Evaluating the impact of in-home behavioral health services on housing first residents’ emergency room and inpatient utilization

Individuals experiencing chronic homelessness are highly marginalized and frequently access acute healthcare services. This program evaluation used secondary data collected from adults experiencing chronic homelessness (n=133) who participated in a Housing First program offering in-home behavioral health services within a large Midwestern city. Participant demographics (e.g., gender, race, age) and data on health factors (e.g., substance misuse and mental health symptoms, and ER visits and inpatient hospitalizations) were collected at program enrollment and at 6-month and 12-month follow-ups. High proportions of missing data led the evaluators to exclude 12-month follow-up and in-home behavioral health data from the analyses. Neither inpatient nights nor ER visits changed significantly between enrollment and 6-months. Males were disproportionately hospitalized throughout the study, suggesting a need for gender-targeted services. Higher rates of hospitalization among African Americans at enrollment subsided by follow-up. Future evaluation should examine if in-home behavioral health services reduced racial health disparities. Acute care use was low overall, likely because of the stabilizing impact of housing. Data limitations suggest a need for more robust study designs to identify causal factors and to enrich our understanding of the role of behavioral health intervention within the Housing First paradigm. Results underscore the importance of using empirically-supported assessment tools to evaluate consumers' individualized needs and responsively allocate supportive services.