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Published in: Journal of General Internal Medicine 9/2019

01-09-2019 | Care | Original Research

Changes in Physical Health After Supported Housing: Results from the Collaborative Initiative to End Chronic Homelessness

Authors: Jack Tsai, Ph.D., Lillian Gelberg, M.D, M.S.P.H., Robert A. Rosenheck, M.D.

Published in: Journal of General Internal Medicine | Issue 9/2019

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Abstract

Background

The permanent supported housing model is known to improve housing outcomes, but there has been sparse research on the effects of supported housing on physical health. Various organizations including the National Academy of Sciences have called for research in this area.

Objective

This observational multi-site outcome study examined changes in physical health among chronically homeless adults participating in a comprehensive supported housing program and the associations between changes in physical health, housing status, and trust in primary care providers.

Design

Data are presented from an observational outcome study analyzed with mixed linear modeling and regression analyses.

Participants

A total of 756 chronically homeless adults across 11 sites were assessed every 3 months for 1 year.

Interventions

The Collaborative Initiative to End Chronic Homelessness provided adults who were chronically homeless with permanent housing and supportive primary healthcare and mental health services.

Main Measures

Days housed, physical health-related quality of life (HRQOL) measured by the Short Form-12 health survey, number of medical conditions, number of treated medical conditions, and number of preventive medical procedures received.

Key Results

Participants showed reduced number of medical problems and receipt of more preventive procedures over time, but there was no statistically significant change in physical HRQOL. Changes in housing were not significantly associated with changes in any physical health outcomes. Over time, participants’ trust in primary care providers was positively associated with increased numbers of reported medical problems and preventive procedures received but not with physical HRQOL.

Conclusions

Entry into supported housing with linked primary care services was not associated with improvements in physical HRQOL. Improvement in other medical outcome measures was not specifically associated with improved housing status.
Literature
1.
go back to reference National Academies of Sciences E, and Medicine. Permanent supportive housing: Evaluating the evidence for improving health outcomes among people experiencing chronic homelessness. Washington, DC: The National Academies Press 2018. National Academies of Sciences E, and Medicine. Permanent supportive housing: Evaluating the evidence for improving health outcomes among people experiencing chronic homelessness. Washington, DC: The National Academies Press 2018.
2.
go back to reference Tsemberis S, Kent D, Respress C. Housing stability and recovery among chronically homeless people with co-occurring disorders in Washington, DC. Am J Public Health 2012;102(1):13–6.PubMedPubMedCentralCrossRef Tsemberis S, Kent D, Respress C. Housing stability and recovery among chronically homeless people with co-occurring disorders in Washington, DC. Am J Public Health 2012;102(1):13–6.PubMedPubMedCentralCrossRef
3.
go back to reference Rosenheck RA, Kasprow W, Frisman L, Liu-Mares W. Cost-effectiveness of supported housing for homeless persons with mental illness. Arch Gen Psychiatry 2003;60(9):940–51.PubMedCrossRef Rosenheck RA, Kasprow W, Frisman L, Liu-Mares W. Cost-effectiveness of supported housing for homeless persons with mental illness. Arch Gen Psychiatry 2003;60(9):940–51.PubMedCrossRef
4.
go back to reference Stergiopoulos V, Hwang SW, Gozdzik A, Nisenbaum R, Latimer E, Rabouin D, et al. Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: A randomized trial. JAMA. 2015;313(9):905–15.PubMedCrossRef Stergiopoulos V, Hwang SW, Gozdzik A, Nisenbaum R, Latimer E, Rabouin D, et al. Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: A randomized trial. JAMA. 2015;313(9):905–15.PubMedCrossRef
5.
go back to reference Cheng AL, Lin H, Kasprow WJ, Rosenheck RA. Impact of supported housing on clinical outcomes: Analysis of a randomized trial using multiple imputation technique. J Nerv Ment Dis 2007;195(1):83–8.PubMedPubMedCentralCrossRef Cheng AL, Lin H, Kasprow WJ, Rosenheck RA. Impact of supported housing on clinical outcomes: Analysis of a randomized trial using multiple imputation technique. J Nerv Ment Dis 2007;195(1):83–8.PubMedPubMedCentralCrossRef
6.
go back to reference Kertesz SG, Crouch K, Milby JB, Cusimano RE, Schumacher JE. Housing First for homeless persons with active addiction: Are we overreaching? Milbank Q 2009;87(2):495–534.PubMedPubMedCentralCrossRef Kertesz SG, Crouch K, Milby JB, Cusimano RE, Schumacher JE. Housing First for homeless persons with active addiction: Are we overreaching? Milbank Q 2009;87(2):495–534.PubMedPubMedCentralCrossRef
7.
go back to reference Tsai J, Kasprow WJ, Rosenheck RA. Alcohol and drug use disorders among homeless veterans: Prevalence and association with supported housing outcomes. Addict Behav 2014;39(2):455–60.PubMedCrossRef Tsai J, Kasprow WJ, Rosenheck RA. Alcohol and drug use disorders among homeless veterans: Prevalence and association with supported housing outcomes. Addict Behav 2014;39(2):455–60.PubMedCrossRef
8.
go back to reference Tsai J, Rosenheck RA. Does housing chronically homeless adults lead to social integration? Psychiatr Serv 2012;63(5):427–34.PubMedCrossRef Tsai J, Rosenheck RA. Does housing chronically homeless adults lead to social integration? Psychiatr Serv 2012;63(5):427–34.PubMedCrossRef
9.
go back to reference Kelly JT. Trauma: With the example of San Francisco’s shelter programs. In: Brickher PW, Scharer LK, editors. Health Care of Homeless People. New York: Springer-Verlag; 1985. p. 77–91. Kelly JT. Trauma: With the example of San Francisco’s shelter programs. In: Brickher PW, Scharer LK, editors. Health Care of Homeless People. New York: Springer-Verlag; 1985. p. 77–91.
10.
go back to reference McAdam JM, Brickner PW, Scharer LL, Crocco JA, Duff AE. The spectrum of tuberculosis in a New York City men’s shelter clinic (1982-1988). Chest Surg Clin N Am 1990;97(4):798–805. McAdam JM, Brickner PW, Scharer LL, Crocco JA, Duff AE. The spectrum of tuberculosis in a New York City men’s shelter clinic (1982-1988). Chest Surg Clin N Am 1990;97(4):798–805.
11.
go back to reference Zlotnick C, Zerger S, Wolfe PB. Health care for the homeless: What we have learned in the past 30 years and what’s next. Am J Public Health 2013;103(Suppl 2):S199-S205.PubMedPubMedCentralCrossRef Zlotnick C, Zerger S, Wolfe PB. Health care for the homeless: What we have learned in the past 30 years and what’s next. Am J Public Health 2013;103(Suppl 2):S199-S205.PubMedPubMedCentralCrossRef
12.
go back to reference Zlotnick C, Zerger S. Survey findings on characteristics and health status of clients treated by the federally funded (US) Health Care for the Homeless Programs. Health Soc Care Community 2008;17(1):18–26.PubMedCrossRef Zlotnick C, Zerger S. Survey findings on characteristics and health status of clients treated by the federally funded (US) Health Care for the Homeless Programs. Health Soc Care Community 2008;17(1):18–26.PubMedCrossRef
13.
go back to reference O’Connell JJ. Premature mortality in homeless population: A review of the literature. Nashville: National Health Care for the Homeless Council, Inc.; 2005. O’Connell JJ. Premature mortality in homeless population: A review of the literature. Nashville: National Health Care for the Homeless Council, Inc.; 2005.
14.
go back to reference Baggett TP, Hwang SW, O’connell JJ, Porneala BC, Stringfellow EJ, Orav EJ, et al. Mortality among homeless adults in Boston: Shifts in causes of death over a 15-year period. JAMA Intern Med 2013;173(3):189–95.PubMedPubMedCentralCrossRef Baggett TP, Hwang SW, O’connell JJ, Porneala BC, Stringfellow EJ, Orav EJ, et al. Mortality among homeless adults in Boston: Shifts in causes of death over a 15-year period. JAMA Intern Med 2013;173(3):189–95.PubMedPubMedCentralCrossRef
15.
go back to reference Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, et al. Housing status, medical care, and health outcomes among people living with HIV/AIDS: A systematic review. Am J Public Health 2016;106(1):e1-e23.PubMedPubMedCentralCrossRef Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, et al. Housing status, medical care, and health outcomes among people living with HIV/AIDS: A systematic review. Am J Public Health 2016;106(1):e1-e23.PubMedPubMedCentralCrossRef
16.
go back to reference Mares AS, Rosenheck RA. Twelve-month client outcomes and service use in a multisite project for chronically homelessness adults. J Behav Health Serv Res 2010;37:167–83.PubMedCrossRef Mares AS, Rosenheck RA. Twelve-month client outcomes and service use in a multisite project for chronically homelessness adults. J Behav Health Serv Res 2010;37:167–83.PubMedCrossRef
17.
go back to reference Ware JE, Kosinski M, Keller SE. How to score the SF-12 physical and mental health summary scales. 3rd ed. Lincoln: Quality Metric, Inc.; 1998. Ware JE, Kosinski M, Keller SE. How to score the SF-12 physical and mental health summary scales. 3rd ed. Lincoln: Quality Metric, Inc.; 1998.
19.
go back to reference Anderson LA, Dedrick RF. Development of the Trust in Physician scale: A measure to assess interpersonal trust in patient-physician relationships. Psychol. Rep. 1990;67(3, Part 2):1091–100. Anderson LA, Dedrick RF. Development of the Trust in Physician scale: A measure to assess interpersonal trust in patient-physician relationships. Psychol. Rep. 1990;67(3, Part 2):1091–100.
20.
go back to reference Derogatis LR, Spencer N. The brief symptom index: Administration, scoring, and procedure manual. Baltimore: Johns Hopkins; 1982. Derogatis LR, Spencer N. The brief symptom index: Administration, scoring, and procedure manual. Baltimore: Johns Hopkins; 1982.
21.
go back to reference McLellan AT, Luborsky L, Woody GE, O’Brien CP. An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. J Nerv Ment Dis 1980;168:26–33.PubMedCrossRef McLellan AT, Luborsky L, Woody GE, O’Brien CP. An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. J Nerv Ment Dis 1980;168:26–33.PubMedCrossRef
22.
go back to reference Neale MS, Rosenheck RA. Therapeutic alliance and outcome in a VA intensive case management program. Psychiatr Serv 1995;46:719–23.PubMedCrossRef Neale MS, Rosenheck RA. Therapeutic alliance and outcome in a VA intensive case management program. Psychiatr Serv 1995;46:719–23.PubMedCrossRef
23.
go back to reference O’Toole TP, Johnson EE, Aiello R, Kane V, Pape L. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program. Prev Chronic Dis 2015;30(7):886–98. O’Toole TP, Johnson EE, Aiello R, Kane V, Pape L. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program. Prev Chronic Dis 2015;30(7):886–98.
24.
go back to reference O’Toole TP, Johnson EE, Borgia ML, Rose J. Tailoring outreach efforts to increase primary care use among homeless veterans: Results of a randomized controlled trial. J Gen Intern Med 2015;30(7):886–98.PubMedPubMedCentralCrossRef O’Toole TP, Johnson EE, Borgia ML, Rose J. Tailoring outreach efforts to increase primary care use among homeless veterans: Results of a randomized controlled trial. J Gen Intern Med 2015;30(7):886–98.PubMedPubMedCentralCrossRef
25.
go back to reference Thom DH, Hall MA, Pawlson LG. Measuring patients’ trust in physicians when assessing quality of care. Health Aff (Millwood) 2004;23(4):124–32.CrossRef Thom DH, Hall MA, Pawlson LG. Measuring patients’ trust in physicians when assessing quality of care. Health Aff (Millwood) 2004;23(4):124–32.CrossRef
26.
go back to reference O’Connell JJ, Oppenheimer SC, Judge CM, Taube RL, Blanchfield BB, Swain SE, et al. The Boston Health Care for the Homeless Program: A public health framework. Am J Public Health 2010;100(8):1400–8.PubMedPubMedCentralCrossRef O’Connell JJ, Oppenheimer SC, Judge CM, Taube RL, Blanchfield BB, Swain SE, et al. The Boston Health Care for the Homeless Program: A public health framework. Am J Public Health 2010;100(8):1400–8.PubMedPubMedCentralCrossRef
27.
go back to reference Jezewski MA. Staying connected: The core of facilitating health care for homeless persons. Public Health Nurs 1995;12(3):203–10.PubMedCrossRef Jezewski MA. Staying connected: The core of facilitating health care for homeless persons. Public Health Nurs 1995;12(3):203–10.PubMedCrossRef
28.
go back to reference Thompson SJ, McManus H, Lantry J, Windsor L, Flynn P. Insights from the street: Perceptions of services and providers by homeless young adults. Eval Program Plann 2006;29(1):34–43.CrossRef Thompson SJ, McManus H, Lantry J, Windsor L, Flynn P. Insights from the street: Perceptions of services and providers by homeless young adults. Eval Program Plann 2006;29(1):34–43.CrossRef
29.
go back to reference Hudson AL, Nyamathi A, Greengold B, Slagle A, Koniak-Griffin D, Khalilifard F, et al. Health-seeking challenges among homeless youth. Nurs Res 2010;59(3):212–8.PubMedPubMedCentralCrossRef Hudson AL, Nyamathi A, Greengold B, Slagle A, Koniak-Griffin D, Khalilifard F, et al. Health-seeking challenges among homeless youth. Nurs Res 2010;59(3):212–8.PubMedPubMedCentralCrossRef
Metadata
Title
Changes in Physical Health After Supported Housing: Results from the Collaborative Initiative to End Chronic Homelessness
Authors
Jack Tsai, Ph.D.
Lillian Gelberg, M.D, M.S.P.H.
Robert A. Rosenheck, M.D.
Publication date
01-09-2019
Publisher
Springer US
Keyword
Care
Published in
Journal of General Internal Medicine / Issue 9/2019
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-019-05070-y

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