142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Housing saves society money: Results of a program evaluation of a housing retention program for homeless PLWHA in NYC

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Danielle Strauss, MPH , HATSS, Harlem United Community AIDS Center, New York, NY
Monika Grzeniewski, MPH , HATSS, Harlem United, Bronx, NY
Kelsey Louie, LCSW, MBA , Hatss, Harlem United Community AIDS Center, New York, NY
Kevin Rente, MA , Housing Department, Harlem United Community AIDS Center, New York, NY

In 2012, Harlem United, a NYC, nonprofit organization received funding from the NYS DOH, AIDS Institute, to place 50 unstably housed, HIV positive, triply diagnosed individuals in stable housing and to provide them with assistance to retain housing for at least one year.  The aim of the program is to reduce Medicaid utilization by housing a population identified as high Medicaid utilizers, thus assisting them to adhere to medical treatment in order to reduce hospitalizations and ER visits.  An outcome evaluation was designed to measure participants’ risk of housing instability before and after program intervention.


A risk assessment was developed to measure participants’ risk of housing instability.  Questions addressed:

  • Housing stability, including rent payment and eviction history
  • Adherence to medical and mental health treatment
  • Substance abuse
  • Involvement with the criminal justice system
  • Domestic violence
  • Social supports

Response choices were scored based on severity of risk; higher risk behaviors received higher scores and positive behaviors suggesting lower risk received negative scores.  Assessments were administered at baseline and at 6 month follow up. 

Lessons Learned

Preliminary results suggest that participants’ scores on risk assessment decrease from baseline to 6-month follow up.  Within that 6-month period, participants transitioned from unstable housing to a permanent housing situation.  Once placed, participants received a minimum monthly intervention to address their barriers to housing retention and care coordination services related to their medical, mental health and substance abuse needs.  As a result of these interventions, participants were more likely to visit their primary care provider and less likely to utilize the emergency rooms for primary care.  In addition, we suspect that their CD4 counts will increase and their HIV viral loads will decrease, they will feel better, and have an improved quality of life.

Conclusions/Next Steps

Ultimately, the evaluation team aims to use this tool to categorize participants as low, moderate, and high risk for housing instability, and expects to see a reduction in risk over time.  We hope that the results of this evaluation will justify enhanced funding for housing programs for high Medicaid utilizers, as a means of reducing Medicaid costs to society.

Learning Areas:

Administration, management, leadership
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Social and behavioral sciences

Learning Objectives:
Describe how supportive housing programs targeting homeless individuals living with HIV/AIDS can help reduce Medicaid costs to society. Discuss how supportive housing help's stabilize homeless individuals living with HIV/AIDS and improves health outcomes.

Keyword(s): Homelessness, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a Managing Director of supportive housing programs targeting PLWHA for 4 years and am the Managing Director of the the Housing Retention program discussed in this abstract. I helped develop this program and program evaluation and am currently responsible for implementing both.
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.