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.
Breaking the Fall – Covid Interventions Prevented Homelessness Struggling workers are either everyone’s responsibility now or everyone’s problem later. When poorly paid workers become jobless at the thin edge of the job market and then unable to pay rent, homeless destitution follows. In fact, we are equipped with the tools we need to protect workers from the sharper edges of joblessness and to combat homelessness.
The Realization Project is a system-change demonstration project of the Economic Roundtable. It has produced public domain library of screening, instructional, personal restoration, and employment tools. The project uses predictive analytic screening tools, which can be downloaded here, to identify unemployed workers with a high risk of becoming persistently homeless.
COVID-driven loss of jobs and employment income will cause the number of homeless workers to increase each year through 2023. Without large-scale, government employment programs the Pandemic Recession is projected to cause twice as much homelessness as the 2008 Great Recession. The Economic Roundtable used data from the 2008 Great Recession to estimate the linkage between job loss and homelessness and forecast the amount and type of pandemic-driven homelessness in Los Angeles, California and the United States.
More taxpayer dollars are being spent on homeless housing and services, yet homelessness in Los Angeles County increased 12% last year and chronic homelessness is up 17%. Society needs to do better. Homelessness is an income problem as well as a housing problem — and both need to be addressed to solve L.A.’s
In major U.S. metropolitan areas, the number of long-term homeless needing housing far exceeds the available housing supply, making it difficult to move persistently homeless individuals off of the streets. One of the most promising approaches to reducing these numbers lies in early identification and quick, effective intervention to help those most likely to become persistently homeless. Two new screening tools from the Economic Roundtable can help the most vulnerable people get access to the public services they need as soon as they become homeless, or even before they are homeless, and reduce the flow of people into chronic homelessness.
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.
Why aren’t more welfare parents becoming economically self-sufficient after participating in the LA County Welfare to Work Program, GAIN (Greater Avenue for Independence)? What has happened to these parents since entering the labor market after GAIN? The answers to these and other questions are presented in “Prisoners of Hope,” a report originally requested by the Los Angeles County Board of Supervisors on December 19, 2000.
Recent welfare reform legislation mandates that aid recipients become employed and economically self-sufficient. The allowable interval of continuous assistance is limited to 24 months for current recipients and 18 months for new recipients, with a lifetime limit of five years on welfare. At least 150,000 current welfare recipients in Los Angeles County must move into the workforce, securing at least partial employment by December 1999.