HUD/HHS/VA Collaborative Initiative to Help End Chronic Homelessness: Preliminary Client Outcomes Report. Differences between CICH clients and comparison group subjects

02/26/2007

Baseline differences

Compared with CICH clients, comparison group subjects were less likely to have experienced 4 or more episodes of homelessness (54% vs. 68%), and less likely to have been primarily unemployed (34% vs. 46%), within the previous 3 years (Table 17). They were also less likely to be Asian/Pacific Islander (0% vs. 3%), and had fewer mental health problems than CICH clients. Comparison group subjects also had fewer mental health and substance abuse diagnoses (2.6 vs. 3.6), with a lower likelihood of having been diagnosed with bipolar disorder (12% vs. 37%) or with anxiety disorder (22% vs. 44%). Differences in access to healthcare service at baseline were mixed, with comparison group subjects reporting higher rates of being uninsured (34% vs. 17%) and having fewer healthcare providers (3.7 vs. 4.7) than CICH clients, while being more likely to have a regular source of healthcare (90% vs. 76%) (Table 17). Comparison group subjects were also more likely than CICH clients to have received vocational rehabilitation services during the previous 3 months (25% vs. 13%), but were less likely to have received housing services (42% vs. 91%) or case management visits in the community (4% vs. 52%) than CICH clients. Finally, comparison group subjects had spent fewer days in the hospital during the previous 3 months than CICH clients (0.6 vs. 2.2), while being somewhat more religious and placing a greater importance on faith in their lives than CICH clients (2.1 vs. 1.9, on a scale from 0-3).

Overall group differences

After adjusting for site, the baseline value of the dependent variable, and the 14 baseline covariates described above and presented in Table 17, significant differences between the two groups during the 12-month follow-up period were found on five service use measures and on two outcome measures. Overall, CICH clients were 1) more likely to have health insurance (i.e., were less likely to be uninsured), 2) more likely to have a primary treater for mental health or substance abuse problems, 3) more likely to be visited by a case manager in the community, 4) had a greater number of different healthcare providers, and 5) received a more integrated "package" of housing and supported services than did comparison group subjects (Table 18, "group" column). CICH clients were also housed a greater number of days, were less likely to be homeless at the time of assessment, and had higher public support incomes than comparison group subjects. No other statistically significant differences between groups were found.

Differences in rates of change

Rates of change in the proportions of individuals having a usual treater for both physical health problems and mental health/substance abuse problems increased for CICH clients, while decreasing for comparison subjects. The same was true of the proportion of subjects receiving a more integrated package of housing and supported services, although the declining proportion among comparison group subjects was less than was the case for the two primary treater/provider measures (Table 18, "group*time" column). Both groups showed increasing rates of being visited in the community by a case manager, but the rate of change was greater for CICH clients than for comparison group subjects.

Both groups showed dramatic improvements in housing rates over time, although the rate of improvement among CICH clients was substantially greater. CICH clients' participation in community activities remained largely unchanged, while comparison group subjects' participation declined modestly over time. A gradual, modest decline in the average number of days in jail was found among CICH clients, in contrast to more widely fluctuating decreases and increases in jail time observed from quarter to quarter among comparison group subjects.

Finally, there were no significant differences in total costs or changes in cost over time, although the overall pattern of total cost data suggests that CICH clients began with somewhat higher costs at baseline, but that at 12 months costs were not substantially different. Some differences were found between the groups in rates of change on the measure of quarterly substance abuse treatment costs, but these fluctuations are likely to reflect the relatively small number of clients in the comparison group.

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