An Evaluation of a Housing First and Assertive Outreach Team Intervention with Chronically Homeless Individuals with Co-Occurring Disorders

Background

This study seeks to understand whether enrollment in a Housing First/Assertive Community Treatment intervention is associated with a reduction in all types of criminal justice system contact for chronically homeless persons. The primary hypothesis is that enrollment in the program will have a significant impact on reducing arrests and incarcerations related to living in public (homeless crimes) and illegal substance use (drug crimes). Because of Housing First programs unfortunately initially destabilize chronically homeless individuals, it is expected that the program impact will be delayed: as such, clients’ arrest and incarceration rates would not be expected to decrease immediately after enrollment. The third hypothesis is that arrest and incarceration for other types of crimes will not be impacted by program enrollment.

Methods

Participants were chronically homeless individuals, with a recent criminal history, enrolled in a Housing First/Assertive Community Treatment program during an 18-month period. The sample includes all program participants who had been arrested at least once in the 12 months prior to program enrollment (N=53). Participants were prioritized for enrollment based on the following criteria: medical vulnerability; prior resistance to services; and a history of failed housing placements.

Demographic information, such as age, gender, and race/ethnicity, was collected from the agency’s intake assessments and used to provide a description of the sample. Changes in client’s housing status were recorded in these data. Program assessments also included self-report measures of participants’ history of substance abuse, mental illness, and physical health. Jail data were obtained from county jail records for the one-year period before and after enrollment and included new charge bookings.

Analyses modeled the three crime types as counts of arrests for homelessness-related crimes, drug crimes, and other crimes over four 6-month periods. Initial examination of the data indicated that all three models showed deviation from a Poisson distribution as indicated by both overdisperson and Pan’s (2001) Quasi-Likelihood under the Independence model Criterion (QIC). Better model fit was achieved using negative binomial regression. All analyses were conducted using SPSS 23.0.

Results

The first hypothesis was partially supported, in that the HF/ACT program was associated with a reduction in homelessness-related crimes but not drug-related crimes. As predicted, this effect (second hypothesis) was delayed, suggesting that changes in clients’ behavior did not happen immediately upon moving into housing. The third hypothesis (no change in other crimes) was also supported and the HF/ACT program did not reduce general criminal activity that is not a direct consequence of street living. 

Conclusions

There are important social work policy and practice implications from this study.  First, the reduction in crimes related to living in public, confirms that some portion of criminal justice contact among this population can be reduced with the provision of housing. Second, there is a period of destabilization with a housing intervention and there is need for additional initial support when housing chronically homeless individuals.  Lastly, the study may indicate the need for additional services to target criminogenic needs to address the goal of overall reductions in recidivism among this population.