Partnerships to Demonstrate Effectiveness of Supportive Housing for Families in the Child Welfare System

This was a randomized controlled trial comparing child welfare business as usual (BAU) with two levels of supportive housing (SH). To identify eligible families, a screening tool was developed that helped social workers apply a "housing lens" very early in family child welfare involvement. The study examined the extent to which implementation was faithful to the model and how well state and community partners collaborated. The research included a process evaluation, outcomes study, and economic analysis. Access to either intervention group was associated with higher family preservation and reunification, with service model intensity demonstrating minimal impact. An economic evaluation revealed that the intensive model cost the most, but the existing SH program and routine care incurred equivalent per-child costs.

Study Overview

• Status: Completed
• Conditions: Mental Health; Physical Health
• Intervention / Treatment: Other: Intensive Supportive Housing Services; Other: Program Supportive Housing Services

Detailed Description

Supportive Housing for Families is a care management program that serves families who are experiencing child welfare needs (risk of losing custody of children or difficulty regaining custody of children) and severe housing needs. The program has been in operation for over 10 years and has been demonstrating positive outcomes for clients in terms of housing stability and family environment outcomes.

A federally funded, five-year demonstration project and evaluation focused on a new and enhanced version of the program, the Intensive Supportive Housing for Families program (ISHF). Through a three arm randomized controlled trial, this study compared clients in three groups: parents who are randomly assigned to (1) enroll in ISHF, (2) participate in the existing Supportive Housing for Families (SHF) program, and (3) receive Child Welfare Business as Usual Services. This was the first randomized evaluation of this program, and the grant required examination of whether those who participate in an enhanced version of the program, which incorporates prompt access to evidence-based interventions, vocational services, and trauma services, show superior outcomes than clients randomized to the existing program. Further, clients in both of these conditions (SHF and ISHF) were compared to those receiving child welfare services in Connecticut as usual (BAU) without a supportive housing intervention.

This research has three components: a) a process evaluation, b) a cost/economic analysis, and c) an impact analysis.

The process evaluation and cost analysis were previously completed while the project was ongoing. Now that the project has ended, the final report on all project activities has been submitted to the funder, the Administration for Children and Families.

This impact analysis addressed the following primary research questions:

1. Do clients who receive supportive housing services (SHF and ISHF interventions combined) demonstrate improved child welfare outcomes compared to those in the Child Welfare (DCF) Business as Usual (BAU) intervention?
2. Do clients who receive any supportive housing services (those in the SHF and ISHF interventions combined) demonstrate improved parental well-being compared to those in the Child Welfare (DCF) Business as Usual (BAU) intervention?
3. Do clients who receive supportive housing services (SHF and ISHF interventions combined) demonstrate improved parenting skills compared to those in the BAU intervention?
4. Do clients who receive any supportive housing services (those in the SHF and ISHF interventions combined) demonstrate increased self-sufficiency compared to those in the BAU intervention?
5. Do clients who receive any supportive housing services (those in the SHF and ISHF interventions combined) demonstrate improved child development compared to those in the Child Welfare Business as Usual intervention?
6. Do clients who receive any supportive housing services (those in the SHF and ISHF interventions combined) demonstrate improved child well-being compared to those in the Child Welfare Business as Usual intervention?

A set of secondary research questions ask: across each of these outcomes (i.e., child welfare, parental well-being, parenting skills, self-sufficiency, child development, child well-being), are there differential effects across the three intervention options, ISHF, SHF, and BAU [such that those in ISHF show greater improvement than clients in the SHF program who show greater improvement than those in BAU]?

Main outcome measures were assessed at 12, 18, and 24 months post-randomization. Housing outcomes included shelter stay and subsidy deployment. Child welfare outcomes included child removal and reunification, subsequent allegations and substantiations, and case closure.

Results: Access to either intervention group was associated with higher family preservation and reunification, with service model intensity demonstrating minimal impact. An economic evaluation revealed that the intensive model cost the most, but the existing SH program and routine care incurred equivalent per-child costs.

The PI of this research was originally at the University of Connecticut and moved to Chapin Hall. The research has concluded and the investigators are drafting a manuscript.

• Study Type: Interventional
• Enrollment (Actual): 217
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: ADULT; OLDER_ADULT; CHILD
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Families who were newly involved with the child welfare system, demonstrated high housing instability or homelessness, and evidenced high service needs.

Exclusion Criteria:

• N/A

Study Plan

How is the study designed?

Design Details

• Primary Purpose: OTHER
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
NO_INTERVENTION: Business As Usual; Families who were involved in the child welfare services
ACTIVE_COMPARATOR: Intensive Supportive Housing for Families; Families who were randomly assigned in this group	Other: Intensive Supportive Housing Services; an intensive treatment SH model with a higher dosage of case management, family teaming, and access to a vocational specialist
ACTIVE_COMPARATOR: Program Supportive Housing for Families; Families who were randomly assigned in this group	Other: Program Supportive Housing Services; The existing statewide SH model that included routine access to housing (voucher) and case management

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Preservation	Number of children not being removed from their family	2 years
Reunification	Number of children being reunified with their family	2 years
Housing stability	Whether family remained stably housed or experienced recidivism on homelessness or near homelessness	2 years

Collaborators and Investigators

• Sponsor: Chapin Hall at the University of Chicago
• Collaborators: University of Connecticut
• Investigators: Principal Investigator: Anne Farrell, Ph.D., Chapin Hall at the University of Chicago

Publications and helpful links

Helpful Links

• Study description and link to final report to the Administration on Children and Families of the Department of Health and Human Services

Study record dates

Study Major Dates

• Study Start (ACTUAL): November 1, 2013
• Primary Completion (ACTUAL): December 31, 2017
• Study Completion (ACTUAL): December 31, 2017

Study Registration Dates

• First Submitted: June 8, 2020
• First Submitted That Met QC Criteria: October 15, 2020
• First Posted (ACTUAL): October 22, 2020

Study Record Updates

• Last Update Posted (ACTUAL): October 22, 2020
• Last Update Submitted That Met QC Criteria: October 15, 2020
• Last Verified: October 1, 2020

More Information

Terms related to this study

• Other Study ID Numbers: IRB18-0174

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No