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Outcome Evaluation of the Shelter-A-Family Program Kimberly Jacob Arriola, PhD, MPH Associate Professor November 20, 2013 3rd Annual Georgia Supportive Housing Association Conference SAF Program Staff Joyce Sloan, LCSW-Program Director Naomi Haynes, MSW-Program Manager Ja’Nai Johnson, MSW-Coordinator Nefertari I, BSW-Case Manager Ronterius Sanders, MS-Case Manager Stacie Fitzgerald, LCSW-Counseling Manager Pamela Crosling, MS-Substance Abuse Counselor Shondella Andre, BA-GED Instructor Today’s Agenda Overview of the program Purpose of the outcome evaluation Evaluation methods CMHS TRAC NOMs Staff-administered supplemental evaluation interview Findings & limitations Conclusions Program Description SAF is a community-based, supportive housing program for families with children who have experienced: long-term homelessness where the head of household suffers with disabilities of: *mental illness *substance abuse and/or *HIV/AIDS Provides site-based supportive services to 43 families in HUD-funded apartment units in NW Atlanta Program Goals To help formerly homeless individuals: Reduce and eliminate substance dependency and use Achieve mental and emotional stability Move toward greater self-reliance To promote child safety and development To prevent future homelessness among children traumatized by: Homelessness Abuse & neglect Parent’s substance abuse and MH challenges Eligibility Must be experiencing long-term homelessness, as defined by HUD Very low income Verifiable disability, as defined by HUD, of mental illness, substance abuse, or HIV or AIDS Must be a family with child(ren) under the age of 18 Single female headed households Single male headed household Two parent, married household Supportive Services Intensive case management Home –based counseling sessions On-site substance abuse individual & group treatment Life skills training Mental health support groups for adults and youth Provide access to resources, including health, asset development, and linkages to community activities & groups On-site GED instruction, educational and employment supports, job search assistance Assertive Community Treatment (ACT) Team meetings Monthly community meetings Program Modification SAF I Established in 2005 June 1, 2009 received additional funding from SAMHSA to provide site-based supportive services Adopted Housing First Model. 23 families in current analyses SAF II Effective February 1, 2013 20 families that were consolidated into existing SAF program Initially resided at Delowe Village Families First Project G.R.O.W. Program Outcome Evaluation To explore change in clients based on: Housing stability Physical and mental health and sense of wellbeing Dependence on illegal and harmful substances Academic, vocational, life and social skills, and income Perceived family & community support Outcome Evaluation Constructs CMHS TRAC NOMs Demographic data Functioning Stability in housing Education and employment Crime and criminal justice Social connectedness Evaluation Interview Medical status and health insurance Drug/alcohol use Psychiatric status Health and well-being Child well-being Outcome Evaluation Constructs CMHS TRAC NOMs Demographic data Functioning Stability in housing Education and employment Crime and criminal justice Social connectedness Evaluation Interview Medical status and health insurance Drug/alcohol use Psychiatric status Health and well-being Child well-being CMHS TRAC NOMs Instrument Baseline Assessment conducted within 7 days of program enrollment Reassessment interview conducted every 6 months (+/- 30 calendar days) Administered by staff CMHS TRAC NOMs Data Assessment Baseline 6 month assessment 12 month assessment 18 month assessment 24 month assessment 30 month assessment 36 month assessment Clinical Discharge (as of 8/1/13) Number of Assessments 55 31 29 24 19 14 11 17 Supplemental Evaluation Interview Largely based on the Addiction Severity Index (McGahan, Griffith, Parente, & McLellan, 1986) Key domains Medical status and health insurance; Drug/alcohol use; Psychiatric status; Health and well-being Child well-being Administered by staff after TRAC NOMs Supplemental Evaluation Interview (as of 8/1/13) Assessment Baseline 6 month follow-up 12 month follow-up 18 month follow-up 24 month follow-up 30 month follow-up Interviews Conducted 44 26 20 12 9 5 Client Demographics Client Characteristics Gender Female Marital Status Single Unknown Age 0-17 years 18-36 years 37+ years Race/Ethnicity Black (based on service utilization data) SAF (N=86) Client n (%) SAF II (N=58) Client n (%) 49 (57) 38 (66) 26 (30) 55 (64) 16 (28) 42 (72) 38 (44) 25 (29) 20 (23) 35 (61) 14 (24) 9 (15) 75 (87) 55 (95) Results: Housing Stability TRAC NOMs “In the past 30 days, where have you been living most of the time?” Owned or rented house, apartment, trailer, room Results: Physical Health TRAC NOMs “How would you rate your overall health right now?” Excellent or very good Results: Functioning TRAC NOMs 8 separate items Response options ranged from 1 (SD) to 5 (SA) Percent who strongly agree Results: Emotional Health Supplemental Evaluation Interview “How many days in the last 30 days have you experience these psychological or emotional problems?” E.g., serious depression, hallucinations, serious anxiety or tension Results: Substance Use Random drug screens 170 screens performed on 31 clients Based on service utilization data Number of clients screened Number of screens Positive Negative Inconclusive Percent positive SAF I 21 SAF II 10 121 49 9 61 51 7% 15 27 7 31% Results: Academic, Vocation, Social Skills TRAC NOMs “Are you currently enrolled in school or a job training program?” Not enrolled or Enrolled full or part time Results: Social Connectedness TRAC NOMs 4 items E.g., “I am happy with the friendships I have” Response options ranged from 1 (SD) to 5 (SA) Percent who strongly agree Limitations Study design Small numbers of participants Effect sizes Consolidation of 2 programs Child well-being data Limited number of children in which there are 2 or data points that are clearly linked to a particular child Conclusions Clients are largely achieving stable housing Indicators of adult well-being show improvement over time Lower rates of drug use were found among SAF I clients (7%) than among SAF II clients (31%) Enrollment in an academic, vocational, or job skills program has remained somewhat flat over time Participants reported greater satisfaction with their friendships at 36 months, but other measures of social connectedness did not yield clear patterns. Thank You! Kimberly Jacob Arriola RSPH of Emory University 1518 Clifton Road, NE Room 520 Atlanta, GA 30322 [email protected] 404-727-2600