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Research Questions

  1. How was the HMST program implemented?
  2. How do community stakeholders view the program?
  3. How did the program affect client service use and outcomes?
  4. How did the program affect public spending?

In Santa Monica, California, homelessness is a chronic and persistent problem. It is also expensive. Individuals experiencing chronic homelessness suffer disproportionately from serious physical and mental health conditions and are less likely than the general population to seek services to address these conditions. For these reasons, chronically homeless individuals are often repeat users of emergency services — including medical, law-enforcement, and paramedic-response services. This pattern of service use is costly for cities in terms of both dollars and manpower.

Assertive community treatment — an approach to homelessness that gets people into affordable housing and provides health care and other support services — can reduce public costs associated with chronic homelessness. In 2016, the City of Santa Monica invested $600,000 into such an approach, creating the Homeless Multidisciplinary Street Team (HMST). The HMST consists of a team of specialists who locate and engage the most-intensive service users among Santa Monica's homeless individuals to help them obtain housing and address other needs.

The program aims to reduce the burden on public service providers and diminish associated public costs by lessening the number of times that homeless individuals use public services and interact with public service providers, including police and emergency medical responders.

RAND researchers evaluated the program's success in achieving its goals. They used a mixed methods approach that combined a qualitative analysis of the effect of the HMST on important stakeholder groups and a quantitative analysis both of the effect of the HMST on important outcomes and on potential cost savings associated with these effects.

Key Findings

Evaluators found evidence for some success within the HMST, but analyses were limited

  • The HMST has had a positive effect on the clients they serve.
  • The program is viewed within the community as a valuable resource.
  • It estimated that the HMST yielded savings to the City of Santa Monica that offset 17 percent to 43 percent of the investment.
  • Analyses are limited to the outcomes for which data were available; they do not include many financial and nonfinancial benefits associated with the program and so should be viewed as conservative.

Recommendations

  • City officials should work with the stakeholders in the community to improve data collection and access for clients of the HMST and a comparison population.
  • Data collection should be expanded to providers outside of the City of Santa Monica to track outcomes beyond the narrow focus of this evaluation.
  • The HMST should provide more information on the effects of its efforts to the other stakeholders in the community.
  • The experience of clients should be evaluated further, with a more focused set of interviews with clients on the effects of the HMST.
  • The HMST should foster early coordination with potential step-down providers to improve the success of handing off clients to them when appropriate.
  • The HMST should reach out to other providers in the community who might be affected by the program. There could be opportunities to partner with other providers in the community that might see changes from the efforts of the HMST.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Program Implementation

  • Chapter Three

    Community Perceptions of Program Effectiveness

  • Chapter Four

    Changes in Outcomes and Financial Impact

  • Chapter Five

    Discussion, Conclusions, and Recommendations

Research conducted by

The research described in this report was sponsored by the City of Santa Monica and conducted by the Community Health and Environmental Policy Program within RAND Social and Economic Well-Being.

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