ority access to a unit in a PBTH program increases families’

housing stability and improves other family outcomes during a 20-month followup interval. The chapter begins with a description of the PBTH intervention as implemented in the study. It then shows the extent to which families in both the PBTH and UC groups used transitional housing and other housing and service programs available to them in the study sites. The next five sections present the effects of being offered the PBTH intervention (as compared with UC) on outcomes within the five study domains—housing stability, family preservation, adult well-being, child well-being, and self-sufficiency.

8.1 Project-Based Transitional Housing (PBTH) Intervention

The PBTH intervention provides a place for families to stay for a finite period of time during which they are provided a wide array of services that include case management and either direct provision of or referral to services identified through an assessment of family needs. PBTH was offered to study families in all of the sites except one.102 In total, 368 families were randomly assigned to this intervention (ranging from 4 in Minneapolis, Minnesota, to 66 in Hono-lulu, Hawaii) and referred to 46 different PBTH programs.103 Of these 368 families, 294 (80 percent) responded to the 18-month followup survey and so are included in the impact analysis in this report.

The objectives of transitional housing are to prepare families for permanent housing by providing case management and

other services that help overcome barriers to housing stability and to address other psychosocial needs that the family may have. For this study, the team selected transitional housing programs that provide housing primarily in “project-based”

facilities or housing units. The study’s definition specified that PBTH does not allow for families to “transition in place”

in private-market apartments or single-family homes, taking over responsibility for the housing unit’s lease toward or at the end of the program of transitional assistance. The study excluded transition-in-place programs in order to generate a strong contrast between PBTH and community-based rapid re-housing (CBRR), which also is time limited and uses scattered-site housing units in which the family can stay and pay the rent at the end of the CBRR program. The few programs to which study families were referred that offer scattered-site transitional housing require families to relocate to other housing at program completion.

PBTH programs often receive funding from federal Suppor - tive Housing Program (SHP) grants, which results in some consistency across PBTH programs. For instance, the SHP grant limits transitional housing assistance to 24 months, funds a broad range of supportive services, and sets parame - ters for the way in which programs must calculate participant rent contributions when they choose to require them. Not all the PBTH programs in the study receive funding from SHP grants, however. Most have a wide range of funding sources, including private foundation grants and local fund-raising proceeds. Some programs are faith based, and many of those programs are completely privately funded.

All PBTH programs in the study provide only temporary housing assistance. The study team allowed any time limit on tenure but specifically sought programs that offered at least 6 months of assistance. Nearly all programs provided a maximum of 24 months of assistance. Programs offering

102 PBTH was not offered in Boston, Massachusetts. Also, PBTH was very limited in Minneapolis, Minnesota, with only four families randomly assigned to PBTH.

103 Much of the information describing PBTH in this section is based on the 30 PBTH programs that provided program data. These 30 programs represent 293 of the total 368 PBTH referrals. More detail about specific PBTH programs is provided in Gubits et al. (2013), Appendixes A and B.

referrals to permanent housing assistance at the end of the transitional housing period were included in the PBTH in -tervention for the study, but not programs that guaranteed permanent assistance.

8.1.1 Housing Assistance in PBTH

PBTH programs offered a place to stay and receive services in varied physical environments. As shown in Exhibit 8-1, nearly three-fourths of families were referred to PBTH programs that provided families with individual apartments (or occasion - ally single-family houses) during their participation in the program. One-fourth were referred to programs that provided private sleeping rooms but shared kitchens or bathrooms.

Family Payments and Savings Requirements in PBTH Most families (92 percent) were referred to PBTH programs that required a program fee or rent contribution from pro-gram participants, based on 30 percent of their income (80 percent of programs that charged a fee) or other factors such as family or unit size (20 percent of programs that charged

a fee; see Exhibit 8-2). More than one-half of the families were referred to PBTH programs that required them to save money while in the program.

Families in PBTH usually ate their meals independently while enrolled in the program; 74 percent of families referred to PBTH programs were responsible for providing their own food while living in PBTH. The agency provided food in three programs (representing 10 percent of referred PBTH families) for which the programs’ facilities were former hotels where families did not have private kitchen facilities, and 16 percent of families assigned to PBTH were referred to programs that provided some but not all of the families’

food. Some agencies commented that, if families were respon - sible for at least one meal per day, they would be eligible for Supplemental Nutrition Assistance Program (SNAP) benefits.

8.1.2 Assessment of Family Needs in PBTH

All PBTH programs indicated that the program conducted a formal assessment of study families at the beginning of the program.104 Program staff reported that the assessments

Exhibit 8-1. PBTH Housing Settings

Type of PBTH Percent of Families Assigned to PBTH Programs With Housing Units of This Type (N = 293)a

Separate apartment with private kitchen and bathroom 73

Private sleeping room but shared kitchen, bathroom, or both 27

PBTH = project-based transitional housing.

a Program data were not collected from 16 programs that collectively had 75 PBTH family referrals.

Note: Percentages are unweighted.

Sources: Program data; random assignment records

Exhibit 8-2. Family Rent Contributions and Savings Requirements in PBTH

PBTH Program Features Percent of Families Referred to PBTH Programs With These Characteristics (N = 293)a Are families required to pay a program fee or rent?

Yes 92

No 8

(If yes) How is the program fee or rent determined?

Percentage of income 80

Flat amount based on family or unit size 20

Does the program require families to save money while in the program?

Yes 55

No 45

Who is responsible for food for participating families?

Families provide own food 74

Program provides food 10

Both 16

PBTH = project-based transitional housing.

a Program data were not collected from 16 programs that collectively had 75 PBTH family referrals.

Note: Percentages are unweighted.

Sources: Program data; random assignment records

104 As part of program data collection, the study team asked program staff whether they conducted an assessment of families, when it occurred, which domains were addressed as part of the assessment, whether a standardized tool was used to ensure that assessments were conducted and reported systematically across program staff, and the extent to which assessments resulted in goal setting and service plans for family members.

Short-Term Impacts of Housing and Services Interventions for Homeless Families 92 Compared With Usual Care (UC)

covered a broad range of topics, exploring family needs related to housing; self-sufficiency; employment; physical health, mental health, and substance abuse; child-specific needs; parenting; and family life skills. A few programs in-cluded other assessment domains such as domestic violence, trauma, debt burden, and cultural needs, but these domains were not widespread areas of assessment. The assessments all resulted in a formal service plan (or equivalent) with goals for the adults in the household, designed to help families address their needs. Fifty-eight percent of families were referred to programs that developed goals specifically for the children.

8.1.3 Supportive Services Provided in PBTH

Participating PBTH programs provided comprehensive case management and provided many supportive services directly, in some cases making referrals to other programs that com - mitted to providing the service. Although all PBTH programs focused on ending a family’s homelessness through placement in permanent housing, more than 90 percent of families were referred to PBTH programs that also provided services related to self-sufficiency (for example, financial management, or help obtaining public benefits) and to employment and training.

Exhibit 8-3 shows the wide array of services offered in PBTH programs and the extent to which the service was provided through case management, by other program or agency staff beyond the case manager, or through a formal arrangement with an external agency that guaranteed the family’s access to the service because of PBTH enrollment. The second column

of the exhibit shows the percentage of families referred to programs that offered each type of service. The subsequent columns report the percentage of families referred to programs that provided the service as part of case management or in other ways. In some cases, addressing a service through case management meant providing direct assistance by the case managers, whereas in other cases addressing a service through case management meant that the case managers provided referrals to other programs, advocated on behalf of the family to access the service, helped remove barriers to receiving the service, or coached and supported a family in their attempts to obtain the service.

In addition to the nearly universal focus on self-sufficiency and employment and training services, more than 75 percent of PBTH families were referred to programs that provided services to address life skills, mental health care, parenting needs, and physical health care. About two-thirds of PBTH families were referred to programs that provided child advo-cacy and care related to substance abuse.

Case Management Intensity in PBTH

PBTH programs considered case management a core part of the intervention. PBTH providers often described the central focus of their programs as case management rather than providing families with a place to stay. The average case management ratio for PBTH programs was 20 families per PBTH case manager.105 Exhibit 8-4 shows that nearly three-fifths of families were referred to programs in which

Exhibit 8-3. Types of Supportive Services Offered in PBTH Programs and How They Are Delivered

Types of Supportive Services

Percent of Families Referred to PBTH Programs That Offer Services of This Type

Through Case

Management By Other Program or

Agency Staff Through Dedicated Linkages With Other Agencies

Housing search and placement assistance 100% 100% 16% 4%

Self-sufficiency (overall) 92 92 NA NA

Childcare/after-school care 24 13

Financial literacy/money management 8 14

Help obtaining public benefits 3 2

Transportation 0 0

Employment and training 92 88 14 13

Life skills 82 82 10 2

Mental health care 82 82 19 5

Parenting skills 82 75 14 9

Physical health care 81 77 6 12

Child advocacy 67 67 0 0

Substance abuse 62 58 9 5

Family reunification 29 23 5 0

PBTH = project-based transitional housing.

NA = data not available.

a Program data were not collected from 16 programs that collectively had 75 PBTH family referrals.

Note: Percentages are unweighted.

Sources: Program data; random assignment records

105 See Chapter 7, footnote 5, for how the case management ratio is measured.

Exhibit 8-4. PBTH Case Management Intensity (ratio and frequency)

Average Number of Clients per Case Manager

Percentage of Families Referred to PBTH Programs

That Offer Case Management in Each of the Following Packages (N = 285)a

Total Weekly or

More Often Biweekly Monthly Quarterly

10 or fewer Clients 13 0 0 0 13

11 to 20 clients 42 3 0 0 45

21 to 30 clients 15 6 7 0 28

More than 30 clients 6 8 0 0 14

Total 76 17 7 0 100

PBTH = project-based transitional housing.

a Program data on client ratios were not collected from 17 programs that collectively had 83 PBTH family referrals.

Note: Percentages are unweighted.

Sources: Program data; random assignment records

a case manager worked with 20 or fewer families at a time and met with families weekly if not more often. The other two-fifths were referred to programs with lower intensity case management, in which case managers had active caseloads of more than 20 families but generally fewer than 30. These programs still often met with families weekly, although some met only biweekly or monthly. Intensity can also be measured by the amount of time that case managers spent with families at each visit. Reported visit times varied from 15 to 90 minutes, with programs reporting 1-hour case management sessions most frequently.106 The PBTH case management ratios were higher and the frequency of meetings was lower than for the UC shelters from which families were recruited for the study, probably reflecting the relatively longer period of time that PBTH programs expected to be working with families.

Case management was often offered for up to 6 months after families moved out of the PBTH program, but program staff generally indicated that postexit supportive contact was ini-tiated by families. These programs said that they maintained an open-door policy for families to contact them if desired but that case managers did not initiate continued regular contact with families.

8.1.4 Eligibility Criteria for PBTH

Many of the PBTH programs established eligibility criteria to limit admissions to the types of families they deemed appropriate for PBTH assistance. PBTH programs were fairly restrictive in terms of which types of families they targeted.

As part of recruiting families for this study, the study team

screened candidates to see which program they would qualify for, based on eligibility criteria provided by the participating programs and questions asked of the families in the study’s baseline survey.107 Of the 1,564 families considered for ran - dom assignment to an available PBTH unit, nearly three-fourths were screened for sobriety or willingness to engage in substance abuse treatment. More than two-thirds of families considered for PBTH were screened for minimum incomes or employment.108

In addition to screening related to family behavior and em - ployment, slightly more than one-half of the families screened for PBTH were asked questions to determine whether their households were the correct size for the available transitional housing unit. Unit size criteria were an artifact of the project- based nature of PBTH. For example, if a two-bedroom unit was available, a family had to have the right number of people and right mix of ages and genders to be considered for the unit to avoid overcrowding or underuse. Family composition criteria limited enrollment for families based on the types of people who were part of their household. For instance, some programs excluded adult males, male children older than age 13, or any children of either gender older than a certain age. Family composition criteria sometimes reflected the challenges of housing families in congregate settings and sometimes reflected program goals and design.

On the basis of this screening, only 77 percent of study families were eligible for random assignment to PBTH. After random assignment, 18 percent of those referred to PBTH programs were screened out by programs as ineligible despite

106 Additional details about each program’s case management are shown in Gubits et al. (2013), Appendix B-5.

107 The major categories of screening questions and their relative use in screening study families for available PBTH, CBRR, and permanent housing subsidy (SUB) openings are shown in Gubits et al. (2013), Exhibit 2-11.

108 Many PBTH programs (with 68 percent of families referred) required families to have sufficient income to be able to pay their own rent in coming months. The pro-grams thus asked the study team to limit referrals to families who indicated (in responses to screening questions) having some type of income, participating in Temporary Assistance for Needy Families (TANF), or being willing and able to obtain employment shortly after enrolling in the program.

Short-Term Impacts of Housing and Services Interventions for Homeless Families 94 Compared With Usual Care (UC)

the previous screening by the research team. Families screened out at baseline are not included in the study sample, but those determined ineligible after random assignment are.

Those families determined ineligible by programs must be included in the impact estimates to preserve the compara-bility of the PBTH and UC families—that is, some of the UC families might also have been found ineligible by programs had they been assigned to PBTH.

8.1.5 Program Rules in PBTH

After they were enrolled in a PBTH program, families re-mained eligible for assistance (up to the maximum length of stay) as long as they complied with program rules. As shown in Exhibit 8-5, 52 percent of PBTH families were referred to programs that imposed curfews, and 42 percent of PBTH families were referred to programs that limited overnight visitors, even though most PBTH is provided in private apartment settings.109 Eighty-seven percent of fam-ilies were referred to programs that required participation in services or activities in order to remain in the program.

For instance, PBTH programs often required participants to work with a case manager to develop goals and to identify and pursue actions needed to achieve them. Some programs also required participation in services such as a money management class, substance abuse assessment, or group counseling sessions.

8.2 Program Use by Families in the Project-Based Transitional Housing (PBTH) Versus Usual Care (UC) Comparison

Each impact comparison in the study may be thought of as a distinct experiment or test, and this chapter addresses only the comparison between PBTH and UC, without reference to the families who were randomized to the permanent housing subsidy (SUB) or community-based rapid re-housing (CBRR) interventions. In total, 707 families took part in the test of PBTH versus UC. These families all had the opportunity to be assigned to PBTH or UC at the point of random assignment and were assigned to one of these two interventions—368 families to PBTH and 339 families to UC.110 Seventy-nine percent of these 707 families (294 PBTH families and 262

Each impact comparison in the study may be thought of as a distinct experiment or test, and this chapter addresses only the comparison between PBTH and UC, without reference to the families who were randomized to the permanent housing subsidy (SUB) or community-based rapid re-housing (CBRR) interventions. In total, 707 families took part in the test of PBTH versus UC. These families all had the opportunity to be assigned to PBTH or UC at the point of random assignment and were assigned to one of these two interventions—368 families to PBTH and 339 families to UC.110 Seventy-nine percent of these 707 families (294 PBTH families and 262

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