# Presentation: 410970

## The Dynamics and Costs of Homelessness: Informing Public Policy with Data 

- Stephen Metraux, Ph.D.
- Health Policy Program
- University of the Sciences in Philadelphia

## Background – NY/NY Study  Research Questions

- Background – NY/NY Study  Research Questions

- 1 - What is the extent of services use for homeless individuals with severe mental illness (SMI) in the following systems?
- 		- City shelter
- 		- State psychiatric hospital
- 		- State Medicaid
- 		- City hospital (HHC)
- 		- Veterans’ Administration hospital
- 		- State prison
- 		- City jail
- 2 - How does receiving a NY/NY housing placement affect the use of these systems?
- 3 - Is the cost of NY/NY housing offset by the costs related to the use of these services?

## Background – NY/NY Study

## Background – NYNY Study

## Homeless mentally ill are heavy service users (37% of last 2 years spent in institutional settings)

Providing services for homeless mentally ill is expensive ($40,449 per person per year)

Providing NY/NY housing for homeless and mentally ill at costs reduced by 30% ($12,145 savings per person)

94% of supportive housing costs offset by service reductions

- Providing services for homeless mentally ill is expensive ($40,449 per person per year)
- Providing NY/NY housing for homeless and mentally ill at costs reduced by 30% ($12,145 savings per person)
- 94% of supportive housing costs offset by service reductions

- Background – NY/NY StudyFindings

## Permanent housing with supportive services is an effective response to homelessness among chronically mentally ill and difficult to serve populations  
The costs of homelessness range beyond homeless services, and solutions to homelessness should be supported by a larger network of service systems
Mechanisms and partners needed for capital costs
The study should be replicated in other geographic areas and with other homeless subgroups

- The costs of homelessness range beyond homeless services, and solutions to homelessness should be supported by a larger network of service systems
- Mechanisms and partners needed for capital costs
- The study should be replicated in other geographic areas and with other homeless subgroups

- Background – NY/NY StudyPolicy Implications

## Putting Together a Cost Study

- Funding
- Data Availability
- Data Access
- Institutional Review Board
- Database Integration
- Data Analysis
- Dissemination of Findings

## Funding
Determine purpose of study
Decide on scope of work
Identify possible funding sources
Identify costs
Personnel
Data acquisition
Consulting

- Determine purpose of study
- Decide on scope of work
- Identify possible funding sources
- Identify costs
- Personnel
- Data acquisition
- Consulting

- Putting Together a Cost Study #1

## Data Availability
Identify target population
Is there a control population?
What types of services do they use?
What types of data are available that document the use of these services?

- Identify target population
- Is there a control population?
- What types of services do they use?
- What types of data are available that document the use of these services?

- Putting Together a Cost Study #2

## Data Access
Political considerations
Confidentiality considerations
Anxiety about control over data
Legal considerations
Data quality issues
Cost issues
Bureaucracy

- Political considerations
- Confidentiality considerations
- Anxiety about control over data
- Legal considerations
- Data quality issues
- Cost issues
- Bureaucracy

- Putting Together a Cost Study #3

## Institutional Review Board
Ensures that the interests of human subjects are protected
Particularly interested in safeguards for maintaining confidentiality and anonymity
Often will expedite review because no contact with research subjects is involved
HIPAA compliance
Special populations are often involved

- Ensures that the interests of human subjects are protected
- Particularly interested in safeguards for maintaining confidentiality and anonymity
- Often will expedite review because no contact with research subjects is involved
- HIPAA compliance
- Special populations are often involved

- Putting Together a Cost Study #4

## Database Integration and Matching
Matching databases
Data management issues
Confidentiality and security

- Matching databases
- Data management issues
- Confidentiality and security

- Putting Together a Cost Study #5

## Data Analysis
Know the capabilities of your data
Have expertise available
Methodological rigor vs. “user friendliness”

- Know the capabilities of your data
- Have expertise available
- Methodological rigor vs. “user friendliness”

- Putting Together a Cost Study #6

## Dissemination of Findings
Advocacy
Creating a body of research
Integrating findings with other related messages

- Advocacy
- Creating a body of research
- Integrating findings with other related messages

- Putting Together a Cost Study #7