Triage Tool Uses Health Care Info to House Homeless With Better Support Systems

Mathematica Policy Research released a study demonstrating that a triage assessment tool used by the Massachusetts Shelter and Housing Alliance (MHSA) can successfully predict the emergency resource utilization of chronically homeless individuals.

The MHSA partners with organizations and service providers in the state to place chronically homeless people in housing with appropriate supportive services. Since the use of the triage assessment tool began in February 2015, it has placed 624 people who are frequent users of emergency services in Pay for Success housing.

The scoring for the triage assessment tool was developed by Tom Brigham, director of MHSA, and based on 2013 research by Dr. Monica Bharel and Dr. Jessie Gaeta, both of whom were working with Boston Health Care for the Homeless at the time.

MHSA created the triage assessment tool to identify people who use emergency services at a high rate. When homeless individuals receive care at emergency shelters or health service providers, the staff  collects five vital pieces of information: The patient’s homelessness history, use of emergency services, physical health, mental health and substance abuse.

The triage assessment tool uses this information to analyze the patients and assign scores to each, resulting in a total score that MHSA uses to rank individuals’ likelihood of using emergency services again. The study found that this score did in fact correlate to future use of services among the chronically homeless.

MHSA is examining homelessness through the lens of health care because rates of mental and physical health issues are significantly higher among the homeless population than in the general population.

“We have a pool of chronically homeless people that are high utilizers of emergency services, like ambulance rides, emergency room visits, hospital stays,” said Dr. Singumbe Muyeba, research and evaluation specialist at MHSA. Information collected could indicate what kind of health, medical and behavioral conditions exacerbate homelessness and vice versa, leading to a more comprehensive understanding of chronic homelessness and how to eradicate it.

“The stability of housing itself dramatically changes health care utilization,” said Joe Finn, President and Executive Director of MHSA. “Really our point in all of this is stressing that in the balance of things, housing is a cheaper alternative than staying in shelters.”

MHSA found that before in the six months before clients are placed in Pay for Success supportive housing, the average stay in the hospital per client is seven days, and after housing it drops to two days, according to Dr. Muyeba.

Pay For Success places people in low-threshold, permanent supportive housing, a method that leads to higher retention and success rates. “The thing that we can’t vary on is the method or the fidelity based model,” said Finn. “You can’t put somebody out for not meeting with their case manager, or using, or because they’re struggling with their psych medication.”

He added that one of the reasons there are people on the street is because other housing opportunities present conditions that tenants are not always in a position to comply to.  And it works. Pay for Success saw a 95 percent retention rate in the first year, according to Muyeba.

Ideally, MHSA would not have to triage, and everyone in need would have access to appropriate housing. But because resources are so limited, the triage and assessment tool is essential to provide an objective ranking to identify the most vulnerable individuals and get them into housing quickly, and to ensure the right resources are going to the right people.

MHSA plans to continue its work to secure between 750 and 1300 new housing opportunities in Massachusetts by 2020, which they said is an attainable goal. “If we have a plan, and talk about how we might do that, make that our target number, we can get those units,” said Finn. “If we don’t, the impact on our other systems of care is going to be dramatic.”

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