Impacts of CBRR Compared With

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Chapter 8. Impacts of Project-Based Transitional Housing

9.4 The Community-Based Rapid Re-Housing

9.4.2 Impacts of CBRR Compared With

and SUB-versus-CBRR comparisons.

The proportions of PBTH families shown in the second column are similar to the proportions of all PBTH families shown in Exhibit 8-6. The first two columns show that 51 percent of families assigned to CBRR used rapid re-housing (whereas only 13 percent of PBTH families did so) and 55 percent of PBTH families used transitional housing (whereas only 24 percent of CBRR families did so). The numbers of months of program use (in columns 3 through 6) and the proportions using the program in the month of followup survey response (in columns 7 through 8) are largely similar to those in the previous exhibits. By the followup survey month, less than one-half of both groups are participating in any program. Of the CBRR families, 35 percent are partici-pating in some program in the survey month compared with 41 percent of the PBTH families.131 Only 5 percent of CBRR families were still receiving rapid re-housing in the survey month compared with 22 percent of PBTH families who were still receiving transitional housing at this point.

9.4.2 Impacts of CBRR Compared With PBTH

As discussed in Chapter 3, CBRR and PBTH proponents have divergent views about the package of housing assistance and services that homeless families need. From the perspective of CBRR proponents, CBRR is expected to reduce homeless-ness relative to PBTH and may improve housing stability, family preservation, adult well-being, child well-being, em - ployment, and earnings. CBRR is also expected to reduce the length of the shelter stay from the time of study entry.

These expectations reflect the fact that CBRR provides rapid-ly delivered housing assistance toward the goal of recipients quickly exiting shelter for community-based housing, thus targeting what CBRR proponents think should be the main objective of homeless interventions. On the other hand, PBTH proponents expect that PBTH will improve long-term housing stability, employment, earnings, education, and adult well-being relative to CBRR and may improve family preservation and child well-being. These expectations of PBTH proponents are because PBTH addresses barriers to housing stability and attempts to put families on track for better employment and earnings. The next section addresses the experimental short-term impact evidence on these diver-gent expectations.

131 These proportions of families participating in any program are calculated by subtracting from 100 percent the proportions with no use of programs in the survey month (shown in the exhibit).

Short-Term Impacts of Housing and Services Interventions for Homeless Families 122 FAMILY OPTIONS STUDY Community-Based Rapid Re-Housing (CBRR), SUB Compared With

Project-Based Transitional Housing (PBTH), and CBRR Compared With PBTH

Impacts on Housing Stability in the CBRR-Versus-PBTH Comparison

Exhibit 9-18 shows the effect on housing stability of being assigned to CBRR relative to being assigned to PBTH. The first panel of the exhibit shows some evidence that assignment to CBRR leads to greater use of emergency shelter and stays in places not meant for human habitation than assignment to PBTH. The third row shows that 25 percent of CBRR families experienced homelessness defined in this way in the past 6 months compared with only 15 percent of PBTH families.

CBRR also increased the number of days in the past 6 months spent homeless or doubled up from 40 to 61, or about 3 weeks.

These outcomes are both based on responses to the followup survey. Given that transitional housing is not included in the study’s definition of homelessness, the fact that 22 percent of PBTH families were still using transitional housing at the followup point when nearly all CBRR families had finished use of CBRR by this time likely influenced these results.

The outcome measuring any stay in emergency shelter in months 7 to 18 after random assignment is largely based on administrative Homeless Management Information System (HMIS) data. This outcome does not show a difference in emergency shelter usage between CBRR and PBTH families.

The bottom three panels of the exhibit show no statistically significant differences between CBRR and PBTH families in housing independence or number of residential moves.

Families assigned to CBRR were less likely to report poor or fair housing quality than were families assigned to PBTH (27 compared with 37 percent).

Exhibit 9-4 presents a statistical test of whether CBRR speeds exit from emergency shelter as compared with PBTH. The third row of the exhibit shows no evidence of such an effect.

The difference in average lengths of baseline shelter stay between the two groups is not statistically significant.

Impacts on Family Preservation in the CBRR-Versus-PBTH Comparison

Exhibit 9-19 shows the effects on family preservation in the CBRR-versus-PBTH comparison. We found no evidence of differential effects of these interventions on family separations or reunifications, although the numbers, particularly in the case of reunifications of family members separated at the time of the baseline survey, were too small to yield a strong test.

Exhibit 9-18. CBRR Versus PBTH: Impacts on Housing Stability

Outcome CBRR PBTH ITT Impact Effect

Sizea

N Mean (SD) N Mean (SD) Impact (SE)

Homeless or doubled up during the followup period At least 1 night homelessb or doubled up in past 6 months

or in shelter in past 12 months (%) [Confirmatory]c 179 48.9 (50.1) 197 41.4 (49.7) 7.5 (5.7) 0.13 At least 1 night homelessb or doubled up in past 6 months (%) 179 43.1 (49.6) 197 34.0 (48.3) 9.1 (5.6) 0.16 At least 1 night homelessb in past 6 months (%) 179 24.9 (43.5) 197 15.2 (37.4) 9.7** (4.8) 0.20 At least 1 night doubled up in past 6 months (%) 179 34.6 (47.5) 197 31.2 (47.3) 3.4 (5.5) 0.06 Any stay in emergency shelter in months 7 to 18 after RA (%) 179 19.9 (41.8) 197 18.5 (38.7) 1.4 (4.4) 0.03 Number of days homelessb or doubled up in past 6 months 179 60.7 (77.8) 197 39.5 (68.3) 21.2** (8.8) 0.25

Number of days homelessb in past 6 months 179 25.2 (52.9) 196 12.5 (41.8) 12.7** (6.0) 0.22

Number of days doubled up in past 6 months 179 43.8 (69.4) 197 33.8 (62.5) 10.0 (8.1) 0.14

Housing independence

Living in own house or apartment at followup (%) 179 63.0 (49.1) 170 60.0 (49.6) 3.0 (6.1) 0.05 Living in own house or apartment with no housing assistance (%) 179 45.3 (49.5) 170 46.8 (49.7) – 1.5 (5.9) – 0.03 Living in own house or apartment with housing assistance (%) 179 17.7 (38.9) 170 13.2 (34.3) 4.5 (4.1) 0.09 Number of places lived

Number of places lived in past 6 months 179 1.7 (1.0) 196 1.7 (1.1) 0.0 (0.1) 0.02

Housing quality

Persons per room 175 1.8 (1.4) 195 1.8 (1.3) 0.0 (0.1) 0.03

Housing quality is poor or fair (%) 178 26.8 (43.9) 195 36.6 (48.5) – 9.7* (5.3) – 0.18

CBRR = community-based rapid re-housing. PBTH = project-based transitional housing.

ITT = intention-to-treat. RA = random assignment. SD = standard deviation. SE = standard error.

*/**/*** Impact estimate is significantly different from 0 at the .10, .05, and .01 levels, respectively, using a two-tailed t-test.

a Effect size column shows standardized effect sizes, which were calculated by dividing impact by standard deviation for the entire usual care group.

b The definition of homeless in this report includes stays in emergency shelters and places not meant for human habitation. It excludes transitional housing.

c After adjustment for multiple comparisons, the impact on the confirmatory outcome is not statistically significant at the .10 level for the CBRR-versus-PBTH comparison.

Notes: Impact estimates and outcome means are regression adjusted for baseline characteristics and are weighted to adjust for survey nonresponse. See Chapter 5 and Appendix B for outcome definitions.

Sources: Family Options Study 18-month followup survey; Program Usage Data

Exhibit 9-19. CBRR Versus PBTH: Impacts on Family Preservation

Outcome CBRR PBTH ITT Impact Effect

Sizea N Mean (SD) N Mean (SD) Impact (SE) Current or recent separations of family members present at baseline

Family has at least one child separated in past 6 months (%) 177 12.7 (34.3) 194 12.0 (34.7) 0.7 (3.6) 0.02 Family has at least one foster care placement in past 6 months (%) 177 3.6 (18.1) 195 1.9 (14.2) 1.6 (1.9) 0.07 Spouse/partner separated in past 6 months, of those with spouse/partner

present at RA (%) 64 33.6 (48.4) 54 26.5 (44.2) 7.1 (8.7) 0.13

Reunification of family members reported as separated at baseline Family has at least one child reunified, of those families with at least one child

absent at RA (%) 44 37.9 (48.7) 39 31.2 (48.6) 6.7 (12.2) 0.13

Spouse/partner reunified, of those with spouse/partner absent at RA (%) 16 27.0 (47.9) 17 39.9 (50.7) – 12.9 (23.7) – 0.23 CBRR = community-based rapid re-housing. PBTH = project-based transitional housing.

ITT = intention-to-treat. RA = random assignment. SD = standard deviation. SE = standard error.

*/**/*** Impact estimate is significantly different from 0 at the .10, .05, and .01 levels, respectively, using a two-tailed t-test.

a Effect size column shows standardized effect sizes, which were calculated by dividing impact by standard deviation for the entire usual care group.

Notes: Impact estimates and outcome means are regression adjusted for baseline characteristics and are weighted to adjust for survey nonresponse. See Chapter 5 and Appendix B for outcome definitions.

Source: Family Options Study 18-month followup survey

Impacts on Adult Well-Being in the CBRR-Versus-PBTH Comparison

Exhibit 9-20 shows statistically significant effects on 3 of the 8 adult well-being outcomes in the CBRR-versus-PBTH comparison. All three of these significant effects have CBRR producing more favorable outcomes than PBTH, which is surprising because PBTH programs have an explicit focus on adult well-being.

The first row shows that CBRR reduces the proportion of family heads with poor or fair physical health in the past 30 days by 11 percentage points (from 34 to 23 percent).

The second panel of the exhibit shows that CBRR reduces the average level of psychological distress by a standardized effect size of 0.28 relative to PBTH. The third statistically significant effect is shown in the fourth panel of the exhibit, with CBRR reducing the proportion of family heads reporting alcohol dependence or drug abuse from 16 to 10 percent.

Exhibit 9-20. CBRR Versus PBTH: Impacts on Adult Well-Being

Outcome CBRR PBTH ITT Impact Effect

Sizea N Mean (SD) N Mean (SD) Impact (SE) Adult physical health

Health in past 30 days was poor or fair (%) 178 22.7 (43.6) 197 34.0 (46.8) – 11.3** (4.8) – 0.21 Adult mental health

Goal-oriented thinkingb 178 4.51 (0.92) 197 4.35 (1.03) 0.16 (0.11) 0.13

Psychological distressc 178 6.22 (5.04) 197 8.06 (5.87) – 1.84*** (0.58) – 0.28

Adult trauma symptoms

Post-traumatic stress disorder (PTSD) symptoms in past 30 days (%) 179 21.1 (41.0) 197 24.4 (42.4) – 3.3 (4.6) – 0.07 Adult substance use

Alcohol dependence or drug abused (%) 179 9.5 (32.3) 197 16.3 (36.0) – 6.8* (3.9) – 0.17

Alcohol dependenced (%) 179 7.1 (27.8) 197 12.4 (31.6) – 5.3 (3.5) – 0.14

Drug abused (%) 179 3.4 (20.7) 197 4.6 (22.0) – 1.2 (2.1) – 0.04

Experience of intimate partner violence

Experienced intimate partner violence in past 6 months (%) 179 8.2 (29.4) 197 9.3 (28.9) – 1.1 (3.2) – 0.03 CBRR = community-based rapid re-housing. PBTH = project-based transitional housing.

ITT = intention-to-treat. SD = standard deviation. SE = standard error.

*/**/*** Impact estimate is significantly different from 0 at the .10, .05, and .01 levels, respectively, using a two-tailed t-test.

a Effect size column shows standardized effect sizes, which were calculated by dividing impact by standard deviation for the entire usual care group.

b Goal-oriented thinking is measured with a modified version of the State Hope Scale and ranges from 1 to 6, with higher scores indicating higher levels of positive, goal-oriented thinking.

c Psychological distress is measured with the Kessler 6 (K6) scale and ranges from 0 to 24, with higher scores indicating greater distress.

d Alcohol dependence is measured with the Rapid Alcohol Problems Screen (RAPS4), and drug abuse is measured with six items from the Drug Abuse Screening Test (DAST-10).

Notes: Impact estimates and outcome means are regression adjusted for baseline characteristics and are weighted to adjust for survey nonresponse. See Chapter 5 and Appendix B for outcome definitions.

Source: Family Options Study 18-month followup survey

Short-Term Impacts of Housing and Services Interventions for Homeless Families 124 FAMILY OPTIONS STUDY Community-Based Rapid Re-Housing (CBRR), SUB Compared With

Project-Based Transitional Housing (PBTH), and CBRR Compared With PBTH

The effect on psychological distress appears consistent with results found in other pairwise comparisons. In particular, PBTH families on average report more psychological distress than either CBRR or SUB families. On the other hand, the study team interprets the effects on physical health and sub - stance use with some caution. The mean CBRR values for these outcomes appear somewhat more favorable than the mean values for the entire CBRR group. In a parallel manner, the mean PBTH values for these outcomes in this compari-son sample appear somewhat less favorable than the mean values for the entire PBTH group. We found no suggestion in other pairwise comparisons that CBRR families have par-ticularly good physical health or low substance use, nor that PBTH families have particularly poor physical health or high substance use.

No effects of CBRR relative to PBTH are observed on either the proportion of family heads with PTSD symptoms or the pro-portion of family heads experiencing intimate partner violence.

Impacts on Child Well-Being in the CBRR-Versus-PBTH Comparison

As Chapter 3 addressed, differential effects of CBRR and PBTH on child well-being would be expected to be indirect, via effects on housing stability, self-sufficiency, and adult well-being, which were modest and in different directions.

Only 2 of 15 cross-age outcomes (Exhibit 9-21) and 2 of 11 age-specific outcomes (Exhibit 9-22) appeared to reflect program impact. Of these outcomes, 1 cross-age effect favored PBTH, for which school enrollment was 6.6 percentage points higher, and the other favored CBRR, for which preschool or Head Start Program enrollment was 16.8 percentage points higher. The 2 age-specific effects favored CBRR; 15 percent more of children ages 1 year to 3 years, 6 months met all developmental milestones on the Ages and Stages Question-naire (ASQ-3; panel 1 of Exhibit 9-22), and children ages 8 to 17 years reported slightly lower levels of trait anxiety (panel 3). Results for the developmental screening test (effect

Exhibit 9-21. CBRR Versus PBTH: Impacts on Child Well-Being Across Age Groups

Outcome CBRR PBTH ITT Impact Effect

Sizea

N Mean (SD) N Mean (SD) Impact (SE)

Child education

Preschool or Head Start enrollmentb (%) 74 46.6 (49.4) 94 29.8 (48.0) 16.8** (7.8) 0.28

School enrollmentc (%) 172 86.7 (34.1) 197 93.3 (27.4) – 6.6** (3.1) – 0.20

Childcare or school absences in past monthd 176 0.80 (0.90) 209 0.94 (0.94) – 0.14 (0.11) – 0.11

Number of schools attended since RAe 186 1.94 (0.94) 218 1.95 (0.85) – 0.01 (0.11) – 0.01

Grade completion (not held back) (%) 155 93.5 (24.6) 185 90.8 (28.2) 2.8 (3.3) 0.07

Positive childcare or school experiencesf 206 0.65 (0.56) 237 0.61 (0.57) 0.03 (0.06) 0.04

Positive childcare or school attitudesg 208 4.37 (1.00) 237 4.26 (1.02) 0.11 (0.10) 0.09

School gradesh 137 2.93 (0.99) 168 3.02 (0.84) – 0.09 (0.12) – 0.07

Childcare or school conduct problemsi 185 0.24 (0.44) 216 0.21 (0.43) 0.03 (0.04) 0.05

Child physical health

Poor or fair health (%) 258 2.2 (17.4) 299 6.6 (21.2) – 4.4 (2.7) – 0.16

Well-child checkup in past year (%) 257 91.1 (29.2) 299 91.7 (28.2) – 0.6 (3.0) – 0.01

Child has regular source of health care (%) 258 94.4 (21.1) 299 95.7 (21.9) – 1.2 (2.1) – 0.04

Sleep problemsj 257 2.12 (1.04) 300 2.11 (1.07) 0.02 (0.11) 0.01

Child behavioral strengths and challenges

Behavior problemsk 217 0.39 (1.27) 248 0.41 (1.16) – 0.02 (0.13) – 0.01

Prosocial behaviorl 217 – 0.10 (1.11) 249 – 0.01 (1.13) – 0.09 (0.12) – 0.06

CBRR = community-based rapid re-housing. PBTH = project-based transitional housing.

ITT = intention-to-treat. RA = random assignment. SD = standard deviation. SE = standard error.

*/**/*** Impact estimate is significantly different from 0 at the .10, .05, and .01 levels, respectively, using a two-tailed t-test.

a Effect size column shows standardized effect sizes, which were calculated by dividing impact by standard deviation for the entire usual care group.

b Base for preschool or Head Start enrollment is children ages 1 year, 6 months to 5 years.

C Base for school enrollment is children ages 6 to 17 years.

d Absences outcome is defined as 0 = no absences in past month, 1 = 1 to 2 absences, 2 = 3 to 5 absences, 3 = 6 or more absences.

e Number of schools outcome is topcoded at 4 or more schools.

f Positive childcare or school experiences outcome is defined as – 1 = mostly negative experiences, 0 = both positive and negative experiences, 1 = mostly positive experiences.

g Positive childcare or school attitudes outcome is parent report of how much child likes school and ranges from 1 to 5, with higher values indicating greater like of school.

h School grades outcome is defined as 1 = mostly Ds or Fs, 2 = mostly Cs, 3 = mostly Bs, 4 = mostly As.

i Childcare or school conduct problems outcome is defined as 0 = no conduct problems reported to parent, 1 = parent contacted about conduct problems or suspension or expul-sion from school or childcare center.

j Sleep problems outcome ranges from 1 to 5, with higher values indicating more frequent tiredness upon waking and during the day.

k Behavior problems outcome is measured as the standardized Total Difficulties score from the Strengths and Difficulties Questionnaire (SDQ).

l Prosocial behavior is measured as the standardized Prosocial domain score from the SDQ.

Notes: Impact estimates and outcome means are regression adjusted for baseline characteristics and are weighted to adjust for survey nonresponse. See Chapter 5 and Appendix B for outcome definitions.

Source: Family Options Study 18-month followup survey (parent report)

Exhibit 9-22. CBRR Versus PBTH: Impacts on Child Well-Being Developmental Outcomes by Age Group

Outcome CBRR PBTH ITT Impact Effect

Sizea

N Mean (SD) N Mean (SD) Impact (SE)

Ages 1 year to 3 years, 6 months

Met developmental milestonesb (%) 47 87.2 (39.8) 57 71.9 (44.4) 15.3** (7.4) 0.28

Low birth weightc (%) 12 3.8 (28.9) 15 5.7 (25.8) – 1.9 (8.3) – 0.05

Ages 3 years, 6 months to 7 years

Verbal abilityd 88 – 0.27 (1.06) 91 – 0.31 (0.88) 0.04 (0.21) 0.03

Math abilitye 88 – 0.39 (0.87) 86 – 0.19 (0.92) – 0.19 (0.16) – 0.16

Executive functioning (self-regulation)f 75 14.04 (16.27) 79 15.11 (15.83) – 1.07 (1.76) – 0.05 Ages 8 to 17 years

Anxietyg 89 33.75 (7.00) 104 36.36 (8.06) – 2.61* (1.41) – 0.25

Fearsh 90 65.57 (13.53) 106 67.45 (14.77) – 1.88 (2.24) – 0.09

Substance usei (%) 89 11.93 (33.10) 103 10.41 (32.24) 1.53 (4.61) 0.04

Goal-oriented thinkingj 89 21.91 (4.19) 102 23.03 (4.97) – 1.12 (0.68) – 0.16

School effort in past monthk 88 2.68 (0.82) 106 2.86 (0.82) – 0.18 (0.13) – 0.17

Arrests or police involvement in past 6 monthsl (%) 51 4.79 (23.76) 60 13.36 (34.28) – 8.57 (6.09) – 0.21 CBRR = community-based rapid re-housing. PBTH = project-based transitional housing.

ITT = intention-to-treat. SD = standard deviation. SE = standard error.

*/**/*** Impact estimate is significantly different from 0 at the .10, .05, and .01 levels, respectively, using a two-tailed t-test.

a Effect size column shows standardized effect sizes, which were calculated by dividing impact by standard deviation for the entire usual care group.

b Met developmental milestones outcome is defined as scoring above the typical development cutoffs in all domains of the Ages and Stages Questionnaire (ASQ-3).

c Base for low birthweight outcome (parent report) is children born since random assignment who are at least 1 year old at followup.

d Verbal ability outcome is the nationally standardized score from the Woodcock-Johnson III (WJ III) letter-word identification scale.

e Math ability outcome is the nationally standardized score from the WJ III applied problems test.

f Executive functioning outcome is the Head Toes Knees Shoulders (HTKS) score and ranges from 0 to 40, with higher scores indicating greater executive functioning.

g Anxiety (child report) is measured using the A-Trait scale from the State-Trait Anxiety Inventory for Children (STAIC). Scores range from 20 to 60, with higher scores indicating greater anxiety.

h Fears outcome (child report) is the score from the Fears Scale and ranges from 33 to 99, with higher scores indicating more fear.

i Substance use (child report) is measured with 23 items from the Centers for Disease Control and Prevention (CDC) 2011 Youth Risk Behavior Survey.

j Goal-oriented thinking (child report) is measured with a modified version of the Children’s Hope Scale and ranges from 6 to 30, with higher scores indicating higher levels of posi-tive, goal-oriented thinking.

k School effort outcome (child report) ranges from 1 to 4, with higher scores indicating greater effort during school day and on homework.

l Arrest or police involvement in past 6 months is from parent report.

Notes: Impact estimates and outcome means are regression adjusted for baseline characteristics and are weighted to adjust for survey nonresponse. See Chapter 5 and Appendix B for outcome definitions.

Sources: Family Options Study 18-month followup survey (parent report); Family Options Study 18-month child survey (child report); ASQ-3; WJ III; HTKS

size of 0.28) are large enough to be important, but without more consistent evidence of effects they are probably best interpreted as random variation.

Impacts on Self-Sufficiency in the CBRR-Versus-PBTH Comparison

Exhibit 9-23 shows statistically significant effects on 4 of the 20 self-sufficiency outcomes in the CBRR-versus-PBTH comparison. No statistically significant differences emerged in the employment outcomes of CBRR and PBTH family heads or in average family income or income sources. The third panel contains some puzzling results. CBRR increased the proportion of family heads who participated in any type of school or training and the number of weeks in school or training since random assignment relative to PBTH. CBRR also decreased the proportion of family heads who partici-pated in basic education and vocational education, however.

The contradictory evidence leads us to believe these results are by chance, unlikely to be replicated in other studies.

The team therefore concludes that CBRR had little or no effect on self-sufficiency outcomes relative to PBTH.

Summary of CBRR-Versus-PBTH Comparison Across Domains

For a number of reasons, the CBRR-versus-PBTH comparison offers a weaker test than the other pairwise comparisons in the study. The number of families in this comparison sample is the lowest of the pairwise comparisons and so provides less statistical power than the other tests.132 In addition, takeup rates for the assigned interventions—55 percent for PBTH families and 51 percent for CBRR families—are lower than for other comparisons.

132 The smaller comparison sample is in large part because of the greater selectivity of PBTH programs, leading to the absence of PBTH from the randomization sets of 356 families. See Gubits et al. (2013), Exhibit 3-5, for more information on the relative selectivity of PBTH, CBRR, and SUB programs.

Short-Term Impacts of Housing and Services Interventions for Homeless Families 126 FAMILY OPTIONS STUDY Community-Based Rapid Re-Housing (CBRR), SUB Compared With

Project-Based Transitional Housing (PBTH), and CBRR Compared With PBTH

Exhibit 9-23. CBRR Versus PBTH: Impacts on Self-Sufficiency

Outcome CBRR PBTH ITT Impact Effect

Outcome CBRR PBTH ITT Impact Effect

문서에서 Family Options Study (페이지 153-0)