Pay For Success: Permanent Supportive Housing for the Chronically Homeless

Santa Clara County has partnered with Abode Services to provide 112 units of permanent supportive housing (PSH) for up to 6 years for chronically homeless individuals with multiple co-morbidities who are high cost users of services in the County. Because the target population of high cost users who are chronically homeless greatly exceeds the supply of permanent supportive housing to be made available via this mechanism, the County plans to use this opportunity to examine the effectiveness of PSH compared to treatment as usual by ethically allocating a limited resource using a lottery type system for eligible individuals who consent to participate in the Pay For Success (PFS) initiative. Specifically, while there are estimated to be over 2,500 people in Santa Clara who would be eligible for participation on any given night, the PFS program will only provide 112 PSH units at any given time. As the study duration will last six years, the investigators anticipate that approximately 150-200 people will be housed via this mechanism. Outcomes will be reported to the Institutional Review Board (IRB) on a quarterly basis and will be based on scheduled quarterly reports provided to the county. This evaluation will be a randomized controlled trial comparing the outcomes for chronically homeless individuals randomized to receive PSH to those who are randomized to receive usual care. The aims of this study are to: 1. measure months of stable tenancy for individuals who are placed in PSH; 2. examine differences in utilization of health services and the criminal justice system; and 3. monitor the changes in use of longitudinal care. All data utilized for this evaluation will be County administrative data. The investigators hypothesize that some costly and acute health services utilization will decrease over time for the intervention group, while other more sustaining health services will increase.