Preventive vs. Remedial Screening Tools The Economic Roundtable has developed five predictive screening tools to identify and prioritize high-need homeless individuals who will have high future public costs because of ongoing crises in their lives that are resolved in expensive institutional settings, including jails and hospitals.
This streamlined triage tool was developed for the Santa Clara County Center for Population Health Improvement (CPHI). It provides an empirical tool for prioritizing patients for permanent supportive housing using close-to-real-time data that is available to CPHI. In addition, an industry-wide switch in medical diagnostic classification systems necessitated a conversion of all diagnostic variables from the ICD-9 classification system to the ICD-10 system.
The current issue of HUD’s peer-reviewed journal, Cityscape, includes an article on the Silicon Valley Triage Tool that was developed by the Economic Roundtable. This statistical model provides a fair, objective tool for triage—prioritizing which individuals should have immediate access to permanent supportive housing. Santa Clara County voters have approved major investments in affordable housing for people experiencing homelessness, but the number of individuals who need housing still substantially exceeds the amount of housing that is available for them.
This paper explains the methods used to develop the Silicon Valley Triage Tool for identifying homeless individuals in jails, hospitals and clinics who have continuing crises in their lives that create very high public costs. The model is very robust and accurate, taking advantage of advanced prediction methodologies and a unique and exceptionally valuable database created by Santa Clara County, home to Silicon Valley, linking service and cost records across county departments for the entire population of residents who experienced homelessness over a six-year period – a total of 104,206 individuals.
Why the Silicon Valley Triage Tool is Important: The number of homeless people needing housing far exceeds the available housing supply, and there is not a fair, objective system for prioritizing who gets to be housed. The triage tool addresses this problem by identifying individuals for whom the solution of housing costs less than the problem of homelessness.
Public assistance programs are Los Angeles’s primary interface with individuals experiencing homelessness and can be a catalyst for connecting at-risk and homeless recipients with crucial services and reducing the massive public costs associated with chronic homelessness. The vital role is to identify tripwire events among all recipients, particularly children and transition-age youth, and quickly connect at-risk individuals with needed employment, behavioral health and housing services.
This report identifies the characteristics of the most vulnerable, distressed and costly homeless residents of Santa Clara County to guide strategies for stabilizing their lives through housing and supportive services, improving their wellbeing and reducing public costs for their care. The county spent $520 million a year providing services for homeless residents over the six years covered by this study. Costs are heavily skewed toward a comparatively small number of frequent users of public and medical services. Individuals with costs in the top 5% accounted for 47 percent of all costs and had average costs of over $100,000 per year.
Evaluating the outcomes for 163 hospital patients screened from April 2011 to May 2013 by the 10th Decile Project in Los Angeles, which works with hospitals to identify the 10 percent of homeless patients with the highest public and hospital costs – the 10th decile – and provide immediate services for placing these individuals into permanent supportive housing.
Different conditions of body and mind found among homeless adults provide a basis for predicting who will have very high public costs – in the 10th cost decile. This report presents a triage tool developed specifically for use in hospitals or clinics where there is not access to data from other agencies about the use of non-medical public services.
The triage tool, or crisis indicator, identifies homeless individuals in hospitals and jails who have continuing crises in their lives that create very high public costs. This redesigned tool is four times more accurate than the earlier screening tool released in 2010. The tool is developed for use in jails, hospitals and clinics where homeless individuals with high levels of need and high public costs are most likely to be found. Discovery of the exceptionally high public costs for people in the 10th cost decile has led to interest in identifying these individuals and giving them high priority for access to permanent supportive housing. This group accounts for well over half of all public costs for homeless adults, and their costs decrease by 86 percent when they live in permanent supportive housing.
Counties bear large hidden costs for individuals with disabilities who are indigent or homeless. This includes costs for health care, jails and probation in addition to readily identifiable county costs for public assistance. A large share of this cost is health related – costs that the federal and state governments would pay through Medi-Cal if the individuals were receiving Supplemental Social Security Income (SSI).
The central question investigated in this study is the public costs for people in supportive housing compared to similar people that are homeless. The typical public cost for residents in supportive housing is $605 a month. The typical public cost for similar homeless persons is $2,897, five-times greater than their counterparts that are housed. This remarkable finding demonstrates that practical, tangible public benefits result from providing supportive housing for vulnerable homeless individuals. The stabilizing effect of housing plus supportive care is demonstrated by a 79 percent reduction in public costs for these residents.
A comprehensive strategy with 25 actions, accountable agencies, timelines, and performance benchmarks to prevent and end homelessness in Los Angeles County. From 2002 through 2004 the Economic Roundtable and the Institute for the Study of Homelessness and Poverty at the Weingart Center carried out research, listened to ideas from community stakeholders, and met with public officials in order to prepare this strategic plan for ending homelessness in Los Angeles County.