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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.

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.

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