Preventing Homelessness Among Youth and Families with Children
- Families and households
- Housing stability
- Housing and neighborhoods
Over half a million people experience homelessness in the United States on any given night, and one out of four people experiencing homelessness are children or youth between the ages of 18 and 24. Many homelessness prevention programs provide case management and financial assistance to individuals at imminent risk of experiencing homelessness, but there is a lack of evidence on whether both components are necessary for an effective program. Researchers evaluated the impact of the Youth and Family Homelessness Prevention Initiative (YFHPI)—case management and emergency financial assistance—compared to only financial assistance on housing stability for youth and families with children in King County, Washington. As part of the formal study, case management paired with financial assistance did not improve housing stability compared to financial assistance alone. Based on these results, researchers and the YFHPI team worked together to understand the findings’ nuances and make changes to the service to improve outcomes for those receiving case management paired with financial assistance.
The US Department of Housing and Urban Development (HUD) estimates that close to 600,000 people experience homelessness in the United States on any given night. Families with children account for nearly one-third of those experiencing homelessness on a given night, and one out of four people experiencing homelessness are children or youth between the ages of 18 and 24. Furthermore, Black and Indigenous people remain overrepresented among those who experience homelessness. Notably, people who identify as Black or African American account for 37 percent of all people experiencing homelessness and 50 percent of people experiencing homelessness as members of families with children but make up 12 percent of the total US population.1
Homelessness prevention programs seek to prevent homelessness among individuals and families by providing services such as financial assistance and case management. However, there is limited rigorous evidence on the effectiveness of homelessness prevention programs, including those that combine financial assistance and case management. Programs composed of these elements have been effective in other contexts, such as increasing college degree completion. Additional research is needed to determine whether programs that offer both components are more effective at preventing homelessness compared to financial assistance alone.
Context of the evaluation
In 2015, King County, Washington declared homelessness a state of emergency. King County has a much larger population of people experiencing homelessness than other counties its size. Of the over 13,000 people experiencing homelessness in King County on a given night, nearly 27 percent are families with children and 8 percent are unaccompanied youth aged 18-24. King County launched the Youth and Family Homelessness Prevention Initiative (YFHPI) to provide emergency financial assistance and personalized case management for families with children and transition-age youth under 25. YFHPI is the county’s largest prevention program, spending about $5 million per year.
YFHPI provides services through a network of social service agencies that are embedded in communities with a higher risk of homelessness. Agencies in the network provide a wide range of services for and are deeply connected to a particular community. YFHPI case managers customize the level of case management services based on each client’s situation. Case management activities can include navigating interactions with landlords, identifying suitable housing, and broader activities that support housing stability related to budgeting, employment, and dependent care. Case managers work to develop a trusting relationship with their clients so they can better navigate a path to housing stability.
Details of the intervention
Researchers conducted a randomized evaluation to test the impact of case management and financial assistance on homelessness prevention.
Researchers partnered with King County to run the study and recruited participants through YFHPI. Study participants had to be eligible for YFHPI, which requires that clients be residents of King County, have a dependent child or household head below age 25, and be at imminent risk of losing housing. As with national homelessness trends, people of color were disproportionately represented in the study, with 56 percent of participants identifying as Black or African American compared to 7 percent of all King County residents.
YFHPI case managers screened potential clients using a risk screening tool, which summarizes clients’ responses as a risk score ranging from low risk of experiencing homelessness to high risk. All clients with a risk score within the “moderate” range were invited to participate in the study. People scoring as low risk were not eligible for YFHPI and people scoring as high risk were automatically offered YFHPI.
Upon confirmation of eligibility, case managers informed clients about the study, including data collection procedures and the potential to be randomly assigned to receive financial assistance with or without case management. Clients who did not agree to participate in the study received access to both case management and financial assistance. Those who agreed to participate were randomly assigned to either receive financial assistance with case management or without case management (funds only).
|Case Management + Access to Flexible Funds Group
|Access to Flexible Funds Only Group
|Assigned a Case Manager
|Access to Flexible Funds
|Case manager approves and pays the expenses
|Case manager approves and pays the expenses
|Navigating interactions with landlords; identifying housing
This study design addressed the researchers’ two main ethical considerations. First was the rationing of case management. Because capacity was already limited—the case managers did not have sufficient time to provide all the assistance they would like to every client—random assignment was a fair way to decide how to allocate time that was already being rationed. Second was who would be in the study and who would not be. To address this concern, people who opted out of the study or had high risk scores were guaranteed financial assistance and case management.
The combined case management and financial assistance intervention reflects the YFHPI program as it had been operating prior to the study. The funds only intervention operates through case managers but is simpler, providing immediate financial assistance to clients once their need has been confirmed. Financial assistance given to the funds only group can be used to cover the same expenses as the standard YFHPI program, which usually goes to paying back rent.
To measure housing stability, the researchers looked at homeless program use through Homeless Management Information System (HMIS) data maintained by the county. They also used eviction data from housing court records and consumer reference data on address changes. Researchers also measured outcomes beyond housing stability using administrative data on health care use, public benefits use, and arrests.
Results and policy lessons
Housing stability outcomes: Overall, case management did not improve housing stability significantly, on average, beyond financial assistance alone. Participants who received case management and financial assistance were more likely to access other homelessness services but were not more likely to be evicted. Within one year of random assignment, 7.8 percent of the case management and financial assistance group enrolled in homeless programs compared to 3.5 percent of those who received financial assistance alone, an increase of 123 percent. While this result may be counterintuitive in light of the support provided through case management, one possible explanation is that the case management group had greater access to homeless programs in the event they lost their housing (and people in the funds-only group who lost housing had less access).
Researchers also conducted non-experimental analysis based on non-random, natural variation in approaches across case managers, including how quickly different case managers paid financial assistance. This analysis found that case management may lead to positive outcomes when it is more intensive and pays financial assistance quickly. In response, King County has since modified the YFHPI program to focus case management on intensive services and to provide financial assistance more quickly.
Other outcomes: In terms of outcomes beyond housing stability, the use of public benefits was similar between the two study groups. While case management may have connected participants to benefits, it did not lead to greater take-up compared to the financial assistance-only group.
Health-related outcomes were more ambiguous. The case management group experienced an 4.1 percentage point (95.4 percent) increase in emergency room visits, from 4.3 percent in the funds-only group to 8.4 percent in the case management group, but a decrease in the number of mental health prescriptions filled compared to the funds-only group. Since case managers may connect clients to healthcare services, it is uncertain whether changes in healthcare use are driven by differences in health or by greater referrals for the case management group.
Lastly, researchers found that the case management group was 3.1 percentage points more likely to be arrested; 7.0 percent of the case management group was arrested within one year compared to 3.9 percent of the financial assistance only group. Arrests can be an indicator of criminalized activities but are also associated with inequities in the criminal legal system. However, this result does indicate that case management did not reduce interactions with the police.
While this study contributes to the evidence base on homelessness prevention programs, rigorous evidence in this area remains limited, and studies of programs in other locations are needed. One area of specific exploration is assessing the effect of providing clients agency to choose the supports most needed, such as funding or more intensive case management programming.