Impact of Clinically Focused Housing Navigation Services on Housing and Behavioral Health Outcomes for Individuals Experiencing Homelessness

Background/Purpose: A five-year demonstration project, the Road to Health and Housing (R2H) Program provided clinically focused housing navigation for adults experiencing homelessness with serious mental illness (SMI) and co-occurring disorders (COD). R2H operated in a partnership model to support individuals with SMI and COD access stabilizing physical and behavioral health care services to alleviate barriers to housing acquisition. The R2H program worked alongside the local homeless system Coordinated Entry System (CES), acting as a bridge for homeless individuals that have been “matched” to a housing agency with an available housing unit. R2H staff provided client advocacy, working to eliminate behavioral health bias and discrimination by housing providers. As the R2H lead and housing navigation provider, we designed and implemented this project in partnership with a clinical behavioral and primary health care clinic, legal services organization, and local CES administrator; the underlying program assumptions were that clinically focused housing navigation would 1) reduce time from “matched” to housing acquisition; 2) reduce number of client “matches” needed; and 3) increase housing retention through behavioral and physical health service utilization.

Methods: Through this collaborative model, we were able to obtain programmatic health and housing data, as well as comparative system data. Housing outcome data was obtained from the local Homeless Management Information System, which houses CES data. This included demographic and outcome data information on R2H program participants and two comparable groups (general homeless population and those with SMI/COD not enrolled in R2H); there was minimal demographic variability between groups. Data on three specific outcomes was obtained: number of matches to permanent housing; time to housing acquisition; and housing retention rates after 12 and 24 months. To assess the program’s impact on self-reported behavioral health outcomes, R2H evaluation staff conducted baseline, 6-month and 12-month assessments on a variety of measures, including behavioral health symptomology; behavioral and primary health service utilization (appointment types, number of visits, etc.) was collected from the R2H clinical partner.

Results: Final 5-year data show R2H clients requiring more unit “matches” than the general CES population (2.61 vs. 1.78) even though they take less time to enter housing (78 vs 88 days). Once housed, R2H clients remain housed at 12 and 24 months at higher rates than the general CES population (87% vs 67%; 68% vs. 43%); R2H staff attribute these outcomes to the exercise of client choice within the housing process. While only 38% accessed the mental and medical health services offered, between baseline and six-month follow-up there was a 105% increase in aggregate functioning scores, 19% increase in overall health scores and 56% decrease in reported psychological stress.

Conclusions/Implications: Social justice and racial equity includes the power of choice. This partnership supported client exercise of choice within housing and health systems as access to services was never rescinded even when health services or a housing unit was declined. This is crucial as individuals experiencing homelessness are frequently members of other marginalized communities. Housing navigation programs that advocate for clients should be incorporated into CES systems whenever possible.