Very little has been published about outreach programs in general, so the literature on costs and cost-effectiveness is consequently slim. An experimental study in New York (Shern et al., 2000) evaluated an outreach program for people living on the streets that included engagement, low-demand shelter/drop-in services, respite housing, and community rehabilitation. The enrolled clients had better outcomes than the control group, including a 54 percent reduction in nights sleeping on the street. However, because the enrolled clients were engaged in more services through the program, and through this engagement were more likely to be hospitalized, Rosenheck concludes that the intervention resulted in increased costs.
Rosenheck also cites the experience of the ACCESS program with street outreach: clients contacted through street outreach had significantly improved housing and clinical outcomes. However, because of the high costs of engagement and enrollment, Rosenheck argues that the outreach likely increased program costs substantially. Only one in five screened candidates entered the program, and engagement took twice as long for the people recruited through street outreach as for those recruited from shelters or other programs. The review does not speculate on the potential costs of outreach per case, nor does it report on how service utilization patterns may have changed as a result of enrollment (such as inpatient or emergency room costs, police contacts, or emergency medical transport charges). However, a more recent evaluation study reported reduced inpatient stays associated with enrollment in the ACCESS program (Rothbard et al., 2004).
Finally, Rosenheck also cites a VA study that tracked outreach and health care costs for people who were homeless and had a severe mental illness. Results showed that costs increased by 35 percent in the year after entry, including an increase of $855 in health care costs and a total of $2,285 after combining case management and residential treatment costs. He concludes that outreach can be costly, when it is effective, but notes, “This is not surprising, since the very reason for conducting outreach is to enhance access to services for the underserved” (p. 1565).1