Abstract
In 2012, the Department of Health Services in Los Angeles County created the Housing for Health (HFH) initiative, which provides permanent supportive housing (PSH) and rental subsidies to homeless individuals who are among the highest utilizers of acute care overall and particularly under Medicaid. In addition to housing and rental subsidies, HFH provides intensive case management services and connects clients to a broad range of health, social, and income support services in the community. HFH is a partner of Los Angeles County Whole Person Care Pilot (WPC-LA), a program implemented under California’s Section 1115 Medicaid Waiver focused on providing care coordination and housing support services to enrollees with complex care needs.
We used data from a mixed-methods evaluation of HFH between 2016 and 2018 that was designed to gauge HFH’s effectiveness and its impact on health service utilization and outcomes in other public service sectors, such as social services, mental health services, and public health. We examined the perspectives of a broad range of PSH stakeholders from interviews on the impact of HFH.
Data were collected through semi-structured in-depth interviews with 14 key informants, and nine focus groups in which 42 formerly homeless tenants and 29 providers of PSH programs participated. Verbatim transcripts were independently coded by at least two research team members. Emerging patterns and themes were identified using a process of constant comparison analysis across and within distinct data sources.
Study participants included current PSH tenants, direct service providers, housing and homeless services program administrators, and multisectoral agency leaders in both public and private sectors.
Stakeholders indicated positive impacts of HFH as it has expanded the reach and intensity of PSH. They commented on HFH’s capacity to address housing needs including outreach, intake, engagement, placement, and stabilization. Stakeholders said that HFH’s multisectoral and collaborative approach and use of intensive case management services have enhanced continuity of care with positive effects on tenant outcomes. Reported challenges to HFH implementation were related to the context of extremely limited housing inventory and a workforce not yet sufficient to meet increasing demand with frequent turnover. Systems-level facilitators, including enhanced communication and accountability practices, were cited as essential to support ongoing implementation and to ensure fidelity of the HFH approach.
Stakeholders perceived that HFH was a catalyst for positive change in the administration and delivery of PSH programs and services in Los Angeles.
Our findings from senior administrator perspectives point to the importance of cross-sectoral leadership, and the need to reconcile disparate organizational cultures through enhanced communication and inter-organizational accountability. Formerly homeless tenant and direct service provider perspectives support the value of adopting person-centered approaches in the planning and delivery of services across sectors. Finally, the model of partnership provided by HFH and WPC-LA builds on long-standing and trusted community providers to support the sustainability of these efforts.
The full study is available here.