Making the Business Case for Supportive Housing

Providing integrated housing, health care, and social services and evaluating the effect in Minnesota

Dates of Project: Pilot Program: 2001 through 2007

Description: The Supportive Housing and Managed Care Pilot recruited participants with the most complex needs. They had long histories of homelessness exacerbated by medical problems, mental illness, chemical dependency, traumatic experiences, and for some, children with special needs. Services along with housing included intensive case management, help accessing benefits, income support programs, health care, aid with family relationships, support, and reunification; and life skills development.

Most participants entered the pilot exhausted and despairing, unwilling to embrace services. Establishing rapport with participants with highly complex needs took considerable time and effort, and trusting relationships became the linchpin of effective services.

For the evaluation, researchers conducted annual interviews and focus groups with participants, service providers, program administrators, and other stakeholders to investigate the program's successes, challenges, and lessons learned. Stakeholders used evaluators’ annual reports to improve the program. The evaluators also examined the types and costs of publicly funded services used by 518 participants.

Key Results, Findings, and Conclusions:

  • During the stage of the pilot supported by RWJF (2001 through August 2003), a total 277 participants—including 49 families with 57 parents and 151 children, and 69 individual adults—received housing and individualized services including the coordination of health care, mental health, and social services. With support from the Minnesota Legislature and other funders, the pilot continued to deliver services to an additional 471 participants through the period examined by the evaluation, to November 2005. Thus the pilot engaged a total of 748 people.

The evaluation found:

  • The average cost of these individualized services per participant per year (excluding rental assistance provided in the pilot) was $4,239—an amount equivalent to roughly six days of publicly-funded inpatient treatment for mental health illness or substance abuse.
  • Pilot participants reported much greater housing stability nine months after joining the program, and they sustained that stability after 18 months.
  • The pilot spurred a desirable shift in the types of publicly funded services used by participants, but it had less impact on the overall cost of those services. Single adults shifted toward more routine and preventive medical care and outpatient mental health services, and away from inpatient mental health and detox services and prison. Children's use of outpatient medical services rose, whereas their use of inpatient mental health services fell.
  • Although shifts in service use often did not reduce near-term costs, they addressed the underlying causes of homelessness and could ultimately reduce financial and social costs that could stretch over generations.

See The Minnesota Supportive Housing and Managed Care Pilot: Evaluation Summary for more findings.

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Supportive housing pilot in Minn. helps chronically homeless clients obtain & keep housing; get needed care

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