Program Use by Families in the Community-

문서에서 Family Options Study (페이지 112-115)

Chapter 7. Impacts of Community-Based Rapid Re-

7.2 Program Use by Families in the Community-

(CBRR) 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 CBRR and UC, without reference to the families who were randomized to the SUB or project- based transitional housing (PBTH) interventions. In total, 1,144 families took part in the test of CBRR versus UC. These families all had the opportunity to be assigned to either CBRR or UC at the point of random assignment and were assigned to one of these two interventions—569 families to CBRR and 575 families to UC.94 Of these 1,144 families, 79 percent (455 CBRR families and 451 UC families) responded to the 18-month followup survey, and thus 906 families are in-cluded in the CBRR-versus-UC impact comparison reported in this chapter. This section describes the extent to which the 455 CBRR families used the CBRR intervention and other programs that were available in the community—both within and outside the homeless services system—during the followup period. Parallel information is presented for the 451 UC families.

Exhibit 7-4 shows the use of seven types of homeless and housing assistance programs by these families. The first column shows the percentage of families assigned to CBRR who ever used each program type during the followup period.95 The second row (shaded in the exhibit) shows the takeup of CBRR by the families assigned to that interven-tion; 59.7 percent of families referred to a CBRR program received rapid re-housing assistance at some point during the followup period—meaning that they followed up on the referral, were deemed eligible by the program, found a housing unit, and received one of the types of temporary rental assistance provided by CBRR.69

The second column shows the percentage of families assigned to UC who ever used each program type during the followup period.97 The shaded row of the second column shows that 19.6 percent of the UC families received rapid re-housing assistance during the followup period, despite not being given priority access to CBRR. Presumably these families learned about the availability of CBRR, perhaps from friends or family members,98 or they may have already been clients of the community-based nonprofit organizations that admin - istered the local CBRR programs.

93 Additional details about each program’s case management are shown in Gubits et al. (2013), Appendix B-3.

94 In the entire study, 746 families were randomly assigned to UC. Only 575 of these families had CBRR available to them when they were randomized, however. Therefore, only these 575 UC families are part of the CBRR-versus-UC comparison sample. All 569 families randomly assigned to CBRR during the course of the study had UC avail-able to them, so all are part of the CBRR-versus-UC comparison sample.

95 The followup period is from the calendar month of random assignment through the calendar month of response to the 18-month followup survey. Therefore, the length of the followup period differs across families. This period lasts for a median of 21 calendar months for the full sample.

96 All percentages, means, and medians in the exhibit are weighted to adjust for survey nonresponse and hence as best possible represent the full experimental sample of 1,144 families. The findings on program use are thus in line with similarly weighted impact estimates provided subsequently in the chapter.

97 The percentages in the first seven rows of these columns are not mutually exclusive because some families use more than one program type during the followup period.

98 Emergency shelter staff committed to not referring UC families to active interventions to which they were not assigned. This commitment may not have been upheld in all cases.

Exhibit 7-4. CBRR Versus UC: Program Use Since Random Assignment if Ever Used Type of Housing Assistance

Percent Used in Month of Followup

Survey Response

CBRR UC CBRR UC CBRR UC

Mean Median Mean Median

Subsidy (SUB)b 9.0 9.8 10.4 10.5 10.3 10.5 8.7 8.6

Rapid re-housing (CBRR) 59.7 19.6 7.6 6.5 6.9 4.5 5.7 2.2

Transitional housing 18.8 24.2 8.3 6.0 8.9 7.5 7.0 9.4

Permanent supportive housing 5.1 7.5 8.2 10.5 10.0 8.0 3.9 5.7

Public housing 5.2 6.1 10.3 10.5 10.5 10.5 5.1 5.0

Project-based vouchers/Section 8 projects 3.4 4.1 12.9 11.5 14.0 16.5 3.2 3.9

Emergency shelterc 87.1 86.5 3.9 2.0 4.5 3.0 7.7 9.8

No use of homeless or housing programsd 11.9 27.4 18.4 18.0 19.5 20.0 59.5 56.3

N 455 451 455 451

UC = usual care. RA = random assignment.

a Percentage of families who ever used a type of assistance program during the period from the month of RA to the month of the 18-month followup survey response (median period duration: 21 months). Percentages do not add to 100 because some families used more than one program type during the followup period.

b Subsidy assistance is housing choice vouchers plus site-specific programs offered to families assigned to permanent housing subsidy (SUB) group in Bridgeport, Connecticut and Honolulu, Hawaii.

c All families were in emergency shelter at random assignment. Percentages less than 100 percent for ever used emergency shelter are due to missing data on shelter use.

d No use of homeless or housing programs (ever used) indicates no use of the six program types in this table during any of the followup period and no use of emergency shelter after the first 6 months after RA. No use in the month of the followup survey response indicates no use of any of these seven program types.

Notes: Percentages are regression adjusted, controlling for site and randomization ratio. Percentages, means, and medians are weighted for survey nonresponse to represent full comparison sample.

Source: Family Options Study Program Usage Data

The first row of the exhibit, along with rows 3 through 6, show participation in other types of homeless and housing assistance programs. Twenty-eight percent of these UC families (not shown in the exhibit) found their way to SUB or other permanent housing programs and one-fourth found their way to transitional housing, despite the lack of preferen - tial access to those programs through the study. The use of programs other than rapid re-housing programs is always higher for the UC group than for the CBRR group, presumably because the UC group was not referred directly to the CBRR intervention and so turned to other types of programs. The seventh row shows the percentages of families in the CBRR and UC groups who used none of the six types of programs during the followup period, nor used emergency shelter from the seventh month after random assignment onward.

About 12 percent of CBRR families and 27 percent of UC families fall into this group.

The mean and median number of months of use for each program type are also shown in the exhibit (third and fourth columns for CBRR families, fifth and sixth columns for UC families) for only those families who ever used a given program type.99 The number of months of rapid re-housing assistance use (median of 7 months) is higher for the families who had priority access to CBRR than for the 19.1 percent of UC families who received rapid re-housing assistance (median of 5 months).

Whereas the previous columns consider all experience from between randomization and the point at which the survey was administered, the last two columns consider the program use as of the month of the survey. Although the team expects that most outcomes in the report will be influenced by assis-tance received during the entire followup period, some out-comes will be particularly strongly influenced by assistance received at the time of followup survey response. The last two columns of the exhibit show the percentages of CBRR and UC families who received each type of program in the calendar month of the followup survey response. The first row of the seventh column shows that the rapid re-housing assistance had ended for most of the CBRR families who ever received it and for the UC families who ever received it. The majority of both CBRR (60 percent) and UC families (56 percent) were not participating in a homeless or housing program at the time they responded to the followup survey.

Thus, differences are not expected in the outcomes of CBRR and UC families in areas that reflect the families’ current experience, but only in those that reflect a lasting influence of families having been offered temporary rental assistance to help them leave homelessness.

As Exhibit 7-4 makes clear, the CBRR families used a range of programs in addition to the program to which they were referred by the study, which is consistent with the design of the study. Families were not required to use the intervention

99 Hence, 0 values are not factored into the means, nor do they pull downward the medians of the various distributions.

Short-Term Impacts of Housing and Services Interventions for Homeless Families 82 Compared With Usual Care (UC)

to which they were assigned and also were not forbidden from using other programs that were available to them in their community. The intent of the study was to maximize use of the assigned active intervention (in this case, maximize use of the CBRR intervention by the CBRR families) and to create the largest possible contrast between the program mixes of different assignment groups (in this case, CBRR versus UC). As shown in the exhibit, the use of CBRR was quite different for the CBRR and UC groups. The contrast in usage of CBRR—59.7 percent for CBRR families and 19.6 percent for UC families—is sizable, although smaller than the analogous contrast between the SUB and UC groups.

As is conventional in random assignment analyses, our goal is to estimate the intention-to-treat (ITT) impact—that is, the difference in impact by the program to which families were assigned, regardless of whether they actually used that program (or some other program). This goal is consistent with the policy option of making a treatment available to a family but without the ability to force a family to use that treatment.

Because not all families randomly assigned to CBRR used CBRR, and some families assigned to UC did use CBRR, the true ITT impact is likely smaller than it would have been had

the gap in CBRR usage been wider (assuming that CBRR truly has a nonzero impact on families who use it). In particular, the difference in the use of CBRR by the CBRR and UC groups is narrow enough, given the relatively small sample size avail - able for analysis, that the study may have failed to detect as statistically significant one or more ITT impacts large enough to be of policy importance.

Additional detail about the use of the CBRR intervention by CBRR families is shown in Exhibit 7-5. This exhibit shows that nearly one-half (46 percent) of CBRR families who used rapid re-housing did so for less than 6 months, and 81 per-cent did so for less than 12 months.100 These relatively short periods of use may be surprising, given that the program rules permit use of CBRR for up to 18 months. They reflect the reality, however, of how the program was being admin-istered in the study sites and how families were using it.

The remainder of the chapter reports estimated impacts in the various outcome domains that—if statistically significant—

can be causally attributed to the offer of a temporary housing subsidy to the families randomly assigned to CBRR at the start of the followup period as opposed to no such directed referral or privileged access being provided to UC families.

Exhibit 7-5. Number of Months of CBRR Receipt During Followup Period by CBRR Families Who Ever Used CBRR

CBRR = community-based rapid re-housing.

a Percentages are weighted for survey nonresponse to represent all families in comparison sample.

Note: N = 274.

Source: Family Options Study Program Usage Data

100 Exhibit 7-5 shows that just over 4 percent of CBRR families who used CBRR did so for 18 or more months. HPRP-funded rapid re-housing was limited to 18 months of assistance. CBRR usage durations longer than 18 months are probably best interpreted as using the maximum allowable assistance of 18 months.

12

10

8

6

4

2

Number of months of rapid re-housing receipt 0

0.25–0.75 1.00–1.75 2.00–2.75 3.00–3.75 4.00–4.75 5.00–5.75 6.00–6.75 7.00–7.75 8.00–8.75 9.00–9.75

10.00–10.7511.00–11.7512.00–12.7513.00–13.7514.00–14.7515.00–15.7516.00–16.7517.00–17.7518.00 or more

Percent of CBRR families who ever used RRa

7.3 Impacts on Housing Stability

문서에서 Family Options Study (페이지 112-115)