Changes in Health Care Utilization and Associated Costs After Supportive Housing Placement by an Urban Community Mental Health Center.

Permanent supportive housing (PSH) for individuals experiencing homelessness and living with mental illness can reduce utilization of crisis care services and increase utilization of outpatient care, although the extent to which pre-housing utilization patterns influence post-housing utilization remains unclear. Therefore, pre- and post-housing health service utilization was examined in 80 individuals living with a chronic mental illness who were and were not utilizing health care services in the years pre- and post-housing. Overall, the proportion of tenants utilizing outpatient services, including outpatient behavioral health services, increased from pre- to post-housing. Tenants who did not use outpatient behavioral health services prior to housing were disproportionately less likely than their peers to use those services after being housed. Among tenants who utilized crisis care services prior to being housed, reductions were observed in the number of crisis care visits. Results suggest PSH leads to changes in health care utilization and associated costs.

The use of data to assist in the design of a new service system for homeless veterans in New York City.

OBJECTIVE: Operation Home is an agreement between the City of New York and the US Department of Veterans Affairs to design a new service system to help end veteran homelessness in New York City. The authors' task was to obtain data to inform the design of this new system. METHODS: A variety of methods were used. The group reviewed relevant literature and data from street homeless survey samples, analyzed shelter data, and consulted with VA homeless program staff on the findings. We then surveyed case managers at a veterans' shelter regarding their clients and determined their housing eligibility using a standardized logic model, and led two focus groups of veterans at this shelter regarding their views of the current shelter system and services for homeless veterans and how these might be improved. RESULTS: Among those resident in shelters during 2006, 37.2% of self-identified veterans compared to 0.9% of others reported their prior residence as supported housing, suggesting the need for more intensive case management at veterans' supported housing sites to help them sustain their tenure. The lack of interconnectedness among the various information systems made it more difficult to collect and analyze pertinent data. To begin to address this, a data match was undertaken to estimate the proportion of veterans resident in the veterans' shelter who were not in receipt of VA benefits to which they may be entitled. CONCLUSION: The data obtained through collaboration between staff from NYC's Department of Homelessness Services, US Department of Veterans Affairs facilities in the New York/New Jersey region and Common Ground Community led to information that informed the evaluation design of the new system. The identification of gaps in available data on homeless veterans will lead to projects both to improve and share data.