Chapter 13. Conclusions
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 reduced reported alcohol and drug problems relative to UC.
SUB reduced intimate partner violence when compared with UC or CBRR. Finally, SUB lowered the number of schools attended by focal children relative to the all the other inter-ventions.
SUB reduced labor market engagement but improved food security and reduced economic stress. Assignment to SUB led to reductions in employment during the followup period relative to all other interventions and reduced employment in the week before the followup survey compared with as-signment to UC and PBTH. For example, 61 percent of the UC group had worked for pay at some point after random assignment, but only 50 percent of the SUB group had done so. Relative to CBRR and PBTH, SUB reduced current earnings and reduced annual family income in the year before the survey. Compared with UC, SUB increased the proportion of families receiving Temporary Assistance for Needy Families, or TANF, and the Supplemental Nutrition Assistance Program (SNAP) and reduced the proportion of families with income from earnings in the month before the survey. Compared with PBTH and UC, SUB led to improve-ments in food security.
Families assigned to SUB reported less economic stress in the 6 months before the interview compared with reports from CBRR, PBTH, and UC families.
148 For example, the same family may have used PBTH and SUB at different points during the followup period.
The benefits of SUB were achieved at lower cost than UC and PBTH and at only slightly greater cost than CBRR. On average, SUB programs cost slightly less than $1,200 per family per month, lower than the corresponding monthly costs for emergency shelter and PBTH but higher than the monthly cost for CBRR. SUB families used less emergency shelter and PBTH during the followup period than families assigned to those interventions. As a result, total costs of program use by families assigned to SUB were clearly less than those of PBTH families (by about $3,100) and only slightly higher than those assigned to UC (by $500). Total cost of program use for families assigned to SUB was $1,500 more than for families assigned to CBRR. The nearly equiv-alent cost of program use for SUB as compared with UC during the followup period was driven both by decreased time in relatively more expensive emergency shelter and by decreased use of relatively more expensive PBTH programs.
13.4 Community-Based Rapid Re-Housing (CBRR)
The CBRR intervention offered short-term rental assistance lasting up to 18 months (median length of use was 7 months) to rent private-market housing. CBRR also offered limited case management services focused on housing and self- sufficiency. CBRR typically received funding from the Home - lessness Prevention and Rapid Re-Housing Program, or HPRP. What do the findings from this study tell us about this intervention?
Takeup of CBRR was relatively low. Of families randomly assigned to CBRR, 60 percent used CBRR during the 20-month followup period, much lower than the 84-percent takeup rate for SUB in that random assignment arm. Families assigned to CBRR in some instances also used transitional housing (19 percent) and multiple forms of permanent sub sidies (23 percent across all types of permanent subsidy). Qualitative research suggested that the short duration or uncertainty about the duration of assistance made some families reluctant to use CBRR assistance (Fisher et al., 2014).
CBRR led to more rapid departures from emergency shelter than UC. One of the goals of CBRR was to promote more rapid exit from emergency shelter into housing. The impacts measured by the study provide evidence that this goal was achieved, relative to UC. Assignment to CBRR leads to slightly faster exit from emergency shelter than assign-ment to UC, with no significant difference compared with shelter exits in SUB or PBTH.
CBRR was equivalent to UC and less effective than SUB in preventing subsequent stays in shelters and places not
meant for human habitation and in improving other aspects of housing stability. The study found that priority access to CBRR was equivalent to leaving families in UC—
and substantially less effective than priority access to SUB—
in reducing subsequent stays in shelters or places not meant for human habitation and in improving other aspects of housing stability. Modestly worse results for CBRR than for PBTH may result from the fact that 22 percent of families assigned to PBTH were still in PBTH programs at the time of the followup survey, but only 6 percent of CBRR families were still receiving CBRR. Priority access to CBRR had little impact on other outcomes compared with priority access to UC, with the exception of increasing family income, receipt of SNAP, and food security. As noted previously, SUB had slightly better outcomes than CBRR regarding separation of spouses, intimate partner violence, children’s school outcomes, and economic stress, but CBRR improved work effort, annu - alized earnings, and annual family income compared with SUB. Perhaps surprisingly given the additional services pro vided by PBTH, CBRR enhanced several aspects of adult well-being relative to PBTH, reducing psychological distress, alcohol dependence or drug abuse, and the frequency of fair or poor health.
CBRR has the lowest monthly cost of the active interven tions studied, and total costs during the 21 months after random assignment for those assigned to CBRR were slightly lower than those of families assigned to SUB. CBRR programs had a lower per-family, per-month cost than PBTH and SUB, averaging slightly less than $900. Housing costs comprised, on average, 72 percent of these costs. Total costs of all pro - grams used by participants assigned to the CBRR intervention during the followup period were on average lower than total costs for all the other interventions. CBRR total costs were only 5 percent lower than SUB, however, because the greater use of SUB programs by families in the SUB ran-domization arm was offset by the greater use of transitional housing, PSH, and emergency shelter programs by CBRR families. Costs of program use for families assigned to CBRR were $3,000 lower than for UC, $8,000 lower than for PBTH, and $1,500 lower than for SUB over 21 months.
13.5 Project-Based Transitional Housing (PBTH)
The PBTH intervention offered housing for up to 24 months, coupled with a wide array of social services. The study focused primarily on housing provided in facility-based settings (although some PBTH families were referred to programs with scattered-site units from which they were required to move when assistance ended). PBTH programs offered
Short-Term Impacts of Housing and Services Interventions for Homeless Families 160 Chapter 13. Conclusions
comprehensive case management, referral to outside pro-viders, and direct services in several areas and also offered access to employment training, life skills, mental health care, parenting skills, and physical health care. The scope of needs addressed in PBTH programs was similar to that of emer-gency shelters. During the followup period, 54 percent of respondent families assigned to PBTH used that form of assistance for an average of 12 months. The Family Options Study provides several lessons about the PBTH model.
Takeup of PBTH was relatively low. PBTH providers were more selective than either SUB or CBRR providers regarding the families they would serve. Only 77 percent of families considered for the study passed the initial screening for PBTH that took place before random assignment, and 18 percent of those who passed and were assigned to PBTH were sub-sequently screened out by the PBTH programs as ineligible.
Of the families assigned to PBTH, 54 percent used some form of transitional housing during the followup period. This low level of takeup reflects a combination of family choices and program eligibility requirements, with some families considered ineligible by the programs to which they were assigned and some families choosing not to use PBTH assis-tance. Qualitative interviews suggest that the fixed location of PBTH units may have been a barrier when the assigned location was not close to families’ schools, work, transporta-tion, and support networks, or when families perceived the programs to be in bad neighborhoods (Fisher et al., 2014).
Families assigned to PBTH also used CBRR (10 percent) and various forms of permanent subsidy (21 percent, including SUB and other forms of permanent subsidy).
PBTH reduced stays in emergency shelter and on the street compared with UC but did not lead to other effects. Com - pared with UC, priority access to PBTH reduced the propor-tion of families who reported stays in shelters or places not meant for human habitation in the 6 months before the sur-vey. This finding may reflect the fact that about 22 percent of families who were assigned to and who used PBTH were still in PBTH at the time of the followup survey. In four other domains, however, most indicators examined reveal equivalent results with or without assignment to PBTH after shelter (that is, compared with UC assignment).
PBTH costs less than shelters on a per-family, per-month basis, but total costs for PBTH families during the period after random assignment were the highest among all inter-ventions, including UC. PBTH programs cost slightly more than $2,700 per family per month, with supportive services constituting 42 percent of these costs—a lower monthly cost than emergency shelter but higher than SUB and CBRR.
The cost of total program use for PBTH families during the followup period was substantially higher than for UC (by
$2,500), SUB (by $3,100), and CBRR (by $8,000).