In 2017, Los Angeles County initiated the Just in Reach Pay for Success project, which aimed to provide long-term housing and supportive services as an alternative to jail for individuals who had a history of homelessness and one or more chronic behavioral or physical health conditions. This report examines whether the program was associated with reduced use of county services, including justice, health, and homeless services.

Cover: Just in Reach Pay for Success
Read Online

Just in Reach Pay for Success

Impact Evaluation and Cost Analysis of a Permanent Supportive Housing Program

by Sarah B. Hunter, Adam Scherling, Matthew Cefalu, Ryan K. McBain

Download eBook for Free

FormatFile SizeNotes
PDF file 1.3 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

Research Questions

  1. Who was enrolled in JIR PFS, in terms of demographic and service characteristics?
  2. Did PSH placement change participant use of county services and associated costs?

Discharging individuals from jails and prisons who may be poorly equipped for independent living—such as those with a history of chronic health conditions, including serious mental illness—is likely to reinforce a pattern of homelessness and recidivism. Permanent supportive housing (PSH)—which combines a long-term housing subsidy with supportive services—has been proposed as a mechanism to intervene directly on this relationship between housing and health.

In Los Angeles County, jail has become a default housing and services provider to unhoused individuals with serious mental health issues. In 2017, the county initiated the Just in Reach Pay for Success (JIR PFS) project, which provided PSH as an alternative to jail for individuals with a history of homelessness and chronic behavioral or physical health conditions.

The authors of this report assessed whether the project led to changes in use of several county services, including justice, health, and homeless services. The authors examined changes in county service use, before and after incarceration, by JIR PFS participants and a comparison control group and found that use of jail services was significantly reduced after JIR PFS PSH placement, while the use of mental health and other services increased. The researchers assess that the net cost of the program is highly uncertain but that it may pay for itself in terms of reducing the use of other county services and therefore provide a cost-neutral means of addressing homelessness among individuals with chronic health conditions involved with the justice system in Los Angeles County.

Key Findings

  • The JIR PFS program was associated with significant reductions in use of county jail, probation, homelessness, and inpatient physical and mental health services and significant increased use of outpatient mental health services relative to a comparison group.
  • JIR PFS program costs—associated with PSH and more frequent use of mental health outpatient and probation services post-housing—were mostly offset by savings in other service areas—most notably, less county jail time, fewer inpatient days for mental health and physical health care, fewer emergency department visits, and less temporary housing use relative to the comparison group.
  • The program achieved high one year housing stability rates of 82 percent.

Table of Contents

  • Chapter One

    Background

  • Chapter Two

    Methods

  • Chapter Three

    Results

  • Chapter Four

    Discussion

  • Appendix A

    Cost Estimates

  • Appendix B

    Data Cleaning and Processing

  • Appendix C

    Substance Abuse Prevention and Control Data

  • Appendix D

    Service Use and Costs Estimates

  • Appendix E

    Sensitivity Analyses

Research conducted by

This research was sponsored by the project financing of the JIR PFS initiative through JIR PFS, LLC, and a grant awarded to the Corporation of Supportive Housing through the U.S. Department of Housing and Urban Development/U.S. Department of Justice Pay for Success Permanent Supportive Housing Demonstration Program. The work that provided the basis for this publication was supported by funding under an award with the U.S. Department of Housing and Urban Development. This research was conducted by the Community Health and Environmental Policy Program within RAND Social and Economic Well-Being.

This report is part of the RAND Corporation Research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.