1. Outcome Evaluation of the Shelter-A-Family Program Kimberly Jacob Arriola, PhD, MPH Associate Professor November 20, 2013 3 rd Annual Georgia Supportive Housing Association Conference

2. SAF Program Staff  Joyce Sloan, LCSW-Program Director  Naomi Haynes, MSW-Program Manager  Ja’Nai Johnson, MSW-Coordinator  Nefertari I, BSW-Case Manager  Ronterius Sanders, MS-Case Manager  Stacie Fitzgerald, LCSW-Counseling Manager  Pamela Crosling, MS-Substance Abuse Counselor  Shondella Andre, BA-GED Instructor

3. Today’s Agenda  Overview of the program  Purpose of the outcome evaluation  Evaluation methods CMHS TRAC NOMs Staff-administered supplemental evaluation interview  Findings & limitations  Conclusions

4. Program Description  SAF is a community-based, supportive housing program for families with children who have experienced: long-term homelessness where the head of household suffers with disabilities of: *mental illness *substance abuse and/or *HIV/AIDS  Provides site-based supportive services to 43 families in HUD-funded apartment units in NW Atlanta

5. Program Goals  To help formerly homeless individuals: Reduce and eliminate substance dependency and use Achieve mental and emotional stability Move toward greater self-reliance  To promote child safety and development  To prevent future homelessness among children traumatized by: Homelessness Abuse & neglect Parent’s substance abuse and MH challenges

6. Eligibility  Must be experiencing long-term homelessness, as defined by HUD  Very low income  Verifiable disability, as defined by HUD, of mental illness, substance abuse, or HIV or AIDS  Must be a family with child(ren) under the age of 18 Single female headed households Single male headed household Two parent, married household

7. Supportive Services  Intensive case management  Home –based counseling sessions  On-site substance abuse individual & group treatment  Life skills training  Mental health support groups for adults and youth  Provide access to resources, including health, asset development, and linkages to community activities & groups  On-site GED instruction, educational and employment supports, job search assistance  Assertive Community Treatment (ACT) Team meetings  Monthly community meetings

8. Program Modification  SAF I Established in 2005 June 1, 2009 received additional funding from SAMHSA to provide site-based supportive services Adopted Housing First Model. 23 families in current analyses  SAF II Effective February 1, 2013 20 families that were consolidated into existing SAF program Initially resided at Delowe Village  Families First Project G.R.O.W. Program

9. Outcome Evaluation  To explore change in clients based on: Housing stability Physical and mental health and sense of well- being Dependence on illegal and harmful substances Academic, vocational, life and social skills, and income Perceived family & community support

10. Outcome Evaluation Constructs  CMHS TRAC NOMs Demographic data Functioning Stability in housing Education and employment Crime and criminal justice Social connectedness  Evaluation Interview Medical status and health insurance Drug/alcohol use Psychiatric status Health and well-being Child well-being

11. Outcome Evaluation Constructs  CMHS TRAC NOMs Demographic data Functioning Stability in housing Education and employment Crime and criminal justice Social connectedness  Evaluation Interview Medical status and health insurance Drug/alcohol use Psychiatric status Health and well-being Child well-being

12. CMHS TRAC NOMs Instrument  Baseline Assessment conducted within 7 days of program enrollment  Reassessment interview conducted every 6 months (+/- 30 calendar days)  Administered by staff

13. CMHS TRAC NOMs Data (as of 8/1/13) AssessmentNumber of Assessments Baseline55 6 month assessment31 12 month assessment29 18 month assessment24 24 month assessment19 30 month assessment14 36 month assessment11 Clinical Discharge17

14. Supplemental Evaluation Interview  Largely based on the Addiction Severity Index (McGahan, Griffith, Parente, & McLellan, 1986)  Key domains Medical status and health insurance; Drug/alcohol use; Psychiatric status; Health and well-being Child well-being  Administered by staff after TRAC NOMs

15. Supplemental Evaluation Interview (as of 8/1/13) AssessmentInterviews Conducted Baseline44 6 month follow-up26 12 month follow-up20 18 month follow-up12 24 month follow-up9 30 month follow-up5

16. Client Demographics (based on service utilization data) Client Characteristics SAF (N=86) Client n (%) SAF II (N=58) Client n (%) Gender Female49 (57)38 (66) Marital Status Single26 (30)16 (28) Unknown55 (64)42 (72) Age 0-17 years38 (44)35 (61) 18-36 years25 (29)14 (24) 37+ years20 (23)9 (15) Race/Ethnicity Black75 (87)55 (95)

17. Results: Housing Stability  TRAC NOMs  “In the past 30 days, where have you been living most of the time?” Owned or rented house, apartment, trailer, room

18. Results: Physical Health  TRAC NOMs  “How would you rate your overall health right now?” Excellent or very good

19. Results: Functioning  TRAC NOMs  8 separate items Response options ranged from 1 (SD) to 5 (SA) Percent who strongly agree

20. Results: Emotional Health  Supplemental Evaluation Interview  “How many days in the last 30 days have you experience these psychological or emotional problems?” E.g., serious depression, hallucinations, serious anxiety or tension

21. Results: Substance Use  Random drug screens 170 screens performed on 31 clients  Based on service utilization data SAF ISAF II Number of clients screened 2110 Number of screens 12149 Positive915 Negative6127 Inconclusive517 Percent positive7%31%

22. Results: Academic, Vocation, Social Skills  TRAC NOMs  “Are you currently enrolled in school or a job training program?” Not enrolled or Enrolled full or part time

23. Results: Social Connectedness  TRAC NOMs  4 items  E.g., “I am happy with the friendships I have” Response options ranged from 1 (SD) to 5 (SA) Percent who strongly agree

24. Limitations  Study design  Small numbers of participants  Effect sizes Consolidation of 2 programs  Child well-being data Limited number of children in which there are 2 or data points that are clearly linked to a particular child

25. Conclusions  Clients are largely achieving stable housing  Indicators of adult well-being show improvement over time  Lower rates of drug use were found among SAF I clients (7%) than among SAF II clients (31%)  Enrollment in an academic, vocational, or job skills program has remained somewhat flat over time  Participants reported greater satisfaction with their friendships at 36 months, but other measures of social connectedness did not yield clear patterns.

26. Thank You!  Kimberly Jacob Arriola RSPH of Emory University 1518 Clifton Road, NE Room 520 Atlanta, GA 30322 kjacoba@emory.edu 404-727-2600