Dynamics and Costs of Behavioral Health Services Use by Patterns of Family Homelessness

Little is known whether the differential patterns of homelessness among families are associated with differences in their characteristics and needs, which is critical in developing more effective interventions for homeless families. The current study represents the first effort to examine whether and how homeless families' intensive behavioral health service utilization patterns change prior and subsequent to their index homelessness spell and residential instability period.

A total of 1,564 adults in homeless families were followed for 2 years before and 4 years after their initial homeless episode. The analyses were based on the integration of administrative records from Philadelphia, including data from their respective homeless shelter, child welfare, and Medicaid systems.

Based on patterns of homelessness, three subgroups were identified among homeless families: the transitional, the episodic, and the long-term groups. Significant differences were observed across the three groups in the prevalence of intensive behavioral services use (29% in the episodic group vs. 13% in the transitional group vs. 7% in the long-term group). The proportion of behavioral service users considerably decreased during the homelessness period and then increased afterwards. Homeless period is very expensive relative to the pre- or post-homeless periods regarding the use of public services; however, higher cost is mainly driven by cost of shelters.

The findings suggest that homeless families are heterogeneous regarding the level of service needs, homeless shelters play a limited role in reducing service needs, it would be efficient to develop diversion programs from homeless shelters, and homeless families may benefit from interventions post-homelessness.