Health service utilization of chronically homeless adults in supportive housing: Individual and program-level contributions

More than two million people experience homelessness in a given year in the United States. About 20 percent of the adult homeless population is considered chronically homeless. Using secondary data from the Collaborative Initiative to Help End Chronic Homelessness (CICH) evaluation, the goals of this research were to determine: (1) To what extent do the individual characteristics that distinguish the chronically homeless population, including severity of homelessness, chronic medical conditions, mental illness, substance abuse, and veteran status, inhibit or facilitate health service utilization after enrollment in permanent supportive housing; and (2) How specific supportive housing program characteristics influence health service utilization of chronically homeless adults over time.;The study sample included 700 chronically homeless adults enrolled in one of eleven treatment sites. The study's results suggest several individual characteristics are associated with health service utilization. Need variables have consistent positive associations with health service utilization. Mental illness is associated with increased probability of having a usual source of care, and with increased inpatient days over time. Lack of health insurance is negatively associated with health service utilization upon enrollment in programs, but over time is associated with increased inpatient days and likelihood of having a usual source of medical care. Despite its role as an enabling characteristic in studies with other homeless populations, veteran status was not associated with increased health service utilization in this sample.;Some associations are found between program characteristics and health service utilization. Being enrolled in a program with health-related goals in program planning is associated with increased emergency department days and outpatient days at the sixmonth interview. Having a higher nurse to client ratio is associated with decreased emergency department days over time. Being served by a program with a health-oriented lead agency is associated with increased outpatient days over time.;The study's results indicate that program planners and policy makers should carefully consider program characteristics as a means to achieve specific health service utilization goals related to outpatient and ED utilization.