Health Starts at Home Evaluation Findings from the First Six Months - PowerPoint PPT Presentation

Health Starts at Home Evaluation Findings from the First Six Months of Follow-up February 25, 2020

Evaluation Background • Collaborative evaluation development during the planning phase • The Boston Foundation • Urban Institute • Grantee partnerships • Long time horizon to improve housing situations • Evaluation includes short, intermediate and long-term outcomes • Collaboratively-developed shared Core Measure data • Self-report & EMR data • Homeless Management Information System (HMIS) data • Housing Outcome data

Core Measures Methodology • Partnerships collected core measures data at six-month intervals from enrolled families • Data transferred quarterly to HRiA for analyses • Baseline data collection was completed in April 2018 • Of 205 families with complete baseline data, 182 families (89%) also had complete six-month follow-up data • 55 of these families (30%) were in shelter at baseline • Significance testing was conducted to determine whether change between timepoints were statistically significant ( P <.05) • Analyses were also stratified by number of sub-population groupings to explore differences (e.g. residence in shelter at baseline, change in housing type, and indicators of health status at baseline)

Eligibility Criteria Percent of families meeting HSAH eligibility criteria, by baseline shelter residence More than half of income to housing 94.5% Unable to pay rent on time in prior year 2+ moves for economic reasons in prior year Homelessness in prior year 63.0% 60.6% 43.3% 34.5% 22.8% 21.8% 1.8% Family Not in Shelter at Baseline (n=127) Family In Shelter at Baseline (n=55)

Baseline Demographic Characteristics Age group of enrolled child, all families Language spoken at home, by baseline shelter residence Family In Shelter at Spanish, English , Other, Baseline (n=55) 58.2%* 40.0% 1.8% Family Not in Shelter at Spanish, Other, English , Baseline (n=127) 70.1% 7.1% 22.8% *Significant difference Not in Shelter vs. In Shelter; Chi-square test, P<.05

Baseline Economic Characteristics Educational attainment of enrolled caregiver, all families High School Graduate Some College or Less than High All (n=182) or Equivalent , 29.1% Beyond , 22.5% School , 48.4% Household Income, by baseline shelter residence $500 or less, Median: All (n=175) Over $500, 61.7% 38.3% $900 Family Not in Shelter $500 or less, Over $500, 74.0% $1,200 at Baseline (n=123) 26.0% Family In Shelter at $500 or less, Over $500, 32.7% $346* Baseline (n=52) 67.3%* *Significant difference Not in Shelter vs. In Shelter; Chi-square test, P<.001

Change in Housing Indicators Housing type of enrolled families, by timepoint Apartment Friends/Family Shelter/Other All Families at Baseline 43.6% 23.8% 32.6% (n=181) n=13 n=13 n=9 n=6 n=8 All Families at 6 Months 49.7% 17.1% 33.1% (n=181)

Change in Housing Indicators Caregiver rating of housing quality Caregiver rating of housing satisfaction Dissatisfied or Very dissatisfied Poor or Very poor 57.7% 53.0% 35.4% 34.8%* 28.0% 21.9%* 15.4%* 4.0%* Baseline 6-Months Baseline 6-Months Baseline 6-Months Baseline 6-Months All Families (n=178) Families that moved to All Families (n=178) Families that moved to Apartment at 6-months (n=25) Apartment at 6-months (n=25) *Significant Change Baseline vs. 6-Month; McNemar's test P<.05

Change in Caregiver Mental Health Status 76.4% 65.5% 62.4% 56.3% 49.2%* 42.1%* Caregivers screened positive for Anxiety Baseline 6-Months Baseline 6-Months Baseline 6-Months Symptoms (GAD-2) All Caregivers (n=181) Family Not in Shelter at Baseline Family In Shelter at Baseline (n=127) (n=55) 76.4% 63.6% Caregivers screened 58.9% 51.2% 42.8%* 33.6%* positive for Depressive Symptoms (PHQ-2) Baseline 6-Months Baseline 6-Months Baseline 6-Months All Caregivers (n=181) Family Not in Shelter at Baseline Family In Shelter at Baseline (n=127) (n=55) *Significant Change Baseline vs. 6-Month; McNemar's test P<.01

Change in Caregiver Health Status Caregiver rating of their own overall health Excellent, Very good, Good 65.2% 61.1%* 61.3%* 58.6% 47.8% 47.2% Baseline 6-Months Baseline 6-Months Baseline 6-Months All Caregivers (n=181) Caregivers with Anxiety Caregivers with Depressive Symptoms at Baseline (n=113) Symptoms at Baseline (n=106) *Significant Change Baseline vs. 6-Month; McNemar's test P<.01

Change in Child Health Status Caregiver rating the overall health of enrolled child Excellent, Very good, Good 82.9% 82.1%* 76.8% 73.0%* 69.0% 58.1% Baseline 6-Months Baseline 6-Months Baseline 6-Months All Index Children (n=181) Children of Caregivers with Children with History of ED visits at Fair/Poor Health at Baseline (n=74) Baseline (n=84) *Significant Change Baseline vs. 6-Month; McNemar's test P<.01

Change in Child Healthcare Utilization Use of health care services by enrolled child Use of Urgent Care in prior 6 months Use of ED in prior 6 months 66.7% 61.9% 46.7% 45.3% 43.0% 42.9%* 39.4% 38.1%* Baseline 6-Months Baseline 6-Months Baseline 6-Months Baseline 6-Months All Index Children (n=179) Children with Fair or Poor All Index Children (n=179) Children with Fair or Poor Health at Baseline (n=42) Health at Baseline (n=42) *Significant Change Baseline vs. 6-Month; McNemar's test P<.01

Preliminary Data on Housing Status at end of Follow-up • To examine ‘final’ housing outcomes for each HSAH family, administrative data were obtained from the HSAH partnerships • Data were collected/updated as of November 2019 • Of the 205 enrolled families, 199 (97%) had administrative housing data • Average length of enrollment was 26 months (range 12 – 48 months)

Preliminary Data on Housing Status at end of Follow-up Tenant-based vouchers n=55 Apartment (n=86, 64%) Project-based vouchers n=7 Retained, stabilized, or Public Housing n=23 Public Housing Unit obtained new housing RAFT n=11 (n=21, 16%) (n=134, 67%) HomeBASE n=22 Shared Apartment Other n=16 (n=27, 20%) All Families (n=199) Apartment (n=12, 18%) Public Housing Unit No Change, in Shelter, or (n=2, 3%) Stability worsened Shared Apartment (n=65, 33%) (n=27, 42%) Shelter or Transitional Housing (n=24, 37%)

HMIS Data Matching Process • Dataset: Massachusetts Department of Housing and Community Development (DHCD) Emergency Assistance System • Timeframe: March 2013-October 2018 • Matching process: Finder file sent by program staff to DHCD

HMIS Data Matching Results • 76 percent of families had a recorded shelter stay during the analysis period • 92 percent of shelter stays began before HSAH enrollment • The average length of stay in shelter was 348 days • Families that used shelter had similar average monthly incomes as all HSAH families (around $825/month) • In families with a shelter stay, 69 percent of index children identified as Hispanic compared to 80 percent of all index children in the same programs

Next Steps • Follow-up data match later in 2020 • Capture data on more families • Longer follow-up period to assess change in shelter and EA use after HSAH enrollment