Impact of housing and work supports on outcomes for chronically homeless adults with mental illness: LA's HOPE.

OBJECTIVE This study examined the impact of a federally funded housing and employment demonstration program (Los Angeles' Homeless Opportunity Providing Employment [LA's HOPE]) for homeless adults with mental illness. METHODS The sample included all participants enrolled between July 1, 2004, and May 17, 2005, in one of 18 Los Angeles County community mental health centers offering a state-funded program (AB2034) to reduce homelessness among people with serious mental illness. Fifty-six demonstration clients enrolled in three centers received housing and special employment supports. Their outcomes were compared with those of 415 clients enrolled in the county's other 15 AB2034 programs during the same period. Data included demographic characteristics, circumstances at enrollment and in the previous 12 months, and outcomes for at least 13 months after enrollment. Outcomes analyses used propensity score matching. RESULTS Demonstration clients got and kept housing and worked in paid employment and employment-related activities at rates significantly higher than those of the comparison group. Other than client group, no personal characteristics made any systematic difference to employment outcomes. Several personal characteristics-race and ethnicity, preenrollment length of homelessness, and whether the client had a co-occurring substance use disorder-affected housing outcomes independently of client group. CONCLUSIONS The demonstration provided the structure and resources to help clients achieve better housing and employment outcomes than the comparison group had. The outcomes for LA's HOPE clients suggest that this very challenged population can achieve improved work outcomes if programs devote adequate and appropriate resources to help them.