research on desc programs

DESC programs are extensively evaluated, and many involve academic research resulting in peer-reviewed scientific journal articles and other published reports.

Bringing physical healthcare services to a behavioral health service site increases access to care for people with mental illness who haven't been receiving it.

University of Washington and King County researchers collaborated with DESC to examine the effects of bringing physical healthcare services to behavioral health clinics at DESC and Harborview Medical Center. Results inclulded significant increases in access to physical health services for homeless people with serious mental illness. See:

Integrating Primary Care Into Community Mental Health Centers: Impact on Utilization and Costs of Health Care - Psychiatric Services (ahead of print, published online July 01, 2016)

Housing First for people with serious psychiatric problems eliminates homelessness and significantly reduces psychiatric hospitalizations

Researchers from Depaul University and King County examined the effects of a DESC single-site Housing First program for people with serious psychiatric problems. Some tenants came from long-term street homelessness while others had less street homelessness due to lengthy psychiatric hospitalizaitons. Tenants showed high housing retention (90%) and a significant (44%) reductions in days hospitalized, in stark contrast to a comparison group who received "usual care" in the community. See:

Housing First as an effective model for community stabilization among vulnerable individuals with chronic and non-chronic homelessness histories - Journal of Community Psychology (Volume 44 | Issue 3, April, 2016)

Single-site Housing First case study

This article in Housing, Care and Support describes the key features and evidence base of the "single-site" Housing First model in use at DESC, using our 1811 Eastlake program as a case study. See:

Single-site housing first for chronically homeless people - Housing, Care and Support (Volume 18 | Issue 2, 2015)

Housing First reduces use of Emergency Medical Services

The peer-reviewed journal Prehospital Emergency Care includes a paper examining the use of EMS services by DESC supportive housing tenants before and after being housed.  In the study University of Washington researchers found an average reduction of 54% in the number of contacts with EMS in the two years after obtaining housing. See:

Housing First is Associated with Reduced Use of Emergency Medical Services - Prehospital Emergency Care (Volume 18 | No.4, October-December 2014)

Study highlights promising pharmaceutical intervention for alcohol-dependent tenants at DESC

DESC worked with researchers from the University of Washington/Harborview Medical Center to pilot the addition of a pharmaceutical intervention to assist alcohol-dependent housing tenants with improvements in their alcohol outcomes. A small study documented a strong desire by tenants to try the intervention, and subsequent improvements in alcohol use outcomes for those who participated. The pilot study led to funding for a larger study currently underway. See:

Extended-release Naltrexone and Harm Reduction Counseling for Chronically Homeless People with Alcohol Dependence - Substance Abuse (Published online: April 29, 2014)

Housing First retains people in housing, even when they were not actively seeking it.

A study of housing retention among DESC housing residents who were chronically homeless and affected by long-term severe alcohol problems found that clients were both interested in housing and able to retain it over the two-year study period. Residents had not actively sought out this housing, but were found and offered the housing opportunity by DESC staff. Many of them reported that they did not believe they could have succeeded in abstinence-based housing, and continued alcohol use did not predict housing failure. See:

Housing Retention in Single-Site Housing First for Chronically Homeless Individuals with Severe Alcohol Problems - American Journal of Public Health (Volume 103 | Issue S2, December 2013)

Motivation to change is more important factor than treatment attendance in alcohol use decreases among DESC clients

A study in the journal Addictive Behaviors examined the underlying factors associated with reductions in drinking and alcohol-related problems among DESC clients. Motivation to change was consistently associated with improved alcohol outcomes, whereas treatment attendance was not. One implication is for more focus on enhancing client motivation to change rather than simply insisting on treatment attendance. See:

Motivation to change and treatment attendance as predictors of alcohol-use outcomes among project-based Housing First residents - Addictive Behaviors (Volume 37 | Issue 8 August 2012)

Homeless people with alcohol problems reduce drinking in housing allowing alcohol

Research published in the American Journal of Public Health documents decreases in alcohol use and alcohol-related problems among residents of DESC's 1811 Eastlake program. The results provide a strong rebuttal to the "enabling" hypothesis, which held that providing alcohol-dependent people with housing where they were not prohibited from drinking would cause them to drink even more and experience more dire consequences as a result. See:

Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories - American Journal of Public Health. (Volume 102 | Issue 3, March 2012)

Permanent Supportive Housing: An Operating Cost Analysis

A study put out by the Corporation for Supportive Housing and Enterprise Community Partners examines the costs of permanent supportive housing, examining 20 projects ranging in size from 24 to 96 units, from New York to Los Angeles.

Permanent Supportive Housing: An Operating Cost Analysis - (September 2011)

First national Housing First study; housing retention is high despite significant challenges in the lives of participants.

The first-ever national study to examine Housing First programs looked at participants in three programs around the country, including DESC. Participants had high levels of housing stability: 84% were in housing after 12 months. The findings demonstrate that Housing First programs are successfully housing people with serious mental illness and that intensive, ongoing services and housing subsidies are a critical component. See the following two publications:

HUD: The Applicability of Housing First Models to Homeless Persons with Serious Mental Illness - (July 2007)

Housing stability among homeless individuals with serious mental illness participating in housing first programs - Journal of Community Psychology (Vol. 37 | Issue 3, March 3, 2009)

JAMA research shows DESC housing saves taxpayers millions.

In the first outcomes paper from DESC's 1811 Eastlake Housing First program for chronically homeless people with severe alcohol problems, University of Washington researchers show that providing housing and on-site services without requirements of abstinence or treatment is significantly more cost-effective than allowing them to remain homeless. See the following two publications:

Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems - The Journal of the American Medical Association (Vol. 301 | No. 13, April 1, 2009)

1811 Eastlake: 2009 Evaluation highlights (one page, April 2009)

Criminal history among chronically homeless people is not predictive of their ability to retain housing.

In the first peer-reviewed published study to look specifically at the correlation of previous criminal history to housing retention, DESC Director of Housing Programs Daniel Malone determined that the presence of a criminal background did not predict housing failure. His findings suggest that policies and practices that keep homeless people with criminal records out of housing may be unnecessarily restrictive. See:

Assessing Criminal History as a Predictor of Future Housing Success for Homeless Adults With Behavioral Health Disorders - Psychiatric Services (Volume 60 | Issue 2, February 2009)

Housing First for chronically homeless people is associated with decreased jail time.

A UW study examined criminal history as a predictor of housing retention and subsequent jail time for chronically homeless people housed in a DESC Housing First program. As with the other study, criminal history did not predict housing failure. This study also showed that prior criminal activity while homeless is predominantly minor, and that subsequent bookings into jail and days in jail decrease substantially. See:

Exposure to Project-based Housing First is Associated with Reduced Jail Time and Bookings - International Journal of Drug Policy (Volume 24 | Issue 4, July 2013)

Self-report of public service utilization by chronically homeless people is accurate in the short term.

University of Washington researchers collaborating with DESC compared the correspondence between self-report and archival records on public service utilization over short (30 days) and longer (3 years) periods by chronically homeless people. Recall of events over the short term corresponded closely with archival records. See:

Agreement between self-report and archival public service utilization data among chronically homeless individuals with severe alcohol problems - Journal of Community Psychology (Volume 39, Issue 6, pages 631-644, August 2011)

Qualitative studies add to the understanding of the lives of chronically homeless people served in housing first programs.

Interviews with and close observation of chronically homeless people after housing acquisition yield important insights into motivations and past experiences of participants. University of Washington researchers collaborating with DESC explored issues relevant to a female subpopulation in one study. In another, a focus on perceived positive and negative effects of alcohol use were explored to gain a stronger basis for the development of more tailored harm reduction interventions. A third study documented the experiences of residents and staff living and working in a Housing First program, identifying strengths and challenges of these programs. See the following publications:

A House is Not a Home: A Qualitative Assessment of the Life Experiences of Alcoholic Homeless Women - Journal of Social Work Practice in the Addictions (10:158-179, 2010)

Where Harm Reduction Meets Housing First: Exploring Alcohol's Role in a Project-based Housing First Setting - International Journal of Drug Policy (Volume 23 | Issue 2, March 2012)

Exploring Transitions Within a Project-based Housing First Setting: Qualitative Evaluation and Practice Implications - Journal of Health Care for the Poor and Underserved (Volume 23 | Issue 4, November 2012)

DESC's Vulnerability Assessment Tool found to have strong properties of reliability and validity.

The Washington Institute for Mental Health Research and Training conducted a psychometric analysis of DESC's Vulnerability Assessment Tool, concluding the tool has strong temporal and inter-rater reliability, as well as strong evidence of convergent and concurrent validity. See the report here.

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