Architecture Commons^™

Rethinking Homelessness Prevention Among Persons With Serious Mental Illness, Ann Elizabeth Montgomery, Stephen Metraux, Dennis P. Culhane

Dennis P. Culhane

Homelessness And Children's Use Of Mental Health Services: A Population-Based Study, Jung Min Park, Stephen Metraux, Dennis P. Culhane, David Mandell

Dennis P. Culhane

This study examined whether children who become homeless differ from other low-income children in their mental health service use before and after their first homeless episode, and to what extent homelessness is associated with an increased likelihood of mental health service use. Differences between children with and without new onset of sheltered homelessness in the use of mental health services emerged following homelessness and widened over time. Sheltered homelessness and foster care placement history were associated with increased odds of receiving inpatient and ambulatory mental health services. Findings underscore the importance of collaborations between homeless assistance, foster care, and mental …

The Patterns And Costs Of Services Use Among Homeless Families, Dennis P. Culhane, Jung Min Park, Stephen Metraux

Dennis P. Culhane

This study examines families’ use of behavioral health hospitalization and foster care placement prior to, during and following shelter use, comparing families based on shelter pattern and type of housing exit. Results show that inpatient and foster care services use drops in the homelessness period, but rebounds following exit, regardless of pattern of shelter use, and type of housing exit. Results suggest that shelters supplant use of services, but not on a sustained basis. Despite declines in concurrent services use, the homelessness period is overall more costly for episodically and long-term shelter users, primarily owing to the high costs of …

Service Use And Costs For Persons Experiencing Chronic Homelessness In Philadelphia: A Population-Based Study, Stephen R. Poulin, Marcella Maguire, Stephen Metraux, Dennis P. Culhane

Dennis P. Culhane

Objective: This study is the first to examine the distribution of service utilization and costs with a population-based sample that experienced chronic homelessness in sheltered and unsheltered locations in a large U.S. city. Methods: This study used shelter and street outreach records from a large U.S. city to identify 2,703 persons who met federal criteria for chronic homelessness during a three-year period. Identifiers for these persons were matched to administrative records for psychiatric care, substance abuse treatment, and incarceration. Results: Twenty percent of the persons who incurred the highest costs for services ccounted for 60% of the total service costs …

Ending Chronic Homelessness: Cost-Effective Opportunities For Interagency Collaboration, Dennis P. Culhane, Thomas Byrne

Dennis P. Culhane

Faced with a difficult economic climate with high levels of unemployment and widespread home foreclosures, the Administration of President Barack Obama has created a unique opportunity to rethink and redirect fundamental policies and practices ranging from health care to regulation of the financial industry. A similar opportunity exists to change Federal homeless assistance policies and programs.

Institutional Discharges And Subsequent Shelter Use Among Unaccompanied Adults In New York City, Stephen Metraux, Thomas Byrne, Dennis P. Culhane

Dennis P. Culhane

This study empirically examines the link between homelessness and discharges from other institutions. An administrative record match was undertaken to determine rates of discharge from institutional care for 9,247 unaccompanied adult shelter users in New York City. Cluster analysis and multinomial logistic regression analysis was then used to assess associations between different types of institutional discharges and the likelihood of persons subsequently experiencing extended shelter stays. Results show that 28% of the cohort was discharged from institutional care within the 90-day period preceding their initial shelter entry, with different types of institutional discharge associated with differences in subsequent patterns of …

Behavioral Health Services Use Among Heads Of Homeless And Housed Poor Families, Jung Min Park, Stephen Metraux, Dennis P. Culhane

Dennis P. Culhane

Objectives. This study compares the use of and cost for behavioral health services among heads of homeless and housed poor families. Methods. Medicaid records for 59,135 heads of families receiving Temporary Assistance to Needy Families benefits were matched with data from Philadelphia’s municipal shelter system. Propensity score matching was used to select a matched control group to those identified as having been homeless between 1997 and 2003. Behavioral health services utilization was then assessed based on Medicaid claims records. Results. Substantially higher levels of behavioral health services use and corresponding costs were found among heads of families with a history …

Using Adult Linkages Project Data For Determining Patterns And Costs Of Services Use By General Relief Recipients In Los Angeles County, Stephen Metraux, Dennis P. Culhane

Dennis P. Culhane

This study examines services use and related costs for two cohorts of General Relief (GR) recipients in Los Angeles County. The study is made possible by the creation of the Adult Linkages Project (ALP), a data warehouse containing data on the GR recipients that spans eight Los Angeles County departments. This integration of data sources and County departments enables a unique window into the comprehensive use of County services by GR recipients, and allows for the exploration of hidden costs that GR recipients incur to Los Angeles County. The identification of such services use patterns forms the basis for service …

Health And Social Characteristics Of Homeless Adults In Manhattan Who Were Chronically Or Not Chronically Unsheltered, Aaron J. Levitt, Dennis P. Culhane, Joe Degenova, Patrick O'Quinn, Jay Bainbridge

Dennis P. Culhane

Objective: This study compared health and social characteristics of two groups of homeless adults in Manhattan—those who were chronically unsheltered and those who were not. Methods: Outreach workers conducted brief, structured interviews with 1,093 unsheltered homeless adults. Respondents were later categorized as being chronically unsheltered on the basis of New York City criteria (sleeping without shelter at least nine of the previous 24 months). Results: The sample had high rates of substance abuse (65%), serious medical issues (42%), and repeated trauma (51%) and low rates of medical insurance (47%) and income entitlements (26%) entitlements. Sixty-seven percent were chronically unsheltered, and …

Homelessness Among Persons With Severe Mental Illness In An Enhanced Community-Based Mental Health System, Eri Kuno, Aileen B. Rothbard, June Averyt, Dennis P. Culhane

Dennis P. Culhane

Objective: Homelessness and patterns of service use were examined among seriously mentally ill persons in an area with a well-funded community- based mental health system. Methods: The sample consisted of 438 individuals referred between 1990 and 1992 to an extended acute care psychiatric hospital after a stay in a general hospital. Those experiencing an episode of homelessness, defined as an admission to a public shelter between 1990 and 1993, were compared with those who were residentially stable. Data from a longitudinal integrated database of public mental health and medical services were used to construct service utilization measures to test the …