Study finds permanent supportive housing could help end chronic homelessness

The Best Kind of Medicine

Study finds permanent supportive housing could help end chronic homelessness

A (since cleared-away) homeless encampment in San Jose, California. (Jon Evans/Flickr/ CC by 2.0)

A comprehensive, first-of-its-kind study conducted by the University of California, San Francisco (UCSF) has found that Project Welcome Home, a $19 million permanent supportive housing initiative in Santa Clara County, California, has enjoyed a high level of success in providing safe, secure, and lasting shelter to “the most complex” of homeless people. This includes individuals experiencing chronic homelessness, with disabilities and medical conditions and those who have “frequent encounters” with jails, hospitals, and emergency rooms per a news article published by UCSF.

The results of the study, published in Health Services Research and considered as one of the first randomized controlled trials to test the effectiveness of placing the most vulnerable of the unsheltered population in permanent housing with access to voluntary support services, is an encouraging sign for not only five-year-old Project Welcome Home but for similar programs in the Bay Area and further afield. Those combine subsidized housing with mental health counseling, addiction treatment, and other targeted support services. Project Welcome Home is operated by Abode Services, with support from Santa Clara County, which has one of the highest (and increasing) numbers of people experiencing homelessness in the United States.

In the study, researchers found that 86 percent of randomized participants—199 in total—who had secured permanent, supportive housing remained in these facilities for several years. It took roughly ten weeks on average for people to successfully secure housing, and 70 percent of the 169 successfully housed participants were placed multiple times. Yet for almost the entire duration of the two-and-a-half-year study, the participants remained consistently housed.

Of the 244 individuals who qualified to enroll in Project Welcome Home but weren’t selected in a lottery system that would have secured them a place with that program, roughly one-third of this control group ultimately secured housing through other permanent supportive housing programs offered in Santa Clara County not associated with Project Welcome Home. As reported by The Mercury News, only three qualifying chronically homeless individuals approached to participate by outreach workers declined to do so.

While they only represent roughly five to ten percent of the overall chronically homeless population, the high-risk participants involved with the study averaged five hospitalizations, 20 ER visits, five rounds of receiving emergency psychiatric services, and three periods of being jailed within two years before being enrolled in Project Welcome Home.

“The folks that we serve in this program have been extraordinarily sick and on the streets a long time, but the resiliency that they show once housed is always inspiring,” said Louis Chicoine, chief executive officer of Abode Services, in the UCSF news article. “Abode, through a multi-disciplinary team has provided the housing, clinical, and peer support needed to get people in their own homes and help them achieve their wellness goals.”

This isn’t to say that the program has been 100 percent foolproof. Some participants did find themselves in hospital and/or jail during the duration of the study and some, including those who were successfully housed, passed away. (About six percent of total participants from both groups died during the study.) In fact, researchers found that participants were more likely to die while in housing versus living unhoused. Participants that secured housing were also just as likely to require emergency medical care as their counterparts who did not secure housing during the duration of the study. This finding proved that even after participants secured—and stayed put in—supportive housing, the health impacts caused by years of chronic homelessness don’t necessarily magically disappear after such a positive shift.

“These people are so far down the road in their illnesses, you’re so far from primary prevention,” Dr. Maria Raven, one of the study’s co-authors who serves as associate professor of emergency medicine and chief of the Department of Emergency Medicine at UCSF said. “It is an effective intervention, but it’s late in their life course.”

Reliance, however, on outside emergency psychiatry services did decrease among housed participants compared to unhoused participants, which isn’t entirely surprising as mental health counseling is among the support services offered by Project Welcome Home.

Despite the bumps in the road—and deaths—experienced by the study’s participants, the overall results in the study are wildly positive considering that the chronically unhoused individuals that comprised both groups are so often considered far beyond help.

“It works. It improves people’s lives. It keeps people housed,” Dr. Margot Kushel, a professor of medicine and director of the UCSF Benioff Homelessness and Housing Initiative who co-authored the study alongside Raven and Matthew Niedzwiecki, an assistant professor in emergency medicine, told the Mercury News. “It ends homelessness. Full stop.”

And county officials have duly taken notice of the successes of Project Welcome Home.

“This study proves what we already know: Housing is medicine,” Santa Clara County deputy executive Ky Le explained in the UCSF news release. “The real challenge is harnessing the will necessary to create this solution at scale. I’m hopeful that this study will be one more tool in our efforts to end homelessness in our community.”