Academic journal article Cityscape

Prioritizing Homeless Assistance Using Predictive Algorithms: An Evidence-Based Approach

Academic journal article Cityscape

Prioritizing Homeless Assistance Using Predictive Algorithms: An Evidence-Based Approach

Article excerpt

Overview

Homelessness is a major social problem in the United States, with large public health impacts affecting millions of individuals and families and costing billions of dollars. The most recent annual numbers available from the U.S. Department of Housing and Urban Development (HUD) are for 2016 and show 1,421,196 people used an emergency shelter or a transitional housing program at some point during the year (HUD, 2016). The most recent point-in-time numbers are for 2017 and show, on a night in January, 553,742 people were homeless. Among individuals, 24 percent were chronically homeless (HUD, 2017).

The health, personal, and economic challenges that chronically homeless individuals experience and the lack of effective, coordinated services to address these problems often lead to a vicious cycle of diminished well-being with serious implications for their service utilization patterns (Economic Roundtable, 2015a). The impairments of some of these individuals might impede access to needed health services and other support systems, such as employment services. Consequently, they cycle through costly emergency-driven public systems without getting the ongoing care they need to address severe mental illness, substance use disorders, or chronic health conditions (Caton, Wilkins, and Anderson, 2007; Folsom et al., 2005).

The number of individuals experiencing homelessness substantially exceeds the number of affordable housing units available for them. This shortfall includes permanently affordable housing with supportive services that is needed for many chronically homeless individuals. Managing the gap between housing supply and demand is a challenge for city and county housing agencies. The predictive algorithm we describe provides a fair, objective tool for triage-prioritizing which individuals may receive Housing First.

Growth in homelessness over the last three decades has been exacerbated by economic downturns, loss of affordable housing and foreclosures, stagnating wages, an inadequate safety net, and the closing of state psychiatric institutions. In response to this growing need, the federal response to homelessness shifted in 2009 from uncoordinated short-term responses to avert homelessness-primarily using shelters-to long-term housing solutions. Permanent housing subsidies have since been shown to significantly increase housing stability, food security, and child well-being (Gubits et al., 2016).

The first component of the federal strategy shift was providing permanent supportive housing (PSH), that is, housing that is permanently affordable combined with ongoing supportive services for people experiencing chronic homelessness, and prioritizing those individuals with the most severe disabilities for assistance. The second component was connecting PSH to street outreach, shelter, and institutional "in-reach" to identify and engage people experiencing chronic homelessness. The third component was communitywide adoption of Housing First to provide permanent housing as quickly as possible in order to end chronic homelessness and prevent its recurrence (USICH, 2015).

The Housing First model was introduced by Pathways to Housing, a New York City nonprofit, to provide homeless intervention services to adults with psychiatric diagnoses and substance abuse problems. The nonprofit provided immediate housing and services to homeless adults with cooccurring diagnosis as a matter of right, with no preconditions. It also incorporated a harm reduction approach to psychiatric and substance abuse treatment and empowered the consumers of services to make choices about housing and services (Greenwood, Stefancic, and Tsemberis, 2013).

The Housing First approach makes housing stabilization the centerpiece of homeless assistance and recognizes that some people need more than housing assistance to stabilize. A small but highly visible segment of the chronically homeless population has substantial service needs. …

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