Housing First an Effective Solution to Homelessness in Alaska

Presented bySarah Shimer MPH

141st Annual Meeting - American Public Health Association

Tuesday, November 18, 2014

Institute for Circumpolar Health Studies ● 3211 Providence Drive ● Anchorage, AK 99508

Phone 907-786-6581 ● Fax 907-786-6576

Presenter Disclosures

2

Sarah Shimer

The following personal financial relationships with commercial interests relevant to this

presentation existed during the past 12 months:

No relationships to disclose.

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Overview

• Introduction

• Methods

• Health findings

• Qualitative analysis

• Summary

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Study Personnel

• David Driscoll, PhD, MPH

• Rick Brown, PhD

• Janet Johnston, PhD

• Travis Hedwig, PhD

• Chelsea Chapman, PhD(c)

• Sarah Shimer, MPH

• Rebecca Barker

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Homeless in Alaska

• Demographics– 731,000 residents in Alaska

• Geography– 1.3 people per square mile

• Lifestyle– Fishing, hunting, foraging– Seasonal work

Housing First

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• Housing without preconditions of treatment or compliance• Robust services with no coercion to participate• Tenancy is not dependent on participation in services• Most vulnerable • Harm reduction• Lease agreements, tenant protections, rent payment• Project-based or scattered site

Data Collection Methods

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• Move into Housing First

– Semi-structured qualitative life history interview

– Quantitative health survey

– Staff interviews

• 12-18 months after move in

– Semi-structured qualitative interview

– Quantitative health survey

– Staff interviews

Tenant Demographics

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• Many years homeless

• Frequent use of “sleep off” facilities

• Frequent use of emergency medical services

• Age range is 24 to 66

• Approximately 2/3 of tenants are male

• Most born in Alaska

• 69% of tenants have at least a high school degree or GED

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Health Conditions at Baseline

PTSD

High blood pres

sure

Other

Depres

sion/B

i-polar

Seizu

res

Hepati

tis

Tuberc

ulosisUlce

r

Chronic Infec

tion

Asthma

Heart

Disease

Phobias

Diabete

s0%

10%

20%

30%

40%

50%

60%

70%

Total %

Health Complaints in Past Month

10

Dental

Head tr

auma

Stitch

es

Lice/b

ed bugs*

Scab

ies/ra

shes

Stomac

h

Seizu

res

Broken Bones

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

BaselineFollow Up

Health Provider Visits

11

Surge

ry

Physica

l Exa

m*

Mental

Crisis

Counseling

ER*

Dentist

Eye D

octor

Ear/H

earin

g PT

Lab W

ork

MRI/Cat

Scan

*

Prescri

ption

Other*0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

BaselineFollow Up

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Medication Adherence

High Medium Low0%

10%

20%

30%

40%

50%

60%

BaselineFollow Up

Alcohol Consumption Quantity

13

14%

38%28%

20%

Baseline

Less than 89 to 1717 to 32more than 32

20%

50%

23%

7%

Follow Up

Less than 89 to 1717 to 32more than 32

Alcohol Consumption Frequency

Baseline Follow Up

14

8%

38%53%

Once a week or lessFew times a weekDaily or near daily

25%

24%

51%

Once a week or lessFew times a weekDaily or near daily

Home and Habits

• A place to call home• Relationships

– Family– Friends– Staff

• Daily activities– Games– Food– Movies

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“Their lives are better than they were when they came off the street and they have dreams again. You see people

that walk around with no dreams. You see it in their eyes, and to be able to walk in and tenants have dreams again

and connections with their family and be pretty comfortable with who they are, where they are, I think

that’s successful.” Staff

Success at Housing First

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Conclusions

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• Most tenants enter the facilities with one or more serious health

condition

• Self-reported changes include:

• Improved medication adherence

• Fewer ER visits

• Reduced drinking

• A shift in relationships to family and staff

• A shift in daily activities to include non-drinking activities

Acknowledgements

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Thank you to all those who have made this project possible, especially to:• Tenants and staff at Karluk Manor and South Cushman• Alaska Housing Finance Corporation• Alaska Mental Health Trust Authority• Tanana Chiefs Conference• RurAL Cap• The communities of Anchorage and Fairbanks

Contact Information

Institute for Circumpolar Health Studies: ichs.uaa.alaska.edu

Sarah Shimer: sshimer@uaa.alaska.edu

Thank You

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