Cost-Effectiveness Studies

The Patterns and Costs of Services Use among Homeless Families

Dennis Culhane, Jung Min Park, Stephen Metraux
October 2011

This study examines families’ use of behavioral health hospitalization and foster care placement prior to, during and following shelter use, comparing families based on shelter pattern and type of housing exit. Results show that inpatient and foster care services use drops in the homelessness period, but rebounds following exit, regardless of pattern of shelter use, and type of housing exit. Results suggest that shelters supplant use of services, but not on a sustained basis...

Beds Not Buses: Housing vs. Transportation Costs for Homeless Students

National Law Center on Homelessness and Poverty
September 2011

A report released by the National Law Center on Homelessness & Poverty shows that providing affordable housing to homeless families is more cost-effective than providing federally mandated transportation for homeless students.

Costs Associated With First-Time Homelessness For Families and Individuals

Jill Khadduri, Josh Leopold, Brian Sokol, and Brooke Spellman
March 2010

This study measures costs associated with first-time homeless individuals and families incurred by homeless and mainstream service delivery systems in six communities. Unaccompanied individuals were studied in Des Moines, Iowa; Houston, Texas; and Jacksonville, Florida.  Families were studied in Houston, Texas; ...

Cost of Rural Homelessness: Rural Permanent Supportive Housing Cost Analysis

Melany Mondello, Jon Bradley, Tom Chalmers McLaughlin, and Nancy Shore
May 2009

This study is the first-ever statewide study of supportive housing in a rural setting, demonstrating that affordable housing with attached services is also effective outside of large metropolitan areas.  The study found that rural supportive housing is less expensive than homelessness and provides people ...

Effect of a Housing and Case Management Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults: A Randomized Trial

Laura S. Sadowski, Romina A. Kee, Tyler J. VanderWeele, and David Buchanan
May 2009

The Chicago Housing for Health Partnership (CHHP) is a “hospital-to-housing” effort that identifies chronically ill homeless individuals at hospitals, moves them to permanent supportive housing, and provides them with intensive case management services so that they can maintain their health and ...

Supportive Housing Means Less Time in Mental Health, Nursing Homes, Prisons

The Heartland Alliance Mid-America Institute on Poverty
April 2009

This analysis focused on 177 supportive housing residents in Illinois and the impact of supportive housing on their use of expensive, primarily publicly-funded services.  Analysis compared the 2 years before they entered supportive housing with the 2 years after.  Data were collected on these residents from ...

Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems

Mary E. Larimer, Daniel K. Malone, Michelle D. Garner, David C. Atkins, Bonnie Burlingham, Heather S. Lonczak, Kenneth Tanzer, Joshua Ginzler, Seema L. Clifasefi, William G. Hobson, and G. Alan Marlatt
April 2009

Chronically homeless individuals with severe alcohol problems often have multiple medical and psychiatric problems and use costly health and criminal justice services at high ...

Where We Sleep: Costs When Homeless and Housed in Los Angeles

Daniel Flaming, Patrick Burns, Michael Matsunaga, Gerald Sumner, Manuel H. Moreno, Halil Toros, and Duc Doan

The purpose of this study was to identify public costs for different types of homeless individuals when they are housed and when they are not housed, the extent to which any cost savings when housed are sufficient to pay the cost of housing, and the public agencies that bear ...

Frequent Users of Health Services Initiative: Final Evaluation Report

Karen W. Linkins, Jennifer J. Brya, and Daniel W. Chandler, PhD
August 2008

The Frequent Users of Health Services Initiative was a five-year, $10 million project jointly funded by The California Endowment and the California HealthCare Foundation.  Frequent users are a small group of individuals with complex, unmet needs not effectively addressed in the high-cost acute care settings of ...

Cost and Threshold Analysis of Housing as an HIV Prevention Intervention

David R. Holtgrave, Kate Briddell, Eugene Little, Arturo Valdivia Bendixen, Myrna Hooper, Daniel P. Kidder, Richard J. Wolitski, David Harre, Scott Royal and Angela Aidala
July 2007

The Housing and Health study examined the effects of permanent supportive housing for homeless and unstably housed persons living with HIV.  While promising as an HIV prevention intervention, providing ...

Accountability, Cost Effectiveness and Program Performance: Progress since '98

Dennis P. Culhane, Wayne D. Parker, Barbara Poppe, Kennen S. Gross and Ezra Sykes
March 2007

In the report "Accountability, Cost Effectiveness and Program Performance: Progress since 1998," the authors summarize the progress made in the past decade toward making homeless assistance programs more accountable to funders, consumers, and the public. They observe that research on the costs of ...

Denver Housing First Collaborative Cost Benefit Analysis and Program Outcomes Report

Jennifer Perlman and John Parvensky
December 11, 2006

The Colorado Coalition for the Homeless created the Denver Housing First Collaborative (DHFC) in 2003 with funding provided by a collaboration of federal agencies.  The DHFC is designed to provide comprehensive housing and supportive services to chronically homeless individuals with disabilities. Initial federal funding created the ...

Impact of Permanent Supportive Housing on the Use of Acute Health Services by Homeless Adults

Tia E. Martinez and Martha R. Burt
July 2006

This analysis examined the impact of permanent supportive housing on the use of acute care public health services by homeless people with mental illness, substance use disorders, and other disabilities. The sample consisted of 236 single adults who entered supportive housing at two San Francisco sites. Eighty percent had a diagnosis of dual ...

Estimated Cost Savings Following Enrollment in the Community Engagement: Program Findings from a Pilot Study of Homeless Dually Diagnosed Adults

Thomas L. Moore
June 2006

This report discusses the estimated cost-benefits of providing community-based therapeutic care and case management to adults experiencing chronic homelessness and multiple disabling conditions. The treatment approach used was adapted from the empirically tested Assertive Community Treatment (ACT) model and is locally referred to as the Community Engagement Program ...

Impact of the San Diego Serial Inebriate Program

James V. Dunford, Edward M. Castillo, Theodore C. Chan, Gary M. Vilke, MD, Peter Jenson and Suzanne P. Lindsay
January 2006

The study examines the impact of the San Diego Serial Inebriate Program on the use of emergency medical services (EMS), and emergency department (ED) and inpatient services by individuals repeatedly arrested for public intoxication. This was a retrospective review of ...

Cost-effectiveness of Supported Housing for Homeless Persons With Mental Illness

Robert Rosenheck, Wesley Kasprow, Linda Frisman, and Wen Liu-Mares
September 2003

In 1992, the US Department of Housing and Urban Development (HUD) and the US Department of Veterans Affairs (VA) established the HUD-VA Supported Housing (HUD-VASH) program to assist homeless veterans with mental illness and/or substance abuse disorders.  In this study, homeless veterans with psychiatric ...

Cost-effectivess of Critical Time Intervention

Kristine Jones

Cost-effective programs are needed to assist homeless persons with severe mental illness in their transition from shelters to community living. This study investigated the cost-effectiveness of the critical time intervention program, a time-limited adaptation of intensive case management...

Capitated Assertive Community Treatment Program Savings: System Implications

Daniel Chandler and Gary Spicer
September 2002

In a California county of one million people, 4% of all clients served in 1994 were found to use 38% of publicly funded mental health services. A controlled experiment was designed to test whether a capitated Assertive Community Treatment (ACT) program could produce outcomes that were equivalent or better than “usual services” for a ...

Costs and Effectiveness of Substance Abuse Treatments For Homeless Persons

Joseph E. Schumacher, Stephen T. Mennemeyer, Jesse B. Milby, Dennis Wallace and Kim Nolan
June 2002

This study presents a cost analysis of two randomized controlled studies comparing four drug addiction interventions for homeless persons. The studies controlled for some limitations of previous research in this area including random assignment. Findings are based on treatment costs obtained ...

Public Service Reductions Associated with Placement of Homeless Persons with Severe Mental Illness

Dennis P. Culhane, Stephen Metraux, and Trevor Hadley
January 2002

This article assesses the impact of public investment in supportive housing for homeless persons with severe mental disabilities. Data on 4,679 people placed in such housing in New York City between 1989 and 1997 were merged with data on the utilization of public shelters, public and private hospitals, and correctional ...

Cost-Effectiveness of Services For Mentally Ill Homeless People

Robert Rosenheck
October 2000

About one-quarter of homeless Americans have serious mental illnesses. This review synthesizes research findings on the cost-effectiveness of services for this population and their relevance for policy and practice. Service interventions for seriously mentally ill homeless people were grouped into three overlapping categories: 1) outreach, 2) case management, ...

Cost Effectiveness of Assertive Community Treatment

Anthony F. Lehman

Homelessness is a major public health problem among persons with severe mental illness (SMI). Cost-effective programmes that address this problem are needed. This study evaluates the cost- effectiveness of an assertive community treatment (ACT) programme for these persons in Baltimore, Maryland...

Hospitalization Costs Associated With Homelessness in New York City

Sharon A. Salit, Evelyn M. Kuhn, Arthur J. Hartz, Jade M. Vu, and Andrew L. Mosso
June 11, 1998

Homelessness is believed to be a cause of health problems and high medical costs, but data supporting this association have been difficult to obtain.  In this study, researchers compared lengths of stay and reasons for hospital admission among homeless and other low-income persons in New ...

Cost-effectiveness evaluation of three approaches to case management

Nancy Wolff

In this study the authors compared the cost-effectiveness of three approaches to case management for individuals with severe mental illness who were at risk for homelessness: assertive community treatment alone, assertive community treatment with community workers, and brokered case management (purchase of services). Individuals were randomly assigned to the three treatment conditions and followed for 18 months...

Housing cost for adults who are mentally ill and formerly homeless

Barbara Dickey

The goal of this study was to evaluate the costs, under two different housing conditions, to the state mental health agency of caring for adults who are homeless and mentally ill...