USING DATA TO END HOMELESSNESS

Joshua D. Bamberger, MD, MPH

Josh.bamberger@sfdph.org

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

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- 1600 units in 40 buildings Tailor housing to needs of individual

Initially SRO, now new buildingsPriority to people with multiple disabilities93% with Axis I mental illnessAt least 18% HIV+

SF Health Dept’s Housing

DAH Portfolio

•

253 286604 678 704 704

8780 0

177 247 339

689

0200

400600

8001000

12001400

16001800

99-00 2001-2 2003-4 2005-6 2007-8 2009-10

2011-2015

NewMaster-lease

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- 1811 Eastlake, Seattle

• Compared to controls, housed Ps showed greater reductions in overall costs

• Cost offsets of housing > $4m for 1st 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

Windsor Empress LeNain PBI CCR West Folsom Dore

Plaza 149 Mason

990 Polk Mission Creek

0.0

5.0

10.0

15.0

20.0

25.0

30.0

R² = 0.76418262009445

Move-out not death

Move-out not deathLinear (Move-out not death)Linear (Move-out not death)

Windsor Empress LeNain PBI CCR West Folsom Dore Plaza 149 Mason 990 Polk Mission Creek

7.6

3.5

6.8

3.9

5.3

2.7

5.0

3.5

2.5

4.0

3.1

R² = 0.388887624467414

Death by Quality of Housing%death

Death Rate/year0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

Death rate Le Nain vs. Mission Creek 2006-2011

Le Nain death %

MCSC death %

The more beautiful the housing the better the outcome

POPULATION SNAPSHOT

Veteran PIT Counts, 2009-2012

* 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, 2009 - 2012

2009 2010 2011 2012 -

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

75,609 76,329

67,495 62,619

43,409 43,437 40,033

35,143

32,200 32,892 27,462 27,476

Total VeteransSheltered VeteransUnsheltered Veterans

Nu

mb

er

of

Ve

tera

ns

*

2010 2011 2012 2013 2014 20150

100

200

300

400

500

600

HennepinLexingtonTacomaFort WorthBirmingham

Measured

-------Projected

______

Number of Homeless Veterans in 5 Communities with Greater than 40% reduction 2010-2012

2005 2006 2007 2008 2009 2010 2011 20120

500

1,000

1,500

2,000

2,500

0%

2%

4%

6%

8%

10%

12%

14%

16%

1,932

1,9141,530

1,470 1,400

812

601542

14%14%

13%

10%

9%

5%4%

3%

Utah Annualized Chronic Homeless Count: 2005-2012

Chronic Count% Chronic of Total Homeless Persons

Source: 2012 Utah Homeless Point-In-Time Count

2009 2010 2011 20120

50

100

150

200

250

300267

224

177

126

Veterans in Minneapolis/Hennepin County 2009 - 2011

total veterans

2009 2010 2011 2012

775 779

566

351

Point-in-time count for Minneapolis/Hennepin County Con-tinuum

total chronic homeless

21.8424.26

17.59

10.36

• 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

Josh.bamberger@sfdph.org

San Francisco Department of Public Health

University of California, San Francisco, Dept. of Family and Community Medicine