Understanding Rapid Re-housing

Systematic Review of Rapid Re-housing

Outcomes Literature

Daniel Gubits

Korrin Bishop

Lauren Dunton

Michelle Wood

Tom Albanese

Brooke Spellman

Jill Khadduri

July 7, 2018

U.S. Department of Housing and Urban Development | Office of Policy Development and Research

Table of Contents

Chapter 1: Introduction .................................................................................................................1

Approach to this systematic review of the outcomes literature ................................................................. 1

Existing research on rapid re-housing ....................................................................................................... 2

Organization of this report ......................................................................................................................... 3

Chapter 2: The Rapid Re-housing Program Model: Origins and Variations ..........................4

RRH program design and implementation ................................................................................................ 5

Outreach and eligibility ........................................................................................................................ 6

Housing identification ........................................................................................................................... 7

Rental assistance .................................................................................................................................... 7

Case management and services ............................................................................................................. 8

Progressive engagement ........................................................................................................................ 8

Community context of RRH programs ...................................................................................................... 9

Chapter 3: Assessing Outcomes of RRH Programs .............................................................. 10

Challenges in comparing outcomes measured across RRH programs .................................................... 10

Exits to permanent housing ..................................................................................................................... 11

Length of time program participants spend homeless ............................................................................. 19

Returns to homelessness .......................................................................................................................... 24

Chapter 4: Conclusion ............................................................................................................... 31

References ................................................................................................................................... 33

Appendix A: Summary of Examined Studies .......................................................................... 39

Appendix B: Destination Type Response Categories in HMIS ............................................. 47

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Chapter 1: Introduction

The primary goal of rapid re-housing (RRH) is to provide temporary assistance that quickly moves individuals and families who experience literal homelessness into permanent housing while providing appropriate time-limited supports to help them stabilize there (National Alliance to End Homelessness, 2014a). Guidance released by the U.S. Department of Housing and Urban Development (HUD) and the United States Interagency Council on Homelessness (USICH) in 2012 specifies three core components for RRH programs: (1) housing identification, (2) rent and move-in assistance, and (3) case management and services.

The purpose of RRH at the level of the homeless services system is to reduce overall homelessness or homelessness for a particular subpopulation by moving people through the shelter system as rapidly as possible. This in turn frees up beds for other people in crisis, allowing the CoC to move additional people through short-term assistance and into permanent housing, thus freeing up additional RRH resources to move more people out of shelter or in from the street.

A comprehensive set of RRH practice standards was published by the National Alliance to End Homelessness (NAEH) in 2016, with input from the U.S. Department of Veterans Affairs (VA), the U.S.

Department of Housing and Urban Development (HUD), the U.S. Interagency Council on Homelessness (USICH), and nationally recognized, high-performing RRH and technical assistance providers. Those standards included performance benchmarks in three areas:

1. Reduce the length of time participants in RRH programs are homeless.

2. Exit households from RRH to permanent housing.

3. Limit returns to homelessness within a year of program exit.

This systematic review of RRH outcomes literature summarizes the available evidence on rapid rehousing with a specific focus on how rapid re-housing programs have performed in relation to these performance benchmarks. This report also presents descriptive information on the design and implementation of RRH programs, drawing on the research literature and on the authors’ knowledge of RRH practice.

Approach to this systematic review of the outcomes literature

To conduct this systematic review, a research team at Abt Associates searched multiple sources to identify the universe of previous research on rapid re-housing. The team began by searching the following databases: Medline Complete, Academic Search Complete, EconLit, Science Direct, JStor, and EBSCO

Discovery Service. The research team conducted the searches using terms such as “rapid re-housing,”

“rapid re-housing programs,” “rapid re housing program evaluations,” “rapid re-housing outcomes,” and

“HPRP.” Next, the research team scanned for studies of rapid re-housing outcomes on websites of various organizations, including: NAEH, HUD Exchange, U.S. Department of Health and Human Services, the U.S. Interagency Council on Homelessness, and CSH. The research team also posted requests for recommendations of RRH studies on the national listservs managed by HUD, USICH, and NAEH.

Finally, staff reviewed the references included in all studies identified to determine whether any additional studies could be included in the systematic review.

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After identifying potential sources, the research team reviewed abstracts and study summaries to determine which studies to include in the systematic review. The team screened the studies using the following criteria:

• Included studies that analyzed the experiences of families, individuals, and special populations (such as youth or veterans) who receive rapid re-housing assistance;

• Included RRH randomized controlled trials, quasi-experimental studies (matched comparison groups), observational studies (outcome assessments, case study reports, and descriptive analyses), qualitative assessments, and completed dissertations.

• Excluded studies that did not specifically report rapid re-housing outcomes.

• Excluded studies that did not describe a program that met the criterion of the core components for rapid re-housing, as established by HUD and USICH: (1) housing identification, (2) rent and move-in assistance, and (3) case management and services.

Through this process, the research team identified 76 potential studies and then screened out 33 studies.

Of the studies screened out of the review, 9 did not meet the criteria for types of studies to include, and 24

did not measure program outcomes. These 24 studies provided information the research team used to understand the background and development of rapid re-housing but are not included in the systematic review of program outcomes presented in Chapter 3. The team reviewed the remaining 43 studies, all of which measured outcomes of rapid re-housing programs at the local, multi-community, or national level.

The team examined in detail the text of each study and extracted the information from each study relevant to the systematic review. Summaries of the 43 studies reviewed for this report can be found in Appendix A.

Existing research on rapid re-housing

As the number of communities in the U.S. implementing rapid re-housing programs has grown over the past decade, the federal government and other organizations funded numerous studies to better understand how rapid re-housing works and the outcomes associated with program participation.

In 2015, the Urban Institute reviewed the growing body of research on rapid re-housing (Cunningham et al, 2015). Since that time, additional studies have been published. The largest-scale efforts to measure outcomes are found in the reports by HUD on the HPRP program and by the VA on the SSVF program.

• Homelessness Prevention and Rapid Re-housing Program (HPRP): The final program summary reports outcomes for the 140,000 households that received rapid re-housing assistance from the 2,500

HPRP-funded projects nationally (U.S. Department of Housing and Urban Development, 2016a).1

• Supportive Services for Veteran Families (SSVF): The most recent annual report presents outcomes for the 166,000 households who have received SSVF rapid re-housing assistance from over 400 programs in fiscal years 2012 to 2015 (U.S. Department of Veterans Affairs, 2016b). Other 1 Generally in this review, we use the term “program” to mean services offered by local RRH providers. In a few cases, we also use this term as it is used by federal policymakers—to describe federal funding streams. When

“program” is used to refer to federal funding streams, we use the word “projects” to describe the local services funded by the federal dollars.

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research uses SSVF data to examine returns to homelessness by those who received rapid re-housing assistance (Byrne et al., 2015).

• Rapid Re-housing Demonstration Program (RRHD): This evaluation measured outcomes for more than 1,300 households who received rapid re-housing assistance in the 23 demonstration communities from 2009 to 2012 (Spellman et al., 2014).

• Family Options Study (FOS): This study randomly assigned 569 families from September 2010 to February 2012 to receive priority access to short-term rental subsidies offered through 27 rapid rehousing programs in 12 communities (Gubits et al., 2015). The study reports impacts of priority access to the short-term subsidies relative to priority access to other types of programs and relative to no priority access to any particular type of program (a “usual care” group).

Much of the existing RRH research utilizes Homeless Management Information System (HMIS) data as its primary data source. Typically, a local service provider uses its HMIS to collect information on clients and the services delivered to them. These data are then used by the CoC, the local group charged with developing an effective response to homelessness within the community, for system-level reporting and management. Over time, HUD has refined and enhanced the standard HMIS data elements to allow for the calculation of detailed performance measures for systems, providers, and programs, including RRH

programs.

Organization of this report

The next chapter describes the origins of RRH, federal investments in RRH programs, and the core components of RRH and variations in the way they have been implemented in different communities.

Chapter 3 makes systematic use of the benchmarks established by NAEH, assessing the findings on the outcomes of RRH from a variety of studies.

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Chapter 2: The Rapid Re-housing Program Model: Origins and

Variations

In the late 1980’s, PATH Beyond Shelter, a local agency in Los Angeles, California, piloted the idea of providing short-term rental subsidies to move families rapidly from shelters to conventional housing.

Columbus/Franklin County, Ohio, and Hennepin County, Minnesota developed system-wide approaches to rapid re-housing for homeless families in the 1990’s, based on the premise that extended shelter stays simply prolong homelessness in ways that are costly to both families and communities. As more communities experimented with this new approach to providing assistance to homeless individuals and families, the components of rapid re-housing programs became more clearly defined.

In 2007, the U.S. Congress appropriated funds for the Rapid Re-housing for Homeless Families Demonstration (RRHD) (Spellman et al., 2014). Beginning in 2009, 23 Continuums of Care (CoCs) received three-year RRHD grants to develop and operate rapid re-housing programs. At the same time the first RRHD programs opened in fall 2009, rapid re-housing was adopted nationwide in response to the Homelessness Prevention and Rapid Re-housing Program (HPRP) funded under the American Recovery and Revitalization Act (ARRA) (P.L. 111-5, February 2009). HPRP provided $1.5 billion dollars to communities nationwide to be spent within a three-year period on either homelessness prevention or rapid re-housing.2 HPRP marked HUD’s first major investment in the rapid re-housing model of providing homeless assistance.

The federal investment in rapid re-housing continued over the last decade. The Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009 established rapid re-housing as an eligible type of program for funding from both the Continuum of Care Program (CoC) and Emergency Solutions Grants Program (ESG). These two funding streams have been instrumental in allowing communities to continue and expand rapid re-housing programs after HPRP funds were expended. HUD’s investment in RRH through the CoC and ESG programs increased substantially, from 87 million in federal FY2013 to 279 million in federal FY2015). This increased level of funding resulted in a surge in the number of RRH programs across the country. In 2016, communities reported 77,141 rapid re-housing beds dedicated to assisting homeless families and individuals, a 28 percent increase from the prior year (U.S. Department of Housing and Urban Development, 2016e).

During the same period, the U.S. Department of Veterans Affairs (VA) also invested in rapid re-housing.

In 2012, HUD, VA, and the U.S. Department of Labor (DOL), partnered to fund a three year pilot program, the Veterans Homeless Prevention Demonstration Program (VHPD), in five communities.

Targeted to veterans returning from Afghanistan and Iraq, as well as female veterans, the program offered housing assistance, case management and employment counseling. The Supportive Services for Veteran Families (SSVF) Program is based in part on lessons from VHPD and provides substantial resources, $373 million in federal FY2015, to fund homelessness prevention and rapid re-housing for homeless veterans and their families. Preliminary data show that in FY 2016 SSVF RRH served 67,581 veterans, five times as many veterans as in FY 2012 (U.S. Department of Housing and Urban Development, forthcoming).

2 This review does not consider programs that provide only homelessness prevention assistance.

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Exhibit 1 shows the amounts that these major funding streams have provided to rapid re-housing in recent years. In addition to HUD and VA funding, some communities use funds from the Temporary Assistance for Needy Families (TANF) program and other federal sources to support rapid re-housing programs.

Exhibit 1: Federal funding for rapid re-housing, by funding source ($ in millions) Rapid Re-housing

FY2010

FY2011

FY2012

FY2013

FY2014

FY2015

FY2016

Funding Source

HPRP*

Total for 3 years = 425

—

—

—

—

ESG (committed)

—

42

67

51

72

81

68

CoC

—

—

13

36

99

198

249

SSVF

—

—

59

99

241

373

396

(budgeted)

* This includes only funding for rapid re-housing and excludes prevention-only programs.

Sources: U.S. Department of Housing and Urban Development, 2016a; 2016f; 2017; U.S. Department of Veterans Affairs, 2016.

Note: All figures in millions of dollars. Amounts do not include TANF funding spent to support RRH programs, or state, local, or private funding for RRH programs.

In some CoCs, local leaders leveraged the increased federal investment in RRH to attract state, local, and private investment in RRH programs. As RRH programs continue to mature, many CoCs are embracing RRH as a replacement or a complement to transitional housing, based on the premise that RRH can offer a more cost-effective and less expensive approach to providing assistance to homeless families and individuals.

RRH program design and implementation

In an effort to standardize the development of RRH programs, in the summer of 2012 HUD and the U.S.

Interagency Council on Homelessness released guidance on core components of RRH programs. The guidance defines rapid re-housing as “an intervention designed to help individuals and families to quickly exit homelessness and return to permanent housing” and specifies the three core components that should be part of a rapid re-housing program:

1. Housing identification;

2. Rent and move in assistance; and

3. Rapid re-housing case management and services.

While the federal guidance defined the components of RRH, local providers are given broad flexibility in how they administer these program elements. RRH is used to serve a variety of target populations, including families with children, single adults, veteran households with and without children, and unaccompanied youth. Some RRH programs are designed to accommodate a wide range of populations, and some are designed to serve a specific subpopulation such as homeless veterans or youth. RRH

programs can be customized based on the characteristics and needs of the type of household served by the program or based on other factors such as local housing market conditions.

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Outreach and eligibility

Rapid re-housing programs require close collaboration with emergency shelters, street outreach, and other homeless assistance programs to identify prospective individuals and families who are homeless and need assistance to secure housing quickly and successfully. Screening for RRH may be conducted as part of a community’s coordinated entry system for people in need of shelter and re-housing services.

The 2012 federal guidance on RRH core components clarified that rapid re-housing assistance is supposed to follow a “Housing First” philosophy, meaning that assistance should be provided without imposing eligibility restrictions or screening out households considered unlikely to succeed without rental assistance after RRH ends. Under a Housing First approach, programs seek to resolve the housing crisis by providing housing and services without first addressing any preconditions such as sobriety, employment or income. 3

However, prior to the 2012 guidance and, in some cases, continuing after that guidance was issued, some communities screened out households with perceived high barriers to maintaining stable housing following their participation in a RRH program. Some of the studies included in this review concluded that RRH could be better focused to provide assistance for the most vulnerable individuals and families (Paprocki, 2012; OrgCode Consulting, Inc., 2015). However, some service providers described a conflict between following a Housing First philosophy and using a rapid re-housing approach. Case managers felt that the short duration, limited amount of RRH assistance, and focus primarily on housing stabilization does not provide the level of supportive services necessary to address other needs such as physical health, mental health, and life skills. According to this view, some clients need such services in order to maintain their permanent housing (Fyall et al., 2016).

Early RRH programs often implemented narrow eligibility requirements that eliminated households with housing barriers such as criminal history or lack of income. The RRHD evaluation described some local program designs focused on serving “a small subset of ‘high-functioning’ homeless families who have high levels of self-sufficiency and few barriers” (Burt et al., 2016). Another study, conducted in Massachusetts, noted that the end of HPRP left a gap in funding that resulted in service providers being more selective about who they screened into the program, often opting for clients “most likely to succeed in the program” (Meschede & Chaganti, 2015). The Family Options Study included rapid re-housing programs that primarily were funded by HPRP and found that 30 percent of families considered for random assignment to a rapid re-housing program would have to meet minimum work or income requirements, 17 percent would have to meet screening criteria related to sobriety, drug testing, or treatment requirements, and 15 percent would have to meet criteria regarding their criminal background (Gubits et al., 2013).

3 The Housing First approach to homelessness assistance was originally developed as a program philosophy or model for permanent supportive housing (PSH) for formerly homeless people with behavioral health issues who had chronic patterns of homelessness and often were reluctant to accept help from the homeless services system. Over time, Housing First has come to refer to any program that provides assistance to people experiencing homelessness—not just PSH—that has the following characteristics: 1) “a focus on helping individuals and families access and sustain permanent rental housing as quickly as possible; 2) a variety of services delivered to promote housing stability and individual well-being on an as-needed and entirely voluntary basis; and 3) a standard lease agreement to housing – as opposed to mandated therapy or services compliance (National Alliance to End Homelessness, 2016b).”

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Screening practices may have changed over time, following the federal guidance. SSVF’s FY 2015

annual report notes an increase in clients’ lengths of stay in the program from the previous year, and infers that this could be a result of better targeting to higher barrier households now that communities have more experience implementing the program (U.S. Department of Veterans Affairs, 2016b). HUD

officials have expressed the view that increasing numbers of communities are following the federal guidance on targeting programs to the most vulnerable. For example, in-reach to shelters and coordinated entry systems may be focuses on identifying households that should be given a priority for limited RRH

funds because they are unable to secure housing on their own.

Housing identification

Housing identification services offered by RRH projects typically consist of housing search assistance to locate housing units and assistance with rental application and screening processes. RRH programs also identify landlords willing to participate in the program and address potential barriers to landlord participation. Housing identification services may be provided by separate staff within a program, depending on funding and program capacity. Alternatively, case management staff may provide housing identification and related placement support as part of their overall case management responsibilities.

When programs have separate housing specialists, they work with case management staff to recruit landlords and manage partnerships with landlords.

Rental assistance

Rental assistance provided by RRH programs is time-limited. HUD programs limit it to 24 months and SSVF to a maximum of 12 months in a two year period (U.S. Department of Housing and Urban Development, 2011; U.S. Department of Veterans Affairs, 2016a). Typically, the length of assistance is shorter. SSVF and local experience suggests that RRH assistance usually lasts an average of just over 3

months (U.S. Department of Veterans Affairs, 2016a). In the RRH component of HPRP, 26 percent of households exited within a month and another 50 percent within 6 months (U.S. Department of Housing and Urban Development, 2016a). The average length of assistance for families who used the rapid rehousing programs to which they were given priority access in the 12 communities in the Family Options Study was slightly longer, 8 months (Gubits et al, 2016).

The depth of the rental subsidy can vary, with some programs providing a fixed amount to all households, others basing assistance on a formula than considers the participant’s rent and income, and others providing amounts that phase down over time. Some communities provide flexible package of rental assistance determined by the case manager’s assessment of the assisted household’s income and expenses.

RRH programs can also provide cash assistance for move-in expenses such as security deposits, utility deposits and payments, and help with moving costs. Some programs also provide assistance with payments for rental arrears or back payments owed on utilities. In the SSVF program, rental assistance is part of a broader category of Temporary Financial Assistance, which can also include cash assistance not related to housing expenses such as transportation, clothing, or child care.

Administration of rental assistance varies by program and community. Depending on the mix of funding sources and local partnerships, rental assistance may be administered by a provider agency, a centralized administrative agent such as a housing authority, or a combination of entities.

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Case management and services

Rapid re-housing case management should begin at the time of program enrollment while the household is still in emergency shelter. RRH case managers provide a variety of housing-related services, including helping the household determine what type of permanent housing would make sense, given the household’s needs and financial resources. Case managers may also help households address issues that could impede their ability to access housing such as debt or legal issues, arrears, or poor credit history (Cunningham et al., 2015). In RRHD programs, case managers assist households in developing a housing and self-sufficiency plan, which includes assistance in identifying where to live, how much rent the household can afford, and assistance facilitating referrals (Burt et al., 2016). Other RRH programs focus more generally on addressing barriers that prevent the household from accessing or maintaining stable housing. Case managers also may begin to help households gain income that would help them pay rent.

After the household secures and moves into its housing unit, the case manager assists with stabilization services, including identifying community-based supports for the household, helping with money management, and resolving any problems that arise related to the housing unit or landlord relationships.

Linkage to community-based services that support ongoing stabilization and those that are available in times of financial or other crises are prime objectives.

Although case management is one of the core components of RRH programs, the amount and duration of case management provided to RRH participating households can vary greatly. In the Family Options Study, the frequency case management in RRH programs ranged from weekly to quarterly meetings between the household and case managers (Gubits et al., 2013). Both in the Family Options Study and the RRHD study, the frequency of case management declined after the household moved into permanent housing (Gubits et al., 2013; Burt et al., 2016). Some RRH programs continue to hold in-person case management meetings while the household resided in permanent housing, while other programs reduce case management services to monthly or bi-monthly check-in calls (Burt et al., 2016). Case management services often end when the program and participating household determine the household is able to maintain its housing for the foreseeable future—that is, the household is not at risk of imminent return to homelessness and has been connected with other service providers and community supports.

Progressive engagement

A distinguishing feature of RRH programs is the ability to scale the amount and duration of assistance to the individualized needs of each participating household and to change the amounts over time as needs change. This is commonly referred to as “progressive engagement” or “progressive assistance”. When programs follow the progressive engagement model, they address both predictable and unpredictable needs through individualized support, problem-solving, linkage to other services, and financial aid best suited to support the participant’s housing stability and avoid a return to homelessness. Households may need rental assistance that extends over a period of time, they need other types of cash assistance such as payment of rent arrears or security deposits, or they may need more or less intensive housing search assistance and case management. The underlying premises of a progressive approach to assistance are:

• The needs of a particular household relative to obtaining and maintaining permanent housing are not fully predictable;

• The type, amount, and duration of assistance can be individualized to address a household’s needs and quickly and successfully; and

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• Cost-effective use of the resources of the homeless services system requires that the assistance provided be no more than it takes to stabilize a household in permanent housing.

RRH programs implementing a progressive engagement approach to providing housing identification, rental and move-in assistance, and case management use an individualized, flexible approach tied to the level of each participating household’s current apparent need. This allows for changes in the amount, intensity, and expected duration of assistance as participants’ needs change or are better understood over time. It also assures that “just enough” assistance is provided to resolve the housing crisis through housing placement and achievement of a basic modicum of stability such that a participant is not at risk for immediate return to homelessness. Under a progressive assistance approach, a case manager discontinues assistance when housing stability appears likely in the near-term and sufficient linkages to other federal, state and local benefit programs, community-based services, and neighborhood resources are in place to complement and reinforce housing stability.

The SSVF program incorporates a progressive assistance approach, and HUD has been encouraging communities to adopt the philosophy of progressive engagement or assistance as well. The extent to which that has occurred is not known. The web survey and in-depth interviews with RRH programs planned for this study will collect detailed information about whether programs use progressive engagement and what this approach entails for different programs.

Community context of RRH programs

Each community has unique characteristics that may influence how a RRH program is implemented and operated. These include the local housing market, unemployment rates, employment opportunities, and household income. Recognizing this gap in the research, some studies have tried to discuss how community context impacts the implementation of rapid re-housing programs.

The RRHD study examined how community context affected implementation of the program in the 23

demonstration communities through the use of rental vacancy rates and local Fair Market Rent (FMR) levels. More than three-fourths of the study communities had rental vacancy rates greater than five percent, and 45 percent of families were in housing markets with FMRs in the top quartile nationally.

Analysis found that families in areas where vacancy rates were above five percent were less likely to return to homelessness within 12 months than families in tighter rental markets. The study inferred that this could reflect the fact that families in looser housing markets have greater opportunity to move to other housing units to alleviate high housing costs (Spellman et al., 2014). In cities with tight housing markets, some RRH programs are experimenting with allocating resources to support additional landlord recruitment and management capacity.

A study assessing the extent and predictors of a return to homelessness among veterans following exit from the SSVF program used the zip codes from client records for over 40,000 veterans who exited SSVF

between FY 2012 and FY 2013 to examine the extent to which community-level housing market conditions predicted subsequent returns to homelessness. This data covered 1,495 counties, which allowed for a diverse review of housing market conditions. The median rent for a two-bedroom apartment in these counties ranged from $438 to $2,060. The across county housing vacancy rate averaged 16

percent and 29 percent of households reported being rent-burdened. The study found no significant relationships between community-level housing market factors and the likelihood of a return to homelessness (Byrne et al., 2015). This finding does not support the hypothesis that the success of rapid re-housing programs is highly dependent on local housing market conditions.

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Chapter 3: Assessing Outcomes of RRH Programs

This chapter reports the results of a systematic review of the outcomes of RRH programs, focusing on the three performance measures established by NAEH in its Rapid Re-housing Performance Benchmarks and Program Standards. The overarching objective of RRH is to swiftly move households who experience homelessness into permanent housing and to stabilize them. The NAEH performance measures translate this objective into three measurable goals for RRH programs:

1. Reduce the length of time participants are homeless;

2. Exit households to permanent housing (PH); and,

3. Limit returns to homelessness within a year of program exit.

In most communities the performance targets for these measures have only been recently established in order to assess the effectiveness of local programs. Many federal, state and local funding sources for RRH

are also only beginning to establish performance expectations. However, these measures (with some variation in definition) have been used in studies of RRH outcomes and effects for the last several years.

These measures align with the objectives of RRH assistance and the goals of the program so provide a uniform basis for comparing evidence from RRH research.

Challenges in comparing outcomes measured across RRH programs

Because rapid re-housing is, by definition, a flexible intervention that providers can tailor as they see fit to different target groups, and because assistance also can be tailored according to participants’ needs, it can be challenging to compare RRH programs and to compare evidence from the studies of RRH that have been completed to date. For example, some RRH programs are designed to provide assistance to a specific subpopulation like veterans, families, or youth. Because of the increased homogeneity of the group being served, the RRH program may be able to better tailor their services to the needs of this population. However, this may make the program less comparable to other RRH programs that serve a broader population or a different population.

Another source of program variation that may limit the comparability of outcome measures is the variety of screening criteria used by RRH programs and possible changes to those criteria over time. Some of the studies in this systematic review of program outcomes provide information on the screening criteria applied by the program or programs measured, but most do not. Another challenge derives from the flexibility that permits each RRH program to customize its approach to providing assistance for households, varying the amount and duration of case management, rental assistance, and overall length of program participation. Some RRH programs—in particular, those funded through SSVF —are intentionally designed to function as a “crisis” intervention. This means that the RRH programs aim to address only the current crisis preventing the household from securing and stabilizing in housing for the near-term and avoids focusing on non-housing related issues. Programs may be following a “progressive engagement approach” to a greater or lesser extent or not at all.

Local community conditions, such as tight housing markets, depressed economic conditions, or a lack of public transportation may also shape the design of RRH programs in their community, further complicating efforts to compare the outcomes of different RRH programs. A particularly important

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component of community context is the condition of the local housing market. Communities with tight rental markets and low vacancy rates may struggle to find housing units for participating households. The availability of affordable housing units that can be leased by program participants may influence how the RRH program is designed and the extent to which households are able to maintain their housing after exiting the program.

The other components of this Understanding Rapid Re-housing Study seek to overcome the challenges to comparing programs. In particular, a web survey and in-depth interviews with RRH program staff will permit the study team to document the central programmatic features of RRH, including program goals, funding sources, population served, household point of entry, targeting, structure and duration of rental assistance, case management model (intensity, stages and duration, services focus), and use of progressive engagement. That will provide a platform for categorizing program models and for future assessments of program outcomes across RRH programs following different models.

Exits to permanent housing

This review of outcomes measured by national and local studies and performance measurement efforts starts with “exits to permanent housing,” followed by length of time homeless and returns to homelessness. The studies used for each measure are indicated in the exhibits and described in more detail in Appendix A.4

The homeless assistance system uses three broad categories to classify housing situations for a family or individual: homeless, in permanent housing (PH), and in temporary housing. The HUD definitions for these categories are as follows:

• Homeless: staying in a place not meant for human habitation (e.g., a vehicle, an abandoned building, bus/train/subway station/airport or anywhere outside); staying in emergency shelter; staying in a hotel or motel with an emergency shelter voucher; staying in transitional housing for people who are homeless.

• Permanent housing (PH): staying in a place the household rents or owns (with or without rental subsidy); staying or living with family or friends on a permanent basis.

• Temporary housing: staying or living with family or friends on a temporary basis; substance abuse treatment facility or detox center; other institutional settings; hotel or motel paid for without emergency shelter voucher.

Families and individuals participating in a RRH program typically move in to PH during their time in the program and may receive additional RRH rental assistance, case management and stabilization support after moving into PH. Some families and individuals may exit RRH upon placement into PH if the RRH

program provided only housing identification and one-time cash assistance for move-in costs. HUD’s HMIS data standards were updated starting in fiscal year 2015 with a new data element (“Residential 4 Although the Family Options Study is in many ways the most rigorously designed study of RRH, it is not used in this systematic review, except for the measure of returns to homelessness. The Family Options study describes outcomes for families randomly assigned to receive priority access to short-term rental subsidies, but the period of measurement starts with random assignment rather than with entry into homelessness or enrollment into a RRH

program, which means that it cannot be used for the first two NAEH performance measures.

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Move-In Date”) specifically intended to capture the date of move-in to permanent housing for RRH

participants as a way to better track time spent homeless from RRH program enrollment to successful achievement of PH. HUD and VA-funded rapid re-housing programs began recording the residential move-in date for participants starting in fiscal year 2015.

Exhibit 2 shows the different ways that families and individuals can move through RRH programs.

Exhibit 2: Possible pathways for RRH clients

All entries in RRH program

(A) → Move into PH → No continuation of RRH assistance (e.g., move-in financial assistance only with no short-term subsidy), Exit to PH

(B) → Move into PH → Continue with RRH assistance (e.g., short-term rental subsidy) → Exit to PH

(C) → Move into PH → Continue with RRH assistance→Leave PH (unable to maintain PH even while still in RRH program)→ Exit to homelessness or temporary housing (this is more rarely occurring pathway)

(D) → No move into PH, Exit to homelessness (e.g., emergency shelter or transitional housing) or temporary housing (e.g., staying or living with family or friends on temporary basis) Since 2014, all homeless assistance programs participating in HMIS have been required to enter the exit destination of a household when the household exits the program. The exit destination categories in HMIS are shown in Appendix B. For RRH programs, the destination at exit reflects the place where the household currently resides at the time of exit. This includes permanent housing destinations for RRH

assisted households who move to PH with RRH assistance and later exit the program while still residing in PH. From the HMIS data fields of project entry date, residential move-in date, project exit date, and destination we can define two closely related measures for RRH.

Permanent housing success rate (among all program exits):

𝑇𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 ℎℎ′𝑠 𝑒𝑥𝑖𝑡𝑒𝑑 𝑡𝑜 𝑃𝐻 𝑑𝑢𝑟𝑖𝑛𝑔 𝑎 𝑡𝑖𝑚𝑒 𝑝𝑒𝑟𝑖𝑜𝑑

(

) × 100

𝑇𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 ℎℎ′𝑠 𝑡ℎ𝑎𝑡 𝑒𝑥𝑖𝑡𝑒𝑑 𝑝𝑟𝑜𝑔𝑟𝑎𝑚 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒 𝑡𝑖𝑚𝑒 𝑝𝑒𝑟𝑖𝑜𝑑

This is NAEH’s articulation of this performance measure. NAEH states a performance target of 80 percent for this measure (NAEH, 2016a). Using the types of client pathways defined in Exhibit 2, this measure is equivalent to

𝑨 + 𝑩

(

) × 100

𝑨 + 𝑩 + 𝑪 + 𝑫

Maintain housing success rate (only among PH move-ins):

( 𝑇𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 ℎℎ′𝑠 𝑤ℎ𝑜 𝑚𝑜𝑣𝑒𝑑 𝑖𝑛 𝑡𝑜 𝑃𝐻 𝑎𝑛𝑑 𝑒𝑥𝑖𝑡𝑒𝑑 𝑡𝑜 𝑃𝐻 𝑑𝑢𝑟𝑖𝑛𝑔 𝑎 𝑡𝑖𝑚𝑒 𝑝𝑒𝑟𝑖𝑜𝑑 ) × 100

𝑇𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 ℎℎ′𝑠 𝑤ℎ𝑜 𝑚𝑜𝑣𝑒𝑑 𝑖𝑛 𝑡𝑜 𝑃𝐻 𝑡ℎ𝑎𝑡 𝑒𝑥𝑖𝑡𝑒𝑑 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒 𝑡𝑖𝑚𝑒 𝑝𝑒𝑟𝑖𝑜𝑑

Some studies appear to provide this measure. This approach to measuring a PH success rate only includes those households who have moved in to PH. It does not include households who are unable to move in to PH while being in the RRH program. This measure should generally be high as it will only be less than

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

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100 percent due to the relatively rare occurrence of households leaving PH while still in the RRH program or just as a short-term rental subsidy ends.

Using the types of client pathways defined in Exhibit 2, the maintain permanent housing success rate is equivalent to

𝑨 + 𝑩

(

) × 100

𝑨 + 𝑩 + 𝑪

The second success rate provides a different numeric value than the first, with the “maintain-permanent-housing” success rate typically higher than the PH success rate. Therefore, assessments of program performance should take note of the measure definition being used.

Ideally, outcomes should be examined at the “household” level, which means at the family level for families and at the individual level for individual clients. However, historical HMIS data can be difficult to analyze at the household-level, so some studies report results at the “client level,” separately counting all family members in families.

Exhibit 3 presents the PH success rates (among all program exits) from studies that have examined this measure. Some studies only offer the maintain-permanent-housing success rate. These are noted in the table. The table is sorted by study size, with the largest studies (as measured by number of households and number of local programs) listed first.

Understanding Rapid Re-housing:

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Exhibit 3: Exits to Permanent Housing Measure

Study Citation

Percent with Exit

Number of

Target

(Study Abbrev.,

to Permanent

Households

Notes

Population(s)

Location)

Housing

and Programs

U.S. Department of Veterans

RRH + Prevention:

RRH +

• Analysis of HMIS data.

Veterans Affairs,

(both Singles

78% (2012-2015)

Prevention:

• Of 49,880, about 5/6 in households without children ~

2016b (SSVF,

and Families)

RRH only:

N (2012-2015)=

41,500 and about 1/6 in households with children ~8,300.

nationwide)

71% (FY2015)

165,590

70% - Veterans in

RRH only:

household’s without N (FY2015) =

children (FY2015)

49,880

79% - Veterans in

Progs. = 407

households with

children (FY2015)

U.S. Department of Singles,

84.1% Year 1

N (3 yrs total)

• Analysis of Quarterly and Annual Performance Reports

Housing and

Families

81.8% Year 2

~140,000

from grantees

Urban

82.9% Year 3

Progs. ~ 2,500

• Oct 2009 to Sept 2012, nationwide.

Development,

• 2,500 is all subgrantees for prevention and RRH, not clear

2016a (HPRP,

if all offered RRH.

nationwide)

Community Shelter

Singles and

FY11- FY16: 87.8%

N: FY11-16

• Analysis of HMIS data.

Board, 2012-2017

Families

FY11: 92%

=3,995

• Rate for entire time period is calculated from annual

(Columbus, OH)

FY12: 91%

FY11=388,

reports.

FY13: 91%

FY12=821,

• Number of households with exits in period calculated as

FY14: 87%

FY13=539,

total households served minus number of carryover

FY14=609,

FY15: 85%

households in following period. Carryover households in

FY15=840,

FY16: 88%

each period are calculated as total households served

FY16=798

minus new households.

Progs.: FY11-

• Annual rates are published rates, which are 1 to 2

16=7, FY11-

percentage points higher than calculated rates in FY11,

12=7, FY13-

FY12, FY15, and FY16.

15=5, FY16=4

• July 2010 to June 2016.

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Study Citation

Percent with Exit

Number of

Target

(Study Abbrev.,

to Permanent

Households

Notes

Population(s)

Location)

Housing

and Programs

Spellman et al.,

Families

84.6%

N = 1,319

• Analysis of HMIS data.

2014 (RRHD, 23

Progs. = 23

• From Exhibit 6, summed rental housing no assistance,

CoCs nationwide)

rental with assistance, and PSH to get 84.6. Assumes

doubled up is not permanent.

• 2009 to Aug. 1, 2012

EveryOne Home &

Singles,

66%

N=777

• Analysis of HMIS data and 2014 Annual Performance

Aspire Consulting,

Families

Progs.=9

Report.

2015 (Alameda

• Calculated from Figure 11. Page 12 says 68% but that does

County, CA)

not match N’s in Figure 11.

Drake et al., 2016

Singles,

84%

N=669

• Analysis of HMIS data.

(Connecticut)

Families

Progs. ~ 14

• Feb 1 2013 – Nov 1 2015 “active in CT RRH”, with valid

exit destinations.

Institute for

Singles,

Singles—96%

Singles: N=318

• Analysis of HPRP Annual Performance Report.

Children, Poverty,

Families

Families—98%

People in

• Not clear whether this is PH success rate (all program

and

families:

exits) or PH success rate (all move-ins)

Homelessness,

N=1,125

• Not clear whether “after receipt of RRH and/or diversion

2014

Progs.~Multiple

assistance” is equivalent to all who entered the program.

(Philadelphia)

providers in Phil

• Programs targeted to households most likely to maintain

stable housing after assistance.

• Oct. 2009 to Sept. 2012.

OrgCode

Singles,

SSVF-funded—

SSVF-funded:

• Analysis of HMIS data.

Consulting, Inc.,

Families

70%

N= 495 Progs. =

• N of 16 suggests 87% might be 87.5%.

2015 (Northeast

ESG-funded—87% 12

• Nov. 2012- Sept. 2014

Florida)

ESG-funded: N=

16

Progs. = 4

Understanding Rapid Re-housing:

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Study Citation

Percent with Exit

Number of

Target

(Study Abbrev.,

to Permanent

Households

Notes

Population(s)

Location)

Housing

and Programs

Finkel et al., 2016

Families

89.5% (rounded to

N = 483

• Analysis of HMIS data.

(RRHD, 23 CoCs

90% in text)

Progs. = 23

• 1,098 served were screened in as likely to be successful.

nationwide)

Wilkins et al. 2014 describes variation in target population.

• 500 of 1,098 were located and consented to be part of

study.

• Subset of full sample analyzed in Spellman et al. 2014.

Borns, 2016

Families

85%

N= 269

• UMOM self-reported analysis of HMIS data.

(Phoenix,

Progs.=1+

• Programs are UMOM plus subcontractors.

Maricopa County,

• In footnotes, lists 40 unsuccessful exits, so 229/269=85%.

AZ)

• These are families with exits between July 2010 and Oct

2015.

Yatchmenoff &

Families

58%

N=247

• Analysis of HMIS and case manager exit reports.

Webb, 2012

Progs.=7

• Cannot exactly match usual measure. Categories do not

(Portland, OR &

exactly match HMIS categories.

Vancouver, WA)

• Might be a few percentage points higher, up to 63%

(155/247).

• 24-month program (unclear). Few details about program

model provided.

• 2006 – 2011.

Patterson et al.,

Families,

77%

N=133

• Analysis of HMIS data.

2016 (midsize

Veterans

Progs.=Unknown • Exits from Oct 2012 through Oct 1. 2015. Post-HPRP.

Tennessee city)

(1 midsize city)

Abt Associates

Singles,

63.1%

N=130

• Analysis of HPRP Annual Performance Report

Inc., 2013

Families

Progs.=6

• N is households (report also gives numbers for clients).

(Hartford, CT)

• Oct. 2009 – Sept. 2012

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Study Citation

Percent with Exit

Number of

Target

(Study Abbrev.,

to Permanent

Households

Notes

Population(s)

Location)

Housing

and Programs

MEMconsultants,

Youth

50% for sample

N=111 (non-

• Analysis of HMIS data.

2016 (King County,

where non-move-in

move-in exits

• Rates presented here are calculated from information

WA)

exits tracked

tracked)

provided in study results.

(80% for sample

Progs. = 2

• 2010 to early 2016.

where only exits

[N=75 (only exits

after move-in

after move-in

tracked)

tracked)

Progs. = 2]

Knowledge

Families

(94.4% for sample

[N=106

• Analysis of “case files”. (Not clear whether HMIS is used,

Advisory Group,

where only exits

Progs. = 1]

no mention of HMIS.)

2016 (Richmond,

after move-in

• Entries and exits between Oct. 2013 and Feb. 2016.

VA)

tracked)

• Maintain housing success rate (only among move-ins)

• Sample may be maintain housing success rate (only among

move-ins) Table 1 has no indication of families who did not

move in to PH.

King County, 2015

Families

(87% for sample

[N=91 (only exits

• Data sources not provided.

(King County, WA)

where only exits

after move-in

• Few analysis details provided.

after move-in

tracked)

• Number of households calculated from information provided

tracked)

Progs. = 6]

in study results.

• Maintain housing success rate (only among move-ins)

• Enrolled Nov 2013 – Dec 2014.

Focus Strategies &

Singles,

75%

N= 88

• Analysis of HMIS data.

Kate Bristol

Families

Progs.=4

• HPRP Oct. 2009 to June 2012.

Consulting, 2012

(San Jose, CA)

Paprocki, 2012

Singles,

Singles—55%

Singles: N=29

• Analysis of HMIS data.

(San Francisco)

Families

Families—63%

Progs.=5

• HPRP period Oct. 2009 – Jun 2012

Families: N=60

• Small sample size because almost all SF HPRP funds

Progs.=5

spent on Prevention, not on RRH.

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pg. 17

Study Citation

Percent with Exit

Number of

Target

(Study Abbrev.,

to Permanent

Households

Notes

Population(s)

Location)

Housing

and Programs

Meschede et al.,

Families

47.3%

N=55

• Analysis of exit survey data.

2016

Progs.=

• Exit surveys administered by program staff.

(Massachusetts)

[“handful”]

• 47.3% assumes 11 of 55 living with family or friends and 13

of 55 with “other/don’t know” exit destination are not in

permanent housing.

Note: The number of programs generally represents the number of local providers of RRH. For the SSVF and HPRP studies, the number of programs is equivalent to the number of grantees or projects.

Understanding Rapid Re-housing:

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pg. 18

Among the 18 studies that measure exits to permanent housing,5 the performance reports on the HPRP

and SSVF funding streams are by far the largest and thus their results represent the most meaningful statistics for this measure. In total, HPRP projects served about 140,000 RRH clients from 2009 to 2012.

The proportions of exits to PH were in the 82 to 84 percent range in the three years the funding stream existed. The SSVF projects served 166,000 veterans (most in households without children) from 2012 to 2015. The proportion of exits to PH from both RRH and homelessness prevention services over this time period was 78 percent. In fiscal year 2015, 71 percent of Veterans who exited SSVF funded RRH were in permanent housing. Veterans in households without children had a lower success rate (70 percent) compared to those in households with children (79 percent). The report does not speculate on the reasons for a higher exit rate to PH among households with children compared to households without children.

Other studies include many fewer households experiencing homelessness but generally find similar rates of exit to PH. Over six years, the 7 RRH programs in Columbus, Ohio had a relatively high 88 percent rate of exit to PH. In the RRHD study, 85 percent of the 1,300 families served through August 2012

exited to PH (Spellman et al., 2014). In Alameda County, California in 2014, the rate of exit to PH was lower, at 66 percent (EveryOne Home & Aspire Consulting, 2015). This lower rate may be explained by the composition of the almost-800 client households. Most client households in Alameda County were individuals, and almost half of the households were chronically homeless individuals. In the State of Connecticut from 2013 to 2015, 84 percent of almost 700 households exited to PH.

Two studies provide the alternative measure of exits to permanent housing based on all move-ins with RRH financial assistance, rather than on all exits. As expected, these rates are relatively high, with a rate 94 percent in Richmond, Virginia (Knowledge Advisory Group, 2016) and a rate of 87 percent in King County, Washington (King County, 2015). One study does not state clearly which measure is being reported. Reporting on the HPRP experience in Philadelphia, the study finds very high rates of 96 percent for singles and 98 percent for families (Institute for Children, Poverty, and Homelessness, 2014).

Of the remaining nine studies that report PH success rates for all household exits, five find rates lower than the larger studies (Yatchmenoff, 2012; Abt Associates, 2013; MEMconsultants, 2016; Paprocki, 2012; and Meschede et al, 2016) and four find rates in the same range (OrgCode Consulting, Inc, 2015; Borns, 2016; Patterson et al., 2016; and Focus Strategies & Kate Bristol Consulting, 2012).

Overall, with the most weight given to the very large studies of the HPRP and SSVF funding streams, the expected range for PH success rates is about 71 to 84 percent. As the proportion of households with children increases and the proportion of one-person households decreases, the expected PH success rate should generally increase as well.

Length of time program participants spend homeless

The second performance measure identified by NAEH is the length of time that program participants who exit to PH spend homeless after RRH program enrollment. NAEH provides a benchmark of 30 days or less for this measure (NAEH, 2016a). This measure uses HMIS information on the date of RRH program enrollment (when services such as case management or housing identification are first provided) and on the date of residential move-in (when a household moves in to PH). Enrollment into the program may occur when households are staying in emergency shelter or on the street. For those who are staying in 5 Since Finkel et al., 2016 analyzes a subset of the sample examined in Spellman et al., 2014, these reports are counted as a single study.

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shelter, RRH program enrollment may occur at almost the same time as shelter entry, or there may be a lag before RRH program enrollment. Time spent homeless before RRH program enrollment is not included in the measure. The relatively recent addition of the residential move-in date to HMIS facilitates the calculation of this measure. Those who move to PH either with or without program assistance, are included in the measure. Individuals and families who do not move to PH (for example, those who move to transitional housing or who exit to staying with family or friends on a temporary basis) are not included.

This length of time homeless measure does not directly connect to either of the measures of exits to permanent housing described in the previous section. Those measures are based on circumstances at program exit rather than achievement of initial move-in to PH, which often occurs during participation in the RRH program. The complement to this length of time homeless measure is a measure of move-in success (shown in the text box).

Move-in success rate (all program entries):

(𝑇𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 ℎℎ′𝑠 𝑡ℎ𝑎𝑡 𝑒𝑛𝑡𝑒𝑟𝑒𝑑 𝑑𝑢𝑟𝑖𝑛𝑔 𝑎 𝑡𝑖𝑚𝑒 𝑝𝑒𝑟𝑖𝑜𝑑 𝑎𝑛𝑑 𝑚𝑜𝑣𝑒𝑑 𝑖𝑛 𝑡𝑜 𝑎 𝑃𝐻 𝑢𝑛𝑖𝑡 ) × 100

𝑇𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 ℎℎ′𝑠 𝑡ℎ𝑎𝑡 𝑒𝑛𝑡𝑒𝑟𝑒𝑑 𝑅𝑅𝐻 𝑝𝑟𝑜𝑔𝑟𝑎𝑚 𝑑𝑢𝑟𝑖𝑛𝑔 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒 𝑡𝑖𝑚𝑒 𝑝𝑒𝑟𝑖𝑜𝑑

This measure links the maintain-permanent-housing success rate with the larger group of all households using the program. This measure would make clear exactly what proportion of RRH participants are contributing to the length of time homeless measure, adding transparency to the assessment of program performance. Although no studies currently provide this rate, it would be easy to calculate from the underlying HMIS data.

Using the types of client pathways defined in Exhibit 2, the move-in success rate (all program entries) is equivalent to

𝑨 + 𝑩 + 𝑪

(

) × 100

𝑨 + 𝑩 + 𝑪 + 𝑫

In the review of the RRH outcomes literature, the research team found only seven studies that provide information on length of time program participants spend homeless and provide some information about sample size (a criterion we used for inclusion). By far the largest of these studies is the fiscal year 2015

report for SSVF (U.S. Department of Veterans Affairs, 2016b). Of the almost 18,000 veteran households who exited to PH and who had data on move-in date, the average length of time between program enrollment and move-in was 45 days. Exhibit 4 reproduces a figure from the SSVF report showing the cumulative distribution function for the sample. A little more than a third of client households (35

percent) spent 2 weeks or less homeless after program enrollment, 55 percent spent 30 days or less, and 85 percent spent 90 days or less.

Understanding Rapid Re-housing:

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pg. 20

Exhibit 4: Time to Housing Placement and Length of Participation among Rapid Re-housing Veteran Exiters, FY 2015

Note: This is a reproduction of U.S. Department of Veterans Affairs, 2016b, Exhibit 23.

The next largest three studies provide varying results. A study of Connecticut programs from 2013 to 2015 reports a result almost identical to that from the SSVF study—an average of 1.4 months between program enrollment and move-in to PH (Drake et al., 2016). A study of a large Salt Lake City RRH

program reports an average of only 26 days for program participants between 2008 and 2012 (NAEH, 2012). And a study of Alameda County, California reports a longer average of 143 days—between 4 and 5 months—between program enrollment and PH move-in. The reason for the shorter average in Salt Lake City is not clear. In the Alameda County study, almost half of program entrants were chronically homeless individuals, and this may contribute to the longer time required to obtain PH.

Of the three studies with the smallest sample sizes, the San Jose study has a length of time spent homeless by program participants similar to that found in Salt Lake City (Focus Strategies & Kate Bristol Consulting, 2012) and the two King County, Washington studies have lengths generally longer than SSVF but shorter than Alameda County (King County, 2015 and MEMconsultants, 2016).

Overall, giving the most weight to the large SSVF study, the research team concludes that the expected length of time spent homeless between RRH program enrollment and move-in to PH is about 45 days. It is not clear whether or not to expect shorter or longer lengths for non-veteran households. The length of time spent homeless by SSVF participants may be shortened relative to non-veteran populations because of the relatively greater availability of permanent supportive housing for veterans provided by the HUD-VASH funding stream. Given the evidence from existing RRH studies included in the review, it appears that many programs may have difficulty reaching the NAEH benchmark of 30 days.

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Exhibit 5: Length of Time Program Participants Spend Homeless Measure

Study Citation

Number of

Target

(Study Abbrev.,

Households

Notes

Population(s)

Average Outcome

Location)

and Programs

U.S. Department of

Veterans

45 days

N= 17,782

• Analysis of HMIS data.

Veterans Affairs,

(both Singles

Progs.=407

• Also provides derived percentages from

2016b (SSVF,

and Families)

cumulative function in Exhibit 23.

nationwide)

• They tracked date of move-in.

• FY2015

National Alliance to

Families

26 days

N=”over 1,000” • Data sources not provided.

End Homelessness,

Progs.=1

• Few analysis details provided.

2012a (Salt Lake City)

• Road Home in Salt Lake City

• Not entirely clear that this is all families who went

to PH, but assume so.

• 2008 to 2012 (state RRH pilot + HPRP period)

Drake et al., 2016

Singles,

1.4 months (SD = 2.1)

N ~ 562 to

• Analysis of HMIS data.

(Connecticut)

Families

1,175

• Feb 1 2013 – Nov 1 2015 “active in CT RRH”,

with valid exit destinations.

• 562 = 84% of 669 with exit destinations. No N

given for those who were housed. Not clear what

exact N is.

EveryOne Home &

Singles,

143 days

N=514

• Analysis of HMIS data and 2014 Annual

Aspire Consulting,

Families

48% achieved PH by 90

Progs.=9

Performance Report.

2015 (Alameda

days or less

County, CA)

King County, 2015

Families

Move-in to permanent

N= 148

• Data sources not provided.

(King County, WA)

housing within—

Progs. = 6

• Few analysis details provided.

60 days or less: 46%

• Enrolled Nov 2013 – Dec 2014.

90 days or less: 60%

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Study Citation

Number of

Target

(Study Abbrev.,

Households

Notes

Population(s)

Average Outcome

Location)

and Programs

Focus Strategies &

Singles,

28 days

N=66

• Analysis of HMIS data.

Kate Bristol

Families

Progs.=4

• Measures days from enrollment to the first

Consulting, 2012 (San

payment. Only includes clients who received

Jose, CA)

financial assistance. Assumed that the first

payment would be security deposit/first month’s

rent.

• Leaves out those who have unknown exit

destinations, some of whom could be to PH. First

payment is OK proxy for move-in date. If

anything, biased downwards. No move-in without

money for those with financial assistance.

• HPRP Oct. 2009 to June 2012.

MEMconsultants,

Youth

Program 1: 76 days

Prog. 1: N=44

• Analysis of HMIS data.

2016 (King County,

Program 2: 88 days

Prog. 2: N=43

• Program means program or subprogram.

WA)

Program 3: 56 days

Prog. 3: N=12

• 2010 to Early 2016.

Program 4: 40 days

Prog. 4: N=5

Program 5: 26 days

Prog. 5: N=5

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 23

Returns to homelessness

The third performance measure identified by the NAEH is the proportion of client households who do not return to homelessness within one year after program exit to PH. The research team identified several different measures of return to homelessness after program exit. Most of the studies were performed prior to the publication of the NAEH performance measure document, so there may be more uniformity in measures in the future. However, there appears to be some ambiguity in the NAEH measure definition that may have the unintended consequence of contributing to continuing future variation in measure definition. The NAEH document describes the measure and then defines it with a formula. The description is “For a program to meet this performance benchmark, at least 85 percent of households that exit a rapid re-housing program to permanent housing should not become homeless again within a year”

(NAEH, 2016a). The key parts of this measure description are: (1) the percentage should be calculated out of a denominator of households who exited to PH, not out of all program exits; (2) each household should have at least one year of follow-up data so that a household can be observed to not have returned to homelessness in the year after exit; (3) only households who return to homelessness within one year of program exit should be removed from the numerator.6

The NAEH document notes that the community’s HMIS must cover at least 80 percent of the programs in the community for HMIS data to be sufficient to calculate this measure. The lower the HMIS coverage, the more returns to homelessness that may be missed in the measure. The document states that, without adequate HMIS coverage, a measure can be calculated using alternative data collected for a representative sample of households who exit to PH. A return to homelessness rate calculated with survey data may be higher than a rate for the same sample calculated with HMIS data because HMIS does not include stays in places not meant for human habitation. One study (MEMconsultants, 2016) mentions the difficulty in determining whether a re-appearance in HMIS data after RRH program exit signals an actual return to homelessness. In the past, some HMIS records have had a great deal of ambiguity as to the exact type of service being delivered. Some households receive services from emergency shelters while they are not currently experiencing homelessness. Only services that have homelessness as a participation criterion should be used to identify returns to homelessness.

Of the studies reviewed, several reported some type of measure of return to homelessness. However, only two studies (conducted in Alameda County, California and King County, Washington) appear to provide results that are directly comparable to the NAEH benchmark of 15 percent or less return to homelessness within one year. There were a number of dimensions on which the other measures of returns to homelessness differed. Some studies provide rates calculated with a denominator of all program exits rather than only exits to PH. A few studies report the percent of returns within a two-year follow-up period rather than a one-year period. A longer period than one-year is certainly of policy interest, but is 6 The formula provided by the document introduces some ambiguity about time periods. The formula states the measure as the fraction “Total number of households who did NOT return to homelessness during time period

[divided by] Total number of households exited to permanent housing during the same time period”. Taken literally, the denominator would not be well-matched to the numerator because the non-returns to homelessness are (at least partially) observed in the period after that when the program exits occur. The research team assumed that the intended definition is instead the fraction “Of households who exited to permanent housing during time period, total number of households who did NOT return to homelessness during the 12 months after exit [divided by] Total number of households exited to permanent housing during the time period.” Essential to this definition is the idea that the follow-up year for each household starts at their program exit and, therefore, there is a different calendar period for each household.

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 24

not the measure deemed appropriate by the NAEH to assess program performance. A handful of studies report the percent of returns to homelessness with differing lengths of follow-up across households. This type of measure is less useful analytically because it does not allow for easy comparisons across programs (or across historical periods for the same program). Finally, the Family Options Study7 provides some measures of returns to homelessness that are timed to study enrollment rather than to program exit. This type of outcome definition facilitates comparisons across interventions of different lengths, but is less useful for understanding the timing of returns to homelessness for households using RRH.

Exhibit 6 presents the return to homelessness identified in the reviewed studies. The largest study of returns to homelessness after RRH program exit is based on SSVF data (Byrne et al., 2015). This study finds one-year rates of returns to homelessness after RRH exit of 16 percent for single adults and nine percent for families.8 It also finds two-year rates of return to homelessness of 27 percent for single adults and 16 percent for families. These rates are based on all RRH exits, rather than only exits to PH, so may be biased upwards. On the other hand, the authors point out that their return measure captures only returns to VA-specialized homeless programs and not to all providers using HMIS. Therefore, they note that their measure may be downwardly biased, particularly for families, since VA program have not traditionally served families with children. The study does not provide confidence intervals around the one- and two-year rates of return to homelessness, but these should be wider for the two-year rates than the one-year rates for a couple of reasons. First, as the authors note, typically survival analysis has widening confidence intervals because recidivism over time reduces the sample sizes in the later periods. Second, there are relatively few client households with two full years of post-exit data.9 Given the much larger starting sample of single adults than families and the higher likelihood that single veterans would seek services at VA-specialized programs compared to families, the rates found for single adults should be considered somewhat more reliable than the rates found for families.

The RRHD study provides another result for return to homelessness by families after exit from RRH.

Like that provided by the SSVF study, the RRHD study result is based on RRH programs throughout the 7 The value of the Family Options Study evidence is based in part on its sample size and in part on its strong research design. The study randomly assigned 2,282 families to four groups: CBRR, in which families were offered priority access to short-term rental subsidies (up to 18 months); SUB, in which families were offered priority access to long-term rental subsidies (usually housing choice vouchers); PBTH, in which families were offered priority access to project-based transitional housing ; and Usual Care, in which families received no priority access to a program but were free to pursue whatever assistance was available in their communities.

While generally a majority of, but not all, households using rapid re-housing assistance receive short-term rental subsidies (assistance is intended to be customized to the needs of the family), all households assigned to the CBRR group received access to short-term subsidies. The study’s two follow-up survey respondent samples each included at least 250 families assigned to CBRR who used the short-term subsidies. However, because of the experimental design, the study analyzed outcomes relative to the time of random assignment, not relative to entry and exit from the short-term rental assistance provided by RRH programs. The study therefore did not measure outcomes that align with the NAEH benchmarks.

8 All studies report proportions with return to homelessness, rather than the complementary NAEH measure of households without a return to homelessness. Therefore, we discuss these rates as returns to homelessness.

9 In order for a client household to have two full years of post-exit data, the household would need to have exited by January 1, 2012. Since the SSVF programs began in October 2011, it seems likely that only a few households would have exited by January 1, 2012. Table 1 shows that 70 percent of exits occurred in federal fiscal year 2013 (with the remaining 30 percent exiting in fiscal year 2012). If the first quarter the programs operated had one-half the number of exits as the other quarters of federal fiscal year 2012 (because exits only occur after households have had time to move through the program), then a very basic analysis suggests it is possible that less than 5 percent of the sample has two full years of post-exit data (30 percent/7 = 4.3 percent).

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 25

United States. Of nearly 1,500 families who exited from RRH programs, only six percent were found to have returned to homelessness within a year of program exit (Spellman et al., 2014). This rate is based on all RRH exits, not just those exits to PH and so may be higher than what would have been found among only the families who exited to PH. This study identifies some subsequent homelessness with the RRH

exit destination, a possible strategy when examining all families who exit a program.

The differences in rate calculations create some difficulty in comparing rates across studies. Of the other studies with sample sizes of 500 or more, a study of Philadelphia during HPRP funding finds returns to homelessness of 14 percent with follow-up lengths of 14 to 45 months (Taylor & Pratt-Roebuck, 2013); a study of Salt Lake City finds a similar rate over (presumably) a similar length follow-up period (NAEH, 2012); a study of Georgia finds a return rate of seven percent within two years of exit (Rodriguez, 2013); a study of Alameda County finds a rate of nine percent within one year of exit (EveryOne Home & Aspire Consulting, 2015); and a study of Connecticut finds constant return rates for families of about 5 percent in follow-up cohorts of roughly one, two, and three years after exit and escalating rates for single adults of 4, 11, and 18 percent over the three follow-up periods (CT Coalition, 2013).

Five other smaller studies generally find rates that are somewhat lower than those found in the SSVF

study. The outlier among these other studies is the return to homelessness rate found in the Family Options Study. Of the almost 300 families who had priority access to and used RRH rental subsidies, 23

percent had a stay in emergency shelter during the one-year period starting a half-year after study enrollment. In the six months before the first follow-up survey (completed roughly 20 months after study enrollment) 22 percent of these families reported having experienced homelessness (Gubits et al, 2015).

These follow-up periods should roughly coincide with or fall within the first year after program exit (given that it took about two months after study enrollment for these families to move-in to a rental unit and then they had subsidies that lasted for about seven months). It is unclear why the Family Options Study rate of return to homelessness is higher than that found by other studies. The study’s use of survey data in addition to HMIS data may explain some of the discrepancy.

Overall, given the expected upwards bias of studies that counted returns among all exiting households, it seems that the NAEH benchmark of 15 percent or lower returns to homelessness of those who exited to PH should be within the reach of most programs. Higher rates of return to homelessness for single adults compared to families with children should be expected (Byrne et al., 2015; CT Coalition, 2013; and Rodriguez & Eidelman, forthcoming). More evidence is needed to show the extent to which variation in HMIS coverage and the use of survey data affect calculated rates of return to homeless

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 26

Exhibit 6: Returns to Homelessness Measure

Percent with

Study Citation

Number of

Target

return to

(Study Abbrev.,

Households

Notes

Population(s)

homelessness

Location)

and Programs

within 12 months

Byrne et al.,

Veterans

Singles

Singles:

• Analysis of VA’s National Homeless Registry.

2015 (SSVF,

(both Singles

Within 1 year: 16%

N=19,554

• Out of all exits, not out of all exits to PH, potentially biasing

nationwide)

and Families)

Within 2 years:

Progs.=151

returns upwards.

26.6%

Families:

• Outcome: to a VA-specialized homeless assistance program

Families

N=4,106

(SSVF or non-SSVF) by Jan. 1, 2014. But not matched to HMIS

data, potentially biasing returns downwards.

Within 1 year: 9.4%

Progs.=151

• Authors note that lack of HMIS data may have more downward

Within 2 years:

Effective

bias for families than for individuals, as “VA-specialized

15.5%

sample sizes at

homeless programs have not traditionally served families with

1-year and 2-

children”.

year points are

• Authors note sample size reduction toward end of observation

smaller,

particularly at

period due to prior recidivism.

2-year point.

• Maximum follow-up about 27 months, minimum follow-up is 3

months.

• Likely more than 95% right-censoring by 2-year mark. Particular

issue for families, which start with smaller sample. Wider

confidence intervals at 2 years than at 1 year.

• All SSVF exits from Oct. 1, 2011 to Sept. 30, 2013.

Spellman et al.,

Families

Within 1 yr. of exit:

N= 1,459

• Analysis of HMIS data.

2014 (RRHD, 23

6.0%

Progs.= 23

• Out of all exits, not out of all exits to PH, potentially biasing

CoCs

returns upwards.

nationwide)

• 23 families from RRH program exit destination, plus 65 families

in returns data alone, not reported how many in both.

• Because returns only collected in 22 of 23 CoCs, should have

dropped 23rd site from analysis. Seems to be included, resulting

in small downwards bias.

• 40 of 88 (46%) returned immediately or within weeks to ES or

TH.

• 2009 to Aug. 1, 2012.

Abt Associates

▌pg. 27

Percent with

Study Citation

Number of

Target

return to

(Study Abbrev.,

Households

Notes

Population(s)

homelessness

Location)

and Programs

within 12 months

Taylor & Pratt-

Singles,

Returns over a 4-

N= 1,169

• Analysis of HMIS data.

Roebuck, 2013

Families

year timeframe

Progs. =

• Just under 50% of client households have less than 2 years of

(Philadelphia)

regardless of exit

multiple

follow-up data.

date: 13.6% of

providers in

• Outcome: any return to shelter Oct. 2009 to July 2013.

households

Phil.

• Received RRH housing assistance from Oct. 2009 to May 2012.

National Alliance

Families

Returns within

N=”over 1,000” • Data sources not provided.

to End

unknown time

Progs.=1

• Few analysis details provided.

Homelessness,

frame: 13%

• Not clear whether returns are for all exits or only for exits to PH.

2012a (Salt Lake

•

City)

Road Home in Salt Lake City.

• 2008 to 2012 (state RRH pilot + HPRP period).

Rodriguez, 2013

Singles,

Returns within 2

N~ 650

• Analysis of HMIS data.

Families

years of exit: 7.2%

Progs= whole

• Author provided N in email.

of people in

state

• Out of all exits, not out of exits to PH.

households

• RRH exits from 11/20/2009 to 11/19/2010.

CT Coalition

Singles,

Returns by 2013

Sum across

• Assumed analysis of HMIS (data source not clearly provided).

2013 (State of

Families

from 2010 exits:

three exit years

• Few analysis details provided. Sample sizes by exit year not

Connecticut)

Families: 5%

N=”over 1,600

provided.

Singles: 18%

households”

• Not clear whether returns are for all exits or only for exits to PH.

(families and

from 2011 exits:

•

singles)

Although footnote says 2012 exiters were measured 9 months

Families:6%

post-exit, there is a reference to “CTHPRP Returns to Shelter

Progs.=

Singles 11%

Report” Aug. 2013 (unavailable on web). For Dec. 2012 exiters,

unknown

Aug. 2013 would have been less than 9 months (if all windows

from 2012 exits:

(statewide)

for all years of exit end on same date in 2013).

Families: 5%

Singles: 4%

Abt Associates

▌pg. 28

Percent with

Study Citation

Number of

Target

return to

(Study Abbrev.,

Households

Notes

Population(s)

homelessness

Location)

and Programs

within 12 months

EveryOne Home

Singles,

Returns within 1

N~500

• Alameda County analysis of HMIS data.

& Aspire

Families

year: 9%

Progs.=9

• No sample size is given for returns calculation. 514 exited RRH

Consulting, 2015

to PH in 2014.

(Alameda

• 9% is for “Return to shelter or TH 12 month Average 2014.”

County, CA)

• Out of exits to PH, as specified in NAEH benchmark measure.

• Analytic sample not described. Presumably returns sample

exited RRH in 2013.

Finkel et al.,

Families

Returns within 1

N= 483

• Analysis of HMIS and survey data.

2016 (RRHD, 23

year: 10%

Progs. = 23

• Out of all exits, not out of all exits to PH, potentially biasing

CoCs

returns upwards.

nationwide)

• Does not report how many are recorded as returns to homeless

due to survey alone.

• Subset of full sample analyzed in Spellman et al. 2014.

Gubits et al.,

Families

22.6% in ES in

N= 272

• Analysis of HMIS and survey data.

2015 (FOS, 12

months 7 to 18 after

Progs.= 27

• 272 CBRR families who used rental subsidies.

CoCs)

RA

• Does not report how many are recorded as returns to homeless

21.5% Homeless in

due to survey alone.

past 6 months

• Random assignment took place from Sept. 2010 to Jan. 2012.

before 20-month

survey

Rodriguez &

Singles,

Returns within 2

Households

• Analysis of HMIS data.

Eidelman,

Families

years of exit:

with children

• Out of all exits, not out of exits to PH.

forthcoming

households with

N=248

• RRH exits from 7/1/2011 to 6/30/2012.

children: 8.9%

Households

households without

without

children: 12.2%

children N=131

Progs= whole

state

Abt Associates

▌pg. 29

Percent with

Study Citation

Number of

Target

return to

(Study Abbrev.,

Households

Notes

Population(s)

homelessness

Location)

and Programs

within 12 months

Borns, 2016

Families

Returns over a 5-

N= 229

• UMOM self-reported analysis of HMIS data.

(Phoenix,

year timeframe

Progs.=1+

• Results for UMOM plus subcontractors.

Maricopa

regardless of exit

• These are families with exits between July 2010 and Oct. 2015.

County, AZ)

date: 7%

• Out of exits to PH, as specified in NAEH benchmark measure.

• Returns as of Oct. 2015.

• Families with exits between July 2010 and Oct. 2015.

MEMconsultants,

Youth

Returns within 1

N= 100

• Analysis of HMIS data.

2016 (King

year: 7%

Progs. = 3

• Out of exits to PH, as specified in NAEH benchmark measure.

County, WA)

Returns “after more

• An additional 22% returned within 1 year to other services or

than 1 year”: 13%

prevention. Housing status not clear on these records.

• Exited to PH 2010 to March 2015.

Knowledge

Families

Returns within 6

N=100

• Analysis of “case files.” (Not clear whether HMIS is used, no

Advisory Group,

months: 7%

mention of HMIS.)

2016 (Richmond,

Within 1 year: 18%

• Few analysis details provided. Appears that analysis may have

VA)

been performed incorrectly.

• Calculated that 18/100 is 18%. Ignores that perhaps 16 did not

get to 12-month window but had not returned yet.

• Entries and exits from Oct. 2013 to Feb. 2016.

Abt Associates

▌pg. 30

Chapter 4: Conclusion

Research on rapid re-housing is increasingly important as more communities shift resources toward the intervention. The significant and ongoing federal investment in RRH programs indicates that it will continue to be a key program used by communities to address homelessness. The flexibility of RRH

allows programs to administer varying amounts of the RRH core components of housing identification and placement support, financial assistance, and case management to best meet the needs of the household being served. RRH programs can be designed to target specific subpopulations, including veterans and youth. At the same time, external community characteristics such the local housing market, unemployment rates, and household income influence the design and implementation of RRH programs and also drive variation between RRH programs. Prior to the development of federal guidance on the core program components in 2012, some RRH programs used eligibility requirements to screen out households with perceived high barriers to succeeding in maintaining housing. Some programs still may do that, despite the federal guidance.

Of particular interest is how RRH is performing on outcomes that are closely related to the program’s central objectives of quickly moving people experiencing homelessness out of shelters and stabilizing them in permanent housing. NAEH developed a set of performance benchmarks that reflect those objectives 1) the length of time people are homeless before being placed into housing, 2) the percentage of people who exit rapid re-housing programs to permanent housing destinations, and 3) the rate at which those people return to homelessness within one year of program exit. The Abt study team used those performance measures to conduct a systematic review of the literature on RRH outcomes available as of early 2017. The study team identified a total of 76 studies of RRH from national searches, referrals from researchers, and reviewing study reference lists. After screening to omit studies that did not examine program outcomes or did not describe a program that met the definition of rapid re-housing core components, the team considered 43 studies in the review. This review included new research completed after a 2015 literature review (Cunningham et al. 2015) was completed.

The review finds evidence (from 18 studies that measured this outcome) that rapid re-housing programs are meeting the 80 percent benchmark established for exits to permanent housing, with HPRP studies reporting exits to permanent housing between 82 to 84 percent. SSVF reports somewhat lower exit rates of 78 to 80 percent and lower rates for households without children. NAEH established a benchmark of 30 days for the time households spend homeless after program enrollment. The evidence available (from seven studies that examined this outcome) indicates that many programs have difficulty meeting this target. Less evidence exists about achievement of the third benchmark, returns to homelessness within one year of program exit (15 percent). The review found a good deal of variability in the measures used to evaluate return to homelessness and also found that many studies were conducted before the benchmark was established. Based on the studies that examined this, and taking into account expected upward bias of studies that counted returns among all exiting households, we believe that the benchmark appears to be attainable. However, more evidence is needed to show the extent to which variation in HMIS coverage and the use of survey data affect the calculations of rates of return to homelessness. Overall, this review has shown that several large studies provide evidence about rapid re-housing progress in meeting NAEH

benchmarks, but gaps in knowledge persist about the influence of variations in program design and implementation as well as community contextual factors on RRH outcomes.

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 31

Other components of the Understanding Rapid Re-housing Study will provide additional information on how RRH programs are currently implemented and the experiences of households before, during, and after program participation. Specifically, the web survey of CoCs and RRH programs and interviews with RRH staff will provide more insight into what are the central programmatic features of RRH, including program goals, targeting, structure and duration of housing assistance and case management services.

This information, combined with rich qualitative data from program participant interviews, will offer data for future assessments of RRH program outcomes.

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 32

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Massachusetts Law Reform Institute. 2010. A Bridge to Where? Short-Term Housing Assistance for Homeless Families in Massachusetts and the Ongoing Need for Affordable Housing and Emergency Shelter. Boston, MA: Massachusetts Law Reform Institute.

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Mayfield, Jim, Callie Black, and Barbara E.M. Felver. 2012. Employment Outcomes Associated with Rapid Re-housing Assistance for Homeless DSHS Clients in Washington State. Olympia, WA: Report prepared for the Washington State Department of Commerce, Community Services and Housing Division. https://www.dshs.wa.gov/sites/default/files/SESA/rda/documents/research-11-185.pdf

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MEMconsultants, LLC. 2016. Young Adult Rapid Re-housing Retrospective Analysis. Seattle, WA: Report prepared for All Home King County in partnership with the Raikes Foundation.

Meschede, Tatjana and Sara Chaganti. 2015. "Home for now: A Mixed-methods evaluation of a short-term housing support program for homeless families." Evaluation and Program Planning. 52 (2015): 85-95. https://iasp.brandeis.edu/pdfs/2015/Elsevier.pdf (accessed January 28, 2017).

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National Alliance to End Homelessness. 2012a. Promising Strategies: Utah Workforce Services and The Road Home A Public/Private Partnership to End Family Homelessness. Case study.

http://b.3cdn.net/naeh/3dc987b56fb1d727c2_a5m6i29ud.pdf (accessed January 13, 2017).

—. 2012b. Promising Strategies: Mercer County Board of Social Services and Mercer Alliance to End Homelessness. Case study.

https://peerta.acf.hhs.gov/sites/default/files/public/uploaded_files/Mercer%20County%20Case%20St

udy-_md_7-kf.pdf (accessed February 15, 2017).

—. 2014a. Core Components of Rapid Re-Housing. Fact Sheet.

http://www.endhomelessness.org/library/entry/rapid-re-housing2 (accessed December 2, 2017).

—. 2014b. Alameda County Social Services Agency and EveryOne Home. Case study.

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OrgCode Consulting, Inc. 2015. Rapid Re-Housing Outcomes Study. Jacksonville, FL: Report prepared for the Emergency Services & Homeless Coalition of Northeast Florida.

Paprocki, Anne. 2012. Evaluation of San Francisco’s Homelessness Prevention and Rapid Re-Housing Program. Berkeley, CA: Goldman School of Public Policy, University of California at Berkeley.

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Patterson, David A., Stacia West, Taylor M. Harrison, and Lisa Higginbotham. 2016. "No Easy Way Out: One Community’s Efforts to House Families Experiencing Homelessness." Families in Society: The

Journal of Contemporary Social Services. 97 (3): 212-220. http://dx.doi.org/10.1606/1044-

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Rodriguez, Jason. 2013. Homelessness Recurrence in Georgia: Descriptive Statistics, Risk Factors, and Contextualized Outcome Measurement. Atlanta, GA: State Housing Trust Fund for the Homeless,

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Rodriguez, Jason and Tessa Eidelman. Forthcoming. “Homelessness Interventions in Georgia: Rapid ReHousing, Transitional Housing, and the Likelihood of Returning to Shelter.” Housing Policy Debate.

Shah, Melissa Ford, Callie Black, Barbara E.M. Felver, Chris Albrecht, and Lance Krull. 2014. The Ending Family Homelessness Pilot: Rapid Re-Housing for TANF Families. Olympia, WA: Report prepared for the Washington State Department of Commerce, Community Services and Housing Division. https://www.dshs.wa.gov/sites/default/files/SESA/rda/documents/research-11-203.pdf

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Shah, Melissa Ford, Qinghua Liu, Deleena Patton, and Barbara Felver. 2015. Impact of Housing Assistance on Outcomes for Homeless Families: An Evaluation of the Ending Family Homelessness Pilot. Olympia, WA: Report prepared for the Washington State Department of Commerce, Community Services and Housing Division.

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Sloan, Margaret F., Karen A. Ford, and Daisha M. Merritt. 2015. “Shifts in Practice Based on Rapid ReHousing for Rural Homelessness: An Exploratory Study of Micropolitan Homeless Service Provision.” Contemporary Rural Social Work 7(2): 127-134.

Spellman, Brooke, Meghan Henry, Meryl Finkel, Natalie Matthews, and Tom McCall. 2014. Brief #3.

Rapid Re-housing for Homeless Families Demonstration: Subsequent Returns to Shelter for All Families Served. Washington, DC: Report prepared by Abt Associates for U.S. Department of Housing and Urban Development, Office of Policy Development and Research. Government Printing Office. https://www.huduser.gov/portal/sites/default/files/pdf/RRHD-Brief-3.pdf (accessed February 2, 2017).

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to-End-Youth-Homelessness.pdf (accessed March 1, 2017).

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3-APR-Analysis.pdf (accessed January 27, 2017).

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Department of Veterans Affairs.

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Wilkins, Carol, Martha R. Burt, Natalie Matthews, and Brooke Spellman. 2014. Brief #2. Rapid Rehousing for Homeless Families Demonstration: The Role of Assessment Tools. Washington, DC: Report prepared by Abt Associates for U.S. Department of Housing and Urban Development, Office of Policy Development and Research. Government Printing Office.

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Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 38

Understanding Rapid Re-housing: Systematic Review of Rapid Re-housing Outcomes Literature Appendix A: Summary of Examined Studies

Study Citation

Timeframe

Geographic Area

Design Methodology

Outcomes Examined

Abt Associates Inc.,

2009-2012

Capital Region, CT

• HMIS data analysis.

• Housing outcomes at exit

2013

• Client focus groups.

• Effect on homeless prevalence in community

• Stakeholder interviews.

• Housing stability outcomes post-exit

• Economic outcomes

• Housing market and community context

• System design

• Cost comparisons

Borns, 2016

2010-2015

Phoenix, AZ

• HMIS data analysis.

• Housing outcomes at exit

• Returns to homelessness

• System design

Building Changes,

2010-2015

King County, WA

• Program review.

• System design

2016

• Economic outcomes

Burt et al., 2016

2011-2011

Nationwide

• Site visits and phone surveys

• System design

with stakeholders.

• Housing market and community context

Byrne et al., 2015

2011-2013

Nationwide

• Analysis of data from VA’s

• Returns to homelessness

National Homeless Registry

• Veterans

and VA electronic medical

• Housing market and community context

records.

•

•

System design

Survival analysis.

• Multilevel Cox proportional

hazards regression models.

Chaney, 2014

2012-2014

Vermont

• Longitudinal study.

• Cost comparisons

• Data from housing providers,

• Health & safety outcomes

Medicaid beneficiary claims,

• Effect on homeless prevalence in community

and Department of

• Rural context

Corrections.

Community Shelter

2010-2016

Columbus, OH

• HMIS data analysis.

• Housing outcomes at exit

Board, 2012-2017

• System design

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 39

Understanding Rapid Re-housing: Systematic Review of Rapid Re-housing Outcomes Literature Study Citation

Timeframe

Geographic Area

Design Methodology

Outcomes Examined

Cross Sector

2015-2016

Connecticut

• Program document review.

• System design

Consulting, 2016

• Stakeholder interviews.

• Economic outcomes

• Focus groups.

•

• HMIS data analysis.

• Client surveys.

Cutuli et al., 2017

2003-2014.

Hennepin County,

• Longitudinal mixed modeling.

• Child well-being

MN

• Random assignment.

• Housing intervention comparisons

• Matched comparison groups.

• Families

• Data from Family Options

Study linked to education

records from large urban

school districts.

Drake et al., 2016

2014-2016

Connecticut

• HMIS data analysis.

• Housing outcomes at exit

• Focus groups.

• Time to housing placement

• Case studies.

• Other measures of well-being

• System design

EveryOne Home &

2013-2014

Alameda County,

• Report of local HMIS

• Housing outcomes at exit

Aspire Consulting,

CA

performance measures.

• Returns to homelessness

2015

• Time to housing placement

• Economic outcomes

• System design

Finkel et al., 2016

2009-2013

Nationwide

• HMIS data analysis.

• Housing outcomes at exit

• Client surveys.

• Returns to homelessness

• Address history data analysis. • Economic outcomes

• Site visits and phone surveys

• Housing market and community context

with stakeholders.

• System design

• Families

• Health & safety outcomes

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 40

Understanding Rapid Re-housing: Systematic Review of Rapid Re-housing Outcomes Literature Study Citation

Timeframe

Geographic Area

Design Methodology

Outcomes Examined

Focus Strategies &

2009-2012

San Jose, CA

• Program document review.

• Housing outcomes at exit

Kate Bristol

• Key informant interviews.

• Economic outcomes

Consulting, 2012

• HMIS data analysis.

• Time to housing placement

• Cost comparisons

• Other measures of well-being

• Housing intervention comparisons

• System design

Fyall et al., 2016

2014-2016

Seattle, WA

• Stakeholder interviews.

• Single adults

• HMIS data analysis.

• System design

• Client and landlord interviews. • Housing stability outcomes post-exit

• Housing market and community context

Gubits et al., 2015

2010-2015

Nationwide

• Random assignment design.

• Returns to homelessness

• Longitudinal study.

• Housing stability outcomes post-exit

• Client surveys.

• Cost comparisons

• Program cost data analysis.

• Housing intervention comparisons

• Administrative data systems

• Economic outcomes

analysis.

• Child well-being

• Other measures of well-being

Gubits et al., 2016a

2010-2015

Nationwide

• Random assignment design.

• Housing stability outcomes post-exit

• Longitudinal study.

• Housing outcomes at exit

• Client surveys.

• Administrative data systems

analysis.

Hennepin County

2014-2015

Hennepin County,

• Experimental design.

• Returns to homelessness

Center of Innovation

MN

• Stakeholder interviews.

• Young parents (under age 25)

and Excellence,

• Service and housing data

• System design

2016

analysis.

• Child well-being

• Economic outcomes

• Effect on homeless prevalence in community

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 41

Understanding Rapid Re-housing: Systematic Review of Rapid Re-housing Outcomes Literature Study Citation

Timeframe

Geographic Area

Design Methodology

Outcomes Examined

Hickert et al., 2010

2006-2010

Salt Lake County,

• Data from Housing Authority

• Economic outcomes

UT

and Bureau of Criminal

• Housing stability outcomes post-exit

Identification.

• Criminal history outcomes

• Comparison of participants of

• Health & safety outcomes

two programs.

•

•

Cost comparisons

Client case files analysis.

• Others measures of well-being

• Client surveys.

•

•

System design

Case manager surveys.

• Descriptive and statistical

analyses.

• Cost-benefit model.

Institute for

2009-2013

Mercer County, NJ

• Case study.

• Cost comparisons

Children, Poverty,

• HMIS data analysis.

• Economic outcomes

and Homelessness,

• Housing market and community context

2013a

• Families

Institute for

2005-2011

New York City, NY

• Case study.

• Cost comparisons

Children, Poverty,

• HMIS data analysis.

• Housing market and community context

and Homelessness,

• System design

2013b

• Families

Institute for

2010-2012

Philadelphia, PA

• Case study.

• Housing outcomes at exit

Children, Poverty,

• Summary of HPRP

• System design

and Homelessness,

performance report, a

• Economic outcomes

2014

matched comparison group

• Housing market and community context

study, and results of a client

survey.

King County, 2015

2013-2015

King County, WA

• Data analysis (source not

• Housing outcomes at exit

provided).

• Time to housing placement

• Pilot program evaluation.

• Housing market and community context

Knowledge Advisory

2013-2016

Richmond, VA

• Client case files review.

• Housing outcomes at exit

Group, 2016

• Returns to homelessness

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 42

Understanding Rapid Re-housing: Systematic Review of Rapid Re-housing Outcomes Literature Study Citation

Timeframe

Geographic Area

Design Methodology

Outcomes Examined

Massachusetts Law

2000-2010

Massachusetts

• Stakeholder opinion piece.

• Housing market and community context

Reform Institute,

• Policy analysis.

• Cost comparisons

2010

• Statewide housing data

analysis.

Mayfield et al., 2012

2005-2010

Washington

• Quasi-experimental, matched

• Economic outcomes

comparison group design.

• HMIS data analysis.

MEMconsultants,

2010-2016

King County, WA

• Stakeholder interviews.

• Housing outcomes at exit

2016

• HMIS data analysis.

• Returns to homelessness

• Literature review.

• Time to housing placement

• Youth

• System design

• Economic outcomes

Meschede et al.,

2009-2011

Massachusetts

• Mixed-methods.

• Housing outcomes at exit

2016

• Client and stakeholder

• Economic outcomes

interviews and focus groups.

• Housing market and community context

• Client and stakeholder

• Housing stability outcomes post-exit

surveys.

• HMIS data analysis.

National Alliance to

2008-2012

Salt Lake County,

• Case study.

• Returns to homelessness

End Homelessness,

UT

• HMIS data analysis.

• Time to housing placement

2012a

• System design

• Families

• Employment outcomes

National Alliance to

2008-2012

Mercer County, NJ

• Case study.

• System design

End Homelessness,

• HMIS data analysis.

• Effect on homeless prevalence in community

2012b

• Cost comparisons

• Economic outcomes

• Families

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 43

Understanding Rapid Re-housing: Systematic Review of Rapid Re-housing Outcomes Literature Study Citation

Timeframe

Geographic Area

Design Methodology

Outcomes Examined

National Alliance to

2007-2013

Alameda County,

• Case study.

• System design

End Homelessness,

CA

• HMIS data analysis.

• Families

2014b

OrgCode

2012-2014

Northeast Florida

• Report of local HMIS

• Housing outcomes at exit

Consulting, Inc.,

performance measures.

• Economic outcomes

2015

• System design

Paprocki, 2012

2009-2012

San Francisco, CA

• HMIS data analysis.

• Housing outcomes at exit

• Client interviews.

• System design

• Stakeholder focus groups.

• Economic outcomes

• Public meetings attendance.

Patterson et al.,

2012-2015

Knoxville, TN

• HMIS data analysis.

• Housing outcomes at exit

2016

• Survival analysis.

• Cox regression.

Rodriguez, 2013

2009-2010

Georgia

• HMIS data analysis.

• Returns to homelessness

• Predictive models of

• Housing intervention comparisons

recurrence.

• Housing market and community context

• Multivariate models.

• Logistic regression.

Rodriguez &

2011-2012

Georgia

• HMIS data analysis.

• Returns to homelessness

Eidelman,

• Predictive models of

• Housing intervention comparisons

Forthcoming

recurrence.

• Housing market and community context

• Multivariate models.

• Logistic regression.

Shah et al., 2014

2011-2013

Washington

• HMIS data analysis.

• System design

• Comparison group of TANF

• Economic outcomes

clients in balance of state.

• Health & safety outcomes

• Child well-being

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 44

Understanding Rapid Re-housing: Systematic Review of Rapid Re-housing Outcomes Literature Study Citation

Timeframe

Geographic Area

Design Methodology

Outcomes Examined

Shah et al., 2015

2013-2015

Washington

• Matched comparison groups.

• Economic outcomes

• HMIS data analysis.

• Criminal history outcomes

• Housing intervention comparisons

Sloan et al., 2015

2012-2013

Nationwide

• Stakeholder interviews.

• Rural context

• Snowball sampling technique. • System design

Spellman et al.,

2009-2013

Nationwide

• HMIS data analysis.

• Housing outcomes at exit

2014

• Returns to homelessness

• Housing market and community context

• Families

• Housing stability outcomes post-exit

U.S. Department of

2011-2012

Nationwide

• Analysis of HPRP grantees’

• Housing outcomes at exit

Housing and Urban

Quarterly Performance

• Economic outcomes

Development,

Reports and Annual

• System design

2016a

Performance Reports,

including HMIS data.

U.S. Department of

2011-2012

Nationwide

• Analysis of HPRP grantees’

• System design

Housing and Urban

narrative responses to HUD’s

Development,

Annual Performance Reports.

2016d

U.S. Department of

2014-2015

Nationwide

• HMIS data analysis.

• Housing outcomes at exit

Veterans Affairs,

• SSVF grantee quarterly

• Time to housing placement

2016b

reports.

• Economic outcomes

• SSVF client surveys.

• Effect on homeless prevalence in community

• Veterans

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 45

Understanding Rapid Re-housing: Systematic Review of Rapid Re-housing Outcomes Literature Study Citation

Timeframe

Geographic Area

Design Methodology

Outcomes Examined

Yatchmenoff, 2012

2006-2011

Multnomah,

• Longitudinal study.

• Housing outcomes at exit

Washington, and

• HMIS data analysis.

• Economic outcomes

Clackamas

• Client case files analysis.

• Housing stability outcomes post-exit

Counties in OR;

•

•

Clark County in WA

Stakeholder interviews.

Health & safety outcomes

• Child well-being

• Families

• System design

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 46

Understanding Rapid Re-housing: Systematic Review of Rapid Re-housing Outcomes Literature Appendix B: Destination Type Response Categories in HMIS

Field Names

Data Types/Response Categories

Destination Type

Deceased

Emergency shelter, including hotel or motel paid for with emergency shelter voucher

Foster care home or foster care group home

Hospital or other residential non-psychiatric medical facility

Hotel or motel paid for without emergency shelter voucher

Jail, prison or juvenile detention facility

Long-term care facility or nursing home

Moved from one HOPWA funded project to HOPWA PH

Moved from one HOPWA funded project to HOPWA TH

Owned by client, no ongoing housing subsidy

Owned by client, with ongoing housing subsidy

Permanent housing for formerly homeless persons (such as: CoC project; or HUD legacy programs; or HOPWA PH)

Place not meant for habitation (e.g., a vehicle, an abandoned building, bus/train/subway station/airport or anywhere outside)

Psychiatric hospital or other psychiatric facility

Rental by client, no ongoing housing subsidy

Rental by client, with VASH housing subsidy

Rental by client, with GPD TIP housing subsidy

Rental by client, with other ongoing housing subsidy

Residential project or halfway house with no homeless criteria

Safe Haven

Staying or living with family, permanent tenure

Staying or living with family, temporary tenure (e.g., room, apartment or house)

Staying or living with friends, permanent tenure

Staying or living with friends, temporary tenure (e.g., room apartment or house)

Substance abuse treatment facility or detox center

Transitional housing for homeless persons (including homeless youth)

Other

No exit interview completed

Client doesn’t know

Client refused

(if Other) Specify

(text)

Understanding Rapid Re-housing:

Systematic Review of Rapid Re-housing Outcomes Literature

pg. 47

Document Outline

Table of Contents

Chapter 1: Introduction

Chapter 2: The Rapid Re-housing Program Model: Origins and Variations

Chapter 3: Assessing Outcomes of RRH Programs

Chapter 4: Conclusion

References

Table of Contents

Table of Contents

Chapter 1: Introduction

Chapter 2: The Rapid Re-housing Program Model: Origins and Variations

Chapter 3: Assessing Outcomes of RRH Programs

Chapter 4: Conclusion

References