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

Health Starts at Home Evaluation

Findings from the First Six Months of Follow-up

February 25, 2020

Evaluation Background

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

Core Measures Methodology

• Partnerships collected core measures data at six-month intervals from

enrolled families

• Data transferred quarterly to HRiA for analyses
• Baseline data collection was completed in April 2018
• Of 205 families with complete baseline data, 182 families (89%) also had

complete six-month follow-up data

• 55 of these families (30%) were in shelter at baseline
• Significance testing was conducted to determine whether change between

timepoints were statistically significant (P<.05)

• Analyses were also stratified by number of sub-population groupings to

explore differences (e.g. residence in shelter at baseline, change in housing type, and indicators of health status at baseline)

Eligibility Criteria

63.0% 1.8% 60.6% 21.8% 22.8% 34.5% 43.3% 94.5% Family Not in Shelter at Baseline (n=127) Family In Shelter at Baseline (n=55) More than half of income to housing Unable to pay rent on time in prior year 2+ moves for economic reasons in prior year Homelessness in prior year

Percent of families meeting HSAH eligibility criteria, by baseline shelter residence

Baseline Demographic Characteristics

Spanish, 70.1% Spanish, 58.2%* English , 22.8% English , 40.0% Other, 7.1% Other, 1.8% Family Not in Shelter at Baseline (n=127) Family In Shelter at Baseline (n=55)

Age group of enrolled child, all families Language spoken at home, by baseline shelter residence

*Significant difference Not in Shelter vs. In Shelter; Chi-square test, P<.05

Baseline Economic Characteristics

Educational attainment of enrolled caregiver, all families Household Income, by baseline shelter residence

Less than High School , 48.4% High School Graduate

• r Equivalent , 29.1%

Some College or Beyond , 22.5% All (n=182) $500 or less, 38.3% $500 or less, 26.0% $500 or less, 67.3%* Over $500, 61.7% Over $500, 74.0% Over $500, 32.7% All (n=175) Family Not in Shelter at Baseline (n=123) Family In Shelter at Baseline (n=52)

*Significant difference Not in Shelter vs. In Shelter; Chi-square test, P<.001

Median: $900 $1,200 $346*

Change in Housing Indicators

49.7% 43.6% 17.1% 23.8% 33.1% 32.6% All Families at 6 Months (n=181) All Families at Baseline (n=181) Apartment Friends/Family Shelter/Other

n=13 n=13 n=6 n=8 n=9

Housing type of enrolled families, by timepoint

Change in Housing Indicators

35.4% 21.9%* 28.0% 4.0%* Baseline 6-Months Baseline 6-Months All Families (n=178) Families that moved to Apartment at 6-months (n=25) Poor or Very poor 53.0% 34.8%* 57.7% 15.4%* Baseline 6-Months Baseline 6-Months All Families (n=178) Families that moved to Apartment at 6-months (n=25) Dissatisfied or Very dissatisfied

*Significant Change Baseline vs. 6-Month; McNemar's test P<.05

Caregiver rating of housing quality Caregiver rating of housing satisfaction

Change in Caregiver Mental Health Status

*Significant Change Baseline vs. 6-Month; McNemar's test P<.01

58.9% 42.8%* 51.2% 33.6%* 76.4% 63.6% Baseline 6-Months Baseline 6-Months Baseline 6-Months All Caregivers (n=181) Family Not in Shelter at Baseline (n=127) Family In Shelter at Baseline (n=55)

Caregivers screened positive for Depressive Symptoms (PHQ-2) Caregivers screened positive for Anxiety Symptoms (GAD-2)

62.4% 49.2%* 56.3% 42.1%* 76.4% 65.5% Baseline 6-Months Baseline 6-Months Baseline 6-Months All Caregivers (n=181) Family Not in Shelter at Baseline (n=127) Family In Shelter at Baseline (n=55)

Change in Caregiver Health Status

*Significant Change Baseline vs. 6-Month; McNemar's test P<.01

Caregiver rating of their own overall health

58.6% 65.2% 47.8% 61.1%* 47.2% 61.3%* Baseline 6-Months Baseline 6-Months Baseline 6-Months All Caregivers (n=181) Caregivers with Anxiety Symptoms at Baseline (n=113) Caregivers with Depressive Symptoms at Baseline (n=106) Excellent, Very good, Good

Change in Child Health Status

*Significant Change Baseline vs. 6-Month; McNemar's test P<.01

Caregiver rating the overall health of enrolled child

76.8% 82.9% 58.1% 73.0%* 69.0% 82.1%* Baseline 6-Months Baseline 6-Months Baseline 6-Months All Index Children (n=181) Children of Caregivers with Fair/Poor Health at Baseline (n=74) Children with History of ED visits at Baseline (n=84) Excellent, Very good, Good

Change in Child Healthcare Utilization

45.3% 43.0% 66.7% 42.9%* Baseline 6-Months Baseline 6-Months All Index Children (n=179) Children with Fair or Poor Health at Baseline (n=42) Use of Urgent Care in prior 6 months 46.7% 39.4% 61.9% 38.1%* Baseline 6-Months Baseline 6-Months All Index Children (n=179) Children with Fair or Poor Health at Baseline (n=42) Use of ED in prior 6 months

Use of health care services by enrolled child

*Significant Change Baseline vs. 6-Month; McNemar's test P<.01

Preliminary Data on Housing Status at end of Follow-up

• To examine ‘final’ housing outcomes for each HSAH family, administrative

data were obtained from the HSAH partnerships

• Data were collected/updated as of November 2019
• Of the 205 enrolled families, 199 (97%) had administrative housing data
• Average length of enrollment was 26 months (range 12 – 48 months)

Preliminary Data on Housing Status at end of Follow-up

All Families (n=199) Retained, stabilized, or

• btained new housing

(n=134, 67%) Apartment (n=86, 64%) Public Housing Unit (n=21, 16%) Shared Apartment (n=27, 20%) No Change, in Shelter, or Stability worsened (n=65, 33%) Apartment (n=12, 18%) Public Housing Unit (n=2, 3%) Shared Apartment (n=27, 42%) Shelter or Transitional Housing (n=24, 37%) Tenant-based vouchers n=55 Project-based vouchers n=7 Public Housing n=23 RAFT n=11 HomeBASE n=22 Other n=16

HMIS Data Matching Process

• Dataset: Massachusetts Department of Housing and Community Development (DHCD)

Emergency Assistance System

• Timeframe: March 2013-October 2018
• Matching process: Finder file sent by program staff to DHCD

HMIS Data Matching Results

• 76 percent of families had a recorded shelter stay during the analysis period
• 92 percent of shelter stays began before HSAH enrollment
• The average length of stay in shelter was 348 days
• Families that used shelter had similar average monthly incomes as all HSAH

families (around $825/month)

• In families with a shelter stay, 69 percent of index children identified as

Hispanic compared to 80 percent of all index children in the same programs

Next Steps

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