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OBJECTIVE: The complex needs of homeless populations result in use of a wide range of services and high costs for housing programs and psychiatric and medical care. Allocation of resources is often not congruent with assessed needs. A series of cost-congruence hypotheses was developed to test assumptions that needs are associated with resources provided for appropriate services in homeless populations. METHODS: 255 homeless individuals were followed over two years and categorized according to housing status over time. Detailed individual information was obtained at baseline and follow-up data one and two years later. Extensive agency-derived and self-reported service costs for specific service types (medical, psychiatric, substance use, homeless maintenance and amelioration) were derived, and individual service-use data were collected. Multiple regression models were used to test service cost hypotheses regarding housing status (consistently housed, housed late, lost housing, consistently homeless) and service-congruent needs. RESULTS: Medical and psychiatric service-use costs and homeless maintenance costs varied among housing groups. As expected, serious mental illness predicted psychiatric service costs, and alcohol (but not cocaine) use disorders predicted substance abuse-service costs. Serious mental illness also predicted substance abuse-service costs, acute behavioral health care costs, and total costs. CONCLUSIONS: This study followed a homeless cohort prospectively and provided estimates of agency-derived costs of service use for a large number of agencies. This research increases the understanding of patterns of service use in a homeless population and informs the provision of services appropriate to the complex needs of this difficult-to-serve population. |
