1. Using data to end homelessness Joshua D. Bamberger, MD, MPH Josh.bamberger@sfdph.org San Francisco Department of Public Health University of California, San Francisco, Dept. of Family and Community Medicine

2. Housing and Homeless Studies • Cost • Before and after studies • Randomized controlled trials • Mortality • Retrospective case control • Quality of Life • Retrospective cohort studies • Populations based homeless prevalence • Creating a Narrative

3. Creating a Narrative • Housing is less expensive than homelessness • For people w/ homelessness and AIDS, ARVs are necessary but not sufficient to improve mortality • The right treatment for the condition

4. SF Health Dept’s Housing • Direct Access to Housing- 1600 units in 40 buildings • Tailor housing to needs of individual • Initially SRO, now new buildings • Priority to people with multiple disabilities • 93% with Axis I mental illness • At least 18% HIV+

5. DAH Portfolio

13. Cost: Plaza Retrospective Before and After • 106 Chronically homeless adults • Cost year before housing: $3,132,856 • Cost year after housing: $906,228 • Reduction in healthcare costs: $2,226,568 • Cost of program: $1.1million/year • Reduction in public cost in first year: $1.1 million • More than 90% of reductionamong 15 tenants who cost more than $50,000/year prior to being housed • Regression to the mean

14. Cost: KCC Random assignment trial • Brand new building with 174 units • Homeless, high users of a managed care system • Comprehensive healthcare utilization • Randomly assigned to treatment or regular care • Followed prospectively for 5 years • Outcomes included: Healthcare cost, mortality, jail

15. Cost- 1811 Eastlake, Seattle • Compared to controls, housed Ps showed greater reductions in overall costs • Cost offsets of housing > $4m for 1st year • More time in housing associated with greater reduction in costs • 6-mo within-subjects reductions in typical alcohol use Figure and findings from Larimer et al. (2009)

17. Mortality

19. Quality of Housing and Outcome • Ranking of housing from worst to best housing • Private bath better than shared bath • New building better than renovated • Nursing better than no nursing • Senior better than non-senior

23. The more beautiful the housing the better the outcome

24. Population Snapshot

25. Veteran PIT Counts, 2009-2012 * * CoCs only required to conduct a new count of unsheltered homelessness in odd numbered years; in 2012, only 32% of CoCs opted not to do a new unsheltered count, providing an incomplete picture of trends in the number of unsheltered homeless Veterans Source: PIT data, 2009 - 2012

26. Number of Homeless Veterans in 5 Communities with Greater than 40% reduction 2010-2012

30. Common aspects of “positive outliers” • Common values and philosophy of practice, strong leadership, housing first • Targeting • High level of communication (HIPPA busters) • Use of data to inform policy and measure success

42. Creating a Narrative • Housing is less expensive than homelessness • For people w/ homelessness and AIDS, ARVs are necessary but not sufficient to improve mortality • The right treatment for the condition

43. Using data to end homelessness Joshua D. Bamberger, MD, MPH Josh.bamberger@sfdph.org San Francisco Department of Public Health University of California, San Francisco, Dept. of Family and Community Medicine