USING DATA TO END HOMELESSNESS Joshua D. Bamberger, MD, MPH San Francisco Department of Public Health University of California, San Francisco, Dept. of Family and Community Medicine

Housing and Homeless Studies Cost Before and after studies Randomized controlled trials Mortality Retrospective case control Quality of Life Retrospective cohort studies Populations based homeless prevalence Creating a Narrative

Housing is less expensive than homelessness For people w/ homelessness and AIDS, ARVs are necessary but not sufficient to improve mortality The right treatment for the condition

 Direct Access to Housing units in 40 buildings  Tailor housing to needs of individual  Initially SRO, now new buildings  Priority to people with multiple disabilities  93% with Axis I mental illness  At least 18% HIV+ SF Health Dept’s Housing

DAH Portfolio

Cost: Plaza Retrospective Before and After 106 Chronically homeless adults Cost year before housing: $3,132,856 Cost year after housing: $906,228 Reduction in healthcare costs: $2,226,568 Cost of program: $1.1million/year Reduction in public cost in first year: $1.1 million More than 90% of reduction among 15 tenants who cost more than $50,000/year prior to being housed Regression to the mean

Brand new building with 174 units Homeless, high users of a managed care system Comprehensive healthcare utilization Randomly assigned to treatment or regular care Followed prospectively for 5 years Outcomes included: Healthcare cost, mortality, jail Cost: KCC Random assignment trial

Cost Eastlake, Seattle Compared to controls, housed Ps showed greater reductions in overall costs Cost offsets of housing > $4m for 1 st year More time in housing associated with greater reduction in costs 6-mo within-subjects reductions in typical alcohol use Figure and findings from Larimer et al. (2009)

Mortality

Ranking of housing from worst to best housing Private bath better than shared bath New building better than renovated Nursing better than no nursing Senior better than non-senior Quality of Housing and Outcome

The more beautiful the housing the better the outcome

POPULATION SNAPSHOT

Veteran PIT Counts, * CoCs only required to conduct a new count of unsheltered homelessness in odd numbered years; in 2012, only 32% of CoCs opted not to do a new unsheltered count, providing an incomplete picture of trends in the number of unsheltered homeless Veterans Source: PIT data, *

Number of Homeless Veterans in 5 Communities with Greater than 40% reduction

Common values and philosophy of practice, strong leadership, housing first Targeting High level of communication (HIPPA busters) Use of data to inform policy and measure success Common aspects of “positive outliers”

Creating a Narrative Housing is less expensive than homelessness For people w/ homelessness and AIDS, ARVs are necessary but not sufficient to improve mortality The right treatment for the condition

USING DATA TO END HOMELESSNESS Joshua D. Bamberger, MD, MPH San Francisco Department of Public Health University of California, San Francisco, Dept. of Family and Community Medicine