In this report, the authors present the final evaluation of the Pima County Housing First Initiative, which offers permanent supportive housing and case management for individuals who are involved with the criminal justice system and have experienced homelessness. Overall, the added costs of the initiative—including bridge housing and supportive housing services—were counterbalanced by reductions in costs to the criminal justice and health systems.
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Research Question
- What impact did the PCHF Initiative, which offers permanent supportive housing and case management for individuals who are involved with the criminal justice system and have experienced homelessness, have on service utilization and associated costs?
In this report, the authors present the final evaluation of the Pima County Housing First (PCHF) Initiative, which offers permanent supportive housing (PSH) and case management for individuals who are involved with the criminal justice system and have experienced homelessness. Those who have been placed in detention, including jail or prison systems, encounter significant barriers to reentry and reintegration, and individuals with complex physical and behavioral health conditions are at heightened risk of homelessness. This study is one of the first to examine the impact of PSH on such individuals.
In its first two years, the PCHF Initiative enrolled 314 adult clients. Over 70 percent of these individuals were provided with a housing voucher, and close to 60 percent were provided with supportive housing. Among those tracked for 12 or more months from program enrollment, criminal justice system service utilization declined by over 50 percent and hospital-based health care utilization declined by more than 40 percent.
These reductions in services offset the programmatic costs of housing and social services attributable to the PCHF Initiative. However, to determine whether the relationship between program participation and shifts in service utilization are causal, a more rigorous study design would be needed.
Key Findings
- In total, 314 individuals were enrolled in the PCHF Initiative between April 2019 and April 2021.
- In the 12 months prior to program enrollment, participants utilized a range of criminal justice services that were estimated to cost over $4 million, or $13,259 per participant. Participants also received care for a range of health conditions in hospital settings, costing approximately $1.5 million, or $4,772 per participant.
- Average time from referral to intake was 44 days, from intake to voucher receipt was 36 days, and from voucher receipt to move in was 51 days.
- Of 314 participants, 81 (26 percent) exited the program before receiving a housing voucher. Among those 185 participants who received a voucher and ultimately moved into housing, 136 (74 percent) were still housed as of June 30, 2021.
- Among the 89 participants who had received PSH by July 1, 2020, 73 were still housed 12 months after moving in, yielding a 12-month housing retention rate of 82 percent.
- Among the 186 participants who had been enrolled in the PCHF Initiative for 12 or more months, criminal justice–related services declined by more than 50 percent and costs declined from an average of $13,640 per participant to $7,193.
- Health care costs declined by 45 percent from 12 months pre- to post-enrollment among this same group of 186 participants.
- Overall, the findings suggest that the PCHF Initiative may be cost neutral. However, to determine whether this relationship is causal would require a more rigorous study design.
Recommendations
- Consider reviewing program fit for prospective clients. A minority of clients accounted for a disproportionate amount of criminal justice and health service costs within the PCHF Initiative. By examining the specific cases that consumed the most resources and time, Pima County may identify additional insights about the types of populations that the PCHF Initiative can most effectively reach and serve.
- Consider refining PCHF initiative administrative processes. Of 314 individuals enrolled in the PCHF Initiative from April 2019 through April 2021, approximately 40 percent had not received supportive housing. This is partially attributable to extended wait periods at each step in the progression to supportive housing.
- Consider tracking programmatic costs and client outcomes over a longer time horizon. Numerous Housing First programs have evaluated client outcomes over a one-year time period. However, it is possible that the benefits of program participation accumulate over a longer period (e.g., two or three years).
- Consider a larger-scale evaluation that includes a comparison group. The ability to evaluate program successes was constrained by (1) the relatively small number of clients (186) who had been enrolled in the PCHF Initiative for 12 or more months and (2) the absence of a comparison group.
- Take stock of current program successes. Overall, this pilot evaluation indicates several early successes in the PCHF Initiative—including connecting clients with housing and supportive services, extending stable housing for well over 100 clients, and improving criminal justice system and health care service utilization.
Table of Contents
Chapter One
Project Description
Chapter Two
Methods
Chapter Three
Program Participant Characteristics
Chapter Four
Program Progress
Chapter Five
Outcomes
Chapter Six
Summary and Conclusions
Appendix A
Criminal Justice–Related Cost Estimates
Research conducted by
This research was sponsored by Pima County and conducted by the Community Health and Environmental Policy Program within RAND Social and Economic Well-Being.
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