Online Program

Creating and evaluating innovations in homeless services: The challenges of integrating social services and medical services for high- need homeless populations

Wednesday, November 6, 2013

Beth C. Weitzman, PhD, Steinhardt School of Culture, Education and Public Health, New York University, New York, NY
Carolyn Berry, PhD, NYU School of Medicine, New York, NY
Tod Mijanovich, PhD, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY
Ariel Sankar-Bergmann, MPA, Steinhardt School of Culture, Education and Human Development, New York University, New York City, NY
A major contributor to public spending on Medicaid is a small subset of individuals who are caught in a revolving door of emergency room visits, hospitalizations, detox stays, and involvement in other costly health services. Often referred to as ‘super-utilizers' or the ‘5:50 population' (the 5% of beneficiaries who account for 50% of costs), these individuals have complex and co-occurring physical and behavioral health needs and limited support. Efforts to reduce these costs have relied on either traditional case management (with or without housing) or medical care management (with little attention to housing or other service needs), and have proven to be of limited efficacy. Although many public health and homeless service providers believe that the costs created by high-risk, high-need individuals could be reduced through the use of housing programs that integrate medical care management models and social service case management models, achieving this integration is less well understood. This paper analyzes the challenges that the Corporation for Supportive Housing faced when trying to implement a program that achieved this type of integration. Specifically, we examine how a lack of coordination between social service providers and institutions, e.g. state Medicaid offices, can limit the ability of evaluators and program staff to both measure the effects of a program and to identify and serve the target population. By identifying the different challenges that medical versus social service agencies faced when responding to this type of innovation, programs wishing to design similar innovations will be better equipped to avoid these pitfalls.

Learning Areas:

Program planning
Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
Discuss the challenges in evaluating a model of homeless services which is attempting to integrate traditional social services with medically supportive services. Differentiate between the characteristics of social service and medical care/case management. Identify major barriers to care coordination for homeless high-utilizers of medical care

Keyword(s): Homelessness, Homeless Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My research interests focus on urban policies affecting poor families and their children. I have served as the principle investigator on multiple grants which evaluated programs aimed at meeting the health, social service, housing, and educational needs of poor urban families. My research has been funded by the New York City’s Human Resources Administration, the National Institute of Mental Health, the Edna McConnell Clark Foundation, and the Robert Wood Johnson Foundation’s Urban Health Initiative.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.