Monthly Cost of All Program Use at the

Chapter 12. Intervention Costs

12.8 Monthly Cost of All Program Use at the

Families in Each Intervention Arm

Exhibit 12-20 shows the monthly costs of all program use at the followup survey for each pairwise comparison. This analysis uses the per-family monthly program cost for each type of program and information about the mix of program types families were using at the time of the followup survey.

As discussed in Chapters 6 through 9, the mix of programs used during the month of the followup survey is different than what is observed during the entire followup period.

For example, in the SUB-versus-UC comparison, 84 percent of families assigned to SUB used SUB at some point during

the followup period and 75 percent were using SUB at the time of the survey (see Exhibit 6-2). Of the families assigned to SUB, 13 percent used rapid re-housing during the followup period, but none were using rapid re-housing during the month of the survey. Altogether, 6 percent of families assigned to SUB used transitional housing at some time during the followup period, but only 1 percent of families were using transitional housing at the time of the survey. Among families assigned to UC, 12 percent used SUB during the followup period and 11 percent were using SUB in the month of the survey; 20 percent used rapid re-housing during the followup period but only 3 percent used rapid re-housing during the month of the survey. Similarly, 21 percent of families assigned to UC used transitional housing during the followup period but only 8 percent were using this type of assistance during the month of the survey. Do the relative costs of programs used by families in each intervention arm also differ when we consider only the month of the followup survey?

Exhibit 12-20 shows that in contrasts involving SUB and CBRR, the relative costs of the program use associated with each intervention arm are similar for the entire followup period and in the month of the followup survey. In the month of the followup survey, costs of program use for families assigned to CBRR are lower than for families assigned to SUB (by $102), UC (by $203), and PBTH (by $271). This pattern is consistent with comparisons of the costs of program use during the entire followup period, in which families assigned to CBRR had lower total costs of all program use than did families assigned to any of the other interventions. This find - ing reflects the greater use of and the lower per-family monthly program cost of CBRR compared with other interventions.

In all contrasts involving SUB, the costs of program use during the month of the followup survey are slightly higher for families assigned to SUB. Compared with families assigned to UC, costs of program use for families assigned to SUB were $20 higher in the month of the followup survey. The costs of program use for families assigned to SUB were $88 higher than for families assigned to PBTH and were $102 higher than for families assigned to CBRR. These differences in costs are relatively small because the costs associated with the greater use of SUB during the month of the followup survey were offset by the use of the higher cost emergency shelter and PBTH among families assigned to the other interventions.

For the PBTH-versus-UC and SUB-versus-PBTH comparisons, the relative costs for the followup survey month are different than for the entire followup period. For example, in the PBTH- versus-UC comparison, the costs of program use during the full followup period are $2,432 higher for families assigned

Short-Term Impacts of Housing and Services Interventions for Homeless Families 154 Chapter 12. Intervention Costs

Exhibit 12-20. Average Per-Family Monthly Costs for Program Use at Time of the Followup Survey, by Comparison

CBRR = community-based rapid re-housing. ES = emergency shelter. PBTH = project-based transitional housing. SUB = permanent housing subsidy.

Notes: Averages are for all 18-month survey respondents in each arm of each pairwise comparison and are weighted for survey nonresponse to represent full comparison sample.

Cost estimates assume a site-specific average cost per month based on the Family Options Study cost data and HUD administrative data. The other category includes permanent supportive housing, public housing, and project-based assistance (project-based vouchers or Section 8 projects).

Sources: Family Options Study cost data; HUD Public and Indian Housing Information Center records (SUB); Tenant Rental Assistance Certification System records (SUB); Financial Data Schedule records (SUB); Family Options Study Program Usage Data

Assigned intervention Panel A

SUB

N = 530 UC

N = 415 CBRR

N = 455 UC

N = 451 PBTH

N = 294 UC

N = 262

$1,200

$1,000

$800

$600

$400

$200

$1,200

$1,000

$800

$600

$400

$200

Cost of program use in survey month

Assigned intervention Panel B

SUB

N = 381 CBRR

N = 308 SUB

N = 230 PBTH

N = 187 CBRR

N = 179 PBTH

N = 197 ES PBTH CBRR

SUB Other

Cost of program use in survey month

$1,086 $1,066

$895

$1,098

$1,009 $1,012

$1,081

$979

$1,065

$977

$718

$989

SUB vs. UC CBRR vs. UC PBTH vs. UC

SUB vs. CBRR SUB vs. PBTH CBRR vs. PBTH

to PBTH but are nearly equivalent in the month of the fol - lowup survey. Compared with SUB, the costs of program use for families assigned to PBTH are $3,063 higher during the entire followup period but are $88 less in the month of the followup survey. Compared with CBRR, families assigned to PBTH have higher costs of program use in the month of the survey and during the entire followup period.

It is not clear how expected future costs of homeless or housing assistance will compare across the interventions.

Importantly, the SUB intervention usually lasts beyond the

followup period reported here. Costs of providing SUB are indefinite and will likely continue to grow at nearly the per- month cost. Families assigned to UC or the other interven-tions, however, may experience greater housing instability than their counterparts assigned to SUB. This instability could result in higher future costs from subsequent use of relatively more expensive shelter and transitional housing programs.

The costs of program use during a longer (36-month) period will be examined in the 36-month report for the Family Options Study along with the impacts measured during the longer period.

Short-Term Impacts of Housing and Services Interventions for Homeless Families 156

CHAPTER 13. CONCLUSIONS

H

UD launched the Family Options Study in 2008 to fill a gap in knowledge about which housing and services interventions work best for families experiencing homelessness. This report provides the first rigorous evidence about the relative effects of priority access to permanent housing subsidies (SUB), community-based rapid re-housing (CBRR), project-based transitional housing (PBTH), and usual care (UC)—that is, leaving families to find their way out of shelter without priority access to one of the three active interventions. Nearly 2,300 families in 12 sites across the country were randomly assigned to one of these four treatment arms after spending at least 7 days in emergency shelter. Random assignment yielded well-matched groups of families, with no systematic differences in baseline characteristics. Families were free to take up their assigned interventions or make other arrangements on their own, so families in each treatment arm used a mix of programs.

Nonetheless, the study generated substantial contrasts in program use during the followup period—that is, the program or set of programs families used was influenced strongly by the intervention to which families were randomly assigned.

Random assignment and the subsequent contrasts in program use provide a strong basis for drawing conclusions about the relative impacts of the alternative interventions on several aspects of family well-being.

What do the findings from the study tell us about these in-terventions and their effects? Each of the four sets of families created through random assignment supply important infor-mation for policy, inforinfor-mation summarized in turn in this chapter for the UC, SUB, CBRR, and PBTH interventions.

The most important lessons from the study emerge from comparisons between the interventions, which tell us how effective a given approach to homelessness assistance is by contrast with an alternative approach. Of particular interest is how the active interventions—PBTH, CBRR, and SUB—

that offer priority access to particular forms of assistance compared with allowing families to navigate the UC system on their own. To interpret these comparisons, the chapter begins by addressing how the Family Options Study, in its design and in the program use patterns that emerged within that design, informs policy.

13.1 Meaning of Impact Comparisons

The inherent strength of the experimental research design employed in the Family Options Study is the assurance that the groups that are created through the random assignment process will be similar to each other. Because it is not possible to account for, or to use statistical methods to control for, all the variability that may exist among individual families, randomly assigning a large number of families to different interventions is the most certain way to ensure that the groups will be comparable.

The Family Options Study tests for the impacts of three dif - ferent potential emphases in federal or local assistance policy to homeless families; (1) What impact would priority access to project-based transitional housing (the PBTH arm of the experiment) have on families in shelter who are not able to resolve their episodes of homelessness quickly? (2) How does this impact compare with the impact of providing access to community-based rapid re-housing (the CBRR arm)? (3) How does this impact compare with the impact of providing access to a permanent housing subsidy (the SUB arm)? In each case, the corresponding policy question is, what impact would this policy emphasis have on the outcomes of families in shelter, relative to usual care or another policy emphasis?

The followup data for study participants tell us what would happen were each of these ways of targeting offers and access pursued as federal or local policy. The pairwise comparisons between active interventions show the impact of offering families priority access to one intervention rather than an - other. The data also allow for the comparison of each of these options with current policies that do not create priority access to any particular form of housing assistance (that is, the UC arm). The pairwise comparisons between active intervention arms and UC show the impact of referring a family to a specific type of program compared with the impact of letting families pursue assistance on their own.

The analysis in this report measures the impact of having been offered a particular intervention regardless of whether the family involved actually received the intervention. The findings reflect the real way in which the homeless assistance system interacts with families, in that families are offered an

intervention rather than mandated to accept the assistance being offered. Whether families participate in an assigned program reflects the relative desirability and accessibility of the interventions for families within the context of the other options they may choose to pursue on their own.

As is shown in the report, a substantial number of families did not use the active intervention to which they were referred, and some used other interventions. The full experimental sample for a given arm collectively shows how different forms of housing assistance are used when families are given priority access to one particular program type while simultaneously having the freedom to use other forms of assistance available in their communities. Including all the families randomly assigned to UC similarly reveals the range of programs used when no priority access is provided. The programs used by UC families (including the interventions examined in this study) exist in communities and would each continue to exist even with a stronger federal or local push for only one of them. Thus, the full-sample comparisons between random assignment arms—known as intention-to-treat (ITT) impact estimates—provide the best guide to policymakers in a messy, complex world and are reported here as the main study findings.

All this said, evidence of the effects of a particular program type on families who actually use that approach (for example, the effect of CBRR on the families who use CBRR) compared with equivalent families who do not use the approach would have high value to the homeless assistance field. Such infor - mation is important not because any federal or local policy action could actually create such a contrast for the population of all shelter-housed families, but because efforts to improve a particular intervention model need to be based on knowl-edge of what actually participating in that model does for families as compared with not participating. Furthermore, an individual family’s choice among the options available in its community is best guided by head-to-head contrasts in the results to be expected if the family actually participated in one program type versus another. For these reasons, ana - lyses of the effect of treatment on the treated (using quasi- experimental methods not structured exclusively around full-sample random assignment comparisons) will be impor - tant to consumers of the study’s results. The evaluation will seek to provide such information in future project reports—

particularly regarding the SUB and CBRR interventions—

building off the core ITT analyses and policy information presented here but subject to statistical limitations in isolating the direct effects of participation in the experi-mental data.

13.2 Usual Care (UC)

Emergency shelters in this study were the entry points into homeless assistance in each site. Families randomly assigned to UC typically remained in emergency shelter and sought whatever assistance was available in the community. The experiences of UC families reflect how the homeless services system works when families in shelter are not given priority access to another homeless or housing assistance program.

The study provides valuable information about what types of assistance families use without special offers of assistance and how families in shelter for at least 7 days fare over time.

UC families (that is, families to whom random assignment did not give priority access to any active intervention) spent substantial periods of time in emergency shelter after random assignment. UC families spent an average of 4 months in emergency shelter after random assignment (nearly all immediately after random assignment). More than one-half (53 percent) of UC families spent 3 or fewer months in emergency shelter, 23 percent spent 4 to 6 months, and 24 percent spent more than 6 months in emergency shelter during the followup period.¹⁴⁷

Emergency shelters offered a range of supportive services.

The shelters provided a range of supportive services in primarily congregate settings (dorms or other group living situations). All the shelters offered comprehensive needs assessments, case management, supportive services, and referrals to other programs. Shelters in some instances also offered supportive services such as access to physical health care, employment training, child advocacy, life skills training, mental health care, and parenting services.

UC families participated in homeless and housing assis - tance programs at fairly high rates. Some families assigned to UC did not use any other form of homeless or housing assistance besides shelters, but most did. In particular, 28 percent of UC families accessed some form of permanent subsidy, 25 percent received transitional housing, and 18 percent received rapid re-housing.

UC families were not faring well 20 months after study enrollment. One-half of UC families reported being homeless or doubled up in the 6 months before the survey or had a stay in shelter in the year preceding followup data collection.

In months 7 through 18 after random assignment, 28 percent of UC families stayed in emergency shelter. In the 6 months before the survey, 15 percent of families had been separated

147 Analysis of program use and cost of total program use used data during a median of 21 calendar months.

Short-Term Impacts of Housing and Services Interventions for Homeless Families 158 Chapter 13. Conclusions

from a child who was with the family in shelter at study out-set, and 4 percent had children in foster care. Fair or poor health was reported by 32 percent of UC family heads, and 31 percent worked in the week before the followup survey.

At the time of the survey, 15 percent reported alcohol depen - dence or substance abuse, and 12 percent had experienced intimate partner violence in the past 6 months. More than one-third of families were food insecure. Most children had experienced a school move since random assignment.

Monthly costs for emergency shelter were substantial.

The study found that the emergency shelter programs used by the UC families cost slightly more than $4,800 per month per family. Of this total, 63 percent were for supportive services. Altogether, costs of all the homeless and housing programs and associated services that families assigned to the UC group accessed—whether in a shelter or in active programs—were about $30,000 during the followup period in the comparisons involving UC.

13.3 Permanent Housing Subsidy (SUB)

In most cases, the families assigned to the SUB active interven - tion were given priority access to a housing choice voucher, or HCV, and they may have been offered housing search assistance (they were not offered ongoing social services).

This type of assistance is not generally accessible to families while in emergency shelter unless they reach the top of waiting lists for subsidies during that period. What does the Family Options Study tell us about permanent subsidies for homeless families?

When SUB is available to families in shelter, they take it up at high rates and continue to use it for a sustained period. SUB programs were the least likely of the active interventions to exclude families because of eligibility rules.

For example, only 2 percent of families in the study were not given the opportunity to be randomly assigned to SUB because of answers to screening questions asked before ran-dom assignment. Of the families ranran-domly assigned to SUB, however, 11 percent were subsequently found to be ineligi-ble. Altogether, 84 percent of respondent families assigned to SUB used SUB at some point during the followup period, for an average of 16 months. Smaller numbers of families assigned to SUB used CBRR (13 percent) and transitional housing (6 percent), with some overlap among the three groups.¹⁴⁸ Some families assigned to SUB used other forms

of permanent subsidy to which they did not have priority access (for example, public housing or permanent support-ive housing [PSH]), bringing the total who used any form of permanent subsidy to 87 percent.

Compared with CBRR, PBTH, and UC, SUB caused striking improvements in housing stability. Priority access to SUB reduced the incidence of subsequent stays in shelter or places not meant for human habitation by one-half when compared with priority access to CBRR or PBTH or with UC alone. SUB also led to notable improvements in other aspects of housing stability relative to the other interventions, reducing the in-cidence of doubling up, subsequent emergency shelter stays, housing crowding, and number of places lived during the followup period.

The benefits of SUB extended beyond housing stability, especially when compared with UC. The benefits of priority access to SUB extended beyond housing stability, with re -ductions in child separations relative to UC and PBTH and reductions in foster care placements relative to UC. SUB also reduced psychological distress relative to UC and PBTH and

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