Studying Permanent Supportive Housing Outcomes during the COVID-19 Pandemic

Background and Purpose: Permanent supportive housing (PSH) is an evidence-based practice to address homelessness. This paper describes key challenges and baseline findings from a mixed-methods comparative effectiveness study of PSH that was conducted during the COVID-19 pandemic. The study considered two distinct approaches to implementing PSH. The first approach is place-based PSH (PB-PSH), or single-site housing placement in which an entire building with on-site services is designated for PEH. The second approach is scatter-site PSH (SS-PSH), which uses apartments rented from a private landlord while providing mobile case management services. To date, limited research related to the comparative effectiveness of PB-PSH versus SS-PSH has been mixed to date. This study examines outcomes related to COVID-19 and patient-centered quality of life.

Methods: People experiencing homelessness in Los Angeles County who were approved for PSH were eligible to participate if they had either been housed in the past 2 weeks or expected to be placed in housing in 30 days. PSH placement is determined through a county-run coordinated entry system, which identifies clients’ needs and matches them with available housing options. Because the system typically assigns individuals approved for PSH to specific nonprofit, community-based agencies that are ultimately charged with securing housing and supportive services, recruitment was conducted through 26 agencies. Once recruited, study participants completed 6 monthly surveys after move-in using smartphones provided by the study team.

Results: Study recruitment was supposed to occur during 6 months starting in January 2021 but was extended due to delays in recruitment. These delays included COVID-19 delays (e.g., recruitment sites shut down due to outbreaks, study team members testing positive) and delays that may have been indirectly related to the COVID-19 pandemic, including high staff turnover or recruitment sites having competing priorities. At the end of recruitment in July 2022, 641 PEH had been referred from recruitment sites and 563 PEH enrolled in the study and completed a baseline demographic survey. Of the 563 participants in the study, 452 had recently moved into housing when they enrolled. Another 111 participants were approved but still waiting for housing placement; these individuals were more likely to indicate that they had specific housing preferences (e.g. living with a partner or pet) as compared to those who had moved in.

Conclusion and Implications: Recruitment during the pandemic, while successful, was challenging given that in-person contact was not permitted at times either by recruitment sites or the research institutions during COVID-19 surges and high community transmission, which particularly affected homelessness programs in Los Angeles. To overcome recruitment challenges, flexible strategies were employed that included extending the recruitment period and the distribution of cell phones with paid data plans. Housing preferences among people experience homelessness should be an important part of program design and preferences appear to play an important role in terms of whether housing placements are accepted.