HUD/HHS/VA Collaborative Initiative to Help End Chronic Homelessness: Is System Integration Associated with Client Outcomes?. Introduction


Collaborative Initiative to Help End Chronic Homelessness (CICH)

In response to the goal of eliminating chronic homelessness, and the request that federal agencies increase their level of collaboration to accomplish this goal, the U.S. Departments of Housing and Urban Development (HUD), Health and Human Services (DHHS), and Veterans Affairs (VA) launched a new 3-year federal Initiative in October 2003 through the U.S. Interagency Council on Homelessness entitled The Collaborative Initiative to Help End Chronic Homelessness (CICH). Through this Initiative, persons experiencing chronic homelessness receive permanent supported housing funded by HUD, and supportive primary healthcare and mental health services provided by the Health Resources Services Administration (HRSA), the Substance Abuse and Mental Health Services Administrations (SAMHSA) of DHHS, and by the Veterans Health Administration (VHA) of VA. A chronically homelessness person was defined, in this initiative, as "an unaccompanied homeless individual with a disabling condition who has either been continuously homeless for 1 year or more or has had at least four episodes of homelessness in the past 3 years" (NOFA, 2003).

The key components of the CICH intervention involved: 1) providing comprehensive primary health, mental health, and substance abuse treatment services linked to housing; 2) creating additional permanent housing; 3) increasing the use of mainstream resources that pay for services and treatment for this population; 4) replicating service, treatment and housing models that have proven to be effective ( e.g. Stein & Test, 1980; Tsemberis & Eisenberg, 2000); and 5) supporting the development of infrastructures that sustain the housing, services and treatments and interorganizational partnerships beyond the designated CICH funding period.

The 11 communities funded by HUD, HHS and VA to implement CICH included Chattanooga, TN; Chicago, IL; Columbus, OH; Denver, CO; Ft. Lauderdale, FL; Los Angeles, CA; Martinez, CA; New York, NY; Philadelphia, PA; Portland, OR; and, San Francisco, CA.

Each of these communities (sites) developed a comprehensive plan to end or reduce the prevalence of chronic homelessness in their community through the development of sustainable, cost-effective partnerships among providers in the private and public sector. The specifics of these plans varied across communities, but each plan included strategies for providing permanent housing, linking comprehensive supports with housing, increasing the use of mainstream services; integrating systems and services, and, ensuring the sustainability of these efforts beyond the initial 3-year funding period.

National Performance Outcomes Assessment

The three federal agencies sponsoring the Initiative (HUD, DHHS & VA) enlisted the VA Northeast Program Evaluation Center (NEPEC) to conduct a national evaluation of CICH network collaboration and client outcomes to monitor the implementation and effectiveness of the $35-million Initiative by using a common evaluation methodology across all 11 sites.

Client outcomes evaluation

The goals of the client outcomes component of the national evaluation were to provide a site-by-site description of program implementation, as well as descriptive information on clients served; services received; longitudinal housing quality, stability, and satisfaction; and, client outcomes in health and functional domains. Outcome data from the evaluation were provided to the sites throughout the implementation of program to guide program development, and have been provided on a quarterly basis to the sites to allow ongoing monitoring of service delivery and outcomes. Monthly site-level statistics were provided to local CICH grant recipients on the implementation of evaluation procedures as well as to federal sponsors, beginning in May 2004, and updated longitudinal client outcome statistics were provided every 3 months beginning in January 2005. Preliminary outcomes data from the first 12-months of program operation were reported in early 2007 and showed improved client outcomes in housing and health status (Mares & Rosenheck, 2007).

Network collaboration evaluation

The network component of the national evaluation examined the extent to which local agencies collaborated in delivering CICH services along four dimensions: 1) implementing clinical best practices as recommended by SAMHSA; 2) coordinated service delivery and planning; 3) inter-organizational trust and respect; and, 4) exchanging resources. Annual assessments in each of these dimensions were made by telephone interviews administered by NEPEC staff to one key informant at each of the primary human service agencies delivering CICH services, or an average of 6.7 key informants/agencies per site. Three years of key informant interview data were collected around January of each year, beginning in 2004. Preliminary network outcome data from the first 3 years of network data collection were also reported in early 2007, and showed high levels of collaboration trust and increased use of evidence-based practices across the 11 sites over the period of program implementation (Greenberg & Rosenheck, 2007).

In this report, baseline network outcomes data were merged with 12-month client outcomes data to examine the association of inter-agency collaboration at the start of the program with client outcomes during the first year of program operation. The association between changes in inter-agency collaboration over time and longitudinal client outcomes will be examined after the collection of CICH client outcomes data is completed.

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