HUD/HHS/VA Collaborative Initiative to Help End Chronic Homelessness: Preliminary Client Outcomes Report. Association of service use and client outcomes


An analysis of aggregated data pooled across sites and time points showed that after, adjusting for site and service use measures bivariately associated with each outcome, each service use measure was significantly associated with at least one outcome measure.

Service use measures associated with the largest number of outcome measures included participation in alcoholics anonymous or narcotics anonymous (AA/NA) (associated with 11 outcomes), coordination of services, and having a money manager (9 outcomes), along with therapeutic alliance with a mental health/substance abuse provider (8 outcomes). The remaining 11 service use measures were associated with between 3 and 6 outcome measures (Table 16).

The two service use measures associated with the smallest number of client outcome measures were: a) any contact with landlord and b) total number of outpatient visits, which were each associated with only one outcome. Landlord contact was associated with a higher level of mental health functioning, and total number of outpatient visits with decreased total health care costs, indicating a savings in total health care costs of $61 per outpatient visit, on average (Table 16). The number of outpatient mental health visits and the number of different service providers were each associated with only two client outcomes.

AA/NA participation

Clients who participated more frequently in AA/NA meetings were housed an average of 8 days less per quarter than other clients. and showed significantly higher healthcare costs for all 3 types of care examined as well as for total outpatient costs. Those with more serious substance abuse problems most likely required a higher level of use of healthcare services. These clients also experienced more distress due to psychiatric symptoms. However, those participating in AA/NA were more actively involved in the community, had larger social networks, were more likely to be employed, and were more satisfied with their primary mental health/substance abuse treater than other clients (Table 16, column 9).

Having a money manager

Clients assigned to a money manager had more negative outcomes, including: fewer days of housing, more psychotic behaviors, and higher costs in the medical and mental health domains in addition to overall higher inpatient care costs. Clients having a money manager were also more likely to receive public support payments, and consequently, more total income than did clients without a money manager (Table 16, column 14). Presumably assignment of a money manager reflected these circumstances rather than being caused by them.

Coordination of services

Clients receiving more coordinated services had better outcomes than others, including having a greater number of days housed and more satisfaction with their housing. Coordination of services was also positively associated with greater satisfaction with life overall and greater trust in one's doctor; with higher levels of mental health functioning and less distress due to psychiatric symptoms; and with decreased rates of illicit drug use and less severe drug problems (Table 16, column 18).

Therapeutic alliance

As with coordination of services, the strength of the therapeutic alliance between clients and primary mental health or substance abuse providers was associated with several positive outcomes including greater housing satisfaction and greater satisfaction with life overall. The alliance was also associated with larger social support networks, higher levels of mental health functioning, and with lower rates of drug use and less serious drug problems (Table 16, column 10).

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